Contact: Catherine Pascoe 01962 845649 [email protected]

1. Summary

The following decisions are sought:

a) That the Executive Member receives and accepts the outcome of the consultation.

b) That the Executive Member approves the final Joint Hampshire Commissioning Strategy for Older People's Mental Health needs.

c) That the Executive Member approves the implementation area and receives a report back in 12 months to approve the roll-out to the whole County.

2. Reason

2.1 There is already a high level of demand for services for older people with mental health needs, both in specialist and generic services.

2.2 A large increase in demand for services is anticipated over the coming years due to growth in the local population of older people.

2.3 It will not be possible to meet the growing demand within the resources available unless we change the way we currently deliver services.

2.4 Working together across health and social care services and wider communities should provide a much more effective and coordinated response to complex needs and promote independence and inclusion in society.

2.5 Therefore the Joint Hampshire Commissioning Strategy for Older People's Mental Health has been produced to provide a commissioning framework and identify priorities to support joint service development and modernisation over the next five year period. (See Appendix 3 for a summary of the strategy).

3. Other Options considered and rejected:

3.1 Continuing with separate NHS and social care strategies for mental health services for older people would exacerbate the difficulty that people find with the health and social care interface and would limit options for achieving better outcomes within the resources available.

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

Executive Member for Adult Social Care

Contact: Catherine Pascoe 01962 845649 [email protected]

1. Summary

1.1 Throughout 2007 a broad range of stakeholders were involved in the development of a Joint Older People's Mental Health (OPMH) Commissioning Strategy for Hampshire.

1.2 In line with good practice set out in the Hampshire Compact Agreement, the draft strategy was subject to a formal 12-week consultation period, between 3 December 2007 and 3 March 2008.

1.3 This report updates the Executive Member on the response to the consultation, seeks Executive Member approval of the final document and outlines the approach to be taken when implementing the strategy. Further more detailed implementation plans will be produced following final agreement of the strategy.

1.4 The consultation reinforced the direction of the strategy and in particular the key strategic priorities identified by Hampshire Adult Services and Hampshire Primary Care Trust:

· Supporting carers

· Promoting independence and access to universal well-being services

· Balancing specialist and generic services

· Pathways in and out of hospital

· Mechanisms to enable organisations and individuals to work together towards shared goals

1.5 Having taken into account all responses throughout the consultation and engagement process, it is therefore proposed that the draft strategy be approved, unchanged by both organisations. A summary of the Equalities Impact Assessment is attached at Appendix 1. A report on the formal consultation is attached at Appendix 2. An executive summary of the strategy is attached at Appendix 3. The full strategy will be available on the Hampshire County Council website.

1.6 Further work is required to identify the resource implications of implementing the commissioning intentions outlined in the strategy. Since the strategy must be implemented within the envelope of resources available, any decisions around disinvestment and reinvestment will be examined as separate but linked business cases.

2. Recommendations:

The following decisions are sought:

a) That the Executive Member receives and accepts the outcome of the consultation.

b) That the Executive Member approves the final Joint Hampshire Commissioning Strategy for Older People's Mental Health needs.

c) That the Executive Member approves the implementation area and receives a report back in 12 months to approve the roll-out to the whole County.

3. Definitions

3.1 Older people's mental health is often divided into functional mental health and organic mental health:

· Functional mental health refers to conditions such as depression, anxiety and psychotic disorders.

· Organic mental health refers to dementia.

4. Contextual information

4.1 A number of factors make this strategy an important piece of work:

· Currently there is a high level of need related to services for older people with mental health needs, both in specialist and generic services.

· A large increase in demand for services is anticipated over the coming years due to significant demographic changes and growth in the local population of older people.

· Services need to be aligned and coordinated across the health and social care system in order to support the needs of this client group.

4.2 Once agreed, the following organisations have confirmed their intention to implement the strategy:

· Hampshire Primary Care Trust (HPCT)

· Hampshire County Council Adult Services Department (HCCASD)

· Hampshire Partnership NHS Trust (HPT)

· Surrey and Borders Partnership NHS Trust (SaBPT).

