Agenda item

This report has been provided following the committee’s request for a report from CNWL (Central and Northwest London NHS Foundation Trust) on the mental health provision on offer for people with more complex mental health needs.

Sarah Mansuralli (NHS Brent Clinical Commissioning Group) presented a report to the committee on the findings of a recent review of IAPT (improving Access for Psychological Therapies) services and pathways to psychological therapy services in Brent. The report had been provided following the committee’s request for a report on the mental health provision for people with more complex mental health needs.

Sarah Mansuralli advised that IAPT was a Department for Health (DfH) programme aimed at supporting the implementation of the National Institute for Health and clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders. Roll-out of IAPT had begun in 2008 and Brent IAPT had been established following a successful application by Brent Primary Care Trust (PCT) in 2010. Investment in Brent IAPT from Brent PCT had initially been achieved via a redesign of existing mental health services, including psychological services provided by Central and North West London NHS Foundation Trust (CNWL). Part of this re-design encompassed diverting a proportion of investment from secondary care psychological services to primary care based IAPT services. This diversion of funds was based on an analysis of the annual referrals and examination of therapy provision by IAPT London Lead which indicated that the majority of referrals seen in secondary care would be appropriate for an IAPT service. Brent IAPT currently provided services at Step 2 (primary care, low level interventions) through to Step 4 (secondary care, high level interventions).

Sarah Mansuralli explained that the review of IAPT services and pathways to psychological therapy services had concluded that capacity of Step 4 interventions in secondary care, which encompassed psychological treatment for more complex mental health needs, was currently limited. This had resulted in delays for patients in accessing appropriate therapeutic interventions. Nationally the average split between individuals requiring low level interventions and high level interventions was approximately 60:40. It had been found that in Brent this trend was reversed, with 60 per cent of those individuals accessing mental health services requiring high level interventions and the remaining 40 per cent requiring low level interventions. In response to the outcome of the review, it was proposed to combine funding within IAPT and vacant sessions in secondary care services to increase the provision of step 4 interventions within secondary care. This would effectively result in a realignment of services to meet demand by shifting service capacity from Step 2 to Step 4. Brent PCT would continue to monitor the level and type of demand on the services. It was also proposed that a review would be held in the forthcoming financial year of art therapies and psychotherapy to determine how this resource would be utilised.

During in the subsequent discussion the committee sought assurance that the proposed shift in funding to increase capacity at Step 4 would not result in a lack of capacity for services provided at Steps 1 to 3. Members also noted the importance of preventative care and queried whether there was a danger that redirecting funding away from primary care services might result in a further increased demand on secondary care services. The committee noted that at present IAPT services were meeting the needs of approximately 10 per cent of those with depression and/or anxiety and further information was sought on the progress made in meeting the target set out in the NHS Planning guidance for 12-13 and 13-14 of 15 per cent. Members also queried, in light of the proposed review, whether there was an intention to retain art therapies.

Sarah Mansuralli advised that the realignment of services sought to target the level of need. Data gathered at the time of patients’ referrals indicated that at the point of accessing these services, there was a greater demand for higher level intervention than lower level intervention. Therefore, whilst it was acknowledged that Stage 2 services had an important preventative role to play in reducing escalation of lower level need cases, it remained necessary to increase capacity at Stage 4 whilst maintaining a good service at Stage 2. The committee was advised that in addition to the realignment of services already described, there was a further £200,000 IAP funding for 2012/13 and a further £200,000 for 2013/14 dedicated to staffing to help meet demand. In response to a query requesting further clarification of these funds, Sarah Mansuralli explained that these funds were drawn from the Primary Care Groups (PCG), which had prioritised mental health. With regard to the performance of IAPT services in meeting the needs of those with depression and/or anxiety disorders in Brent, this currently stood at nearly 9 per cent; it was anticipated that this would be increased to 11 per cent in the forthcoming year and it was intended that the 15 per cent target would be reached by 2014/15. Natalie Fox (Service Director CNWL) added that this was the national target. The art therapy service would be maintained and it was intended that a range of therapy services would continue to be accessible to support the differing needs of patients.

RESOLVED:

That the report be noted.