Archived decisions

Theme from consultation

Overview of comments

Response from HCCAS and HPCT

Support for direction of draft strategy.

Good summary of current position and gaps identified.

Welcome agreement from both HCCAS and HPCT on joint priorities.

Support for: early intervention, use of technology, well-being interventions, the general hospital experience, the emphasis on person-centred care and the focus on information.

Keep on talking to people from all communities.

Suggestions for further development of needs led care pathways.

HCCAS and HPCT will approve the draft strategy following formal consultation and we will continue to engage with our stakeholders as we implement it.

We welcome the comments received and the needs led care pathways will be further refined during implementation.

Concern about sufficient resources to implement the strategy:

· Money

· Staff

· Training.

More funds needed for older people's mental health; specifically more resources for prevention. Move resources from general hospital to community.

Concern that services are sparse in some areas and may be further reduced.

Staff training is cited by many as vital to support person-centred care in all sectors.

Concern about reliance on voluntary provision.

Welcome formalised links between voluntary and statutory sectors and expanded provider role of voluntary sector.

Mapping the total HCCAS and HPCT resources spent on older people's mental health services in all sectors of care is an early priority to identify areas of overlap / gap and opportunities to work better together at targeting resources where they are needed.

Since publication of the draft strategy, new national funding has been announced:

· to enable more personalised social care services and support

· for carers

· for psychological therapies to support those with mild to moderate mental ill-health.

These will support delivery of improved outcomes for older people with mental health needs and their carers.

Any specific decisions arising from the strategy about disinvestment or reinvestment in services will require separate business cases so that they can be assessed.

Development and implementation of a joint training plan for staff across health and social care is an early priority.

HCCAS and HPCT are committed to working with the voluntary sector and proactively engaging with them as a key player in the market as a provider of services.

Concern about health and social care organisations working collaboratively to implement the strategy.

It will be a challenge to keep this strategy as a priority and co-ordinate across all strands of the plan and link with related work streams.

There needs to be an implementation plan.

Concern that the governance arrangements `have teeth' and that the voluntary sector is included.

More and better co-operation needed between both HCCAS and HPCT at strategic, commissioning and operational levels

Health and social care integration in community mental health teams.

No specific target dates are included.

Need to adopt new approaches to joint working and to deliver planned improvements.

Strategy needs to be fully implemented across the county.

Need for improved working across Authority boundaries.

A Joint Implementation Board will be set up to oversee implementation of this strategy against agreed project plans. The Assistant Director (Commissioning and Partnerships) from HCCAS and the Area Director of Commissioning responsible for commissioning older people's mental health services from HPCT will be core members of this Board, which will report to the management boards of both HCCAS and HPCT. A jointly funded project manager will be appointed.

It is proposed to test proposals and implement the strategy initially in one locality in Hampshire: the Winchester, Eastleigh and Test Valley area. We will then look to transfer learning across the county, whilst recognising that a "one size fits all" is not appropriate. A steering group will be established to support implementation in the Winchester area and a detailed implementation plan will be developed.

Both HCCAS and HPCT are keen for the high level of stakeholder engagement achieved in developing this strategy is continued during implementation and in the governance arrangements.

All areas in Hampshire will meet the agreed standards for integrated working between social care and specialist mental health services and there will be further work on developing joint assessment processes.

We plan to implement this strategy in line with other key areas of work for both HCCAS and HPCT (e.g. the Carers', Older People's Well-being and Primary Care Mental Health strategies) and we will identify how each of these will deliver improvements for older people with mental health needs.

The national dementia strategy is due to be published in 2008 and we will take account of what that says for Hampshire. The national strategy will also support us in implementing our plans.

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

(See the Equality Impact Assessment for a full response to this question.)

Older people are disadvantaged generally in society and do not receive a fair share of resources.

Concern about older people unable to speak up for themselves, or who felt disempowered and for those who live alone and have no one to speak for them.

Need for support for older people who use deaf sign language.

Need for advocacy services and independent advice and support for older people with mental ill-health to take up direct payments.

Little mention of people with young onset dementia and no mention of older people with learning disabilities and dementia or people with substance problems.

