1 Children’s Emotional Wellbeing and Mental Health Collaborative Commissioning Pilot Newcastle Local Authority and Newcastle CCGs have agreed to establish a Collaborative Commissioning Pilot (CCP), with a view to designing and commissioning a radically different whole system, whole family response to the psychological and emotional needs of children and young people in Newcastle. This will bring together schools, health, social care and public health To develop further the transition work taking place across all agencies between children and adult services Gateshead Council and Gateshead CCG have agreed to join the Collaborative Commissioning Pilot to develop tier 3 & 4 services across Newcastle and Gateshead As part of this programme, Gateshead and Newcastle will develop individual arrangements for collaborative commissioning of tiers 1 & 2 Childrens Collaborative Commissioning Group (Chair Chris Piercy) April 2017 Phase 1 – December 2015 If successful, an integrated response to the emotional and psychological needs of children, young people and families will improve outcomes, reduce inequalities and reduce the impact of poor mental health on the economy Establish links between Adult mental health (AMH) and Child and Adolescent Mental Health (CAMHS). Children’s Collaborative Commissioning Board (with membership) Childrens’ Collaborative Commissioning monitoring and quality trial
services 6-18 year old crisis transition – crisis care pathway Establish multi-agency protocols pathways for emergency presentation Identify case studies of poor transition and good transition of transition worker role Identify model of transition Consider transition of young people while in crisis To ensure we have an in year provision prior to transfer into Dawn Scott Contract almost complete Parallel and seamless service Primary care liaison service linking to AMHS Reduce downstream demand and in relation to crisis and reduce morbidity Provide focus upon need and continuity Improve quality of transition care for young people and their families. New contract assessment to adult services NCC Performance meetings. September 2015
Integrated wellness model To use a holistic assessment approach and buddying system to deliver community focused mental health promotion and support training for staff and volunteers who may come into contact with individuals who may be mentally unwell. Gateshead public health Recently commissioned and ongoing Help to prevent escalation of mental health issues Gateshead public health monitoring and performance report 4 Support people living with complex and multiple mental health needs Continuation of the fulfilling lives project Offering one support service. Fulfilling partnerships 7/8 program with annual review Support people living with complex to move from crisis to stability, have a home, a job and sustained Fulfilling partnership In 1st year, 131 referrals received from 49 agencies (71% outside of FL partnership). 53:47% Split between Ncle & Head. Referral profile is representative of demographic diversity. Work ongoing to further engage women, under 24, over 65 and BME groups. LGBT engagement to be considered further. 68:32% Male female split. (Full demographic data available on request). being
particular focus on women vulnerable to domestic abuse. Extensive system mapping has been completed and will provide an overview of the multiple complex needs system in Gateshead/Ncle. 5 Mental health employment integration trailblazer pilot ‘Hub and spoke’ model, with a central team resource of employment support brokered into existing psychological wellbeing services commissioned by Clinical Commissioning Groups (CCGs). Individually tailored support will be provided through joint case management with a six month intervention that continues in work. Small task and finish group of LA and Public health – including Newcastle and Gateshead Introduce agreed delivery model April 2015 (see update note from June - revised to end of 2015 – this is a national pilot). Ongoing Supporting people to compete in the open-labour market. Better job outcome rates Better job sustainability Improved clinical recovery rates, reduced relapse rates, earlier engagement Local economic benefit To aid the development of North-East combined authority and Health & Wellbeing Boards Northumberland County Council is leading this work via the North East Combined Authority. Behavioural Insights Team (Cabinet Office) is involved in the development of the methodology of recruitment to the for those out of work. Some issues regarding consent and sharing information. Work ongoing but model is likely to be developed and working later this year – end of 2015. Therefore revise timescale
the Wellbeing for Life Board in Newcastle undertaking data analysis of mental health and employment. Health and Wellbeing Board Co-ordinator local initiatives to improve employment opportunities for those with Mental Health problems. 6 Peer Support and Community Self-help for those with severe and enduring MH issues Maintenance and self-management techniques disseminated and preventative activity promoted VCS and recovery College (NTW) partnership working Ongoing Review April 2016 Fewer relapses Condition management User and education User and carer empowerment Signposting Contract monitoring and MHPB
7 Primary care initiatives Social prescribing for mental health Care plans IAPT and counselling services Further develop primary care work with the development of a defined work stream from the MHPB current capacity issues limit the further development of primary care based mental health services Consider wider use of social prescribing pilot (2014/15) to help those with mental heal problems – peer support and peer champions including response to avoid crisis or support de-escalation. Look at the further use of care plans for those with complex mental MHPB primary care work stream and further clinical lead time to be resourced VOLSAG MHPB Primary Care work stream Local IAPT Providers 2016 April 2016 September 2016 March 2016 People still go to their GP at a time of crisis and this should enable more timely and effective local care To help prevent and better manage mental health problems for those with LTCs Support people suffering from depression and anxiety disorders and helping to prevent relapse MHPB Wellbeing for life LA, public health, ways to wellness board CCGs, IAPT Providers , MHPB Current contract monitoring CCGs. Care Act Steering Group Newcastle City Council CCG working with the national eSCR team to pilot a local enhanced summary care record which would be able to act an enhanced SPN for mental health patients. Training for GPs has taken place around complex care needs of SMI patients VOLSAG - The social prescribing offer for people with LTCs is only now operational in West Newcastle. Over the next year it will monitor the range of needs of clients involved and build the case for extending two other groups/conditions. We will also develop understanding of Personal Health Budgets, their local implementation, and any potential contribution to the broader aspects of the plan.
