CONTENTS

Page

1.

Introduction

3

2.

Objectives for 2003/04

4

3.

National Policy Guidance

6

4.

The Local Population

8

5.

Organisational Issues

9

6.

Performance and Activity

10

7.

Financial Resources

14

8.

Human Resources

16

9.

Action Plan

17

APPENDICES

1.

Population

2.

Mental Health Budgets

3.

Mental Health Performance

4.

Mental Health Training

5.

Integrated Mental Health Structure Charts

1.

INTRODUCTION

1.1

This document summarises Hampshire County Council Social Services' plans for adult mental health services for 2003-06. It is intended to inform Social Services and NHS staff, users and carers, voluntary sector partners and others of the social care agenda in mental health. This document should assist in the implementation of Local Delivery Plans as required in the Priorities and Planning framework; and also NHS Mental Health Trust plans as the Social Services Department develops more integrated arrangements with NHS partners.

1.2

The Mental Health National Service Framework (NSF) and supporting guidance spells out most of the requirements for adult mental health services. Local Implementation Teams (LITs) based on Primary Care Trust (PCT) localities have the primary responsibility for implementation of the NSF. These comprise key local stakeholders, including service providers, users and carers. The organisational responsibility for implementing the NSF is a joint one between PCTs and Social Services. Hampshire County Council Social Services covers a geographical area served by seven PCTs and their corresponding LITs. The population of the County Council is served by two NHS Provider Trusts (West Hampshire Trust and Surrey Hampshire Borders Trust).

1.3

Recovery and Mental Health

Research into users` needs in preparation for the NSF identified the following issues as most important to mental health service users:

i. Satisfaction with accommodation

ii. Employment or other purposeful daily activity

iii. Sufficient income to support themselves

iv. Participate in social and leisure activities

v. Self respect in social roles, family and work

vi. Not feeling a burden upon family carers

vii. A sense of partnership with their paid carer

viii. Achieving a balance between risk and safety in everyday life

1.4

Over the past few years mental health service users have increasingly used the language of `recovery' in speaking of their mental health experience. Instead of adopting a `medical model' of mental illness that speaks of symptoms and relief from them, a recovery approach aims to support an individual in their own personal development, building self esteem and identity, and finding a meaningful role in society. Recovery does not necessarily mean restoration of full functioning without support, including medication; it does mean developing appropriate support and coping with mental health experiences rather than being given support by mental health services.

There is no single agreed definition of recovery, but it has a number of dimensions:

i. Internal factors within the person such as the awakening of hope, insight and determination

ii. Self-managed care -how a person manages their own mental health and copes with the difficulties and barriers they face

iii. External factors - maintaining connections with family, friends and professionals, including people who believe they can cope with and recover from their mental illness

iv. Empowerment - combining the above to provide self-help, advocacy, and caring what happens to themselves and others

Further information can be obtained at www.mentalhealthrecovery.org.uk

1.5

The services commissioned and provided by the Social Services Department therefore have a central role to play in promoting recovery, although the recovery model will continue to challenge the nature of services and the way they are delivered. A key priority for the next year will be to work with service users and staff to explore the implications of recovery and seek to build it into the everyday practice of staff.

2.

OBJECTIVES FOR 2003/04

2.1

Mental Health Service Objectives are determined largely by the national policy agenda described in Section 3 below. Each PCT has prepared a Local Delivery Plan (LDP) with planned investment and projected activity for these targets for the period 2003-06. The County Council's corporate and Social Services Departmental objectives and how they relate to mental health objectives are described in the Action Plan (section 9).

2.2

2.3

National Mental Health targets from the Priorities and Planning Framework, NHS Plan 2003-05

i. Reduce duration of untreated psychosis to a service median of less than 3 months, (individual maximum less than 6 months) and provide support for the first three years for all young people who develop a first episode of psychosis by 2004.

ii. Offer 24-hour crisis resolution to all eligible patients by 2005.

iii. By Dec 2003, deliver assertive outreach to the 20,000 adult patients with severe mental illness and complex problems who regularly disengage from services.

iv. Increase breaks available for carers and strengthen carer support and networks to the benefit nationally of approximately 165,000 Carers of people on CPA by 2004.

v. Improve mental health care in prisons so that all prisoners with severe mental illness have a Care Plan by April 2004 (approximately 5,000 prisoners nationally) and ensure appropriate use of secure and forensic facilities by 2004, contributing to the national target of moving 400 patients from high secure hospitals by 2004.

vi. Ensure that by April 2004 protocols are in place across all health and social care systems for the care and management of older people with mental health problems.

Workforce

These targets have been estimated to have the following implications for the Hampshire and Isle of Wight Health Authority Area by 2005:

Strategic Health Authority

Hampshire CC Area

National Target

Weighted population

1,464,031

1,240,000

49,139,000

Assertive outreach teams

6

3*

220

Crisis Resolution Teams

10

7

335

Early intervention teams

1

1

50

Graduate Primary Care mental health staff

29

20*

1000

Community Gateway staff

15

8*

500

Staff employed to increase breaks to carers

20

14

700

* Estimate

A more detailed analysis of the social care implications is in Section 8 on Workforce.

2.4

Information System

Many of the other LDP objectives also have implications for mental health services. It is a local priority to procure a joint adult mental health information system. Within mental health services there is also a national requirement to implement the mental health minimum dataset by April 2004.