4.3 A broad range of engagement has been integral to development of the strategy, including:

· Establishment of a multi-agency Steering Group

· A consultation exercise undertaken by the Alzheimer's Society on behalf of the Steering Group. 17 pre-existing groups of people who have an interest in older people's mental health were visited. These included 2 groups from black and minority ethnic communities and one gay group.

· Two workshops attended by representatives from a full range of stakeholders

· Multi-agency and multi-professional workgroups, with representation from carers and the voluntary sector, who considered:

- Needs based care pathways for dementia and functional mental illness

- The acute and community hospital experience

- Needs analysis and performance measures

· A formal 12-week consultation on the draft strategy

5. The strategy provides:

5.1 A commissioning framework for Hampshire County Council and Hampshire Primary Care Trust for older people's mental health services that will deliver:

· Clear statements of commissioning intentions

· A modernisation programme for health, social care, and voluntary sector providers

· Priorities that make a real difference in the short term to medium term

5.2 A robust analysis of the mental health needs of older people in Hampshire to inform commissioning.

5.3 A whole health and social care system focus for improvement that spans all aspects of the dementia and functional mental health needs based pathways for older people.

5.4 Cohesion with other related health and social care commissioning strategies, e.g. primary care mental health, day care activities, extra care sheltered housing.

6. Aims of the Strategy

6.1 The strategy aims to secure services that deliver:

· holistic, person-centred health and social care, which address mental, as well as physical health, needs and which provide dignity and respect

· flexibility and are able to change in line with people's unique circumstances, enabling independence and choice

· a comprehensive specialist older people's mental health service as part of a fully integrated pathway of care

· promotion of equity of access to services and support based on individual and population needs

· treatment and care based on the best available evidence of effectiveness.  

7. Commissioning priorities

7.1 Commissioning priorities have been produced based on:

· Needs led care pathways for dementia and functional mental illness (developed as part of this strategy), which take a holistic approach to an individual's needs

· The identified gaps in service

· Messages from people who use services, their carers and professionals

7.2 Hampshire County Council and Hampshire Primary Care Trust have identified five key strategic priorities, which target the areas which most need attention:

· Supporting carers, so that they themselves are enabled to provide care and support and are actively involved in planning care for the older person with mental health needs.

· Promoting independence and access to universal well-being services, so that individuals can maintain their independence and live as "normal" a life as possible for as long as possible.

· Balancing specialist and generic services through skilling up mainstream staff, removing barriers to services and gaining clarity on the respective roles and functions of specialist mental health and mainstream services, so that the majority of mild and moderate severity mental health needs can be managed in mainstream settings.

· Pathways in and out of hospital, so unnecessary admissions are avoided and the older person with mental health needs receives timely and appropriate care in response to their individual needs while in hospital and the focus is on maintaining independence on discharge.

· Mechanisms to enable organisations to work together towards shared goals, so that shared governance arrangements support delivery of the joint strategy.

7.3 A Joint Commissioning Strategy for Adult Mental Health is also under

development and a draft of this document will be subject to a formal consultation

period later in the year. Links have been made between the two documents,

particularly in relation to the functional mental health care pathway.

8 Formal Consultation for OPMH Strategy

8.1 In line with good practice set out in the Hampshire Compact Agreement, the draft strategy was subject to a formal 12 week consultation period, between 3 December 2007 and 3 March 2008.

8.2 Responses to the consultation largely support the proposals outlined in the strategy, though significant concerns were expressed about:

· The level of resources available to support implementation

· The need for health and social care services to work more collaboratively to support implementation

· Experiences of older people with mental health needs in the General Hospital setting

8.3 Further strong emphasis was placed on the need to support unpaid carers.

8.4 The strategy raises challenging issues around ageless services and the way in which resources are currently allocated based on client groups rather than need. This was reinforced by comments received in the consultation.

