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A Report on the Findings of a Consultation on Proposed Changes to Mental Health Day Services in Westminster

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Summary Report prepared by:

Adult Social Care Business Analysis Team (London Borough of Hammersmith & Fulham, Royal Borough of Kensington and Chelsea, and Westminster City Council)

Sept 2016

Contents

Summary

  1. Introduction………………………………………………………….……3
  2. The proposal for mental health day services…………………………4
  3. The consultation process……………….………………………………6
  4. Summary of key findings……………………………….………………8
  5. Analysis of consultation survey results….…………………………...11

Appendix – Detailed Consultation Responses

Available on request

1. Introduction

Between 18th March and 29th April 2016, Westminster City Council, Central London Clinical Commissioning Group (CCG) and West London CCG consulted on proposed changes to mental health day services in Westminster. The council and the NHS are committed to consulting widely with people who use their services, their carers and other key stakeholders before any decisions are taken.

This report describes how the council and CCGs undertook the consultation and sets out the views that people taking part expressed during the consultation period.

2. The proposal for mental health day services

Rationale for change

During the consultation, the council and CCGs proposed a change in the way mental health day services could be provided from December 2016 onwards, when contracts with the original providers end:

  • Mental health day services to be reshaped to make them more focussed on recovery and to offer support to more people, so they can achieve the best possible goals and outcomes
  • Give people increased choice and control by offering a personal budget to all those who are eligible, so they can then buy a wider range of services to meet their needs directly from the provider they choose
  • Allow efficiencies to be made within mental health day services to offer greater value for money in what is a challenging financial climate

Services affected in the proposals

Four services were affected by the proposals, with The Recovery Support Service (RSS) operating out of two sites.

Service / Location / Provider / Service type / Number of people accessing the services
Westminster Recovery Support Service (RSS) / 1 St. Mary’s Terrace, London, W2 1SU / Central and North West London NHS Foundation Trust / Building based day service / 74 across both sites
66 Lupus Street, London, SW1V 3EQ / Building based day service
Portugal Prints / Arlington House, 220 Arlington Road, London, NW1 7HE / Wandsworth and Westminster Mind / Building based and community arts service / 22
Flexicare / 5 Ecclestone Street, London, SW1W 9LX / Befriending Service / 73
Oremi Centre* / 5 Golborne Road, London, W10 5PA / Hestia / Building based day and outreach service / 41

*This consultation relates to Westminster residents using the Oremi Day Service provided by Hestia in the Oremi Centre in Kensington and Chelsea.

The proposal for day services

The detail around the proposal for day services can be found in the consultation survey to service users and carers in the Appendix. The proposed model has been summarised here:


3. The consultation process

How people’s views were sought

The consultation ran from 18th March to 29th April 2016. As part of the consultation, the following activities were carried out:

  • A letter with a postal survey was sent to all people living in Westminster who were currently in community mental health teams and aged 18-74. All those known to have used the affected day services in the last year were included in the sample (regardless of age). A total of 1,041 clients were sent a letter. Carers of clients in the cohort were also included (a further 69 people). The letter described the proposed changes and invited the recipient to respond using the survey attached (see Appendix) using the freepost envelope. These forms were also shared at events and a number were distributed at the affected sites.
  • A webpage was set up with details on the consultation, with the option to fill in the survey online. A dedicated email address was also set up for people to leave their feedback.
  • A dedicated consultation phone line was also set up for the consultation period, with the phone number publicised via the survey. People were given the option to use this if they had any questions or concerns.
  • Two public consultation events were held in the borough, one in the South at the Abbey Centre and one in the North at the Stowe Centre. Dates for these events were publicised in the letter to clients, their carers and other stakeholders and posters were distributed across Libraries, GP practices and other community venues. The events lasted 1-1.5 hours, where proposals were presented and a chance to voice opinions or concerns was given, both to the whole group and in tables. This information was then collected and summarised.
  • An independent advocate collected views from those using the affected services: at both RSS sites, at Portugal Prints, with Flexicare users and at the Oremi Centre. These sessions gave a chance for people to give detailed feedback in a different setting to the consultation events or the survey.
  • A market engagementevent with service providers was held at the Abbey Centre as part of informing interested providers about the proposed plans for mental health day services in Westminster. The existing services providers were all represented. As part of this, providers were invited to given detailed feedback on the strengths and weaknesses of the proposals.

