Agenda item

Presentation by RCCG and RDaSH (Graeme Fagan and Steph Watt)

Steph Watt (Programme Lead) and Kerry Booker, RDaSH, gave the following powerpoint presentation:-

 

Engagement activity

-          Six whole system stakeholder events during the Summer

-          Multi-agency steering group

-          Online and survey questionnaires

-          Options paper to Commissioners October, 2015

-          Eight engagement events November, 2015-January, 2016

-          Formal consultation February-March, 2016

-          Implementation from April, 2016

 

What stakeholders said

-          Waiting times are too long for some Services

-          Access routes are confusing

-          Organising Services around age creates an artificial barrier

-          Too many hand offs (Adult Services)

-          Improve communication

-          Once in Service the Service is good

 

Financial Constraints

-     Year on year 3-4% efficiency savings

-     £1.2M in Rotherham for 2016/17

-     Change the model to limit cuts in clinical services

 

Principles

-     Integrated partnership working

-     Patient focussed/needs driven

-     Focus on quality of life (recovery/wellbeing)

-     Maintain/improve quality

-     Release savings

 

Proposals

-          Cultural change – partnership working, recovery/wellbeing focus, integrated needs driven working and agile working

-          A Trust-wide move from cross-Borough business divisions to a place-based Rotherham model

-          A new gateway to Services

-          Service re-design

 

Recovery and Wellbeing Focus

Traditional Approach

-     Description

-     Focus on the disorder

-     Illness/deficits-based

-     Based on reducing adverse events

-     Individual adaptations to the programme

-     Rewards passivity and compliance

-     Expert Care Co-ordinators

-     Service-led goals

-     Service-led evaluation

-     Fosters dependency

-     Pessimism about outcomes

Recovery Approach

-          Understanding

-          Focus on the person

-          Strengths based

-          Based on hopes and aspirations

-          Provider adaptations to the individual

-          Fosters empowerment

-          Individual is the expert

-          Individual-led goals

-          User-led evaluation

-          Fosters independent

-          Creates hope

 

Gateway to Services

Taking a phased approach to:-

-     A 24/7, all age, single contact number

-     Mental Health Gateway

-     Rotherham Hub – Health and Social Care, Mental Health and Social Care, Health

-     Electronic directory

 

Adult (18+) Service Options

-          Do nothing: not an option

-          Community-based ageless service

-          All-age service based in 2 localities – Older Peoples Team centrally located or embedded in localities

-          Opportunities to co-locate?

-          Review and embed Social Care roles

 

Discussion ensued on the presentation with the following issues raised/clarified:-

 

·           The proposal to release a couple of old Council stock properties for the development into a facility for those released from hospital but did not require care/intermediate care, would be in relation to the Older People agenda and not Mental Health

 

·           RDaSH was presently looking at getting a single system and a different electronic record that should be able to “talk” to other systems.  A single systems paper was being developed to take to various companies that, hopefully, would be rolled out in 2017 within the Trust

 

·           RDaSH was developing physical health screening so rather than having to make an appointment for a client for an ECG etc. they had nurses who were trained.  This was being rolled out gradually.  The physical health screening clinics were initially for high dose prescribing but were then to be rolled out to patients with psychosis.  The Early Intervention Services were the first point of contact for somebody with psychosis as a young person who was treatment naïve; they would have all the screening there before being prescribed anything.  There were Key Performance Indicators against that to achieve for those patients

 

·           There had been broad support for a Rotherham-wide approach to Access to Support.  RDaSH recognised that it was complex and took time; the focus would be on the Mental Health gateway but the relationship between Mental Health and Social Care had come out really loud and clear in the consultation engagement work.  RDaSH was also mindful that the Council was changing how it worked and the need to work closely together to avoid patients/service users being passed from one to the other.  The more RDaSH could understand about the bigger picture the more they could help patients and carers

 

·           Currently in Adult Mental Health Services all referrals came through to a reception member of staff who would answer basic questions.  From there if it was someone who needed clinical advice or the admin worker felt it was well beyond the basics of what they could answer, it was currently passed to a trained Social Worker who triaged all referrals, including Safeguarding, and linked in with Assessment Direct when required or with the Access Team.  RDaSH wanted to maintain and grow that function because they knew from clinicians, patients and the feedback from GPs, that they wanted to speak to someone who knew what they were talking about.  That did not mean that the admin staff did not know but in terms of the clinical expertise the triage would have clinically trained staff, nurses and Social Workers.  It was hoped to expand it across the board for all ages/services but would not be a call centre type service.  Older people’s referrals went straight to treatment teams as in CAMHS

 

·           There were a number of initiatives concerning engagement with patients on waiting lists.  In those cases where a patient had been waiting longer than one would expect, Team Managers had them on their caseloads and would actively contact them, either by telephone or in writing.  A number of RDaSH services now ensured that repeat letters were sent followed up by telephone calls particularly in Primary Mental Health Care and within the Access Teams.  An Engagement Policy had been introduced over the last 2 years for those people who were not really engaging with the service or the service was finding it difficult in engaging with them particularly in terms of the Crisis and Access Teams.  There was an expectation that those Teams would actively follow clients up rather than just writing to them and discharging them from services if they did not engage.  There was a recognition that people who were mentally quite unwell or very vulnerable did not engage for those reasons.  In terms of those people with personality disorder and suicide, RDaSH always reviewed suicides within their Service very robustly and action plans developed with the families 

 

·           RDaSH currently had an Access Team that conducted the first assessment and then made a decision as to whether to pass them through to a Treatment Team. As part of the transformation, the Access Assessors would be embedded in the Treatment Teams thereby facilitating a closer relationship, easier communication and hopefully address the need for someone not having to repeatedly tell their story  

 

·           With regard to the All Age Services based in two localities a piece of work was being conducted across the Trust looking at the demographic of Rotherham, buildings and the volume of referrals.  The terms North, South, East and West were being used but the localities would be divided to enable balanced teams.  Consultation would take place with the Council, CAMHS and Primary Care as to how they divided up Rotherham and mirror those as far as possible  

 

·           RDaSH Services linked into the multi-agency meetings and arenas as well as the MARAC and MAPPA, particularly for those who were very vulnerable within Rotherham’s communities.  There would be a lot of work within the transformation to ensure that none of the existing work was disrupted.  Development of some new services was taking place within the Criminal Justice arena, working with Early Help, for those young people that were picked up by the Police and were in the Police Custody Suites as well as those young people that were not taken into custody but were arrested

 

·           Work had taken place with the Rotherham CCG and the voluntary and community sector to identify representative groups with regard to consultation.  An event had been arranged for January, 2016, which would be publicised through the Trust in an endeavour to get as wide engagement as possible

 

·           RDaSH were interested in a shared directory with the Council and a meeting would be held in the New Year to discuss further

 

·           An electronic directory would be one tool in a range that would be used.  There were accessible information standards and guidance so work was taking place with all the different contracts around looking at how information was provided

 

Steph and Kerry were thanked for their presentation.

 

Resolved:-  (1)  That the information provided about Mental Health Transformation be noted.

 

(2)  That Option 3 would be the Health Select Commission’s preferred option.

 

(3)  That the Select Commission receive an update on the final approved option.