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									Overview and Scrutiny Committee
MENTAL HEALTH SERVICES IN
CAMBRIDGESHIRE AND PETERBOROUGH:
JOINT OVERVIEW AND SCRUTINY COMMITTEE
19th December 2011

                                                                                      Action
19. DECLARATIONS OF INTEREST

    Councillor V McGuire declared a personal interest under Paragraph 8 of the
    Code of Conduct by reason of working for caring agencies as a carer.
    Councillors Heathcock, Kenney and V McGuire declared a personal interest
    as members of Cambridgeshire Older People’s Enterprise (COPE).

20. MINUTES OF LAST MEETING

    The minutes of the meeting held on 29th November 2011 were confirmed as a
    correct record and signed by the Chairman, subject to replacing “Advice and
    Information Centre” in the heading at the foot of page 2 with “Advice and
    Intervention Centre”.

21. PROPOSED REDESIGN OF MENTAL HEALTH SERVICES ACROSS
    CAMBRIDGESHIRE AND PETERBOROUGH: FURTHER INFORMATION

    The Committee considered further information on various aspects of the
    consultation proposals:
    a)   Travel planning
    b)   Issues for carers
    c)   Training for care staff
    d)   Supported housing
    e)   Feedback from meeting with acute staff at Fulbourn Hospital
    f)   Advice and Brief Intervention Centre
    g)   Other issues raised by members.
    Officers introduced written reports and presentations in relation to travel
    planning, training for care staff, supported housing and other issues raised by
    members; information on the other topics was presented orally. The Chief
    Executive of Cambridgeshire and Peterborough Foundation Trust also spoke
    about the consultation proposals in the context of his assessment of the
    Foundation Trust as a whole.

    Attending to present information and respond to members’ questions and
    comments were:
        from Cambridgeshire County Council (CCC)
            Claire Bruin, Service Director: Strategy and Commissioning (Adult
            Social Care)
            Graham Hughes, Service Director: Strategy and Commissioning,
                   Environment Services



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       David Frampton, Commissioning Manager Mental Health, Community
             and Adult Services (CAS)
       Robert Nicholls, Interim Mental Health Commissioning Officer, CAS
   from NHS Cambridgeshire (NHSC) and NHS Peterborough (NHSP)
       John Ellis, Head of Mental Health, Learning Disability and Substance
              Misuse Commissioning
       Claire Warner, Commissioning Service Improvement Manager
   from NHSP and Peterborough City Council (PCC)
       Tony Cox, Interim Assistant Director (Mental Health and Learning
             Disability)
   from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT)
       Attila Vegh, Chief Executive
       Annette Newton, Director of Operations
       Keith Spencer, Director of People and Business Development.

Members raised and noted various issues in each of the areas covered.

Travel planning

The Service Director: Strategy and Commissioning (CCC) introduced his
written presentation on the Cambridgeshire Future Transport (CFT) project, a
joint initiative with partners from across Cambridgeshire and Peterborough,
including health services, working together to find solutions to transport and
accessibility challenges. It was not, however, specifically focussed on travel
for mental health patients or visitors.

Members noted that the initiative had had its origins in the proposals a year
ago to withdraw subsidies from all bus services. The need had been identified
to find lower-cost alternative solutions to meet residents’ travel requirements;
this was being done by
 exploring ways to pool budgets and/or jointly provide services, e.g. by
    using the same vehicles to transport children to and from school and to
    transport older people at other times of day
 trying to create a new provider market and establish a franchising process;
    a pilot bus franchise to serve the Duxford area had started recently
 looking at how organisations shared information and worked together.

The Commissioning Service Improvement Manager (NHSC) added that about
£15,000 had been transferred to community car schemes when two older
people’s mental health wards had been closed earlier in 2011. Figures were
being recorded by destination hospital, and to date had shown 49 visits to
Peterborough from the Cambridgeshire area; these figures would be
examined more closely, including the Acer catchment area and the impact of
the ward’s closure. The Commissioning Service Improvement Manager said
that the benefits of working with the CFT project or with the community car
scheme would also be considered, and offered to update the Committee later.

