Item 4 Appendix B
JCPB 16th OCTOBER 2008 PUBLIC BRIEFING COMMENTS/QUERIES - OFFICIAL
Care Group / Agenda Item No / JCPB / ResponseGeneral / 4 / With regard to the public briefing will all Councillors and other senior Board members be attending all the public briefings and will the questions and answers form part of the Board papers as an Appendix? / Not all JCPB members will attend all public briefings but our public involvement approach does rely on there being good representative attendance from JCPB and will not work if this does not happen.
Finance / 4A / Re HPFT underspends:
1.Do we know where the gaps in community services are?
2.Have posts been advertised? Are we paying the right amount (Herts weighting?) / The actual % variance in terms of underspend is CATT 1.47%, AOTs 3.91%, HSTs 2.02% and CSTs 2.57%, CMHTs 0.76%. The AOTs have generally an establishment of 10-12 wte so an approximate 0.4wte vacancy and the commensurate caseload can be managed in the short term.
Job description and person specification are evaluated against set criteria across 16 core factors to give a total score for the role. Each banding has a range of scores and the job evaluation determines therefore which banding a role falls into. For many roles, there are generic national profiles to ensure that like jobs are banded consistently. Everyone in Hertfordshire receives 5% fringe except those working in North Herts, who get no allowance, and a small handful in Waltham Cross/Cheshunt who qualify for 15% outer London. The % is based on basic pay and there is a minimum/ maximum, subject to annual inflation. Current rates are:
5% min £891 max £1544
15% min £3261 max £4156
Generally vacancies are being actively recruited to wherever possible.
Finance / 4A / Whilst it is pleasing that counselling is being developed there surely must be concerns regarding computerised therapy in that many users and carers are amongst the poorest in society and many will not have a computer in the home because of the costs - how is this to be addressed? / Computerised CBT (cCBT) is only offered following assessment of need within the Enhanced Primary Mental Health Service. Once cCBT is offered to service users they will be able to choose how they wish to access it. There is no expectation that service users have their own computer. Therefore provision will be made to access cCBT in a variety of ways.
Finance / 4A / It is stated within the Investment Proposals 2008, that c£550K is to support a range of pilots, 08/09 ... which might provide improved outcomes. What are the proposed pilots, what are the agreed outcomes and what measures are to be introduced to show best value? / The innovation fund is highlighted in more detail in agenda item 4d page 3. Further details regarding each project will be posted on the JCT webpage.
D&A / 4B / Bearing in mind that money for Alcohol Treatment is not ring fenced what is the approximate amount of money per head available at this date to be spent on the 848 open clients listed at 31.8.08? / Although alcohol monies are not ring fenced by central government, locally we can prioritise specific initiatives.
The uplift will be used to supplement existing services.
The money spent will be dependant on individual need, and can range from a brief intervention at low cost, to detox and rehab which can cost £15000.
D&A / 4B / With regard to the transfer of the ongoing management of the supervised consumption budget to HPFT, Page 3 D & A, which is currently held by the JCT, what budget are the JCT holding and what will be the amount transferred to HPFT? Similarly what was the budget for the Rehab. held by the JCT and how much was transferred to HPFT by the JCT? / The budget for supervised consumption has yet to be agreed with HPFT.
The rational is the same as with the rehab budget that the budget should reflect the need and can be best determined by the provider.
LD / 4C / How is Adult Care Services at HCC proposing to address the over spend of E2.3 million on Learning Disability services i.e. will services have to be cut and if so which ones? What are the estimated increased costs of the closure of Specialist Residential Services and those in Assessment and Treatment services? / Senior officers in ACS are scrutinising budgets and commitments and exploring options. No decisions have been made to cut services. Further information will be presented to future JCPB meetings.
Funding invested in SRS will be available for move on services. Recent experience of people moving on from TATs is that costs of the new services are significantly lower than TATS. People are eligible for additional benefits when living in the community and these too will add to the funding available. Until all individual move on/service design plans are developed we will not know total costs
WAMH / 4D / Bearing in mind that the occupancy rate of Working Age Mental Health Acute units is still very high and not within IIYMH or the Healthcare Commission requirements, both stating that adult acute units should run at an 85% occupancy rate, what number of Adult acute beds would be required to have an occupancy rate of 85% rather than the c110% as a present, on an ongoing basis? What number of adult acute inpatient beds are available in Hertfordshire at present? / JCT and HPFT believe that the problem is not that there aren’t enough beds available, but further development of crisis resources and work on accelerating discharge into appropriate supported accommodation is required. The review of IIYMH findings further support our conclusions. Currently there are 124 acute beds available and work is underway with HPFT to ensure that these beds are used appropriately and resourced properly to ensure a therapeutic environment and standardisation of admission criteria across the County.
WAMH / 4D / As the rate of those under section/involuntary patients is as reported by the JCT c76% in Hertfordshire which is twice the English average of 36%, BMJ 14 October 2008, what implications does this high figure in Hertfordshire have for the number of adult acute beds required? / Through development of community resources and alternatives to admission we would hope to offer people options other than voluntary admission when they feel themselves reaching crisis. HPFT is undertaking work to ensure that inpatient services are sufficiently robust to deal with the increased percentage of people under section.