Summary of people reached via different methods during the consultation

MethodDatePeople reached

Letter:

Postal survey invitation18/04/161,110 sent (incl 69 carers)

Responses (incl. web survey)Consult. Period167 received

Consultation meetings:

South event (Abbey Centre)06/04/1618 attended

North event (Stowe Centre)14/04/1616 attended

Engagement with independent advocate:

RSS – St Mary’s Terrace21/04/1611 service users

RSS – Lupus St13/04/167 service users

Flexicare25/04/163 service users 1 staff

Portugal Prints15/04/162 service users 1 staff

Oremi12/04/169 service users 2 staff

Provider market engagement event:

Abbey Centre25/04/1612 people representing

8 providers

Other approaches:

Telephone response line Consult. Period7 enquiries and requests

for clarification

Public (General) Consult. Periodx2 Email responses

Healthwatch Central West London Consult. PeriodEmail response

Wandsworth & Westminster MINDConsult. PeriodEmail response

ASC Contracts TeamConsult. PeriodEmail response

WCC Supported Housing TeamConsult. PeriodEmail response

4. Summary of key findings

The following themes came across most strongly across the range of material collected over the consultation (more detail can be found in the Appendix of Detailed Responses which is available on request):

Aspect / Description
12 week ‘recovery’ offer /
  • A number of respondents and providers felt that 12 weeks was not enough time to recover, with service users talking of recovery taking years or even decades. What happens at 12 weeks? Some were therefore worried about having enough time to build up trust and a relationship with the keyworker and wondered whether the keyworker would be sufficiently skilled to support them over this short period
  • Conversely, some providers felt there was no point retaining clients in the service if their needs were immediately clear (e.g. long term clients)
  • Commissioners pointed out that the proposed service had commonalities with the WCC Floating Support Service and wondered whether the role could sit within or be carried out by that service to avoid duplication
  • Some service users also worried about duplication with other mental health services e.g. two sets of goals/ care plans etc
  • The link with the wider mental health care pathway is insufficiently strong.The service needs to be developedalongside primary care services and secondary services redesign

Proposed closure of RSS sites /
  • Those using RSS sites in particular were concerned about the proposed closures. They felt that their day centre provided a purpose in their lives, a place to build confidence and interact socially, have food and a place to feel safe.
  • Some of them felt closing the buildings would not save money as drop-in sessions still have to be provided anyway. Some people felt that at least one building should remain open and some suggested that they should be allowed to use their personal budget to pay for the day centre

How services could be made more efficient /
  • There was a level of understanding that services could be made more efficient and more modern. Providers generally felt that the proposal was in line with a move away from buildings-based services towards recovery and personalisation
  • Some respondents felt that under-capacity in services could be because of service eligibility and challenges getting a personal budget
  • Some respondents were not clear on how proposed efficiencies would be made, if potentially a greater range of community sessions are to be provided and a greater number of people potentially referred to the short term service
  • Some RSS service users felt that the council just wanted to sell the buildings and did not care about their needs

Eligibility for a personal budget /
  • Some respondents (particularly those attending Oremi) were concerned their support would disappear if they were not eligible for a personal budget. They were concerned about the stress and uncertainty of being re-assessed. It may also make these services unsustainable long-term
  • Some people were not clear about how and where they can use their personal budget i.e. in other boroughs and suitable models of support e.g. peer support brokers and joint health and social care personal budgets

Time taken to get a personal budget that can be used to purchased person-centred services /
  • There was concern that the current process for getting a personal budget was too slow/ bureaucratic (with a direct payment taking even longer) and could slow down the recovery process and result in the proposed model not working, leaving service users with no service
  • A minority of respondents raised the issue around the impact of personal budgets on their ability to spend their own money how they choose (in instances where they contributed fully to their support)

Social contact and participation /
  • There was concern from both service users and providers that the proposed approach was an individualised one and that social interaction and group participation may disappear if day centres closed. Many participants valued the social interaction that the current system allows and felt it had contributed to their mental wellbeing and recovery

Peer support approach /
  • Respondents were generally positive about peer support sessions, with providers recognising they have a good track record of co-production and involving service users
  • Providers suggested that the peer support approach would be the aspect of the new service that would be able to provide the social interaction currently generated by day centres and therefore stressed its importance.
  • However, some service users felt that peer support could be a way of saving money and wanted reassurance that staff (including peer supporter) would be properly trained
  • Respondents pointed out that peer support and drop-ins could be either available in the short term 12 week period (e.g. signposting and support for those discharged from hospital) to long term (post 12 weeks) for social/ lifestyle activities e.g. gym or swimming

Suitability of community locations /
  • Some respondents felt worried that community spaces like libraries etc may not be appropriate for those with mental health needs and were worried about stigma or a lack of support if they had a relapse in public

Location and timing of community sessions /
  • Respondents wanted drop-ins/ peer sessions in a range of venues around the borough, so they were close enough to visit
  • Respondents felt strongly that there should be a clear timetable of sessions and that programming of these events should be consistent and not be shifted around.