The LDP priorities for information management and technology are:

i. Infrastructure: access to NHS Net

ii. Implement electronic booking by December 2005

iii. National Prescription Service: by 2007

iv. Electronic records: including integrated care records service by December 2005

2.5

Local Social Services Objectives

There are a number of local Social Services objectives that complement national mental health priorities:

1. Workforce Development

The development of the workforce needs to embrace a number of principles, including:

(i) the promotion of sound evidence practice

(ii) Support and mixture of staff so they are confident and competent professionals

(iii) The need to work in partnership with users and carers

Specific objectives include:

i. Establishing posts; including mental health practice development worker, senior practitioner social workers and other posts to support new service development programmes in an integrated service

ii. Joint training and development programmes in an integrated service

iii. Evaluate recruitment and retention strategy

iv. Implementation of General Social Care Council requirements for registration of social workers

2. Consolidate CPA/Care Management Integration

i. Use of audits to evaluate practice including user focus

ii. Implementation of fair access to care requirements including reviews, use of direct payments, and new social services eligibility criteria

3. Information and Performance Management

i. Promote development of an information culture in teams to improve local practice and performance against national targets (C31: people helped to use at home 3.0, B15 Units costs £399)

ii. Connection of CMHTs to effective IT systems, including Hampshire County Council's IT 2000, SWIFT systems and the NHS Net.

iii. Procurement and phased implementation of PHAMHIS (subject to available resources)

4. Protection

i. Implementation of joint agency adult protection procedures

ii. Review and implementation of inter-agency guidelines on child protection

iii. Option appraisal for the Department to expand the role of the Receivership Unit to cover Appointeeship for adults with mental incapability

iv. Response to new Mental Health Bill and Mental Incapacity Bill.

5. Integration

i. Consolidate the development of integrated Mental Health Trust and Social Service management

ii. Scoping the issues to improve joint commissioning with PCTs

3.

NATIONAL POLICY GUIDANCE

3.1

Mental Health Policy is summarised in a number of key government documents:

i. Modernising Mental Health Services: Safe, Sound and Supportive (1998)

ii. Mental Health National Service Framework

iii. NHS Plan (Mental Health Chapter)

They emphasise the need to modernise both services, the organisational arrangements for service delivery and the legal framework including a new Mental Health Act. The major organisational arrangements to support implementation are summarised in:

i. Shifting the Balance of Power within the NHS (2001)

ii. Delivering the NHS Plan (2002)

3.2

Detailed requirements for mental health services are spelt out in a number of other key documents including:

i. National Institute for Mental Health in England (NIMHE)

ii. Modernising the Care Programme Approach

iii. Mental Health Information Strategy

iv. Final Report by the Workforce Action Team

v. Changing the Outlook: a strategy for developing and modernising mental health services in prisons

vi. Dangerous People with Severe Personality Disorder Programme

vii. Mental Health Promotion Project

viii. National Suicide Prevention Strategy for England

ix. Mental Health Policy Implementation Guides (several)

x. Women's Mental Health: into the mainstream

These can be found on the Department of Health website (www.doh.gov.uk/mentalhealth/index) and on the National Institute of Mental Health England (NIMHE) website (www.nimhe.org.uk )

3.3

Social Care Policy and Guidance

There are a number of specific mental health requirements for social care services published by the Social Services Inspectorate (SSI)

i. National Standards for the Provision of Social Care Services in the High Security Hospitals (2001)

ii. Detained: Inspection of Compulsory Mental Health Admissions (2001)

iii. Modernising Mental Health Services: Inspection of Mental Health Services (2002)

They can be found on the SSI website:

www.doh.gov.uk/cos/socialcarepublications/mentalhealthanddisabilities

3.4

These SSI reports describe national standards for mental health social care. The Modernising Mental Health Services inspection report found that nationally:

i. Councils with Social Services Responsibilities (CSSRs) were engaging well with planning for the implementation of the NSF

ii. There is slow progress in ensuring that services and practices are safe

iii. There is a risk that crucial social care perspectives might be lost, e.g. supported accommodation, rehabilitation, attention to children's needs, and a robust approach to race equalities issues

iv. A risk that mental health service users and their carers might miss out on the benefits of social care modernisation programmes, e.g. promoting independence; commissioning; performance management and business planning

Hampshire Social Services will need to ensure that it learns the lessons from these inspections and that new partnership arrangements for commissioning and providing care ensure a strong focus on social care dimensions of local services.

3.5

Other Social Care Policies

There have been a number of important initiatives that will affect the commissioning and delivery of mental health social care:

i. The recommendations from Lord Laming's Inquiry into the Care and Treatment of Victoria Climbie. It is of crucial importance for all services to ensure that children are adequately protected, and that all professionals who have contact with children or their parents are competent to identify risks and seek appropriate intervention

ii. Continuing Care: NHS and Local Authority Responsibilities: this requires the development of consistent criteria and guidance for eligibility

iii. Fair Access to Care: this requires a consistent eligibility criteria framework for services, a requirement to ensure that Direct Payments is considered in assessment, and that services are reviewed

iv. Fairer Charging Policies for Home Care and other non-residential social services: this has required a new charging policy to ensure equitable treatment between care groups

v. Abolition of Preserved Rights for residential and nursing home fees: this affects approximately 35 mental health service users in Hampshire

vi. Free Nursing Care

vii. The Introduction of the Care Standards Commission and the General Social Care Commission: these initiatives have introduced new standards for residential and domiciliary care; and for the training and registration of social care workers

viii. Welfare to Work Joint Investment Plans (JIP)

ix. No Secrets: guidelines on investigating and addressing adult abuse

x. Supporting People: a new system of planning, providing and funding housing related support services

3.6

Local Government and Other policies

There are a number of local government initiatives that affect Social Services departments including:

i. The introduction of the Comprehensive Performance Assessment (CPA) for Local Authorities (not to be confused with CPA - Care Programme Approach in mental health), of which the Social Services Star Rating is a part. Hampshire County Council is rated as an `Excellent' Authority, and the Social Services Department has a Two Star rating. This provides the Department with a number of freedoms from inspection and to deploy grants in a flexible way in accordance with local priorities.

ii. Introduction of Overview and Scrutiny Committees (OSCs) that allow Elected Members to scrutinise NHS Performance. Elected members of the Social Care Policy Review Committee have identified PCT investment in mental health as a particular issue to monitor closely

4.

THE LOCAL POPULATION

The tables in appendix 1 indicate the adult (aged 18-64yrs) population changes (table 1) and prevalence rates of mental health problems in Hampshire (table 2). This has not been updated to incorporate recent census data.

