Agenda item

To provide information on Priority 4 of Placed Based Partnership – Improving mental health and wellbieng of the Brent population, including an update on the discussions between the Place Based Partnership (Brent ICP) and the NWL ICB regarding mental health funding levels.

Robyn Doran (Director of Transformation, CNWL and Brent ICP Director) introduced the report, which detailed the progress of the ICP mental health and wellbeing workstream, which was one of 4 ICP priorities. In introducing the item, she highlighted the following key points:

·         The mental health executive subgroup was representative and had members from the third sector, all agencies, and a Community Champion. Within the mental health workstream there were 4 priorities which had been established following discussions with residents, service users and partners. The priorities set were around improving access to employment and training for people with mental health conditions, improving access to accommodation and good housing, improving access to CAMHS, and support for children and young people that focused on early intervention and prevention through the THRIVE model.

·         Accessibility was highlighted as a challenge. Managing access and increased demand was a big challenge in Brent, particularly adult mental health and CAMHS. This tied in with the discussions around levelling up, as Brent was an area that traditionally had high demand for mental health services for both adults and children and was an area with lower core funding for those services.

·         A snapshot of data was provided to give the Board a picture of mental health in Brent:

o   There was an average of 65 crisis presentations per week in Brent over the last 6 months. In comparison, the average number of presentations was 36 in Westminster and 34 in Kensington and Chelsea. This showed the clear high demand at A&E in Brent and it was added that Northwick Park Hospital was one of the busiest in terms of activity around mental health.

o   Of the people presenting to A&E, 50% were unknown to mental health services, which was a new picture following Covid-19 and unique to Brent.

o   The average length of inpatient stay in Brent was 32 days, which had reduced over the last few years from 39 and was slightly below the CNWL average.

o   The hotspots for crisis presentations were NW10 and NW2 and closely followed by HA9 and NW6. The importance of working with GPs in those areas was highlighted, as they had a big role to play around mental health access to services. There was a joint working group led by Dr Haidar with GPs and all partner agencies looking at how GPs were supporting mental health needs, how people were accessing mental health services, what wraparound support was available within GP practices and social prescribing. Referrals were hugely variable amongst GPs so the ICP was looking to understand why some GPs were referring more than others.

o   IAPT services had not been performing to target for a while during and after Covid and it was found that the workforce had not necessarily representative of the people being served in the community. As a result, the ICP had worked with communities and GPs to employ people directly from communities so that the IAPT team was much more representative. Now, IAPT access target rates had gone up to 96% as well as the recovery rate.

·         It was highlighted that this was only a snapshot of the data and not the full picture, which the ICP were currently trying to build. It was essential that the ICP had a clear understanding of mental health in Brent in order to put that to the NWL Integrated Care Board (ICB) to ask for levelling up. 

Tom Shakespeare (Managing Director, Brent ICP) added further context around funding for mental health services. He highlighted that officers had been working hard locally and across CNWL as the mental health provider with GP colleagues to gather data and tell that story about the pressure points in the system. From that, the ICP expected to be able to bring that to the ICB to show where the gaps were and where resources were needed urgently. There had been a slight increase in funding to mental health services as a result of the Mental Health Investment Standard, so the ICP would be working with CNWL to understand how much of that would go to Brent. It was understood that it would not be enough to get funding where it needed to be, so the ICP would be looking for additional funding for particular areas and potentially from some non-committed reserve funds within the ICB.

In considering the report, the following points were raised:

·         The Chair highlighted that the overarching themes detailed in paragraph 5.9 of the report provided helpful metrics for the Board to monitor success against. He felt that there was an opportunity for a whole system approach for early intervention and prevention, in order for the NWL ICB to be able to offer a standard service across the system. 

·         Officers would bring back further information on mental health in autumn, likely October – November 2023.

·         The Board were pleased to see proposals to bring down the CAMHS waiting lists in Brent. They highlighted that the mental health support package available for young people could be very different to what was then available as they entered adulthood. As such, the Board asked what transitional arrangements were in place to support young adults’ mental health through that transitional period, which was often crucial in terms of outcomes in health, employment and education. Robyn Doran highlighted that transitions was a large area of work that needed attention. Across the ICB and CNWL there had been a piece of work done over the past year, with young people going through transitions, to look at what their needs were and how they could be met in different ways. It was agreed that officers could bring back more information on transitions at a later meeting.

·         In response to whether there were any proposals to bring down the waiting times for ADHD diagnosis in children and adults, Robyn Doran explained that the challenge in demand for diagnosis was around resources. There were limited resources locally, with some access commissioned across other providers, but there were not enough resources to meet the need. ADHD diagnosis was on the list to discuss with the ICB.

·         The Board welcomed the section in the report around increasing the number of disability confident employers locally and the work being done with Sure Trust and Brent Works to support people into employment. They proposed that employers that were already working towards becoming disability confident may be good candidates to train as mental health first aiders to support people with mental health difficulties to stay in work. Mental health first aid was something that had been looked at by Brent ICP and could be explored further. There were employment teams within Trusts, but those were limited, and it was thought that having access to mental health first aid would make a difference.

·         The Chair asked for a future report to focus on resource, service and performance issues around mental health services for Brent residents, which was one of residents’ biggest concerns. This should focus on the issues locally, at a NWL system level, and at a national level.

The Board RESOLVED:

i)              To note the content of the report, in particular the collaborative approach taken by the Integrated Care Partnerships, which ensures mutual accountability, clear priorities, and responds to issues from NWL ICB and from across Brent partners, and is committed to supporting all partners across health, the Council, and the Community and Voluntary Sector to work better together.