In answer to members’ questions, the Service Director said that
   CFT was not intended to provide for completely new needs, but he would
    be happy to explore working with Health colleagues with a view to joining
    up services, and to facilitate making adjustments to services (subsidised or
    commercial) within the CFT project


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   CCC and NHS each had their own responsibilities and budget constraints,
    which meant that they could not simply pool money in one pot
   CFT was engaged in dialogue with the voluntary sector and Dial-a-Ride,
    and was including them in the development of the new franchises in
    Duxford and the Huntingdon area
   the Ambulance Trust, as itself a provider of transport services to NHSC
    and NHSP, had not been included in the CFT project
   CFT covered such questions as whether it might be possible to re-use a
    vehicle that would otherwise be idle for part of the day; this involved
    painstaking, detailed work in the quest to provide transport services more
    effectively with the limited money available.

In the course of discussion, members
   commented that the layout of the Fulbourn Hospital site was such that
    anybody unfamiliar with it might have difficulty finding their way round,
    particularly a frail, vulnerable person arriving by bus in the dark
   pointed out that many villages did not have a bus service, and queried
    whether buses between Huntingdon and Peterborough ran at hourly
    intervals during the evening as well as in the daytime; the Commissioning
    Service Improvement Manager said that she would check commuter and
    off-peak timings, and commented that a community car could be more
    appropriate than the bus for more elderly or frail travellers
   asked when the proposed transport arrangements would come into effect;
    the Commissioning Service Improvement Manager said that the temporary
    closure of Acer Ward ahead of the consultation because of safety issues
    meant that transport arrangements had not been implemented ahead of
    the closure, and it would be premature to put them in place before a final
    decision on Acer’s future had been reached following the consultation.

At the Chairman’s invitation, Robert Boorman, speaking on behalf of COPE,
reported the experience of one elderly member visiting her son in hospital in
Peterborough; because of her blindness and a lack of bus services, she had
been spending £14 a day to visit him. COPE had raised her case with CPFT,
who were working with her towards a solution, but it was unlikely that she was
the only person experiencing such difficulties. Mr Boorman also said that it
was important that leaflets giving information about transport possibilities be
provided in all the mental health wards and contain accurate information.

Issues for carers

On behalf of David Jordan of the Peterborough and Fenland Rethink Group,
the Scrutiny and Improvement Officer reported that Rethink had raised
concerns about support for carers of people of working age and of older
people. Members stressed the importance of ensuring that family carers
were given adequate support, and that they would be able to have easy
access to the Advice and Brief Intervention Centre (ABIC).

NHSC officers reported that they had met with Mr Jordan and with carers, and
were actively working to address carers’ concerns. These included issues of
patient confidentiality when contacting services. Work was therefore being
done to develop a “Trusted Carer” status, under which, once a person had

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been identified as a trusted carer, confidentiality restrictions would be lifted.
CPFT’s CAMTED-OP (Cambridgeshire Training, Education and Development
– Older People) team had tended to bring family carers into training sessions;
funding for the programme had ceased, but efforts were being made to make
a business case for funding to be resumed.

The Director of Operations, CPFT, said that the Trust had been working with
carers on the development of its Carers’ Strategy, which was integrated with
the Local Authority’s Carers’ Strategy. The Trust expectation was that all
carers be offered an assessment of their needs, which should include such
matters as the carer’s transport needs; many carers had already received this
assessment.

