Agenda item

(To receive a report from Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) which  sets out the Lincolnshire Partnership NHS Foundation Trust (LPFT) Draft Clinical Strategy 2016-2021.  Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust) and Chris Higgins (Deputy Director of Strategy and Business Planning, Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

A report by Jane Marshall (Director of Strategy – Lincolnshire Partnership NHS Foundation Trust (LPFT)) was considered which set out the Lincolnshire Partnership NHS Foundation Trust (LPFT) Draft Clinical Strategy 2016-2021. 

Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust), Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust (LPFT) and Chris Higgins (Deputy Director of Strategy – Lincolnshire Partnership NHS Foundation Trust (LPFT) were in attendance for this item.

Members were given an overview of the draft clinical strategy, which was intended to translate the organisation's Mission into the deliverable objectives and actions through a series of agreed priorities and would sit centrally to the governance framework, informing the development of Divisional plans, dependent sub-strategies and the Trust's overarching Integrated Business Plan.

The Strategy was the result of work completed since the summer of 2015 during which time staff, patients and carers, commissioners, partners, Governors and the public had been consulted about their views on what should be done to improve clinical services.  The aim was to implement a new clinical strategy for 2016/17 and beyond which reflected the ambition to provide the best possible care but also a strategy co-created with service users but which remained aligned to national policy and best available evidence.

Current clinical priorities had been derived from feedback, local delivery objectives and national policy.  The clinical priorities were:-

·       More people will have good mental health;

·       More people will have a positive experience of care and support;

·       More people with mental health and learning disability problems will have good physical health;

·       People will have better access to services;

·       Support integrated health and social care in Lincolnshire;

·       Fewer people will suffer avoidable harm;

·       Promote recovery and independence;

·       Support our people to be the best they can be;

·       Maximise NHS resources;

·       Ensure our estate is fit for modern healthcare delivery.

Members of the Committee had held a working group on 12 November 2015 to discuss the draft Clinical Strategy following which a joint statement, from the Committee and Healthwatch Lincolnshire, was presented to the Committee at its meeting on 16 December 2015 for approval.  Dr Brewin formally thanked the Committee for their support and input into the strategy.

The Draft Clinical Strategy was expected to be presented to the Board of Directors of Lincolnshire Partnership NHS Foundation Trust in March 2016 for final approval.

Members were given the opportunity to ask questions, during which the following points were noted:-

·       A substantial proportion of the population were likely to suffer some mental health problems at some point in their lives and concern was noted about the isolation of young people as a result of social media;

·       The veteran's service within the LPFT was working with patients to consider expansion in to community services and engagement with communities was broadening to assist with this.  Team models were being considered to provide the right level of support;

·       It was reported that there was a bespoke Ministry of Defence (MOD) unit on one of the wards in Boston which was for ex-servicemen requiring inpatient care.  The Trust were in constant dialogue with groups who were part of a network supporting veterans and members of the armed forces at a community level;

·       Recent press coverage had implied that some chemical therapies were not effective and focus should be talking therapies.  In response it was agreed that talking therapies did have a good evidence base for keeping people in their own lives by the Steps to Change programme in addition to the Improving Access to Psychological Therapies (IAPT) strategy.  Chemical based therapies were now being questioned and the availability of a wider range of therapies more specific to individual patients were increasing.  Chemical based therapies may still be the best option for some patients but it was acknowledged that these would not be used as frequently as in recent years;

·       The comments received by Healthwatch Lincolnshire from patients were largely based around their dissatisfaction with the support from the community after discharge and the wider issue of the relationship with primary care and the support which GPs could give.  There appeared to be a wide ignorance of mental health within GP practices and primary care generally despite the increased need for mental health support.  These points made in relation to access, discharge and transition were agreed as was the fact that 90% of mental health work was undertaken within a primary care setting.  At present, the Trusts' cooperation with primary care needed to improve, with the emphasis on integrated working while consideration was being given to the availability of treatment;

