To receive a presentation on the work of the ²gether NHS Trust over the previous year, and an overview of its future plans.

The Committee received a presentation from the Shaun Clee, Chief Executive, ²gether NHS Trust, on the work of the Trust over the previous year.  The presentation is appended to the Minutes at Appendix 1.

In his presentation, Mr Clee highlighted the following areas:

·         That the number of agency staff being used was being reduced in order to improve the patient experience, as many often didn’t  know the staff who were looking after them.

·         That the number of beds within the service had been reduced from 29 to 16, allowing for a greater focus on care within the community.

·         That reductions had also been made in readmissions and waiting times.

·         That added value had been provided thorough psychiatric liaison.  For those over 65, a quarter of patients did not go home after admission to the acute hospital in an unplanned way.  Of the 80% of those in this age range, 40% were suffering from undiagnosed dementia.  A bid had been made to the NHS West Mercia PCT Cluster for acute and community liaison services in order to try and ensure that patients were not admitted in this manner

·         That joint working between providers and commissioners within the Quality, Innovation, Productivity and Prevention (QIPP) Delivery Board was proving beneficial.

·         That GP’s were actively working with ²gether though the GP Parliament, and there was a willing process of engagement.

·         That more patients were being seen faster than the number seen in the year to date in 2011.

In the ensuing conversation, the following points were raised:

·         That there were signs and symptoms that GP’s were aware of which would result in a referral of mental health patients though the Improving Access to Psychological Therapies (IAPT) care pathway.  There were referrals to the County’s mental health team from twenty four care clusters across twenty one spectrum mental health areas.  It had been ensured that GP’s were sighted on what the areas were, and all Practices had access to the Clinical Director.  There were variations in rates of referral between practices, but it was not possible to quantify why this was as there was no electronic record system.  The GP mental health leads were very proactive, and understood that such variations were important and should be considered by their colleagues. 

·         In reply to a question, Mr Clee said that the spend on Agency nursing staff had been reduced by approximately 5%.  It was the intention that no agency nurses would be used at all, and staff would be taken from an in-house bank of nurses.

·         In reply to a further question, he said that it was difficult to ensure that mental health patients received the optimal care in the Wye Valley Trust A&E Department, which was why a bid had been made to the PCT Cluster for acute and community liaison services to help provide additional resources.

·         That there was a clear link between economic wellbeing and suicide rates, which had increased nationally as unemployment had risen. A 1% rise in unemployment figures could be matched by an increase of 7% in suicide rates.  The suicide rate rise across Europe was closer to 25%.  There was insufficient data to show a trend in Herefordshire as there had only been one suicide of a patient known to ²gether since ²gether had taken over the service in April 2011.

·         That a patient journey through the admissions system would be presented to the next meeting attended by ²gether NHS Trust.

·         Mr Clee replied to a further question by saying that the Out of County adult placement liaison was going well, and patients were being brought back into the County where appropriate.  This was both helpful to the patients and provided a cost benefit to the County.  Panels were in place to look at wrap around care issues for patients.

·         In reply to a question, Mr Clee said that one of the weaknesses of the system was the lack of joined up thinking between the agencies working in the field.  There was also a lack of supported housing in the County, and work was underway with the social housing providers to address the matter. The strength of the present system lay in monthly meetings with GP’s to drive up awareness of the available care pathways.

·         A Member suggested that, as part of the change management process when ²gether first took over, it would have been useful to have audited the number of people who had approached the service, but who had not returned for treatment.  Mr Clee concurred, and said that the service had been managed as closely as possible, and that there had been no reduction in staff or beds and no diminution in service. 

·         In reply to a further question, Mr Clee said that there was a national requirement to see patients within 7 days of referral; this was also a contractual obligation placed on ²gether NHS Trust.  The evidence base indicated that the first 48 hours were crucial, and whilst it would not be possible to reach that target, the emphasis had been to ensure patients were seen within 5 days.  Since October, all patients had been seen within this timescale.

·         That 2gether staff had links with Job Centre Plus, and all staff were trained to be mindful of the employment status of patients.  As employers, ²gether NHS Trust employed people with mental health issues.

RESOLVED: That Cabinet be recommended that it should investigate how Herefordshire Council might undertake the process of becoming part of the Mindful Employer Initiative, and should prioritise the necessary resources to enable the process to take place, and inform the Committee of its decision.