LIT implementation plans may contain more sophisticated local population needs assessments, or refer to other local NHS documents such as Health Promotion or Public Health reports. The Office for National Statistics has recently published `Psychiatric Morbidity Among Adults Living in Private Households, 2000', which updated the findings of the 1993 survey. Among the findings were that in the general population there were (between 1993 and 2000):

i. Similar proportions of the population with neurotic disorders (164 per 1000) and psychiatric disorders (5 per 1000)

ii. An increase in sleep problems

iii. Higher use of illicit drugs (from 2% to 4% of adults)

iv. 119 per 1000 men and 29 per 1000 women were significantly dependent on alcohol

The concern arising from an increased use of alcohol and drugs by mental health service users has resulted in the issuing of Dual Diagnosis Guidance to assist services in managing this.

5.

ORGANISATIONAL ISSUES

5.1

Mental Health NHS Trusts

Hampshire Social Services works with two Mental Health NHS Trusts, West Hampshire NHS Trust and Surrey Hampshire Borders NHS Trust. County Council Policy is to promote the development of a County-wide mental health Trust, and subject to formal consultation and approval it is hoped that the following organisational arrangements will be in place by April 2004:

i. Adult Mental Health Services for Hampshire County Council residents to be provided by West Hampshire NHS Trust, except:

ii. Adult Mental Health Services for residents in the Blackwater Valley to be served by a Surrey-based Trust, in recognition of the needs of a natural community that crosses County and Strategic Health Authority boundaries.

5.2

Integration

From April 2003 the Social Services Department will have integrated the management of its services with the two specialist mental health trusts under a formal partnership agreement under Section 31 Health Act 1999. The key features include:

(i) Jointly appointed Locality Managers, CMHT managers and Development managers for each PCT locality across Hampshire

(ii) Joint management of budgets: there is no formal pooling of budgets, though some social care funds may be transferred under Section 28B Health Act

(iii) Partnership Boards to oversee effective implementation of the arrangement.

Outline organisational charts are shown in Appendix 5. The next year will require consolidation of these arrangements including further development of a shared organisational culture and joint systems.

5.3

PCTs

PCTs are developing new organisational arrangements in response to the new responsibilities given them under the Shifting the Balance of Power. Most PCTs now have a mental health lead to help drive the implementation of the NSF. The Department has begun working with some PCTs to develop its approach to joint commissioning, including:

i. Joint approaches to commissioning, service development and redesign, and performance management of local services provided by NHS Trusts and the independent and voluntary sector

ii. The commissioning of specialist services, e.g. Forensic Mental Health through the Wessex Consortium

iii. Preparatory work with the South East Development Centre to develop a learning set for mental health commissioners

As part of the integration process the Department redesignated one of its operational service managers as a strategic service manager. It can now provide more dedicated support to LITs and linkage with PCT mental health leads and Trust locality managers.

5.4

The Voluntary and Independent Sector

A strong voluntary sector is of critical importance. Many social care services are delivered through contracts with the voluntary and independent sector (approximately £2.5 million planned for 2003/04). It can also be expected that up to £2.5 million will be spent on residential care, all of which will be in the independent and voluntary sector. Voluntary sector providers face additional financial pressures from a number of Government initiatives e.g. Care Standards Act and Supporting People (i.e. the loss of Supported Housing Management Grant for care homes).

The County Council and NHS organisations have agreed a Compact with the voluntary sector. The department will seek to strengthen its links with the voluntary sector and engage them in LITs, the Recovery agenda and its implications for the development of mental health services

6.

PERFORMANCE AND ACTIVITY

6.1

6.2

6.3

Inspection: Performance in social care is assessed by a variety of means nationally and locally. Arrangements concerning the Statutory bodies that oversee the performance of Social Care are in the process of change, but include proposals to establish the Commission for Social Care Inspection (CSCI, pronounced `sea sky'), bringing together the functions of the National Care Standards Commission and the Social Services Inspectorate. CSCI will assess the performance and quality of social care, and publish performance ratings. It will work alongside the Audit Commission, and the Commission for Health Care Audit and Inspection (CHAI). CHAI will include the functions currently undertaken by the Mental Health Act Commission (subject to legislative change).

Performance Assessment: The Department of Health is currently consulting on the development of an integrated mental health Performance Assessment Framework (PAF). However, Social Care and NHS Care currently have separate performance assessment arrangements based on the separate organisations that commission and provide care. The exception to this is the Annual Monitoring of NSF Implementation by the LITs. This includes, on a joint agency basis: service and financial mapping, self assessment of progress in a range of service areas (traffic light ratings of red, amber and green) and themed reviews (Appendix 3).

Best Value: Social Care Services are subject to the statutory requirement of Best Value, with plans and outcomes reported in the Best Value performance Plan.

6.4

Social Care performance is assessed by the SSI as follows:

i. Joint Review by the SSI and Audit Commission (every 5 years: these arrangements are subject to change)

ii. The Performance Assessment Framework (PAF) - annual performance against a range of indicators

iii. Delivery and Improvement Statements to SSI - including the use of PAF data

iv. Inspection of specific services and Best Value Reviews

The findings are collated by the SSI and inform the Social Services Departments Star Rating and the County Council's Comprehensive Performance Assessment.

6.5

6.6

6.7

Mental Health Specific Performance

In addition, mental health performance is monitored through the following:

i. Mental Health Act Commission: biannual inspection

ii. Annual NSF Monitoring: reporting to the Strategic Health Authority and SSI (and collated nationally)

iii. Local Monitoring of activity, e.g. Mental Health Act, and a range of other performance information such as use of community and residential services (see appendix 3).

iv. Specific service reviews, including inquiries following serious untoward incidents. These are usually conducted jointly with NHS Trusts, with action planning monitored through Trust Clinical Governance arrangements.

Generally, performance of mental health social care services in Hampshire is good. Best Value reviews have now been completed for all mental health services, and five year action plans are in place. Appendix 3 provides further information.

With regard to reviews following serious untoward incidents, an Independent Inquiry and action plan following three Homicides in North and Mid Hampshire was published in July 2001. There are currently several internal reviews being conducted jointly across Hampshire following serious incidents, and these will be reported in accordance with national guidelines.

