To consider a joint report by North Cumbria and Morecambe Bay Clinical Commissioning Groups (copy enclosed).
The Committee considered a report by the Chief Operating Officer, North Cumbria CCG and Director of Planning and Performance, Morecambe Bay CCG which updated members on changes to mental health services in North and South Cumbria in respect of the CCGs’ joint Commissioning Intentions. Members noted that the changes affected Adult Mental Health Services, Children and Young People’s Mental Health Services (CAMHS) and Learning Disability Services.
Members were informed that with regards to mental health services, the Commissioning Intentions also recognised that although Cumbria Partnership Foundation Trust (CPFT) provided some good services they had had a CQC rating of ‘Requires Improvement’ for a number of years. It was explained that many of the underlying issues were difficult for a small Trust in a challenging geographical position to address on its own. It was highlighted that linked to this, there were a number of services, particular CAMHS, which had been in need of significant improvement for some time, despite the best endeavours of the Trust. It was felt wider organisational change or support was needed to make a difference.
The Committee noted this was supported in a ‘Patient Safety Initiative’ meeting between the Trust, CCGs and NHS England, NHS Improvement and CQC, where national mental health leads supported delivery of the commissioning intentions as a way of accelerating improvement in services.
Members were informed that the commissioning intentions for mental health services set out three clear objectives, the need to:
· ensure an improvement in the quality of services, particularly for areas such as CAMHS
· ensure the clinical and financial sustainability of services;
· deliver care models and pathways consistently across the wider Integrated Care System footprints for North and South Cumbria: ie in the South, across Morecambe Bay and as developed across Lancashire and South Cumbria Integrated Care System; in North Cumbria, as developed across North Cumbria and the North East of England.
The Committee were informed that the Commissioning Intentions of Morecambe Bay were clear and that the CCG believed the best way of addressing the three drivers was a transfer of services from CPFT to Lancashire Care NHS FT (LCFT). It was explained that the intentions for North Cumbria were for services to be delivered by, or in a very robust partnership with, Northumbria Tyne and Wear NHS FT (NTW).
It was explained to the Committee that NTW provided improvement support to other trusts through its consultancy arm, Trust Innovations (NTW TI). Members noted that NTW TI had been supporting improvement work in Cumbria since 2018, with an early focus on CAMHS. It was felt that this was essential as all organisations recognised that whilst a transfer of services could bring about significant improvement and clinical sustainability over the medium term, there was also a need to continue improving services whilst the process of transfer was taking place.
The Committee received an update on future arrangements and members were informed that all health organisations had undertaken appropriate assurance work and agreed that a transfer of services to LCFT was appropriate and should take place on 1 October, in line with the transfer in the North. It was explained that in reaching this agreement, a key feature was an improvement plan for services transferring linked to wider improvement for LCFT.
A member raised a concern regarding referrals to the Service and felt that until recently adult mental health services had been very good but following the retirement of the psychiatrist, which had left the post vacant, referrals were being rejected. It was also explained that referrals to CAMHS were also being rejected and welcomed any future improvements.
The Committee was informed that there were great challenges for medical recruitment but it was felt that the merger of two Trusts in the north would see an improvement in the recruitment of psychiatrists. It was explained that the CAMHS service had experienced a huge increase in demand for Tier 3 (a range of mental health professionals and specialists who were trained and experienced in working with young people and their families) and highlighted the challenges around access to the Service.
Members were informed that the intention in the south of the county was for the ICCs to look at mental and physical well-being highlighting the importance of embracing the wider community regarding the prevention agenda.
A discussion took place regarding CAMHS in the west of the county and members were informed that schools in West Cumbria had raised their concerns regarding the lack of assessment by the Service. Members were informed that the West Cumbria Mental Health Network had been unable to contact anyone from Tier 3 regarding a Conference scheduled for 24 June and asked that this be investigated as a matter of urgency. It was confirmed that the Joint Chair of Cumbria Partnership NHS Foundation Trust and North Cumbria University NHS Hospitals Trust would contact colleagues within CPFT to ensure engagement took place at the West Cumbria CAMHS networking event.
The Committee discussed the effects of mental health in schools. Whilst welcoming mental health first aid in schools concerns were raised regarding the intense stress on pupils and staff, highlighting in particular, the expectation for teachers to diagnose mental health problems.
Members requested that a report be considered at the next meeting of the Committee regarding how Lancashire Care and NTW would be improving services in South Cumbria and North Cumbria respectively. It was agreed that Lancashire Care would incorporate details on and implications of the review of urgent mental health services across Lancashire and South Cumbria.
Whist it was felt the reorganisation seemed to be justifiable and heading in the right direction concerns were raised regarding capacity issues of LCFT. Members were informed that, as with North Cumbria, LCFT and CPFT were working together with NTW on the transfer process, including the Business Transfer Agreement and workforce arrangements etc. It was noted that Morecambe Bay CCG would work with CPFT and LCFT on the appropriate contractual changes to support the transfer.
The Committee were informed that all organisations coordinated arrangements as a collaborative joint endeavour through a monthly Programme Board with associated sub groups for workforce, communications, IT, estates etc. It was explained there were also discussions in place between the two CCGs, LCFT and NTW with a view to maintaining continued north/south bed flows to units in other parts of the county to ensure patient needs were met and best use of resources.
A discussion regarding the importance of engagement and communication took place. Concerns were raised regarding the lack of attendance at engagement events, highlighting that only 57 people had engaged in the 28 sessions organised in the north. It was felt there was a need to understand where to go to engage with the mental health system and who the public would contact to discuss future services. The Committee was informed there was regular engagement with NTW and Lancashire Care. The Committee felt that the disbanded Cumbria Mental Health Group had been an excellent forum for communication.
During the course of discussion it was recognised that communication could have been undertaken more effectively. The challenge to manage the message to inform the public that there would be no change in service provision and that this was about securing a long-term provider was highlighted to members. The importance of communicating with people to assure them that services would improve was emphasised. Members were informed that engagement events were also being organised for staff.
Members asked for further details regarding ‘appropriate assurance work’ and the recent presentation to the Cumbria Health and Wellbeing Board on CAMHS would be circulated to members of the Committee together with any other appropriate information.
During the course of discussion a member raised a concern regarding hoarding which had been recognised as a mental health issue and asked what resources were available across the service to deal with this. It was agreed this matter would be discussed at the next meeting of the Committee in July.
(1) the report be noted;
(2) the presentation to the Cumbria Health and Wellbeing Board on CAMHS be circulated to members of the Committee together with any other appropriate information;
(3) a report on how Lancashire Care and NTW would be improving services in South Cumbria and North Cumbria respectively be considered at the next meeting of the Committee.