8.5 The consultation reinforced the direction of the strategy, in particular the key strategic priorities identified by HCC and HPCT.

8.6 The strategy will be further refined during implementation, especially the care

pathways.

8.7 A full report and response to comments received is attached in Appendix 2 and

will be available on the consultation website from the end of April.

9. Approach to Implementation

9.1 In order to get the maximum benefit in terms of achieving outcomes for older people and their carers when implementing the strategy, and given that so many elements of it are integrally related to others, it is proposed to focus the first stage of strategy implementation on one health and social care economy area. This should provide the best chance of delivering on whole systems change.

9.2 It is intended to test out proposals in one area and move on to other health and social care economy areas in due course, transferring learning from the initial implementation site. However, it is recognised that each health and social care economy area is different and it is not anticipated that a "one size fits all" approach can be adopted, whereby models that work in one area can be picked up and transplanted wholesale elsewhere.

9.3 The Winchester health and social care economy area, consisting of Test Valley, Winchester and Eastleigh districts has been identified as the preferred area since:

· It primarily serves Hampshire residents.

· It contains a mix of urban and rural areas.

· The County Council, the PCT and the Acute Trust are happy to engage.

· There are other related projects about to commence which could be influenced and engaged.

· It is a manageable area, but large enough to have a significant impact in the county.

10. Governance arrangements and leadership

10.1 A Joint Implementation Board for Older People's Mental Health will be established, which will oversee delivery of strategic priorities against agreed project plans. The Assistant Director (Commissioning and Partnerships) from Hampshire Adult Services and the Area Director of Commissioning responsible for OPMH commissioning at Hampshire Primary Care Trust will be core members of this board. Clear accountability lines back to the PCT and Adult Services management boards will be established.

10.2 A project manager will be appointed, jointly funded by Adult Services and HPCT and will be responsible for the overall coordination of the strategy and ensuring progress on implementation. Funding for this post from Adult Services will be found from existing resources.

10.3 The strategy refers to a number of other areas of strategic work currently underway, which are not being led by OPMH drivers but which are important in the context of delivering on outcomes for older people with a mental health need. For example, Extra Care Housing Strategy and Falls Prevention work.

10.4 In terms of governance arrangements it would not normally be expected to have progress on these other strategies monitored under the OPMH umbrella, however, since they are of real importance in relation to the whole system delivery of outcomes for older people with mental health needs, it is necessary to ensure that the OPMH agenda is adequately covered in these other areas of work. It is therefore proposed that project leads in these key areas will be required to specifically identify the OPMH deliverables for their pieces of work, so that these can be tracked and monitored by the OPMH Implementation Board.

10.5 In addition, any future reports to the Executive Member and to the Departmental Management Team in Adult Services concerning the development of older people's services will need to set out how they contribute to the OPMH Strategy, in order that the needs of older people with mental health issues are considered across the board.

10.6 A steering group will be established to support implementation in the Winchester area and a detailed implementation plan will be developed.

10.7 Both Hampshire Adult Services and Hampshire PCT are keen to ensure that the high degree of engagement of stakeholders achieved in strategy development thus far is continued during the implementation phase: in particular, noting the importance of service users, carers and voluntary sector engagement and ensuring continued representation in the governance arrangements.

11. Financial Implications

11.1 Detailed financial information on OPMH is extremely difficult to obtain both in respect of PCT and Adult Services funding. Work is continuing within both organisations to overcome the difficulty of extrapolating OPMH spending from more generic older people's or mental health spend. Indicative figures only are available and these are shown in the summary table below in order to provide an indication of the scale of provision. In the case of Adult Services figures, these are an estimate based on extrapolating 50% of the overall figure for older people.

11.2 The strategy needs to be implemented within the cash envelope available. Any decisions resulting from this strategy around disinvestment and reinvestment elsewhere must be examined as separate, but linked, business cases. In particular the strategy challenges the distribution of resources between working age and older people with mental health issues.

