Agenda item

6.1  Gwen Kennedy, Deputy Director of Nursing and Commissioning, NHS Southwark, and Patrick Gillespie, SLaM Service Director of Lambeth and Southwark Adult Mental Health Services, briefed members about the proposed changes to SLaM services and the Systemwide Sustainability Programme (see Appendix A).

6.2  Jo Kent, SLaM Deputy Director of Southwark Adult Mental Health Services, related that a number of focus groups had been held over the last couple of months to discuss the changes and that approximately 60 to 70 people had attended. The questions and answers from these groups are being collated and will be presented at a stakeholder event on 19 October. The key issues evident to date from the focus group feedback include as follows:

-  discharge planning and how patients will be able to re-access secondary services once in primary care;

-  how SLaM is engaging with primary care;

-  concerns whether peer networks will be available, if these are wanted.

6.3  Members queried whether some of the patients cared for under the Care Programme Approach (CPA) are incentivised to stay on this programme by the related benefits system. The SLaM deputy director explained that the CPA was introduced approximately 20 years ago and some people had been receiving services as they were long-term CPA patients, rather than having recently received a full needs-lead assessment. The SLaM service director added that the key benefit for CPA patients is their entitlement to a freedom pass. He noted however, that local authorities, who determine the eligibility criteria, are currently reviewing who receives these passes.

6.4  In response to member queries regarding the proportion of the PCT budget spent on mental health services, Malcolm Hines, NHS Southwark Finance Director, stated that between £60 to £70 million is used annually to fund mental health services, which is close to 15% of the total PCT budget.

6.5  Members commented that there is a perception that mental health is the poor relative of health services and asked whether the 3.7% savings required from mental health is the same percentage required from other health services. The NHS Southwark chief executive remarked that this is an important point and one that the PCT has considered in detail. The Southwark PCT spend on mental health is comparable with Lambeth and generally is high.

6.6  Ann-Marie Connolly, Director of Public Health, added that Southwark’s budget spend on mental health services was benchmarked with the spend on comparable populations. She confirmed that Southwark’s allocation is both high on spend and spend per head.

6.7    Members queried why savings were necessary when the government had ring-fenced health funding. The chief executive responded that health spend increases every year due to the aging population and increasing opportunities to spend more on new medicines and advancing technology. She explained that a 4% budget increase would be needed to maintain the current service provision, and that while the government has signalled that there may be some level of budget growth, it will not be comparable to the curve in recent years and there will be a gap. The finance director added that Southwark has the highest population growth in south east London at approximately 2.5 to 3% annually.

6.8  Members questioned whether mental health services are particularly susceptible to population changes and inflation and therefore whether the level of cuts to SLaM’s funding is fair. Jane Fryer, the medical director deemed the cuts to be proportionate to the population and inflation. She commented that inflation tends to have a greater impact on hospital services where the drugs and equipment used can be very expensive.

6.9  Members referred to comments from the director of public health, suggesting that there is a high level of spend in Southwark, but that the outcomes don’t reflect these levels. It was queried whether this indicates that there are efficiencies to be made. The director of public health explained that over the last 20 years there has been considerable work and learning about new approaches for patients. Of the different approaches tried some were very good and some less effective, which demonstrated that the funding could be used in a better way.

6.10  Members queried why there are changes being made to the estate before the accommodation audit is carried out. The SLaM deputy director replied that as there would be staff reductions, SLaM would not need as much staff accommodation as present and that there has been a wish to move out of 27 Lambeth Road for many years. She added SLaM has signalled its interest for accommodation at Larcom St and is trying to obtain space in modern fit-for-purpose buildings. The Southwark SLaM service director added that the number of beds was not being reduced, but they are looking to see how beds can be used more efficiently.

6.11  Members referred to the tables outlining SLaM’s current and future community structure and commissioned activity levels (pp. 64, 65) and noted that dual diagnosis no longer appeared as a future activity. The SLaM deputy director explained that SLaM had lost its contract with Southwark PCT to carry out dual diagnosis, but that the relevant staff would still be based within SLaM teams. She emphasised that SLaM currently provides key workers for 1600 patients in Southwark and is committed to sustaining that number.

6.12  In response to member queries regarding the Equality Impact Assessment (EIA) the medical director stated that this is a work in progress that will be revisited as the plans are progressed. Members asked whether a strategy had been devised on how to mitigate the higher impact on the BME community. The SLaM deputy director responded that early intervention approaches were used and have lead to some very good results. The ‘Care for Life’ project was also mentioned, which involves staff visiting faith groups and schools so that people in need can be directed into appropriate services.

6.13  Regarding consultation, the Southwark SLaM service director explained that SLaM is hosting stakeholder reference groups and is undertaking a consultation with its staff this autumn. It was clarified however, that the PCT is leading on the broader public consultation. Members therefore queried whether there would be a formal consultation. The director of nursing and commissioning replied that officers were intending to ask the sub-committee for its view before reaching this decision.