WAMH / 4D / It is mentioned regarding Adults of Working Age that further development of community services will reduce the rate of admissions - is it not correct that staff who are at present looking after those in the community are to be transferred from HPFT to GPs and that therefore those with the most serious mental illness are to have fewer staff to look after them in the community? What further development of community services are being proposed and how will this reduce the rate of admissions? / The development of EPMHS to deliver IAPT is underway. HPFT are contracted to deliver a shift workload to primary care over the lifetime of the FT contract. Additional investment as highlighted in the finance report has enabled HPFT to accelerate the development of EPMHS without further reducing resources within CMHT’s. Clearly demonstrating how closely the JCT are working with HPFT to ensure a smooth transition of resource with a primary care focus whilst retaining appropriate levels within secondary care in order not to compromise service provision for those with the most serious mental illnesses.
WAMH / 4D / With regard to the Serious Untoward Incidents has analyses taken place, for example simple graphs, which gives comparisons for each acute unit, and for Hertfordshire as a whole, of: bed numbers, occupied bed days, average length of stay, occupancy
rates, re-admission rates, rates of section, number of admissions, for the last 2/3 years? and For Community services: contacts, referrals accepted and rejected, caseloads, etc. If not do you not think this would inform on Serious Untoward Incidents, the number of beds required, and other issues which may transpire from the analyses? / There are a number of contributing factors causing the high bed occupancy rate at present. HPFT do have the types of information you itemise. They are utilising this information and working with the JCT to develop appropriate short, medium and long term plans in line with IIYMH outcomes to meet the needs of the local population.
It is unclear at present to say if there is a direct correlation between items you site and SUI’s. Again there can be a number of contributing factors that cause an SUI. As shown in the SUI report there is a robust investigation and reporting system in place where learning’s can be applied to change practice and or service provision.
WAMH / 4D / Withregard to the medical professional allegedly killed by a patient who had been transferred from Albany Lodge, the adult acute unit in St. Albans, to a place in Bedfordshire was not Albany Lodge running at about 120% occupancy rate at the time? and what sort of place was the patient transferred to? / As stated in the SUI report the police investigation has not concluded. Therefore final learning from the outcomes of the investigations have yet to be applied.
WAMH / 4D / When was the HCC audit NICE Schizophrenia Guideline carried out? Its figure of 79% differs very considerably to the results of the POMH-UK re-audit, which shows only 21% were screened. It is evident therefore that the figures/facts quoted in the Board’s minutes vary dramatically from those given in your written response to me. I shall be sending a detailed report on this discrepancy to the JCPB and HPFT. / HPFT will shortly provide confirmation of the date the audit was completed.
The JCT has arranged to meet this carer to further clarify the issues she has raised in this report. The SCG will make a decision when they next meet on 2nd Dec whether to provide a further exception report to the JCPB. This will be based on the review of the discrepancy between this carer’s report and HPFT’s response.
MHSOP / 5 / Was all the money 'saved' by repatriating persons, Older Persons, back from North Essex and Barnet, Enfield and Haringey Mental Health Trust used for additional reinvestment within the county? How many extra beds and what extra community based services were made available with the £3 million raised? / This question has been answered in previous board reports. Additional beds within Hertfordshire have been provided at Elizabeth Court in Stevenage and Seward Lodge in Hertford was redeveloped and had its facilities upgraded. Community teams have been expanded across West and East and North Herts including new Consultant Teams and a Dementia Intensive Outreach Team.
LD / 6 / In principal I am happy about the LD Employment Strategy – but in view of the current economic situation – and possible significant increases in unemployment, - you may end up encouraging LD patients about prospects that will not materialise. Is there room to adjust plans to accommodate changes in potential job availability? / We are of the view that people with learning disabilities have the same rights to work as everyone else, and increasingly this is their expectation, credit crunch or not. We are committed to providing support etc to make sure this can happen. Our strategy includes working with employers and specialist and mainstream support agencies to help people get and keep jobs. The strategy is not based on specific jobs but looking at individual aptitudes and opportunities, so will accommodate any changes in potential job availability. We are of the view that in times of uncertainty having a good, comprehensive and agreed strategy is even more important.
LD / 6 / As regards the employment strategy for people with a Learning Disability and those with a Mental Health problem how many of those with a Learning Disability and how many with a serious
Mental Health problem are employed by Hertfordshire County Council, the Primary Care Trusts and the Joint Commissioning Team, respectively? What percentage of the workforce do these figures represent? / Sorry not to be able to provide exact answers but the figures kept are for all people with disabilities rather than separated out, and this assumes people declare their disability. For some people with learning disabilities (and possibly other disabilities) they choose not to do this – as they want to be treated the same as everyone else in society. Within LD services we do employ some people with ld eg in person centred planning team, as co chair of the partnership board and have plans to employ more, both for long term jobs and for short pieces of work.
