JOINT COMMISSIONING PARTNERSHIP BOARD

THURSDAY 6 NOVEMBER AT 10AM

WORKING AGE MENTAL HEALTH

Author: Wayland Lousley, Planning & Commissioning Manager, Mental Health (Adults of Working Age)

Tel: 01438 843232

  1. Purpose of report

To provide the Joint Commissioning Partnership Board (JCPB) with the latest performance and monitoring information in relation to Working Age Mental Health.

2.Summary: Points arising from the meeting of the Strategic Commissioning Group

This report was included in the Strategic Commissioning Group’s discussion on the 2nd September and SCG would like to highlight the following areas for the particular attention of the Joint Commissioning Partnership Board:

Early Intervention in Psychosis(Please reference 3.1.1)

HPFT are currently working to meet the target of 150 new cases per year. The first quarter has been slow leaving the Team behind target. HPFT are devising an Action Plan to redress the shortfall. The JCT will request progress updates from HPFT which will be reported back to the JCPB through the strategic commissioning group.

Health Care Commission and Pressures on Acute Inpatient Services & Bed Occupancy(Please reference 3.2 & 3.5)

In discussion with Joint Commissioning Team (JCT) an action plan is being developed by Herts Partnership Foundation Trust (HPFT) to address the Health Care Commission audit identified weak areas.

SCG have noted the recent 2.5% reduction in bed occupancy rates for quarter 1 to 109.87%. Through investment planning to increase the availability of therapies and activities on the acute wards and the introduction of the Star Wards approach by HPFT the SCG is looking to see further reductions in bed occupancy rates over the next quarter.

The Healthcare Commission has also issued the results of its annual survey of service users for NHS Trusts providing community mental health services. Working with HPfT the JCT will also be developing an action plan to address areas of weakness.

Serious Untoward Incidents (Please reference 3.4)

HPFT has provided an initial interim report attached as appendix 1 for SCG and JCPB consideration. The findings of thefull report will be considered by the Strategic Commissioning Group so that their conclusions can be presented to the JCPB in January 2009.

Enhanced Primary Mental Health Services (EPMHS) and Improved

Access to Psychological Therapies (IAPT)(Please reference 3.6.2)

SCG would like to highlight to the JCPB the exceptional work being done by HPFT to develop this service in such a short time frame. West Herts will be operational from 1st October 2008 with East & North Herts by April 2009.

3.Background Information

3.1Targets

3.1.1 Healthcare Commission Targets 08/09

Indicator / Target 08/09 / Position at end of Q1
Early Intervention in Psychosis- New Cases / 150 New cases a year / 31 New Cases
Crisis Assessment and Home Treatment / 1636 / 783 accepted referrals
7 Day Follow up / 100% of all admissions (DH) 95% (Monitor Target) / 95.3%
Assertive Outreach / 330 unique Service Users / 293unique Service Users

3.2Pressures on Acute Inpatient Services and Bed Occupancy

The bed occupancy rate for quarter 1 is 109.87% which is a decrease from last quarter which was 112.44%. Work to improve the quality of care within acute wards is continuing. Through the Innovation Fund a stepping stones project has been commissioned from Mind in Mid Herts to support Service Users at the QEII, Lister and Albany Lodge. Investment in acute services is also currently being negotiated. It is expected that with the further development of community services that the rate of admissions will lower.

3.3Suicide Prevention Stakeholder Event

In July the Suicide Audit and Prevention Group hosted a stakeholder event inviting representatives from 12 differentOrganisations all with an interest in reducing Hertfordshire’s suicide rate. The session focussed on the reasons precipitating suicide and the possible actions that could be taken to prevent suicide.Discussions will inform the Suicide Prevention Strategy which will come to the next JCPB after a follow-up event to get stakeholder feedback on the draft and input from the Strategic Commissioning Group.

3.4Serious Untoward Incidents (SUIs)

Further to requests for more detailed information from both SCG and JCPB on the increase in recorded SUIs, Herts Partnership Foundation Trust (HPFT) have provided an initial interim report attached as appendix 1. This interim reportwill be followed by a full year analysis commencing in September with publication due in October which will provide a detailed look at the recorded SUIs for that given period. The findings of this fuller report will be considered by the Strategic Commissioning Group so that their conclusions can be presented to the JCPB inJanuary 2009.

3.5Healthcare CommissionReview of HPFT hospital services for people with acute mental health problems.

The group wishes to make JCPB members aware of the recent review of acute inpatient services within HPFT. The review took place in July 08 and rated these services as ‘Fair ‘. Commissioners will be discussing with HPFT how any areas of weakness can be improved. An action plan will be drawn up jointly and JCPB updated on this at future meetings.

3.6Investment ProposalsUpdate

A general update table on the investments agreed is attached as Appendix 2 with some specific detail highlighted below.