11.3 However, the challenge is not only in relation to how resources are allocated equitably between working age and older people's mental health services, but also how resources are allocated across all care groups in an equitable way. If the strategy needs to be implemented within the cash envelope available we will need to be clear what the particular envelope is: ie is this just the current resources spent on older people's mental health, or the current resources spent on mental health, or the current resources spent in Adult Services.

11.4 Hampshire Adult Services recognises that providing services for older people with mental health needs is a core business activity.

11.5 In January 2008 the Government announced the allocation of the new Social Care Reform Grant, provided to support the transformation of social care and delivery of more personalised services and support. Hampshire Adult Services receives £1.5 million for 2008/2009, plus further funds in following years.

11.6 Additional funding for carers has also been made available.

11.7 This is good news since, though these funds are not explicitly linked to the OPMH Strategy, the reforms to be achieved using this funding will support priorities identified in the OPMH Strategy, in conjunction with improving outcomes for all adult service users, and their carers, including older people with mental health needs.

11.8 In conjunction with identified statutory sector expenditure it is also essential that opportunities for attracting further grants/resources to support older people's mental health services, such as any future Partnerships for Older People Projects funding and access to funding for the voluntary sector, are proactively pursued.

12. Equalities Impact Assessment

12.1 The initial Equalities Impact Assessment work undertaken as part of the strategy development was expanded following the formal consultation process, when further information regarding any unintended consequences or practical implementation issues was gathered and considered in the development of the final version of the strategy. A summary of the Equalities Impact Assessment is attached at Appendix 1.

12.2 It is widely reported that people with mental health problems, black and minority ethnic communities and older people experience social exclusion. It follows, then, that black and minority ethnic older people with mental health problems are particularly vulnerable.

12.3 Generally access to services for black and minority ethnic older people and their carers remains problematic. Barriers include issues of language, knowledge of what services are available, and the attitudes and practices of service providers, as well as cultural factors in the perception and understanding of mental illness. Black and minority ethnic older people with mental health problems and their carers need to have access to appropriate and responsive services.

12.4 The development of this strategy has been informed by independent consultation (led by the Alzheimer's Society) which included stakeholders drawn from black and minority ethnic communities, mixed gender groups and people from the gay community. No concerns were expressed specifically in respect of these groups, however, issues have been identified in relation to age related barriers to accessing service and barriers in relation to diagnosis.

12.5 The clear commissioning intention in this strategy is to work towards removing barriers to accessing services based on age or diagnosis for all older people with mental health needs.

12.6 In addition, key priorities identified in the strategy focus on promoting social inclusion through the Older People's Well-Being Strategy, self-directed support agenda, opening out of day opportunities and promotion of awareness amongst the general public about dementia and depression in older age.

13. Delivering ageless services

13.1 The responses required to address functional mental health needs are different

to those required for dementia. Thus two separate care pathways have been developed as part of the strategy. The main concerns relating to barriers to accessing services based on age are linked with the functional mental health pathway.

13.2 The intention is to work towards providing services based on need and not age,

where such services may provide the most appropriate response for an older person or where a person over 65 years of age may choose to access working age adult services and these are able to meet their need.

13.3 This will put additional pressures on some working age adult services. The additional demand may result in working age services needing to reconsider how their resources can be used most effectively if resources continue to be allocated on the basis of client groups. However, any increase in demand for working age adult services which results from the proposals in this strategy will in no way equate to the demographic pressures and anticipated increase in demand that older people's services will experience.

14. Removing barriers to accessing mainstream services based on mental health need

14.1 If all current generic older people's community support services are to be accessible for individuals with mental health needs (including short-term crisis prevention, intermediate care, reablement and rehabilitation services) this raises significant workforce development issues, but also the need for clarity in relation to the roles of, and relationship between, specialist and mainstream services.

14.2 Further work outlined in the strategy to address these issues will be carried out as part of implementation in the Winchester area.

