Agenda item

Lincolnshire Sustainability and Transformation Partnership: Mental Health

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership (STP) and Lincolnshire Partnership NHS Foundation Trust (LPFT), which updates the Committee on progress and strategic activity in relation to the NHS direction for delivery of Mental Health Services in Lincolnshire.  Jane Marshall, Director of Strategy, Lincolnshire NHS Foundation Trust will be in attendance for this item)


The Chairman welcomed to the meeting the following representatives:-


Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust, Rachel Redgrave, Head of Commissioning, Mental Health, South West Lincolnshire Clinical Commissioning Group and Christopher Higgins, Deputy Director of Operations, Lincolnshire Partnership NHS Foundation Trust.


The Chairman also advised that a member of the public, Mrs Penny West had requested to address the Committee with regard to the report.  The Chairman invited Mrs West to speak for a period of 3 minutes to address the issues set out in the report.


In her short address to the meeting Mrs West raised the following questions:-


·         Page 30 of the report - The provision of community mental health services for working age adults (People aged 18 to 65).  Whether people aged 66 and over would be disadvantaged; and whether this was an example of age discrimination.  Reassurance was given that there was no discrimination on the basis of age, but traditionally mental health services had been organised into 0 – 18, 18 – 65, and 65+.  Confirmation was given that people would be able to access services regardless of age;

·         Page 34 of the report – Older Adult Services.  Whether the beds provided were short term and whether issues of patient isolation were being addressed.  Clarification was given that works were about to commence to upgrade patient environment at Brant Ward, Lincoln to create single rooms to protect patient dignity.  Confirmation was given that day room facilities would also be available; and

·         Page 32 of the report – Workforce Development – whether there would be 'deskilling' of staff.  The Committee was advised that the workforce plan was to support the service transformation.  To ensure successful delivery it was critical there was a skilled and well-supported workforce, who was trained to deliver evidence based interventions at the right level.  It was highlighted that nurses would always be supported by a doctor.  It was highlighted further that the changes to roles were to help meet the recruitment difficulties Lincolnshire was facing.


In guiding the Committee through the report presented there was an acknowledgement of the Health Scrutiny Committee for Lincolnshire and the Lincolnshire Health and Wellbeing Board's support to mental health work stream.


It was highlighted that the content of the report focussed on what was in the Lincolnshire Sustainability and Transformation Partnership (LSP).  It was highlighted further that the priorities for the Lincolnshire Partnership NHS Foundation Trust (LPFT) were the repatriation of mental health patients back to Lincolnshire, and the transformation of the community mental health teams.  Page 29 of the report detailed that the LPFT was currently looking at bringing back both male and female patients who currently went out of county for bed based psychiatric intensive care and acute mental health placements.  The report highlighted that since the start of the programme the number of male patients going out of area for psychiatric intensive care had been reduced to zero and the total number of patients who went out of area for care had reduced and regularly dipped below the trajectory of 18 patients.  It was highlighted further that the plan was to reduce the number going out of county further.


The report highlighted that part of the solution to reduce the numbers was to improve the provision in Lincolnshire through the transformation of community mental health teams.  The Committee was advised that over the last 18 months, the division had listened to patients and stakeholders; and that their comments had been used to shape the current service plan to ensure that it was fit for purpose.  It was noted that the service plan consisted of three distinct pathways: Long Term Care, Psychosis/Trauma and common mental health disorders.  Details relating to the transformation were shown on pages 30 to 32 of the report.


The Committee was advised that the Lincolnshire Mental Health Crisis Concordat had been successful in securing capital funding of £640k to develop 'places of safety' in both Lincoln and Pilgrim Emergency Departments; and to build a mental health crisis hub.  The Committee noted that LPFT had also received additional income for perinatal mental health services for women and families; and that the county council continued to support the improvement of mental health services for children and young people with investment in Healthy Minds, in addition to the Section 75 Contract for Adult Care and the Managed Care Network.  It was also highlighted that Lincolnshire had excellent community services in place for children and young people; and an excellent inpatient unit for Child and Adolescent Mental Health Services in Lincolnshire based in Sleaford.


