FoCUS Committee Responses to Questions - August 2014

    Hospital Services

    • Q1: The NW FoCUS group was pleased to hear from staff and a service user that the revised format of the Mutual Help (Community) meeting at the ACU was working well. To FoCUS' knowledge these meetings are not replicated across other services e.g. Acute LD units, Older Person wards. Is it possible to replicate these meetings in other wards? View answer to Q1.
    • Q2: Will the Acute Care Pathway pilot include specific measures to evaluate the impact on carers? Suggested indicators were: overall carer’s experience; timeliness of support; what actions were taken and the overall outcome. View answer to Q2.

    Community Services

    • Q3: There are a number of staff leaving Elmbridge CMHRS. What plans are in place to ensure a smooth transition? View answer to Q3.
    • Q4: Remote working – Horley. At the last Committee a discussion was had regarding individuals having to travel a long way for their appointments particularly if they lived in the Horley area. Dr Rachel Hennessy commented that should a person not be able to attend an appointment they will be visited in their homes, in addition to this Dr Hennessy commented that the Trust are currently in conversations with GPs and other organisations in the area to assess the possibility of using some of their services and space. Whilst the Group appreciate this is happening they would like to know if there is a timeline for this work and a definitive proposal about when this will happen? View answer to Q4.
    • Q5: Social Care transfers from Working Age Adult care to Older Adult Services. Please advise the procedure for doing this transfer and what reassurances are given that any Working Age Adult input an individual is receiving is carried on into the Older Adult Service? View answer to Q5.
    • Q6: Following on from concerns with disabled parking at Guildford CMHRS, there is no disabled parking at Waverley CMHRS. Can the Trust look into providing disabled spaces? View answer to Q6.
    • Q7: How does the Trust ensure timely support, practical help, parenting support and help with benefits – families must have the right support at the right time? View answer to Q7.

    IAPT (Improving Access to Psychological Therapies) Services

    • Q8: If people using IAPT services wish to extend their time of therapy, is this decided by the provider, GP or person using the services? View answer to Q8.
    • Q9: Update on IAPT service - Commissioners report says that SABP has a large waiting list. Why is this the case – do the Trust find that a lot of people do not respond to offers of assessment? View answer to Q9.

    GP Referrals

    • Q10: GP referrals – Can we have an update on the length of time it takes for a person who uses services to be seen when referred: A “routine” referral; an urgent referral. Are there delays occurring and if so why? View answer to Q10.

    Criminal Justice Service

    • Q11: Whilst the Group were pleased to learn about the Criminal Justice and MH Liaison and Diversion Services, members continue to be concerned about the pathway for those in the Criminal Justice system. Could the Trust explain what happens to people who use services who enter the Criminal Justice system and how they are referred on? View answer to Q11.

    Corporate Services

    • Q12: PALS attend the Working Age Adult Mental Health Acute ward community meetings, but do not regularly visit other SABP service’s wards. FoCUS believes it would be beneficial for PALS to regularly visit, even if the demand is not apparent to the Trust, in particular to the wards that have raised concerns in the CQC reports. View answer to Q12.
    • Q13: PALS is recruiting 5 volunteers to assist their work. FoCUS has concerns that there is a reliance on volunteers rather than increasing staff. View answer to Q13.
    • Q14: Has the Trust considered having an easy to read section of the website or to review what is currently on the website to ensure it is accessible? FoCUS members would be happy to assist with the review of the website. View answer to Q14.

         

        Q1: The NW FoCUS group was pleased to hear from staff and a service user that the revised format of the Mutual Help (Community) meeting at the ACU was working well. To FoCUS' knowledge these meetings are not replicated across other services e.g. Acute LD units, Older Person wards. Is it possible to replicate these meetings in other wards?

