Agenda item

The Integrated Care Director (ICD) at North East London NHS Foundation Trust (NELFT) delivered a one-year programme update on the progress of the Barking and Dagenham Community Mental Health Transformation Programme, the background behind this and the challenges. In 2019, all areas across the country had been required to submit their plans around a new framework for community mental health services, with the bid submitted by NELFT and its partners being ranked as one of the most positive bids and transformation programmes. The update also provided context as to:

·  The vision and principles of the Mental Health and Wellness Teams;

·  The progress as of May 2023, with a particularly positive element being the development of Peer Support Workers who were now embedded within Mental Health and Wellness Teams and who were employed by MIND, further highlighting the importance of partnership working and the fact that statutory organisations were not always best placed to employ and develop peer support, which worked best through the Voluntary and Community sector;

·  The training of all staff in different approaches and modalities, such as in trauma-informed care and open dialogue (an approach involving the people who were around an individual);

·  The introduction of more point of care testing, to support more physical health monitoring, as physical health issues tended to be higher in those with mental health conditions;

·  Increased engagement with the Voluntary and Community sector;

·  The next steps to be undertaken, such as developing the service offer for young adults, and developing more Peer Support Workers across the life course;

·  The fact that transformation work was being undertaken, as caseloads and demand continued to increase.

In response to questions from Members, the ICD stated that:

·  The programme had a number of measures relating to aspects such as recruitment, staff training and individuals with severe and enduring mental health issues accessing physical health checks. It also had outcomes measures around individuals’ social engagement and ability to move into employment opportunities, as there were lower rates of employment amongst those with mental health issues. These measures were being worked through with the wider system and the mental health collaborative.

·  There had been some very sad cases involving young people and knife crime in Barking and Dagenham, which often had a ripple effect across young people in schools. Recently, NELFT had ensured that there were Mental Health Support teams in schools to support with the impact of these incidents, running workshops around mental resilience, working from a trauma-informed perspective and looking to create whole schools’ approaches around mental health and wellbeing.

·  Before the Covid-19 pandemic, the Integrated Mental Health team (between NELFT and Barking and Dagenham Council) had been disaggregated, which had been followed by investment from the Council in terms of social care capacity. The disaggregation had enabled Health to focus on health care, and social care to focus on social care issues. Through the transformation programme, social care colleagues were working collaboratively with NELFT as part of a steering group with local resident and lived experience representation; whilst this had all been a large change, there was now a very productive way of working.

·  Whilst there were bed flow issues in terms of mental health beds at Goodmayes Hospital, with the lowest bed base for mental health beds in Northeast London and the second lowest bed base in the country, it did not have significant delayed transfers of care as in other areas of Northeast London. There was also frequent praise for the collaborative work between social care and the Health community team, in terms of supporting people to move on, and move on with a care package.

·  Whilst the Mental Health and Wellness Teams were not physically co-located, there were a range of different workers within the service, and social workers and health workers were part of ongoing reviews and joint care plans, as part of more integrated working.

·  There were always challenges around workforce retention. Whilst the NELFT workforce had increased, NELFT did not have the workforce whole time equivalent that was now dealing with the increased demand. A percentage of the workforce was also agency and locum.

·  Caseloads per worker were monitored to ensure that these were not unmanageable, particularly for cases around those who had more severe mental health diagnoses.

·  All health agencies were working through a degree of backlog; for example, certain assessments had had to be suspended for a period of time during Covid-19 and this had increased waiting lists. NELFT was working through recovery plans to reduce these waiting lists, and it also worked within national targets for assessment, based on the risk stratification. The vast majority of patients who came through to NELFT came through its Access team, and were seen within 18 weeks.

·  NELFT was part of a national quality improvement programme along with the Royal College of Psychiatry, specifically looking at the Autism Spectrum Disorder (ASD) service and how patient flow could be improved.

·  Services were now much more linked than previously. Barking and Dagenham had also not received a Regulation 28 report (whereby a coroner would look into the death of an individual receiving treatment and whether this had been preventable) for a number of years.

·  NELFT worked very closely with the police in terms of domestic abuse. There was a Mental Health Liaison Police Officer and NELFT did lots of case-by-case joint working with this officer. NELFT received MERLIN reports when there was a domestic abuse incident, and it also undertook dash risk assessments, with staff upskilled to be able to undertake these and refer into MARAC and other support agencies. NELFT was also part of the Violence Against Women and Girls’ group (VAWG). It was able to share information with the Police in terms of those individuals who came to the attention of the Police due to being unwell, as well as was able to work with other agencies in supporting those individuals who frequently used emergency services, known as “frequent fliers”. NELFT also worked with the Police in terms of reducing the potential risk to staff and the public, in terms of those individuals who were particularly aggressive, to promote a zero-tolerance approach.

·  NELFT staff were trained in smoking cessation skills, and would refer patients on to further specialist services as appropriate. Quite often, many accessing NELFT services had quite ingrained smoking habits and as such, staff used the ‘making every contact count’ approach in their service delivery. Healthy eating and increased physical activity approaches were also used, for example, employing Support, Time and Recovery workers to accompany individuals to access healthy living programmes as necessary.

·  Supporting residents with their mental health in the community was the goal, rather than in an entirely hospital-based setting. This would be achieved through infrastructure such as the community hubs and new health centres, encouraging a community-based model and greater flexibility for residents. Support was also being provided in schools, such as through the Schools’ teams, and the Thrive approach, ensuring a whole life course approach.

·  In terms of risks relating to delivering the model, workforce recruitment and retention, high population growth and the parity of funding as to this, and the long-term impact of the Covid-19 pandemic were all cited as factors.

·  Improving Access to Psychological Therapies (IAPT) services had been renamed nationally as ‘Talking Therapies’.

·  Around 40 to 60% of all GP consultations related to mental health. It was hoped that the Talking Therapies Practitioners could be linked to each GP Practice and the relevant Primary Care Network (PCN), to enable them to look into the residents seeking help, troubleshoot any issue and ensure multi-disciplinary working at a PCN level. This would also mean that individuals presenting to their GP with lower level needs could be seen by Talking Therapies or the PCN mental health practitioner, those with high-level needs could be seen by secondary care services in crisis response services and inpatient units, and then those who did not fall into the criteria of low-level need and the areas that Talking Therapies would benefit, could be seen and supported by the Mental Health and Wellness Team.