Agenda item

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provides an update to the Committee on the activities of LPFT. Sarah Connery, Chief Executive LPFT and Chris Higgins, Director of Operations LPFT will be in attendance for this item)

Consideration was given to a report from Lincolnshire Partnership NHS Foundation Trust, (LPFT) which provided the Committee with an update on the activities of LPFT.

The Chairman invited the following representatives from LPFT: Sarah Connery, Chief Executive and Chris Higgins, Chief Operating Officer, to remotely, present the item to the Committee.

In guiding the Committee through the report, mention was made to:

·       The challenges during the last 12 months for the NHS and the local community, with the continued impact of the Covid-19 pandemic, rising demand for mental health services and the increasing cost of living;

(Councillor M A Whittington joined the meeting at 10:12)

·       The Trust’s Covid-19 response, it was noted that there had been temporary changes to ward-based services in response to unprecedented staffing pressures, these changes were listed on page 22 of the report.  Reference was made to the temporary closure of Ashley House, Grantham.  The Committee noted that prior to its temporary closure, the service had been operating below its 100% occupancy since 2018; and that an alternative open rehabilitation provision remained available at Maple Lodge in Boston, with other rehabilitation care also being available at Discovery House in Lincoln.  It was noted further that for the three-years prior to the temporary closure, Ashley House had 52 admissions, of which 14 had been from Grantham and the surrounding area.  The closure had therefore not had a direct adverse effect on any one geographic population.  It was also highlighted that the Trust, had on occasion, had to make use of out of area bed placements.  It was highlighted further that this was being closely monitored and was only used when absolutely necessary;

·       Changes to services, it was noted that the Trust continued to utilise the learning from delivering services in a different way during the pandemic, details of which were shown on pages 23 to 25 of the report;

·       The Mental Health and Wellbeing Transformation Programme;

·       The new Acute Mental Health Wards;

·       Increased crisis support;

·       The increasing demand on services.  It was highlighted that nationally there had been an increase in the number of people needing to access mental health services.  The Committee noted that during the last two years, there had been notable increases in the following services: children and young people services, in particular young people experiencing an eating disorder; adult autism diagnostic assessments; early intervention in psychosis; chronic fatigue; and talking therapies.  It was reported that despite the increased demand the Trust continued to perform well against nationally set waiting times for most services, with only the children and young people services currently being an outlier compared to national expectations;

·       Suicides.  It was reported that the Trust had a local suicide prevention strategy, which strived to achieve zero suicides for those people known to the service. It was highlighted that on average only 20 percent of suicide deaths in the county were known to mental health services.  It was reported further that the Trust worked closely with public health colleagues at Lincolnshire County Council and other local partners such as Lincolnshire Police and district councils on a county wide strategy for suicide prevention;

·       Staff recruitment and retention.  The Committee was advised that the Trust had received substantial additional investment to expand teams, to meet increasing demand, and to transform ways of working in the local community.  It was highlighted that recruitment remained one of the Trust’s main risks. The report highlighted that currently there was 333 vacancies, largely in two professional areas of nursing and additional professional, scientific and technical which included roles such as psychology and social workers.  Page 32 of the report provided the Committee with a summary of the main workforce projects and initiatives for 2022/23, to help the Trust meet its recruitment and retention challenges;

·       Awards and Accreditations achieved despite the challenges and pressures of the pandemic.  These were listed on page 34 of the report; and

·       The future ambitions for mental health, learning disabilities and autism services.