·       Trust representatives advised that they were to attend a Task & Finish Group to discuss how to address these issues as part of the Lincolnshire Health and Care (LHAC) programme;

·       It was reported that 10% of the budget must be removed within the next three years from back office functions.  The Trust were required to show that they were working as efficiently and productively as possible;

·       Discussions were being held with local gyms in relation to 'social prescribing', for example members of the armed forces struggling with PTSD (Post Traumatic Stress Disorder) as patients who engaged in physical activity to help maintain their fitness levels to help avoid slipping into a deeper depression;

·       Page 35 of the report referred to "Increased Prevention" within the Key Financial Challenge box.  It was agreed that the language used within the report could be clearer but that this particularly referred to changing the approach 'upstream' and giving patients access to treatment programmes earlier in order to prevent a higher level of treatment at a later time.  It was agreed that consideration would be given to make this section of the Clinical Strategy clearer;

·       The discrepancy between age groups was highlighted, for example up to 64 years of age, a wide range of services were available, but after 65 years mental health services had traditionally focussed on dementia only. It was acknowledged that the world had moved on, in particular with dementia and early onset dementia which required the services to be shaped to meet the needs of individuals rather than being based on age alone.  Further work with commissioners was needed as services had been historically commissioned based on age;

·       Page 39 of the report, under the national 'Must Do's', had "Achieve Financial Balance" at the top of the list.  Members questioned whether this should be the main priority when patient care should be the top priority.  It was explained that this order had followed the national list but it could be changed in the local strategy.  It was also stressed that there was a difficulty finding a balance to achieve good quality care within the current financial constraints;

·       In relation to support for patients suffering with drug and alcohol issues, it was explained that the line between cause and effect was not always clear and that some of the patients treated under alcohol services were often the most vulnerable people in society.  It was, therefore, inappropriate to favour one group over another and important to treat everyone with need in the same way to avoid wider consequences for other parts of the health system and community;

·       It was difficult to differentiate between the broad spectrum of conditions presented and if a person was in need whether they had the right to treatment.  It was difficult to balance the right thresholds for accessing care;

·       The Managed Care Network was starting to see community groups and organisations reaching more people.  Investment by the Trust was resulting in the same amount of money leading to services for more people and more initiatives of this type were being considered to make more services available;

·       Although there were issues with patients being admitted to units far from home, it was suggested that they were admitted to ensure they received the specialist treatment needed rather than being in a hospital close to home which did not have those specialisms.  Within Lincolnshire there was a broad range of services but it was noted that there was a particular shortage of beds for eating disorders and perinatal care.  However, the Trust had an excellent relationship with the Nottinghamshire unit where Lincolnshire patients were admitted.  There was no Psychiatric Intensive Care Unit (PICU) within the county, but it was hoped to establish one at Lincoln County Hospital within the year;

·       Often by choice, people with severe mental illness did not want to engage with a health professional, but the Trust remained assertive in actively contacting these patients to advise them of the risks of not accepting help;

·       An event at Carholme Court was planned for 24 February 2016, where the community team would host an open evening providing case studies, discussions and details of services offered. Eating disorders was a good example of a range of conditions, information for which would be available;

·       It was suggested that the emphasis on reducing childhood obesity was having a detrimental effect on some children who were developing eating disorders for fear of becoming overweight;

·       Development of Neighbourhood teams within the LHAC and in GP practices would see a broad range of mental health workers within those teams.  It was proposed to have a suite of people within each of those teams to enable GPs to focus on the work they need to do;

·       The Committee asked if it would be possible to have training of the cause and effect of mental health issues.  LPFT confirmed that they would be pleased to deliver a training programme for the Committee which would cover a broad range of areas.

RESOLVED

1.    That the comments of the Committee on the draft Clinical Strategy be considered by Lincolnshire Partnership NHS Foundation Trust; and

2.    That a training session be arranged for the Committee, to be delivered by representatives of Lincolnshire Partnership NHS Foundation Trust, to raise the Committee's awareness of mental health, including the various services and treatments available.