Agenda item

6.1  The chair welcomed Steve Davidson, SLaM Service Director - Mood Anxiety and Personality Clinical Academic Group, and Zoë Reed, Executive Director of Strategy and Business Development, to provide an update on the Psychological Therapy Service.

6.2  The Service Director said since the large stakeholder event on 16 May they have been developing a framework that has focused on looking at the patient experience and monitoring activity. He explained that the service now has a single point of entry and referrals are considered by a group of senior therapists. He reported that the service now knows much more clearly what the demand is.

6.3  A member asked about honorariums and noted that the paper says that it is hard to provide data on their hours and modalities as this had not been fully monitored. The Service Director responded that we now have a clearer idea of the data, as their activity is now more closely supervised as a condition of the contracts with schools. He reported that formerly there was not enough oversight of this by management.

6.4  The Service Director reported that the honorariums who came to the consultation event gave feedback. He explained that the honorarium therapists would come onto training programmes, but the service can only supervise honorariums  if there are sufficient senior enough therapists. He explained that SlaM could be quite selective as the hospital is quite prestigious, and the service would get as many honorarium as could be properly supervised and managed. He said this practice will continue.

6.5  A member asked for clarification on whether all the modalities would continue and the Service Director responded that some will be delivered across different therapeutics. A member asked about the specialist trauma team and the Service Director said that some trauma work will be picked up by the cognitive therapy team and more significant trauma integrated into the psychotherapeutic service. He said there is now a much smaller contribution to the national team.  A member asked if there will be a reduction in the number of specialised therapists, and commented that he knew of two who have been redeployed and not working on trauma any longer. The Service Director said it would be hard to say if there would be a reduction but overall there will be less provision. The member voiced concerns about the needs of armed forces personnel  and asylum seekers, remarking that both groups often suffer trauma.

6.6  The Service Director commented that the former trauma team was a national team, so the number of Southwark and Lambeth beneficiaries was small. He went on to say that the service is committed to providing a service for people with complex needs, and explained that because the team is co-located with a social work team they can now better support the social needs of service users, for example improving access to housing benefit. The member reiterated the importance of the armed forces receiving an excellent service. He pointed out that asylum seekers often need access to complementary services, such as language services.

6.7  A member questioned the inconsistencies in some of the documentation and asked for clarity on whether there is going to be a reduction in Psychodynamic Psychotherapy. The Service Director responded that a single point of service will help by bringing together a single pathway, and being clear about what is on offer, what the pathway is,  and the length of time service users will wait to access and for how long they will receive treatment. He remarked that there is good evidence that some therapeutic interventions can help over a shorter amount of time. He assured the members that while the number of full time therapists has gone down the service has maintained the same level of honorariums. However, he added, demand is not the same as supply and the single point of service will allow the service to better map need. He ended by answering that this is a completely new service so it is hard to answer.

6.8  A member commented that it sounds like the health service do not know the level of demand but has reduced the supply. The Service Director elaborated that formerly SLaM had separate services working in different ways, however, he said that he did not think it was entirely helpful to say we want to maintain the same level of service. A member asked if residents in Southwark are getting a poorer service and the Service Director responded that much of the Southwark service is now delivered through the IPPT service, which scores the best in the country. He explained that many people will now be offered and receive this service.

6.9  A member asked if SLaM have done any modelling on the  effect of universal credits , and that housing benefits being paid to a named person in the house monthly, rather than the landlord,  could exacerbate family conflict. He noted that pilot areas have demonstrated rising homelessness. SLaM directors responded that they are working with the council on reviewing the likely effects of the welfare cuts and introduction of the universal credit.

6.10  A member asked about the  number of referrals received and made for domestic abuse service and SLaM directors said that they would provide additional information.

6.11  The chair then invited Gwen Kennedy, Director of Client Group Commissioning, to comment. She explained that commissioners are scrutinising the data coming through and that they have prioritised people being seen as quickly as possible and being offered a service at the right time. She reported that the commissioners will be monitoring the new service, and in particular the delivery of psychodynamic therapy and trauma services.

6.12  A member asked how the Director will ensure that consultation and engagement with staff and community takes place. She responded that commissioners will be ensuring that the Equality Impact Assessment is completed right at the beginning and that there will be consultation and engagement early on, and that user representation is around the table.

6.13  A member asked how the commissioners will ensure that the users are the right people and not just selected. The Director explained that they have been holding thematic events that people have shown an interest in participating in. A member commented that he would like to hear not just about consultation, but involvement. Furthermore the committee would like to see evidence on how involvement has led to service change. He said  that the distribution of power in the hands of doctors can be very concentrated and that patient involvement can provide a more balanced view point.  

6.14  The Director reported that GP practices have patient groups and that there is a sub group of the Clinical Commissioning Group board. A member commented that patient groups participants are often retired people. She explained that commissioners are focused on ensuring that the right people are engaged around an issue, for example Dulwich Hospital and health services. She went on to remark that there are wonderful doctors in Southwark and model practices .The Director explained that they are working on developing  engaging communities and learning from the local authority .She reported that commissioners have employed an outside agency to assist with engagement work.

6.15  A member asked the Director whether Southwark has the right balance of different psychological and psychotherapeutic service modalities, and if she was concerned that Lambeth’s provision of psychotherapeutic services is higher. She responded that there is an inheritance and Southwark developed practiced IPPT in a good way. She went on to report that the CCG will be looking at the data at the beginning of the new financial year in order to consider the most sensible decisions to be made. She added that the CCG are investing in data in order to make more informed decisions.

6.16  A member asked about levels of referrals to SOLACE by doctors and noted that this looked low in recent data presented to the Overview and Scrutiny Committee, and that this might indicate a training need.

RESOLVED

More data will be obtained on GP referrals to SOLACE.

More information will be provided on the impact of the universal credit on mental health service.