During consideration of this item, the Committee raised some of the following comments/concerns:

·       Concern was expressed on the pressures for services, and the lengthy waiting times.  It was highlighted that the mental health and wellbeing transformation programme would help alleviate some of the pressures, details of what had been completed so far in this major transformation project were shown in Appendix A to the report.  Reassurance was given that emergency cases were prioritised.  The Committee noted that there was also commitment to increase children and young people capacity, however, recruitment as previously mentioned had been a limiting factor.  The Committee was also advised that the Trust continued to lobby NHS England, and that the Trust was also working as an East Midlands Alliance to try to attract people to come and work in Lincolnshire.  It was highlighted that the Trust was also growing its own staff through training and apprenticeship programmes.  The Committee noted that the Trust was also in contact with local schools and colleges, to try and attract young people to have a career within the Trust;

·       What help was being provided to Ukrainian and Russian expatriates living in Lincolnshire.  The Committee was advised that the Trust was working as a system to recruit refugee members of staff, with a focus initially on medical training and staffing.  It was noted that it was believed that two refugee nurses would be joining the Trust.  It was highlighted that there was more that could be done, but it was necessary to ensure that there was a proper role for them and that they were properly trained.  It was noted that international qualifications did not directly match.  Reassurance was given that the Trust was committed to making international recruitment a success, and that every time there had been an international crisis of this nature, the Trust was always there to respond on how services were provided to actively support those in need.  It was highlighted that the Trust had developed care packages over the years to reach out to people wherever they were.  The Committee was advised that if families needed mental health support because of the impact of the Ukrainian crisis, the Trust would actively work with them;

·       General mental health provision in the Boston area.  The Committee noted that the Trust was committed to making sure that there was appropriate provision on the east coast.  The Committee noted further that there were inpatient wards in Boston, as well as a thriving community service offer.  It was reported that Boston was one of the first pilot sites out of twelve in the county to get investment into the community health transformation programme.  This was investment in community resources and community assets and prescribing. The Committee noted that this programme was still in development, but already, the impact was being seen in the Boston area.  It was highlighted that one of the challenges on the east coast was expanding the provision of crisis night light cafes. It was highlighted that the Trust was working with the community and voluntary sector to rebuild capacity and capability, and the desire to provide mental health services.  Reassurance was given that the Trust was committed and had an active programme to stimulate that market to get people coming forward to provide the services.  The committee noted that the Trust wanted to upgrade the inpatient unit at Pilgrim Hospital, so that it was modern fit for purpose, and provided an outstanding environment to treat patients, and for staff who worked there.  Further reassurance was given that the Trust was committed to Boston.  Representatives agreed to respond directly to provide a written response to these questions;

·       The need to ensure that nationally more effort was placed on training more mental health staff;

·       Some concern was expressed that residents in Lincolnshire did not receive help until they were at a critical level and in some cases, when it was too late.  The Committee was advised that the transformation programme investment would ensure that community assets were integrated with secondary services.  The Committee was reminded that only 20% of those who had taken their lives were known to mental health services.  It was highlighted that work was ongoing to make sure that those in need of support got the support they needed, to prevent the need for escalation; and that more was being done with the third sector to build up more resilience.  The Committee was advised that further development on the east coast was due in the next year regarding mental health support teams.  Trust representatives agreed to make a copy of the implementation plan available to members of the Committee outside of the meeting;

·       Whether the mental health liaison scheme at Lincoln County Hospital was a hospital wide scheme or just in A & E, and whether there were any plans to expand it further.  The Committee noted that the liaison service was available at Lincoln, Boston and Grantham and that it was planned that the service would be extended to Louth and Skegness.  Confirmation was given that the assessment centre at Lincoln was in addition to and would not replace the mental health liaison scheme;

·       The need for the expansion of the new urgent assessment across the county.  There was recognition that services were Lincoln centric and that steps were being taken as part of the transformation programme to expand them across the county;

·       Recognition of the challenges faced regarding the expansion of services;

·       Chronic fatigue.  The Committee noted that the Trust’s specialist chronic fatigue syndrome service had been working closely as part of the system’s Long Covid clinics.  It was noted that demand was currently greater than current capacity and that waiting lists were increasing as a result.  The Committee was advised that discussions were being held with local commissioners for additional investment to expand the team to meet the current demand;

·       The need to concentrate the increase in provision of services in the east and south east parts of the county;

