Steph Watt, Strategic and Transformation Lead for Integrated Physical and Mental Health Projects (TRFT and RDaSH) and Dianne Graham and Jo Painter, Rotherham Care Group, to give a powerpoint presentation
Minutes:
Dianne Graham, Rotherham Care Group Director and Steph Watt, Strategic and Transformation Lead for Integrated Physical and Mental Health Projects (TRFT and RDaSH) presented an overview of the transformation work which built on the presentation at the September meeting.
Previously the service had been structured around services for older adults and services for younger adults but now the pathways were less age specific. The prevention, recovery and wellbeing approach linked in with the Council’s strategic objectives and was more community focused.
Rotherham Care Group Objectives
Integrated and streamlined services for adult mental health and learning disabilities
• Where care wraps round the patient, removing age and structural barriers
• Prevention, recovery and wellbeing approach
• Delivered as close to home as possible
• With clear and timely access
• Which deliver efficiency savings
Phase 1: Completed
• Care group formation
• Leadership and management team
• Hospital Liaison Service – for mental health and learning disability, supporting TRFT on services and reducing time spent in A&E
• Dementia Local Enhanced Service (LES) - support for GPs who are supporting people with dementia and facilitating diagnosis in primary care
New place based structures had been implemented for Rotherham, Doncaster and Lincolnshire respectively, which enabled them to focus on their own localities and understand their own communities better and to work within them.
Phase 2: Update
Care co-ordination centre
• Moved to Urgent and Emergency Care Centre
• RDaSH Staff transferred and trained
• Launch January 2018 with phased implementation
Ferns: extended pilot
• Re-hab for medically fit cognitive and neuro patients
• Positive evaluation particularly from patients /carers
12 beds for patients with cognitive decline or dementia who had also been in TRFT for a physical health issue. The joint pilot with TRFT would run until April 2018 and the trust was building the business case to be able to sustain it. Patients benefitted from the extra care and more were returning home on discharge rather than to residential care.
Community Team formation
• Interim: North base: tbc South: Swallownest
• Release Howarth and Badsley Moor Lane – efficiency savings
• Co-locate with physical health and social care
Admin review
• Staff consultation November 2017
• Implementation February 2018 to align to the new structures
Unity: new patient record system
• Development phase nearing completion
• Rotherham go live: April 2017
Pathway Framework
• Prevention, recovery and wellbeing model
• Objective, resolve more, sooner
• Pathway framework:
– Brief Interventions
– Complex care
– Long term conditions
Rotherham ‘All Age’ Clinical Pathways
Retaining specialism & expert approaches within an integrated model - based on NICE guidance and evidence around the types of intervention.
Pathway Development
• Access: to services planned and unplanned
• Acute: urgent & emergency
• Common MH disorders
• Complex emotional needs
• Early intervention in psychosis
• Group review – collation of local groups in Rotherham
• Trauma pathway - for people experiencing Post Traumatic Stress Disorder or trauma as a result of sexual or emotional abuse
• Woodstock Bower pilot - lithium prescribing pilot for dealing with patients in primary care rather than secondary care and supporting both their physical and mental health.
Social Prescribing
• Increase social activity
• Reduce social isolation and dependence
• Improve confidence and self-esteem
• Support healthy and sustainable discharges from services and create capacity
In partnership with the voluntary and community sector this was working with people with long term mental health conditions who had been in service for a long time and looking at ways to discharge them, supporting them to transition from secondary care to community activities e.g. gym, Pilates, and support into employment through community assets. People reported greater self-confidence and self-esteem and it also contributed to reducing social isolation and loneliness, which was a big issue.
Initial evaluation indicates positive outcomes
• Over 240 users from secondary mental health services
• Over 90 per cent made progress against at least one well-being outcome measures
• 48% increase in measures for all outcome scores
• Circa 50-60% discharge rate for those referred
• Highly commended at the Health Service Journal awards
• VAR submitted a bid to Department of Health Social Prescribing Fund to expand the scheme to reduce reliance on secondary services at the point of referral
Well Being Hub
• Pilot project with Rotherham United Community Sports Trust
• Combined delivery of health and wellbeing activity
• Delivered at the ground
• To be evaluated, potential to expand as a community
Joint groups with Rotherham United such as stress management were followed by a sports activity, promoting mental health and wellbeing. Good results were being achieved with people changing their lives and achieving good health outcomes. Evaluation would take place in 2018.
Next Steps
• Acute and Community Place Plan
– Integrated Contact Centre
– Rapid Response
– Locality Roll Out
– Integrated Discharge – work with TRFT, supporting reablement and care home liaison teams
– Care Homes
• Core 24 – responding to people in crisis
• Core Fidelity
• Clinical Review – aligning staff skills to the new pathways
Following the presentations the following questions and issues were raised:
What did you see your role as being in addressing stigma around mental health problems and awareness raising around mental health with front line staff, such as techniques for appropriate communication?
- It was a responsibility and sometimes it was about having those ordinary conversations about mental health. We talked last week about using social media more, which was something that RDaSH needed to capitalise on. The trust had a Twitter account but was not yet on Facebook and social media could be used to get key messages out.
- The project with Rotherham United was a good example, as being delivered at a community facility that service providers went into, this removed the perceived stigma of going to a labelled mental health service.
- Similarly with the Place Plan, RDaSH would go into the community and into GPs to deliver. Hopefully over time this would also help to change the perceptions and dialogue about perceptions of mental health.
- Plus there were positive things happening nationally such the work of the Princes, Government investment in mental health and changes in media coverage.
