To hold a public accountability session for organisations within the health sector.  This session shall focus on the 2gether NHS Foundation Trust.

The Committee received a presentation from Mr Merker, Director of Service Delivery, 2gether NHS Foundation Trust which was published as a supplement to the Agenda.

In the ensuing discussion, the following points were addressed:

·         That the Committee would be provided with a list of waiting times for patients, together with information on the number of referrals made against the time that patients had waited for their appointments. 

In reply to a question, Mr Merker said that since September 2013 the Learning Disability specialist services had a clear focus as a result of the commissioning arrangements between health and social care.  The Service was in a larger clinical network as a result of changes, which allowed for different professional discussion between clinical colleagues.  Work was still required around various clinical pathways. 

·         That one of the aims of the Lets Talk service was to provide an alternative to the GP for those suffering from depression for those with low level needs.  This should help reduce the level of prescribing.  Mental Health nurses liaised with GP’s to discuss the best way forward for treating patients.

·         That it was unlikely that the fatal stabbing that had happened at the Wooton Lawn Hospital in Gloucestershire could happen in Herefordshire.  Appropriate training had been provided to all staff in the unit, and a restraint procedure team had responded to the incident.  No restraint procedures had initially been in place.  The matter had been reviewed both internally and externally, and improvements had been made in certain areas.  The reviews had found that the level of training had been appropriate.  Mr Merker extended an invitation to the Committee to undertake a site visit of any of the facilities run by the Trust in order to see for themselves how they operated.

In reply to a comment concerning staffing levels in the Stonebow Unit, Mr Merker said that whilst there was an issue of safe staffing levels in any ward, the Unit had to report on a weekly basis both externally and internally on staffing levels, and if staff had concerns, they were encouraged to voice them.  He undertook to provide the Committee with a briefing note on the situation as soon as possible. 

·         That staff were flexible in their case workloads, and were encouraged to discuss concerns that they might have over their caseloads.  In reply to a further question, Mr Merker suggested that, in order to address questions as to how adult and older people mental health services worked with primary care and GP’s, a session should be held with clinicians who were delivering services on the front line. The Herefordshire Clinical Commissioning Group (HCCG) was investing in Dementia care, and the Trust had been able to target waiting times, which had been reduced to four weeks.  Support was offered during the subsequent interim period until a diagnosis was provided, which should be no longer than eight weeks.

• That there were three wards at the Stonebow Unit, one Adult and two Older People wards.   The bed numbers had been reduced, but it should be borne in mind that the crisis resolution and treatment team was active 24 hours a day and 7 days a week, and that (6% of people seen by the Trust were supported in the community.  Bed pressures were felt in the areas of specialist intervention and support.  For general mental health issues, no patients were sent outside Herefordshire.  It was necessary to provide specialist mental health and psychiatric care out of County.  The Programme Manager Children and Mental Health Services (HCCG) added that at the present time there were thirty adults placed outside the County with mental health issues, and four young people.  It was noted that there were no mental health children’s beds in Herefordshire; the closest such beds were in Birmingham. 

In reply to a question concerning the risk of deprivation of liberty for residents, the Director of Adults Wellbeing said that this was an issue that would have to be addressed.  The Mental Capacity Act differed from the Mental Health Act in that staff needed to be aware of assessing when patients were capable of making a decision.  There were 169 outstanding assessments of this nature in the County, and at least 20,000 nationally.  Most Local Authorities had around a thousand assessments to deal with.  The Local Authority was the supervising body, and additional staff had been employed to deal with the issue, as there were six different assessments that had to be undertaken.  The issue did not apply to those living independently in their own homes.  The Law Commission was undertaking a review in the coming year, and it was hoped that extra resources would be provided to deal with the situation.

In reply to a Member’s question regarding the reconfiguration of the CAMHS service, Mr Merker said that the joint commissioning of the service between the HCCG and the local authority meant that improved efficiencies had allowed for resources to be released back into the system.  A CAMHS Strategy Group had been set up for Children’s Wellbeing, and would be tasked with bringing services together in a more efficient way.  The Director of Children’s Wellbeing undertook to circulate a briefing note to the Committee from the Council and the HCCG on the matter.

In reply to a question, Mr Merker said that Gloucestershire’s Let’s Talk programme had been set up before Herefordshire’s, which is why it was delivering ahead of the local one.  Herefordshire’s programme would reach its targets in March. The service was expecting to receive 180 new cases a month.

The Independent Chairman of Healthwatch said that it was important for Members to visit the Stonebow Unit in order to understand the issues with the Unit. A Board Member from Healthwatch attended the Board meetings of the 2gether NHS Foundation Trust, and governance and involvement with the organisation was an important issue.  He added that the Leadership of the Trust has always been open and inclusive to Healthwatch.

Mr J Saunders OBE, Non-Executive Director, 2gether NHS Foundation Trust said that the Trust was subject to financial, political and demographic pressures and had a very effective performance and assurance process.  There were continuous demands on the Trust to improve performance and to find new and imaginative ways of providing services.

Resolved:

That

a)    The presentation be noted; and;

b)    Briefing notes on the staffing levels at the Stonebow Unit and the CAMHS Strategy group be provided to the Committee.