        A: We receive reports back from community meetings at the Acute Care Forum so I would be happy to discuss this at our September Meeting to see if this can be implemented across all inpatient services. Andy Erskine, Director of Mental Health Services

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        Q2: Will the Acute Care Pathway pilot include specific measures to evaluate the impact on carers? Suggested indicators were: overall carer’s experience; timeliness of support; what actions were taken and the overall outcome.

        A: We have a range of metrics around the pilot which will include:

        • Qualitative review of experience/satisfaction – including carer and family experience,
        • Involvement in care planning and discharge
        • Support to carers/families identified in the care planning/discharge process
        • Timeliness of all aspects of support will be key in our evaluation – including support for carers/families.

        Helen Rostill, Director of Innovation and Development

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        Q3: There are a number of staff leaving Elmbridge CMHRS. What plans are in place to ensure a smooth transition?

        A: We believe that the situation has improved and the staff team feels more consistent and stable than 6 months ago, but we would acknowledge that there has been a period of staff change at Elmbridge CMHRS. There are currently 24 people in post at Elmbridge CMHRS and there are 9 vacancies (not all full-time). We are recruiting to these posts and have ensured that there are locums in place (6 wte equivalents are covering the vacant posts). As we recruit people we will ensure there is a handover from locum workers to the new workers. Andy Erskine, Director of Mental Health Services

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        Q4: Remote working – Horley. At the last Committee a discussion was had regarding individuals having to travel a long way for their appointments particularly if they lived in the Horley area. Dr Rachel Hennessy commented that should a person not be able to attend an appointment they will be visited in their homes, in addition to this Dr Hennessy commented that the Trust are currently in conversations with GPs and other organisations in the area to assess the possibility of using some of their services and space. Whilst the Group appreciate this is happening they would like to know if there is a timeline for this work and a definitive proposal about when this will happen.

        A: As part of the work in developing community hubs which is just starting in the east of the county we are looking at the postal codes of all people who use services to ensure that we are providing the best options for the majority of people. This will inform the location of the hub and any additional facilities that may be needed. When this issue was discussed with the mental health GP Lead there was no local GP facility that could be made available for any clinics in the Horley area but I am happy to revisit this with the new mental health GP lead when appointed. Dr Rachel Hennessy, Medical Director

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        Q5: Social Care transfers from Working Age Adult care to Older Adult Services. Please advise the procedure for doing this transfer and what reassurances are given that any Working Age Adult input an individual is receiving is carried on into the Older Adult Service?

        A: The development of social care input within older people’s mental health started approximately 2 years ago following a redesign in Surrey County Council Personal Care and Support where 10 posts were allocated to our teams to support this.

        Following the redesign within working age adults an additional 4 posts and a senior post was allocated to support the development of social care within our older persons’ services to focus on complex social care needs. Surrey county council policy and procedures were followed for consultation and organisational redesign.

        In terms of pathway, where a person over 65 continues to receive services within working age adult mental health then people would continue to access social care within working age adult mental health but funding would be authorised by Personal Care and Support. Where a person over 65 is transferred to older persons services and they have complex social care assessment needs then they would receive social care support from those services. However, where a person has established needs and social care input they would be transferred to Surrey County Council Personal Care and Support for social care. Alison Armstrong, Director of Older Adults

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        Q6: Following on from concerns with disabled parking at Guildford CMHRS, there is no disabled parking at Waverley CMHRS. Can the Trust look into providing disabled spaces?

        A: Currently the design is being developed and is due for week commencing 12th August, the design has had to take account of the different ground levels to ensure the ground is level. The next stage is to seek approval from the landlord as we lease this building and seek planning approvals. Benita Mehra, Director of Property and PMO

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        Q7: How does the Trust ensure timely support, practical help, parenting support and help with benefits – families must have the right support at the right time?

        A: Our Children and Young People’s Services (CYPS) provide a wide range of mental health and learning disabilities services for the benefit of children, young people and adults in Surrey.

