TRUST NAME: Herts Partnership Foundationtrust (HPFT)

Third party commentary: HertfordshireCounty Council Health Scrutiny Committee (12 March)

TRUST NAME:Herts Partnership FoundationTrust (HPFT)

C6: Health care organisations co-operate with each other and social care organisations to ensure that patients’ individual needs are properly managed and met

Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.

In Hertfordshire, formal integrated partnerships between health and the County Council have been in place since 2002. The County is believed to have the most integrated joint commissioning arrangements in the Country, with a budget of £250 million currently being overseen by the Joint Commissioning Partnership Board (JCPB). Little distinction ismade between health and social care budgets when contracting forintegrated mental health services. The recent scrutiny of mental health (Dec 2008) provided evidence of the significant joint work undertaken between the County Council, Health Trusts and user/carer groups. Members were pleased to hear that, since that scrutiny,Enhanced Primary Care teams have been put in place comprising 35 staff. Training is received from the University of Hertfordshire.

Evidence provided by mental health user groups (Guideposts and Viewpoint) strongly affirm that partnership working with statutory organisations has improved year-on-year. They confirmed that the good relationship between user groups and the Joint Commissioning Team (JCT), Primary Care Trusts (PCTs) and HPFT have enabled the JCT to take a more innovative approach in service provision and development. The current situation is one that needs to continue for the best interests of both providers and commissioners and users.Mental health users expressed concern at the uncertainavailability of long term funding and that some of the new initiatives and service developments implemented using the new finance would be unsustainable when these funds expired; however, during the recent scrutiny of mental health services (Dec 2008) commitment by JCT to embed mental health services into primary carewas demonstrated. Evidence provided by Adult Care Services (ACS) and JCT highlighted that joint working for older people with mental health problems needs to be further developed.

New regulations for the handling of complaints are due to come into force in April 2009. This will have an impact on the way ACS and the NHSresolve complaints. HPFT and social care services will need to develop protocols and processes to meet these changed requirements.

A lot of strong evidence was received in relation to this core standard. Partnership is the essence of Hertfordshire Partnership Foundation Trust working; there is joint responsibility to deliver social care in partnership with Adult Care Services. Members were assured of the Trust’s compliance with this core standard.

C13: Health care organisations have systems in place to ensure that:-

a)staff treat patients, their relatives and carers with dignity and respect

b)appropriate consent is obtained when required for all contacts with patients and for the use of any patient confidential information

c)staff treat patient information confidentiality, except where authorised by legislation to the contrary

Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.

Members heard from JCT that government standards arein place and providers (i.e. HPFT) perform well against these. Formal user/carer input into commissioning is more advanced for mental health services (Viewpoint is commissioned to provide user input and Carers in Herts provide carers’ input) than for learning disability services. Commissioners recognise the need to improve user/carer input into learning disability service provision. Members are minded to suggest to the Health Scrutiny Committee that this is added to the future work programme.

User and carer organisations stated that the Trust is listening to and acting upon information given to it in relation to this core standard.

Confidentiality is a difficult issue in services provided to mental health users and those with learning disabilities. Carers often have a high degree of involvement in individual’s lives’. It is often expressed as an issue of concern for carers and this is recognised and being addressed. HPFT staff training also includes aspects of privacy and dignity for users.

Some issues for resolution aretransferred to the formal complaints process because of the serious nature of the issues raised or because they have taken longer than five days to resolve; complaints are now being received concerning those who have been detained under the Mental Health Act or who are under Community Treatment Orders. Most clinical practice complaints concern direct care; there have been five complaints about confidentiality. There have been no complaints about lack of privacy of dignity.

Concerns raised last year about services provided in a learning and disability unit have been tackled by the Trust and the unit has subsequently been closed. Residents have been relocated and staff successfully redeployed. Generic job descriptions have been introduced across the Trust to ensure movement of staff between units. Members commended the proactive approach taken by the Trust. Members regard this as evidence of a high performing Trust ensuring that it does not become complacent in its responsibilities; furthermore Memberswere pleased to hear that the lessons learnt will be applied across all relevant services.

Members commended the openness of the Trust regarding concern raised last year about services provided in a learning disability unit and praised the positive and proactive stance of the Trust in addressing it. Members were assured of the Trust’s compliance with this core standard.

C17: The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving health care services

Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.

