Agenda item

5.1  The chair invited Cha Power, Deputy Director- Mental Health Older Adults and Dementia, and Zoë Reed - Executive Director of Strategy and Business Development, to present. The SLaM directors reported that the Equality Impact Assessment had been completed. The Home Treatment Team pilot is up and running and quarterly data will follow as agreed.

5.2  The Deputy  Director reported that recent activity data shows that the service took 49 admissions last year and this year the service has made 43 admissions, which is a marginal decrease . He explained that there had been 120 referrals. The chair asked what happens to people who are not accepted and the Deputy Director explained that they are either admitted or sent to the community health team.

5.3  A member said that he understood that the service  have more beds because of homelessness and deprivation. The Deputy Director explained that the service does accept people of no fixed abode, but the numbers are quite small. He went on to comment that the service would not really expect people without homes to be treated much differently by the mental health team, and the expectation is that service users would be housed in a hostel, if appropriate, or admitted to a ward , if needed .

5.4  The Deputy Director was then asked if someone in that situation, who was refused admission, would get support and he responded that the service often get people with quite complex problems, for example: mental health, dementia and social problems. The service director was asked how about the numbers of people referred to the service who were homeless and he responded that it was less than ten every two years, however, he added, this could rise with cuts to welfare. He went to comment that the service is seeing a rise in acutely unwell people. The chair asked for supplementary information on homelessness and the rise in acutely unwell people.

5.5  The Deputy Director was asked if he thought that two or three treatments a day from the Home Treatment Team is accurate, and he confirmed that this is what the evidence is showing. He went on to comment that home treatment seems to be working and maintaining people in their home – and it is also helping with discharge. A member asked if the service is monitoring to see if service users need admitting, and he responded that we are monitoring. He explained that they had been asked to do this by the commissioners and the service is capturing data and stories.

5.6  A member asked if people can access talking therapies and he was assured that they can, if needed. He was then asked to elaborate on the concerns about safeguarding noted in the paper. He explained that a patient receiving  home treatment would have a dedicated case worker who visits 3 or 4 a day. He was asked if they would spend time with the service user and the Deputy Director explained that sometimes a visit would just be providing  reassurance that the patient is well, and this could be a short visit of around  30 minutes, however, longer visits also take place of about two hours . He was asked if services such as meals on wheels would be used and he confirmed that they would.

5.7  A member said that he was told about someone who was informed that to get a service he would need to go to his GP - but he was too ill and anyway did not see the need. He commented that if these barriers exist then someone with a mental health problem could end up in a crisis. He asked how we can get people support and a referral when the family is concerned. The Deputy Director explained that the service do have an open access referral policy form both families and professionals. He added that the service also takes referrals from Accident and Emergency and that they want to make the service accessible. He reported that many older people with mental health problems are known, however some people are resistant to receiving treatment. He explained that the service do have recourse to mental health legislation if they are a danger to self or others.  He said there is a balance of risks because hospitals are sometimes not good places to be and there is a risk of institutionalisation.

5.8  A member commented that she understood that there is predicted to be an increasing number of older people living in Lambeth and Southwark. She asked if the service needs more capacity, can the beds be brought back, and noted the cost pressures. The Deputy Director commented that the service is working closely with demographic experts in commissioning to predict need. He explained that the service also have capacity to flex resources to meet demand as it fluxes.  He said that if the estimates show that the service needs to provide additional beds then these can be provided. A member asked how this could be done if the NHS budget is flat and the Deputy Director responded that the service have long stay beds, which have some under used capacity,  so these  might be looked at if there was an acute need .

5.9  A member commented that the report shows a lower number of users from both Southwark and Lambeth, compared with Croydon and Lewisham, and a lower number of Southwark BME groups than Lambeth and Lewisham. She asked for an explanation and the  Deputy Director said he will look into this and report back.

5.10  The SLaM Directors were asked if the Home Treatment Team is about increasing productivity or reducing costs, and the Deputy Director responded that he has always had concerns about the ability of community services to provide services in the evening and over weekends. He explained that this new service provides this option.  He explained that in-patient admission can be very traumatic for older people; the service has to work very hard to return older people home, so admission should be an absolute last resort, which is better avoided.

5.11   A member commented that the paper talks about cost saving quite a lot, and surely there is a trade off between cost and quality of services. The Deputy Director responded that this is not about getting rid of beds – it is about providing better care. He was then asked if he would be rationing in-patient care and he said that he would expect that there will be a reduction. He explained that the service will be looking at the evidence of the pilot cases to see if there is a need for adaptations. He added that the demographics show that there will be a growth in demand. There is a rising BME population which will mean an increase in vascular dementia.

5.12  A member asked if more home treatment means more medication and the Deputy Director responded that he would not expect that. He explained that the Home Treatment Team is a mixed team that is not particularly medical led and that the emphasis will be on recovery. He explained that a lot of the dementia drugs are not that effective anyway – and additionally those older people with dementia and challenging behaviours who are taking drugs that deal with these conditions need very close monitoring. He said that we do not always get the balance of risk right, but the service try and balance community treatment with hospital admission.

5.13  A member asked how many members of staff were involved in the Equality Impact Assessment. The Executive Director of Strategy and Business Development explained that she, the Deputy Director, and another member of staff worked on the document. The member said that the evidence and analysis on the ‘Gender Reassignment’ and ‘Religion/ Belief’ category was weak. The Executive Director responded that they aim to continuously improve and that they are seeking advice from the Lesbian, Gay, Bisexual & Transgender patient group and from other stakeholders and partners. A member commented that the committee want to see more evidence that that the Equality Impact Assessments are used as an active tool in order to improve services, and not just an irritant at the end, and furthermore there is a duty to comply with the law. He pointed out that there is a risk of being judicially reviewed and this happened to Birmingham Council.

RESOLVED

The Equality Impact Assessment will be developed.

An additional analysis of spare capacity will be provided.

Supplementary information will be provided on the service offered to homeless older people with mental health needs.

Additional information will be provided on the rise in acutely unwell people.

An explanation will be provided for the lower number of users from both Southwark and Lambeth, compared with Croydon and Lewisham, and why there is a lower proportion of Southwark BME service users compared with Lambeth and Lewisham.

Data and patient journey vignettes will be provided on medication levels used by the Home Treatment Team.