Dr John
McGrath, an Islington GP and Clinical Representative on the NCL CCG
Governing Body, introduced this item. Adding to the information
already provided in the agenda pack, Dr McGrath observed that he
saw this review as part of a bigger puzzle, along with the
Community Services Review, about the link between how people
experience good mental health and how people experience good
physical health. Other elements included the community mental
health framework transformation, which involved aligning mental
health professionals with primary care services and working with
providers on the intended outcomes from services. Through the
baseline review of NCL mental health services, the current baseline
position had been set out and a core offer developed to establish a
minimum entitlement for NCL residents. The core offer included a
single point of access with a single up-front holistic assessment
of health needs, with multiple avenues of access, meaning that
people did not necessarily have to go through their GP. Service
users with complex needs would be provided with personalised care
planning.
Dr
McGrath added that, in a post-pandemic world, the societal
consequences and the impact of the pandemic on mental health needed
to be recognised and that support from the voluntary and community
sector was important, as well as from statutory mental health
services.
Dr
McGrath and Sarah Mansuralli, Executive
Director of Strategic Commissioning at NCL CCG, then responded to
questions from the Committee:
-
Asked by Cllr Tomlinson for further detail on the
proposed ‘single point of access’, Dr McGrath said that
the strategic view should be allowing a model that works, so that
this could differ between boroughs. In Camden, for example, there
was a website which hosted mental health resources and directed
people into the different levels of mental health support that was
available. Whichever model was used, the aim would be to ensure
that a resident knows where to go to access support.
-
Asked by Cllr Tomlinson for further detail on the
use of technology to reduce the need for patients to explain their
situation multiple times, Dr McGrath said that the ambition was to
progress this at pace, but that it was also important to ensure the
safety of data transfer between organisations, particularly because
of patient anxieties about where the information was stored. There
were now digital platforms such as “Patient Knows Best”
which enabled health information to be shared securely with
healthcare professionals.
-
In response to a query from Cllr Tomlinson about the
role of GPs, Dr McGrath acknowledged that mental health was a huge
part of the clinical workload of GPs, not just in terms of the
conditions themselves, but also because of the impact of
psychological ill-health on the management of long-term physical
health issues. What was envisaged was a much closer linkage between
GPs and the vast array of non-statutory mental health support
provided by community and voluntary organisations and to make use
of the links between physical health, primary care, early
intervention and mental health support.
-
Asked by Cllr Cornelius about the case for change,
Dr McGrath responded that gap analysis had been carried out on
existing conditions in the boroughs a which highlighted the
differences between boroughs and the gaps that needed to be
addressed. Cllr Clarke observed that deprivation was clearly linked
with mental health and distress and emphasised the importance of
community organisations in providing support to residents, as well
as the role of talking therapies. Dr McGrath concurred with this,
adding that the emphasis needed to be on community wealth building
and relationships in the community, including cultural competency
and an awareness of the lasting impact that the pandemic had caused
on mental health and wellbeing.
-
Asked by Cllr Connor about co-production and the
role of residents, Sarah Mansuralli
said that co-production was discussed a lot, for example when
developing personalised care plans. The issue was then how to
mainstream co-production and to do this in a more consistent way at
different levels. There was further work to do, including by
enabling experienced service users to actively participate in
discussions.
-
Cllr Connor noted that the report on page 5 of the
agenda pack referred to Children and Adolescent services being
particularly fragmented and requested that further detail on this
be provided in the next report. (ACTION)
-
Cllr Connor asked whether there were any plans to
join up services provided by Barnet, Enfield and Haringey Mental
Health Trust (BEH-MHT) with those provided by Camden and Islington
NHS Foundation Trust. Dr McGrath said that he had noticed an
increased ability for communication across the organisations about
care and service design along with a clearer idea of trying to
ensure a consistent offer across the NCL population. Sarah
Mansuralli added that there was now
closer collaboration the two organisations and, while they remained
as two distinct organisations, they now had a joint Chief Executive
and were moving towards a joint management team. This enabled
better analysis of the available beds across both sites for
example, which enabled mutual aid with patients in the north
accessing services in the south and vice-versa. This collaboration
would be built on through the review.
-
Cllr Connor noted that the report on page 8 of the
agenda pack referred to service users with complex needs being
allocated a clinical case manager. She added that local Councillors
were often made aware about concerns relating to individuals with
high mental health needs and it could be difficult for Councillors
to know who to contact for assistance as the individuals were
usually in contact with multiple agencies. Dr McGrath said that
complex cases were often dealt with by multiple agencies, including
through a MARAC, and that the intention of the coordination
referred to in the report was to bring statutory and voluntary
services together under a case manager so that people were not
bounced around so much. Cllr Connor said that this case management
aspect was an area of particular interest to local Councillors and
requested that the Committee be kept updated on this at future
meetings. (ACTION)
-
Cllr Cornelius raised the use of ‘mental
health champions’ within local authorities as a way of
helping to raise the profile of the issue and to link local
individuals and organisations with services.
RESOLVED –
That a future update report on the issues discussed should be
provided to a future meeting of the Committee to include details
on:
- How
information on available services is communicated to
residents;
- How
co-design/co-production is embedded, with examples of how this was
working in practice;
- Child
& Adolescent mental health services and how the fragmentation
of services (as referred to in the report) was being
addressed;
- The closer
working relationship between BEH-MHT and C&I NHS
Trust;
- A single
point of communication for queries relating to service users with
complex needs.