Archived decisions

Hampshire County Council

Adult Services Policy Review Committee Item 9

29 March 2006

Mental Health National Service Framework: Autumn Assessment 2005

Report by the Director of Adult Services

Contact: Graham Collingridge Ext: 847277

Email: [email protected]

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of the following Corporate Aims:

Aim 1 - Maximising life opportunities is achieved through Standard One of the National Service Framework through promoting good mental health and tackling discrimination.

Aim 4 - Building strong and safe communities is achieved through service developments described in the report 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 achieved through the training and workforce developments required by the National Service Framework to support service development.

1.	Summary

1.1	This report summarises the findings of the Autumn Monitoring of the Mental Health National Service Framework (NSF) 2005. Progress has been made in implementing key national targets including Crisis Resolution and Home Treatment teams. Plans are also in place to establish Early Intervention in Psychosis Teams by April 2006. These plans include an agreement to fund twelve additional social work posts from health service resources. Further work is required to meet targets for mental health services in primary care and black and minority ethnic community development workers. 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.	Impact Assessment

2.1	In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. An assessment of the requirements of black and minority ethnic communities under the National Service Framework was made in November 2004 and reported to the Policy Review Committee in January 2005. Since then Hampshire has been identified as a `Focused Implementation Site' for early implementation of Delivering Race Equalities in Mental Health, and this is included in the Local Area Agreement.

3	Consultation with Local Members

3.1	There has been no specific consultation with local members on this County wide performance report.

4	Introduction

4.1	The Mental Health (NSF), published in 1999, describes the range of services required for a modern mental health service for adults of working age 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, carer's 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 December 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.
4.2	Performance in delivery of the Mental Health NSF contributes to PCT and Mental Health Trust Star Ratings. It also contributes to Adult 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.
4.2.1	PCTs and the County Council's Adult Services hold joint local responsibility for the implementation of the NSF. Local Implementation Teams (LITs) based on PCT localities are the primary vehicle for achieving this.
4.2.2	Many of the services required under the NSF are delivered jointly through a partnership between Hampshire Partnership NHS Trust and the County Council under a Section 31 Health Act integrated service agreement. Services in Blackwater Valley are delivered in partnership with Surrey and Borders Partnership NHS Trust.
4.2.3	Following significant underperformance against national targets in 2004 the Strategic Health Authority (SHA) identified mental health services as a key local priority, and established a Modernisation Board with PCTs, Hampshire Partnership Trust, Hampshire County Council, Southampton and Portsmouth City Councils. The SHA also identified £1 million pump priming to establish crisis resolution and home treatment, and early intervention in psychosis teams. The Board consulted on proposals to reduce inpatient beds from 25 per 1000 population to approximately 20 per 1000, with savings to be reinvested to provide long term funding for the new services. These proposals have included the funding of twelve additional social workers to be employed by the County Council.
4.2.4	Consultation with local people has indicated widespread support for the modernisation proposals. Some concerns have been raised about the location of specialist eating disorder and perinatal (mother and baby) services at Melbury Lodge in Winchester; of the closure of beds at Lee Grove House in Lee on Solent and in Havant; the accessibility of Romsey residents to the Woodhaven inpatient service in the New Forest; and the transfer of some day hospital services in Winchester to the Priory Gardens community support services. Most consultations raised issues regarding the availability of support to carers. Carers were concerned to ensure there is sufficient support available in a crisis in the new community based services. More generally, consultees emphasised the importance of developing primary care mental health services, access to a broad range of crisis services, and access to housing.
4.3	The current report describes the outcome of the Autumn Monitoring 2005 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: -
4.3.1	Self-assessment against thirty-nine target areas (forty two ratings due to data monitoring and user & carer involvement having subsections for each rating).
4.3.2	A themed review on choice (this included learning disability, older person's mental health and child and adolescent mental health services).
4.3.3	Financial mapping and submission for national analysis.
4.3.4	A local assessment was also made of the adequacy of child protection processes within mental health services.
4.3.5	Service mapping with submission to a national data base will take place at the end of March 2006.
4.4	Progress was monitored by the Strategic Health Authority (SHA) through validation meetings with LITs. The outcome of the Autumn Assessment in each LIT was communicated to the relevant PCT Chief Executive and the Director of Adult Services. Information on the self assessment, service and financial mapping is collated by the Department of Health for national monitoring purposes.