Remodelling of social care duty system for Newcastle City Council health needs in primary care Consider a Local Enhanced service Further develop CBT courses aimed at service users with a LTC in Gateshead and Newcastle Remodelling to take account of the Care Act and to include : of skill mix of roles Training for staff in duty teams Newcastle City Council Regularly reviewed via Care Act Steering Group. Improved ability to respond to mental health patients with social care needs Care Act Steering Group Newcastle City Council. Remodelling ongoing 8 Ensure that the police forces in Newcastle and Gateshead are involved in any To ensure of Transport Police ensuring Led by NTW and other partners April 2015 Greater understanding and awareness of mental health issues. Enhancing Police liaison meetings MHPB BTP are now involved in the Police Liaison Group meetings with Northumbria Police and NTW.
changes and service developments to mental health service provision engagement around project or service developments that supports the prevention of mental health crisis. Need to ensure ongoing commitment to this work partnership working (Better improve understanding of each other’s roles and remits NTW - Clinical Police Liaison lead meets regularly with Police and updates on service changes etc. 9 Develop multiagency guidance on all partnership matters Develop online mental health services, practice working protocols Northumbria Police and NTW December 2015 Mutual understanding of local mental health services leading to better service user experience Police and NTW Mental Health Programme Board BTP are keen to be involved in this as we are keen to understand and adhere to local procedures agreed between partners wherever possible where it doesn’t conflict with our policies. NTW - This is ongoing project and will hopefully soon be out to all agencies for consultation, including BTP. 10 To ensure that carers have clear access to methods of support at times of urgent need and crisis To ensure carers and service users have Ensure continued involvement of carers representatives in the urgent care work stream meetings Newcastle Carers centre, Crossroads and Gateshead carers, all partners Ongoing with review April 2016 Ensure carers needs are met to help support and prevent mental health crisis in service users MHPB/Carers groups Service user and carer feedback
access to information and support to prevent an urgent need occurring and enable early intervention. Continue to develop work with NTW around sessions for carers. Understand the experiences of people urgent care services Understand the groups/individual service users who have regular contact with the multiple agencies and cross agency planning to support preventative care Urgent and emergency access to crisis care 11 Continue the consultation around the future of specialist mental health services with a focus on the inpatient bed modelling Be able to evaluate “Deciding Together” consultation to develop future services which may include provision of Alliance CCG’s March 2016 in line with deciding together timetable Enable correct decisions to be made on future specialist mental health services including bed modelling. CCGs Consultation still ongoing with the development of Case for Change document and subsequent Consultation document.
help them handle difficult calls. The CCG is also working with the mental health trust to obtain clearer interface guidance around patients with dual diagnosis and alcohol/substance misuse problems. The DOS also includes the local alcohol and substance misuse services. 14 Further develop a crisis housing We currently have four crisis beds for Newcastle and nil beds in Gateshead. We have no formally agreed capacity for Specialist, clinical or non-clinical. Although there are local providers with informal capacity Identify an appropriate future crisis beds model (clinical, specialist, crisis team beds or non-clinical) required and assessment of capacity needed. Investigate and research models of daytime crash pads. These may include social nursing, homeless, safeguarding, MHPB and urgent care work stream group December 2015 stay options Benefit from CMHT support. Support in surrounding. Support more focused on need (i.e., clinical, specialist, crisis or non-clinical) Immediate support available in a crisis. Better targeted support for that individual Capacity and occupancy rates. Throughput and turnover. Workshop session of the Urgent Care work stream to review and consider crisis housing model September (?). The urgent care work stream has started to evaluate different crisis models?
