Contact: Lucy Butler

1. Summary

1.1 This report summarises:

· progress made on implementing the key national targets from the Annual Monitoring of the Mental Health National Service Framework (NSF) 2006, particularly where further work in social care aspects was indicated in the report of 10 October 2007: suicide prevention and appointment of Community Development Workers

· progress made on implementing the action plan in Hampshire Partnership NHS Trust (HPT) to address the National Patient Survey 2007 results

· the targets, with reference to the social care aspects, of the annual Monitoring of the Mental Health NSF 2007

1.2 The outcomes will impact on the delivery of the following Corporate Priorities:

· Hampshire safer and more secure for all - through suicide prevention strategies and implementation of Delivering Race Equality, which include reduction in fear of services and through implementation of the Mental Health Act 2007 and Mental Capacity Act 2005, which reduce risk

· Maximising wellbeing - particularly through services addressing social inclusion, recovery and commissioning

2. Recommendations

a) The Safe and Healthy People Select Committee are asked to note and comment on the contents of this report

3. Background

3.1 Mental Health NSF

3.1.1 The Mental Health NSF, published in 1999, describes a range of services required for a modern mental health service and spells out a ten year programme for modernisation. Subsequent guidance on a number of services has been published. National discussions are currently taking place on the post ten year programme.

3.1.2 Primary Care Trusts (PCTs) and the County Council's Adult Services hold joint responsibility for the implementation and monitoring of the NSF. Local Implementation Teams (LITs) are the primary vehicle for achieving this. Since January 2008, the LITs have been reduced from 7 to 3: North (covering Basingstoke and Alton/Bordon), West, covering the New Forest, Eastleigh, Romsey, Winchester and Andover, South East, covering Havant, Petersfield, Fareham and Gosport, with a Stakeholder Group in North East Hampshire, which joins with North Hampshire for annual monitoring purposes. Each LIT is chaired by either a Hampshire PCT or Adult Services Commissioner. The LIT chairs report to the Joint Mental Health Commissioning Board, chaired by the Adult Services Assistant Director Commissioning and the PCT Area Director of Commissioning.

3.1.3 There have been annual assessments on a range of targets since 2000, which change depending on national progress on implementation, and in recent years a themed review. The 2006 themed review was on dual diagnosis and in 2007 the subject is commissioning. This report describes progress in the LITs on the 2006 assessment and shows the 2007 targets, which have increased in number and require additional evidence, with greater emphasis on social care aspects.

3.2 National Patient Survey 2007 (NPS)

3.2.1 The Healthcare Commission undertakes an annual survey of people accessing adult and older person's community mental health services. In HPT, 850 people on standard or enhanced Care Programme Approach (CPA) were surveyed in 2007, with a 45% response rate, one of the highest in the country. Following receipt of the results, action plans were incorporated into the Trust's Service User and Carer Involvement, National Patient Survey and Choice workplan for 2007-08.

4. Progress on the annual monitoring targets of the NSF 2006

4.1 Progress has been made on the appointment of Community Development Workers (CDWs) since October 2007. There are now 9 funded posts within Hampshire and 8 workers in post, one having left in March 2008. Additionally there are 2 new specialist pan-Hampshire posts for children and older people, which will be advertised shortly. These CDWs meet as a group with their colleagues from Southampton, Portsmouth and the Isle of Wight and they attend the LITs to give voice to BME communities.

4.2 In respect of suicide prevention, there is work in progress to develop a single suicide prevention strategy across the PCT to replace the 7 original PCT strategies. Adult services are represented in the working group. Additional work is taking place on data collection from both Coroner's Courts and Provider Services to ensure that information is obtained in a timely way. Provider Trusts currently undertake annual suicide prevention audits, the results of which will be reported to the LITs in future. It is anticipated that there will also be further work on the sharing of findings from Critical/Serious incidents across organisations to improve the learning of lessons.

4.3 Work is ongoing to complete the Joint Hampshire Commissioning Strategy for Adult Mental Health, which should be open to consultation in late summer. This document will provide an overview of the joint work programme of Adult Services and the PCT to improve mental health services, picking up all aspects of the annual assessment that require actions to achieve a green rating.

4.4 A draft personality disorder strategy has been written on behalf of the Hampshire and Isle of Wight Mental Health Network, which is currently being reviewed by members of the network. Decisions about future actions will be made at the Network meeting on 30^th April. Funding has been identified to employ a Project Manager to work exclusively on this project for the Network partners.

4.5 Links have been made with some of the Hampshire Action Teams and Local Strategic Partnerships to ensure that the needs of people with mental distress and social exclusion have been taken into account in their workplans. Additionally each LIT will be working on updating and implementing the social inclusion plans, previously developed, during 2008-09.