5	Outcome of Autumn Monitoring

5.1	Self Assessment In 2005 LITs assessed progress against thirty nine 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 2004 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.
5.2	The key messages from the self assessment are: -
5.2.1	There has been substantial progress in establishing Crisis Resolution and Home Treatment Teams, and significant progress in establishing Support Time and Recovery (STR) Workers, two key national targets. The STR workers should be in place by the December 2006 target date. There were also improvements in workforce planning and recruitment and retention, and a joint workforce plan, commissioned by the Workforce Development Directorate of the SHA and the County Council is near completion.
5.2.2	An exact comparison between 2004 and 2005 is not possible as new targets and tighter criteria have been introduced, but in Autumn 2004 there was an average of seven reds, thirteen ambers and twenty four greens in each locality, and in Autumn 2005 there was an average of four reds, nineteen ambers and nineteen greens.
5.2.3	Key national targets that are not being met include Early Intervention in Psychosis Teams, Graduate Primary Care Workers, and Community Development Workers for black and minority ethnic groups. Early Intervention in Psychosis Teams will be in place by April 2006 but will not be able to meet national activity targets. This situation is reflected nationally and the Department of Health is requiring local recovery plans to be in place to ensure that targets are met. In general, there were no clear funded plans in place to implement primary care graduate workers and community development workers. The Department of Health's position is that funding has been given to PCTs for these workers and they should now be in place (primary care workers) or being recruited to (community development workers). The SHA required submission of action plans for `Red' and `Amber' rated services following the Autumn Assessment and is currently assessing them.
5.2.4	Other issues arising through the Autumn Assessment process that require particular attention in the forthcoming year include: the remodelling of the roles and functions of Community Mental Health Teams (now that Crisis and Early Intervention Teams are in place); collaborative commissioning arrangements for specialist services and out of area treatments (identified by an Audit Commission report); preparation for a new Mental Health Act, including the development of advocacy services; the development of services for people with a personality disorder; and strengthening of joint work with the criminal justice service. The latter includes the development of suitable places of safety for people detained under the Mental Health Act, and mentally disordered offender schemes to divert people with serious mental health problems away from custody and into treatment where appropriate.
5.2.5	The review of child protection arrangements suggested that adequate arrangements are in place to safeguard children and address the needs of child carers. A number of localities requested a review of adult protection arrangements and this will need to be included in the work programme for the forthcoming year.
5.3	Choice Review The Choice Review identified the following priorities. An action plan has been agreed with Hampshire Partnership Trust to take these issues forward:
5.3.1	*Life choices*: maintaining people in, and supporting people to return to, employment, education and community participation; choice of support in community settings, including better access to direct payments, the use of advance directives, and access to psychological therapies; access to health promotion services; and tackling stigma and discrimination.
5.3.2	*Accessing and engaging with services*: this included access to information and to advocacy
5.3.3	*Assessments*: this emphasised empowering service users to shape the assessment process
5.3.4	*Choice of care pathways*: this included supporting people to manage their own conditions, access to alternative therapies, and choice of service provider
5.4	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.

6	Conclusion

6.1	The autumn monitoring of the Mental Health NSF 2005 identifies significant progress in implementing some of the key components of modern mental health services. Areas that require more focused attention in the coming year include the development of Primary Care services, and delivering accessible and appropriate services for black and minority ethnic communities. The momentum achieved for service improvement needs to be maintained in a challenging financial climate and in a period of significant organisational change.


Recommendation(s)

That:

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

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 2005: file held at Trafalgar House containing detailed reports on the assessment process.

Review of progress on implementing the National Service Framework for Mental Health in Hampshire and Isle of Wight 30 December 2005 (Hampshire and Isle of Wight Strategic Health Authority)

Appendix 1 - Glossary

Assertive Outreach	An active form of care and treatment for people with severe and persistent mental disorder who have difficulty in maintaining lasting and consenting contact with services.
BME	Black and Minority Ethnic group
BVH	Blackwater Valley and Hart
CMHT	Community Mental Health Team
CPA	1) Care Programme Approach - joint health and social care mental health assessment process 2) Corporate Performance Assessment
Crisis Resolution and Home Treatment (CRHT)	For adults with severe mental illness with an acute psychiatric crisis of such severity that without the intervention of a CRHT team would require hospitalisation.
Dual Diagnosis	(Also know as Co-Morbidity) A broad spectrum of Mental Health and Substance Misuse problems that an individual might experience concurrently.
Early Intervention in Psychosis	A service designed to intervene at an early stage in first episode psychosis for people aged 14 to 35. This is important as the first four years of psychosis carry the highest risk of serious sustained physical, social and legal harm.
EH	East Hants
ETVS	Eastleigh and Test Valley South
F&G	Fareham and Gosport
Gateway Workers	Work with Primary Care Teams, NHS Direct, accident and emergency and specialist services to respond to people with mental health problems who need immediate help.
Graduate Primary Care Mental Health Workers	Employed in Primary Care to support the delivery of brief, evidence-based effective interventions and self-help for people with common mental health disorders of all ages.
IOW	Isle of Wight
LIT	Local Implementation Team
LSP	Local Strategic Partnership
MH	Mid Hants
NF	New Forest
NH	North Hants
NSF	National Service Framework
PC	Portsmouth City
SC	Southampton City
SHA	Strategic Health Authority
STR Workers	Support Time and Recovery Workers help services users to have an ordinary life, assisting them with their every day, practical needs in whatever setting they find themselves to facilitate recovery.

