Hampshire County Council

Executive Member, Social Care

Item

30 July 2002

Outcome of Best Value Review of Mental Health CPA/Care Management

Report of the Director of Social Services

Name

Best Value Review of Mental Health Services: Care Programme Approach/Care Management

Purpose of the service

_ To assess the health and social needs of people experiencing mental distress and their carers, provide care planning, access to care provision, monitoring and review, using the Care Programme Approach (CPA)

_ Integrated operation of CPA by health and social services

_ To achieve meaningful involvement for service users and carers

_ To meet legal duties under the NHS & Community Care Act 1990 and the Mental Health Act 1983

Current performance

In 2000/1 the Department Of Health evaluation showed that in 2000/1 Hampshire, as compared with other Authorities, was rated as being good in the following areas for mental health services:

_ The unit cost of residential and nursing care

_ The number of people helped to stay in their own home

_ The number of people admitted to residential care

Consultations with service users, carers and partner organisations highlighted current performance strengths:

_ Some service users and carers expressed satisfaction with the service they received, with support in the community, their keyworker and care plans and some involvement

_ There was development of some assertive outreach services

_ There was recognition of need for further integration

_ There were links with police, housing, probation

_ There was improved ethnic recording and directories of services

Areas for improvement were identified through internal audit, further consultation and comparison:

_ There was a large gap in provision of carers assessments

_ Carers and service users felt they needed more information and a greater level of involvement.

_ Need for greater integration with health services, single point of access and integrated information systems

Recruitment and retention of staff needed improvement

Proposed improvements and how they will be achieved

_ Carers needs assessed, consistency and choice for carers, and service development informed by carers' needs:

_ THROUGH countywide approach to maximising carers assessments and support provided to carers and making sure new service developments are influenced by carers' needs

_ See also the outcomes of the Carers & Respite Care Best Value Review

_ Empowerment and involvement for service users and carers to be improved:

_ THROUGH training for service users and carers to participate fully in service planning and development

_ Involvement of service users and carers in staff training to ensure a service user/carer-centred approach

_ CPA Care Co-ordinators (professional staff such as social workers and community psychiatric nurses) to be better equipped to provided an integrated, holistic mental health service with service user and carer focus:

_ THROUGH an accredited modular training and development programme

_ Recruitment and retention of mental health workforce to be improved, to provide an effective, professional, integrated service:

_ THROUGH a recruitment and retention package for Approved Social Workers (who carry out legal duties under the Mental Health Act)

_ Implementation of a workforce development plan for all mental health staff

_ Equitable, accessible mental health services out of hours across the county, including the Approved Social Work Service:

_ THROUGH development of a joint model of out of hours mental health services between health and social services

Conclusion

The findings of this Best Value Review supported the need to make improvements in the service in the areas identified above. The improvements will be introduced over the next few years to ensure that the service is continually improving and building on existing strengths. However these improvements are not set in stone and the review team hope to develop mechanisms for ongoing consultation so that we work to meet the needs of service users and carers over time.

Outcome 1: CPA Care co-ordinators are equipped to provide an integrated, holistic mental health service through accredited modular training and development programme

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Training programme established

Training needs identified through personal development plans (PDP)

Care co-ordinators attending relevant modules/ achieving qualifications

Performance improved, identified in personal development reviews

Training programme established

All staff undergoing regular PDP process, needs identified

All care co-ordinators enabled to attend relevant training & development opportunities

Integrated, holistic operation of care co-ordination across Hampshire

Some training opportunities, not consistent

Patchy implementation of PDP process in SSD & Trusts

Staff not always available to attend training, not prioritised

Inconsistent, variable practice around the county , not fully integrated

Funding and availability of trainers

Time and motivation to prioritise PDP process

Workloads & staff shortages stop attendance, lack of staff & manager commitment, managing change

Cultural differences between health and social services, fear of loss of identity

1. Identify funding streams for training

2. Create structure/ steering group to ensure staff, service user & carer involvement in structure, planning and delivery of training

3. Confirm accreditation arrangements

4. Identify providers

5. Organise infrastructure to deliver training

6. Write modules

7. Link to vocational bodies SW/OT/ nursing, & unions

8. Individual audit of workers' needs

9. Begin delivery of training

10. Review structure,

content, progress

Training managers & CPA lead officers (Trusts & SSD)

1. By Mar 2003

2. By Mar 2003

3. Mar 03

4. Mar 03

5. Mar 03

6. Mar 03

7. Mar 03

8. Mar 03

9. Sept 03

10. Mar/03 Jun/Sep

ongoing

Not yet costed, discussions ongoing with universities, bid has been submitted to Workforce Development Confederation for funding, other streams being identified.

