Archived decisions

Contact: Martha Fowler-Dixon

1. Summary

1.1 This report summarises:

· The findings of the Autumn Monitoring of the Mental Health National Service Framework (NSF) 2007, showing progress and actions to address targets requiring improvement.

· the use of the Mental Health Act 1983 (MHA 1983) in 2007/08 - work undertaken by Approved Social Workers (ASWs) in relation to assessments under the MHA 1983, including the County Council's use of Guardianship under the MHA 1983. Please note, statistics are available for Guardianship from April 2007 to March 2008, but only available from October 2007 to March 2008 for other detentions.

· the National Patient Survey 2008 results for Hampshire Partnership NHS Trust (HPT), with comparison to the previous year's survey and aspects to be worked on this year.

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

· Hampshire safer and more secure for all - through implementation of the MHA 1983, as amended by the MHA 2007 reducing risk to service users and others, through suicide prevention strategies and through implementation of Delivering Race Equality, to impact on reduction of fear of services.

· 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 (New Horizons), which will be in place after the 2008 Autumn Assessment.

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 in partnership with statutory and third sector organisations. The three Local Implementation Teams (LITs) and one Stakeholder Group is the primary vehicle for achieving this. Each LIT, chaired by either a Hampshire PCT or Adult Services Commissioner reports to the Joint Mental Health Commissioning Board (JCB), 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; commissioning in 2007. This report describes the LITs' self assessments on the 2007 targets, as ratified by the Strategic Health Authority (SHA).

3.2 Use of the Mental Health Act 1983

3.2.1 This section of the report details statistics relating to the County Council's role and responsibilities with regard to the MHA 1983. Under S114 MHA 1983 the Local Authority has a duty to appoint a `sufficient' number of ASWs to carry out its legal responsibilities. ASWs carry out a statutory function on behalf of the Local Authority which involves assessment of individuals who are identified as suffering from a mental disorder, (according to a legal definition), and are in need of hospital admission which might require detention. There were sixty-nine ASWs employed and warranted by Hampshire County Council during this reporting period, mainly based within the various integrated adult mental health community teams, with three based in older persons teams and six in the Out of Hours Team. The ASW service is managed in collaboration with Hampshire Partnership NHS Trust and Surrey and Borders Foundation Trust (NE Hants).

3.2.2 The MHA 1983 Section 7 (Guardianship) provides the local authority with powers in relation to people with mental disorder: to require residence, to require attendance at a specified time for the purpose of medical treatment, occupation, education or training, to require access by a doctor, approved social worker or other person specified by the guardian. Guardianship is used for number of purposes e.g.: ensuring that there is a proper legal framework within which to make care decisions where a person lacks mental capacity (particularly older persons with dementia requiring residential care); encouraging younger persons with severe mental illness to stay in one place and not drop out of services; enabling access to be given to socially withdrawn individuals who would otherwise refuse services at home leading to neglect; preventing exploitation by relatives or other carers.

3.3 National Patient Survey 2008 (NPS)

3.3.1 The Healthcare Commission undertakes an annual survey of people accessing adult and older person's community mental health services. In 2008 the survey was completed by 58 Trusts. Nationally there was a 34% response rate, a reduction on 2007 due to earlier sampling.

4. Outcome of the Autumn Assessment of the NSF 2007

4.1 Self assessment targets with social care element highlighted are shown in Appendix 2.

4.2 Self assessment outcomes for the Hampshire LIT areas and surrounding authorities are shown in Appendix 3.

4.3 Although it appears that the ratings have regressed since last year, it should be noted that only five retained the same wording as last year and the numbers of targets increased from twenty-six to thirty. There have also been changes to the LIT boundaries, which have affected the ratings.

4.4 All targets relating to teams - Crisis Resolution and Home Treatment, Early Intervention in Psychosis, Assertive Outreach and in-patient units - were green, as were the new targets relating to legislation (Mental Capacity Act 2005 and Mental Health Act 2007).

4.5 Progress made within HPT in meeting the mental health needs of people with a learning disability has resulted in an improved green score. The NE Stakeholder Group felt that although SABP had scored above national average on the Greenlight Toolkit, there were insufficient joint protocols, especially around commissioning, for an amber or green rating to be made. Progress to achieve a green rating will be monitored by the Stakeholder Group.

4.6 Vocational support meets the criteria for green rating in all areas but the NE, where there are no vocational advisors in place. A review of the contracts is about to start which will determine value for money and compare with the system in the NE which directly uses job brokers and Job Centre Plus. This review will be linked to the Improved Access to Psychological Therapies (IAPT) in primary care, which is aimed at increasing the numbers of people obtaining or remaining in work. The PCT has recently submitted their state of readiness for IAPT and are awaiting information about future funding.

4.7 An improvement on last year has shown the appointment to all the Community Development Worker (CDW) posts and subsequent to the Autumn Assessment, the appointment to two additional more senior posts leading on work with older people and young people from BME groups.

4.8 In respect of suicide prevention, there is work in progress, led by Public Health, to develop a single suicide prevention strategy across the PCT to replace the seven original PCT strategies with Adult Services represented on the working group. Provider Services have suicide prevention plans in place, thus scoring green, and currently undertake annual suicide prevention audits, the results of which are being reported to the LITs. However, there is currently no progress on mental health promotion, also a public health responsibility.