Appendix 2 - Mental Health Autumn Assessment 2005

	SCPCT	NHPCT	BVHPCT	F&GPCT	EHPCT	MHPCT	IOW	PCPCT	NFPCT	ETVSPCT
1. Carer support workers	AMBER	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN
2. Graduate workers	GREEN	RED	RED	RED	RED	AMBER	RED	GREEN	RED	RED
3. Primary-secondary interface	GREEN	AMBER	GREEN	AMBER	AMBER	AMBER	GREEN	GREEN	AMBER	GREEN
4. Assertive Outreach	GREEN	AMBER	AMBER	AMBER	GREEN	AMBER	GREEN	AMBER	AMBER	AMBER
5. Crisis Resolution	GREEN	GREEN	GREEN	AMBER	AMBER	AMBER	GREEN	GREEN	AMBER	AMBER
6. Early Intervention in Psychosis	RED	RED	RED	RED	RED	RED	RED	RED	RED	RED
7. Secure Places/Intensive care	AMBER	GREEN	GREEN	AMBER	AMBER	GREEN	GREEN	GREEN	AMBER	AMBER
8. Acute Inpatient Services-service user feedback	GREEN	GREEN	AMBER	AMBER	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER
9. STaR workers	RED	RED	RED	AMBER	AMBER	GREEN	RED	GREEN	RED	RED
10. Prison (MH) Services	GREEN	GREEN	GREEN	AMBER	AMBER	GREEN	GREEN	GREEN	GREEN	GREEN
11. Gender - Sensitive Services	GREEN	GREEN	AMBER	AMBER	GREEN	GREEN	AMBER	GREEN	AMBER	AMBER
12. Housing	AMBER	AMBER	GREEN	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER
13. Local strategic partnerships	GREEN	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	GREEN	GREEN	AMBER
14. Service user led services	AMBER	AMBER	AMBER	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER
15. Mental Health of people with Learning Disabilities	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	GREEN
16. Help with employment	AMBER	GREEN	GREEN	AMBER	AMBER	GREEN	AMBER	GREEN	GREEN	GREEN
17. Vocational and Social Outcomes for people with mental health problems	AMBER	GREEN	AMBER	AMBER	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN
18(a). Data monitoring and governance	GREEN	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	GREEN	AMBER	AMBER
18(b).Implementing the policy Delivery Race Equality in mental health care	GREEN	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	GREEN	AMBER	AMBER
19. Community Development workers (Black and Minority Ethnic communities)	RED	RED	RED	RED	RED	RED	RED	AMBER	RED	RED
20. Representative workforce	AMBER	GREEN	GREEN	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	GREEN
21. Care Co-ordination	AMBER	AMBER	GREEN	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	GREEN
22. Co-ordination between age specific services	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	GREEN
23. Planning process	GREEN	AMBER	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN
24. Governance	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	AMBER
25(a). Service user involvement	GREEN	AMBER	AMBER	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER
25(b). Carer involvement	GREEN	AMBER	AMBER	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER
25(c). Not for profit Sector involvement	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN
26. Recruitment and Retention	GREEN	GREEN	GREEN	AMBER	GREEN	AMBER	AMBER	AMBER	GREEN	AMBER
27. Agency and Locum Staff	AMBER	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER
28. Workforce Planning	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER
29. Education and Training	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	GREEN
30. Employment of Service Users	GREEN	GREEN	RED	AMBER	AMBER	GREEN	AMBER	GREEN	GREEN	AMBER
31. Suicide prevention	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER	GREEN	GREEN	AMBER	AMBER
32. Advocacy	GREEN	GREEN	RED	AMBER	AMBER	GREEN	AMBER	AMBER	RED	GREEN
33. Mental Health Promotion -Standard one strategy	GREEN	AMBER	RED	AMBER	AMBER	AMBER	GREEN	AMBER	GREEN	GREEN
34. Specialist Services	GREEN	GREEN	GREEN	GREEN	GREEN	GREEN	AMBER	GREEN	GREEN	GREEN
35. Personality Disorder Services -Dedicated services within MH services system	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	GREEN	GREEN	AMBER	AMBER
36. Personality Disorder Services -Social inclusion and eligibility criteria for access to services	GREEN	GREEN	AMBER	AMBER	GREEN	AMBER	GREEN	GREEN	GREEN	AMBER
37. Personality Disorder Services -range of therapies offered and access from primary care	AMBER	AMBER	AMBER	AMBER	AMBER	AMBER	GREEN	RED	AMBER	AMBER
38. Mental Health Act 1983 Section 135/136/Places of safety	AMBER	GREEN	GREEN	AMBER	AMBER	AMBER	GREEN	AMBER	AMBER	AMBER
39. Dual Diagnosis (Substance misuse and mental illness)	GREEN	GREEN	GREEN	AMBER	AMBER	AMBER	AMBER	GREEN	GREEN	GREEN
TOTAL GREEN 207	25	22	19	13	20	22	16	31	23	16
TOTAL AMBER 176	14	16	16	26	19	18	22	9	14	22
TOTAL RED 37	3	4	7	3	3	2	4	2	5	4
Total Indicator Replies 420	42	42	42	42	42	42	42	42	42	42

