Contact: Pamela Noble, ext.5295

1. Summary

1.1 This report describes the progress that has been made on the mental health National Service Framework targets at the fourth stage of national monitoring. The monitoring indicates that there continues to be a substantial amount of investment and service development required in order for local mental health services to meet national requirements.

2. Monitoring Performance

2.1 The National Service Framework (NSF) for mental health is a ten year programme of development with year on year targets expected to be delivered at Strategic Health Authority (SHA) level through the Local Implementation Teams (LIT's). The seven LIT's covering Hampshire are multi agency forums with a joint lead from Primary Care Trusts (PCT's) and Social Services, with local stakeholders represented, including: service users; carers; Providers; Voluntary organisations; health and social care professionals.

2.2 Annual monitoring takes place with 2002 - Stage 4, representing the fourth year of the monitoring programme which includes implementation of the relevant targets within the NHS Plan based on the position as at September 2002

2.3 This monitoring is also part of the performance process for Adult Mental Health, and for social care this joint process largely replaces the need for separate monitoring through the Autumn position statement. The assessment has been validated by the Social Services Inspectorate (SSI) and SHA.

2.4 Mental Health providers were star rated for the first time this year with the results based on last year's (2001/02) self-assessment component stage three monitoring.

Future star ratings will be informed by progress towards the targets in the Priorities and Planning Guidance 2003-2006. The stage four information will support this assessment.

2.5 Stage 4 Requirements

There were four key elements to the exercise:

1. Self-assessment

LIT completion of a traffic light system based on 41 predetermined criteria. (see appendix 1 - not attached.)

2. Themed Reviews

LITs were asked to assess local provision against three areas:

· Mental health promotion and suicide

· Acute in-patient services

· Mental Health services for prisoners

3. LIT review and update of the service mapping database

Completion was via a national database which required all LITs to complete a template for each of their local services. All services were mapped and information included: size of team, number of patients seen, site of the service and allows for any shared services to be identified.

4. Financial Mapping

LITs were required to complete standard spreadsheets that asked for all adult mental health spend to be listed against the service type. This includes PCT budgets, all service providers allocation (NHS/voluntary/private) and the Local Authority contribution.

2.6 Completion

LIT members were primarily responsible for completion of the exercise with assistance from the mental health leads in the PCT's, and financial colleagues supporting the financial mapping.

All information had to be returned by the end October 2002 to the Department of Health (DoH), for aggregation into national publications. Information from the DoH on the outcomes is planned for early 2003 including an electronic national atlas detailing the service mapping.

2.7 The mapping identifies gaps at local level which should inform future investment decisions to implement mental health NSF. This information is fed into three year Local Delivery Plans (LDPs) currently being compiled by PCT's, with significant investment required if national targets are to be achieved for both existing services and the development of the new priorities such as: Early Intervention; Assertive Outreach; Crisis teams.

See appendix 2. for details of mental health targets (not attached)

3. Summary Outcomes

3.1 Self Assessment

The traffic light framework for the self-assessment process, has a descriptive statement for each of the forty one criteria and individual LIT's score each criteria red, amber or green as appropriate for the statement which most nearly matches the local situation. The aim is to develop services which score `green', which indicates targets are or will be met within a set timescale.

See appendix 3 for details of the Self Assessment results for all ten LITs within the Hampshire and Isle of Wight SHA which includes the three unitary authorities

Summary of Results for Hampshire LIT's.

Key Message

The clear message from this section is that there are significant service deficits including key targets in the LDPs. Without PCT's prioritising mental health through appropriate financial investment the seven LITs in Hampshire are likely to fail to achieve key targets for mental health.

3.2 Service Mapping

Information gathered for all the individual mental health services in each LIT area was entered directly onto the national database (http://www.dur.ac.uk/service.mapping/). It is presently being analysed by Mental Health Strategies. As the information is of such a huge volume it has not been included in this report but can be viewed on the national database.

3.3 Financial Mapping

The level of financial information required is complex and includes the Social Services contribution, PCT budgets and all service providers' allocation (NHS/voluntary/private).

Social services continues to be able to successfully map and identify its funding. The NHS experienced difficulty identifying its funding streams. The process has been more difficult due to organisational changes in the SHA and the development of PCTs and the resulting disaggregation of budgets.

The outcome of these changes and the monitoring is that for this current financial year we do not have a clear picture from PCT's of what monies have been invested in Mental Health Services.