LD / 6 / Within the section on carer support and employment it states that carers are to assist the person they care for to look for work and/or training and education - is it going to therefore be the responsibility of carers to undertake this work in addition to their caring role? Is it not an insult to suggest that carers choose to become a carer rather than work or train when all they get is c£50 a week leading to poverty. It should be noted that Carers UK have reported that 7 out of 10 carers had to give up work to care, but that nearly half would like to work. How is the JCT going to address the issue of carers wishing to work when there is no mention of additional care for the users? / The report says that where carers can provide support this helps the cared for person, but not that this is the expectation. The report identifies the need for carer support. This particular report focuses on employment for people with learning disabilities. I believe the carers strategy is the report that covers carers wishing to work.
WAMH / 7 / Regarding the issue of supply and demand Mental Health Housing Strategy, page 15, the 6.1 new long-stay people per 100K prevalence how will the closure of 60% of group homes assist in this process? How many people will be affected? Is the removal of their home likely to exacerbate their mental illness which may require further stays in an acute ward? / The proposed closure of the group homes will not have a direct impact on long stay high needs services. Group homes receive minimal support and do not fit in to the high need residential type services. The style of group home accommodation is no longer popular with individuals who wish to have their own home as opposed to a shared environment. Any moves will be done within a full personalised care planning process with the individuals needs and wishes fully accounted for.
WAMH / 7 / With regard to the sale of 7 house in Hemel Hempstead it is stated that this money is scheduled for re-investment - is all the money received from the sale to be re-invested in mental health services or is some to be returned to the PCT to spend as they wish on other services? / All of the money made available from the sale of these group homes is to be re-invested in accommodation services for mental health
WAMH / 7 / With regard to Appendix A of Supply and Demand whilst there is mention of referrals for various support house from Low Secure, Rehab to Group Homes there is no mention of the number of parsons accepted for this treatment or the number refused. How many people were accepted into these placement, how many were refused and what happened to those who were refused? / The care planning process matches needs of individual service users to appropriate services. Therefore individuals not placed in the resources identified in appendix A would have alternative services identified.
WAMH / 7 / Whilst the JCT are "keen" to see a comprehensive stepped approach to crisis housing within the Housing Strategy there is no mention of Crisis Housing within the Strategy, why is this so? and how many crisis beds are the JCT "keen" to see and many crisis beds are required? / This strategy document is in early draft format and presented to JCPB to ensure full participation as early as possible.
Following the review and stock take of IIYMH, proposals will be made for the development of crisis accommodation and associated models of care. These proposals will be incorporated into the accommodation strategy.
WAMH / 7 / How many beds are being proposed for Supported Accommodation -Group Homes, Independent low support flats, Independent high Support flats: how many for rehabilitation: and how many for Long stay/residential accommodation? Will the amount stated cover the needs and new needs for those with a mental health problem? / We are currently undertaking a more robust needs analysis of accommodation needs. When complete this will inform us of the requirements for accommodation over the next 5 years.
WAMH / 7 / It is good the strategy identifies that it is important to support people to be part of the community and not all housed together. Having a ‘halfway house’ on the way out of hospital is important. / Where appropriate the strategy will look at the current rehab units and whether these currently meet the need for Hertfordshire. The introduction of Individual budgets will allow for clear person centred plans for people to be supported within any new accommodation.
WAMH / 8 / It is important that community groups are available as it gives people a place to go when anxious and can allow staff to chat with service users. This is also very important when you have had a crisis and may feel isolated. / Types of crisis support along with additional community networks of support will be included in the accommodation strategy as well as highlighted in the IIYMH strategy review.
WAMH / 8 / As MHP is strongly highlighted, will the funding continue and grow past 2010? Would HPFT consider an ‘MHP Champion’ at Board level to ensure it continues as part of services? / Mental Health Promotion is a very important tenet of our commissioning direction. We can however not currently make commitments past the life of the current strategy, but will review this and the success of any projects funded over the course of the current strategy when it is due to expire. The operational director of HPFT is the responsible champion for implementing the NSF for which mental health promotion is standard one.
IIYMH / 8 / As the Strategic direction of IIYMH has changed beyond all recognition as regards input of money, services available, services promised etc. the use of IIYMH as a yard stick for going ahead without consultation is surely untenable? / The purpose of the item is for JCPB to consider whether there is or will be a significant shift in the strategy. A topic group of the Health scrutiny committee will also be considering this.
PBC / 9 / With regard to Practice Based Commission whilst it is stated that there are 12 PCB localities within Hertfordshire, what areas of Hertfordshire/towns/old PCT areas are not covered by PBC? / All areas are covered by PBC
PBC / 9 / As regards Practice Based Commissioning what will be the influence/impact on PBC of lack of Adult Acute Beds within the PBC area, the lack of crisis beds, and Specialist Adult Mental Health Accommodation, etc? How will the money flow from one PBC area to another if there is no or sufficient services available in a particular PBC area? Will a PBC in one area cover the whole of that geographical area whether or not other GPs in the area are within the PBC? Will patients with a mental health problem have to register with the PBC which commissions a particular mental health service in order to obtain a service? or? As these issues are important for the immediate future would the JCT take the time to address these questions. / These are all key questions that reflect the range of issues that need exploring before practice based joint commissioning can be fully implemented and which this paper proposes need further work.
061108 Public Briefing Comments and Queries 1