Agenda item

To consider updates on the delivery of the North West London Sustainability and Transformation Plan and on the Mental Health Transformation.

4.1       Jane Wheeler (Programme Director, Mental Health and Wellbeing, North West London Collaboration of Clinical Commissioning Groups) gave a presentation providing an update on the North West London Sustainability and Transformation Plan (STP) that had been submitted in October 2016. She explained that there had been a number of changes in respect of health and social care since the STP had been submitted. Jane Wheeler referred to the various ways in which the Council had a voice on how the STP operated, including through the Joint North West London Health and Care Transformation Group, of which the Chairman of the Board and the Council’s Chief Executive were members. The Council also had officer representation on the North West London Strategic Finance and Estates Group, and the Programmes Boards for delivery areas 1 and 2 of the STP respectively (radically upgrading prevention and wellbeing and improving outcomes for children and adults with mental health. Local providers such as the Central London Community Healthcare (CLCH) NHS Trust, the Central and North West London (CNWL) NHS Foundation Trust and St Mary’s Hospital of the Imperial College Healthcare NHS Trust were also represented throughout the governance structure, whilst the citizen voice was represented through the various partner forums.

4.2       Jane Wheeler stated that the STP vision was to help people both be well and live well and to help achieve this integrated out of hospital care services would be delivered across a range of local services based on 4 key components, these being personalised, localised, integrated and specialised. Jane Wheeler referred to the STP’s triple aim, this being:

·         Improving health and wellbeing

·         Improving care and quality

·         Improving productivity and closing the financial gap.

4.3       Jane Wheeler advised that there were 9 priorities, underpinned by a number of projects, to help achieve the triple aim. Every effort was being made to produce more user friendly documents to explain the aims of the STP and what this would mean in terms of changes to services and Jane Wheeler circulated an example of this to Members. Since the STP had been submitted, there had been a number of significant changes, amongst these was the 8 boroughs of the STP coming together to oversee the work and jointly agree priorities and how to resolve challenges. Workstreams for health and social care were also being processed as joint priorities, with teams across agencies working together. There had also been some success in securing national funding where it was available, for example in mental health, diabetes and cancer. Jane Wheeler added that there was much improved access to mental services in general.

4.4       Turning to some of the highlights since the introduction of the STP, Jane Wheeler informed Members that over £500k had been invested in staff for mental health services and £2m had been awarded to boost talking therapies support for patients with diabetes and chronic obstructive pulmonary disease who may also have mental health needs. Phase 2 of Change Academy had led to 8 applicants being trained as part of the ‘High Performing Care and Leading Transformation’ Programme. The Making Every Contact Count programme was due to be rolled out to help frontline staff encourage changes to clients’ behaviour and lifestyle to improve health and wellbeing being. In respect of diabetes, a £2.3m award had been achieved to transform patient’s treatment and care and increased awareness to prevent people developing this condition. All 8 boroughs were also now testing their ‘Home First’ pathways to get people home from hospital as soon as they no longer required medical care. Additional funding had had also been provided to support the first step in creating a single point of access 24/7, 365 days a year for people in mental health crisis as part of an Urgent Care pathway.

4.5       To build on progress to date, Jane Wheeler advised that there would be a reassessment of priorities, finding better ways to communicate the STP’s projects and to keep engaging the population and key partners. There would also be regular reviews of governance structures, a building of relationships with other London STPs and key stakeholders, introducing a consistent way of reporting across the STP’s projects and programmes and further dialogue with partners to identify what is needed or desired and what areas were particularly challenging.

4.6       Chris Neill (Interim Deputy Director, NHS Central London Clinical Commissioning Group) added that the STP was at an important review stage a year into its submission. Internal reviews and discussions with partners were taking place and Chris Neill advised that Healthwatch members were playing a role in helping to make language more accessible for patients. There would also be monthly updates on the progress of implementing the STP.

4.7       During Members’ discussions, the Chairman thanked Healthwatch for the role they were playing in helping to make the language on STP documents more user friendly. She felt that the STP had provided the opportunity for partners to work together more closely and valuable lessons were also being learnt by looking at other STPs. The Chairman asked if there were any papers available detailing comparisons with other STPs.

4.8       Members commented that they would like to see more details about working arrangements for emergency admissions and discharges in respect of mental health cases. There was also the need for a proper community infrastructure to be in place to meet the STP’s aims, including in respect of mental health, to ensure that people were well. Isolation for some residents was also an issue and it was important to have proper networks around such people.  Members stressed that children’s mental health was also an important area for the STP to address.

4.9       Dr Naomi Katz (NHS West London Clinical Commissioning Group) stated that her practice had a number of homeless patients, many of whom were alcohol and drug users. The Point of Access Team had a backlog of such patients needing to be seen as there were certain pathways that these patients could not be directed to and this issue needed to be looked into further. Members commented that there were situations where residents may have problems accessing certain primary care services, particularly in situations where they did not qualify for personal budgets and discussions on the appropriate navigating were taking place on ensuring residents had access to services and were aware of the existence of facilities such as ‘safe spaces’ in community centres.

4.10    In noting that the STP referred to commissioning on a larger scale, it was queried what steps would be taken to ensure that the co-designing potential of services with other partner organisations, such as voluntary organisations, was not lost. It was suggested that lessons learnt from longer running programmes were used to ensure that the right questions were asked during the development of new programmes. Members expressed that they had been impressed by the way health services had responded to the Grenfell Tower fire. It was also requested that the Board be provided with information on how the STP’s investment in Westminster would change things from the residents’ perspective.

4.11    In reply to issues raised by Members, Jane Wheeler advised that a paper was being produced that provided cross comparisons between STPs and that North West London STP colleagues did regularly meet with their counterparts of other STPs. She emphasised that arrangements in the community were critical in helping the STP deliver outcomes and additional resources were also being put into Urgent Care. Primary mental health care services would also be supporting GPs to address capacity issues. Consideration was being given in ensuring that mental health services were pitched at the right level and many things could be improved by being done in a more joined-up manner.

4.12    Robert Holman (Head of Commissioning for Mental Health, NHS Central London Clinical Commissioning Group) advised that most people now had access to a 24 hour response in respect of mental health, however the number of people still visiting Accident and Emergency was not reducing and work was taking place with partner organisations to address this. In respect of closure of day services, he advised that NHS Central London CCG had worked with the Abbey Community Centre and the Beethoven Centre to create ‘safe spaces’ in their centres.

4.13    Chris Neill advised that the London Wide London Healthy Partnerships would also be taking a focus on comparing STPs. He acknowledged that more action needed to be taken on identifying appropriate pathways for homeless people and residents who needed primary care, but did not have access to personal budgets, including those with mental health issues and discussions with Adult Social Care were taking place on this. The STP’s Governing Body was having discussions in respect of level of scale in delivering services and there would be a local focus in terms of the primary care homes.

4.14    Dr Naomi Katz stated that NHS West London CCG was learning from its experiences across a number of work areas and it was acknowledged that one size does not fit all in respect of mental health. Activities had also taken place in mental health in the aftermath of the Grenfell Tower fire.

4.15    Chris Neill suggested that the Board could link its work on mental health with the Community Safety Partnership which also focused on this area. The Chairman agreed that this would be desirable and that the presentation should be made available to the Community Safety Partnership. She also informed the Board that councillors were attending training on suicide prevention on 14 September that had been organised by Councillor Paul Church, Deputy Cabinet Member for Adult Social Services and Public Health.