The Chief Executive of Hampshire & Isle of Wight Strategic Health Authority (SHA), in his reply to Members' earlier enquiry, detailed the following actual allocation to PCTs within Hampshire County Council of additional earmarked funding for mental health services.

Blackwater Valley and Hart identified £250,000 to develop a crisis resolution service in 2002/03. No other PCT identified funding for new services in the current year.

3.4 Themed Reviews

Key messages from this section include:

1) Assertive Outreach, Crisis Resolution and Early Intervention service developments require significant additional investment to bring them to fruition by the target dates.

2) All LITs reported there were either `significant' or `some' problems with recruitment and retention. Additional work is required to ensure workforce strategies are able to determine the future workforce requirements. This would include the new services listed above and the new workers e.g. New Graduate Primary Care Workers.

3) Additional work on the membership of LIT's is in the process of development and PCT engagement in the LIT's differs across Hampshire with only two areas reporting that LIT plans were used as the comprehensive commissioning plan for mental health services. LIT links to related services e.g. Drug Action Teams, Learning Disability services, Older People Mental Health and Children's Services differs and in general is underdeveloped.

4) There has been significant investment in provision of secure beds and further planning is on-going through specialist services commissioning. Work is in progress that aims to meet the secure service targets.

5) The present release system from local prisons for prisoners with mental health needs does not always allow for effective access to community services. Local service provision in the community upon release is limited in most LIT areas.

6) Court diversion schemes have been shown to be effective e.g. New Forest but these need developing across the county which requires further investment.

7) All LITs reported a comprehensive Care Programme Approach,(CPA- assessment and review for mental health) process but only one LIT was able to provide access to this in an integrated electronic manner over 24 hours. Five could not provide 24 hour access to information.

8) All LITs are in the process of establishing acute care forums linked to the acute in-patient units. These have responsibility for improving provision within units and have direct links to provider clinical governance forums. Each forum will develop its own action plan dependant on local need.

9) All LITs have a Mental Health Promotion strategy in place and are undertaking Mental Health Promotion activity. Additional multi-organisational investment would be required to implement the strategies fully. All LITs are working towards the reduction in suicide rate and deaths by undetermined causes by 20% by 2010.

10) Acute in-patient units vary in their capacity to provide women only self-contained units with appropriate services available in only four of the seven LIT areas.

11) Advocacy for in-patient units is sited as a priority for development in several areas, with additional funding being required to implement the service.

For full themed review reports, please see the copy in the Member's Library.

4. Consultation

Stage 4. has been completed by the LITs comprising a range of stakeholders including users, carers and voluntary sector organisations and has been discussed at SHA wide Network Meetings with PCT mental health leads. In addition, the work has been scrutinised by the SSI and SHA.

5. Conclusion

5.1 Stage 4. Monitoring informs the present position of mental health services and current investment in Hampshire and outcomes indicate that a substantial number of areas are not meeting NSF targets, resulting in significant gaps in Mental Health services e.g. Crisis Resolution & Home Treatment; Assertive Outreach; Early Intervention

5.2 Significant investment is needed to meet these national targets both for existing services and the development of new priorities with funding accessed through PCT's. Monitoring of investment (including investment in the Social Care component of Mental Health Services) and outcomes will take place through three year LDPs, The LDP will replace, and to some extent, incorporate a large number of existing plans. A key element of the new process is the involvement of frontline clinicians, users and carers.

Each PCT has to produce a LDP for three years, 2003/04 - 2005/06, for its own area involving:

Provider Trusts; Local Authority Social services Department colleagues; LIT's; and other local planning groups; clinical networks; clinicians and other staff groups; the public. The SHA then works with the PCT's to produce a single LDP for Hampshire & Isle of Wight with NHS acute and specialist trusts involved at each stage as well as the social care community. Trust delivery plans should be agreed by February 2003, with the LDP for the Health Authority signed off by DHSC by end March.

5.4 Once the profile for the three year period is in place, the key milestones and targets will be clear and implementation can take place subject to available resources. The new framework suggests that if performance varies significantly from the plan, intervention from the SHA can be expected.

6. Recommendations

Members are asked to comment on the content of this report.

Section 100 D - Local Government Act 1972 - Background Documents

The Following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt of confidential information as defined in the Act.

Mental Health National Service Framework - Autumn 2002, Stage 4 Position Statement. Department of Health.

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