Evidence was provided by JCT that there are a number of fora and voluntary sector networks through which users and carers can inform commissioning decisions around mental health services. The JCPB also hold its quarterly meetings in public and has briefing meetings in advance of formal meetings to which the public are invited. HPFT is contractually bound to routinely collect evidence of service user and carer experience and to feed this information through to the JCT and JCPB. The outcome of new projects and initiatives undertaken with monies from the innovation fund will be evaluated over the next couple of years and will help inform the Standards for Better Health 2009/10 Topic Group’s deliberations.

The mental health user and carer groups (Guideposts and Viewpoint) are confident that user/carer views are taken into account when designing, planning, delivering and improving health services. Members noted that the results of the new service user questionnaire will be available later in 2009.

Last year the Trust made a commitment to appoint a new PALS & Complaints Officer. Members were pleased to note that this was achieved in March 2008. This is a new post which will enable the Trust to re-launch the PALS service. It is anticipated that this appointment, together with that of the new PALS and Complaints Manager, will enable the Trust to provide an even more effective service. Whilst there has been an increase in both PALS contacts and complaints, Members accepted that this islikely to be the result of several things: HPFT has held sessions in main shopping areas throughout the County to encourage residents to become members of the Foundation Trust. As part of this initiative, PALS and complaints leaflets were re-launched and posters and leaflets were handed out at these events. Posters and complaint leaflets have also been provided to all HPFT units. The comments, compliments and complaints leaflet has a pull out post paid comment card to help users access the PALS and Complaints service more easily. HPFT expect complaints and comments to rise further as it continues to raise awareness of the services available and as a result of the Trust taking on the management of the social services provision of mental health patients (and the associated complaints from that service).

HPFT are delighted that questionnaire results from users aremore complimentary than anticipated. Members regarded this as a further example of a lack of complacency on the part of HPFT and confirmation that it does not always focus on its successes.

Good evidence had been provided in relation to this core standard. Members were assured of the Trust’s compliance with this core standard.

C18: Healthcare organisations enable all members of the population to access services equally and offer choice in access to services and treatment equitably.

Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.

Evidence provided by HPFT of ongoing projects to engage with hard to reach communities, for example the BME (black and minority ethnic) community was endorsed by Guideposts (which represents the needs and interests of BME mental health users). This work is linked into activity being undertaken by the Implementation Group (responsible for implementing the recommendations arising from the review of mental health services) and will also inform the work of the HPFT’s ‘Delivering Race Equality Board’ and ‘Service User Council’(also at C22).

The difficulties of using a multi- service site were noted. Some of the current 80 sites operated are in older buildings which are more difficult for people with physical disabilities to access. Members clarified that the Trust now has contingency arrangements in place to address this.

Users have indicated a desire for treatment closer to home. Early diagnosis and treatment often prevents later, more costly acute admissions. To fund a redesign of services,40% of the funding will be drawn from secondary services. The separate scrutiny of mental health (Dec 2008) explored whether this could be achieved without negative impact and concluded that robust plans were in place and working. It was confirmed at this scrutiny that Enhanced Primary Care teams are now in place made up of 35 staff. Members were aware through evidence provided at this scrutiny by users and carers (and previously) that they have been full involved in planning services.

Members were assured of the Trust’s compliance with this core standard.

C22: Health care organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by:-

(a) co-operating with each other and with local authorities and other organisations

(c) making an appropriate and effective contribution to local partnership arrangements including Local Strategic Partnerships and Crime and Disorder Reduction Partnerships

Based on evidence received 4 & 25 February 2009, unless otherwise stated in the text.

HPFT outlined the development, in conjunction with district and borough councils, of the Mental Health Housing Strategy; the multi-agency work being undertaken on the mental health needs of offenders; and work with practice based commissioning groups. Members had already considered this during the previous scrutiny of mental health services (Dec 2008) and could confirm the evidence provided.

Users and carers confirmed that there are a number of initiatives being undertaken which will make major improvements to mental health care. Service providers, commissioners and service user and carer groups are now “singing from the same hymn sheet”. This represents the real progress being made by both health trusts and the County Council in listening to and ‘taking on board’ service user views. In the view of carers and users co-operation had improved significantly over the last few years.

There was clear evidence of multi-agency co-operation. Members were assured of the Trust’s compliance with this core standard.