Agenda item

To outline the development of the mental health strategy for adult residents of North West London (NWL).

Toby Lambert (Director of Strategy and Population Health, NWL ICB) introduced the paper which presented the NWL Mental Health Strategy for adults. In introducing the report, he highlighted the following key points:

·         The strategy focused solely on the needs of adult residents in NWL. A parallel piece of work looking at the needs of children and young people and transition into adult services would be picked up in September 2024. The strategy also did not expressly focus on promoting resilience and overall wellbeing as there had been a clear view, following strong engagement with the strategy working group which included all NWL trusts and local authorities, that each individual local authority had their own Health and Wellbeing Strategy focused on those areas and therefore it would not be helpful to have a NWL-wide view on that. As such, the strategy focused on an individual’s first contact with mental health services onwards.

·         The engagement and participation process that the ICB went through to arrive at the strategy was detailed. Through the engagement process, the ICB had learned that there had been considerable progress in the mental health services on offer but not enough. Extra investment had been put in and access had been expanded but there was still further work to do. The strategy set out the collective ambition for further improved services, which were encapsulated into 3 main areas.

·         The first area of the strategy was raising awareness and promoting wellbeing. Whilst this was not a wellbeing strategy, it was clear people who came into contact with mental health services needed to be signposted and supported in their wellbeing. There was a degree of hesitancy amongst those of the NWL population who most needed to access services to come forward, which was a major driver of the inequity in outcomes and access that NWL saw, hence the need for promoting awareness of where help was available and how to access services.

·         The second area of the strategy was around increasing the equity and quality of access to mental health services. The Board heard that there was an ongoing programme to develop a common offer across NWL, as currently the services available did vary depending on their resident borough in both practice and access. A common offer meant setting a clear shared specification of what was expected to be available no matter where a patient was in NWL. It was highlighted that there was no significant extra funding coming into the system, although there was a need to increase the productivity of services in NWL because, where mental health services had been expanded, the number of people accessing those services had not yet caught up with the extra resources put in. As such, he highlighted the importance of making the best use of resource in terms of levelling up across NWL to the highest specification of service using the resources already in the system.

·         The third area was around patients receiving right care in the right place and ensuring residents found and could access treatment at the lowest intensity setting which was appropriate for their need. Greater intervention earlier in the pathway took the pressure off services later down the line which were usually more expensive. However, there were issues for residents getting timely access to various parts of the system so this workstream aimed to address that. In particular, there were issues with the amount of time some patients spent waiting for acute beds. There were patients in beds no longer meeting the criteria for that bed who’s care was better provided elsewhere, with the simplest way of addressing the wait for acute beds to address the wait for people trying to get out of those beds.

·         In summing up, Toby Lambert reiterated the three workstreams of raising awareness and promoting wellbeing, increasing the equity and access in care, and getting care in the right place. The aim of those workstreams was to give better outcomes and have services that were more responsive to the individual needs of the population.

The Chair then invited contributions from those present. The following points were made:

·         The Board was encouraged by the detailed strategy which included data and analysis and felt it was well-balanced with a good focus on educating the public, particularly communities who may lack the services on offer or who had certain stigmas around mental health illness. It was recognised that community-based approaches were essential for Brent. 

·         The Board noted the points made about low productivity where there had been an increase in the provision of resources and where that additional resource had not translated to outcomes, and asked whether there was any understanding of why that had been the case. Toby Lambert explained that the reasons were multi-faceted. He acknowledged that it was normal to see a bit of a lag between the expansion of provision and people coming forward to take up that offer, so there was no particular reason to believe the productivity issue would not resolve itself, but it was important to continue to raise awareness amongst every community which was the best way to increase the usage of provision. Even where people were coming forward to use the expanded resources, there were variable caseloads across different parts of NWL, which was not entirely explicable in terms of presentation rate, suggesting there was room for moving productivity or changing the number of cases each community mental health team saw to enhance overall value for money and give greater space for levelling up. He highlighted that if someone was to compare the level of need against the provision in place, then they would conclude there was more than enough need out there to match the level of provision, but there was a careful balance needed to introduce new services at a speed that matched the take-up rate. Sometimes, the speed at which new or expanded services were introduced was faster than the awareness built, as it was challenging to build demand and awareness at the same pace as capacity.

