Agenda item

The Chairman welcomed Matthew Trainer, Chief Executive – Oxleas NHS Foundation Trust (“Chief Executive”) and Lorraine Regan, Service Director (Bromley Directorate) – Oxleas NHS Foundation Trust (“Service Director”) to the meeting to provide an update on adult mental health.

The Service Director informed Board Members that all adult mental health services in the Borough had been fully operational throughout the pandemic, although some were required to be delivered in different ways. There had been flexibility around appointments with staff providing a mixture of both virtual and face-to-face appointments, and the demand for the latter was beginning to increase. A survey of patients had taken place during the summer to gage how they were feeling in relation to the new ways of working and gather feedback. The responses had provided a good sense of how the virtual appointments were viewed, which was mainly positive – some patients considered that virtual appointments were as good as those held face-to-face however there were still a number that had found them difficult. As a result, a review of all patients in Bromley had been undertaken to ensure that they were receiving a mixed approach, which was person-centred and aligned to their needs.

The Trust’s community staff were largely working between their offices and homes; however, it had been recognised that inpatient staff had not benefitted from this flexibility in terms of work / life balance. The Service Director advised that staff uptake of the COVID-19 vaccine currently stood at just over 75% – there was still some work to do, but this was broadly in line with the overall figures being seen. The Trust was working with local partners to ensure that all patients had access to the vaccination. There was a 72% uptake from patients with serious mental illness, which was reasonable, however it was highlighted that some of the hard to reach patients still needed encouragement to come forward. Community nursing teams had also been working to review the care plans of a number of patients who had been shielding – these patients were struggling post-shielding, due to the shift in dynamics and increased social interaction, and they needed to be mindful that this transition would be hard for some individuals.

The Service Director advised that Primary Care Plus (PCP) was the Trust’s “front door” into their adult mental health services. It had been established five years ago to meet the needs of around 250 patient referrals per month. In October 2019 (pre-pandemic) referrals sat at around 300 per month – this figure dropped significantly in April 2020, at the start of the pandemic. However, since then a significant increase had been seen, and for the last couple of months referral had reached approximately 430. It was emphasised that the impact of the pandemic on mental health would still be felt in the coming months and beyond.

Data was provided in relation to Early Intervention in Psychosis (EIP) caseloads which were designed to sit at around 100. In October 2019 they already sat above 120 – during the first half of 2020 the figures increased considerably, recording the highest number of caseloads they had seen. The Service Director highlighted that in addition to high numbers, there had been a shift in the acuity with patients being much more unwell, some of which appeared to be linked to the pandemic. It was noted that the EIP caseload numbers had now started to reduce but remained higher than pre-pandemic levels. With regards to the Trust’s Memory Service, there had been a significant drop in referrals in April 2020, which was understandable as they came from primary care colleagues who faced other priorities related to the pandemic at that time. Referral numbers had since increased, however they had not yet returned to pre-pandemic levels – the reasons for this were considered to be that sadly a number of deaths had been seen in this cohort during the pandemic and that this group of people were the most reluctant to come forward and express concerns regarding their memory. The Service Director noted that the Emergency Department team were also seeing significant demand – overall the increase in demand was not as sharp as that seen in other services, however the acuity was much higher and a lot more of the presentations were leading to patient admissions.

A Member enquired if the Trust had been experiencing any difficulties in recruiting staff and if they were utilising the additional money provided by the government. The Service Director advised that there were some vacancies across the Trust, but there was not a significant number in Bromley. Recruitment had taken place to fill some key vacancies just prior to the pandemic and the workforce had been sustained over the last year. It was noted that of the three boroughs that the Trust worked across, Bromley was sometimes the more challenging to recruit to due to its geography. There were some exciting plans in place to utilise the new funding and they were looking forward to making that investment. The biggest challenge faced by the Trust would be identifying the workforce needed and they were thinking creatively about new posts and news ways of working. Discussions had taken place with London South East Colleges (LSEC) with regards to bringing students straight into the workforce after they left college and using the apprenticeship levy to upskill them.

Another Member noted their concerns regarding the impact of the pandemic on mental health, including the likelihood that it could generate additional problems that had not been seen before, and asked if it was felt that the system could cope with this increased demand. The Service Director said that part of the support that patients had received during the pandemic had been from the community. It was noted that community support had increased during this period and communities had really “pulled together” over the last year which had made a huge difference. The additional funding being directed into mental health was partly to enable services to cope with additional pressures and with the right plans and integrated working in place it should prevent services reaching “breaking point”. The Portfolio Holder for Adult Care and Health highlighted that it was extremely encouraging to hear that there would be a whole system approach to mental health going forward and noted that the Director of Adult Social Care would be happy to join any discussions relating to this.

In response to a question, the Service Director said that pressure on mental health services was being experienced across the age groups and colleagues in Children and Young People mental health services would be presenting an update regarding this at a future meeting of the Health and Wellbeing Board.

The Service Director said that in terms of service development, the Trust were working with colleagues at the PRUH to finalise plans for the establishment of a dedicated Mental Health assessment area for patients presenting in crisis. This would allow more than one assessment to be conducted at once which would help reduce delays. They were also in the final stages of the adult mental health hub, as part of the community transformation work with MIND and other partners, and recruitment would begin in the next few weeks. The hub would offer a new single point of access for all adult mental health services in the Borough and enable interventions to start as early as possible. It was noted that further details could be provided at a future meeting of the Health and Wellbeing Board. Bromley were also leading on an agile working project looking at how colleagues wanted to work in the long term – any good practice from the flexible working over the last year would be used to create a strategy for new ways of working.

The Chief Executive advised Board Members that Oxleas had launched its new strategy which set out its new values – the three main priorities would be:

-  Achieving zero delays;

-  Delivering great out-of-hospital care; and

-  Making Oxleas a great place to work.

The Trust had also been looking at quality and safety management and had identified variations in practice and consistency across the three-borough structure. This had been referenced in a critical Care Quality Commission (CQC) report at the end of the previous year which focussed on the standards in some of the older adult mental health inpatient wards. It was noted that the CQC had made a further visit in recent weeks – they had been pleased with the improvements made and a positive report was anticipated. The Trust’s four older adults’ wards were managed across three different senior management structures which made the “line of sight” for accountability around quality and safety more difficult to manage. Therefore, the Trust were restructuring the management teams along service lines, to bring together the best of borough-based and service line delivery, with dedicated borough-based leadership. This affected approximately 50 post and 4,000 Oxleas staff and the Chief Executive highlighted that no cost savings would be generated from this restructure. It was noted that less changes would be noticed in Bromley as the current Service Director would still be the lead for relationship management in the Borough, and the community mental health teams and local place-based teams would remain.

Councillor Yvonne Bear, an Appointed Governor on the Council of Governors – Oxleas NHS Foundation Trust, informed Board Members that the new strategy had been subject to a long review process. Engagement had been undertaken widely with service users; the community; Governors; and staff and represented a collective view of where Oxleas should be positioned. It was considered that the restructure seemed logical however it was noted that it would have been helpful for Oxleas to have had more communication with the Boroughs prior to its announcement.

The Chairman thanked the Chief Executive – Oxleas NHS Foundation Trust and Service Director (Bromley Directorate) – Oxleas NHS Foundation Trust for their update.

RESOLVED that the Mental Health update be noted.