6.14  Michelle Baharier, CEO of CoolTan Arts, commented that people who are not cared for under the Care Programme Approach (CPA) miss out on a significant range of services and highlighted that Southwark has one of the highest levels of mental health needs in Western Europe. She noted that a consultation meeting had taken place in August but was attended by only 3 service users; that the next meeting will not take place until 19 October; and that the board will be considering related issues already on 14 October. The CoolTan Arts CEO added that her organisation does not have a representative on the service user council, despite requests for this over a long period of time.

6.15  The deputy director of nursing and commissioning responded that it is necessary to be mindful of the distinction between consultation and engagement. She confirmed that attendance at the summer event had been low but stated that many invitations were sent out and that SLaM is making considerable efforts to engage with service users.

6.16  Members queried what service changes had been achieved in response to service users’ views. The Southwark SLaM service director cited an example of a consultant who is now working within a GP surgery. This followed feedback from patients that they would prefer services closer to home in view of the stigma sometimes associated with receiving SLaM services.

6.17  Chris Griffiths, Specialist Health Commissioner, commented that there are other factors to consider than the number of people attending an engagement event. He mentioned that regular meetings are held with Southwark Mind; that the partnership board meets monthly; and that further information is being circulated.

6.18  The chair referred to a letter received that day from Lynne Clayton on behalf of the Southwark LINk, and asked why the LINk would be raising concerns about involvement if there was an effective ongoing dialogue. The medical director commented that the PCT’s intention was to brief the sub-committee early on this issue and that the plans for consultation were still to be finalised.

6.19  Les Elliott, member of Southwark LINk; the Lambeth LINk steering council; and the SLaM member council, commented that he is very impressed by the work of the Southwark SLaM service director and deputy director. He added however that the proposed changes introduce very serious issues and that when a patient is discharged to a GP it can be difficult to get the appropriate structure of services in place to create the new process.

6.20  Rosie Agnew, CoolTan Arts, stated that whether the consultation to date had been formal or informal it appeared that stakeholders had agreed on key strategic decisions, whereas this did not happen as they had not received the relevant data. She added that CoolTan Arts had requested an additional meeting as there had been insufficient advance notice for the summer event and as it had been difficult to obtain the related papers.

6.21  Members asked officers to outline the arguments for and against formal consultation. The specialist health commissioner stated that officers had worked on the objectives for the proposed changes since early this year and that a formal 12 week consultation would delay the achievement of the objectives and reduce savings. This would compel officers to find savings in other areas. The director of nursing and commissioning added that the PCT is not adverse to using a consultation process that is engaging, and remarked that in relation to psychology therapy services, 50 one hour interviews had been held to garner service user views. She reiterated however that it is necessary to take these proposals forward rather than put the brakes on. She agreed that there would be benefits to a formal consultation but that they would not outweigh the savings that would be lost as a result.

6.22  Members asked what more could be done to make the consultation and engagement productive if members were not to request a formal consultation due to the financial pressures. Officers replied that they would be happy to take on board specific suggestions.

6.23  Members suggested that a more effective plan for notifying members about proposed changes is necessary to ensure that the sub-committee can trigger a formal consultation in future without jeopardising savings. The director of nursing and commissioning commented that officers had wanted to submit the proposals to members some time ago, but had been waiting for the new sub-committee to be formed and that this meeting had been the first opportunity. The chair responded that officers could have initially submitted the papers via email.

6.24  Members emphasised the need for a comprehensive EIA and asked officers whether they were confident that by the 19 October they would have delivered on their equality and health obligations. The deputy director of nursing and commissioning confirmed that this would be the case. The deputy service director added that of the focus groups that she had taken part in, she had seen approximately 60 to 70 service users, many of whom had come up with very good suggestions that were being taken on board.

6.25  The PCT chief executive commented that the points raised about the EIA had been well made and taken on the chin. She said that the EIA is taken very seriously, albeit that not all evidence of this had been written down and presented to the sub-committee. She added that a full impact assessment should be carried out; and that an outline should be provided of all the ways in which stakeholder engagement had had an impact on proposals. She also suggested that further discussion take place outside the meeting to agree how to deal with forthcoming issues, (which are likely to soon be stacking up) in a way that is both effective and expedient.

6.26   Members discussed what they might request in lieu of a formal consultation. It was suggested, for example, that feedback be sought from the engagement events; that details be requested of what has been done and is being done for the EIA; and that an earlier trigger process be agreed. It was emphasised that the sub-committee could not be effectively blackmailed to waive a request for formal consultation on the basis that it would exacerbate the financial situation.

RESOLVED:

1.  That the sub-committee agrees not to request a formal consultation on the proposed re-structure of SLaM services, on provision of the following:

-  that the PCT outlines what has been done and what is being done to carry out a comprehensive EIA (which the sub-committee would like to see as soon as complete);

-  that the sub-committee receives feedback on the results of the engagement events, and that ways in which engagement has influenced the service re-design be itemised so that meaningful involvement can be demonstrated;

-  that a plan is devised in liaison with the PCT to ensure that subsequent submissions on service changes are received sufficiently early for the sub-committee to request formal consultation where required; without the consultation period undermining savings objectives or incurring similar disadvantages.

2.  That the PCT come back to the sub-committee with details of the benefits that service users are entitled to who are classified as CPA (Care Programme Approach) patients.