Outcome 2: The mental health workforce is fully staffed to provide an effective, professional, integrated service - focus on Approved Social Workers

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Sufficient number of ASWs recruited and retained in Hampshire to meet legal duties under the Mental Health Act 1983

Working environment improved for ASWs

All potential ASW trainees can be trained

Each ASW rota has enough ASWs to provide sufficient cover

at all times without overloading staff - 1:20,000

Workload is weighted, senior practitioners increased, working hours reduced, profile raised with partners

ASW practice assessors are identified each year for all trainees

Number of ASWs reducing and most new recruits are not ASWs and need training

Unattractive working environment: high workloads in CMHTs, lack of career progression, longer response times from police, doctors, ambulance, beds causing longer working hours

Insufficient number of ASWs to act as practice assessors for trainee ASWs

Competition from higher salaries for ASWs in other nearby local authorities

Lack of resources in CMHTs and in partner services such as police, trusts, ambulance

Lack of time for reduced number of ASWs to take on this additional work

1. Introduce market supplement to aid poor recruitment and retention of ASWs in Aldershot

2. Maintain honoraria payment to ASWs assisting rotas in Aldershot and Havant & Petersfield, when needed

3. Upgrade up to seven MHSW posts to senior practitioner

4. Develop joint workload weighting tool with health

5. Review reappointment procedure

6. Raise profile of ASW role with health colleagues, create `good practice' protocol

7. Improve adverts

8. Introduce £500 honoraria per trainee for practice assessors

9. Review at 6 &12 months

1. Personnel advisor, service & county managers

2. Service managers

3. Personnel advisor, service & county manager

4. Strategic service manager, county manager

5. " "

6. " "

7. Recruitment /retention team

8. Strategic & operational service managers

1. April 2002

2. On-going

3. April 2002

4. Oct 2003

5. June 2003

6. June 2003

7. Apr 2003

8. Sept 2002

9. Oct 02/ Apr 03

£50,000

Outcome 3: An integrated model of mental health services including the ASW service is available to service users and carers out of hours, equitably across the county

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Integrated, responsive, out of hours mental health services with simple access are available to service users and carers across Hampshire

Agreed model of out of hours mental health service including ASW service (model may vary according to local needs)

Implementation plan developed

Services modified as necessary

ASW service run county wide as emergency response from generic Out of Hours Service (OOHS), alongside health extended hours services

Increase in resources to provide ASW service locally out of hours, if that model was adopted

Impact on rest of Out of Hours Service to remove ASW function, if that model was adopted

Lack of new money for development of crisis resolution teams, which could incorporate ASW service locally out of hours

1. Undertake further consultation with health partners in context of development of crisis resolution and extended hours services, to agree model of service from following options:

· No change to existing out of hours ASW service

· Run out of hours ASW service as specialist team within OOHS

· Run ASW service locally from crisis resolution or extended hours CMHTs

· Operate 24-hour specialist ASW team, locally or countywide.

2. Develop implementation plan

3. Modify services

Strategic service manager, county managers MH and OOHS (with trust managers)

1. April 2003

2. April 2004

3. Depend-ent on funding

Unknown until service models are agreed. Development of locally run services may be hampered by lack of new money in 2002/3 or 2003/4 for health or social services to provide crisis resolution and 24-hour services. Any move to separate the ASW function from the rest of OOHS would have resource implications for that service as ASWs also undertake generic work.