        These include early detection and intervention, assessment and diagnosis and a range of intervention options for the children and young people using services. Additionally we offer support and advice to young people and their families and consultation and training to professionals working with children and young people.

        The ‘no wrong door’ approach we adopt together with our partners ensures easy access to services and we are developing our ‘Think Family’ approach in order that adult and children’s services are joined up around the needs of families. This builds on family strengths and empowers them to deal with their problems together to improve their lives.

        Working in partnership with colleagues in health, social care and the voluntary sector, and with a local, community focus, means we can properly signpost children, young people and families to the services that can best support their individual needs.

        The Early Help Partnership, Supporting Families, Troubled Families programme and Safeguarding Board priorities agenda underpin our business plan, developed with our commissioners and partners, and ensure the priorities of the Health and Well Being Board and Children’s Strategic Partnership are achieved.

        When families need benefits advice we ensure we signpost them to appropriate agencies. We are active partners in the Team around the family way of collaboratively working with social care and education and would ensure a rounded inclusive approach when looking at supporting families to access the right support at the right time.

        Our Early Intervention Services are able to support and facilitate access to Self-Directed Support (SDS) for both young people and their Carers and have had much success in creative solutions for young people.

        CYPs facilitates many different carer support groups across Eating Disorders and Early Intervention in particular and has an active recovery based annual event that encourages carers and young people to harness Hope and Optimism through the recovery stories.

        In addition, within Services for People with learning disabilities we will work closely with parents with learning disabilities and in partnership with other agencies to ensure that parents with learning disabilities get the support that they need. Professionals from our CTPLD's often act as professional advocates for parents with learning disabilities helping other agencies to consider how best to support them with all the required reasonable adjustments. Mandy Dunn, Director of Children and Young People's Services

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        IAPT (Improving Access to Psychological Therapies) Services

        Q8: If people using IAPT services wish to extend their time of therapy, is this decided by the provider, GP or person using the services?

        A: There are some limits to the overall number of sessions that we provide for the following reasons:

        • We are paid a sum of money for each individual who uses our IAPT service based on an average number of sessions. We also receive extra payment for evidence that we have helped people’s recovery, and/or helped them to gain/sustain employment. This means that sessions must be flexible and focused on recovery. This is the right approach for everyone.
        • Continuing sessions far in excess of the average number is not likely to be productive for the person – it might indicate that IAPT is not what they need at that time.

        However, within this we do have a considerable degree of flexibility. Our commissioners (the CSU) have provided guidance on an average number of sessions to offer at each step, within the context of the contract. This is how the payment to SABP is calculated, but if needed as the funding is based on an average number and we know that people are different we are able to offer further sessions on the basis of clinical need, to meet the therapeutic goals.

        We would make a decision (together with the person) based on their needs, and the benefits they were getting from the therapy. If someone wishes to continue their therapy but the clinical need is not clear then we would not offer further sessions. Andy Erskine, Director of Mental Health Services

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        Q9: Update on IAPT service - Commissioners report says that SABP has a large waiting list. Why is this the case – do the Trust find that a lot of people do not respond to offers of assessment?

        A: We do have a large waiting list – but it is reducing fast. The reason for our large waiting list is mainly due to 4 factors that occurred when the service started:

        • A large number of referrals from the previous provider
        • Larger than expected demand for the SABP IAPT service (we are 1 of 11 IAPT providers in Surrey)
        • We offered more sessions per person than other Surrey providers.
        • We offer mainly 1:1 support with little group therapy

        Andy Erskine, Director of Mental Health Services

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        GP Referrals

        Q10: GP referrals – Can we have an update on the length of time it takes for a person who uses services to be seen when referred: A “routine” referral; an urgent referral. Are there delays occurring and if so why?

        A: During calendar years 2011 to 2013 (1st January 2011 to 31st December 2013)

        Urgent referrals waited on average 14 days from referral to being seen.

        Routine referrals waited on average 39 days from referral to being seen.