15. Conclusion

15.1 Hampshire County Council and its partners are committed to meeting the challenge of tackling increase in demand for services and support for older people with mental health needs and their carers over the coming years. Working together across health and social care services and wider communities should provide a much more effective and coordinated response to complex needs and promote independence and inclusion in society.

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

Appendices

Appendix 1 Equalities Impact Assessment summary

Appendix 2 Report on formal consultation

Appendix 3 Executive Summary - Joint Hampshire Commissioning Strategy for Older People with Mental Health Needs

The completed impact assessment needs to be published. Please send this to the relevant person in your department to ensure that it is up-loaded onto your departmental website.

Joint Hampshire Commissioning Strategy for

Older People's Mental Health

Response to Formal Consultation on the Draft Strategy

from

Hampshire County Council Adult Services and Hampshire Primary Care Trust

1. Introduction

1.1 The draft joint Hampshire commissioning strategy for older people's mental health was issued by Hampshire County Council Adult Services and Hampshire Primary Care Trust for a period of formal consultation between 3 December 2007 and 3 March 2008. A number of versions of the draft strategy were produced for this consultation:

· Short easy to read copy

· Executive Summary

· Copy of the full length draft document and appendices.

People were invited to answer some questions about the draft strategy and to give their views. We asked:

· Does the strategy reflect your views on current services?

· Do you think the strategy will help to make services better?

· Do you see any problems in putting this strategy into practice?

· Do think anyone is likely to be treated unfairly in putting this strategy into practice?

· Please tell us about any examples of services or support that that you have found particularly helpful.

1.2 A list of those involved in developing the draft strategy and of those invited to participate in the formal consultation is provided in Appendix A.

2. Who replied to the formal consultation?

2.1 A total of 46 replies were received to the consultation, either by using the questionnaire and/or by letter from a range of individuals and organisations. The majority of respondents, including many clinicians, were from health and social care agencies.

The organisations that responded were:

· User Groups:

Deaf Sign Language User Group

Hindu Carers' Group

Havant 50 Plus Forum

· Voluntary Organisations:

Winchester Alzheimer's Society

South East Hampshire Alzheimer's Societies (Hayling Island, Leigh Park, Fareham and Drayton)

East Hampshire Advocacy services

Basingstoke Voluntary Services

New Forest Branch Alzheimer's society

Rushmoor Healthy Living

Age Concern Hampshire

· Statutory Bodies:

Hampshire County Council Active Hearts Scheme

Basingstoke & Deane Borough Council

Hampshire County Council Older People's and Physical Disabilities directorate management team

Surrey & Borders Partnership NHS Trust

Hampshire Partnership NHS Trust

Hampshire Adult Placement Scheme

· General Practitioners:

Hart Locality Practice Based Commissioning group

Rushmoor Locality Practice Based Commissioning Group

Grange surgery, Petersfield

· Others:

Hampshire Domiciliary Care Association

Community Nursing Team

2.2 The draft strategy had been informed by a communications and engagement exercise with people who use older people's mental health services and their carers. The Alzheimer's Society had visited 17 pre-existing groups across Hampshire to find out what mattered to them and this feedback contributed to the draft strategy. During the consultation period, the Alzheimer's' Society went back to a sample of these groups to get their response to the questionnaire.

2.3 In addition to these organisations, responses were also received from a small number of individuals: from people who are carers, people who used older people's mental health services and members of the public.

2.4 Meetings were attended in the period leading up to and during the consultation with key individuals and groups:

· Alzheimer's Society Hampshire Network

· Age Concern Hampshire

· Hampshire Patient and Public Involvement Forum

· Hampshire Domiciliary Care Association

· Basingstoke and Deane Borough Council

· Hampshire County Council Members' Briefing

· Hampshire Primary Care Trust - Area Professional Advisory Committees (these include General Practitioners, pharmacists and other clinicians)

· Hampshire Partnerships NHS Trust - Directorate Service Boards for older people's mental health and adult mental health

· Care services senior managers - Hampshire Primary Care Trust

· Hampshire adult mental health commissioners

· Hampshire County Council Adult Services - contracts team

· Hampshire County Council Adult Services - district senior managers.

