Contact: Graham Collingridge 01962 847277 [email protected]

1. Summary

This report summarises the findings of the Autumn Monitoring of the Mental Health National Service Framework (NSF) 2004. Progress has been made across a range of service areas but most key national targets remain to be met, including the need for crisis resolution and home treatment teams, early intervention in psychosis, and additional staff in Primary Care. Members are asked to comment on the findings of the Autumn Monitoring and advise the Executive Member of any issues that they consider merit further attention by the County Council.

2. Introduction

2.1 The Mental Health (NSF), published in 1999, describes the range of services required for a modern mental health service for adults of working age (excluding CAMH services), and spells out a ten year programme for modernisation. Specific targets have been set in the NHS Plan and subsequent guidance. They include Assertive Outreach Teams (by December 2003), Crisis Resolution and Home Treatment Teams, Early Intervention Teams, carers support and additional staff in primary care (by December 2004). There are other targets for community development workers for black and minority ethnic (BME) groups, and development of Support Time and Recovery (STR) Workers (by 2006). There is also a target to reduce the suicide rate by twenty per cent by 2010. A glossary of terms and abbreviations used in this report is found in Appendix 1.

2.2 Performance in delivery of the Mental Health NSF contributes to PCT and Mental Health Trust Star Ratings. It also contributes to Social Services Star Ratings and therefore to the County Council's Comprehensive Performance Assessment. The availability of modern mental health services is also a necessary pre-requisite for the implementation of proposed new mental health legislation.

2.3 Local responsibility for the implementation of the NSF is held jointly by PCTs and Social Services, with Local Implementation Teams (LITs) being the primary vehicle for achieving this. Hampshire and the Isle of Wight LITs are based on PCT localities.

2.4 The current report describes the outcome of the Autumn Monitoring 2004 of the NSF in Hampshire and the Isle of Wight, with particular reference to the seven LITs within the County Council's boundary. Autumn Monitoring included the following activities:-

2.4.1 Self-assessment against forty target areas (note that several targets are subdivided, so there are forty four rated items).

2.4.2 A themed review of issues concerning black and minority ethnic communities, to establish a local baseline of current activity.

2.4.3 Service mapping with submission to a national data base.

2.4.4 Financial mapping and submission for national analysis.

2.4 Progress was monitored by the Strategic Health Authority (SHA) through meetings with LITs. The outcome of the Autumn Assessment in each LIT was communicated to the relevant PCT Chief Executive and Director of Social Services, in addition to the LIT. Information on the self assessment, service and financial mapping is collated by the Department of Health for national monitoring purposes.

2.5 Successful implementation of the Mental Health NSF will support the aims of the Corporate Strategy in a number of ways. Aim 4, Building Strong and Safe Communities, is achieved through service developments that reduce risk to individuals with mental health problems, and in some cases to other people. Aim 5, Improving Services, is the main aim of the National Service Framework. Aim 6, Developing Councillors and Staff, will be achieved through the training and workforce developments required by the NSF.

2.6 The impact of the Mental Health National Service Framework on local black and minority ethnic communities is being assessed jointly by Local Implementation Teams as required by the Race Relations Amendment Act 2000. Preliminary findings are reported in section 3.3 below.

2 Outcome of Autumn Monitoring

3.1 Self Assessment

In 2004 LITs assessed progress against forty indicators rating each one Red, Amber or Green according to detailed national guidance. A Red rating usually means that there is little or no service in place that meets national requirements. Amber usually means some service is in place, and Green usually indicates a comprehensive service meeting all national requirements. The outcome (with the 2003 assessment for comparison) is shown in Appendix 2. It should be noted that precise definitions may change from year to year, but overall trends are still apparent.

3.2 The key messages from the self assessment are:-

3.2.1 There has been progress in improving implementation across a large number of indicators between 2003 and 2004. An exact comparison is not possible as new targets and revised definitions have been introduced and some targets removed, but trends are still apparent (the numbers below refer to the LITs within the County Council's boundary, and exclude the three unitary authorities). In Autumn 2003 most LITs across the area covered by Hampshire County Council reported an average of six reds, twenty two ambers, and fifteen greens. In Autumn 2004 this was an average of seven reds (due to the addition of new targets), thirteen ambers and twenty four greens.

3.2.2 A significant number of key services and national targets remain red because there is no service in place that meets national guidelines. This includes Crisis Resolution and Home Treatment, Early Intervention, Graduate Primary Care Workers, and an integrated mental health electronic record. The new targets for support, time and recovery (STR) workers and community development workers for black and minority ethnic groups are also largely Red. Workforce planning was also red in a majority of LITs. It is worth noting that the traffic light system does not tell the full story. For example, in Blackwater Valley there has been significant investment in Crisis Resolution and this is expected to be amber if not green by April 2005; and in the North East Hampshire part of the LIT assertive outreach is green, but is adversely affected by the lack of a service in Surrey Heath.

