Agenda item

This report provides the Scrutiny Committee with an update on delivery of the Mental Health and Wellbeing priority as part of the Borough Based Partnership, which brings together commissioning and provider organisations to support the improvement of local health and wellbeing outcomes and reduce inequalities across Brent’s communities and residents.

Phil Porter (Corporate Director Adult Social Care and Health, Brent Council) introduced the report, which provided an update on the mental health and wellbeing Integrated Care Partnership (ICP) subgroup. The Committee heard that mental health and wellbeing was one of the 4 priorities of the ICP, which was now known as the Brent Borough Based Partnership. Phil Porter and Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) co-chaired the ICP, as well as the mental health and wellbeing subgroup. The subgroup had four priorities; access and demand for services; employment outcomes for those with a mental illness; housing options for those with a mental illness; and children’s mental health services. Within those priorities there were programme plans for each, which were all at different stages of development with some more developed than others. In all cases, the subgroup had tried to respond to a mixture of data, evidence and feedback from the voluntary and community sector, the community, and statutory partners, in order to understand where the biggest difference could be made. He highlighted that this subgroup did not look to monitor individual organisation’s performance but was focused on working together and looking at what could be done better together. Robyn Doran added that these priorities were also interfaced with the Brent Children’s Trust work, inequalities work in the borough, and housing, as mental health interfaced with lots of other aspects of the work being delivered in the borough.

The Chair thanked Phil Porter and Robyn Doran for the introduction and invited comments and questions from those present, with the following issues raised:

The Committee asked who the key stakeholders of the borough based partnership were. Robyn Doran advised the Committee that the stakeholders who were part of all ICP groups included all of the health providers in the borough – Central and North West London University Health Trust (CNWL), Central London Community Health Trust (CLCH), and London North West University Health Trust (LNWUHT) – and primary care partners, as well as voluntary and community sector organisations, community champions, and representatives of the local authority. For the mental health subgroup, the voluntary and community sector organisations who were involved were Ashford Place, Brent Centre for Young People, Hestia, Rethink, and Brent Young People Thrive.

In response to whether there were any representatives from organisations who worked particularly with Black communities on the mental health subgroup, Robyn Doran confirmed that there were no specific organisations focusing specifically on Black communities as part of the mental health subgroup. Each subgroup did not necessarily have every community and voluntary sector partner at the table, but there was a lot of interface work with Thrive, Brent Health Matters, and faith groups, and through those links, who had reach with all communities, the subgroup heard the voices of all communities. For example, Danny Maher, who was the group mental health theme lead and worked with Thrive, engaged a wide range of people with mental illness, and had presented a manifesto to the subgroup on the principles on which mental health services should be done as dictated by service users. In Brent Health Matters, Community Co-ordinators fed back the themes they were hearing from all communities. As a result, it was felt there were a number of ways each community’s views were represented and incorporated into the group.

It was agreed that future reports would include breakdowns of the different demographic groups accessing pathways, including ethnicity, gender, and geographical location.

In response to queries about the waiting well initiative, referenced in paragraph 5.4.2 of the report, Sarah Nyandoro (SRO - Mental Health and Wellbeing Esec Group, Brent Borough Based Partnership (ICP)) advised the Committee that this was to avoid children and young people being left without contact or communications when they were waiting for a specialist assessment. The waiting well initiative meant children and young people received contact on a weekly basis to ensure staff were keeping up to date with how they were feeling and if there was any additional support that could be provided for them. Within the initiative, there were links with psychotherapy, so that when children and young people who were eligible for psychotherapy presented with mental health issues, rather than waiting for an assessment they could be immediately signposted, assessed and given a service. An online and telephone counselling service, Cooth, was also available as a talking therapy for young people to get support any time of the day. Robyn Doran explained that the reason these initiatives had been implemented was because there had been over 400 children on the waiting list for more than 18 weeks for an assessment the previous year, which had been partly attributed to a lack of funding in Brent. The Brent Children’s Trust and ICP had made it a priority that the local trust provider, CNWL, put extra resources in, working closely with voluntary and community sector organisations to bring those waiting lists down. As a result, some of these initiatives had been implemented with the third sector to deal with those waiting lists so that children were not waiting for more than 18 weeks for an assessment.