3. What people said in the public consultation.

3.1 Whilst it is not possible to glean statistically significant conclusions from the number of replies received, some clear messages and common themes have emerged from responses to the questions we asked and from other feedback received.

In summary these are:

· Support for the direction of the strategy, with a majority of respondents saying that the strategy reflected their views on the current state of services and was likely to lead to an improvement in services.

· Concerns and problems identified about putting the strategy into practice, especially about sufficient resources (money, staff and training) and about the need for health and social care organisations to work collaboratively to implement the strategy.

· Welcome for the emphasis on support for carers.

· Strong concerns about the experiences of older people with mental health needs in the general hospital setting.

3.2 Each of these themes, plus an overview of points made and the response of Hampshire County Council Adult Services and Hampshire Primary Care Trust is set out in the table below. The overview of comments received is not exhaustive.

Responses to the question asking "do you think anyone is likely to be treated unfairly in putting this strategy into practice?" are covered fully in the Equality Impact Assessment published by Hampshire County Council Adult Services and Hampshire Primary Care Trust.

3.3 A report of all responses to the consultation is available on request, including responses to the questionnaire and letters and comments received.

3.4 There were many suggestions made about services and support that people have found particularly helpful. It is important that we learn from what works well and so we will seek to provide opportunities for sharing good practice across Hampshire.

4. Conclusion

4.1 Hampshire County Council Adult Services and Hampshire Primary Care Trust have determined that the draft strategy will be approved by both organisations on the basis that the formal consultation reinforced the direction of the strategy, in particular the key strategic priorities of:

· Supporting carers

· Promoting independence and access to universal well-being services

· Balancing specialist and generic services

· Pathways in and out of hospital

· Mechanisms to enable organisations and individuals to work together towards shared goals.

4.2 Hampshire County Council Adult Services and Hampshire Primary Care Trust welcome the responses received during the formal consultation and will continue to engage with all stakeholders in implementing the strategy.

Key: HCCAS - Hampshire County Council Adult Services HPCT - Hampshire Primary Care Trust

Joint Hampshire Commissioning Strategy for

Older People's Mental Health

People involved in developing the draft strategy and invited to participate in the formal consultation

The draft Joint Hampshire Commissioning Strategy for Older People's Mental Health was developed with the involvement of a wide range of people, including those who use services and their carers:

· Age Concern Hampshire

· The Alzheimer's Society

· Basingstoke and North Hampshire Hospitals NHS Foundation Trust

· Basingstoke Sikh Society

· Carers Together in Hampshire

· Community Action Hampshire

· Care Services Improvement Partnership South East

· Eastleigh Asian Elders Group

· Frimley Park Hospital NHS Foundation Trust

· Hampshire County Council - Adult Services Department

· Hampshire County Council - Chief Executive's Department Older People's Wellbeing team

· Hampshire Domiciliary Care Association

· Hampshire Primary Care Trust

· Hampshire Partnership NHS Trust

· Hampshire Voluntary Care Group

· Portsmouth University Hospital NHS Trust

· Service users and carers via voluntary sector groups

· Solent Mind

· Southampton University Hospital NHS Trust

· Southern Focus Trust

· Surrey and Borders Partnership NHS Trust

· Voluntary sector Older People's Mental Health Reference Group (established by The Alzheimer's Society to work alongside the steering group for this strategy)