Outcome 4: Carers needs are assessed, risks reduced, crises planned for, consistency & choice for carers and service development informed, thereby promoting carer involvement in service planning and delivery

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Consistent, equitable service offered to carers across Hampshire

Carer Support Workers & Care Co-ordinators identifying and carrying out carers assessments routinely and according to policy

Increased number of carers assessments completed for eligible carers, recorded fully, and informing service development

Assessment tool used across county, choice of assessor in all areas

Carers identified for all service users on CPA, assessments offered and carried out, care plans completed, services provided

Numbers of assessments increased, consistent recording in all cases, evidence of impact on service development

Several different assessment tools, lack of choice of assessor

Number of assessments increasing but still a lack of identification of carers and therefore of assessments

See above, also inconsistent recording of carers assessments and results, although this is beginning to improve, no system to inform service development

Workload of care co-ordinators may reduce time available to carry out carers assessments and carer support workers would not be able to undertake the total volume of carers assessments

Lack of flexibility in current IT system to address mental health needs, until new joint mental health IT systems introduced

1. Produce countywide assessment tool, guidance and policy incl. recording of assessments

2. Distribute documents for trial use & consultation with carers, service users, staff and partner agencies

3. Launch carers pack in Ravenswood MSU

4. Launch new literature during Carers Week

5. Provide relevant training for Carer Support Workers and Care Co-ordinators

6. Review assessment tool, guidance, policy through consultation with carers, service users, staff and partner agencies

7. Repeat Consumer Audit survey?

8. Set up system for assessments to inform service development

Strategic service managers (SSD), training managers, CPA lead officers (Trusts & SSD)

1. May/ June 02

2. June 02

3. June 02

4. June 02

5. Oct 02/ Jan 03

6. Jan 03 & ongoing

7. June 03

8. June 02

Cost of producing paperwork and carers packs: £500

There may be increased capacity of 14 extra CSWs for Hampshire, from additional DOH monies

Cost of training

as yet uncosted

Cost of contract for survey (£5,000)

Outcome 5: Empowerment and involvement for service users and carers is improved through training for service users, carers and staff

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Service users and carers are equipped to participate fully in service planning and development

User/carer-centred approach is central to mental health services

Accessible training is available for service users and carers

Effective representation is achieved

Staff training based on user/ carer-centred approach, involving service users and carers in training

No training of this kind is currently provided county wide. Worker has recently been appointed through Matrix for pilot project in Basingstoke

Training is based on this approach to an extent but not across the board

If service user and carer representatives do not have positive experiences

If there is a lack of support from management and care co-ordinators

Cultural attitudes amongst staff, lack of awareness

1. Ensure that pilot project involves service users and carers in planning of training, and addresses the needs they express e.g. NSF, meeting processes, job descriptions for committee roles, assertiveness

2. Ensure project raises profile of service user and carer involvement with staff & managers

3. Roll out pilot project to other parts of Hampshire, if funding is identified

4. Ensure that current and future care co-ordinator training is based on user/carer-centred approach, fully involves service users and carers

SSD Integrated training project manager and steering group

Training managers & CPA lead officers (Trusts & SSD)

April 2004

April 2004

Beyond 2004 if pilot successful

Mar/Sept 03 and ongoing

£56,000

(from mental health grant)

Costs still being calculated

Outcome 6: Integrating REMIT approach

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Joint approach to ethnic minority monitoring and provision in mental health services

Joint mental health REMIT report and action plan across health and social services

Draft REMIT report/ action plan for SSD

Assessment of ethnic minority needs, representative workforce and cultural competence to be developed for health

Organisational change in health and social services may delay progress

Share draft REMIT report and action plan with health colleagues in WHT & SHBT and work to develop joint action plan

County manager operations

Strategic service manager

December 2002 and ongoing

Opportunity costs

Outcome 7: Developing a joint approach to performance management to aid the scrutiny of CPA

Performance indicator

Performance Target

Current Performance

Barrier to achieving performance target

Action

Officer responsible

Target date

Cost (+/-)/ resource implications

Ref.

Joint arrangements for collection of CPA management and performance information between social services and health

Formal agreement of dataset to be collected, methods to be used;

Duplication minimised, information fully available

Information collected separately, often manually, often duplicated, little co-ordination

New information systems needed to maximise potential for joint streamlined data collection;

DOH often require separate data returns

1. Formal agreement achieved to joint information collection, with dataset defined and methods of collection agreed

2. Use of eCPA and new information systems maximised to achieve information requirements

County manager strategy;

Strategic & operational service/ locality managers;

Information departments health & SSD

April 2003

April 2003 and ongoing

Opportunity costs

Costs met through SCA funding for eCPA and new information systems