HCCAS and HPCT both recognise that providing services for older people with mental health needs is a core business activity. Spending on older people's services has increased and is likely to continue to increase in the coming years to meet demand from the growing population of older people.

Hampshire's Older People's Well-being strategy seeks to identify ways to expand access for older people to universal services.

Raising awareness and understanding in the general population about mental health issues for older people and reducing the stigma associated with such conditions is a priority. The publication of the first ever national strategy for dementia in 2008 will support our efforts in this.

The Mental Capacity Act provides a framework to support decision making in the best interests of those older people who lack the capacity to make their own decisions. There is a comprehensive training programme for all health and social care staff to support implementation.

The needs of older people who use deaf sign language - the training strategy will pick up awareness issues with staff and the availability of communication support will be referred to HCCAS sensory team.

Development of advocacy services is not directly covered by this strategy and remains an outstanding issue to be addressed as we implement the plans.

This is the first Hampshire joint strategy for older people's mental health and its purpose is to lay the foundations for commissioning improved services for this group. People with young onset dementia, substance misuse or learning disability are not excluded from the scope of the strategy. The strategy is intended as a building block for further development and service redesign will benefit others.

Concern about the experience of an older person with mental health needs in the general hospital setting.

Need access to specialist care and support and access to inpatient services that are sensitive to the needs of this group.

Need for clarity on responsibilities and care pathways at interface between community and hospital care.

Improve information sharing in hospital.

Consider alternatives to general hospital.

Engaging general hospitals in the strategy is vital.

By taking a `whole system' approach to implementation in one area in Hampshire, we will be able to follow the individual's experience through all aspects of the care pathway, including their stay in a general hospital.

A focus on the pathways in and out of hospital for an older person with mental health needs is a key strategic priority. Also an early priority is investigating how beds in general and community hospitals are used and looking at whether people's care needs might be met in an alternative setting, either through avoiding admission or earlier discharge.

There is a Hampshire wide group established to support implementation of this strategy with cross agency and multidisciplinary representation from the general and community hospitals, plus voluntary sector and carer representatives.

Welcome support for carers and that this will enable improved support for older people with mental health needs.

Carers are often isolated.

Need to demonstrate valuing of carers' contributions.

Need for early access to information and one point of contact.

Need training for carers in handling behaviours that challenge.

Need for: carers' assessments, transport, specialist day opportunities, crisis support, sitting services and respite services.

The support that carers provide is recognised as critical to enabling older people with mental health needs to maintain their independence.

Early access to information for carers and for older people experiencing mental ill-health is a first priority and the Alzheimer's Society will be leading this work, engaging with General Practitioners and other staff / agencies who have an interest.

We will pick up training for carers as we implement the strategy.

This strategy covers community based support, crisis response services and respite. The Older People's Well-being strategy considers transport issues.

Other issues raised.

Suggestions about quality indicators in relation to well-being, clinical outcomes and the general hospital experience.

What engagement will there be with District/Borough councils?

Need to take account of the different collaborative working arrangements in north-east of Hampshire.

Lack of reference to primary care's role.

Suggestions for enabling early diagnosis and management: open access assessment services, role of the GP.

We welcome all suggestions about what to measure in services for older people with mental health needs.

We will work closely with the District/ Borough Councils on the early priorities to increase the use of telecare and extra care housing for older people with mental health needs.

Provision of mental health services by Surrey and Borders Partnership NHS Trust and cross boundary flows into Surrey mean that this part of Hampshire has unique characteristics. We will make sure that these are recognised within the governance arrangements for implementing the strategy.

Primary care is a vital element of services for older people with mental health needs, specifically: in early intervention/diagnosis, prevention, access to information, access to treatment and care for mild to moderate mental health needs, medicines' use and prescribing; and GPs in particular play a vital role as an older person with mental ill-health travels through the care pathway. The aim is to support GPs and primary care in these roles.

We will need to determine how and where to enable early diagnosis, as there are various models, including memory clinics. Providing generic care staff with assessment skills will be part of the training strategy. Early diagnosis is a major theme of the forthcoming national dementia strategy.