· Winchester and Eastleigh Healthcare NHS Trust

· Winchester City Council

People invited to participate in the formal consultation

· All of the above are being contacted again

· Acute Hospital Trusts Patient and Public Involvement Fora

· Ambulance Services

· Basingstoke Mencap

· Community Action Hampshire Health and Social Care Network

· District Councils

· East Hampshire Advocacy Scheme

· HAD Asian Deaf Community Project

· Hampshire Care Association

· Hampshire County Council Recreation and Heritage Department

· Hampshire Deaf Association

· Hampshire Health Overview and Scrutiny Committee

· Hampshire Partnership NHS Trust Patient and Public Involvement Forum

· Hampshire Primary Care Trust Patient and Public Involvement Forum

· MPs

· NHS South Central Strategic Health Authority

· North Hampshire Mental Health Forum

· Petersfield Citizens Advice Bureau

· Portsmouth City and Southampton City Health Overview and Scrutiny Committees

· Portsmouth Primary Care Trust

· Rethink UK

· Southampton City Primary Care Trust

· Surrey & Borders Partnership NHS Trust Patient and Public Involvement Forum

· Test Valley Community Services

Hampshire Primary Care Trust and Hampshire County Council

Joint Hampshire Commissioning Strategy for Older People's Mental Health

2008 - 2013

Executive Summary

Working in partnership with:

Executive Summary

The scale of the challenges facing Hampshire Primary Care Trust and Hampshire County Council Adult Services, in terms of population changes, growing demand for older people's mental health services and pressure on resources, means that we have to do things differently now. This strategy sets a direction of travel for 2008 - 2013 for all organisations and individuals involved in older people's mental health services that reflects national good practice guidance and that we believe will improve outcomes for older people with mental health problems and their carers.

In this Executive Summary we have proposed some early key areas to focus upon. The full draft strategy contains an overview of everything to be considered.

Why this is important

Depression severe enough to warrant intervention affects one in four older people living in the community. But only one in three of these will discuss the condition with their GP and only one half of those are diagnosed and treated.

Only a third to a half of older people with dementia receive a diagnosis.

Older People with a mental health need account for a significant proportion of those who use health and social care services. A conservative estimate is that:

· 40% of people attending their GP

· 50% of all general hospital inpatients and

· 60% of home care residents have a mental health problem.

One third of people who care for an older person with dementia have depression.

Older people occupy two thirds of hospital beds and 60% of these will have or will develop a mental disorder during their admission. The presence of mental health needs is an independent predictor of poor outcomes for the individual affected.

The direct costs of dementia (Alzheimer's Disease) alone exceed the total costs of stroke, cancer and heart disease in cost of illness studies.

There is a growing demand

Nationally, the number of older people with mental health needs will increase by 30% over the next 15 years.

In Hampshire, significant demographic changes and growth in the population of older people are anticipated over the period of this strategy - 2008 - 2013:

· 16% increase in older people with depression - around 5,500 additional people

· 15% increase in older people with dementia - around 3,000 additional people.

If there is no change to the way we currently deliver services, we will not be able to cope with this growing demand. The increase in funding allocated by the government for 2008 - 2011 to both Hampshire Primary Care Trust and Hampshire County Council will be consumed in meeting this increase in demand, unless we plan jointly to manage our current investment and resources more efficiently and maximise opportunities for older people's mental health.

The benefits of changing how services are delivered

By developing this strategy, we believe there will be improvements to the quality of life for both the older person with mental health needs and their carer.

Effective interventions will promote independence and inclusion in society.

Early diagnosis and treatment and no artificial barriers to access services in a mainstream or specialist mental health setting will enable:

· a coordinated response to complex needs

· planning to avoid crises and unnecessary admissions to hospital that can lead to increased dependency

· access to effective specialist mental health services.

Resources

We have assessed the current level of resources spent on older people's mental health services by Hampshire Primary Care Trust and Hampshire County Council Adult Services - see table below. This is an under-estimate and does not reflect all the associated costs linked to the care needs of older people with mental health problems, particularly in hospital where an individual may be treated for another illness.

Table: Expenditure on Older People's Mental Health Services

Current services - strengths and gaps

We have identified the strengths in our local health and social care provision for older people with mental health needs, for example specialist mental health services are generally well thought of, there are some excellent and innovative services in operation across Hampshire and there is a willingness to work collaboratively across agencies and sectors.

