Agenda Item No 4
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 10th July 2018
Report of the Director of Social Services
Development of a Locality Model of Community Mental Health Provision across the Vale of Glamorgan
Purpose of the Report
- To update Scrutiny Committee on developments in community services for adults with mental health problems in the Vale of Glamorgan.
- THAT the Scrutiny Committee notes the content of this report.
Reason for the Recommendation
- To inform Scrutiny Committee of developments in community mental health services in the Vale of Glamorgan which will help us to meet increasing public, service user and policy expectations.
- Within the Vale of Glamorgan, Social Services staff work in partnership with the Cardiff and Vale University Health Board (UHB) in three Community Mental Health Teams (CMHTs), working to the GP surgeries in the Central, Eastern and Western Vale areas of the local authority area. Currently the teams are based at in Cowbridge, Hafan Dawel in Penarth and Amy Evans Hospital in Barry.
- CMHTs in Cardiff and Vale are jointly operated by the UHB and the Local Authorities. They offer a specialist MDT service including community based outpatients and psychological interventions as part of a whole system in conjunction with in-patients, crisis and home treatment teams, liaison services and a range of specialist community teams such as peri-natal, assertive outreach, borderline personality disorder, forensic, rehabilitation and eating disorders.
- A number of changes have impacted on the operation of CMHTs in particular the development of Primary Mental Health Support Services (PMHSS) and the Mental Health Measure (MHM). These are intended to support CMHTs to focus on those people with the most complex needs. In addition over the last few years, the traditional role of CMHTs has changed with the introduction of Crisis Resolution and Home Treatment Teams (CRHTTs), and other specialist teams which has impacted on the way CMHTs work.
- CMHT staff also describe how the nature of the mental illnesses are becoming more complex and diverse with issues such as dual diagnosis, neuro-developmental disorders and personality disorders increasingly evident. The interpretation of secondary care responsibility has become more diverse as a consequence. This has been a challenge to services. All teams have an appointed Integrated Manager in post whose responsibility includes overall responsibility for the integrated pathway and service user experience through the CMHT from referral to discharge.
- An Integrated Manager in each CMHT is responsible for ensuring that the teams have systems and staff in place to be able to make emergency, urgent and routine assessments and provide suitable advice, care or treatment to adults with mental health problems in their area. The Integrated Managers are employed jointly by the UHB and the Vale of Glamorgan to deliver this function.
- The National Survey of people using Community Mental Health Services 2014 and the Kings Fund Lessons from Mental Health make clear observations in relation to Community Mental health Services. In that they should:
- Provide a simple vertical integration of the whole range of mental health care from in-patient provision to universal community services.
- Provide rapid access to Psychological therapies.
- Have capacity to intervene early and manage illness within the wider context of achieving a fulfilling life.
- Have a system where patients are given in increasing role in self-determination and the patient/professional relationship is valued.
- Have clear links to specialist and universal services and employment.
- Have improving relationships with GPs.
- Have a skill mix of staff where the 'right staff are doing the right job'.
- Have a focus on social inclusion.
- In response to increasing referral demands, a community review of the service began in 2015. It was intended to:
- explore potential alternative models of delivering screening and assessment activity;
- review the use of the existing buildings; and offer a range of more specialist assessments and interventions;
- ensure a resilient and responsive service is in place; and
- deliver a constructive discharge.
- A programme implementation steering group was set up to monitor the progress of four work streams, reporting back to the Community Services Operational Board. The work streams cover the CMHT duty system; review of referral process / assessment models; developing treatment pathways; and workforce and organisational change.
Relevant Issues and Options
- Following the initial Community Services Review, a program of work commenced in January 2018, sponsored by the Mental Health Clinical Board to consider the future service model for delivering community mental health services.
- This proposes that the three current CMHTs operating across the Vale of Glamorgan are co-located at Barry Hospital.
- Capital planning within C&V UHB has secured funding through the Integrated Care Fund to enable accommodation for the amalgamated Vale community mental health services at Barry Hospital in late Summer/Early Autumn.
- Given our concerns regarding the suitability of current premises to accommodate staff and provide services to people with mental illness, coupled with health and safety risks, the Local Authority are supportive of the proposed co-location to Barry Hospital later this year. This means that staff will move from Amy Evans Hospital, Cowbridge and Hafan Dawel, Penarth to Barry Hospital.
- There is an ongoing period of staff consultation which is due to end on 8th July, 2018. The intention, depending on the outcome of the consultation period, is that the Community Services program will oversee the timely delivery of the co-location of the 3 Vale teams into Barry Hospital with the proposed establishment of an integrated locality management structure to support the teams.
- In addition, the community services review suggests the merging of team processes to ease duty pressures and release practitioners time to allow them to spend time with service users on their caseloads to address their care and support needs in a more effective and timely manner.
- The current proposal is to co-locate the teams at Barry Hospital, but the Review is also seeking opportunities to provide 'outreach/satellite' services through clinics at Cowbridge and Penarth to ensure that staff provide services in our communities and keep these connections. One proposal is to consider provision of this service at the Wellbeing Hub proposed in Penarth, located on the Cogan Leisure Centre site, although this is still in early planning stages.
- The details of the consultation document outlining the rationale for change and the options considered are outlined in Appendix 1 and Appendix 2.
Resource Implications (Financial and Employment)
- The proposed integrated management structure does not have any financial implications for the Local Authority. There are no financial implications to the Local Authority to utilise accommodation at Barry Hospital.
- It is hoped that the planned development will support closer scrutiny and review of the current community care provision.
- Dependent on the outcome of the current consultation exercise with staff, if the change of base continues then some staff may attract a reimbursement for any additional mileage encountered as a result of the change of base, however, this is subject to the terms of their contract. Given the small numbers of staff within the local authority we anticipate minimal financial impact and the potential use of pool cars from Barry Hospital, if adopted at these premises, could further mitigate any financial impact.
- Accommodation refurbishment costs and the cost associated with sustaining locality based clinics in the Eastern and Western Vale neighbourhoods are drawn from ICF capital funding for the refurbishment of Barry Hospital and the savings from being released from lease arrangements for the neighbourhood clinics.
Sustainability and Climate Change Implications
- More effective and responsive services do provide opportunities to reduce waste and duplication.
Legal Implications (to Include Human Rights Implications)
- There are no specific legal implications as a result of this report.
Crime and Disorder Implications
- There are no crime and disorder implications as a direct result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
- The Cardiff and Vale Community Mental Health Service aims to provide the same high level outcomes for people of all ages, aims to reduce stigma and promote equality of life chances for all.
- The changes affect all citizens across the Vale of Glamorgan as there is a change of base proposed for all teams. Cardiff and Vale UHB will conduct an Equality Impact Assessment prior to making any changes and will consider it through the appropriate health board mechanisms. The concern most expected to be raised will be in relation to services being less local however this is intended to be mitigated through the continued provision of satellite clinics.
- This service is consistent with the Council's Corporate Plan, Well- being Outcome 4: An Active and Healthy Vale. Mental Health Services support the delivery of the following Corporate Objectives:
- Encouraging and Promoting Healthy Lifestyles
- Safeguarding those who are vulnerable and promoting independent living.
Policy Framework and Budget
- This is a matter for executive decision.
Consultation (including Ward Member Consultation)
- There are no matters in this report which relate to an individual ward.
Relevant Scrutiny Committee
- Healthy Living and Social Care.
Suzanne Clifton Head of Adult Services / Locality Manager.
Linda Woodley, Operational Manager - Mental Health & Learning Disabilities.
Lance Carver, Director of Social Services.