The Committee asked how well connected the ICP and mental health and wellbeing subgroup were with Adult Social Care. Robyn Doran advised the Committee that the teams in the borough were integrated, with a memorandum of understanding between health teams and social care teams, who all worked very closely together on a day-by-day basis.

The Committee felt that there was an overlap between socioeconomic conditions and mental health and wellbeing, and queried why the priorities of employment and housing had been separated and not joined together. Phil Porter advised the Committee that the subgroup brought together and made the connections across all four workstreams, and so they were connected in that sense, but were separated into four workstreams due to the large amount of work under each priority. The people involved in each workstream also crossed over and so connections were made that way. He informed the Committee that those with a mental illness were still the largest growing number of people out of work, so the scale of that was seen by the subgroup to need specific focus. The mental health and housing priority had a strong focus on multiple exclusion homelessness where people with severe and enduring mental illness, or dual diagnosis, or substance misuse, were struggling to maintain their accommodation. Phil Porter agreed that there was overlap, but there was crossover between the workstreams that allowed them to remain connected.

In relation to the priorities, the Committee felt that the fourth priority – managing demand – had a direct impact on the other 3 priorities. They asked how Brent was performing in comparison to neighbouring and similar boroughs in terms of managing demand and if that information could be made available in future reports. Phil Porter advised the Committee that the partnership was trying to work on the principle that communities were not hard to reach, rather that services were difficult to access. There was a strong focus on access and demand, looking at how core mental health and care services could be accessible to all communities in the borough. If people could access services easier and were subsequently able to recover then that would lead to different housing and employment options for them, which was where there was a connection with the other workstreams.

Robyn Doran agreed that benchmarking information on performance in comparison to neighbouring and similar boroughs could be made available, but noted that the demand and complexity within Brent was high in comparison to other boroughs. Phil Porter added that, as a system, the partnership was trying to articulate that need, the scale of that need, the complexity, and the gap in funding, in order to make a joint case about how Brent needed additional funding to meet that need.

Continuing to discuss demand, the Committee asked whether, as a result of successful early intervention and identification, more people would come into the focus which would put further pressure on secured housing accommodation needs for people. The Committee queried whether there was sufficient capacity to cope with that increase as a result of the successful work. Phil Porter highlighted that the partnership did not know the impact the workstreams would have yet, but were aware of those problems within the system. The partnership and subgroup wanted to see a system that recognised everybody should be on their own recovery journey and on their way to independence. The system was not currently sufficiently aligned to make that happen, as a recovery journey was very complicated and difficult to manage. There were some practical things that the partnership could do, for example the partnership had put some additional resources into mental health acute wards through winter planning, to ensure that when patients were ready for discharge they could go straight into the homelessness service to be worked with directly. Robyn Doran added that, often, people with mental conditions who ended up in hospital lost their housing for the wrong reasons. Part of the plan was about ensuring that, from the moment somebody was admitted to hospital, they were supported to get back out and to maintain their housing, so that when they were ready to be discharged their accommodation was ready for them.

In relation to housing, the Committee asked whether there was a lead partner or organisation seeking or commissioning accommodation for people with a mental illness. Phil Porter highlighted that, for supported living accommodation, the partnership was currently working with severe and enduring mental illness and adult social care commissioners to commission the right kind of supported living with the right type of support, as there were a range of needs requiring bespoke solutions. In terms of general needs housing, whether that was social or private rented, there was further work to do. When someone was referred to housing need, housing need were able to source accommodation, but the partnership wanted to research whether that accommodation was appropriate in the long term and supported their recovery. In terms of the recovery journey, the Committee felt it would be useful to have a visual to sum up what they would expect a recovery journey to look like.

Committee members asked what happened to those patients who accessed IAPT but found that it did not work for them. Robyn Doran advised the Committee that at that point it was important to find out what support was right for that person, whether there were other psychological services they could access, and whether there were circumstances affecting the person’s life that needed addressing such as housing and employment that they could be supported with. To do this would require working with the person and referring them to either voluntary sector services or other statutory services. In addition, GP practices now had extra staff resources through the additional role reimbursement scheme to pick up those people and help them navigate through the system.