Reference was also made to the Lincolnshire Multi-Agency review of crisis care commissioned by Lincolnshire County Council to obtain a clear picture of commissioned mental health crisis services across Lincolnshire.  Details of the key issues of the review were listed on page 33 of the report.  It was highlighted that the review had not demonstrated anything that was not already known, but had provided an opportunity to reflect on how Lincolnshire needed to work across the system of provision to respond.


In conclusion, the Committee noted that the Lincolnshire Sustainability and Transformation Partnership and the Lincolnshire Health and Wellbeing Board were supporting mental health and learning disability developments for the benefit of Lincolnshire patients.


During discussion, the Committee raised the following points:-


·         Some reassurance was sought as to when patients were sent out of area, they were receiving the same excellent care that was provided in Lincolnshire.  Reassurance was given that adult contracts were regularly reviewed and visits were made.  It was noted that for Children and Young People the LPFT worked closely with NHS England.  Further reassurance was given that part of the commissioning role was to do quality and safety checks to make sure appropriate standards were maintained;

·         Some concern was expressed relating to the transition from children to adults; and the responsibilities up to the age of 25.  Clarification was given that the 0 – 25 age range for responsibility was for Special Educational Needs and Disabilities.  For mental health services, the service would work with the young person up to the age of 24, and then steps would be taken on an individual needs basis dependent when transition took place;

·         Whether staffing levels at the Psychiatric Intensive Care Unit (PICU) been maintained.  It was reported that it had been a challenge to recruit staff, due to its nature and environment.  There had however been an increase in the salary, which had seen some benefit with regard to maintaining staffing levels;

·         The number of Child and Adolescent Mental Health Services (CAMHS) placed out of area.  The Committee was advised that the number of children place out of area fluctuated.  It was noted that out of area placements were sought for the most complex and specialist needs and that these were the responsibility of NHS England;

·         Had the refurbishment work at Ash Villa been completed?  The Committee was advised that the refurbishment work had been completed;

·         Location of the Physical Healthcare Clinics – It was reported that some localities now had physical healthcare clinics, details of which would be shared with the Committee;

·         Numbers of people attending the benefit groups.  It was noted that it was on the increase and that the Grantham Community Mental Health Team was trialling benefit drop in sessions to support patients with this dimension of living.  One member enquired whether this was a role for the Citizens' Advice Bureau (CABx) and not for mental health professionals.  Reference was also made by a member to a reduction in funding to the CAB from the County Council which had affected some the CABx, particular reference was made to the Lincoln CAB.  Clarification was given that the CAB did also receive funding from other organisations; and to the fact that the Grantham CAB had continued to expand;

·         Whether waiting times for psychology services had reduced.  The Committee was advised that waiting times had reduced significantly; and that work would continue on reducing the waiting times to a single referral route in for patients and a multi-disciplinary team working together to make sure that the patient saw the most appropriate professional for their care;

·         Some concern was expressed to the 18 patients placed out of area; of which 11 were female being away from their families.  Some assurance was sought that this figure needed to be reduced; and what steps were being taken.  The Committee was advised that the matter was being considered and at the moment it was felt that a female PICU was not the answer and that a different approach was needed.  It was highlighted that a bid had been put in as part of the STP to develop estate and that more would be known in November;

·         Where the Bi-Polar Group met and how many attendees were from Lincolnshire.  The Committee was advised that this information would be provided after the meeting;

·         Crisis Hub – The Committee was advised that the Lincolnshire Mental Health Concordat had been successful in securing capital funding to develop places of safety and to also build a crisis hub.  It was reported that the new hub would provide space for patients and carers to access advice and support from LPFT mental health services, alongside supporting organisations such as housing, homelessness support, relationship advice, debt management and drug and alcohol services;

·         The increase in young people needing mental health support.  One member enquired whether there were enough resources.  The Committee was advised that GPs would advise that there were enough resources in place, but children had to be quite poorly to get in to them.  The Committee was advised that Healthy Minds was now promoted in schools to ensure that children received help earlier; and

·         A request was made for a copy of the Workforce Plan and details of the localities of the physical healthcare clinics to be made available to the Committee.


The Chairman on behalf of the Committee extended thanks to the three representatives for their informative presentation.




1.    That the progress of the STP mental health priority be noted.


2.    That a copy of the Workforce Plan and details of the locations of the Physical Healthcare Clinics be made available to the Committee.


3.    That a report on Home Treatment Services be presented to the Committee when released in early 2019.

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