·       That better communication was required to advise members of the public of what services were available across the county, as there appeared to be some inconsistencies.  There was recognition that there were gaps in provision across the county, and that more that needed to be done;

·       What help was being provided to service personnel.  The Committee was advised that the trust had a veteran service, which was highly regarded across the East Midlands area;

·       Some concern was expressed that support was not being provided quickly enough, which had resulted in some suicide cases.  The Committee was advised that there were numerous reasons why someone would take their own life.  Reassurance was given that each incident of suicide was investigated to ensure that lessons were learnt.  It was noted that the introduction of a 24/7 helpline for support and crisis cafes were part of the transformation programme for individuals to be able to make contact; and for young people to have access to healthy minds in schools.  The Committee was advised that where people were waiting to access services, these people were regularly contacted and when appropriate, would be prioritised, if their needs were to change;

·       The provision of in-patient beds.  It was reported that at the moment, it was not known what the demand for in-patient beds would be.  It was highlighted what was available was intensive home treatment support, which would avoid someone having to go into hospital.  It was recognised that there was a balance to be reached to ensure that beds were available if required.  Reference was also made to the reduction in bed availability because of social distancing, leading to out of county placements.  The Committee was advised that in the last couple of months there had been approximately five out of county placements, and that these had been because of a number of Covid-19 outbreaks.   The Committee was advised that the latest figure was four out of county placements, some of whom were satisfied with their placement; and every effort was made to establish relationships during the care period, so that the patient’s journey was not disrupted.  It was noted that the out of county placements were in Nottinghamshire.  Reassurance was given that secure transport arrangements were available, and that digital arrangements were also in place; so that family and friends could stay in contact;

·       The increase in the number of adults diagnosed with autism.  There was recognition that the number was on the increase and that there was a gap in provision, and that work was on going to have an all-age diagnosis.  It was also noted that there had also been an increase in the number of adults with eating disorders needing support;

·       Manthorpe Ward, Grantham.  The Committee was advised that the proposal was to re-open Manthorpe Ward on a pilot basis in a new clinic format, utilising the space as an eight-bed short stay step-up/down service.  The pilot would also enable the Trust to continue with the pilot dementia home treatment and provide additional care pathways in the older adult/dementia services, parallel to the stepped options available to working age adults;

·       Whether the data sharing agreement was county wide and how that fitted into the data sharing care portal.  The Committee was advised that data sharing agreements were already in place with various partners, it was however noted, that data sharing had not been completely rolled out across the county yet.  The Committee noted that the care portal was the mechanism that would make data sharing a reality.  It was highlighted that the Committee was due to consider a further report on the care portal at its 14 September 2022 meeting;

·       24/7 crisis freephone helpline. One member enquired how long after initial contact on average was it before people received follow up support, or potential treatment began.  The Committee noted that the time period varied as this was dependent on the nature of the call; some callers were repeat callers just needing someone to talk to; others were signposted to groups such as a walking group; and some would be seen by professionals the same day if the need was required;

·       The eradication of dormitory accommodation in Boston, due to increasing costs, and what options were now being considered.  The Committee was advised that the Trust was still committed to eliminating dormitory accommodation, and that the Pilgrim Site (or the Norton Lea site) was still being considered, either as a new build option, or a refurbishment scheme and that work was continuing with United Lincolnshire Hospitals NHS Trust regarding this matter; and

·       When the Trust foresaw when it would be returning to its pre-pandemic waiting times and what additional support would be received to help achieve this.  The Committee was advised that this information would be available in the performance report, and that additional investment was available for this to happen.

The Chairman on behalf of the Committee extended his thanks to the presenters from LPFT.

RESOLVED

1.      That the update report from Lincolnshire Partnership NHS Foundation Trust be noted.

2.      That the consultation on the mental health rehabilitation service be considered at the 15 June 2022 meeting.

3.      That mental health provision and suicide prevention be reviewed in more detail by a working group and that membership of the said working group be agreed under item 9 on the agenda - Health Scrutiny Committee for Lincolnshire – Work Programme.