Agenda item

The report provides an update on the commitments made in the Mental Health Crisis Care Concordat (MHCCC) across Kent and Medway. It provides an overview of the work that has been completed in 2017/18.

A multi-agency framework is delivering Kent and Medway MHCCC plans through a partnership approach. This area of work is being addressed by use of existing and planned commissioning intentions and service delivery arrangements and through new partnership arrangements within Crisis Concordat focus working groups.

Discussion:

Both the Deputy Managing Director, NHS West Kent CCG and the Head of Mental Health Commissioning, NHS West Kent CCG introduced the Kent and Medway Mental Health Crisis Care Concordat 2017/18 annual report, drawing the Board’s attention to the key activities over the period. This included, developing a 24/7 acute Liaison Psychiatry Service, 111 service improvements, a Street Triage initiative, introduction of Crisis Cafes and a focus on supporting frequent attenders within the acute environment with holistic packages of support.

It was noted that despite initiatives across Kent and Medway there had been an increase in the number of section 136 admissions in 2017/18; this increase in activity was also reflected in the national figures which had increased over the last 5 years. As result, it was proposed a “deep dive” be undertaken as part of the Kent and Medway STP mental health urgent and emergency care programme to gain a shared and broader understanding of section 136 undertakings. This would inform strategic and policy decisions, joint working, improve outcomes for people detained and increase satisfaction between practitioners and professionals involved in the section 136 process.

It was added that in response to concerns regarding the consistency of the Concordat crisis offer and in line with the changing health landscape, a review of the Concordat was undertaken. This review recognised the successes of the Concordat, however it found that owing to emerging complex governance arrangements in health and social care, the Concordat was unable to efficiently make key decisions, particularly in relation to agreeing funding priorities. As a result, a smaller Concordat, chaired by the Police and Crime Commissioner (PCC), was proposed. The PCC Oversight Group would become the decision making arm of the Concordat and would ensure consistency across the locality in terms of the service model and offer. There would still be three geographical structures reporting into this Group which would be more operational in nature. The Board was advised that the new structures were being put in place in the next 6-8 weeks, following approval by NHS England.

Members raised a number of questions, including:

Priority areas - A Member expressed support for the priorities set out in the annual report. However, he requested that an additional priority, the separation of Crisis Resolution Home Treatment Team (CRHT) and hospital teams, be added. In response, the Board was advised that NHS Long Term Plan was strong in its ambition to continue to develop Mental Health Crisis Services which included a distinct break between CRHT and the way the crisis offer works through hospitals. Assurance was provided that this would be taken forward with Medway Foundation Trust.

Best practice models - In response to questions concerning learning from best practice, the Board was advised that there were examples of innovative best practice nationally. Examples provided included an alternative place of safety model in Manchester, a triage model in Sussex and 24 hour support model in Brighton. It was explained that no single model could be transposed to Kent and Medway but there was an opportunity for learning, through the STP. It was considered that the biggest challenge was how new models could be implemented in a consistent manner across the Kent and Medway footprint, whilst ensuring that the model was appropriate to the local area. With regards to section 136, it was added that there was not one single example of best practice, a whole system approach was needed.

Section 136 - With regards to a question concerning the percentage conversion rates of those admitted, the Board was advised that the conversion rate was circa. 20%, which was considered to be poor. It was anticipated that the “deep dive” would assist in developing a shared analysis and understanding of the cause and the way forward.

Workforce – In response to questions regarding working conditions and support for the Mental Health workforce, it was recognised that working within mental health services was challenging and importance was placed on ensuring staff felt valued. To that end, the deputy Managing Director, West Kent CCG explained that the CCG worked closely with providers to understand how they valued their staff. The Director of Children’s Services, NELFT, added that it was important that basic staff support and management systems were in place including, but not limited to, ensuring adequate supervision, staff rotation, appraisals, ensuring staff were taking annual leave, working reasonable hours and that they understood where to access support and how to escalate problems etc.

Concerning questions in relation to recruitment and retention, the Board was advised that work was ongoing at an STP level to improve this. It was considered that there was a need for commissioners and providers to work in partnership to derive appropriate solutions for the local area. It was anticipated that the new Integrated Care Partnerships (ICPs) would help facilitate this approach.

Self-management and self-care – Referring to advances in helping individuals to manage their own physical health, a Member asked whether there was an opportunity to advance this in relation to mental health. In response, the Board was advised that there was an opportunity to help individuals manage their mental health as part of the Local Care and Prevention agenda. The Deputy Managing Director for NHS Medway CCG provided the Board with some examples of recent commissioned services, including; investment in primary care mental health workers; commissioning of a care navigation service to support people with a range of issues including mental health issues; and provision of support to a range of charities which in turn support patients to improve their own mental health. It was added, the GP lead for Mental Health in Medway had led the Manage Your Mind Service, for which she had recently been awarded an MBE for the results achieved. Nonetheless, it was explained to the Board that a significant cultural shift was required when considering self-management and self-care in Medway. 

Mental health statistics – In relation to questions regarding the well-known statistic that approximately 1 in 4 people in the UK experience a mental health problem each year, it was explained that there were wider societal factors, such as worries about money, employment etc. which influenced the overall number of people reporting that they had suffered with a mental health problem and affecting their ability to cope. The NHS Long Term Plan recognised that this was a national problem and committed to additional mental health investment. At a local level, it was recognised that there was a need to work together in partnership arrangements to respond to and meet the needs and demands of people experiencing mental health issues. With this in mind, it was suggested that the Board receive an update on the “deep dive” at which time the Board could consider in more detail what the greater system and the Local Authority could do in collaboration to provide support for mental health services in Medway.

Decision:

The Health and Wellbeing Board:

a)    noted the progress made in 2017/18 in delivering the Mental Health Crisis Care Concordat (MHCCC);

b)    supported planned work across agencies set out in section 13 of the report; and

c)    requested that an update be provided to the Board on the outcome of the section 136 “deep dive” with a date to be determined.