Agenda item

The Committee will receive a joint presentation from Paula Mawson, WCC Strategy & Commissioning Manager for Health, Wellbeing & Self-care and Eleanor Cappell of the Coventry and Warwickshire Clinical Commissioning Group.

The Committee received a joint presentation from Paula Mawson, WCC Strategy & Commissioning Manager for Health, Wellbeing & Self-care and Eleanor Cappell of the Coventry and Warwickshire Partnership Trust. The presentation covered the following areas:

• The overall aims of the presentation:

•        To provide the committee with an overview of system-wide activity related to supporting mental health and wellbeing for adults in Warwickshire.

•        To highlight key health inequalities in mental health (MH).

•        To provide a focus update on the community MH transformation programme.

·       MH System – a graphic showing key areas of activity, including wider determinants, self-care, physical health, community assets, transformation, alternatives to crisis admission, inpatient services and community care. Reference to the range of mental wellbeing services provided in the community, with the work on Covid MH,  loneliness and isolation used as an example.

·       Health inequalities:

•        Headline findings related to socioeconomic impact and ethnicity on MH, together with wider determinants.

•        Examples of key activity to address health inequalities were provided.

·       Community MH transformation (CMHT) system update:

•        National vision and ambition – members were encouraged to view this YouTube explanatory video: The NHS Community Mental Health Transformation – YouTube

•        Local CMHT vision and ambition 

•        Community MH framework  

·       Expert by experiences – a quote from Claire Handy, a person with lived experience.

·       CMH redesign and core offer – examples of the initiatives undertaken.

·       Primary care integration with examples given of how this would take place.

·       Personality and complex trauma pathway – the vision and ambitions.

·       A graphic showing hopefulness and life skills, leading to enablement.

·       Rehabilitation.

·       Adult eating disorders – the vision and application.

·       Training provision.

·       Parity of esteem – serious mental illness (SMI) health checks – improving physical health of people with SMI.

·       Strategic coproduction: coproduction and community engagement

·       Voluntary and community sector – mental health alliance, working together and community MH coproduction

·       In summary:

•        There was a breadth of activity across the system to support people with mental ill-health, alongside activity to promote wellbeing and address determinants of poor MH and wellbeing to support prevention, early intervention and recovery.

•        Strong partnership working in place across the system (including with the VCS and experts by experience) to support transformation of services.

•        Good progress made to date on a longer journey of change.

Questions and comments were submitted, with responses provided as indicated:

• Several members found the presentation informative and useful.
• A discussion about the commissioning arrangements, the number of new practitioners involved in the service delivery model and the mechanisms being employed to ensure a complementary approach to service delivery, rather than working in silos. There was useful experience from earlier work, good partnership working, governance structures and funding of £23m over three years was in place.
• Reference to previous initiatives to support dementia patients, which had been discontinued. A key aspect was designing the offer around service recipients, for example who needed support at home rather than visiting specialists for specific appointments or group sessions. This point was heard often during times of crisis. It would be raised under the following agenda item on the dementia strategy, as well as being taken into consideration for that strategy.
• Further information was sought on the training provision. There would be a range of different offers from a number of organisations. Examples given were clinical training, compassion circle training and that related to trauma cases. Virtual training through IT solutions added capacity and could be delivered both internally and externally. Providing an incentive for training was raised. Officers would look to scope the training plan and take on board the points raised.
• Frailty was becoming increasingly relevant with the aging population. This would add to service pressures and there was a need to understand more about frailty. Prevention activity should be the key aim and looking at wider determinants of health. It was questioned if this was revisited again in a year what would be seen in terms of investment in preventative measures and evidence of the resultant outcomes.
• Reference to the compassionate communities work in Rugby. This linked to the priorities at ‘place’ and with primary care networks. It was a good example which could be used elsewhere in the county.  Officers spoke further of mental wellbeing support, the service redesign and examples were given of the current services that were contracted separately. In the next few weeks tenders would be sought for a streamlined single contract with collaborative partners to deliver lower-level early intervention work. It was hoped in a year to be able to provide the requested evidence. Work was underway on developing key performance indicators and other critical success factors. There had been extensive engagement with users, providers and others. Ensuring the public understood the revised service offer and then monitoring uptake of services were also mentioned. There were links into the compassionate communities work. The Chair suggested that an update be provided by way of a briefing note at the conclusion of the tender process.
• A question about the provision in rural areas of north Warwickshire and it was confirmed that the mental health service offer was across all Coventry and Warwickshire.
• A concern about the use of acronyms throughout the report. Whilst these had been explained during the presentation, it would be helpful to have them explained in full in the report or an index provided, especially for new members to the Council. Officers were asked to bear this in mind for future reports and an offer to circulate an acronym buster to explain commonly used terms.
• More information was sought about the use of experts by experience and how successful this was. An outline was given of the community outreach work undertaken by Rethink and Grapevine. This tended to involve the same people and a rapport had been developed leading to them becoming experts by experience. They were treated as equals and met in a welcoming environment. The current work on eating disorders was used to show how successful this approach had become and the quality of feedback from participants.
• The Chair asked how services engaged with hard-to-reach people and how they linked with other agencies, such as the police on MH issues. Eleanor Cappell spoke of the MH street triage arrangements for services to work with police. An outline was given of the slightly different working arrangements in Coventry and the north and south of Warwickshire. This joint approach could be developed still further for example with the training offer for police colleagues. The cohort that was hidden and didn’t access services was a key area for primary care to target. Councillor Humphreys asked to be put in contact with the police officers working with MH teams in the north of Warwickshire.
• A point about how district and borough councils were linked into this work especially from the housing perspective. Housing issues could contribute to MH problems. Having a holistic approach was an aim but it did not yet feel that this had been achieved fully. Links were being established with the district/borough housing board. There were known links between homelessness and mental health illness, which would be a further aspect to discuss with housing teams. Despite the extensive work to date, sadly some people still fell through the gaps. There was a strong commitment from all partners to collaborate. The feedback from coproduction and people with lived experience provided a helpful challenge. A member understood there was a regular dialogue between heads of housing and the county council on issues such as homelessness and MH.
• Crisis provision was discussed, specifically the capacity at the Caludon Centre and how support was provided when this centre was full, it being understood some patients had been placed in police cells. There was a place of safety at Caludon. Covid had impacted on capacity and the winter period could also see additional demands faced. There were a number of mental health hubs available at all times, and it was stated that no person should be placed in a police cell.

Resolved

That the Committee notes the presentation.