Appendix 3 - Mental Health Autumn Assessment 2004

PCT LOCALITY

ETVS

F&G

BVH

IOW

Community Development Workers for BME communities

Red

Amber

Red

Green

Red

STaR Workers

Red

Amber

Green

Red

Green

Amber

Red

Suicide prevention

Green

Amber

Green

Red

Assertive outreach

Amber

Green

Red

Green

Crisis resolution

Red

Green

Red

Green

Amber

Early intervention in psychosis

Red

Secure places

Amber

Green

Amber

Green

Amber

Green

Amber

Acute inpatient services- ward organisation

Green

Amber

Gateway workers

Green

Red

Green

Carer support workers

Green

Amber

Green

Amber

Green

Graduate workers

Red

Green

Amber

Red

Care co-ordination

Green

Amber

Green

Amber

Provision - CMHTs

Green

Primary -secondary interface

Green

Amber

Local Directory

Green

Amber

Green

Red

Green

Access Booking and Choice

Amber

Green

Amber

Green

Prison MH Services

Green

Amber

Green

Women's services

Amber

Green

Amber

Green

Amber

Black and Minority Ethnic people's services

Amber

Supported employment

Amber

Green

Amber

Green

Amber

Green

Amber

Vocational and Social Outcomes for people with mental health problems

Green

Amber

Green

Red

Amber

Supported Accommodation

Amber

Green

Amber

Green

Amber

Green

Amber

Local Strategic Partnerships

Green

Amber

User led services

Amber

Green

Amber

Mental health of people with learning disabilities

Green

Amber

Green

Amber

Green

Amber

NHS Direct

Green

Transition protocols

Green

Planning process

Amber

Green

Governance

Amber

Green

Amber

Service user involvement

Amber

Green

Amber

Green

Amber

Voluntary sector

Green

Amber

Recruitment and retention

Green

Red

Amber

Green

Amber

Agency and locum staffing

Green

Red

Amber

Green

Amber

Green

Workforce planning

Red

Amber

Red

Amber

Education and Training

Green

Amber

Green

Amber

Employment of service users

Amber

Red

Amber

Red

Representative workforce

Green

Amber

Integrated Mental Health Electronic Record (MHER)

Red

Green

Red

Amber

Red

Amber

Single sex accommodation

Green

37a

Mental health promotion - standard one lead

Green

37b

Mental health promotion - standard one strategy

Amber

Green

Amber

Red

Green

Amber

Specialist services

Green

Amber

Mental Health Act - Section 135/136 Places of Safety

Amber

Green

Amber

Green

Dual Diagnosis

Green

Amber

Green

Red

Green

Amber

Total Green

233

Total Amber

144

Total Red

Total

440

This content is archived

How the conclusion in this report fits with the Corporate Strategy

Summary

Impact Assessment

Consultation with Local Members

Introduction

Outcome of Autumn Monitoring

Conclusion

15. Mental Health of people with Learning Disabilities