Targets for 2002-2003

The Department agreed a number of key social care targets with the SSI for 2002 - 03 :

i. PAF target (C31) for people helped at home: 3.0 per 1000 (currently 2.8).

ii. PAF target (B15) for unit cost of residential care £395.

iii. Implementation of single line management of mental health services in West Hampshire Trust.

iv. Recruitment and retention of ASWs: 5 per 100,000 population

v. 7 new senior practitioner posts.

vi. Implementation of e-CPA.

vii. Implementation of carers assessment tool in CMHTs.

viii. Use of SCA to develop joint information systems.

ix. User and carer training pilot in North Hampshire.

x. Implementation of Best Value Review of day and community support services

xi. Direct Payments pilot : target 6 users and 4 carers.

The SSI is expected to validate achievement of these targets as part of its assessment in Summer 2003

Inspections

6.7.1 There have been no SSI inspections of Mental Health services. As a result of Hampshire County Council achieving `Excellent' status in the CPA process, it is relieved of the need for a mental health inspection in the forthcoming year. District Audit commended the Department on its Best Value Review of Residential Care in 2002/03. The Mental Health Act Commission conducted its Biannual Inspection in March 2003 and their report is due in Spring 2003.

6.7.2 Hampshire County Council's SSI annual review and monitoring in 2002/03 noted the following for mental health services:

i. Good performance on `adults helped to live at home'

ii. Acceptable residential care unit costs

iii. Good engagement with LITs

iv. Good service integration plans

Areas of concern were issues relating to collection of information about performance across all adult care groups including:

i. Numbers of people receiving a statement of their needs

ii. Numbers of people receiving a review

For the mental health sector, joint action with Mental Health Trusts will be needed to address these information issues. The specific mental health PAF information is found in appendix 3.

6.8

Stage 4 NSF Monitoring

The outcome of the Stage 4 NSF mapping can be summarised as follows (see Appendix 3.2 for details).

i. 16 areas were graded as `Red' (target not met)

ii. 20 areas were amber (target partly met)

iii. 5 areas were green (target met)

Themed reviews identified the following issues:

i. Assertive outreach, crisis resolution and early intervention service developments require significant additional investment to meet NHS Plan targets

ii. All LITs report significant recruitment and retention problems

iii. LITS were still developing and often needed stronger links with PCT commissioning processes and links to other strategic planning frameworks

iv. There has been significant investment in the provision of secure beds through specialist commissioning

v. Further service developments are required as part of the release system for prisoners with mental health needs

vi. There is a need to establish Court Diversion schemes in some areas

vii. A comprehensive CPA process is available everywhere, but not in an electronic format available 24 hours a day 7 days a week

viii. Acute Care Forums have been established by NHS Trusts

ix. All LITs have a mental health promotion strategy, but significant investment is required to implement them

x. Only four out of seven areas can provide appropriate in-patient services for women

xi. Advocacy for in-patients has been cited as a priority for investment in several areas

The overall message is that whilst some progress has been made in implementing the NSF, there are many areas that do not meet national requirements and significant additional investment is required.

6.9

Key Achievements in 2002 - 03 (local targets)

2002-03 has continued to be a period of major change. Key achievements in mental health services include the following:

i. The implementation of integrated service delivery with West Hampshire NHS Trust and Surrey Hampshire Borders Trust.

ii. The delivery of a balanced budget and savings targets.

iii. Improved PAF indicators, contributing to the department's `Two Stars' and the County Council's `Excellent' status.

iv. Implementation of recruitment and retention strategy for ASWs including additional senior practitioners and salary enhancements for ASWs on the North East Hampshire rota.

v. Contribution towards IIP status achieved by the Department and the County Council.

Other significant contributions include:

i. Completion of remaining Best Value Reviews for all mental health services (Residential Care, Carers and CPA/Care Management.

ii. Led development of the Continuing Care Toolkit for Mental Health.

iii. Established an integrated CMHT in Havant.

iv. Continued development of specification and Business Case for the Pan Hampshire Adult Mental Health Information system (PHAMIS), with significant funding from Supplementary Credit Approval.

v. Improvements to CMHT buildings in Gosport and New Milton through the use of Supplementary Credit Approval.

vi. Detailed consultation and critique of Mental Health Bill.

vii. Events: World Mental Health Day; Art Exhibition; Women's Strategy Consultation and Carers Annual Conference.

viii. Introduction of Vocational advisors in New Forest and East Hants.

ix. Comprehensive reviews of social care services and contracts in Mid Hants, North Hants and Blackwater Valley; and County Wide Appropriate Adult service.

x. Establishment of User Development (Fareham/Gosport), Carer Support services (Eastleigh); Training Users and Carers (North Hants).

xi. Joint Procedures for information sharing with Mental Health Trusts

xii. Comprehensive service and financial mapping and Service Reviews for Stage 4 NSF monitoring.

xiii. Transfer of ASW training course to Bournemouth University.

xiv. Qualifications: all ten prospective ASWs gained PQ1 award and first group of staff gained a Certificate in Mental Health

7.

FINANCIAL RESOURCES

7.1

Revenue Budget

The County Council's overall budget position is significantly worse, by £48 million, compared with 2002/03 due to Government changes to the resource allocation formula to local authorities (now called Formula Spending Share, or FSS). Members have however agreed to protect Social Services budgets.

7.2

The Social Services Department budget is £203 million of which over £10million (5%) is for Adult Mental Health (excluding substance misuse and HIV/AIDS). The budget, including 2.5 per cent savings requirement by locality is in Appendix 2.

7.3

There have been some savings generated in 2002/03 as a result of integration, service redesign and review of social care contracts. There will also be some savings from Transitional Housing Benefit (THB) following de-registration of registered care homes in some localities. Reinvestment will support:

i. Pick up for County Wide Appropriate Adult Scheme Pilot

ii. Pick up for Employment development worker

iii. (joint with Southampton City and West Hampshire Trust).

iv. Carers' Support Workers (largely from THB - size of reinvestment to be identified).

