Agenda item

To receive a report from the Head of Democratic Services which presents a briefing paper by the Leeds Health and Care Partnership on the Community Mental Health Transformation and Crisis Transformation Programmes.

The Head of Democratic Services submitted a report which presented a briefing paper by the Leeds Health and Care Partnership on progress made with the Community Mental Health Transformation (CMHT) and Crisis Transformation programmes.

The following were in attendance:

·  Councillor Fiona Venner, Executive Member for Equality, Health and Wellbeing

·  Councillor Salma Arif, Executive Member for Adult Social Care, Active Lifestyles and Culture

·  Caroline Baria, Director of Adults and Health

·  Victoria Eaton, Director of Public Health

·  Shona McFarlane, Deputy Director Social Work and Social Care Service

·  Eddie Devine, Programme Director (Mental Health, Learning Disabilities and Neurodiversity), ICB in Leeds

·  Alison Kenyon, Deputy Director of Service Development, Leeds and York Partnership NHS Foundation Trust

·  Helen Thurston, Interim Programme Manager, Community Mental Health Transformation, Leeds and York Partnership NHS Foundation Trust

·  Dr Jamie Pick, Clinical Director, Leeds and York Partnership NHS Foundation Trust

·  Debbie Thrush, Clinical Lead for Working Age Adults, Community Mental Health Transformation

·  Claire Nixon, Development Manager, Forum Central

The Chair explained that while the Adults, Health and Active Lifestyles Scrutiny Board has previously monitored the development and general delivery of the Leeds Mental Health Strategy, the Board was keen to receive a more detailed update surrounding these two specific Strategy workstreams.

The Chair then invited the representatives of the Leeds Health and Care Partnership to provide a brief overview of their briefing paper, which was presented in the form of a PowerPoint presentation and included the following key points:

Ø  The vision of the Community Mental Health Transformation (CMHT) programme is to re-shape the care offer for adults and older people with complex and ongoing mental health needs, typically referred to as ‘Severe Mental Illness’ or ‘SMI’.

Ø  This new model of care aims to respond to local populations’ needs and remove barriers so that people can access care, treatment and support as early as possible and also live as well as possible in their communities.

Ø  The model design has been informed by a wide range of partner organisations and people with lived experience, including carers.

Ø  The new model will operate in Integrated Community Mental Health ‘Hubs’ which are aligned to Local Care Partnerships (LCPs).

Ø  In moving from model design to testing and delivery, ‘Early Implementer’ Integrated Community Teams were established from March 2024 across 3 LCPs. 

Ø  Some of the key changes are linked to expanding community-based support and involves the introduction of new roles, which include Community Wellbeing Connectors; Peer Support Workers; and Key Workers. The model also includes the co-location of teams ‘anchor days’, to facilitate improvements in multidisciplinary working and provide a sense of belonging for the team.

Ø  Examples of feedback/quotes made by staff within the early implementer teams were shared as part of the presentation, including feedback from a recent visit made by the Health Services Safety Investigations Body (HSSIB).

Ø  Throughout the remainder of 2024 and into 2025, work will continue in terms of evaluating and learning from the wave 1 Early Implementor teams, with the aim of embedding and scaling up to the second and third wave of LCPs. 

Ø  Healthwatch have also been commissioned to undertake community engagement in preparation for phase 2 mobilisation.

Ø  An overview of the mobilisation and evaluation timeframe was shared as part of the presentation.

Ø  An overview of the seven Crisis Transformation programme workstreams was provided as part of the presentation, with each one aimed at addressing the existing challenges around accessing crisis services.

Ø  Particular reference was made to the introduction of the NHS 111 Crisis Line, which went live in Leeds at the end of April 2024.

Ø  It was acknowledged that both the CMHT and Crisis programmes are interdependent in the delivery of an integrated primary-community mental health transformed model of care for Leeds.

The Executive Member for Equality, Health and Wellbeing provided further comment and reflected on her own experience of working in mental health crisis services for many years. Reference was made to the national ‘Mental Health Crisis Care Concordat’, published in 2014, which gave a commitment at that time to improve outcomes for people experiencing mental health crisis and to also put mental health on a par with physical health. However, the Executive Member reiterated some of the demand pressures and challenges that continue to impact services both locally and nationally.

Given the impact of trauma and adversity on people’s mental health, the shift towards a more ‘trauma informed’ approach was welcomed in terms of professionals exploring what has happened in a person’s life when considering support needs, rather than just questioning what is wrong with the individual.  The Executive Member welcomed the Scrutiny Board’s commitment to continue monitoring progress given the importance placed on delivering timely, effective and compassionate mental health crisis services.

