Agenda Item No. 11
The Vale of Glamorgan Council
Scrutiny Committee (Social Care and Health) : 15th July, 2013
Report of the Director of Social Services
Community Mental Health Team for Older People (CMHTOP)
Purpose of the Report
1. To inform Scrutiny Committee about the work of the Integrated Community Mental Health Team and to provide an update following a site visit by the Care and Social Services Inspectorate Wales (CSSIW).
That Scrutiny Committee:
1. Notes the contents of the report.
2. Notes the progress made by the team over the past twelve months.
Reasons for the Recommendations
1. To ensure that Scrutiny Committee is aware of the role and function of the Integrated Community Mental Health Team, the recent evaluation of service performance and the impact of introducing the Mental Health (Wales) Measure 2010.
2. To note the progress that has been made within this team over the past twelve months to improve access to services by older people with mental health issues.
2. The CMHTOP is an integrated team comprising staff from the Vale of Glamorgan Council and the Cardiff and Vale UHB. Within the NHS, it is classified as a Secondary Care service. The team provides care, treatment and support for individuals experiencing severe and/or enduring mental disorders where the level of need, risk and complexity require the provision of specialist care. The inclusion criteria are:
· Adults of any age presenting with the symptoms of a progressive dementia and who are at significant risk due to their behaviour or complex management needs.
· Adults who have developed a serious mental illness or disorder for the first time in later life, usually aged sixty-five or over.
· Identified carers of people in either of the other two categories.
3. The team consists of social workers, social care officers, community psychiatric nurses, nursing assistants, carers' support officer, psychologists, occupational therapist and a physiotherapist. It provides services to residents of Central and Eastern Vale. In addition, the local authority social care staff provide services to residents in the Western Vale, in partnership with Abertawe Bro Morgannwg UHB (ABMU), via the Princess of Wales hospital.
4. The configuration of Adult Services in 2011 provided a locality-based management structure, to enable closer working with the Cardiff and Vale UHB. It also placed the CMHTOP and the Older People community care teams under one manager. This has provided benefits in implementing the Mental Health (Wales) Measure 2010. The Measure clarifies which service users require access to Secondary Care services. Implementation has seen a gradual transition of service users formerly supported through the CMHTOP move to the Older People community teams. Many individuals with dementia are now supported more appropriately by the generic older people's team rather than the specialist CMHTOP.
5. Historically, the team had long waiting times for allocation for assessment and problems in the management of referrals. In 2012 the Social Services Directorate and the Cardiff and Vale UHB acted to deal with these concerns and also instigated an external review of the service, lead by the Delivery and Support Unit and the National Leadership and Innovation Agency for Health (NLIAH). This led to production of a detailed action plan, reinforcing earlier responses to the issues of concern and incorporating new steps to take forward the programme of change. As part of the annual evaluation of the Council's social services, the Directorate invited CSSIW to undertake a site visit, for an objective evaluation of the changes introduced.
Relevant Issues and Options
6. The CMHTOP were visited by CSSIW in February 2013. The purpose of the visit was to:
· gain a clearer understanding of what the service offers and its objective (including governance and accountability);
· evaluate the outcomes the service produces for service users, their families and carers;
· hear from third sector organisations contributing to the service; and
· understand how far integration between social services and health improves the outcomes and supports the Vale of Glamorgan Council to meet its statutory obligations.
7. The themes explored were:
· Getting help -including access and eligibility;
· The services provided;
· The effect on people's lives;
· Delivering Social Services;
· Shaping service;
8. The feedback from the site visit was very positive. The full report is as Appendix 1.
i) The service users and carers interviewed by CSSIW Inspectors praised the commitment, level of knowledge and skills shown by workers. In interviews, Care Co-ordinators were able to show their attention to detail and empathy for the people they support.
ii) It was acknowledged that the Vale of Glamorgan Council commissions a range of good quality services for older people who experience a mental illness, their families and carers.
iii) The presence of a detailed, progressive Action Plan was noted and inspectors considered this to be an appropriate response to the report provided previously the Delivery and Support Unit and NLIAH in November 2012. Progress in introducing effective referral processes, combined with management and monitoring progress, had contributed to a significant reduction in the waiting times.
9. CSSIW acknowledged the level of purposeful integration between Health and Social Care at many levels of the organisation. Reintroducing regular meetings with our partners had helped to ensure a consistent approach and joint ownership of issues. We have recently extended these meetings to include Cardiff Council, to strive for consistency across the UHB area
10. CSSIW identified some factors which continue to have an impact on performance. IT systems are complex and used in silos between organisations, not supporting integration as much as the team would like. The different boundaries for social care and health cause continuous challenges on both a practical working level and in providing strategic direction. CSSIW identified as priorities for improvement:
· improving equity of access to services across the Council area (i.e. Central/Eastern and Western Vale);
· ensuring regular oversight of the contents and quality of Care and Treatment Plans and other supporting documents;
· developing further partnership working in the Western Vale.
These areas are now included in the Action plan, which is monitored bi-monthly joint partnership meeting with Health and Social Care.
11. The CMHTOP has been successful in attaining the targets for allocating referrals within the timeframes stipulated within the Measure. The team are conducting an audit to ensure compliance with data recording requirements in respect of assessments, reviews and care and treatment plans.
12. The Vale of Glamorgan’s Commissioning Strategy for Older People provides strategic direction for older people’s services including those relating to dementia care. There is no distinct Vale of Glamorgan dementia strategy, as the services are addressed throughout other strategies and plans. In addition, there are several strategies developed by our Health partners, in particular "Together for Mental Health", having a specific strategy for dementia for the Vale of Glamorgan is unnecessary at this stage.
Resource Implications (Financial and Employment)
13. Demand for older people's care and support services is growing because of demographic and other pressures. With the introduction of the Mental Health Measure, workload has transferred from the CMHTOP to the Older People's community team. It may be necessary to reallocate resources accordingly and this is being kept under review. There are no implications for the overall budget as a direct consequence of this report.
Sustainability and Climate Change Implications
14. Efficient use of resources is essential, not only to deal with the needs of service users and carers but also to manage staff travel costs and the impact upon the environment.
Legal Implications (to Include Human Rights Implications)
15. There are no legal implications arising from this report. However the Vale of Glamorgan Council will continue to implement and adhere to the Mental Health (Wales) Measure 2010.
Crime and Disorder Implications
16. There are no crime and disorder implications arising from this report.
Equal Opportunities Implications (to include Welsh Language issues)
17. The Mental Health Measure (Wales) 2010 extends the right to mental health care and treatment to all ages ensuring that all citizens have the same opportunity to receive the right care at the right time.
18. Community Leadership:
CL2 – Increase customer satisfaction and improve how customers access services by developing more integrated service delivery with our partners and being more innovative in how public buildings are used.
CL4 – Explore opportunities for working collaboratively within the Vale and regionally which will lead to improved services for customers, support innovation and deliver savings.
19. Health, Social Care and Wellbeing:
HSCW7 – Work with the third sector and business organisations to deliver and preventative, community approach to supporting older people to live as independently as possible, including people with dementia related illness.
Policy Framework and Budget
20. There are no implications for the existing policies. The development of the Operational Policy for the team will need to be ratified in due course and there is delegated authority for doing so.
Consultation (including Ward Member Consultation)
21. This report has been considered by the Cabinet Member for Adult's Services.
Relevant Scrutiny Committee
22. Social Care and Health.
Lance Carver, Head of Service, Adults Service
Suzanne Clifton, Operational Manager, Adults Locality Services
Phil Evans, Director of Social Services