From the work we have done in mapping health and social care provision and in listening to staff from many agencies and to people with mental health problems and their carers, we know that there is variation across the county and that:

· Information and support is patchy and uncoordinated

· Accessing meaningful and stimulating things to do is difficult

· Statutory services are tightly targeted

· Access to respite care and the quality of care provided is variable

· Knowledge and skills about the needs of older people with mental health problems amongst mainstream non-specialist mental health staff is poor

· There is a lack of support in understanding and coping with behaviours that challenge

· Accessing specialist assessment and treatment in some general and community hospital settings is difficult

· There are issues about decisions about long-term care placement being made too early in the discharge process from hospital

· Access to some services is based on age not need

· Mainstream community services cannot always meet the needs of a person with mental health problems

· There are issues around support provided in a crisis

· There are difficulties with flexibility and continuity of provision

· Organisational boundaries can limit the ability to work together.

What we are trying to achieve

We are aiming to secure services that deliver:

· holistic, person-centred health and social care, which address mental, as well as physical health, needs and which provide dignity and respect

· flexibility and are able to change in line with people's unique circumstances, enabling independence and choice

· a comprehensive specialist older people's mental health service as part of a fully integrated pathway of care

· promotion of equity of access to services and support based on individual and population needs

· treatment and care based on the best available evidence of effectiveness.  

Our early commissioning priorities

We have produced our early commissioning priorities based on:

· the needs led care pathways for dementia and functional mental illness (i.e. depression, anxiety and psychotic disorders) that have been developed as part of this strategy, which take a holistic approach to an individual's needs

· the identified gaps in services

· what people who use services, their carers and professionals have told us.

Hampshire Primary Care Trust and Hampshire County Council Adult Services have identified five key strategic priorities, which target the areas that most need our attention:

1. Supporting carers

2. Promoting independence and access to universal well-being services

3. Balancing specialist and generic services

4. Pathways in and out of hospital

5. Mechanisms to enable organisations and individuals to work together towards shared goals.

Key: HCCAS - Hampshire County Council Adult Services HPCT - Hampshire Primary Care Trust

Key: HCCAS - Hampshire County Council Adult Services HPCT - Hampshire Primary Care Trust

Key: HCCAS - Hampshire County Council Adult Services HPCT - Hampshire Primary Care Trust

Key: HCCAS - Hampshire County Council Adult Services HPCT - Hampshire Primary Care Trust

nb* A "Balance of Care" project involves surveying bed utilisation in acute and community hospitals, specialist mental health inpatient services, residential and nursing homes. It creates a snapshot of the ages, conditions and status of patients in these beds on a single date and looks at whether their care needs might have been met in an alternative setting, either through avoiding admission or earlier discharge.

Key: HCCAS - Hampshire County Council Adult Services HPCT - Hampshire Primary Care Trust

How we have developed our strategy

There has been wide engagement from statutory and voluntary agencies and carers, plus support from the Care Services Improvement Partnership. A Steering Group with membership from Hampshire County Council Adult Services, Hampshire Primary Care Trust, Hampshire Partnership NHS Trust, Surrey and Borders Partnership NHS Trust and the Alzheimer's Society has been overseeing development of the strategy.

The Alzheimer's Society has undertaken a communication exercise to find out what matters to people who use older people's mental health services across Hampshire, including meeting service users and their families/carers from gay, black, minority and ethnic groups. We have included some of the things that they have said to us in the tables above.

In 2006 we assessed the level of service provision in Hampshire with the involvement of Older People's Local Implementation Teams (where they were operating).

Needs led care pathways for dementia and functional mental illness, i.e. depression, anxiety and psychotic disorders, which are based on national best practice, have been developed with the involvement of professionals and carers.

We have worked to achieve cohesion with other Hampshire strategies, e.g. Older People's Well-being, Carers, Sheltered Care Extra Housing, Day Opportunities, Mental Health for Working Age Adults and Primary Care Mental Health Strategies.