3.6.1 Innovation Fund

The Innovation Fund received 35 bids totalling £1,324,229. A panel was convened comprising representatives of the PCTs, JCT, HPFT, Viewpoint and Carers in Hertfordshire, who scored each bid against the selection criteria. Following this processfunding has been granted to the following projects:

Organisation / Project/Service / LIT Area / Amount
Hertsmere Commissioning Limited / SU Support / St Albans, Harpenden
& Hertsmere / £47,500
Mind in Mid Herts / Exercise to Health / Stev, NH & Wel Hat / £47,575
Watford & 3 Rivers Furniture Recycling Scheme / Training Courses / Watford, Dacorum & 3 rivers / £28,225
Rethink / Carer support / Across LIT areas / £46,947
HPFT / DVD for BME / WholeCounty / £10,000
Mind in Mid Herts / MH Resource in Hertford / RBBS and SE Herts / £50,000
Herts Mind Network / Vocational Support / Watford, Dacorum & 3 rivers / £48,160
Watford New Hope Trust / Floating support worker / Watford, Dacorum & 3 rivers / TBC
Ascend / Crafty Creations Course / Watford, Dacorum & 3 rivers / £ 6,500
Mind in Mid Herts / Stepping Stones Project / Across LIT areas / £41,100
Herts Health Action with the Homeless- HYHG / MH link & dual diagnosis link for homeless people / Across LIT areas / £36,898
Herts Mind Network / Volunteer recruitment and support / RBBS and SE Herts / £32,141
Dacorum District CAB / Advice for Service Users / Watford, Dacorum & 3 rivers / £27,324
West Herts MDF & Recovery Centre / Insight training & self help / Across LIT areas / £44,038
Letchworth Centre for Healthy Living / Horticultural Therapy / Stev, NH & Wel Hat / £48,000

3.6.2 Enhanced Primary Mental Health Services (EPMHS) and Improved

Access to Psychological Therapies (IAPT)

Within the agreed Investment Planning the funding has been provided for HPFT to facilitate the accelerated roll out of the Enhanced Primary Mental Health Services across Hertfordshire. This will provide the necessary 14.3wte High Intensity (HI) and 8.6wte Low Intensity (LI) workers to be in place by 1st October 2008 across West Herts PCT area which triggers the release of further funding to recruit a further 22 HI and 13 LI trainee workers. HPFT are on target for all of these new workers to be in place by the 1st of October 2008 allowing trainee workers to access the necessary Cognitive Behavioural Therapy course through HertfordshireUniversity. HPFT are also recruiting a similar number of workers for East and North Herts PCT area during Sept - Nov 2008 in order to release SHA funding for 21 HI and 13 LI trainee workers in April 2009.

The Practice Based Commissioning (PBC) groups have been fully involved in the recruiting of these new workers. The new teams will be based within existing Community Mental Health Service sites but will be delivering all face to face interventions within Primary care settings. Work is underway to develop a LES to enable GP practices to appropriately accommodate these new workers on a sessional basis. Although HPFT has had initial discussions with PBC groups across East & North Hertfordshire to prepare for the development of EPMHS to deliver IAPT outcomes further work is required to accelerate the preparation needed to ensure a successful outcome.

Governance will be provided through the development of a "Primary Care Mental Health Development Programme Board" as a subgroup of the Strategic Commissioning Group (SCG) and will provide reports to the SCG and JCPB on a quarterly basis. In addition HPFT will also establish an "Implementation Group", for West Herts PCT and East & Nth Herts PCT areas involving all stakeholders to deliver local governance and consistence to the development of these new services.

Enabling people to return to work is a key feature of this new service. Work is underway to develop an employment strategy that encompasses all the care groups being commissioned by the JCT. Within Adults of Working Age Mental Health (AWAMH) there are a number of schemes and pilot programmes currently in place to help people return to work. These initiatives will inform the development of the employment strategy and will involve wider stakeholders such as the Department for Works and Pensions (DWP).

3.7Physical health Checks

Concerns were raised by a carer in the July 2008 JCPB Public Briefing that “HPFT were failing to screen for metabolic side effects of antipsychotic medication”. Joint commissioners have found it most valuable having a carer point out these concerns and having asked for further information HPFT have now responded by letter demonstrating through recent healthcare commission and POMH-UK audits that metabolic screening is happening and 79% out of 100 randomly selected service users had received a physical health check in the past 12mths.

It is acknowledged that 100% of service users prescribed antipsychotic medication should be receiving physical health checks with metabolic screening. HPFT are committed to achieving this goal through further updating of the Clozapine Policy and the development of a “Shared Care Guideline” between HPFT and the PCT. The JCT will request progress updates from HPFT which will be reported back to Carers in Herts through the strategic commissioning group.

4.Conclusion/Recommendations

The Board are asked to note and comment on the content of this report.

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