4.9 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 it 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.

4.10 Work is on-going within HPT to ensure that Places of Safety within in-patient units are available to all communities. There has been a delay in completing this workdue to staffing issues. Monitoring of this takes place within the multi-agency Criminal Justice Liaison Group.

4.11 Dual diagnosis was added to the targets in 2007 following the previous year's themed review. Work is in progress to write the required commissioning strategy, linked to the DAAT strategic review, undertake a needs analysis and ensure adequate funding to meet those needs.

4.12 A draft personality disorder strategy has been written on behalf of the Hampshire and Isle of Wight Mental Health Network and it was intended that a project manager be appointed to take the work forward. However, due to changes in the SHA, the network no longer exists and the future workstreams are not fully developed.

5. Use of the Mental Health Act 1983

5.1 The ASW Minimum Data Set information in Appendix 4 illustrates activity which ASWs have been involved in during the six month period from 1/10/07. Information from the previous six months is not available due to systems problems. The management and collection of ASW data is currently under review by the ASW Professional Development Manager and IT Services.

5.2 The number of referrals during the six month period is higher than those reported the previous year, probably due to improved data collection.

5.3 The recording period highlights the undertaking of 741 MHA referrals within Hampshire across services. Of these, 77.46% involved adults (aged 18-65), 0.9% involved people with learning disabilities, 17.9% involved persons over 65 years and 3.6% involved children and young people. The assessment of older people during this period is lower than previous periods when it was about 30%.

5.4 Out of the total 741 people assessed under the MHA, 4% were from ethnic minority groups, which is roughly consistent with the population figures extrapolated from the 2001 census.

5.5 Figures for Guardianship show a slight reduction, but preliminary data for 2008 indicates that to be reversed.

6. National Patient Survey 2008

6.1 See appendices 6 and 7 for details of the results and comparison with 2007 for HPT.

6.2 People receiving support from HPT report better than average outcomes in the following areas: - continuity of care from Psychiatrist - trust and confidence in CPN - being told who their care co-ordinator is - being given or offered copy of care plan - have number to call out of hours

6.3 HPT are very positive that service users' rating of their relationship with their Psychiatrist puts them in the top 20% nationally.

6.4 Since last year work on improving the numbers of people receiving copies of their care plan has resulted in an 11% increase in their rating, which is very positive.

6.5 This year they have made a decision to concentrate work on the areas where they scored in the bottom 20% nationally: other aspects of care planning and access to psychological therapy. In terms of care planning, they will be working on enabling service users to have more say in their review and to make the content more meaningful for them.

6.5 The 2009 National Patient Survey may concentrate on people in in-patient units rather than those living in the community, as currently.

7. Impact and Implications

7.1 Legal

7.1.1 There are no known legal implications for Adult Services.

8.2 Financial

8.2.1 At this stage work to address areas requiring improvement in the Autumn Assessment from an Adult Services perspective that may have financial implications has been highlighted in the budget planning process. Funding had been identified for work on the personality disorder strategy, but this is not currently confirmed. The PCT are awaiting information about the level of funding they will be granted for IAPT.

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 continue to 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, ending December 2008, and this is included in the Local Area Agreement.

9. Conclusion and next steps

9.1 Work continues to be required to achieve the targets of the Autumn Assessment and within HPT to increase the ratings given by service users, although improvements have clearly been made.

9.2 A joint workplan with the PCT has been developed to complete the work needed to achieve green ratings in the next Autumn Assessment, which will be reviewed at the Joint Commissioning Board (JCB). See Appendix 8. The LITs also have a reporting schedule to ensure plans are monitored and information reported to the JCB.

9.3 The review of the MHA data collection process that is taking place is to ensure that future information is captured effectively and accurately and with a minimum disruption to the delivery of operational services. It is planned that a report will taken to Executive Member in December proposing the introduction of portable electronic hardware to enhance the efficiency and accuracy of ASW recording of information.

9.4 From 3 November 2008, ASWs will become Approved Mental Health Professionals under the MHA 2007. All 78 currently working have received transition training and will be competent to work under the new Act. The use of the MHA as reported has not been changed.

9.5 HPT have plans in place to work on the two areas of the National Patient Survey that are rated in the bottom 20% nationally: care planning and access to psychological therapy.

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 2007 results

· Mental Health NSF Annual Assessment 2007 targets

· Healthcare Commission (2008) Community Mental Health Services. The views of mental health service users. Key findings from the 2008 survey

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

· None

Appendix 1 - Glossary

Appendix 2

Mental Health NSF Self Assessment Targets 2007/08

Appendix 3 Outcomes of the NSF 2007 Self Assessment

Appendix 4 Use of the Mental Health Act 1983 1 Oct 2007 - 31 Mar 2008

Appendix 5 Use of Guardianship 1 Apr 2007 - 31 Mar 2008

Appendix 6 National Patient Survey results for Hampshire Partnership Trust 2008

Appendix 7 Movement in HPS scoring for HPT

Appendix 8 Autumn Assessment Workplan

Annual Assessment Workplan

All actions to be reviewed at Joint Commissioning Board

Actions and monitoring incorporated into LIT monitoring arrangements