·         The Board highlighted the point in the paper regarding delays in accessing initial treatment when a patient was first referred to a service and asked whether there had been any success in identifying where those delays were in the system. Members were advised that there had been a number of factors causing delays, some of which related to stigma and hesitancy amongst some communities in coming forward with mental health issues. There was also an issue with how quickly the system was able to get people in to access those services because the number of referrals into community mental health services had more than doubled in the last few years. In relation to different community attitudes towards mental health, Robyn Doran (Director of Transformation, CNWL, and Brent ICP Director) explained that, because of the diverse communities in Brent, a number of models had been adapted to better suit different needs. For example, she had visited recently the Gujarati community to speak about IAPT Talking Therapies who had been working with the Gujarati Community, and the community leaders had spoken about what more could be done to encourage young Asian men to access services earlier downstream. The ICP was also aware from the business case presented to the ICB that young Black men were over-represented in patients who had been sectioned in Park Royal Hospital because they did not feel services were accessible to them further downstream and did not want to speak about their mental health with friends and family. As such, she highlighted a need to further develop more culturally appropriate and age appropriate services for different communities. She felt the strategy needed to highlight the importance of being culturally sensitive and adaptable to the communities Brent served.

·         The Board asked what collaboration was taking place with other agencies helping people get into work such as the local authority employment team, DWP, and voluntary sector, as there was a correlation between helping people back into work and overcoming mental health issues. The Board was advised that NWL ICB had been fortunate in receiving a grant award from the DWP of £4.7m to work specifically on the issue of work and health through the West London Alliance (WLA). The WLA would act as the ‘glue’ to bring all partners together through the governance structures already established. In looking into work and mental health, the ICB had seen a complex number of services involved. For example, on the NHS side, appointments were commissioned for those accessing primary care, and for those coming through mental health pathways, but the local authority also commissioned some mental health services for people accessing employment support services and voluntary sector organisations also provided support. As such, navigating those services could be confusing. To counter this, the ICB had launched the ‘at work well’ programme which helped to improve the mapping of services for the people who needed support and streamline that pathway. Robyn Doran added that the Health and Wellbeing Board had previously heard from the ICP Mental Health Executive Sub-Group regarding employment and there were employment specialists both within the Council and CNWL funded by the ICB. Those specialists worked with people with long term mental health problems to help them get back into work, and the sub-group could bring a report to Board in the future regarding the outcomes of that programme.

·         The Board asked for assurance that there would be no negative impact on communities while waiting for the strategy to be implemented, as there had been no formal Equality Impact Assessment completed alongside preparing the strategy. In addition, they asked for a sense of the scale of people who were engaged with in preparing the strategy and whether they were representative of the NWL and Brent population. Toby Lambert advised the Board that the ICB had not done a formal Equality Impact Assessment as there was a view that those types of assessments were more effective when making service changes rather than strategy setting. As the ICB moved into the delivery of the strategy with business cases and changes to service those Equality Impact Assessments would happen. He added that there was an extended piece of work summarised in the overall strategy which reviewed the differences in the NWL population in terms of access, experiences and outcomes which could be shared with the Board and he agreed to provide the details on the number of residents engaged in preparing the strategy.

·         In terms of ‘what next?’, the NWL ICB Mental Health Collaborative would be delivering the next steps. They would be undertaking some rapid work on bringing this forward alongside all NWL boroughs.

·         The Board asked how the strategy would involve and work with Adult Social Care teams. Members were advised that there were representatives from each borough in the Strategy Working Group who were content with the involvement of local authority teams.

·         The Board appreciated that the children and young people mental health strategy would be prepared next, but highlighted the issue of transitions from childhood to adulthood and in particular children’s services to adults. As such, whilst it was recognised there may be repetition, the Board were of the view that transitions applied to both mental health strategies, and many local authorities within NWL had undertaken work around transitional safeguarding which fit into adult services and could be further drawn out in the document.

·         The Board felt the strategy would be strengthened by including some trajectories, outlining what ‘good’ looked like, where the system was currently, what needed to change, and how and when that would happen.

In concluding the discussion and noting the strategy, the Board welcomed the Mental Health Strategy for NWL. Members recognised that the strategy focused on adult mental health across the NWL footprint, but emphasised that Brent ICP had identified transitions as a local priority for both adults and children and therefore felt it was important that both the adults and children’s strategy gave focus to transitions. The Board also advocated for a compact approach illustrating the work being undertaken in each borough by Adult Social Care and other local authority departments such as employment support. The Board also recommended the document highlighted timelines, trajectories and methodologies.