young person, working age and older people support (e.g., may need more nursing care support). Timely response to those who need support in the community. Potential to prevent admission to hospital as default option 15 To enable people with LD and autistic people to access crisis support Reasonable adjustments for people with learning disabilities and autistic people Work with the LD Partnership Boards (or equivalent) to assess and measure the actions and plans emanating from the UC strategy and ensure Chair of the LD Partnership Board (or equivalent) and Urgent Care work stream October 2016 Ensure information and awareness appropriate and suitable for people with a LD (PWLD) and families. Training and skills for staff across agencies to support PWLD and their families Provide more time for supporting PWLD and their families. LD Partnership Board (or equivalent) Gateshead Council is in the process of opening a quiet room designed to be autism friendly. This room will be accessible to all people in Gateshead who visit the civic centre. Gateshead Council has Service Improvement Groups attended by service users and carers to
16 To further assess and develop crisis and urgent care support for BME, LGBT, Kahilla community, refugees and people seeking asylum, new EU migrants, homeless and complex service users To be included in the assessment of the urgent care work stream. Need to upon higher risk groups within the population multiagency case reviews for complex cases MHPB and urgent care work stream group June 2016 Crisis services and residential alternatives to hospital admission should be culturally competent and accessible to people from and minority ethnic communities. Patients under enhanced Care Programme Approach have crisis plans in place that specifically address how to minimise the risk of coercive interventions MHPB Being considered under the development of the mental health urgent care hub. Training and education has been developed within the Kahilla community and a well-attended on raising awareness on the impact of miscarriage, still birth and early infant loss has taken place developed by the Jewish Community Council of Gateshead. There is also work to increase cultural awareness and training within Gateshead IAPT service, Talking therapies. 17 Develop Liaison psychiatry services and for those with mental health problems To further develop and clarify the different liaison services and modes for mental health service users in a variety of care settings. Acute March 2016 Clarity on liaison services available and across partners Access to Mental health specialist staff to acute setting and ensure parity with physical health care MHPB (Note: the Crisis Care Concordat will cross-over with the “Guidance to support the introduction of access and waiting time standards for mental health Funding on all business cases not yet identified and clarification on commissioning intentions. Still awaiting national direction and guidance on development of liaison psychiatry Expansion of the current 5 day Older Persons Mental Health Liaison Team to 7
Consider services for those with dementia, LTCs, older people and working age adults. Clarify care settings e.g., out of suite and hospital teams and waiting times for responses. Identify links to the drug and alcohol teams and assess capacity issues and best care for those with drug and Better trained acute services staff to support those with a MH illness in acute hospitals. Clearer pathways and access to other hospital services. services in 2015/16 and for acute Trusts to identify in their Service Development Improvement Plans (SDIP) how to ensure effective models of liaison psychiatry). days will be included in our business planning round for 16/17. Introduction of a liaison service for working age adults has been identified as a priority in the Emergency Care Service Strategy with a business case in development. Discussions with NTW are underway. Again the time frames would be consistent with the business planning cycle. NUTH - The commissioner and providers will work together to ensure are adequate and effective levels of liaison psychiatry services in the acute hospital setting in line with the national timetable by 2020 (acknowledging that CCGs are responsible for commissioning psychiatry from NTW). NTW - Kath Elliott – Liaison Service Clinical Manger is attending the meeting to
alcohol needs. In line with guidance for plans to be in place by 2020 Identify care pathways for young people attending ED with (e.g., triage, training, access to paediatric ward for under 16 yrs.) discuss this action. To look at what needs to be done and how we can expand the services and look at the benefits of a commissioned service in Gateshead. NUHT - This is now formally within the contract for 15/16 as part of the Service Development Improvement Plan. The work will be led by the commissioners, as per the national guidance. NUTH - Self- harm pathways are already in place at NuTH for young people under 16years – to be reviewed in year within NuTH 18 To ensure that clinician duties and AMHP under the mental health act can be met Review section 12 doctor capacity and availability. Review of current and proposed capacity Review time for Section CCG Medical Director NTW/Acute Trusts Mental Health Programme NTW/Acute Trust/NEAS/LA June 2016 Speedier decision making for section 2 and section 3 of the Mental Health Act CCGs and Mental Health Partnership Trusts to assess. Gateshead council has only one person undertaking AMHP training this year. There is limited interest across teams to undertake this
12 Doctors to attend following request Review time for AMHP to attend following request Refresher training programme for Approved Mental Health Professionals (AMHP) – BME communities’ element requires updating. NEAS – support the development of the Joint Strategic Needs assessment to support the enhancement of AMHP services in Patients assessed and treated appropriately More AMHPs available to undertake assessments for detention Reduce any delay in accessing services for people who are intoxicated training as such we are revising our job descriptions to include a commitment to mandatory AMHP training. NTW - This is something been looked at in NTW in relation to Section 12 doctors availability. It has been part of the trust MHA legislation discussions. No update on far this is progressed, will try and clarify. are currently only in LA. NTW and Northumbria Police, with LAs are collecting data around as part of Street Triage teams. Northumbria police gather information around S136s and this includes timescales. still needs to be further work around data sets around S136s & S135s and all agencies involved
the out of hours setting. Ensure (with guidance) that no one is immediately excluded from assessment due to intoxication and breathalysers are never used as a judgement tool rather than face to face. Mental health Assessment and admission should commence within three hours (Royal College of Psychiatrists guidance for section 136 MHA 1983) in the data collection as per the CQC report Safer Place to be. NTW have guidance for practitioners in frontline services in relation to assessment and intoxication. NCC - Due to demographic of current AMHP workforce Newcastle is reviewing the workforce development plan to ensure sufficient AMHP’s are recruited and trained to maintain statutory responsibilities. consideration for inclusion in programme for ’16 – ’17.
