To hold a public accountability session to discuss the performance of the 2gether NHS Foundation Trust.

The Committee received a presentation on the work of the 2gether NHS Foundation Trust.  Mr Clee, Chief Executive of the Trust, presented the report, and highlighted the following areas:

·         That there was a national increase in mental health which was largely as a result of four main factors.  The population growth within the country; the demographic shift that had seen an increase in elderly; a decrease in the stigma associated with mental illness and increased access to services; more prevalence amongst the population as a result of old age, substance misuse and other factors.

In the ensuing discussion the following issues were highlighted:

·         That all the Department of Health Key Performance Indicators had been met apart from the ‘no children under the age of 18 to be admitted to adult in-patient wards’.  That this had been necessary was an undesirable state of affairs, and had taken place because it was the least worse option for the patient.  The Trust had not been commissioned to provide any under 18 services, as this was dealt with at a regional and national level by the NHS Local Area Teams.  This was a serious issue for the Trust, and it had been raised with NHS England as there was a nationwide bed shortage for children. 

·         That the adult bed base number had not been reduced from 29 to 16.  This had been a contractual obligation, but the number of beds had only been reduced to 21 as little progress had been made with mental health service liaison services in the community, and the crisis teams had been obliged to spend time supporting work in A&E, rather than in the home.  There had been no change in the triage arrangements, and patients who had needed to be admitted had been provided with a bed. The percentage of patients admitted had been reduced from 12% to 8% and no patients had been sent out of area.

·         Mr Clee undertook to provide a briefing paper to the Committee outlining the headline detail behind the Performance Indicators.

·         As there was no forecast for a reduction in demand, 2gether would look to work in different ways with partners and commissioners. The Director of Children’s Wellbeing undertook to provide the Committee with a briefing note on changes to the services.

·         That 2gether was working on awareness around suicide risk, and talking to a wide variety of services to this end.   Areas such as building planning was being discussed to make planners aware of potential hazards around tall buildings.

·         That there was an issue with the A&E Department of the hospital, where patients needed mental health assessments, especially for the over 65 age group, where dementia was an increasing issue.

·         Assessments were done within four weeks and based on individual need and clinical process. 

·         That work was put into socially inclusive initiatives that were funded by 2gether as well as Council funded ones such as the Healthy Lifestyle programme.  Workshops were held in the colleges on mental health issues and diet which were run by service users with support from 2gether staff.

·         That whilst 2gether held a £1.2m contract with the Local Authority for mental healthcare, for which it offered a range of services, it was one portion of the spectrum of care that was offered in the County.   There was a significant financial squeeze on services, and it was expected that another £1m of services would be delivered in 2014-15 to meet the rising demand.  Alternative ways of working were being looked at in order to deliver more effective and cost effective ways of treatment.

·         That counselling services were being decommissioned and Improving Access To Psychological Therapies (IAPT) thresholds were being changed for 2014-15 nationally.  There was significant patient involvement in the service, and 2gether were ahead of the contracted target.  The service offered a stepped model of care for those with mild to complex psychosis.  Alternative methods of delivery would be considered.

·         That there would be a benefit for a System Leader in Mental Health in the County.  This model was used in Bristol, where the lead provider for mental health ensured the most effective use of resources and services as well as providing a simpler service for users. Mr Clee undertook to provide a briefing paper on this model for the Committee.

In reply to a Member’s question regarding access to services for young people, Mr Clee went on to say that there were no beds in the County for young people, and the service was commissioned nationally. Work was undertaken with schools, and every Year 6 pupil in the County was provided with the opportunity to consider mental health and safeguarding issues.  As a result of the complexities of children’s legislation, self-referral was not possible for a child.

The Independent Chairman of Healthwatch Herefordshire said that he had attended the 2gether NHS Trust AGM and The Trust and the Chief Executive had always made it clear that they valued feedback.  He believed the organisation to be effectively led, with involvement in the Health & Wellbeing Board at Chief Executive level.

He went on to point out that the contract for the 2gether NHS Trust would shortly be coming up for renegotiation, and this was a chance to look for opportunities within the challenges presented in the field, but care should be taken not to lose both stability and continuity in the service.

In reply to a question from the Chairman, Mr Clee said that there were a number of risks surrounding a new contract. 

·         There were concerns around the demands made to support the Wye Valley NHS Trust’s A&E Department.

·         There was an ageing population within the County. 

·         There was no powerful social housing provider to lobby on behalf of residents as there was in Worcestershire, and to work to support their residents through recovery. 

·         There was challenge to meet the needs of a significant proportion of service users with complex multiple needs.

RESOLVED:  That further briefing on headlines for Key Performance Indicators for Monitor and the Department of Health be provided before the next meeting, together with an indication of where the patient evidence comes from as part of the 2gether user satisfaction survey.