In response to where the partnership sourced their experts by experience, Phil Porter explained that their first port of call would be Brent Thrive. Danny Maher, who was a subgroup member and worked with Thrive, worked with a number of people who were experts by experience to put together a manifesto of what service users wanted from mental health services. Brent Health Matters also had a range of community organisations involved, and also had Community Champions and Community Co-ordinators who had reach into all communities in Brent, and that infrastructure was used by the partnership. He highlighted that the partnership was relatively new as a system working towards this, so there was still work to do to improve, which the partnership would focus on over the next 12 months.

The Committee noted that the government had promised £150m to go towards mental health support and asked whether Brent had plans to bid for money from that and what the priorities might be. Robyn Doran advised the Committee that the partnership would always bid for money it was eligible for to increase resources and improve services, and would have conversations with councillors, the community, and other stakeholders about the priorities for Brent.

The Committee highlighted that Brent was a diverse borough and there were various reasons a person may not be registered with a GP or come forward to access mental health support. They asked what the partnership was doing in local communities, via faith groups and community organisations, to reach those individuals. Robyn Doran advised the Committee that she felt proud of the work being done in Brent working with faith groups and communities that had not been served well in the past traditionally. Brent Health Matters was a multi-agency team targeting particularly those communities that health and social care services traditionally had not reached. Within that programme, the team had employed people directly from communities that had not been served well in the past into the multi-agency team. There was also a mental health sub team specifically, led by a Senior Nurse in CNWL, with 6 people from different communities employed to work alongside Brent Health Matters and delivering various events around the borough. She had been in a conversation with the team that week where they had told her about the work they were doing with the Romanian community in Kenton, working with the faith leader and community there about how their needs could be better met, because the community had a lack of trust of health and social care services, many of them were not registered with a GP, and some communities did not recognise mental health in the same way that the Committee were using the terminology. It was agreed that a future report to Committee could focus on Brent Health Matters and the inequalities work being done.

Looking back, the Committee asked whether budget restraints as a result of funding shortfalls had impacted mental health support services, noting that those in poverty were disproportionately represented in people with a mental illness. From a health perspective, Robyn Doran advised the Committee that demand had gone up by approximately 1/3, particularly for inpatient services. However, mental health funding had actually seen a growth over the last 5 years as a result of the national strategy for mental health. She highlighted this was still not enough, but there had been growth and it was expected that growth would continue. Phil Porter added that social care had also had no loss in funding, and one particular area that social care overspent on was mental health. Demand in social care had also seen significant growth over the past few years, particularly home care and supported living. The biggest saving across the last ten years in relation to mental health was to move from a dependence model of patients in residential and nursing care to an independence model through supported living. In cutting back to statutory minimums, there were areas for improvements. For example, as part of Danny Maher’s Thrive presentation detailing what service users wanted from mental health services, they had asked for more social, cultural and leisure opportunities to support the recovery pathway. Phil Porter felt there were opportunities to do more across different services, particularly employment, and the work and health programme had been very positive. In concluding, Phil Porter advised the Committee that social care would always meet its statutory requirements, but there needed to be consideration as to whether the national model was sufficiently holistic and preventative to support recovery pathways and avoid escalations, which was difficult to put a figure on in terms of funding.

In response to whether the borough based partnership was pushing for a levelling up in Brent to bridge that inequality of funding in comparison to other NWL boroughs, Robyn Doran confirmed that was the case. In relation to funding for children, a letter had been written to the Integrated Care Board noting that there was not enough funding for children in the borough and demand had increased by up to 30%, pushing for a levelling up there as well.

The Chair thanked those present for their contributions and brought the discussion to an end. The Committee RESOLVED:

i)              To recommend that more detailed statistics on demographics of residents accessing mental health and wellbeing supported are included in future reports, and to ensure these statistics are accessible and easy to understand.

ii)             To recommend that a report on the work of Brent Health Matters is brough to the Committee at a future meeting.

In addition to recommendations, a number of information requests were raised during the discussion, recorded as follows:

i)              For the Committee to receive information on how the partnership was managing demand for mental health services, and how Brent was performing in comparison to other NWL boroughs.

ii)             For the Committee to receive an infographic example of a person’s recovery pathway.