During the Board’s discussions, the following issues were also raised:

Ø  Use of language and terminology – The Board sought further clarification surrounding some of the terminology being used, including ‘Serious Mental Illness’ (SMI), ‘Trauma Informed Approach’ and distinctions between acute and crisis services. Members were advised that although the use of such language and terminology is mandated by NHS England, it can sometimes be unhelpful when developing a model of care that is based around the principle of inclusivity as opposed to exclusions/criteria.

Ø  Maximising the role of the Third Sector – The Board was advised of the work being undertaken to establish a Voluntary, Community and Social Enterprise (VCSE) alliance model that aims to reduce the number of individual contracts held by the ICB with VCSE at the same time as strengthening the position of the sector as a key pillar of community mental health transformation. Reference was also made to transformation grants funding scheme, delivered in partnership by Forum Central and Leeds Community Foundation, which distributed £628,000 of grant funding to 24 small to medium community organisations with the aim of increasing community-based support for people with complex mental health needs.

Ø  Capturing the voice of ‘easy to ignore’ groups - The Board supported the use of this phrase and welcomed the efforts being made to design and deliver services that are responsive to the needs and characteristics of different groups and communities and help reduce inequalities in access, experience and outcomes.

Ø  Referrals and targets linked to Community Crisis – Members acknowledged the high referral rates into community crisis support across LYPFT crisis provision and Oasis crisis house and discussed actions needed to help improve performance in relation to the 4 hours and 24 hours assessment targets.

Ø  Engaging with carers – The Board was pleased to note the active engagement and involvement of carers in both transformation programmes, including direct input from Carers Leeds.

Ø  Supporting people with learning disabilities – Members were advised that the model aims to ensure that care is accessible to everyone irrespective of disabilities, deprivation, ethnicities and other barriers to access and while there has not been a specific focus on people with learning disabilities, there has been detailed work regarding neurodiversity given the high suicide rates among neurodiverse individuals in the UK.

Ø  Focusing on children and young peoples transitions –While the CMH Transformation programme is primarily targeted at adults with complex mental health needs, the Board was pleased to learn that it will also incorporate improving access and pathways for young adults in transition from Children and Young Peoples services. Members were advised that focused work around this specific cohort is at the early stages of development, with a workshop planned in September 2024.  In acknowledging the role of Elected Members as Corporate Parents, Members were pleased to note that care leavers would be factored into the scope of this work too.  While acknowledging that this scoping work is linked specifically to the new transformation programme that is dealing with complex mental health cases, there was a shared frustration in terms of the pace of improvement surrounding transitions in general.

Ø  Access to estates – As the CMHT programme moves into phase 2, the Board discussed the work being undertaken to identify and address infrastructure needs, particularly in terms of access to appropriate estates. Linked to this it was noted that the medium to long term vision is to utilise more community buildings where individuals tend to feel more comfortable accessing services.

Ø  Measures of success – Members discussed measures of success linked to the CMHT programme.  Particular reference was made to tracking numbers of people admitted to acute beds that are unknown/not accessing community services as a proxy measure for effectiveness of proactive community intervention in avoiding hospital admission.

Ø  NHS 111 crisis service – It was acknowledged that the communication surrounding the introduction of this new service was not as expected.  Members were advised that action is currently being taken to make further improvements to this service and that any changes will be communicated more effectively. The Board requested to receive data on the NHS 111 mental health service response times so that this can also be monitored as part of future updates.

Ø  Independent advocates – Members emphasised the importance of patients having timely access to independent advocacy services and were advised that this is generally provided by the Third Sector and that demand levels may have impacted waiting times.

Ø  Symptoms of menopause – The Board was pleased to learn that there is greater recognition of the mental health links associated with the symptoms of menopause and that this has led to initial discussions around developing a specific training programme to help identify and assist those with symptoms.

Ø  Staff engagement and feedback – The Board welcomed the positive feedback reported by staff in relation to the new CMHT model and were advised that while staff feedback had also been collated in relation to the Crisis Transformation work, different engagement mechanisms had been applied.  It was agreed that future updates to the Board would include more detailed information around staff feedback in relation to the Crisis Transformation work.

Ø  The impact of health inequalities – The Director of Public Health reminded Members that the prevalence of Severe Mental Illness (SMI) for 18+ (per 100,000) is a key performance indicator in terms of population health outcomes for Leeds. With an estimated 8,000 adults on the SMI register in Leeds, the latest SMI performance figures reported to the Scrutiny Board last month also highlighted the disparity between the most and least deprived areas. The Board was therefore pleased to note that ‘reducing health inequalities’ is identified as a key outcome indicator linked to the CMHT programme.  In recognition that similar disparities also exist in relation to adults with less severe and more common mental health issues, importance was again placed on tackling health inequalities in general.

The Chair thanked everyone for their valuable contributions and reiterated the Board’s commitment to continue tracking progress surrounding this important area of work.

RESOLVED – That the contents of the report, along with Members comments, be noted.