Gail Kay, Mental Health Programme Lead will provide the Joint Committee with a presentation on this issue.
Gail Kay, Mental Health Programme Lead, provided the Committee with a progress update on the work of the mental health workstream.
The Committee was informed that an overarching aim of the Integrated Care System covering NE and Cumbria was the development of more integrated preventative and early intervention services with a view to
· Reducing the risk of ill health
· Developing individual and community resilience
· Improving the health and wellbeing of the population
· Supporting a financially sustainable system.
The mental health workstream is one of the delivery programmes in place working to deliver the above and its purpose is to:-
· Ensure that mental health is fully integrated across the ‘whole system’ in order to progress the delivery of ‘No health without mental health’ (Department of Health, 2011)
· Support the service transformation process through communication, information, sharing best practice, reducing duplication and progressing system wide engagement
· Inform locality arrangements to progress Integrated Care Systems (ICS) aligned to an informed needs profile
· Understand variation and promote innovation and evidence - based practice to address gaps
The Committee was advised that work was taking place to try and understand what work was taking place across NE and Cumbria and other ICS which was making a difference and an event had taken place in April 2018 to consider what actions needed to be progressed, which had good representation from across the patch and a review of progress had subsequently been carried out in October.
The Committee was advised that the mental health work stream does not have a surveillance or performance monitoring role and does not have statutory authority, this remains with provider organisations and commissioners.
The Committee was advised that following priorities for the mental health workstream have been collectively agreed across NE and North Cumbria:-
· Child health
· Suicide zero ambition
· Acute optimisation (Optimising Acute Services)
· Long term conditions and medically unexplained symptoms
· Older people
· Physical health of people with SMI
The Committee was also provided with a progress update on each of the priority areas and information on the prevalence of mental health conditions/ depression/ percentages of mental health patients with care plans/ premature mortality rates for individuals with serious mental illness/ suicide rates as recorded across NE and Cumbria CCGs.
The Committee was informed that the NE and Cumbria ICS was one of the most complex emerging ICS in the country as many areas were classed as countryside but had an industrial / mining heritage. In addition, more than 20% of the population in the patch was over 65 and there was negative population growth in some areas.
The Committee was advised that population differences are important in terms of informing service need and the population data had been broken down by local authority. The North East authorities tended to be quite similar in terms of age structure, high deprivation and the % of population from ethnic minorities (lower than England) although Newcastle has a younger (median age = 33) and more ethnically diverse population. The more rural areas (e.g. Cumbria) tended to have an older population with lower deprivation than England and low growth. The rural areas tended to have fewer people from ethnic minorities. The homelessness figures appeared to show patchy data collection.
This means that across the ICS there is a need to tackle a large number of factors impacting on individuals’ health and wellbeing.
The Committee was informed that depression is a significant issue for a lot of areas in the North East. As a result, an important area of focus will be whether individuals presenting with depression in primary care have care plans.
The Committee was also informed that the under 75 mortality rate was also above average for the ICS patch as were suicide rates.
Councillor Schofield noted that the Marmot report had highlighted the inequalities suffered by those with mental health issues and that many die approximately 15 years earlier than those without such issues. She queried how the work being progressed would address this issue particularly for groups such as those with learning difficulties.
Gail stated that it was proposed to address this through the priority areas identified and through work with service users and carers to understand people’s needs and what will make the biggest differences in terms of whole system change.
Councillor Schofield noted the response but advised that the Committee was wanting to understand what would make the biggest differences to individuals.
Gail explained that the work was not far enough advanced at this stage to provide that information although work was progressing and they were moving towards where they needed to be in terms of understanding the variants and inequalities.
Councillor Taylor acknowledged the positive work taking place but stated that she was concerned that there would not be the finance in place to achieve what was planned.
Councillor Taylor considered that it would be key to get GPs to screen individuals for risk of suicide and then refer them for counselling. However, Councillor Taylor noted that there were insufficient counselling services in place due to lack of funding.
Gail indicated that it would be necessary to look at where funding is tied up elsewhere in the system to ensure that it was released to be used in the areas it needed to be.
Gail stated that currently they were working towards having clear plans and a vision in place, however, work was still at the planning stage.
Councillor Beadle noted that the tables relating to mortality and noted that reference had been made to significantly higher rate than England and he queried whether it was statistically significant as if that were the case it would mean that there was an issue locally. Councillor Beadle flagged up what appeared to be a number of anomalies with the figures reported and expressed concern around the accuracy.
Gail explained that work was currently taking place with public health leads from across the patch to understand the data sets and the detail behind them Gail acknowledged that at present the data raised more questions than answers.
Alice Wiseman, Director of Public Health for Gateshead, noted that suicide rates were variable and dependent on the coroner in each area. The Coroner for Gateshead will only record a death as suicide if there is no doubt that this is the case and if there is any question a narrative verdict will be reported. Alice noted that there had been 22 deaths in Gateshead but only 3 had been recorded as suicide and it was considered that there was significant under reporting. Alice considered that this was an area which needed to be looked at.
Councillor Beadle considered that if the Committee was to have a proper role in scrutinising the prioritisation of resources etc then it was important that this as based on robust data. Councillor Beadle considered that if local data was better than that from other sources eg Coroners reports then this should be taken into account.
Gail stated that it was good to hear that work was making a difference at pathway and place level.
Councillor Mendelson asked for clarification on how it was proposed to engage with local people.
