Agenda item

Reports have been requested following up from a previous presentation on emergency & urgent care. Evidence is being taking to inform both reviews:

• Review : Access to Health Services in Southwark

• Review : Prevalence of Psychosis and access to mental health services for the BME Community in Southwark

Papers and presentation from:

1. Guy’s & St Thomas’ - Presentation by James Hill, Head of Nursing and Nicola Wise, General Manager - paper circulated with main agenda

2. King’s - Briony Sloper, Deputy Divisional Manager, Trauma, Emergency and Urgent Care - paper attached

1. SLaM - Steve Davidson, Service Director, Mood Anxiety and Personality Clinical Academic Group - paper attached.

Gwen Kennedy, Director of Client Group Commissioning (CCG), will also contribute to the item.

5.1  The chair  welcomed  James Hill, Head of Nursing and Nicola Wise, General Manager , Guy’s & St Thomas’ ; Briony Sloper, Deputy Divisional Manager, Trauma, Emergency and Urgent Care , KCH ;Steve Davidson, Service Director, Mood Anxiety and Personality Clinical Academic Group , SLaM and Gwen Kennedy, Director of Client Group Commissioning Southwark CCG.

5.2  Gwen Kennedy, Director of Client Group Commissioning, opened by saying that there has been an increase in the numbers of people needing mental health service presenting at acute settings; a greater proportion are known to the service.  She chairs a recently convened urgent care board sub group looking at the issue and one of the tasks is to understand the data more. She explained that formally there was an urgent care network managing  diverts across the south east , with a task and finish group that developed an action plan; now pressures have been building again so there was a decision to reconvene this group to look across the system . A member asked if there was an action plan and the Director of Client Group Commissioning said that the group is looking at the former plan and have a draft action plan in development.

5.3  Steve Davidson, Service Director, Mood Anxiety and Personality Clinical Academic Group, SLaM commented that there have been some changes in home treatment since the Guys and St Thomas’ paper was submitted and now emergency staff can make more clinical decisions which have improved assessment speeds.

5.4  A member commented that when she spent a shift with ambulance drivers  they said the biggest issue was mental health; the drivers said that now patients have to be taken to Accident & Emergency, which is often chaotic, whereas formally they could be taken to a police cell - which was a quieter place. Steve Davidson, SLaM, responded that mental health services think that a police station would be about the worst place to go,  given the co-erosive nature of their involvement. James Hill, Head of Nursing, GST agreed and said that A & E is much better because patients can be assessed for physical needs. The member commented that she completely respected the  clinical views expressed but the medics hated people in mental distress being obliged to join a big queue where people might be throwing up or violent .

5.5  James Hill said that Guys and St Thomas’ are building a special suite so that people can be seen in a calmer environment. He explained that medical assessment is needed to see if mental health symptoms have a physical cause; for example delirium in older people can be a sign of infection.

5.6  Briony Sloper, Deputy Divisional Manager, Trauma, Emergency and Urgent Care, KCH said the Denmark Hill A & E department is not well set up for the volume and acuity of patients with mental health; it can be very difficult when a person turns up in an incredibly distressed state. The department are putting in more staff and building physical capacity. James Hill said that Guys & St Thomas are experiencing the same issues and that a lot of their overspend is around mental health.

5.7  A member referred to the work that scrutiny did in 2010 and the community survey about the closure of the crisis suite at the Maudlsey and the need to have a separate room at KCH Denmark Hill A & E. He commented that ultimately King’s agreed, which he was pleased about. Briony Sloper commented that there are some people who use the rooms set aside, but these are not enough. Another member commented that the former crisis centre at Maudsley did offer this provision, and the community warned of the consequences of closure. Briony Sloper said that the A & E has neither sufficient space nor clinicians. A member asked her if rising need was caused by the increasing population, but she said it was about it is about acuity and emphasized that there has been a significant growth in acuity.

5.8  A member asked Briony Sloper what was driving the increasing acuity, but she said she couldn't comment on why. James Hill, GST, said the amount of people of people who need help with feeding and help to deal with social circumstances has increased. Gwen Kennedy added that the sub-group is looking at data and trends. A member asked if the economic pressure is contributing to the rise in acuity and everybody agreed it was. A member asked there was a rise in self harm and Briony Sloper said she did not think there was. Steve Davidson, SLaM emphasized that there is a 25 % increase in admissions and a member asked if this was higher in the city and he said it is.  BrionySloper said that was a particular problem with approved social workers.

5.9  A member commented that the reports indicated that patients with a mental health need will be seen within 30minutes. Briony Sloper said yes, that is correct: it is 30 minutes to be seen for mental health and 60 minutes for physical health - the total journey through the system is 4 hours, from entrance to either leaving or admission to a bed.

5.10  Gwen Kennedy, Southwark CCG emphasized that there is a cohesive approach - we all coming together. A member referred to the move of Public Health to the council and asked where  support to mental health could be best directed. Briony Sloper suggested that it might be better to ask service users and indicated that KCH are looking at the prior three months and asked what happened to those clients. She said that she wouldn’t want to pre-empt this study.

5.11  The Director of Public Health referred to work completed by the UCL Institute of Health Equity, looking at the health impacts of the economic environment.  This highlighted a probable increase in mental health problems.  Young adults are also likely to be affected by low employment and income.

5.12  A member commented that the interim results from the scrutiny survey did indicate that people were going to A & E to access healthcare that doctors might be better placed to provide. He asked if the local E & E department thought this was an issue. KCH responded that Denmark Hill A & E do active streaming; there are GPs on site and the department also liaises with local GPs, however this is not a growth area.  However A & Es are seeing people's who are coming out of hours , often really late because of work pressure. There is also a cultural change; people want treatment more immediately.

5.13  The chair invited resident Tom White to speak. He said that there is a rise in the number of people on wards with mental health problems and referred to vascular dementia. Tom raised concerned about the availability of mental health beds and referred to a temporary closure of a ward for older people which then became permanent, despite assurances he was given to the contrary. He also refereed to a case whereby the nearest place for a mental health bed was Manchester. Steve Davidson from SlaM agreed that there was a demand issue and that patients are being sent to Manchester, and commented that demand is unprecedented. He said that SlaM does not have the resources, and that the most they can do is work to get the model that delivers the best outcomes, but funding is far from what they would want it to be. He explained that SlaM is doing what they can do ensure that conditions do not deteriorate to a crisis point. Training is also being doing for nurses on wards so that there is more capacity to deal with mental health needs, and although this is not a huge investment SlaM does believe it will help. Gwen Kennedy added that the CCG have one plan for urgent care mental health and a longer strategic plan for  mental health at a population level over 5 years.

5.1  A member asked when KCH Denmark Hill is going to open the dedicated mental health suite that has been in the pipeline for several years. KCH staff responded that there are two individual rooms already; the first phase has been completed. The second phase of the suite is reliant on the PFI provider agreeing to a change of use and there have been problems getting agreement and  negotiating space in the Golden Jubilee Wing. Member expressed concern at this delay and referred to a survey the committee conducted which demonstrated that the community considered the provision of an adequate safe space for people in mental distress at the A & E department to be very important. Members referred to the £6.5 million founding provided by central government to provide this dedicated mental health suite.

RESOLVED

The urgent care sub-group, looking at mental health, will provide the draft action plan.

The committee recommended the next administrative committee look at Mental Health as a review topic.

The committee will keep abreast of progress on the Mental Health suite at the Accident & Emergency clinic at King’s Healthcare Trust, Denmark Hill Hospital – an update will be requested for the next meeting.