A briefing from the Gloucestershire Health and Care NHS Foundation Trust (GHC) on the delivery of Mental Health Services.
This briefing is in addition to the Children and Young People’s Mental Health Briefing on Monday 24 January 2022. Members of the Gloucestershire Health Overview and Scrutiny Committee (HOSC) and the Gloucestershire County Council (GCC) Adult Social Care and Communities Scrutiny Committee (ASCC) are invited to join this remote access briefing.
The committee received a presentation on the delivery of mental health services from the Gloucestershire Health and Care NHS Foundation Trust. Presenting the information on behalf of the Trust were Sandra Betney, (Director of Finance and Deputy Chief Executive Officer), Martin Ansell, (Deputy Medical Director of Operations), and Andy Telford, (Community Mental Health Transformation Lead).
The report and power-point presentation can be viewed with the agenda published on the Gloucestershire County Council website.
Outlining some of the challenges presented to the Trust during the pandemic, it was confirmed that there had been a huge demand for mental health services during the past year, a factor that was becoming increasingly notable prior to the pandemic, but significantly greater in recent months, with demand far outstripping the ability to deliver services. In response to the challenges, it had been necessary for the Trust, working alongside partner organisations, to adopt new ways of working, including remote access diagnosis and treatment arrangements, combined with face-to-face appointments. The demand for services, represented by people from all age groups and in various complexities,reflected the national demand. The limited allocation of resources nationally, plus the tendency for elective recovery funds to predominately focus on delivering acute activities during the pandemic had resulted in increased levels of stress and constraint, both financially and on the workforce. The impact of the current demand would undoubtedly impact on delivering wider public sector services, including police and voluntary sector – this was not just an NHS issue.
It was reported that there had been a particularly huge increase in the demand for children’s mental health provision, notably to support eating disorders and self-harming by young people. Impacting on delivering children’s services nationally, this was an area being considered by the Gloucestershire County Council, (GCC), Children and Families Scrutiny Committee. In response to current concerns, a remote access Children and Young People’s Mental Health Briefing had been arranged at 1.00pm on 24 January 2022, to which the members of this committee were invited to attend.
Outlining some of the challenges to other parts of the system, including later life services, backlogs in memory assessment services due to the shutdown of the service during the pandemic and extended waiting times for the majority of services, it was confirmed that flow through system arrangements remained challenging, with community care packages scarce and marked restrictions on care home access. The pandemic had also impacted on people’s ability to access their usual support networks, with evidence of increased social isolation and loneliness, particularly in the older age groups. The ability to diagnose/recognise early changes in mental health had been significantly reduced, resulting in greater acuity and complexity of symptoms when assessments were made.
Ongoing workforce issues emerging during the pandemic continued to be challenging, with COVID-19 related absence and the impact of self-isolation still a factor. Huge efforts were being invested in recruitment activities, (in line with the national response), aiming to attract entry level roles such as staff nurses and newly qualified therapists, whilst at the same time, retaining experienced and specialist practitioners. An increased number of people reviewing their work/life balance and choosing to consider retirement earlier than might have otherwise been considered, was also having an impact on the workforce.
Despite the challenges, the pandemic had also provided some opportunities for change. Examples included; general review of waiting lists/capacity and demand reviews; eating disorder teams implementing routine referral screening/triage with a focus on treatment for urgent patients; additional children and young people consultant time from which to carry out assessments; day treatments, (scheduled to recommence in the next month), supporting admission prevention to emergency departments; a variety of new roles being trialled, including clinical associate psychologists; trust wide focus on workforce issues, (recruitment & retention; staff health & well-being; flexible working and support to those needing to shield). The advances in the use of digital access and technology had been a welcome surprise. It was also acknowledged that, whilst some people may have missed out on early diagnosis, others had benefitted from self-isolation and not having to go out.
Outlining the Trusts’ aspirations, in line with the local NHS long-term plan, members were advised that a key aspiration was to develop new community models built around localities and Primary Care Networks with a focus on improving services for adults, (including young people in transition), experiencing serious mental illnesses. A 3-year programme, with non-recurrent transformation funding tapering off over the 3 years, was underway. Additional funding would be included within the GCCG baseline fund. Other aspirations included the introduction of an alternative assessment/care management framework, (to replace the care programme approach), and introduction of a 4-week waiting time target and increased activity targets. Specific focus would be placed on developing specialist areas, including new models to respond to eating disorders, personality disorders and to consider rehabilitation pathways. Joint working and service provision with voluntary care and social enterprise organisations would continue, with the aim of developing a more community-based approach to delivering mental health services.
In summary, members were advised of ongoing pressures in response to the increased demand for services, combined with the positive recovery response to the pandemic and new models of delivery.
Questioning how long it might be before the delivery of mental health services returned to pre-pandemic performance, members were advised that this was anticipated to be a long-term repercussion of the pandemic. The recovery process was well underway and would be subject to constant review. A significant amount of effort and investment was being directed into providing a good service.
One member questioned the ability and skills of Voluntary and Charitable Organisations, (VCSE), when supporting the delivery of mental health services, to which it was confirmed VCSE organisations formed a valued part of the whole system approach, with the necessary skills training provided.
Responding to questions on the impact of the pandemic on young people, including concerns about people self-harming and eating disorders, officers emphasised the need to reach out to young people to better understand their issues. The GCC ‘Your Circle’ website, (a local directory providing access to information, advice and support for those who need care or wish to stay independent), allows visitors to the site to source information about local groups, societies, clubs and services in Gloucestershire with the aim of enabling people from all age groups to connect to people and activities within their communities, as well as helping to navigate health and care options.
The ‘Your Circle’ website can also help individuals and organisations, including the Trust, promote activities, events and support services via the firstname.lastname@example.org helpline.
Responding to questions on how councillors might support people with mental health issues, it was suggested that, by listening to those who needed help, in whatever environment this might be; schools, doctors’ surgeries, supermarkets, local forums or by simply by engaging in face-to-face discussions, made a valuable contribution. Feedback to the Trust was encouraged.
Responding to questions on the support provided to people from rural communities, (where it might be more challenging for people to reach out for support), it was confirmed that substantial investment had been made in rural communities, including locating specialist teams in the Forest of Dean District. It was acknowledged that challenges remained in other rural locations, including the Cotswolds District, where work was ongoing to address the issues. The first point of contact in many rural locations continued to be with the person’s General Practitioner. A request was made to provide information on cross border service arrangements and this was noted.
Nikki Richardson from Healthwatch Gloucestershire commended the recovery work being undertaken in response to the pandemic but enquired about the number of people who might not be coming forward with mental health issues due to the arrangements during lockdown, including the move to conducting remote access appointments. Nikki was reassured to note there was evidence to suggest some services had started to catch up on any backlogs that might have occurred during lockdown and that improvements in referrals being made direct to mental health practitioners rather than via GP’s was a huge benefit to the system. Ongoing analysis of data from the past year would determine any long-term trends and would be shared with the committee. It was agreed that, since the pandemic, attitudes towards people with mental illnesses had started to change and this was welcomed as a positive outcome.
In summary, the ongoing pressures of delivering mental health services in Gloucestershire were likely to continue but the positive response to the recovery process and the new approaches to delivering more effective services were welcomed.
The report was noted.