- Meeting of Health & Adult Social Care Select Committee, Thursday, 10th September, 2020 10.00 am (Item 6.)
The Committee will hear from representatives from Oxford Health NHS Trust who provide mental health services for the residents of Buckinghamshire. Members will examine the access and quality of the services provided, particularly in light of the current Covid-19 situation.
Dr Nick Broughton, Chief Executive, Oxford Health NHS Trust
Ms Debbie Richard, Managing Director, Mental Health
Dr Vivek Khosla, Clinical Director for Buckinghamshire
The Chairman welcomed Dr N Broughton, Chief Executive, Oxford Health NHS Trust, Ms D Richards, Managing Director, Mental Health and Dr V Khosla, Clinical Director for Buckinghamshire.
The following main points were made during their presentation:
· Oxford Health NHS Trust was one of the largest providers in the country with over 6,500 staff providing services across Oxfordshire and Buckinghamshire (700 staff were based in Buckinghamshire plus 200 in third party providers across Buckinghamshire).
· The Trust was part of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System and had re-organised its services to reflect this.
· The Trust provided all age services in Buckinghamshire.
· There were three main pathways – Adult and Older People, Children and Young People and IAPT (access to psychological services for people suffering with anxiety and depression).
· The Whiteleaf Centre in Aylesbury hosted inpatient services and there were currently four sites in Wycombe with plans to bring three sites together on Easton Street. This project had been delayed due to the current Covid-19 pandemic.
· The CAMHS service had a single point of access and patients were then triaged to the appropriate service. For adults, referrals were mainly via the GP but they could also self-refer. There were plans in progress to make this service a single point of access as well.
· The referral rate had continued to grow over the past two years and last year the CAMHS service saw more patients than it was commissioned to see. During June and July, the referral rate had spiked.
· In Buckinghamshire there were a large number of children diagnosed with autism and ADHD.
· Healthy Minds was one of the best performing services in the country and had been operational for over 10 years.
· The NHS Long-Term Plan, published in 2019, made a commitment to invest in mental health services. Historically, mental health had been relatively underfunded and was struggling to meet demand for services.
· The Trust was rated “Good” by the Care Quality Commission and its ambition was to be outstanding across all services.
· The Trust had created a crisis team with safe havens in Wycombe and Aylesbury which was run by Bucks Mind.
· The current Covid-19 pandemic had impacted on three specific services which had ceased due to the reliance on face-to-face contact but most other services had continued, with limited capacity. Services had been offered digitally as the first port of call and then face-to-face if needed. Young people had been particularly receptive to the digital offer.
· A 24/7 mental health helpline had been established to divert the pressure from 111 and A&E. Whilst this offering had been established quickly, it was deemed unsustainable so the Trust was working with commissioners to find a solution.
· There was a Mental Health Liaison service at Stoke Mandeville which also fed into Wycombe.
· The Trust experienced unique recruitment challenges in South Buckinghamshire due to the high cost of living and competition with London jobs and salaries. The Trust was looking at ways to make the “offer” more attractive. The Chairman asked if the Committee could see the development and recruitment plans.
ACTION: Ms Richards to send the development and recruitment plans
During the discussion, Members asked the following questions:
· In response to a question about the high referral rate, Dr Khosla explained that the Trust saw a fall in demand in April & May and then a spike in June and July. Historically there were seasonal variations with spikes normally seen in September & October time. It was acknowledged that there would be a further spike in demand due to children returning to school in September, The Trust was commissioned to see 35% of those who were referred into the service.
· Dr Broughton went on to say that the Trust was assessing and treating more patients than it was commissioned for. The Trust was pleased to report that it was exceeding its 25% target but it was not funded to treat all patients. Ongoing discussions were taking place with commissioners to address this shortfall.
· A Member asked about the amalgamation of services in Wycombe and what the feedback from service users had been about the proposed move. Dr Khosla explained that bringing the 3 sites together would bring all age groups together and currently the older people site only had four car parking spaces which created a problem with access.
· A Member went on to ask what work had been undertaken to show that this move would lead to better outcomes for patients. The Member asked to see the evidence to support this amalgamation of sites in Wycombe,
ACTION: Dr Broughton, Dr Khosla and Ms Richards to send the business case
· In response to a question about the challenges around recruitment and retention, Ms Richards explained that the Trust was committed to staff learning and development and had recently taken Nurse Cadets into the Trust as well as offering apprenticeships. The Trust had pro-actively recruited during the Covid pandemic.
· A Member asked whether the Whiteleaf Centre was fully staffed and operating at full capacity. Ms Richards responded by saying that it was a very busy site and at times it had to rely on temporary staff. Dr Broughton added that the inpatient services had to run at less than 100% to ensure it could respond to crisis situations.
· In response to a question about staff understanding of patients with Continuing Healthcare (CHC) at the Churchill and the Whiteleaf Centre, Ms Richards explained that CHC had, historically, been provided by NHS ArdenGen on behalf of the CCG but after concerns over service quality, it was transferred to Oxford Health but it was separate to Mental Health and Learning Disability services. Before the start of the Covid pandemic, the Trust worked closely with the CCG and the Council and worked within the national framework for CHC.
· A Member expressed concern about the impact of Covid-19 on in-patients in the Whiteleaf Centre and asked whether there had been any deaths. Ms Richards explained that the Centre was currently running at around 85% capacity which allowed for patients to self-isolate if they were required to do so. Technology was used to help patients keep in touch with their loved ones and visits to the wards had now started again but in a Covid safe way. There had been two deaths at the Whiteleaf – older adults who had been transferred there for end of life care.
· A Member highlighted their role on the Wycombe Community Board mental health sub-group and the focus on suicide awareness and prevention. Ms Richards said that the Trust had a nurse consultant who would be willing to come and speak at Community Board meetings.
ACTION: Ms Richards to provide contact details to Committee & Governance Adviser
· In response to a question about whether the funding for Buckinghamshire was ring-fenced, Ms Richards explained that the funding came through the CCG and, therefore services for Buckinghamshire residents were funded by the Bucks CCG. The CCG received its funding allocation based on a formula which, historically had not played out well for Buckinghamshire due to its perceived affluence. The Trust had been successful in bidding for mental health transformation funding (some of this had been awarded at the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System level). The NHS Long-Term Plan made specific reference to investment in mental health – an additional £15m had been allocated to Buckinghamshire over the next 4 years. This would enable expansion of CAMHS, mental health teams in schools and services for looked after children.
· A Member referred to the non-recurrent funding for CAMHS that was mentioned in the report. Ms Richards explained that CAMHS was jointly commissioned by the CCG and Buckinghamshire Council. The Trust was currently in discussions with commissioners about continuing with the funding so that the demand could be met.
· A Member asked how the Trust was going to map future demand on the service due to the Covid pandemic, particularly in terms of return to work (or not) and loss of income. The Member went on to ask for more details around the Trust’s plans for tackling staff well-being issues during these difficult times.
ACTION: Ms Richards to provide a response after the meeting
· A Member expressed concern about the increased rates of self-harm and suicide amongst LGBTQ+ and mentioned that work of the High Wycombe Youth Club which had helped to reduce self-harming.
The Chairman explained that the Members who were unable to attend the meeting had submitted some questions which would be sent to the Trust after the meeting for a written response.