Responsible Officer: / Lucy Cunliffe – Stockport Together
Details of Organiser: / Irene Harris
Type of Engagement
X Open Meeting / o Focus Group / o 1:1 interview / o Postal survey / o Phone survey / o Email survey / o Online survey
Attendees
Steve Bradshaw, consultant and retired old age psychiatrist
Shirley Hamlett, community engagement officer, CCG
Lucy Cunliffe, communications lead, Stockport Together
Approximately 30 group members of the public
Demographic Breakdown of attendees
Age: / 30+
Disability: / Mixed
Gender: / Mixed
Race: / Mixed
Religion: / Not known
Sexual Orientation: / Not known
Comments and Proposals:
Steve Bradshaw, representing Stockport Together, gave a brief overview of the work to date and the plans that are being proposed to transform health and social care in the borough. The ‘listening event’ was held during the Mental Health Carers’ Group Stockport’s regular meeting at the Quaker Meeting House in Stockport. This was followed by an interactive session to gather the views, questions and feedback of the members of the public.
These have been summarised below:
I think one of the most important parts of this is getting the IT systems right. Will there not be an issue when we come to renew contracts? i.e. when contracts come up for renewal, how will you ensure that the different partner organisations don’t go off and procure their own systems again?
In my experience, decisions about purchasing seem to be made by managers rather than looking at the clinical case…
I don’t know – this is a very complicated issue. I know that Pennine haven’t been on their system long, and I know that the clinicians didn’t want the system they procured.
I do know that GM has sufficient clout and authority to make organisations conform , so if one organisation wanted to change things up, they’d be answerable at a GM-level.
GM haven’t presented any real plans to transform mental health, but in Stockport we have three business cases which cover changes to mental health services – and these have all been passed.
GM is starting to put money into mental health.
With regards to sharing mental health data, thre area a lot more sensitivities around it. The concern exists about sharing the information around GPs and patients, and it’s an example of the complexity in the system. We need to look at how much access should be granted to whom. Often, mental health information contains third party information which isn’t a GP or psychiatrists data to share.
This presumably started before GM Devolution. What authority do they have and can they stop what we’re doing in Stockport?
No, this won’t stop. GM have been involved with this work – they know our plans and are learning from us in many ways. They’ve also given us some funding to help us to implement the changes.
It’s sad that the mental health activity doesn’t seem to be walking on the same path, and appears to be following behind the other services. There was an opportunity for Stockport Together to say we’re going to treat mental health the same as all other health and social care services.
I agree. When I was lead consultant for mental health services, I did get some crisis services off the ground when we were given some mental health investment. But money has always been an issue; we have been underfunded for such a long – and any funding we’ve had has come with a strict stipulation about what it can be spent on.
Stockport Together is doing some specific mental health work:
1) Liaison psychiatry provision at Stepping Hill is still quite patchy – it has psychiatry, psychology and nursing team who can visit a person who is in hospital for a physical health need. Under Stockport Together, very little focus has been given to this so far, but part of the GM strategy covers this area.
Stockport will have a 24 hour core psychiatry service, and RAID will be rolled out more widely.
2) Intermediate tier: focus on helping people return from a hospital stay. While the focus of this will mostly be on the elderly, Stockport Together will aim to reduce unnecessary admissions and readmissions.
3) neighbourhood teams: 4 CPNs have been employed in Stockport. The CPNs, who will carry out visits for known patients, will be based at the Meadows and work out in the localities. Healthy minds (formerly IAPT) deals with working age people with severe and enduring mental health, and we’re trying to get this out into the community.
4) 1.5 psychiatrists, 1.5 psychologists, 8 GPs: a team which will focus on people with complicated needs. They will work with people who could currently have a brief interaction with secondary care.
5) communities: support for people in the community to promote wellbeing. We now need to extend the trials to have someone in the health centres across Stockport who can signpost people to services in the area to help reduce waiting times.
This has been tried in Brinnington and Woodley, and has helped to give people with low-level mental health needs support and advice.
How many GPs are specialists in mental health?
As GPs don’t have an accreditation, it’s hard to know exactly. Some will have had more training than others. As a general rule, younger GPs will have had more mental health training than older GPs.
There aren’t many that have gone and done training in a specific mental health skill.
In Gately we have a mental health trained GP – the scenario that poses the question about whether you would be happy to have services delivered in the community… surely this depends on having appropriately trained staff who are sufficiently skilled to give the care?
The scenarios have been put together to try and gather a wide variety of views from people across the borough.
It seems to be aimed at those people with lower level mental health needs rather than severe and enduring.
Stockport Together is a whole-community programme that includes people with severe and enduring mental health needs .
I remember when care in the community started – it allowed people to take care in the community, but cuts have been made. What is happening to care in the community? and how can it be as good as it was before the cuts?
Relatively speaking, NHS inflation outstrips national inflation so there is never a real increase in funding – when governments say they’ve given more money it isn’t a genuine increase. We did have some funding at some point, but it has been pruned over time. There have been cuts to the number of beds, but this hasn’t necessarily resulted in worse care.
To make improvements, it would be helpful if the community could be more tolerant of and kind to people, the third sector could look after lower grade mental health needs better, and services had better competencies. We also need to improve the intermediate tier offer for mental health, and an improved crisis response offer for people with severe and enduring mental health needs.
[the group had submitted their own ‘scenarios’ which were discussed with Steve].
[Scenario 1 was described by someone who had been through this]. I am very sceptical about RAID and all of these services. If you are under any type of mental health service, you can’t access crisis response – the only support offered in this case is through the Samaritans or the Sanctuary.