7.4

All new additional government funding for mental health advice modernisation is directed through PCTS. Mental Health grant for adults remains at 2001/02 levels. The Department is therefore reliant on PCTs to fund the social care component of modernisation, including ASW posts (which must be County Council employees). Work will need to be done locally on the additional cost of care packages as a result of improved engagement or home treatment that will place additional pressures on social care budgets.

7.5

NHS investment: Analysis of the LDPs

Despite government announcements regarding additional investment in mental health services, there is little cause for optimism locally given the overriding need for the NHS to reach a balanced budget position and address historical deficits. From the key national mental health targets will be delivered across Hampshire and the Isle of Wight over the next three years, although some progress will be made with each target.

Most PCTs have prioritised Assertive Outreach and Crisis Resolution and Home Treatment Teams for delivery in 2003/04 and 2004/05.

An analysis of the planned additional investment identified from the LDPs is as follows:

PCT

2003-06

Blackwater Valley & Hart

310

North Hampshire

429

Mid Hampshire

168

Eastleigh Test Valley South

387

New Forest

96

Fareham & Gosport

141

East Hampshire

112

Total for Hampshire County Council Area

1643

Southampton City*

700

Portsmouth City*

727

Isle of Wight*

191

*For comparison with other PCTs in the Hampshire and Isle of Wight Strategic Health Authority

7.6

NHS Investment in IT

At the beginning of 2003/04 the Strategic Health Authority had £8.2million available for IT developments. A bid has been made to procure the Pan Hampshire Mental Health Information System (PHAMHIS) as follows:

£0.8 million (2003-04), £0.9 million (2004-05), £0.8 million (2005-06)

changes in the National IT programme have resulted in this being under review.

7.7

Supplementary Credit Approval 2003/04

The Department has been awarded SCAs (permission to borrow funds for capital investment) as follows:

2002-2004: £205,000 (for joint information systems developments including PHAMHIS)

2003 - 04: £285,000 (for joint information systems and other NSF service priorities)

8.

HUMAN RESOURCES

8.1

Current Position

i. Adult mental health services are provided mainly through community mental health teams (CMHTs, also called Locality mental health teams LMHTs in New Forest and Eastleigh / TVS)

ii. These are integrated teams of health (Community Psychiatric Nurses - ( CPNs) and Occupational Therapists - (OTs)) and social services mental health professionals, with team management from both services. There are currently fifteen integrated CMHTs in Hampshire with a separate social services and health team in Petersfield. Co-location here is subject to development of a business case and available resources.

iii. There is also an increasing number of specialist mental health teams such as the Rapid Assessment Service in Basingstoke, assertive outreach teams, a forensic service for high and medium secure units and special hospitals a prison CMHT, plus Carers Support Workers (CSWs) for each of the seven localities in Hampshire.

iv. Most professionals in CMHTs undertake holistic assessments, which include identifying accommodation needs, and plan, monitor and review care packages as appropriate.

v. In addition to the care management role, a number of social workers undertake, after specialist training, the functions conferred upon them by the Mental Health Act 1983 (section 114) as Approved Social Workers. A few will also act as supervisors for patients on restriction orders and subject to Home Office reporting.

vi. Mental Health Day Services staff are employed in four of the seven areas of Hampshire, each with a Unit Manager and with a total of thirty eight staff, equating to twenty four full time equivalent support staff (many staff are working part time)

vii. Further support is undertaken through staff in the Voluntary sector (total contract values approximately £2.5m in 2002/03)

Numbers for mental health social workers (MHSWs) are:

Area / Staff in CMHTs

Alton / Aldershot

Basingstoke

Eastleigh / Romsey

Fareham / Gosport

Havant / Petersfield

New Forest

Winchester / Andover

* figures taken from Stage 3 NSF monitoring returns to DOH

Forensic MHSWs 4

Out of Hours Social Workers 10

Central Support for mental health includes two County Managers (Strategy and Operations), 3 strategic service managers , a mental health training project manager, a Mental Health Practice Development Manager, and a joint information systems project officer.

8.2

Future Needs

The 2003/04 workforce plan includes the following workforce requirements to meet NHS Plan targets:

Crisis resolution services:

6 ASW posts (1 per PCT locality except North Hampshire)

Assertive Outreach:

3 ASW posts (North Hants, New Forest, East Hampshire)

Early Intervention

2 ASW posts (estimate - county-wide)

Carers Support Workers

7 support workers (one per locality, two in E Hants)

Wessex Prison CMHT

1 Care Management/ASW post (Mid Hants)

CMHT access and capacity issues:

3.0 ASW (1 Mendos worker and 2 CMHT) from LDP : 2.5 to be funded from LDP, 0.5 from recycling existing resources.

8.3

Desirable additional posts from new investment/recycling (not in LDPs)

8 Social Work Senior Practitioners (BWV, NH, MH, E/TVS, NF,FG, EH, Ravenswood Medium Secure Unit)

1 Contracts Support Officer (HQ)

2 Receivership / Appointeeship Officers (HQ) -would be funded from income generation

1 Information System Project Officer, funded from mental health SCA

8.4

Training and Professional Development

The Social Services Department publishes its overall training plan as a separate document. Investment in Mental Health training is approximately £230,000 funded by two separate grants. Training Support Programme for ASW - related training (approximately £100,000) and mental health grant for training related to NSF priorities (approximately £130,000). An outline training plan including funding source is found in Appendix 4.

Some of this training should be joint funded by the Workforce Confederation.

9.

9.1

9.2

9.3

9.4

9.5

ACTION PLAN

The action plan is framed in terms of the Standards and Supporting Strategies of the Mental Health National Service Framework. Standard 7, concerning suicide also includes actions relating to Adult Protection. The plan is related to the relevant Social Services PAF indicators, NSF monitoring, together with Social Services' objectives and the Corporate Strategy (see below). The lead Social Services personnel is for accountability and performance management purposes. The plan does not attempt to capture the range of responsibilities and joint locality managers or other NHS Trust or PCT personnel.

