Agenda item

An update on the delivery of mental health services from the Gloucestershire Health and Care NHS Foundation Trust.

Angela Potter, (Director of Strategy & Partnerships), Karl Gluck, (Head of Integrated Commissioning: Adult Mental Health, Advocacy and Autism), and Hayley Payne, (Programme Manager: Children and Young People’s Mental Health), at the Gloucestershire NHS Health and Care Foundation Trust, (GHCFT), gave a detailed presentation on the delivery of mental health services in Gloucestershire.

It was reported that, whilst the demand for mental health services had increased in recent years, most areas, until now, had been able to absorb the demand without incurring longer waiting lists or without impacting on the effectiveness of treatment. One area of service experiencing a higher level of demand than in previous years, (pre-pandemic), was the number of people suffering from eating disorders in Gloucestershire. Collaboration with the mental health charity BEAT was being explored to develop therapeutic activities from which to address the increased demand.

A member referred to an incident at the Wotton Lawn Acute Mental Health Hospital and enquired about the security arrangements at the hospital. Whilst it was not possible to enter into specific details, it was explained that Wotton Lawn Hospital was not a secure unit. Whilst the hospital included specialised areas with higher levels of security, wards were not locked. Although no information could be given on the anticipated timescales for publication of the outcome report from a recent investigation at the hospital, it was agreed that the report, when available, would be circulated to the committee. Concerns relating to staff wellbeing at Wotton Lawn Hospital were noted by the Health and Care Team, where it was confirmed staff at the hospital had been well supported following the incident.

A member sought clarification on where the Maxwell Centre was based, (where members of the public detained under Section 136 of the Mental Health Act are evaluated). It was explained that the Maxwell Centre had not moved location and was not currently manned 24/7 by default but could be manned at any time by the crisis team, dependant on need. Dependant on the evaluation, patients were either sent to an inpatient bed or supported through crisis resolution and returned home.

Responding to questions on the influence of social media, it was acknowledged that social media was deemed a significant factor in influencing mental health. Members noted that the NHS worked closely with schools to monitor social media influences. A member asked whether interventions, including ‘young minds matter’ could be implemented at home rather than just at school. It was confirmed that interventions for people physically unable to attend school formed part of the Trust’s work.

In response to a question on how the ‘new locality model’ might be applied across the Cotswolds, it was reported that the plan was to create virtual teams made up of different health care workers who could benefit from discussing patients jointly. Using a phased approach allowed this to be implemented in a tailored way across each region. The option of using buildings and schools in rural locations was being explored to help improve access to services for those located further away from the larger towns and cities.

A member asked if it would be possible to expand the work of the Police/Mental Health Worker mobile unit. It was explained that the current 4 days of operation, focusing on weekends and evenings, offered optimal usage, as it provided coverage during times of expected highest need, whilst minimising overusing Police and Mental Health resources. Although there were no plans to expand, this position would be reviewed regularly and changed, if necessary.

The issue of wait times for ADHD and ASD for diagnosis and treatment was raised. Whilst a focus of work for the department, it was difficult to get the necessary resources from which to reduce wait times. Work was being implemented to help children get support from schools whilst awaiting diagnosis, but diagnosis times were not within the departments resources to improve. It was however, reported that there were plans to pull the ASD and ADHD pathways together into a single neurodiversity pathway, and the gained efficiency from this might reduce wait times.

Bob Lloyd Smith from Gloucestershire Healthwatch added that the publication of a report on autism assessment in Gloucestershire was expected in the New Year.

The Health and Care Foundation Team was asked what was needed to resolve the problem of ADHD and ASD waiting lists. It was explained that, whilst extra investment certainly helped, the main obstacle was the issue of staffing, with a lack of both registered and unregistered staff. Addressing the workforce issue was the most meaningful solution to reducing waiting lists.

A member asked if more independently run academies would be open to taking on the mental health support provision. It was confirmed that academies were more than happy to take on the help. The only issue was that it was sometimes difficult to set up a first contact, a problem relevant to all schools, not just academies.

Bob Lloyd Smith from Gloucestershire Healthwatch commented that the area that received the most feedback on the need for improvement was from the Crisis Service and enquired what could be done to improve this. It was reported that a review had been undertaken in 2020 and that the recommendations from the review were gradually being worked through. One key area that could be worked on was the issue of public information and developing a better understanding of what the crisis service was for.

There had been a significant increase over the last few years of people coming to the Crisis Service with short-term environmentally driven mental distress rather than chronic mental illness. The Crisis Centre did not have the capacity to support all of these cases and it had been necessary to recruit adjacent support services to support the workload of cases, whilst also making it clear to the public which services should be accessed for what reasons.

Expanding on the discussion about waiting times for ADHD diagnosis, a member raised concern about whether ADHD was considered a disability under the Equalities Act and whether children could be excluded from school whilst awaiting diagnosis. The Health and Care NHS Foundation team explained that, in their view, ADHD was considered a disability, but they were unsure if children were being excluded from school because of it. It was agreed to investigate the issue and report back to the committee at a later date. Action: Health and Care Foundation Team

A final question enquired whether there was co-operation between hospitals and health and care trusts outside of Gloucestershire. The question focussed on those members of the public who resided in the more rural areas of the county, with Gloucestershire hospitals located quite a distance from their homes, and hospitals located in Oxfordshire or Wiltshire more accessible. It was explained that, whilst there was co-operation with hospitals from outside the county, this was only viable if the other hospitals were the locations where Gloucestershire residents typically received their care.

Deborah Lee, Chief Executive of the Gloucestershire Hospitals Foundation Trust, was asked to report on a recent case of oesophageal cancer surgery performed at Gloucestershire Royal Hospital. It was explained that this particular case was noteworthy as the surgeons at the hospital had used a new robot technique to perform the surgery, a first of its kind in the UK. Two similar robots were located at Cheltenham General Hospital, funded from additional funding and with the support of HOSC.

Members noted the report and thanked the GHC Foundation Trust for its incredible work and commitment to improving the lives of vulnerable people across Gloucestershire who suffered from mental health issues.