Agenda item

Representatives from Oxford Health came before the Committee in September 2020 and a follow-up letter was sent to them focussing on areas of concerns.  This item provides Members with an opportunity to review these areas, as well as reviewing the current position of mental health services provided by Oxford Health Foundation Trust.

Presenters

Dr John Pimm, Consultant Clinical Psychologist and Professional Lead Buckinghamshire Psychological Pathway and Head of Service IAPT

Dr Tina Malholtra, Consultant Psychiatrist, Clinical Director Buckinghamshire

Ms Donna Clarke, Service Director, Buckinghamshire

Paper

Report attached

The Chairman welcomed Dr Tina Malholtra, Consultant Psychiatrist & Clinical Director, Buckinghamshire; Dr John Pimm, Consultant Clinical Psychologist and Professional Lead Buckinghamshire Psychological Pathway and Head of Service IAPT; and Donna Clarke, Service Director, Buckinghamshire, to the meeting.

During their presentation, the following key points were made:

·       Different services were  offered across Buckinghamshire: Urgent Care services, IAPT (Improving Access to Psychological Therapies), community mental health services, and neurodevelopmental services.

·       These services were regularly evaluated by a team at the University of Plymouth.

·       The team offers assessments on a hybrid basis, with face-to-face and digital appointments. Some services had to be put on hold due to Covid. For example, effective diagnosis of memory impairments was not possible via digital means. This had led to discussions with  the commissioners around how to deliver  memory services in the future.

Buckinghamshire Urgent Care services

·       The service offered 24/7 support for people with mental health problems in urgent and worked closely with the triage service, the NHS 111 helpline, and the voluntary sector.

·       The service aimed to adhere to the model of crisis work, providing home treatment and avoiding hospital admissions where possible. Peer support workers have also been established.

The Covid-19 pandemic had been particularly challenging for patients in the Whiteleaf Centre in Aylesbury due to efforts in minimising infection.

IAPT (Improving Access to Psychological Therapies)

·       The service operates primarily on a self-referral basis.

·       The service hads increased over the past year (around 50%) and was expected to grow substantially over the next two years. Despite the challenges, the number of patients had increased by 25 %.

Community Mental Health Service

·       Many patients require more specialised care but do not meet the threshold for the most complex conditions. For example, patients may show some traits of personality disorders but not enough to receive a formal diagnosis. The community mental health service aims to fill this gap by integrating primary and secondary care through a gateway service, linking patients to the appropriate service for their conditions.

·       The best approach for these 'middle group' patients was often psychosocial, such as through talking therapies, social-based interventions, peer support, and engagement with others.

·       The service had not received any additional funding in recent years. However, new developments within the community mental health framework have shifted the focus to addressing severe and enduring mental illnesses.

·       The service had outcome data for over 95% of patients, which was unusual for mental health services. The recovery rate was significantly above the national target: Around 57% of people fully recover after treatment, with 69% showing a significant improvement, highlighting the success of both patients and professionals in the team.

·       Staff recruitment and retention were one of the main challenges. The team had tried to find innovative recruitment methods and some initiatives were detailed in the report. Since the pandemic, the response rate to advertisements had improved.

Neurodevelopmental services

·       Specialist team for neurodevelopmental conditions, such as ASD (Autism Spectrum Disorder) and ADHD (Attention Deficit Hyperactivity Disorder). These conditions affected people's mental health and social functioning.

·       Oxford Health commissioned a small diagnostic team for adult ASD and ADHD. Demand for these services had been much higher than expected (10 x as much as commissioned), resulting in challenges around strategies to meet population demand.

·       Dr Pimm noted the importance of providing neurodevelopmental services, as comorbidity for such conditions was high and often correlated with other complex conditions.

CAMHS (child and adolescent mental health service)

·       Referrals into the service had increased and in the 2021/2022 financial year, over 12,000 young people were referred to the service. 61% of those referrals were received between January and March. 4% of these patients were seen within 28 days.

·       The service had a single point of access, meaning that parents, professionals or patients themselves could contact the service for support.

·       CAMHS hosted the neurodevelopmental pathway for children aged 5 to 18, offering ASD and ADHD assessments. The service was a collaboration between BHT and Oxford Health and the demand for these services had outstripped the available resources.

·       Increased demand had also been seen in the eating disorders pathway, with many children being referred at a later stage of the condition. This had lead to more complex needs requiring more intensive care.

During the discussion, Members raised the following questions:

·        A Member asked whether any of the £2.7 million funding mentioned in the report would be invested in services assisting children with learning difficulties or speech impairments in Buckinghamshire. It was advised that this particular amount of funding was received for the community mental health services assisting adults and older adults. The services relied on funding from commissioners, which in this case was the CCG. A business case was brought forward to receive more funding to support children with neurodevelopmental conditions to which Oxford Health were awaiting a response.

·        The Chairman suggested that the concerns around support and funding for SEND children should also be communicated to the Children's and Education Select Committee.

·        In response to a Member question, it was noted that although the CCG was transitioning to the newly formed Integrated Care Board, the commissioners for mental health were council officers and not affected by the changes.

·       A Member raised concerns about increased wait times for diagnostic appointments for neurodevelopmental conditions in children. It was explained that delays may have occurred in two places due to the service historically involving both BHT and Oxford Health. This had been alleviated by bringing the teams together and enabling closer working relationships.  It was noted that there was increased demand from patients during the lockdown. For adults, the wait times are 44 weeks for ADHD and 89 weeks for ASD.