Gina Jolly reported on the development of a scheme of Ambassadors for
Carers. By July 2012, there would be 20 such ambassadors working with (not
working for) CPFT as part of the Carers’ Strategy. The CPFT Board would be
considering the strategy at a meeting in January 2012, and the whole strategy
was expected to be in place by the end of 2013. It covered such matters as
training, transport, assessment, and links with other organisations, including
Crossroads and the County Council; the barriers between organisations were
coming down. The triad of CPFT/patient/carer had been coming together for
some time. However, the current proposals lacked the element of face to
face, one to one interaction which carers valued. Asked what she considered
the risks in the proposals to be, she said that they were financial; the voluntary
sector needed money for its staff, and there was a question whether there
were voluntary organisations who could undertake the work required.

The Interim Mental Health Commissioning Officer, CCC, advised that the
Council funded “Making Space”, an organisation for mental health carers
which worked to ensure that carers were not left in isolation but received
information and support. The Service Director: Strategy and Commissioning
said that the Council was working with NHS colleagues, and that the Carers’
Strategy linked in with an overarching, multi-agency carers’ strategy.

The CPFT Chief Executive’s views

Dr Attila Vegh introduced himself as the Chief Executive of CPFT and outlined
the concerns he had identified during his first weeks in post. He said that he
believed in the exceptional quality of the Trust’s staff, but in his personal
assessment, the Trust was failing to deliver on aspects of care, and was not
delivering what staff would expect to receive if they were themselves patients.
He listed deficiencies in
   estates – some facilities such as bathrooms and washing machines were
    not up to standard and were not kept in good repair
   care planning – processes were often bureaucratic and took time away
    from caring work, the care plans were often lengthy and not sufficiently
    practical for carers
   training – this was not always provided at the appropriate level, and could
    become an exercise in ticking boxes
   staff attitude – staff sometimes failed to treat patients with the appropriate
    dignity.



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The Chief Executive said that he had asked for the staff’s help in addressing
these matters. He had
   made a commitment to make no compulsory redundancies as a result of
    the current consultation
   asked that processes be less bureaucratic, with anything broken being
    fixed within a week, and faulty IT equipment replaced within 24 hours
   undertaken to arrange a credit card for each team, to enable it to purchase
    items promptly (rather than the months it had taken to buy e.g. a pot plant
    or a picture) and as a sign that staff were valued
   given staff access to such internet sites as YouTube for purposes of
    patient care information
   asked all staff to challenge the way in which services were delivered
   asked all staff to send him an email promising to make one change; he had
    already received hundreds of personal commitments
  established a system of programme management to support change, with
   managers delivering the various project areas.
He said that he was also talking to the press and MPs; it was necessary to
maintain communication and be honest about the need to improve services.

Asked about his own background, the Chief Executive said that he was a
qualified medical doctor and a clinician, with a PhD in cancer research and a
master’s degree in healthcare management.

Answering members’ questions about the consultation document, the Chief
Executive said that
 he agreed with the concept in principle and with most of its proposals, but
   there were areas where it was necessary to develop thinking further, for
   example in relation to services for children
 he had made a commitment that there would be no compulsory
   redundancies; through careful vacancy management, it was possible to
   make use of staff vacancies to help in delivering savings
 as vacancies did not necessarily match service needs, there would be
   some moving of staff, though not over great geographical distances; this
   was preferable to making people redundant.

Members welcomed the Chief Executive’s approach and vision for change,
and asked him about staffing levels and about whether Cambridgeshire and
Peterborough were receiving a fair share of funding for mental health. The
Chief Executive replied that an exercise was in progress looking at the levels
of staffing required for every ward and every team, so that the Trust could be
confident that the right level of staffing was set for each area; it was expected
that this exercise would be completed by the end of January 2012. Many of
the changes sought, such as use of language and improvement in processes,
were not dependent on funding, but mental health in Cambridgeshire had
been underfunded; Cambridgeshire was in 152nd position for funding among
the 152 primary care trusts in England. He was aware of the funding situation
of acute NHS trusts, but if CPFT was aspiring to be a strong mental health
provider, the level of funding would have to rise above 152nd.