3.2 Black and Minority Ethnic Reviews

3.2.1 Mental Health Services have been identified as a key area nationally where service improvements for black and minority ethnic communities are required. The themed review was intended to support improvements by enabling each LIT to benchmark its position. The Mental Health Act Commission is to conduct a national census of in patients in March 2005, to be followed by a census of community services in 2006, in recognition that the detailed picture at a national level needs to be improved. Locally, the findings from all the reviews will be collated to inform stakeholders of the key issues for action. These will be considered at a conference in February 2005, and will inform future work across the wider health and social care community in Hampshire and the Isle of Wight. The key messages from the reviews were:-

3.2.2 Strategic context: statutory partners had race equality schemes in place, with high level reports going to boards at regular intervals. LITs had not yet identified specific processes to assess systematically the impact of service developments on BME communities. In general, local authorities at County and District level appeared to be more ready to respond to the race equality agenda.

3.2.3 Service user and carer involvement: the proportion of BME people in the local population is often low and there is very little BME service user and carer involvement in service development.

3.2.4 Advocacy: advocacy services are at a minimum level and there are no specific initiatives for BME users.

3.2.5 Workforce: few LITs have specific plans to implement the new requirement for BME community development workers. Two LITs (Eastleigh TVS and North Hampshire) have development workers in their localities as a result of schemes that predate the mental health requirements, and some other LITs had considered the opportunities for developing schemes in partnership with district councils.

3.2.6 Race Relations Amendment Act: all LITs were aware of the requirements but had not had any specific training in it.

3.2.7 Treatment: there is no systematic monitoring of most treatment options given to BME service users at present. Much of this appeared related to the inadequacy of current information systems. Use of the Mental Health Act may be monitored by Trusts, and assessments under the Mental Health Act was reported to Social Care Policy Review Committee in September 2004.

3.2.8 Interpreter services: a language line and translation services are available to staff.

3.2.9 Partnerships: there appear to be no specific arrangements between LITs and specialist voluntary sector organisations.

3.2.10 All LITs reported that the process of undertaking the audit was extremely helpful in identifying key issues for further development. The February 2005 conference is a key part of the process of developing a set of action points to improve the responsiveness of local services to the needs of BME communities.

3.3 Service Mapping

Service mapping enables the Department of Health to identify progress in terms of the number of teams etc, in place in each LIT and SHA area. The information will be updated in Spring 2005 and used to inform star ratings for PCTs and Mental Health Trusts. The information is contained on a website (www.dur.ac.uk/service.mapping/amh) and reports can be run to compare different aspects of mental health services across the county. The electronic map can be converted into a local service directory if required.

3.5 Financial Mapping

A national summary of the financial mapping is being prepared by Mental Health Strategies (www.mentalhealthstrategies.co.uk) for the Department of Health. The completion of the exercise posed a number of significant challenges for NHS organisations including capacity and consistency of approach, and this is likely to be reflected when the national findings are published in 2005.

4. Overview

4.1 The key messages from the SHA to Chief Executives of PCTs and the Director of Social Services are:

4.2 It is a matter of serious concern that most of the key mental health targets will not be met by the due date. In many cases there was also little evidence of robust service and financial planning or of links with the Local Delivery Plan process. As a result the SHA has written to Chief Executives of PCTs requiring the following:

4.3 Written details of costed action plans to hit the mental health targets.

4.4 Details of the organisational arrangements for commissioning mental health services following the refocusing leadership process.

4.5 Request that mental health developments form a key part of a PCT's agenda at board and Senior Management Team level.

4.6 Introduction of robust business processes in LITs to ensure that the financial implications of service developments are properly costed and incorporated into the LDP.

4.7 Workforce and financial planning were posing significant challenges to a majority of LITs. The SHA will undertake some specific action planning with the Workforce Development Confederation to support LITs to implement national guidance regarding workforce planning. It will also undertake some specific work with finance leads to ensure that each locality has a clear understanding of its investment and a consistent approach to reporting.

4 Conclusion

4.1 The Autumn monitoring of the Mental Health NSF 2004 identifies the progress that has been made across Hampshire in implementing the National Service Framework. Whilst there continue to be improvements, there are significant gaps in key services such as crisis resolution and home treatment, early intervention and primary care graduate workers. At the present time there is little evidence that PCTs have adequate plans in place to address national requirements and achieve implementation of the NSF and the SHA has required PCTs to produce action plans to provide specific evidence of commitment to implement the NSF targets.

4.2 Members will want to keep appraised of progress, and where it would add value, to consider the option to refer particular issues to the Health Review Committee.

5 Recommendations

6.1 Members are asked to comment on the contents of this report and advise the Executive Member for Social Care of any issues that require further action

Background Papers

Section 100D - Local Government Act 1972 - Background Documents

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

N.B The list excludes:

1 Published works.

2 Documents which disclose exempts or confidential information as defined in the Act.

Mental Health Autumn Assessment 2004: file held at Trafalgar House containing detailed reports on the assessment process.

Appendix 1 - Glossary

Appendix 2: Mental Health Autumn Assessment 2004

Appendix 3: Mental Health Autumn Assessment 2003