Agenda and minutes

Apologies had been received from Mr P Gretton.

None.

Members of the public wishing to take part should notify the Director of Resources in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 8 December 2014). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

For clarity, Worcestershire Health and Care Trust asked for some additions (in italics) to the Minutes of the Meeting on 5 November.  Members agreed to the following changes and the Minutes were signed by the Chairman.

Who accesses the service?

There was no change in service for those in crisis (16 during the stated period), who would be assessed under the Mental Health Act but a slower response time may be experienced out of hours

Main discussion points

·         Members asked whether there had been an evaluation of the impact of the changes to mental health liaison.  Because of the changes in the data collected, it was not possible to make direct comparison between the current and past service provision, but it was reiterated that all statutory responsibilities were met by WHCT in relation to the Mental Health Act

·         It was clarified that mental health liaison was hospital based, did not go out into the community, and operated from 8am to 10pm.  Outside of those hours the crisis team would respond based on clinical prioritisation to specific patients only.

Attending for this item were:

Worcestershire Health and Care NHS Trust (Providers):

Sarah Dugan, Chief Executive Officer

Sue Harris, Director of Strategy and Business Development

Stephen Collman, Director of Operations

Dr Alan Farmer, Consultant Psychiatrist

Kate Glenholmes, Primary Care Mental Health Lead

Robert Kinnersley, Patient Representative

Integrated Commissioning Unit (Commissioners):

Frances Martin, Director (Adult Services)

Richard Keble, Head of ICU

The Chairman explained that as the Committee had a genuine interest in Mental Health he had asked Worcestershire Health and Care NHS Trust (WHCT) to attend and provide an overview of the services they provide, omitting the complex areas of Dementia and Children's mental health issues, which would be considered separately.

By way of presentation, WHCT highlighted the following areas:

Background

During the 1990s, mental health services nationally changed from institutionalised provision to community based mental health services.  This resulted in some patients moving from a place where they had lived for all their adult life, such as Barnsley Hall near Bromsgrove, to being offered supported living in a community setting.  This shift was monumental for some patients.

Today, patients with mental health issues are identified much earlier, through positive early intervention, and a much wider range of support is available to all patients; there is now a more sophisticated understanding of the different needs of people with mental health problems and how these can be treated.  At present, community mental health services are far reaching, moving away from bed based services to community services, resulting in people having the opportunity to retain friendships and engage in activities including education, hobbies and work and to be as independent as possible, as an overall package to support their wellbeing.  The present picture was a world away from the 1990's.

Current Position

People are at the centre of decision making, with care plans which engage with them and work across professional and organisational boundaries.  With one care plan, there is a need for one co-ordinator and this is also in place, for seamless integration between mental health and social care professionals.

Stepped Care and Range of Services

There was a graded, stepped approach to mental health provision, with the aim being for patients to move smoothly between steps.  The first 3 steps – from recognition to moderate or severe mental health problems - account for 75% of all mental health cases, and were provided within primary careGPs.  Examples included recognition and assessment, watchful waiting, guided self-help, psychological interventions, medication and social support.

Step 4 was more specialist provision, including crisis teams, supporting people who are at significant risk.  Strategies for support included complex psychological interventions, combined treatments and medication.

Inpatient provision and crisis teams were at Step 5, supporting people who present a risk to life or severe self-neglect. Support included medication, combined treatments and Electro-convulsive therapy (ECT).

Patients would not know they were moving between steps, but it was a  very useful tool to explain and justify pathways to Commissioners.

It was noted that the range of mental health services on  ...  view the full minutes text for item 721.

Worcestershire Acute Hospitals NHS Trust Board Meetings

Cllr Vickery reported that concerns had been raised over recent Worcestershire County Council actions, including the loss of a Dementia post and delays in discharge.  In addition, a transport working group had been formed to look at future models and there were concerns about the removal of the park and ride.  He had been impressed with the way the meeting had been run.

Redditch Borough Council

Cllr Witherspoon commented that Dementia was on their Work Programme.