Access isn’t 24 hours at the moment – it operates ‘office hours’, and outside of that you would be directed to RAID. The difficulty is that care co-ordinators often only work 2/3 days a week, meaning that Stockport Together isn’t currently offering the full support.
The crisis response service mentioned isn’t the secondary care mental health service – it’s the name given to a new health and social care crisis response service.
The only point of contact in a mental health crisis is a charity service.
I will try and find out what has happened to RAID/the mental health crisis team
You say Pennine Care is a part of Stockport, but they don’t seem to be making sure that mental health is part of this activity. The Stockport Together programme is using ‘crisis response’ to describe a completely different service.
Your input is extremely important, and it’s crucial we understand these difficulties. Pennine’s role in this partnership is to be at the table talking about the mental health services they don’t already provide. The idea is to strengthen the offer and develop services for the community.
Carers have gathered here today because they’re concerned about their loved ones. When you say Pennine aren’t doing enough – don’t you think we should be worried?
Why don’t you worry about the mental health needs of younger people, outside of the ‘older age’ group?
We want someone who is proactive, not someone who is retired…
In my two days a week as a retired consultant, I am doing training with TPA, social workers, housing, liaison workers… I am doing much more than 2 days’ worth of work.
I am more than happy to ask my colleagues and pin them down to get answers. I am not putting my own energies into severe and enduring mental health apart from to give some knowledge and level of competency.
Most local authority staff don’t have mental health knowledge or skills.
We’re not saying this is all Pennine’s fault. They have engaged with the group many times. Mental health has been given 8% of the CCG budget. Pennine can’t cope with the demand.
The more specific you are about what you want to pursue, the more results you’re likely to get.
It is time that mental health was better funded. Stepping Hill were economically very powerful in Stockport for about a decade which meant that the CCG had less money to spend on mental health, but Stockport had a very successful secondary care service.
This is now starting to change, which is why we’re seeing more of a shift to better funding mental health services.
The hope is that because devolution exists in GM, secondary care will be equalised over the next 2/3 years across the region.
[Steve addressed some of the concerns raised with the scenarios that had been developed by the group].
The situation described in scenario one will be addressed through the work we’ve been doing over the last 12 to 18 months leading up to the creation of the business cases.
Was this addressed because of a letter that was drafted referring to the Human Rights Act?
No – colleagues put together a proposal for difficult to engage people who would traditionally have been bounced around the system.
We have done a pilot in one area, and the business case explaining this has now been signed off, and we have GM funding for this initiative. And the recruitment process for this is underway.
We are aiming to have sufficient staff to take 250 people into a one-to-one service from across the borough for 18 month’s supervision. A further 250 people will be seen through an extended service who will be worked with on a lesser degree – i.e. not one-to-one.
You’ve talked about money being put in, but at another listening event it was talked about money being put in as well as the money being taken out… the NHS has huge problems recruiting and retaining staff.
How are we going to afford it? And how are we going to recruit?
Money is a very complicated subject – with inflation and government funding, the main lobby has been to keep hospital beds, and to keep them at all costs. The difficulty with this is that beds are the most expensive things to keep.
If you try and reduce any acute services to decrease costs, that money can be reinvested into the community.
Brexit is another complication when it comes to staffing – when we remove ourselves from EU, we will have increased difficulties. We rely on EU countries to top up our workforce – we are not training enough or retaining enough of our own staff. Staffing is probably the biggest problem across all professions.
There is a local dilemma, people want to live and work in the area, as we are not as bad as some other areas.
Regarding the financial short-fall: we know we can make savings through these initiatives. People are correct in what they say, but they’re assuming the future based on the past.
As a Stockport resident, professional and carer. I work in forensic mental health, which is the only area that’s well funded. It deals with people who haven’t been looked after by the community and end up either in prison or in a secure hospital.
Cuts to basic services like beds mean that people can’t access them. One of the indirect consequences of cuts to community mental health services is that there is now no support in the prevention of relapse. Carers are trying to get the evidenced treatment or support for people – whether that’s in the community or elsewhere.
You’re totally right – we have been putting so much resource into forensic mental health.
I can try and access information about the crisis support and feedback to the group [the group said that they did not need Steve to access this information, as they are in regular dialogue with Judy Driscoll on this matter].
I don’t have any information about potential Pennine cuts, and I’m sure I would have heard about this if it were the case.
They way mental health budget is divvied up cannot be influenced by us on a local level.
In scenario four – my son was given a certain drug, but a recent news report highlighted that the drug given can result in psychotic or murderous actions. When my son was given the drugs 15 years ago, this is when he attacked his father. Medication is definitely an issue
There are some drugs known to medics to have some negative side effects – i.e. suicidal or homicidal. This isn’t new.
Mental health is vulnerable to getting shot at in the press, particularly when it comes to medications prescribed to treat conditions.
Could we not have been told about the potential side effects as his parents?
The issue around information sharing with GPs often comes down to the person’s capacity. GPs have had difficulty in the past around whether a person has capacity or not. If they lack capacity or has insight to set up so that a parent can act in a person’s interest when they’re unwell.
GPs told my son he was old enough not to have parental representative. He has unrealistic expectations about what he can achieve, but we cannot help him because he is deemed to have his own capacity.
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We have experience of both really good and really bad care co-ordinators, but the main problem is that they just don’t stay around long enough to have any real impact.
Stockport Together is a partnership between NHS Stockport Clinical Commissioning Group, Pennine Care NHS Foundation Trust (mental health services), Stockport Metropolitan Borough Council, Stockport NHS Foundation Trust (Stepping Hill hospital and community health services) and Viaduct Health (a federation representing all Stockport GPs)