Agenda item

 Papers from council officers and South London & Maudsley NHS Foundation Trust (SLaM) are enclosed.

 

The following attended the meeting to present and take questions on the Social Care Review:

 

Southwark Council

 

·  Councillor Richard Livingstone,  Cabinet Member for Adult Care and Financial Inclusion

·  David Quirke-Thornton,  Strategic Director, Children’s & Adults Services

·  Simon Rayner, Assistant Director, Adult Social Care (Mental Health and Learning Difficulties)

·  Richard Adkin, Mental Health Review Co-ordinator, Children's and Adults' Services

 

Wellbeing Hub

 

·  Andrew Farquhar

 

SLaM

·  Dr Matthew Patrick, South London & Maudsely Foundation Trust (SLaM), Chief Executive

·  Kris Dominy, COO, SLaM

·  Jo Kent, Service Director, SLaM

·  Lucy Canning, Service Director for Psychosis CAG

·  Godfried Attafua , Deputy Director, Promoting Recovery, Psychosis CAG

 

CCG

·  Dr Jonty Heaversedge, Clinical Chair, NHS Southwark CCG

 

The following points were made by SLaM in their presentation and by members in the subsequent discussion:

 

·  The process had been difficult; a bumpy road.

 

·  The ending of the previous integration of health and social care was not supported by SLaM. The evidence is that integrated teams give better outcomes.

 

·  SLaM would have preferred to have been informed of the intention to ‘disintegrate’ earlier.

 

·  22 social workers have left SlaM as a result of the change process. Some backfilling to been done by SlaM using CCG funding for 6 months. This will be reviewed going forward.

 

·  95% of issues are sorted out, but there is still a small risk around safeguarding.  One concern is social care assessment if not set up in a timely fashion; however forums are there to address this between SlaM and Southwark social care.

 

·  SlaM said they will do their best to support the new model despite differences.

 

·  The lessons learnt is working together early and closer is better. Working closely from the outset would have allowed better sharing of concerns. 

 

·  A member raised a concern about two early discharges of people with mental health issues, resulting in with two deaths. The SLaM CEO responded that he couldn’t talk about the cases as he was not aware of the details , however there are mistakes made on occasions ; there is no such thing as a perfect service . He remains  of view of that an integrated service is better. 

 

·  The committee suggested coming back in a time period to look at implementation and pick up any concerns

 

Elizabeth Rylance-Watson, read out a statement on behalf of Tom White, spokesperson SPAG:

 

‘Dear Rebecca, understanding social care and mental health as on the agenda is mindboggling! Only the professionals will understand this. In simple terms, in my past business world, when you have a problem you cannot solve, you go back to basics! The A and E at Kings is simply not coping with what they need to be doing, let alone having to take on the burden of also coping with the mentally ill. We are aware that Kings are hoping to provide better services soon, but will not be the ultimate solution, as they just do not have the space! I find it so frustrating that the Maudsley, who have so much space, yet the experts on mental health do not seem to want to do hands on! It would cost nothing to reopen the Maudsley site, as  it is only being used for the Psychiatrists to have meetings. I have discussed with Slam the problem of most of the wards at Kings having to cope with the sick and also the mentally ill. I disagree with them that they do not think this is a problem! I believe this is unfair on the recovering sick, unfair on the mentally ill, and unfair on the nursing staff. I must stress that the CQC  have stated that a busy A and E is not the right environment for the mentally ill. I look forward to the response by SLAM!

 

Elizabeth raised the importance of ‘parity of esteem’ between people needing emergency treatment, whether coming to A & E under a ‘blue light’ needing urgent treatment for physical health, or in a mental health crisis.

 

The subsequent discussion referred to the allocation of 6.5million by Parliament in 2006 to King’s College Hospital to compensate for the closure of Maudsley emergency clinic, for people in mental health crisis, and in order to provide for better facilities in King’s A & E. King’s will be invited to a following meeting.

 

The following points were raised by Southwark Council and by members in the subsequent discussion:

 

·  Other councils have chosen to move towards the model Southwark is adopting and it has worked well:  Newham have been rated at excellent, Merton also followed a similar model. There are different approaches,  given the new flexibility allowed by government

 

·  Southwark are now seeking to "resurrect" social work. The council perspective is focused on residents and community, rather than hospitals, though we do recognise that there is a need to link to hospital and acute care.

 

·  The Strategic Director referred to the tabled document listing meetings with SlaM and partners.

 

·  In the reference to the letter by SlaM he said delayed discharge was an area that Southwark did well on, and that he did not agree with the reference to Mid Staffordshire Hospital. Delayed transfer will probably get worse for detox as the chronic underfunding of health services, but not because of this change.

 

·  A member refereed to the Frances report reference regarding Mid Staffordshire in the SlaM letter, and noted it was specific to staff moral. He asked about this and also other concerns on shared information. Going forward there will be two entry points. The social care one will focus on outcome. Officers said staff moral is good, and that many social workers are very excited about change and looking forward to being able to focus on social and community work. Officers said that there are always questions about change, however there is a good atmosphere; staff do want to focus more on the wider determinates of health.

 

·  Social work outcomes are poor and the council want to chart the direction of change to improve those.  He assured members that it is safe to go ahead with changes on 28th November. The council are prepared meet SLaM regularly, weekly if needed, until SLaM and the council are assured that this is a safe transition.

 

·  A Member asked for the reason for such a strong letter and the Strategic Director referred to underlying philosophical differences and that it feels wrong to ‘disintegrate’. However there are lots of difference ways to integrate and the council do need to listen to service users to.

 

·  The Care Acts emphasis is now much more on community care and increased moves to giving more personalised and agency. This is not total disintegration as there will still be co-location in many places, and the council did not consider that services based in Maudsley as right going forward as they were too institutionalised.

 

 

·  The Wellbeing Hub will offer information, advice and support. It will be open to anybody, and able to also offer more support if needed. There is also peer support, group work, and a partnership with voluntary and statutory teams. A visit was recommended to the committee.

 

·   A member noted the last Good CQC report on the service.

 

·  A member remarked to council officers that he would not critique the changes as your views are well founded, however preparing for change is very important. He asked if the Strategic Director and SLaM CEO could produce a joint letter and if they had met recently, and was given assurances that despite busy diaries this would be happening to take matters forward.

 

 

 

RESOLVED

 

It was agreed that the following recommendations will be put to both SLaM and Adult Social Care:

 

•  A published implementation plan, detailing the future phases of the changes to mental health social care, with clear timelines and further information about the actions being undertaken in each phase

 

•  An agreed meetings programme between SLaM and Southwark Council, both at a high level and an operational level

 

•  A reassurance of the willingness to work closely together to deliver the best outcomes for Southwark residents in changing the approach to delivering mental health social care

 

•  An agreement to attend the April 2017 Healthy Communities Scrutiny Sub-Committee meeting to provide an update on the mental health social care review implementation. The Committee will also invite union representatives, service users and Southwark Healthwatch to attend