Performance Indicators

Key

NSF monitoring:

Performance against standards is usually rated Red (not met), Amber (partly met) or Green (fully met).

Performance Assessment Framework (PAF):

Mental health specific indicators are:

A6: reduction in psychiatric emergency re-admissions

B15: Unit cost of residential/nursing care

C31: adults helped to live at home

The more general performance indicators in the PAF have not been included in this action plan. Most will be addressed through successful implementation of Standards 4 and 5 of the NSF.

SSD Objectives

The aim of the department is:

To work with the people of Hampshire to ensure that their assessed social care needs are met with high quality, cost effective services, within available resources. In doing this we want to offer users and carers the greatest possible choice; and to preserve their dignity, safety and independence.

Hampshire Social Services have 6 overarching objectives:

1. Promote independence and personal development

2. Protect vulnerable adults and children

3. Arrange services which are accessible, convenient and user centred.

4. Strive for best value and greater consistency across Hampshire

5. Ensure that our workforce is competent and confident

6. Develop our partnerships with other agencies.

Corporate Objectives

The County Council's Corporate strategy has 6 aims:

1. Maximising life opportunities - creating opportunities for the whole community.

2. Stewardship of the environment - protecting our environment and ensuring Hampshire remains a place where people want to live.

3. Achieving economic prosperity - leading the development of a strong and sustainable economy.

4. Building strong and safe communities - working together with local people to build strong and safe communities for everyone

5. Improving services - making sure services continuously improve to meet the changing needs of the whole community.

6. Developing councillors and staff - ensuring they have appropriate training and resources to respond to the needs of the people of Hampshire.

The Mental Health Service also needs to work within the Corporate Framework of the Mental Health Trusts, but for simplicity these are not referred here.

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Recovery Model: promote the Recovery Model approach in service commissioning and delivery

Major conference with national speakers January 2004

Not applicable

1, 3, 5, 6

1, 3, 4, 5, 6

Training Project Manager (Barbara Evans)

2. Each LIT has a Mental Health promotion implementation plan which is being implemented

Stage 5 NSF monitoring October 2003

Green rating in NSF monitoring Stage 5

1, 6

1, 4

Strategic Service manager for each LIT

3. Local Strategic Partnerships have focussed on the needs of people with mental distress

3.1 Social Services Partnership Managers are briefed on LIT priorities and enabled to input into LSPs

Stage 5 NSF monitoring October 2003

Green rating in NSF monitoring Stage 5

1, 6

1, 4

Strategic Service Managers

4. Race Equalities

4.1 REMIT plan is developed and reported to relevant Trust and LIT forums

4.2 Plan rolled out to Trusts and LITs

Plan completed June 2003

Reported by October 2003

Green rating in NSF monitoring Stage 5

3, 5, 6

1, 5, 6

County Manager (strategy) - develop plan

County Manager (Operations) - trusts

SSMs - LITs

5. Women's services

5.1 Women's strategy in place

5.2 Complete review of Rape Crisis Services and establish on a sound contractual basis

October 2003

March 2004

Strategy document

Local PI's within service specification

2, 4, 6

4,5

SSM (Pamela Noble)/Training Project Manager (Barbara Evans)

6. Action plans are in place to ensure that people with mental health problems have maximum opportunities to secure employment e.g.

6.1Best Value Action Plan

6.2 Employment Strategy (South West Hampshire strategy revised and consultation on County wide plan)

6.3 Social Care employment contracts reviewed to reflect evidence based practice (e.g. vocational adviser model)

6.4 Mental Health input into JIP

6.5 Development of guidance for County Council managers

6.6 Establish Employment lead in West Hampshire Trust

6.7 CPA audit of employment needs

November 2003

March 2004

March 2004

March 2004

October 2003

April 2003

July 2003

PAF C31

Plans are in place

PI's within service specification

Issues reflected in JIP

Guidance in place

Post established

% of CPA complying with national requirements

1, 3, 4, 6

1, 3, 5, 6

Strategic service managers (Gill O'Leary, Best Value lead) 6.1, 6.3,

(Margot Mottershead) 6.7

County Manager Strategy 6.2, 6.4, 6.5

County Manager Operations 6.6

7. Community Support Services are commissioned and provided that promote maximum independence in accordance with best value principles

7.1 Services demonstrate the following:

i. Compliance with standard Service Specification / Care Standards Act

ii. Annual Review of the service in place

iii. User involvement in planning and running services

iv. Unit Cost established and competitive

v. Contracting arrangements conducted in partnership and comply with standing orders

vi. Integration with other services

vii. Annual review of each service user (FACs compliant)

Progress against Best Value action plan reviewed November 2003

PAF C31

% services compliant with requirement

Unit cost

Numbers of reviews

1, 3, 4, 6

1, 3, 5

Strategic Service Managers /locality managers

Best Value lead:

Gill O'leary

8. Housing :

i. each LIT has an agreed set of priorities for inclusion in local housing strategies

ii. LIT has an agreed process to communicate mental health priorities with local housing planning systems

(Other actions arising from the Best Value Review of Housing and Residential Care are included under Standard 5 NSF below)

Progress reviewed October 2003

Numbers of LITs with clear priorities

PAF A6

1, 3, 6

1, 2, 5

Strategic Service Managers on LITs

Best Value Lead: Gill O'Leary

9. User and Carer involvement: Service users and carers are involved in service planning and delivery

9.1 Advocacy service established (East Hants)

9.2 Establish effective service model for advocacy services (Departmental wide working party)

9.3 Protocol in place for paying users and carers

9.4 Service reviews measure satisfaction

April 2003

March 2004

March 2004

User and carer satisfaction

1, 2, 3

1, 4, 5

Strategic Service Manager (Gill O'Leary)

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Implement recruitment and retention package for ASWs

(additional ASWs for Crisis and Assertive Outreach Teams subject to availability of resources agreed through the LDP process)

Review effectiveness for Best Value Improvement plan: October 2003

ASWs/100,000 population

(local target 5/100,000)

2, 6

5, 6

County Manager (Operations) and Practice Development Manager

2. Development through the LITs of service models for Primary Care and links with other services, including:

· Gateway community mental health workers

· Graduate Primary Care Workers

Systems in place regarding the linkage of primary care and specialist mental health services

Service models and pilots being developed (April 2004)

Implementation subject to available resources (through LDP process)

Likely to be an Amber rating in NSF monitoring Stage 5

(plans in place, but no funding for posts)

6

5

Strategic Service Managers through LITs

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Services models for Crisis Resolution/Home Treatment Teams include agreed care pathways and linkage with Social Services Out of Hours Service and Social Services Direct

March 2004

NSF Stage 5

3, 6

5

County Manager (Operations) / Out of Hours Mental Health Team Manager

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Development of Crisis Resolution and Home Treatment Teams; Assertive Outreach Teams; and Early Intervention Services

Implementation

(March 2006)

Likely to be a Red or Amber rating in NSF monitoring Stage 5

(plans may in place, but limited funding for new posts available)

2, 3, 6

5

Strategic Service Managers in LITs

2. CMHTs are in place which co-locate NHS and Social Services staff (East Hampshire - Havant, and Petersfield), and in accommodation that meets minimum requirements (Hewatt House, Gosport; and Test Valley South)

Havant CMHT April 2003 co-location; date for new premises subject to business case

Petersfield and Gosport: subject to business case development

TVS: March 2004

Jointly commissioned service in place

3, 6

5

Strategic service manager on relevant LIT

3. Services for Mentally Disordered Offenders

3.1 Establish county-wide Appropriate Adult Scheme

3.2 Review of Medium Secure

Social Work arrangements

April 2003

Project Plan: March 2004

Numbers of contacts (in service specification)

Contained in SSI Standards

2

2, 4

4

4

Strategic Service Manager (Pamela Noble)

Strategic Service Manager (Gill O'Leary and Practice Development Manager

4. CPA/CM integration

4.1 Implement the use of e-CPA

across all localities

4.2 Establish CPA register

4.3 Conduct CPA audits across all localities

4.4 Incorporate requirements of

Social Services Fair Access to

Care (FACS) requirements into CPA process including:-

- revised eligibility criteria

- reviews of all users in receipt of Social Care services

- re-entry pathway in accordance with recovery model

4.5 Implement CPA/care

management training programmes

4.6 Pilot Continuing Care

Mental Health `Toolkit'

4.7 Best Value implementation and improvement plan

Completion of CPA audits

West Hants Trust (July 03)

SHBT) (October 03)

FACS requirements (March 04)

Review March 2004

PAF Indicator

E50

CPA performance in report

% reviews completed

3, 4, 6

5

Strategic Service Manager (Margot Mottershead) with CPA Co-ordinators (WHT and SHBT)

Barbara Evans (Training Project Manager)

Gill O'Leary (Strategic Service Manager)

5. Childcare protocol

Ensure needs of dependent children of people on CPA are identified and met

5.1 Audit of care processes

arising from Climbie Inquiry recommendations

5.2 Mental Health and Childcare protocol is revised and implemented in response to local and national inquiry recommendations.

Climbie Audit completed end April 2003-02-21

Revised protocol and implementation plan in place in March 2004

Validation by SSI

2

4

Strategic Service Manager Children (Janet Feat)

County Manager (Operations)

6. Transitions - there are adequate and effective arrangements in place in each locality for:

6.1 Transition between CAMHS and adult services

6.2 Transition between adult and older people's services

October 2003

`Green' in Stage 5 NSF monitoring

3, 6

5

Strategic Service Manager (Margot Mottershead)

7. Direct Payments

7.1 Completion of Direct Payments national pilot scheme

7.2 Future arrangements are in place to enable continued access to Direct Payments after March 2004

Current Contract ends March 2004

National Publication of Pilot Outcome from April 2004 (?)

New arrangements in place by March 2004

10 users on DP

7 carers on DP

DP `champion' in each CMHT

In evaluation report

New contract in place

1, 3, 5

5, 6

Strategic Service Manager (Pamela Noble)

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Implementation of recommendations of the Best Value Review of Residential Care and housing

1.1 Agreed housing priorities (see Standard 1)

1.2 Housing needs are included in CPA assessments

1.3 Joint commissioning / reprovision of long stay /rehabilitation residential care

1.4 Audit of high cost placements

Best Value Implementation Review

CPA audits by October 2003 and annually

Targets to be agreed

July 2003

PAF indicators: A6

B15, C27, C31

1, 3, 4, 6

5

Best Value Lead: Strategic Service Manager (Pamela Noble)

Other actions: relevant Strategic Service Manager on the LIT

County Manager (Operations)

2. CPA actions (see Standard 4)

3. Social work in High and Medium Secure Services

3.1 Agreement to national protocol

As soon as protocol is issued

Agreement in place

2, 5

5

County Manager (Operations)

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Use of initial screening assessment tool

2. Audit of carers assessment

3. Recruitment of additional carer support workers in accordance with LDPs

4. Implementation of Direct Payments for Carers

5. Establish professional support and training and development pathway for Carer Support Workers

6. Carers subgroup or representation on each LIT

March 2004

October 2003

March 2004 (subject to available resources)

Numbers on Direct Payments

LITs with representation

PAF D42

(Carers receiving an assessment)

3

1, 5

Strategic Service Manager (Pamela Noble)

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Care Co-ordinator Competencies established in risk assessment management and care management based on National Occupational Standards.

October 2004

2, 5

6

Strategic Service Manager (Margot Mottershead) and Training Project Manager

2. Adult Protection - Implementation of strategy and procedure including joint training in CMHTs

October 2003

Numbers of staff trained

2, 5

6

Training Project Manager

3. Serious Untoward Incidents:

3.1 Development of joint SUI

procedures with NHS Trusts

3.2 Conduct of joint inquiries and implementation of action plans

October 2003 (Procedure)

Agreement in place

2, 6

5, 6

County Manager Mental Health (Operations)

County Manager Mental Health (Strategy)

4. Adults with mental incapacity:

Implementation of Best Value

Action Plan for the Receivership

Unit:

4.1 Review of Appointeeship processes

4.2 Implementation of new business processes

Best Value Implementation Plan reviewed Nov 2003

Appointeeship Review April 2003

October 2003 (subject to review recommendations)

Numbers of people on Receivership Orders

Numbers of people for whom Department is Appointee

2

5

County Manager (Mental Health Strategy)

Organisational change

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD Person

1. Service Configuration

1.1 Agree arrangements for NHS Trust configuration (WHT/SHBT)

Consultation document Spring 2003

Implementation by April 2004

6

6

County Manager (Strategy)

County Manager (Operations)

2. Integration

2.1 Establish / consolidate new arrangements for integrated locality management

2.2 Implement governance and accountability arrangements

2.3 Development of joint process across Trust/Social Services e.g. Clinical Governance/ Best Value / Inspection

From April 2003

6

4, 5, 6

County Manager (Operations)

County Manager (Strategy)

3. Commissioning

3.1 Develop partnerships with PCTs and LITs and enhance LIT functions

3.2 Establish linkages with other planning frameworks and organisations e.g. District Councils, DAT, CAMHS

3.3 Promote partnership of voluntary sector

- feasibility of formal liaison arrangements to develop mental health contacts

- Contracting arrangements

Strategic Service Managers from April 2003

Strategic Service Managers from April 2003

Consultation outcomes by Spring 2004

Review contracting arrangements by October 2003

Commissioning Practice `Serves People Well' when audited against SSI standards

3, 6

County Manager (Strategy)

4. Finance/Revenue

4.1 Establish new financial management arrangements in integrated structures

4.2 Achieve balanced budget and savings target of 2.5%

From April 2003

Services delivered to budget and in accordance with Standing Financial Institutions

4, 5, 6

5,6

County Manager

(Operations)

5. Finance/Capital

Improvements to 219 West Street, Hewatt House, Gosport, Junction Road and TVS CMHT through Supplementary Credit Approvals and NHS funding

5.1 Petersfield CMHT

5.2 Funding joint information systems through SCA (see information and performance management).

Actions in Standard 4

County Manager

(Strategy)

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD person

1. Recruitment and retention plan

1.1 Recruit to new posts identified in LDP priorities (Standards 4 and 6)

1.2 Establish senior practitioner ASW in each CMHT

1.3 Evaluate effectiveness of current Social Care recruitment and retention strategy for Best Value Improvement Plan

1.4 Agree a joint agency workforce Strategy and Action Plan

By 2006

Review Nov 2003

Joint Strategy March 2004

ASWs/100,000 population

Number of workers in post per locality

5, 6

5, 6

County Manager (Operations)

Strategic Service Manager (Margot Mottershead 1.3)

2.Care Standards Act/ GSCC Code of Practice

2.1 All social care staff to be trained to the minimum standard required by regulations

2.2 Establish training pathways for:-

(a) ASWs, including reapproval

(b) Non-professionally affiliated staff (including access to DipSW) Managers

Barbara Evans to input

March 2004

Numbers of staff with relevant qualification

Pathways in place

5

5

6

6

Training Project Manager

Training Project Manager and Practice Development Manager

3. Maintaining IIP Standards

3.1 All staff have supervision and annual performance development in accordance with agreed guidelines

Reviewed by March 2004

% of staff meeting full requirements

5, 6

6

County Manager (Operations) and Locality Mangers

County Manager (Strategy) for commissioning staff

3.2 Joint NHS/Social Services team briefing system is in place and audited for effectiveness

Implementation begun and subject to

% of staff receiving an briefing

5, 6

6

County Manager (Operations) and Locality Mangers

4. Support staff to implement an integrated service

4.1 Development of induction standards

4.2 Training and development programme for new managers

4.3 Training and development programme for integrated teams

4.4 Establish processes to jointly commission training (Social Services, NHS Trust and voluntary sector/ TOPPS and Workforce Confederation

4.5 Pilot learning set for Commissioners in partnership with South East England Development Centre

October 2003

5, 6

6

County Manager (Operations) / Training Project Manager

5. Role Profiling

5.1 Complete role profiling and link between qualifications and pay

5.2 Implement consistent approach to profile of Day Services' Officers

October 2003

October 2003

5, 6

5, 6

6

6

County Manager (Operations)

Strategic Service Manager (Gill O'Leary

6. Introduce effective systems to ensure maintenance of high practice standards

6.1 Revise Mental Health Act Practice Handbook

6.2 Establish practice development networks for social care practitioners

March 2004

March 2004

5

5

6

6

Practice Development Manager

7. Users and Carers

7.1 The Recovery Model of Mental Health is promoted among staff and built into training programmes, supervision and PDPs (see Standard 1)

7.2 Users and carers receive training to enable effective participation in service development and delivery

Review March 2004

Review Matrix contract in NE Hants in February 2004

Numbers of users/carers who have received training

3, 5

3, 6

6

5

Training Project manager / Practice Development Managers (and all Managers)

Local Action

Milestone

Performance Indicator

SSD Objective

Corporate Objective

Lead SSD person

1. Implementation of the Pan-Hampshire Adult Information System (PHAMIS) (subject to business case approval)

2. Development of IT infrastructure including:-

(a) Links between Hantsnet and NHS net

(b) Contingency plan for use of SWIFT as a parallel or alternative system to PHAMIS

3. Effective use of information systems in CMHTs for practice and management purposes

3.1 Agreed processes in place for data recording and use of e-CPA

3.2 Implementation of Mental Health Minimum Data Set

3.3 Development of `information culture' to achieve effective implementation

Business Case May 2003

Contract September 2003

Phased implementation from October 2003

Timetable to be agreed

Number of bases to be connected

Social Services Department can report on PAF PI

4, 5, 6

4, 5, 6

4, 5, 6

5, 6

5, 6

5, 6

County Manager (Information) / County Manager Mental Health Strategy

County Manager (Information) / County Manager Mental Health Operations

County Manager Operations