Agenda item

(To receive a report from Dr Tracey Swaffer (Head of Adult Psychology Psychotherapies Service, Consultant Clinical Psychologist – Lincolnshire Partnership NHS Foundation Trust) which provides information on the Adult Clinical Psychology and Psychotherapies Service for individuals accessing secondary mental health care.  Jane Marshall (Director of Strategy and Performance – Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

The Chairman welcomed to the meeting Jane Marshall, Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust, Rob Harvey, Divisional Manager Adult Community Mental Health, Lincolnshire Partnership NHS Foundation Trust; and Dr Tracey Swaffer, Head of Adult Clinical Psychology and Psychotherapies Service, Consultant Clinical Psychologist.

Before the start of the presentation, the Chairman asked the Director of Strategy and Performance, Lincolnshire Partnership NHS Foundation Trust, to clarify recent media interest with regard to patient waiting times, it had been reported that there were delays of 31 months to access pathways of care after being assessed for Psychology and Psychotherapies Services at Lincoln and Louth.

The Director of Strategy and Performance agreed that the length of time patients were kept waiting was not acceptable, and that it was a concern for the Trust to be in that position.  The Director confirmed that the longest waits were in Louth and Lincoln, with individuals having to wait 31 months to access 18 session individual pathways of care.  Reassurance was given that the service provided was a good quality service, and those patients that had experienced the journey through the service had made positive comments about the service they had received.  It was noted that 94% of patients who accessed the service felt that they would recommend it to family and friends.  Further details relating to waiting times were contained on page 26/27 of the report presented.

It was highlighted that patients that had been assessed, and were waiting further intervention were never actually left without support; they still had access to the service.  It was reported that the eighteen week target on how the service was progressing was not the same as others as the clinicians providing the service were not doctors.  The Committee was advised that for one to one clinical support, there was a longer waiting time, and that all options were being looked into to reduce the waiting time.  Some of those patients were offered group work, and depending on the individual's needs, some had taken up the offer of group work, others had opted to wait for one to one sessions. 

The Committee noted that guidance given was that anyone entering the service could be offered up to eighteen sessions, but quite often patients did not need that number of sessions.

The Committee was advised that Lincolnshire Partnership NHS Foundation Trust (LPFT) delivered its clinical services from four operational divisions.  The Adult Clinical Psychology and Psychotherapies (ACPPS) was commissioned by South West Lincolnshire Clinical Commissioning Group, on behalf of the Lincolnshire CCG's to provide talking therapies to people who presented to services in Lincolnshire that had moderate to severe levels of Psychological need.  It was highlighted that referrals to the service were received in the main from within the Trust such as Outpatient Psychiatry Clinics, Community Mental Health Teams and Improving Access to Psychological Therapies. 

It was reported that in 2007, the Government had released a significant amount of money to provide increased access to psychological therapies for the general population across the country.  The money had been invested in the development of a stepped care model of psychological intervention.  An explanation of the stepped care model was shown on pages 24/25 of the report presented.

The Head of Adult Clinical Psychology and Psychotherapies Service, Consultant Clinical Psychologist provided the Committee with some background information with regard to the type of patient accessing the service; and details the stepped care model provided.

It was highlighted that from 2012 – 2014 there had been significant increase in referrals to the service by 17%, year on year.  It was highlighted further that the Trust was also obliged to achieve cost improvement savings each year; this had meant that there had been a reduction in the number of psychology posts within the service. 

Since 2012, the Committee noted the service had completed 4,686 episodes of care, which averaged 1,171 episodes per year.  A definition of an episode of care was someone entering and then exiting the service, which could range from 18 sessions of individual therapy, 12 sessions of group based interventions, 8 sessions of formulation driven work to an assessment and formulation of treatment plan for others to implement.