4.6 Good progress has been made within Hampshire Partnership Trust to ensure that people with learning disabilities and mental illness receive a service of the same standard as people without learning disabilities. It is anticipated that there will be a green rating in the 2007 annual assessment on this target.

4.7 A review of mental health advocacy contracts is currently taking place within Adult Services and the PCT prior to a re-tendering in March 2009. The aim is to extend provision of advocacy to areas currently receiving less service, such as the New Forest and community services in parts of Hampshire. This was extended by 3 months to ensure the tendering coincided with tendering for Independent Mental Health Advocacy as provided in the Mental Health Act 2007. To date information is awaited from Government regarding the funding and tendering of this new service.

5. Progress on the workplan following the National Patient Survey 2007

5.1 Hampshire Partnership Trust incorporated actions needed to improve on the patient survey results into an overall workplan to improve the involvement of and services for users and carers, lead by the Associate Director of PALS and Consumer Affairs and overseen by the Service User and Carer Committee.

5.2 Since the October report further analysis of the results has shown that the following areas had statistically significant decreased scores that required actions to improve:

· Less people said they had seen a psychiatrist in the last 12 months

· More people said they had seen 2 different psychiatrists at their last 2 appointments

· Less people said they had been given or offered a written or printed copy of their care plan

· Less people said they understood what was involved in their care plan

· Less people said they were definitely involved in deciding what was in their care plans

5.3 The Trust has produced a folder and leaflet on CPA which is given to all service users; this is currently undergoing evaluation. It will require updating following the recent publication of the Government review of CPA.

5.4 Service users are now involved in the CPA training programme, which focuses on recovery and strengths based model.

5.5 100% of the care plans address work and leisure needs and 100% are reviewed within the timescales agreed.

5.6 A target has been set to ensure that 100% of service users prescribed new medication are offered a copy of written information. This target has yet to be audited.

5.7 To address the need for improved access to psychological therapies, a Cognitive Behavioural Therapy (CBT) strategy is out to internal consultation and training for staff has enabled greater use of this therapy in the Trust.

6 Annual Assessment 2007

6.1 The annual assessment for 2007 is due to be completed by May 2008, so results are not yet available. The targets have increased to 25 this year, with changes to most of the retained ones - see appendix 3.

6.2 There is a greater emphasis on social care aspects within the targets, as shown in the table in appendix 3. The views of Service Users, Carers and the Third Sector determine some of the scoring.

6.3 There is a requirement to show that organisations have plans in place to implement the Mental Capacity Act 2005 and the Mental Health Act 2007, which will score green.

6.3 Preliminary scoring indicates that further work is likely to be required on mental health promotion, primary/secondary care interface, access to psychological therapies and suicide prevention, implementation of the Older Persons' Mental Health Strategy, services for people with a learning disability and mental health in NE Hampshire, advocacy and dual diagnosis with substance misuse. All these areas are included in the Joint Hampshire Commissioning Strategy for Adult Mental Health and most are being worked on currently.

8. Impact and Implications

8.1 Legal

8.1.1 There are no legal implications, as plans are on target to implement the Mental Capacity Act 2005 and Mental Health Act 2007

8.2 Financial

8.2.1 At this stage work to address areas requiring improvement is contained within existing plans for Adult Services. Funding has been identified for work on the personality disorder strategy and the joint mental health strategy at no cost to Adult Services.

8.3 Personnel

8.3.1 No additional staffing requirements have been identified within Adult Services to undertake the NSF work programme. However, the limited available personnel in the PCT may cause delays in timescales of some of the work.

8.4 Impact Assessment

8.4.1 In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. Hampshire has been identified as a `Focused Implementation Site' for early implementation of Delivering Race Equality in mental health and this is included in the Local Area Agreement.

9. Conclusion and next steps

8.1 Progress has been made in all the NSF areas identified in the report of October 2007, however further work is needed on primary mental health services and strategy and mental health promotion. Once the personality disorder strategy is agreed, work will take place on developing the services for people suffering from personality disorders. The continued work on self-directed care and service user led services will impact on a number of the annual assessment targets. The development of the Joint Hampshire Commissioning Strategy for Adult Mental Health will ensure that all work is identified with timescales and monitored through the Joint Commissioning Board.

8.2 Progress has also been achieved on addressing areas of concern from the National Patient Survey within HPT. There is an action plan with timescales, monitored within the Trust through a Service User and Carer Committee.

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

· Mental Health NSF Annual Assessment 2006 results

· Mental Health NSF Annual Assessment 2007 targets

· Healthcare Commission (2007) Community Mental Health Services. The views of mental health service users. Key findings from the 2007 survey

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

· None

Appendix 1 - Glossary

Appendix 2 - Mental Health Autumn Assessment 2006

Appendix 3

Mental Health NSF Self Assessment Targets 2007/08