Presentation on theme: "North Tyneside - