1. Summary

1.1 The following decisions are sought:

That specialist services for Older People with Mental Health needs are embedded in generic social care services for older people. The model aims to incorporate the best of what Community Mental Health Teams for Older People have to offer in terms of specialist expertise with a community service that responds to `all' of the older person and their carers.

2. Reason

2.1 This decision supports Aim Number One of the Corporate Strategy (Maximising Life Opportunities) by contributing to the Cabinet Priority for Older People and Standard 7 of the National Service Framework for Older People relating to mental health needs.

3. Other Options considered and rejected:

Findings from an analysis of national policy and practice, local and national research, performance data, fieldwork undertaken for this study have been used to develop a set of requirements for older people's mental health services in Hampshire against which options for change have been considered.

Three options were evaluated against the requirements. Option 1 was to stay the same, Option 2 to consolidate and expand the current Community Mental Health teams for Older People within existing commissioning and providing arrangements and Option 3 proposed a phased development of a Community Older Peoples Service within a countywide commissioning framework. Option 3 proved the best match with the service requirements.

4. Conflicts of Interest declared by the decision maker or other Executive member consulted -

None

5. Dispensation granted by the Standards Committee -

None

6. Reason(s) for the matter being dealt with if urgent -

Not applicable

Approved by: Date:

Councillor Felicity Hindson

1. Executive Summary

1.1 The core components of a high quality service for older people with mental health problems, synthesised from Standard 7 of the National Service Framework for Older People are:

1.1.1 Early detection and assessment, with primary care having a leading role;

1.1.2 Increasing emphasis on mental health promotion and prevention of ill-health;

1.1.3 Access to specialist services, advice and skills, treatment and rehabilitation, with an emphasis on provision at home and support for carers;

1.1.4 Care management, care co-ordination and treatment planning, including the transition of requirements of the CPA for older people with severe and enduring mental illness; and the implementation of integrated care pathways for dementia and depression;

1.1.5 Increased clarity about the roles and relationships between specialist services and teams, and generalist services including primary health and social care;

1.1.6 Continuous development from sharing good practice and learning from experience; and

1.1.7 Services that anticipate and respond to the needs of older people from minority ethnic communities and people with complex health and social care needs (eg with a learning disability).

1.2 Hampshire County Council, Hampshire Partnership trust and local PCTs are all committed to developing services for Older People with Mental health needs in line with the NSF targets and requirements. However, the developments are being undertaken separately resulting in an uneven service across the County with no unifying strategic vision.

1.3 A model of service for Older Peoples Mental health Services is required that addresses the full range of agencies concerns and requirements and provides a shared vision for those services alongside a robust County Council and PCTs commissioning structure and process.

1.4 A jointly commissioned specialist study by Hampshire Partnership Trust and Hampshire Social Services of the models available for the provision of service to Older People with Mental health problems and their applicability to Hampshire was undertaken from December 2003 to April 2004.

1.5 The main aim of the assignment was to formulate recommendations for effective integrated working for frontline specialist and generic health and social services workers providing assessment, care management and specialist professional input for Older People with Mental health needs in line with the NSF Standard 7.

1.6 While each of the seven PCTs have their own arrangement for specialist health provision for this service user group a common theme is the presence of some form of Community Mental Health Team (CMHT) in place alongside service provision such as in-patient beds, day hospital etc.

1.7 The Department's involvement with these specialist teams and services differs across the county and has been negotiated on a local area basis. We also directly provide or purchase a wide range of social care support services for older people with mental health needs and their carers, with cross county strategies for some service areas such as nursing and residential care, the OT Direct service and care management policies and procedures.

1.8 Available information also suggests that:

1.8.1 There are significant numbers of older people within the Hampshire population with dementia who are not active cases to either Social Services generic Older people teams or the Hampshire Partnership Trust CMHTs.

1.8.2 23% of Older People open as cases to Social Services and defined by care managers as having Mental Health needs are not accessing specialist mental health support.

1.9 There is considerable agreement about the strengths and weaknesses of the current service design. Analysis of these strengths and weaknesses show that while they are generally functioning well for those people who receive it, there is concern about the range and scope of these services being insufficient for the number of local older people with mental health needs both now and in the future.

1.10 Findings from the analysis of national policy and practice, local and national research, performance data, fieldwork undertaken for the study have been used to develop a set of requirements for older people's mental health services in Hampshire against which an option for change has been developed.

1.11 The proposed Hampshire Strategy and model is a phased development of a Community Older Peoples Service within a countywide commissioning framework. This option aims to incorporate the best of what CMHTs have to offer in terms of specialist expertise with a service that responds to `all' of the older person and their carer.

1.12 The strategic aims and objectives for a Hampshire model are:

1.12.1 To provide person centred, outcome focussed assessment, treatment and care services to Older People with Mental health needs and their carers across the local health economy in Hampshire that is user influenced, holistic, responsive and high quality by:

1.12.1.1 Establishing a Community older persons Service in each PCT area that brings together health and Social Service professionals for Older People into `virtual' or completely integrated working arrangements depending on local requirements, and subject to an explicit cost benefit analysis;

1.12.1.2 Social Services and the local PCTs developing a Hampshire Countywide Older Peoples Mental Health Strategic Commissioning Framework and Process complementing the LIT process;

1.12.1.3 Building a strong, well informed and mutually supportive workforce where individuals work within their own acknowledged professional expertise as well as being part of a single process to support Older People.

1.13 There are no immediate financial or workforce implications but these will emerge through the development of an implementation plan.

2.0 Recommendation

2.1 That specialist services for Older People with Mental Health needs are embedded in generic social care services for older people. The model aims to incorporate the best of what Community Mental Health Teams for Older People have to offer in terms of specialist expertise with a community service that responds to `all' of the older person and their carers.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have 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 or confidential information as defined in the Act.

None