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The Head of Mental Health Commissioning said that the Cambridgeshire
primary care trust recognised CPFT’s funding situation but was itself relatively
poorly funded, though partly as a result of modernisation the gap between it
and others was closing. Peterborough’s funding was also low. Mental health
was being asked to make the minimum 1.5% savings in the current financial
year. He pointed out that unlike acute hospitals, no tariff system applied to
mental health, and it was necessary to be realistic about funding. The
consultation was concerned with matters of best practice, and even if more
funding were available, it would still be desirable to implement its proposals.

Asked whether he was happy with the number of acute and rehabilitation beds
that would remain under the consultation proposals, the Chief Executive said
that it was important to consider how to make use of the beds and how to
support patients on discharge; the number of acute beds, judged by
benchmarks, was probably appropriate. The quality of life for a patient was
worse once they were on a ward, so it was better to keep them in the
community and retain their social contacts for as long as possible.

Training for care staff

The Committee noted the paper from the Contracts Manager, CCC, setting out
the position regarding care worker training to appropriately support Service
Users with mental health needs living in the community. Members also noted
the material supplied by CPFT on the activities of CAMTED-OP, which
included training and development for dementia care workers. The Service
Director: Strategy and Commissioning said that specifications for contracts
with home care agencies were being reviewed, including the Council’s
expectations with regard to training for care workers.

Members reported that an agency they had visited had viewed the price being
charged by some organisations for dementia care training as excessively high,
and that the agency had not felt that this expenditure represented good value.
One member commented that it was often said that rapid staff turnover meant
that it was not worth paying to train agency staff. The Service Director said
that, as already happened for safeguarding training, it might be possible to
build in an element of quality assurance for dementia and mental health
training purchased by care agencies. It would also be desirable to build
career pathways which recognised staff who were committed to training, which
would also lead to greater job satisfaction.

Supported housing

The Committee considered a report and presentation on the development of
mental health supported housing in Cambridge. In response to members’
questions and comments, CCC’s Commissioning Manager Mental Health and
Interim Mental Health Commissioning Officer said that
   good care planning and risk assessment were crucial in managing the
    service to make the best use of scarce accommodation resources
   for historical reasons, the vast majority of accommodation was in or just
    outside Cambridge rather than elsewhere
   the question of how to make best use of Fendale Court in Huntingdon was
    being considered. It currently provided a low level of support but the
    possibility was being explored of adding office and sleeping facilities so

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    that staff could sleep in when necessary; the hope was to develop it into a
    hub for services
   when a change of accommodation was being considered for a service
    user, the approach was that the person should move on when they were
    ready to do so
   work was being undertaken with Cambridge City Council to look at the use
    of e.g. sheltered housing to develop accommodation suitable for the needs
    of older service users.

Feedback from meeting with acute staff at Fulbourn Hospital

The Scrutiny and Improvement Officer reported on the meeting with acute
staff, drawing attention to their mixed feelings about the closure of Acer Ward
and their concerns about aspects of rehabilitation. The Director of Operations,
CPFT, said that there was no reason to change the arrangement whereby
service users continued to contact ward staff following discharge, because
they were known to them and their families.

A note summarising key points from the discussions with Fulbourn Hospital
staff is attached to these minutes as appendix 1.

Advice and Brief Intervention Centre

Members expressed concern at the lack of detail and precision in plans for the
ABIC, given its crucial role in delivering the proposals under consultation. It
was important that ordinary people knew what to expect when they contacted
the ABIC and that they could be sure that the person taking their call would
react appropriately.

Officers from CPFT and NHSC advised members that what was being
described was a concept. It would start by being rolled out in Peterborough in
June or July 2012, and would provide a single point of access for callers and
manage incoming referrals. It had been discussed at a recent service users’
group and with GPs. Service users and GPs had fed in many ideas on the
subject; the consultation process was part of building the model. The ABIC
would not be doing something completely new, but would be consolidating the
current somewhat ad hoc arrangements for dealing with telephone calls
seeking information. The ABIC would be trialled in Peterborough then rolled
out across Cambridgeshire.