Coping with change /
  • Many respondents were extremely concerned about change and how it would affect them. They requested that they would need significant support through any change

Suggested safe space locations

The following information was provided from a range of sources about potential locations for safe spaces:

Types of venues
“It may help to use spaces that people are already familiar whilst also considering new spaces”
“Westminster Libraries, church drop-ins and coffee bars”
“Mainly at churches/ church halls, where the atmosphere is very peaceful”
“Consistent venues”
“School facilities over weekends”
“Evening and on-line services (for housebound”
Geographical areas mentioned
  • “Close to people who are suffering from mental health - it is difficult for them to travel to other areas”
  • Lupus St or Pimlico Road
  • Located in the Victoria / Pimlico area
  • SW1 will be ideal.W9 or W10
  • Woodfield Road W9
/ Specific sites
  • Hopkinson House, 88 Vauxhall Bridge Road, London
  • 190 Vauxhall Bridge Road
  • The Abbey Centre
  • Beethoven Centre, W10
  • Breimheim Road (“closed but still vacant?”)
  • Westminster and Wandsworth Mind – also offers a hub space
  • Oremi Centre
  • St Marys Terrace
  • Soho Centre
  • Kilburn Library
  • The Harrow Road near Costcutters (“where the cafe used to be”)
  • Stowe Centre – main hall
  • Venture Centre, Wornington Road, W10
  • Paddington Art Centre

5. Analysis of consultation survey results

Profile of those responding via post or online

Of the 1,110 contacted, a total of 167 people responded to the survey either online or via post. Two thirds were either current or former users of day services. Staff members or those working for mental health support groups accounted for around 1 in 10 of all respondents.

Older people (aged 55+) and women were more likely to respond than younger people and men. Those from White and Black ethnic groups were slightly more likely to respond and those from Asian and Other/ Mixed groups slightly less likely to respond.

Invited: those sent a consultation letter and survey

Responded: Those responding via letter or online

Agree/ disagree with the proposed model

  • Overall, more respondents (46%) agreed with the proposed model for mental health services than disagreed (36%).
  • However, for those currently using the affected day services (listed below), the proportion agreeing with the proposed model (41%) was very similar to the proportion disagreeing (44%).
  • Those attending Portugal Prints and Flexicare were much more likely to agree than disagree
  • However, there were a large proportion of users of RSS and Oremi who strongly disagreed with the proposal – around 4 in 10.

Proportion of survey respondents agreeing or disagreeing with proposed model for mental health data services NB some respondents used multiple services. Total sample: 159

Current day service users agreeing

with model – by age

Feedback on safe spaces

Reasons why people agreed with the proposed model
People who agreed with the proposal generally did so either because the current approach was outdated, the new approach offered a more individualised/ tailored approach, or because the keyworker/ case management approach was the more common approach for services nowadays:
“The current service is old fashioned. It needs changes”
“If it is well-designed, and co-produced with service users, it could be a liberating model”
“Because it offers me the kind of support that I need to learn how to live independently and avoid isolation”
“Support should be more personalised and structured”
“This model resembles the care models in the NHS where there are case management roles which focus on supporting people who present with the greatest health need”
“People with mental health problems are using services in different ways then when day service were last commissioned. We support a restructure that enables more choice and control for people about what services they use and how and which work towards helping people engage and connect with universal services to meet many of their needs”
“I believe that organising it that way [i.e. proposed] would be a good idea. 12 weeks, I think is enough time to assess the needs of a service user, and offering more time to a service user if they are eligible”
“It is a good idea in principal , but there needs to be consideration about relevant recovery [speed] and the pace service users with chronic mental health issues are able to recover as well, as what are realistic expectations in [terms of ] recovery”
“As long as services are easier to access and are more widely advertised”
“It seems streamlined. I also like the idea of a 'befriender' as it can sometimes be difficult to return to socialising after the episode”
Reasons why people disagreed with the model
Those respondents that disagreed with the proposed model generally felt they may end up with a worse service:
“You cannot take money out of such a crucial [service]”
“People need a place to go to for support”
“Key workers can help but are not enough to cure problems of mental health”
“I recognise the need to make changes to the way services are made available. However, I am worried that I may end up with a less favourable service then I have at the moment”
“There was an existing similar service re-design [in a London borough], where the end of block grants caused the eventual de-stabilisation of several quality third sector provider organisations”