Agenda item

Joint Briefing Note

Representatives from Coventry and Warwickshire Partnership Trust and Coventry and Warwickshire CCGs have been invited to the meeting for the consideration of this item.

The Board considered a joint briefing note on the community based mental health and emotional well-being services for the adult population of Coventry, with emphasis on the restoration and recovery from the Covid-19 pandemic. An update on suicide and suicide prevention work in the city was also included. The paper was presented by Dr Richard Onyon, Coventry and Warwickshire Partnership Trust. Councillor M Mutton, Cabinet Member for Adult Services and Councillors Caan and Hayre, Cabinet Member and Deputy Cabinet Member for Public Health and Sport attended the meeting for the consideration of this item. Councillor Claire Golby, Chair of the Adult Social Care and Health Overview Scrutiny Committee at Warwickshire County Council also attended the meeting and Aisha Minhas and Marie Nicholls, Coventry and Warwickshire Partnership Trust, were also present.

The briefing note indicated that improving the Mental Health and Emotional Wellbeing of communities was a key priority both nationally and at a Coventry and Warwickshire level. Partners were working together across the health and social care system to deliver the ambition of the NHS long term plan in the context of understanding the needs of our local populations. By 2023/24 the Long-Term Plan stated ‘All ICSs will have received funding to develop and begin delivering new models of integrated primary and community care for adults and older adults with severe mental illness’. The constraints of Covid-19 had placed additional challenges on delivery, but services had continued throughout the last year, albeit using different ways of engaging with service users.

The Board were informed that Primary Care and Community Mental Health services had been under considerable and increasing pressure. Some people referred to specialist mental health services could have been helped more quickly and effectively if the system was better integrated. GPs were reporting seeing more people with mental health issues as they had come out of isolation as Covid restrictions had been relaxed. Patients were now coming forward who were previously not known to services presenting with mental health needs which was contributing additional pressure within existing services.

Coventry and Warwickshire Health and Care Partnership (HCP) were informed in January that they had been successful in accessing non recurrent NHSE transformation funding to help transform community mental health services in line with the Long-Term Plan. This was in addition to agreed increases in baseline funding. The briefing note highlighted the levels of additional funding over the next four years, to be used to support adults with severe mental illness.

The funding would be used in support of the Long Term Plan’s objectives to have new and integrated models of primary and community mental health care i.e. a community based offer that would include access to psychological therapies; improved physical health care; employment support;, personalised and trauma-informed care; medicines management; and support for self-harm and co-existing substance abuse.  This funding was expected to maintain and develop new services for people with the most complex needs along with  proactive work to address racial disparities and other health inequalities. The Board noted it provided a once-in-a-generation opportunity to boldly transform the  community mental health offer in Coventry and Warwickshire, resulting in an enhanced experience of easily accessible (‘no door’), integrated and seamless pathways for people with severe and enduring mental illness.

Proposals set out key principles of what the future model would look like and also set out the commitment to working with local communities across Coventry and Warwickshire to develop the future model and services. For the next three years, partnership work would re-design and re-organise mental health services and how people could access them. This would include re-organising core mental health teams to work at a “place” based level, and to have an integrated offer across health, social care and VCSE – aligned to Primary Care Networks – with the aim of giving adults and older adults more choice and control over their care, and empowering them to live well in their communities.

The principles of transformation were set out.

The briefing note indicated that the Coventry and Warwickshire Health and Care Partnership (HCP) had identified that by supporting people earlier on in mental health crisis, in the community helped to avoid inpatient admission which was more effective and beneficial to patients for their recovery thereby improving outcomes and patient experience. Following funding from NHSE, a number of services had come online over the last 2 years which had strengthened and transformed the urgent and acute care pathway to enhance inpatient gatekeeping and facilitate early discharge into the community. These services were highlighted in the briefing note.

For 2021/22 to 2022/23 Coventry and Warwickshire Health and Care Partnership had been successful in obtaining funding from NHS England/Improvement to strengthen the mental health crisis pathway by establishing alternative forms of provision.  The purpose of the funding would be to increase the range of local alternatives to A and E, mental health inpatient care and mental health crisis teams. Several initiatives were highlighted.

The briefing note also referred to suicide and suicide prevention. In November 2016, the Health and Wellbeing Board signed off the Coventry Suicide Prevention Strategy for 2016-2019. The strategy was designed to harmonise with the aims and approaches of the West Midlands Combined Authority WMCA mental health commission and with the strategic aims of our neighbouring authority Warwickshire. Whilst the strategy, vision and strategic priorities remained current, the original action plan to November 2019 was refreshed by the steering group and developed into a forward plan for 2020 - 21.  The Coventry and Warwickshire Health and Care Partnership had received suicide prevention funding for 3 years from NHSE. This programme was now complete, and an evaluation report was to be published in the autumn. Key aspects of this programme around crisis support, inpatient safety, real time surveillance, bereavement support and community resources would continue as legacy programmes.

The Board were informed of the initiatives that were working well in Community Mental Health Transformation; Urgent and Acute Care; and Suicide and Suicide Prevention. Concerns were also highlighted which centred around the increasing demands on services. 

Further information was provided on the next steps which for Community Mental Health Transformation were: (i) programme management to be fully established in the next few months including recruitment and establishment of a programme team and the governance framework for the programme, (ii) the  development of the pathways for Eating Disorders, Personality Disorders, Community Rehabilitation with a view to mobilisation and implementation in the second part of the year and (iii) the continued mobilisation of the co-production strategy.

The next steps for Urgent and Acute Care were to (i) implement Phase 2 of the MHAH and CORE 24 standard for the Mental Health Liaison Services, (ii) develop a co-production action plan which was aligned to the Community Mental Health co-production strategy, (iii) implement the Warwickshire Social Intervention Collective Model and (iv) procure the Crisis House provision working with VCSE providers.

The next steps for Suicide Prevention were (i) an audit of Coventry and Warwickshire coroner records was underway to compare deaths during the lockdown period with previous years, with a  joint area learning panel and case review process being in development, (ii) A Coventry and Warwickshire mental health joint strategic needs assessment including suicide would be produced by June 2021 for Health and Wellbeing Boards to consider recommendations, (iii) an all age suicide bereavement support service for Coventry and Warwickshire residents would be in place by September 2021 and (iv) a partnership event to present the projects and evaluation of the NHSE funded suicide prevention programme would take place in September 2021.

Members questioned the representatives and officers on a number of issues and responses were provided, matters raised included:

·  Referring to the recent BBC hospital programme from UHCW, in particular the episode concerning A and E where a young woman on suicide watch was left in a cubicle for 72 hours while a bed could be found, was this a regular occurrence

·  What was happening to mitigate the pressure for inpatient beds

·  Further details about the funding that had been secured for the transformation programme

·  Support for the transformation programme and the benefits it will bring for patients

·  The importance of partnership working

Further details about the suicide prevention measures and an acknowledgement that suicide prevention was an issue for all of society

·  The importance of awareness raising to suicide prevention

·  Information about tackling inequalities

·  What to do if you have concerns about family/ friends in light of patient confidentiality

·  How suicide affects people from all levels of society.

RESOLVED that:

(1) The progress to date be noted and the plans to further progress the mental health and emotional wellbeing support available to Coventry be endorsed.

(2) Information about the additional transformational funding to support community based mental health and emotional wellbeing services for adults, including what percentage of the total budget this represents, be circulated to members.