Other issues raised by members

The Scrutiny and Improvement Officer reported that she had circulated
performance information on IAPT (Improved Access to Psychological
Therapy) for members’ information following the last meeting.

In response to a request for more information on the establishment of the
community-based teams, the Director of Operations, CPFT, said that genuine
consultation was currently being undertaken with a large number of staff to
seek their input into the development of a staffing model for each team. She
expected to be in a position to report on their feedback around the end of the
consultation period.



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22. UPDATE ON FEEDBACK FROM THE CONSULTATION PROCESS

   The Head of Mental Health Commissioning gave a presentation on major
   issues raised to date in the course of the consultation process. A copy of the
   slides is attached to these minutes as appendix 2.

   The Chairman summed up the Committee’s concerns as financing, having
   enough people of the right quality in place, and having a properly functioning
   IT infrastructure.

23. PROPOSED REDESIGN OF MENTAL HEALTH SERVICES ACROSS
    CAMBRIDGESHIRE AND PETERBOROUGH: DEVELOPING A RESPONSE

   The Scrutiny and Improvement Officer presented a report on developing a
   consultation response. The Committee considered the key points suggested
   for inclusion in the response in detail, taking into account the information it had
   received, both oral and written, in the course of its work.

   In the course of extensive discussion of the proposed response, members
   drew particular attention to various matters, including that
      the vision was admirable but lacked detail and a comprehensive time-line;
       the staffing and skill mix for proposed services was not clear, including the
       staffing of the ABIC and of the community mental health teams
      the ongoing development of new ideas in response to consultation
       responses should be welcomed
      the closures of Cobwebs and Acer Ward in advance of the consultation
       exercise had been unfortunate; while safety concerns had prompted the
       closure of Acer Ward, Cobwebs had been a community-based
       rehabilitation centre which had been functioning well. On balance, the
       Committee was inclined to question the need for Cobwebs to be closed but
       to support the closure of Acer Ward, provided that appropriate travel
       arrangements were in place
      in relation to the ABIC, it was essential that staff be appropriately trained
       and that robust IT systems be put in place; the situation must not arise
       where computer failure crippled the centre’s ability to respond to calls
      it was necessary to have sufficient community support in place to
       compensate for the reduction in rehabilitation beds, and to ensure that the
       needs of people who had no family support would be met; although the
       number of acute beds was not due to change, it was not clear that the
       present capacity was adequate to meet anticipated need
      training should include both professional carers and family carers, as well
       as social workers and primary care staff
      positive relationships should be established with the voluntary sector,
       which should be integrated into the process as a valued partner
      the Committee was inclined to prefer the Cambridge cluster approach to
       supported housing to the very scattered Peterborough pattern.

   The Committee agreed that the Scrutiny and Improvement Officer produce a
   draft response, circulate it to all Committee members for approval, and
   produce a final response in consultation with the Chairman.


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24. NEXT MEETING: CONSIDERATION OF THE OUTCOME OF THE
    CONSULTATION

   The Committee was advised by NHSC officers that the date when the Cluster
   Board of NHSC and NHSP would consider the responses to the consultation
   had not yet been determined. It was unlikely to be on the agenda for January,
   as a considerable amount of work had to be done between the end of the
   consultation period and the board meeting.

   The Committee noted that the date of its next meeting, to be held at the Town
   Hall, Peterborough, would be arranged to follow the Cluster Board meeting.




   Members of the Committee in attendance:
   Councillors G Heathcock, G Kenney and V McGuire (Cambridgeshire County
   Council); D Harrington, B Rush, N Shabbir and J Stokes (Peterborough City
   Council)
   Apologies: Councillors P Sales and C Shepherd (Cambridgeshire)

   Time:        5.05pm – 8.50pm
   Place:       Kreis Viersen Room, Shire Hall, Cambridge




                                                                              Chairman




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