19 People in crisis who (under the MHA Act) need transport between NHS facilities or from the community to an NHS facility: will be conveyed in a safe and appropriate and timely way (e.g. somebody admitted to a psychiatric unit from acute hospital care). Explore different pathways and transport options available for these journeys- to include consideration of issues, advocacy and dedicated vehicles Develop NHS ambulance services national protocol that will provide agreed target response times for S136 and a standard specification for use by clinical groups. Police/North East Ambulance Service/NTW NEAS Mental Health lead and Association of Ambulance Chief Executives. November 2015 Clearer pathways, protocols and processes in place to transport people in crisis. Safe and quality transport available for people in crisis People in crisis who are detained section 136 powers can expect they will be conveyed by appropriate transport from the community NEAS/Police/NTW to develop quality and monitoring of people transported in a crisis. Develop performance measurement and through the Mental Health Programme Board and partners/NEAS BTP have this month guidance to staff that an ambulance must be called for all S136 detentions. No individuals are to be transported by police vehicle unless agreement and authority has been given by BTP FCR Duty Officers NTW - Lifeline Transport is in place in Newcastle to covey under the MHA, with contract made clearer. NEAS are used for S136 detentions, from Northumbria Police.
20 Improve practice around section 136 and 135 detentions Street Triage Ensure 24/7 staffing at health based place of safety Reduce the number of people detained by Police under Section 136 Eliminate the use of Police custody for those detained under section 136 Take account of Section 136 configuration from the Deciding Together consultation. Support and further develop Street triage and identify post evaluation and ongoing resources Police CCG, NTW, police Currently funded in Gateshead and awaiting mobilisation in Newcastle ongoing Timely response to at home experiencing mental health issue health issue Improved access to and understanding of crisis services Evaluation of street triage independently and to include service user feedback. Police/Local Authority performance reporting. Northumbria University and NTW already started an evaluation metric and process. Street Triage team reporting to include the data sets set locally to achieve (at the national minimum standards data set (also BTP will endeavour to ascertain the best pathway for the individual in crisis and will consider all options; however we support correct and appropriate use of S136 and will not have a performance target placed upon us to reduce its use. Risk factors in regards to access to lethal means will always be a BTP officer’s primary concern when considering the use of S136. NTW - PoS are staffed by one Crisis Staff member, with the resource based in the teams. Police Custody for can only be authorised by an Inspector in those circumstances where risk cannot be managed in another setting. I’m not sure if there has been any – will check this.
(including Lifeline transport services) reference the CQC “Safer Place to Be” standards in section 136 to be collected by MYH Crisis Teams) Gateshead – Street Triage have con to reduce the number of Section 136s in the area. Newcastle – Street Triage commenced on 26th June and is already making an impact on the S136 pathway, diverting those not needing MHA assessment away from this pathway. There is no data as yet on the activity. Information sharing, communication, strategic development and multi-agency training 21 To allow the sharing of relevant and appropriate information between organisations in the best interests of the patient Explore and be involved in work taking place to enable a shared information system/process with interoperability between acute trust/voluntary organisations including A & E and NTW both in and out of hours. NTW/Local British Transport Police/NEAS – All partners and IT teams April 2016 Service users receive services from all organisations and relevant information is shared to ensure speedy and appropriate services are delivered to support the patient’s needs. Reduce the need for repeat assessments, for MHPB BTP will always consider sharing information with partner agencies the risk to the welfare and life of that individual is identified and the sharing of information will support the reduction of that risk. MOPI and Data protection guidelines are always supported and where possible consent gained if appropriate. Secure NHS.net email addresses will always be requested to be used.