·       A Member asked about the support available to patients following a diagnosis. It was advised that the type of support would depend on the individual case.

·       A Member asked what kind of provisions were in place to reduce readmission to hospital due to physical conditions arising from unresolved mental health conditions. The IAPT LTC (long-term conditions) programme had been implemented to highlight the connection between physical and mental health. Oxford Health had been working closely with BHT and GPs to develop joint programmes for a holistic approach to health. For example, the 'Breathe Well' programme offering pulmonary rehabilitation also had psychological therapists within the team. Similarly, the diabetes and cardiac teams in hospitals included psychologists, as well as the three-tier weight management programme and the long Covid service.

·       In response to a Member question, it was explained that the urgent care service for adults and older adults was availble 24/7. It consisted of a multidisciplinary team including consultants, psychiatrists, nurses, social workers and occupational therapists. Stoke Mandeville Hospital does not have a crisis service, but a psychiatric liason service. It was stated that patients in crisis were diverted to the Whiteleaf Centre than to A&E to ensure they appropriate care.

·       The Chairman noted that the treatment provided at the Whiteleaf Centre may not be the most effective in some severe cases. Dr Malholtra agreed that other provisions would also be welcome and would increase the robustness of the crisis service, but highlighted the importance of the existing service providing 24/7 availability. She further pointed out that preventative work, safety planning and suicide prevention were essential to ensure that severe crisis incidents could be minimised.

·       A Member advised that feedback he had received from young people around self-help apps and other digital provisions had not been particularly positive. Especially during the pandemic, lack of social contact affected many people's mental health. It was suggested that such provisions should be used to enable people to get the help they required, which was often face-to-face.

·       In response to a question about the increase in demand for services, Dr Maholtra explained that mental health services continued to operate during the pandemic, apart from memory and ASD services. However, she suspected that the lack of social contact had contributed to increased referral rates and the complexity of conditions.

·       A recent survey showed that the Oxford Health community mental health services scored lower than the national average. Dr Malholtra explained that new services were being developed to enhance access to crisis services. For example, the gateway service was being implemented to provide a single point of access to signpost patients to the appropriate department. She further advised that feedback wasconsistently being reviewed to improve the services. Dr Pimm added that the 111 mental health line option provided by Oxford Health was launched last year and promoted through several media channels. He advised that communication with recipients was vital as services change to ensure their robustness. There were also plans to link the 111 mental health services with the gateway.

·        The Chairman raised concerns about access to services due to difficulties for some patients in accessing a GP appointment. Whilst GP referrals were the most frequent, referrals to Oxford Health services were mostly self-referrals, e.g. IAPT and CAMHS. Dr Pimms highlighted the importance of GP referrals to more specialist areas. Dr Malholtra added that primary mental health practitioners had been embedded in GP practices or PCNs enabling easier access to GP referrals where necessary.

·        Ms Clarke agreed with a Member's suggestion to raise awareness and increase membership for the Bucks Voice forum. It was also pointed out that attendance might be lowdue to the meetings taking place during the day.

·        A Member asked about the role of GP engagement in linking primary care and community mental health. A workshop had recently been held with GPs, and involvement from service users and carers was welcomed for future workshops. GPs also contributed to the services through mental health practitioners, which are part of the Primary Care Network.

·       In response to a question about the workforce, Dr Pimm explained that Oxford Health was trying to broaden its workforce.

·        A Member suggested that the services could be promoted by community or religious leaders and asked about mental health training for school teachers to raise awareness for mental health in schools. Dr Pimm welcomed the suggestion and highlighted the importance of reaching out to underrepresented groups. Some work had already been carried out with faith communities and public health departments. However, more engagement was necessary to address inequalities.

·        A member welcomed that new services, such as IAPT, were being developed to alleviate pressure on GP surgeries.

·       A Member suggested that more grassroots community development involving smaller, local organisations would be beneficial to make mental health services more accessible. Dr Pimm advised that the community mental health framework was based around neighbourhood teams with strong links to other organisations.

·       A Member raised concerns around follow-up appointments for people with severe mental health issues. It was noted that those core services had not had sufficient funding in the past. The community mental health framework, which included rehabilitation, aimed to address theseissues.

·       Members raised concerns around digital exclusion of patients with severe mental health conditions. Several pieces of evaluation work had been carried out over the last year to examine this issue. TIn some cases, patients preferred digital services, resulting in an improvement in attendance and outcomes. However, the team was aware that some patients may be digitally excluded or required face-to-face interventions and treatments.

·       A Member asked whether the Whiteleaf Centre experienced delays in discharging patients, leading to a shortage of beds. Ms Clarke advised that during the pandemic, some beds needed to be outsourced to control infections. Recently, the focus was around ensuring that the right resources were availble in the community, allowing patients who no longer required hospitalisation to be safely discharged.

·       Cllr Macpherson reassured the Committee that a significant amount of work around mental health was being undertaken by the Health and Wellbeing Board as part of the Council's key strategic priorities (in addition to cardiovascular disease and obesity)..

·       A Members uggested that support services for young people with autism moving into adulthood should be reviewed.

·       The Chairman asked about Oxford Health's involvement in discussions around the recent Integrated Care System governance changes. It was noted that whilst they were involved, they were awaiting final guidance regarding their position in the new structure.

The Chairman thanked the presenters for their attendance and participation. She advised that any additional questions from the Committee would be forwarded after the meeting.