The Divisional Manager Adult Community Mental Health, Lincolnshire Partnership NHS Foundation Trust explained that the current challenge for the service was the continued existence of lengthy waits to access Step 4 service.  To try and address the waiting time, various measures had been put in place, which had focussed upon the development and delivery of new pathways of care that included:-

·         Parameters around the number of sessions offered;

·         Introduction of Group based Interventions;

·         Re-design of referral pathways into the service;

·         Adoption of emerging new therapies such as Acceptance and Commitment Therapy;

·         Skill mixing of staff to offer different types of therapy; and

·         Clear job planning and expectations for those individuals delivering the service.

In conclusion, the Trust advised that they were committed to continuing to look at innovative approaches to address waiting times, whilst ensuring that the continued provision of high quality psychological interventions to those with the greatest severity of need.

During discussion, the Committee raised the following points:-

·         The timescale for how long a patient could access the service.  The Committee was advised that guidance allowed for 18 sessions, per patients as part of their treatment, however, some patients would not require the 18 sessions;

·         A question was asked whether the Trust could have anticipated the situation of long waiting times.  It was reported that the Trust had tried to manage over a number of years, being aware of the pressure and trying to deal with it;

·         The Committee reflected on the type of patient presenting at Tier 4: usually they were patients who had suffered extensive emotional and physical abuse, sometimes over a period of 20-30 years, and often from their childhood. Each patient needed to be treated differently and there was no policy of one size fits all.  For some patients group therapy sessions would work. 

·         It was asked whether as a consequence of waiting for treatment, any patient had attempted suicide.  The Committee was reassured that while patients were waiting, they still had access to the service, they were not left on their own, and support was always given during the waiting period.  It was thought that this point needed to be included and clarified in a report such as the one presented, as the report presented indicated that patients whilst waiting were left on their own;

·         Confidentiality and the use of group meetings.   The Committee noted that not everyone entering the service felt that they wanted to share with others in a group, and opted for the one to one option.  Others, as part of their recovery were able to share with others.  Reassurance was given that people who had opted for group sessions were not exposed at all, only baseline information was shared with others, confidentiality was always maintained;

·         There was also some reflection on the approaches to psychological therapies, in terms of a brief comparison of the cognitive/behavioural approach and the analytical Freudian approach.  Following this it was further confirmed  that a training session with regard to the mental services and treatments would be planned for all members of the Committee, this would then ensure a better understanding of the complex subject matter;

·         Whether there had been any extra funding to deal with increasing cases of Post-traumatic stress.  The Committee was advised that this particular sector were dealt with under the Armed Forces Covenant and that NHS England commissioned the service; and

·         The cost improvement savings of 4% each year and the impact on the service. The Committee were advised that funding was an issue, but the service was doing its best with the funds it had.  Additional funding would always be welcomed.  The Committee was advised further that the Trust were visiting other areas to see if they could provide the service better.  Some members of the Committee felt that lobbying needed to be done to get extra funding.  The Committee were reassured that the service was passionate about providing a good quality service;

·         The need to ensure that when writing a report enough detail was included to make sure the reader could make the correct assumptions, particular reference was page 27, Summary and Conclusions, the wording could have been more positive if the two paragraphs had been changed round and then reference to the steps being taken to rectify the waiting times; 

·         The waiting times applicable for Louth and Lincoln.  The Committee were advised that to help alleviate the waiting time, three new staff were being recruited, one for Louth; and two for Lincoln and that these positions would come into effect from 1 May 2016.  It was hoped that the extra staff would have an impact and reduce the waiting list. The service would also be looking at the skill mix of staff, and where appropriate only applying specialist skills to the more complex cases.  It was reported that that the Trust was exploring all the options, for example using alternative providers,  as waiting times were not at an acceptable level; and

·         The Committee agreed that a briefing paper would be prepared by the Director of Strategy and Performance providing more background on the content of the report, and a progress report should be presented to the Health Scrutiny Committee for Lincolnshire in six months' time.

RESOLVED

1.    That a briefing paper be prepared by the Director of Strategy and Performance at Lincolnshire Partnership NHS Foundation Trust, providing more background on the content of the report, and a progress report be presented to the Committee for Lincolnshire in six months'.

2.    That a training session on mental health approaches and treatments be arranged for members of the Health Scrutiny Committee for Lincolnshire.