Shared protocols (identifying ‘quick wins’ of information that can be shared and longer term action plan on problematic areas. Update the current information Sharing Agreement between NTW and Newcastle City Council – including the use of electronic databases to share information NEAS – sharing information and care example, with complex patients Newcastle City Council - Updated May 2015 with review in 1 year. NTW -The Clinical strategic Network have picked up this action as a regional issue also and are going to assist us all to do some work around this. 22 When restraint has to be used in health and care services it is appropriate Consider Trusts’ policies on restraint and in relation to the Supreme Court NTW/The Newcastle upon Tyne Hospitals NHS Foundation Trust November 2015 Support therapeutic practices to reduce restraint to a minimum Develop extraction of NTW/NUTH quality performance reports on number/type etc. NTW has completed lots of work reviewing the trust Policy and training around PMVA, and this work continues. There is new NICE Guidance out that all organisations will need to
from one agency to another. Ensure that where lessons can be learned from incidents through a process Safeguarding Adults procedures include guidance for escalating concerns and for serious case reviews. NTW - Currently escalated concerns are not an issue between NTW & Northumbria Police as have clear structures in and out of hours. Clinical Police Liaison lead is used to escalate issues and concerns that are not urgent and using Police & Partners Meeting. 24 Improving access to secondary care services Enable community based mental health services to refer individuals to specific secondary care services (NTW) under agreed criteria Identify and produce data set required for performance MHPB Pilot – April – December 2015 (with potential to roll out January to April 2016. Prevent blockages in secondary care Improve information available to GPs by copying them into referrals Data set identified and regular reporting.
26 Paramedic call handlers need to have better awareness of mental health issues Clarify pathways of care across primary care – crisis services – acute mental health services. Ambulance Response times East Ambulance service. Out of hours services providers Start work July 2015 Agreed response times from primary care and out of hours for patients in crisis. Ensure clarity and awareness on pathways of care North East Ambulance Service NEAS - My colleague AJ and I have recently had discussions with TEWV, and have them placed with NTW to discuss better boundary working. NTW engaging with NEAS around this, no work has been undertaken as the, but see action point 29. 27 GP and practice staff training Primary Care will continue to provide MH training to primary care staff. Multiagency Annual review Primary Care staff will be able to signpost more effectively to resources that are already available to help people. Staff will feel better able to offer support themselves. 28 Conflict resolution training Develop training programme for all staff across agencies Multi-agency April 2016 Staff will be provided with skills to resolve conflict therefore enhancing their patient safety when dealing with mental health patients. All through staff training target and measurement. NEAS We have met with NTW and Police colleagues to develop training package. This is also being picked up by the network. 29 Multiagency training and sharing of knowledge and understanding Advice for staff in 999 control All partners September 2016 Training programme to Enhanced relationships and joint learning forums and key Mental Health Programme Board BTP will welcome any joint training opportunities and will, wherever possible attend
to improve of patients undergoing mental health crisis. Identify needs and requirements of mental health advice Awareness of pathways of care Take account of national pilot requirements (e.g., 111) Consider training for those staff in emergency departments develop training role for Urgent Care NEAS staff by March 2016 including ongoing evaluation training for specific partners Available advice for ambulance crews dealing with patients in a mental health crisis in order to identify the most appropriate place of care and management. Will allow the development of robust pathways of care (primary care – crisis – acute mental health services) for patients in crisis who interact with the ambulance call handlers. Establishment of Individual provider training and monitoring of training. Staff to be trained versus staff undertaken training – NEAS to set % target NTW - The Police new recruits have been having MH placements of on data with MH serviced, and 3 hour MH input to their training. These will continue. is a new Police awareness package that has been delivered to some of NTW inpatient staff and couple of community teams, to heighten awareness of partnership working with police, responsibilities and the law. This is open to LAs, & EDs. We have meet as a working group – NEAS, 111, NTW, NorPol, BTP & College of Policing to look at what training we can share and how we can work together as initial meeting, this work is going to be picked up as part of the clinical strategic network action regionally also. Street Triage Briefing had
hub to be built in to the specification and also single point of access for advice To ensure partners have mental health and Learning Disabilities awareness training 999 Control room staff are able to respond more confidently and appropriately to calls with mental health components and access to mental health advice. Patients and service users may be sign posted to mental health services earlier and appropriately. been delivered to officers and includes S135 & S136, MCA areas. Completed within NorPol & BTP locally.