Agenda item

To consider NHS West London Clinical Commissioning Group’s Whole Systems Integrated Care Older Adults and Mental Health Programmes.

4.1       Glen Monks (Associate Director, Whole Systems – Mental Health) introduced the report and provided details about the Mental Health Programme being developed by NHS West London Clinical Commissioning Group’s (CCG) as part of Whole Systems Integrated Care. He advised that the programme was one of two pilot schemes on mental health in London, the other one being developed by NHS Hounslow CCG. There had been extensive co-production with service users, carers, local authorities, voluntary sector organisations, and statutory providers in developing the model of care. Glen Monks stated that model of care would be ‘hub and spoke’ by design and the entire patient journey was being mapped. He advised that an outline model of care had been agreed by the Project Steering Group and a business case was being developed that would be put before the CCG’s Governing Body for approval.

4.2       Members commented that the Board had undertaken extensive work on mental health, including children and young people, and enquired whether service plans, self-help and community support were led by Public Health. One Member emphasised the need for preventative action through intervention at an early stage, including transition from child to adult and he enquired whether the programme addressed the mental health needs of younger adults up to the age of 25 years. He added that the implications for parents and family members of those with mental health issues also needed to be addressed. The Member also enquired whether the records kept by primary care providers could be accessed by other organisations. Another Member remarked that there was room for improvement in information sharing between organisations on mental health needs.

4.3       In reply to Members’ questions, Glen Monks advised that most of the service plans and community support proposals had come through work with the voluntary sector and community groups, which in turn would then be considered in how it tied in with the work and objectives of Public Health. He informed Members that there was a separate strand of work regarding child and adolescent mental health, however it was recognised that more work was needed in the transition from child to adult and ways of addressing this were being considered. This included looking at the needs of 12 to 25 year olds, as well as early years. Glen Monks stated that there was a commitment for all organisations to use a single patients record and he felt this would be achieved over a period of time.

4.4       Dr Richard Hooker (NHS West London CCG) then updated the Board on the Older Adults Programme that was based on similar principles to the Mental Health Programme. He explained that the extent of the programme’s task could not be underestimated and it involved a significant piece of work for NHS West London CCG and its partners, including Healthwatch. The model of care recognised the holistic needs of older adults and there had been extensive engagement with the voluntary and community sector and carers. Dr Richard Hooker emphasised that a core aim of the programme was to provide high quality care and this involved developing a fully integrated model of care with shared patients’ records. To support the programme, caseworkers, typically from a district nurse or social care background were sought and these would be supported by healthcare assistants. The caseworkers would be overseen by GPs and social care workers. Dr Richard Hooker informed Members that the programme had gone live in September 2015 with services provided at St. Charles Integrated Care Centre and the range of services was being developed. Services were also to be introduced at the Violet Melchett Clinic and the model of care recognised transport as an important issue for older adults.

4.5       Dr Richard Hooker added that St. Charles Integrated Care Centre had been revitalised and Age UK had a presence at the site. The Centre also had a number of case managers and mental health staff and other services such as footcare were offered. Services at the Centre had received positive feedback and monthly meetings were held to review progress, as well as monthly Steering Group meetings. An IT specialist had also been recruited to support the programme. 

4.6       During the Board’s discussions, Members sought information on how the Older People Programme’s pathways tied in with the work of the Community Independence Service. The need to take into account the patients’ point of views was emphasised, as well as ensuring they understood how the different pathways worked. Members sought details on how the Programme was funded, including whether resources were available for the voluntary and community sector to play an effective role. In respect of individual care plans, it was asked who was responsible for producing these. Another Member commented on the difficulty of GPs, nurses and care works being obtained from a single source and this often meant that services were duplicated. Councillor Barrie Taylor requested a briefing on work being undertaken to address personality disorders.  Jackie Rosenberg (Westminster Community Network) reported that the National Council for Voluntary Organisations had recently launched a pilot scheme involving volunteers working in care homes and she would feedback the outcomes of the pilot to Members.

4.7       In reply to the issues raised, Dr Richard Hooker commented that it was recognised that presently a lot of older people care services were reactive, and to address this, the programme would seek to work with the Community Independence Service in procuring services and there would also be more working collaboratively with the Rapid Response Service. The case managers would play a key role in ensuring patients knew and understood what pathways were available. In respect of funding, Dr Richard Hooker advised that some funds for the programme had already been received and further funding had been requested. Additional resources were also available for voluntary and community organisations to play their role in the programme and also some funding to increase the number of case workers. The Board noted that savings in other areas had been made which could be used for the programme, whilst patient resilience was being increased through providing more supported self-care.

4.8       Dr Richard Hooker stated that personality disorders affected people of all ages and that it was a significant issue both locally and nationally. The odd or challenging behaviour that a person with a personality disorder may exhibit could impact in a number of ways and it was recognised that this issue needed to be addressed as a priority. The model of care also factored in the desirability of having GPs, nurses and care workers from a single source and to prevent duplication of services. Chris Neill (Adult Social Care Whole Systems Lead) agreed to follow up Councillor Barrie Taylor’s request for a briefing in respect of the work being undertaken to address personality disorders.

4.9       The Chairman emphasised the need for a more joined-up approach in procuring services. The Board agreed the Heads of Agreement Document for the Older Adults Programme.

4.10    RESOLVED:

1.    That the update on the Mental Health Programme and the Older Adults Programme be noted.

2.    That the Heads of Agreement Document for the Older Adults Programme be agreed.