What about RDaSH’s wider role outside public services in awareness raising or developing training in the broader sense?
- The trust worked with Public Health, including delivery of mental health first aid training or supporting delivery for people in communities. There was the work in Wentworth Valley with publicans on how to deal with someone experiencing a mental health crisis. RDaSH did have a key role in training and support, particularly about how you might have a conversation with someone who was struggling emotionally. They also linked in with the Public Health campaign, especially around suicides, drug and alcohol issues etc.
What were the waiting times for treatments and therapies under the brief interventions and were adequate numbers of staff in post?
- For IAPT (Improving Access to Psychological Therapies) the national standard was for treatment to commence within six weeks These were available to everyone in Rotherham via their GP or by self-referral.
- For brief interventions the quicker the better and in urgent care standards were – in an emergency people needed to be seen in four hours for initial assessment and for urgent but not emergency cases within three days.
- For brief interventions and treatment the national standard of 18 weeks was too long. RDaSH were working to reduce their waiting times, for example it was a 12 week standard for assessment for memory problems but they were trying to reduce that to six weeks by March 2018.
Locality roll out – how many areas would RDaSH cover to reach the outlying areas?
- GPs had seven localities but RDaSH were looking at providing services from three bases (north, south and central) ensuring these linked across the seven.
With regards to the pathways framework, was there a safety net for people who might fall through the gaps, such as people with autism?
- Although there were three distinct pathways the intention was to provide the three within each locality, so that people could travel through the pathways, with their locality teams deciding where someone’s care might be delivered, but with the teams taking ownership so no-one should fall through.
- In terms of autism specifically, RDaSH were working with their commissioners and the local authority on where they would fit within an autism strategy. People with autism could and did access RDaSH services. What the trust were trying to do was look at how they could influence the commissioning of autism services as this was still not robust enough in Rotherham. An overall autism strategy was being developed.
From the objectives for the Rotherham Care group and the need to deliver efficiency savings, could you explain the scale of those savings and also the balance between delivering the changes and protecting services whilst managing those financial efficiencies?
- For 2017-18 NHS efficiencies were £1.2m plus £500k Local Authority savings as the trust provided integrated adult mental health services. It had been a real challenge to get to a position of being able to take money out of the system at the same time as transforming the system. Some non-recurrent funding from NHS England had helped in mitigation to support the transformation programme, with a view that efficiencies would be made out of the whole system at a certain point, which was part of the NHS Five Year Forward View.
- It had been a struggle and a lot of savings had come out of the staffing structures with a leaner management and leadership team now having a bigger portfolio with fewer managers and clinical leads. RDaSH had also been supported by funding through the Better Care Fund to support change and build capacity whilst transforming, this year and next.
What was in place to measure the more qualitative feedback of the patient experience and to know how the new pathways were working for people, as the metrics were only part of the story?
- Every aspect of transformation had been subject to a Quality Impact Assessment, which looked at the impacts on service users, staff and finances, although some would not be known until the changes were embedded. The trust was trying to obtain service user feedback as they went along. In The Ferns and social prescribing they had received great feedback so they knew some of the changes made across the partnerships were delivering really good outcomes. It was important to capitalise on what was done well and do more of it.
- For staff it was difficult to go through such a large scale transformation and staff may feel less involved, so more work was needed on staff engagement. At present there had been no really negative stories and there had been regular engagement with stakeholders and service users.
- Transformation commenced with a whole system event involving patients, carers and all the providers and commissioners and the objectives seen earlier resulted from that event. The trust worked with patients and carers to test out plans as they evolved. Case studies, formal evaluations and service reviews with both qualitative and quantitative feedback had been used. As RDaSH moved to implementation of the pathways they would evaluate them all.
What was being done to identify disparities in the health of different sub-groups of service users e.g. lower rates of cancer screening amongst people with learning disability and/or autism compared to other groups, and how was this addressed in the pathways?
- This comes back to the Place Plan again and one of the benefits of working across the system and integrating physical health, mental health and social care. For people with learning disability things did tend to present hand in glove, so the more we could have multi- disciplinary teams physically co-located the easier it was to say we have a patient presenting with these needs and the expertise was together in one place.
Where do you see the potential involvement of the Health and Wellbeing Board (HWBB) in the forward progress of this?
- This was critical and the HWBB was sighted on the transformation programme. Through place based governance it was easier to check alignment of RDaSH transformation with the local authority’s transformation plans and with what the GPs were thinking. People in communities needed to know that organisations were working together to provide services for them. They were also involved in developing the HWBB action plan, so it all linked in together.
- The refresh of the Health and Wellbeing Strategy had been brought forward so that was the overarching strategy and to align with the refresh of the Health and Social Care Place Plan. The transformational groups, such as the one for mental health and learning disability were working very closely together. The HSC meeting on 14 December 2017 would be an opportunity to challenge whether the alignment was effective enough.
Did that also include the Autism Strategy and the working group that was developing it? Would it come back to HSC?
- The Autism Strategy was being led by Adult Social Care. At the moment there were overarching high level aims for the refresh of the Health and Wellbeing Strategy and ensuring a clear “home” for learning disability and autism within it this time was important. It was likely that as part of the governance the HWBB would oversee the development and delivery of the Autism Strategy. It was expected that HSC would want to see the Autism Strategy as it developed and to take account of its delivery.
Dianne and Steph were thanked for their presentation.
Resolved:-
That the progress made in phase two of the transformation plan for RDaSH be noted.