Agenda item

To note a presentation on the North Central London Community and Mental Health Services Review.

Ms Joanne Murfitt introduced the item.

In response to questions relating to feedback from residents, Ms Murfitt informed the Board that:

·      It was helpful to spend time to hear residents’ views.

·      Some of the views expressed frustration regarding waiting times, partly regarding access to autism and ADHD assessments.

·      Money was being spent to reduce waiting times and examinations were being held on how services were being delivered.

·      Many people reported that transition from mental health to adult social services was very difficult and needed to be better prepared.

·      A system was required to be put in place to collect the information to see if the changes were making a difference.

·      People had also reported that it was frustrating and depressing to continuously repeat their story any time that they had a new intervention and perhaps a method of sharing records amongst professionals could be established.

The Board heard that:

·      It was often the case that those working in the health service were too busy to read patient notes and found it easier to ask the patient regarding their issue. Time needed to be given to staff to be able to read the notes. It may be possible to allow people an opportunity to tell their story via a short video.

·      It was important to keep in mind that when a patient was repeating a story, it was sometimes the case that the individual hearing the story was judging whether or not the patient should receive the service they were seeking.

·      In parts of the country such as Scotland, professionals were trauma informed and this had an impact on the way people accessed services in Scotland.

·      It was difficult for young people to transition through the mental health system as the criteria for the work was different in relation to adult mental health services.

·      Clinicians often wanted to hear the story and allow the patient the opportunity to repeat it as a retelling of the story often provided new information.

·      The trauma informed approach was built into how Whittington staff were being trained.

·      A gap analysis had been conducted by provider colleagues in each borough and their local commissioning leads. This assessed the core offer and examined whether or not it met the requirements.  There were variations found between boroughs. In relation to a central point of access, care coordination and trusted assessments, there were areas which were still in development.

·      It had not been possible to invest as much in Haringey and Enfield in relation to community services. There were many challenges regarding children services including issues regarding funding and implementation of processes.

·      One of process to be implemented was to use system investment to the community services. Discussions were proposed regarding the funding, priorities and local discussions about what that may mean practically and how best to implement them in Haringey. The Chair felt it was important to note the long-term effects of the resources gap and how that would interplay with the inequalities or disparities in the borough.

·      The equality of outcome was important for residents regardless of which parts of the borough they lived. This was more important than the record of the service delivery itself.

·      There appeared to be fewer GPs in the more stressed areas in the borough and perhaps they needed to be invited to the Board for a discussion.

·      Unless some services were put in place, it would be difficult to make progress in order to offer a more tailored approach to services.

·      Mental health did not contain attention of physical health received but still a serious issue. It was particularly difficult to get hold of professionals for various issues such as receiving assistant housing. There may be some systemic problems relating to working with mental health services.

·      Over the last couple of years, there had been an effort made to rebalance the investment made in metal health. There was additional funding going into mental health services and demand was also increasing. It was also the case that there was a lack of investment in community services. Therefore, consideration was being given on how to provide better integrated working between community and mental health services to support local people.

·      There was a recognition of mental health issues regarding people who lived in difficult housing circumstances.

·       There was hope of a creation of a central point of access.

·      Haringey’s position with the primary care workforce was very challenged but was improving. Many initiatives were underway, in particular, the employment of pharmacists, social link prescribers, paramedics to support practices and the investment in technology in practices. There was significant investment in primary care estate in Haringey at the moment and there was an increase in the number of teaching practices used. Currently, 66% of Haringey's patients were being served by teaching practices and efforts were underway to increase this.

·      Conversations had been held with providers regarding mixing skills in different areas and how they could work differently. There was an expectation that if funding was to be provided to support communities, then the money would be well-spent.  Providers accept that they needed to do things differently. Approximately £2 - 3 million worth of efficiencies had been identified.

·      There was a discrepancy on funding between Islington and Haringey in relation to investment. This largely related to need requirements and investment for Haringey, Barnet and Enfield would need to take a targeted approach.

·      The Chair noted the importance of prevention as the length of time over a condition could lead to other conditions and other long-term complexities.

·      The Chair also noted that it was important to work well together navigating the different working cultures in order to be efficient and effective.

·      It was important to focus attention on investment and resources.

·      The housing services had its own process but as the housing services were being reshaped, it was possible to re-consider if assistance could be given regarding housing issues.

·      Whittington had for the last few years trying to even things out in relation to allocation of resources.

·      It was important to think about the interconnections between primary and community mental health services.

·      There was a large scope of consideration for Haringey as a borough as to the greatest gaps in service in relation to the core offer including those gaps that had the most impact on outcomes. Some of these would be a resource gap and some would be a cultural gap.

RESOLVED:

That the presentation be noted.