        During calendar year 2014 (1st January 2014 to 30th June 2014)

        Urgent referrals waited on average 11 days from referral to being seen.

        Routine referrals waited on average 26 days from referral to being seen.

        These figures relate to people referred by GPs to our community teams for adult mental health, older adult mental health, child and adolescent mental health and learning disabilities.

        The only delay noted in our quality standards report is that sometimes Home Treatment Teams do not see people within 4 hours. Dr Rachel Hennessy, Director of Medicine

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        Criminal Justice Services

        Q11: Whilst the Group were pleased to learn about the Criminal Justice and MH Liaison and Diversion Services, members continue to be concerned about the pathway for those in the Criminal Justice system. Could the Trust explain what happens to people who use services who enter the Criminal Justice system and how they are referred on?

        A: Approximately 20-25% of individuals assessed by the Criminal Justice Liaison and Diversion service are currently using services provided by Surrey and Borders NHS Trust. If there is an allocated care coordinator or primary worker, the CJLDS team will liaise with them directly. CJLDS have live access to the RIO records system within custody in order to review current care plans, risk assessments and interventions as well as to review treatments and identify involved professionals.

        All persons coming through custody and magistrates court, during operational hours, have the opportunity to engage with a mental health practitioner. Practitioners will, where appropriate, liaise with family, carers, professionals or voluntary agencies (e.g. appropriate adult services) to ensure that each individual receives support and advocacy whilst undergoing custody or court process.

        On the basis of each individual presentation the practitioner will make recommendations as to the type of intervention deemed most appropriate following the assessment. The practitioner will then liaise directly with the agency or provider (this may be CMHRS, GP, Prison in-reach etc) and they will follow the referral protocol of that agency.

        The CJLDS protocol is to ensure that any referral is explained and agreed jointly with the individual – consent is sought and documented and the CJLDS practitioner will then liaise verbally with the referring agency and complete satisfactory referral paperwork/e-referral. Alison Armstrong, Director of Older Adults and Specialist Services

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        Corporate Services

        Q12: PALS attend the Working Age Adult Mental Health Acute ward community meetings, but do not regularly visit other SABP service’s wards. FoCUS believes it would be beneficial for PALS to regularly visit, even if the demand is not apparent to the Trust, in particular to the wards that have raised concerns in the CQC reports.

        A: We try and use our PALS resources as widely as possible. This is why we have started to recruit PALS volunteers to help us reach more people who use services by being able to go more regularly to services that we currently only visit occasionally. We do follow up in services where other agencies such as CQC have raised concerns as appropriate. Tracey Pettit, PALS and Complaints Liaison Service

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        Q13: PALS is recruiting 5 volunteers to assist their work. FoCUS has concerns that there is a reliance on volunteers rather than increasing staff.

        A: The PALS volunteers complement the work of the PALS staff and is was one of innovated approaches we have developed to broaden our scope and capacity to gather independent and impartial insight about the experiences of people who use our services.

        The PALS volunteers are highly valued and fulfill a vital role to improve the overall experience of people who use our services. Volunteering for PALS has also provided a very rewarding experience for people who value making a difference for people who use our services and want to ensure that everyone’s experience of the services we provide is as positive as possible. James Olweny, Associate Director of Quality and Service Improvement

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        Q14: Has the Trust considered having an easy to read section of the website or to review what is currently on the website to ensure it is accessible? FoCUS members would be happy to assist with the review of the website.

        A: Yes, we are planning to develop an easy read section of the public website as part of our plans to make the website responsive to different devices such as tablets and smart phones. Currently, we are unsure of the timescales for having this available but we hope it will be within this financial year. Our Senior Communications Officer, Joanna Bowe, runs a Learning Disability Communications Steering Group which includes people who use services and they have been discussing what the easy read website should include and will continue to input into this project going forward. Stephanie Forster, Associate Director of Marketing and Communications

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