Gail explained that the engagement process had begun with a workshop to identify who they needed to be engaging with going forwards. In addition, it was planned to have a public facing website where good practice could be shared on work such as the mental health trailblazers in schools and the difference that they were making.
Councillor Spillard noted that the work being progressed through the mental health workstream would be contributing to the prevention agenda for the ICS and also noted that many local authorities were taking forward prevention work. However, Councillor Spillard expressed concern at the data presented frim CCGs indicating the percentage of mental health patients with a care plan documented. Councillor Spillard noted that some CCGs appeared to be on or above the baseline in achieving the national figure for documented care plans but five other CCGs did not appear to be meeting this figure and she queried whether this was because some CCGs were still in the process of documenting care plans. Councillor Spillard also queried the size of the problem in individuals not having a documented care plan in place.
Gail indicated that it would be important to ask questions in localities as to why some CCGs were not meeting the national figure as their may be issues impacting on the numbers of individuals presenting such as perceived stigma associated with having a mental health condition. Cultural change is needed on an incremental level to address this issue.
Councillor Robinson advised that Durham’s Health OSC has carried out a Review of Suicide and taken evidence from a range of organisations and would be happy to share the findings with the rest of the Committee.
Councillor Robinson also expressed concern at how the work outlined by Gail was going to be achieved given the significant loss of funding to Public Health services such as those in Durham.
Councillor Robinson noted that in the past funding for work such as the Transforming Disability agenda had been a 40 % local authority 60% NHS funding split. However, as a result of the prevention agenda and the work to help keep more people in the community and out of residential care, it was now the case that local authorities are picking up 70% of the funding bill and the NHS now only provides 30%. Councillor Robinson stated that he had real concerns about how the work for the mental health workstream would be funded and he queried whether any work had taken place on costing.
Gail explained that there was a need to look at issues across the whole system and the Finance Working Group was in the process of looking at this but it was at the very early stages in the process.
Councillor Robinson noted that deprivation figure were high in the North East but Public Health budgets were losing 56 m and the south of the country was getting most of the funding. Councillor Robinson reiterated that he had real concerns as to how the work outlined could be achieved.
Gail stated that it was about partners in the NE and Cumbria coming together to see what could be done better and how the funding pot available can be used to best effect. At this point partners are coming together as a system to share issues and understand what is happening across the patch and some conversations will relate to issues which need to be tackled at scale and dealt with at an ICS level.
The Committee was informed that Directors of Public Health across the system had expressed concern that a two-tier system could end up being created due to the fragmentation of NHS and Local Authority Public Health. The Directors of Public Health would be participating in a review of the Marmot Strategy ten years on as it was key that work was carried out to treat the conditions that lead to mental health issues developing.
Councillor Watson thanked Gail for the information presented but queried whether it might be more relevant to look at socio -economic factors rather than geographical. Councillor Watson stated that as far as Northumberland is concerned there are significant differences between Berwick and Blyth.
Gail advised that information is currently collated on a geographical basis and so it is important to look at what questions that then raises. Gail stated that there are pockets of high deprivation and this needs to be looked at and challenged.
The Chair considered that this brought matters back to the validity of the data and whether it could be relied upon. The Chair considered that the classifications of areas were very broad brush and not very nuanced.
Councillor Dixon stated that everyone was supportive of the intentions outlined by Gail but considered that what had been outlined appeared to represent a wish list. Councillor Dixon queried how much of what had been outline could be delivered at present through known revenue streams.
Gail stated that in the first instance there needed to be agreement on what they wanted to achieve and then from that what the priorities for the region would be. Gail stated that there are pots of funding to which bids for specific projects could be submitted such as the trail blazers to start early improvements but she did not know the position at ICS level. If the Committee would like further information on that then they would need to ask for this information from the Finance leads.
A member of the public who had been a carer for a person with mental health issues raised concerns regarding the Deciding Together Delivering Together process. The member of the public considered that the NHS Trusts involved had been prevaricating in delivering the implementation plan. The member of the public stated that no one disagreed with preventing suicide but he considered that the reality was that nothing was likely to change in the foreseeable future as he considered that there were insufficient mental health beds in the area and decreasing budgets, although significant sums had been spent on the public consultation process. The member of the public considered that the effects of Universal Credit were having an impact on the mental health of individuals whose benefits are being cut and he considered that this could lead to some individuals having to go out of area for treatment if there was insufficient provision available in the area.
Gail stated that there was a difficult journey ahead but the aim was to get a sustainable system in place. Gail stated that she did not know the position in relation to bed provision as part of the Deciding Together Implementing Together process but she could seek feedback on this. Gail reiterated that work was at early stages.
The Chair thanked Gail but indicated that such feedback would not be necessary for this Committee. The Chair advised that Gateshead’s Health and Wellbeing Board would be receiving a progress update on Deciding Together Delivering Together at its next meeting and further updates would be provided as the work progressed.
Alice Wiseman, Director of Public Health for Gateshead, also advised that a meeting was taking place on 14 December regarding the suicide prevention element of the ISC to shape a bid and the Committee would be provided with an update on this in due course.
Councillor Temple queried whether the bid would include Durham Dales and Easington and Alice confirmed that it would.
The member of the public queried whether there was an awareness that the NHS was not meeting the minimum 13 % funding requirement for mental health services and that in reality the percentage was reducing. The member of the public offered to share information.
The Chair advised the member of the public that any information shared would be passed on to the CCG.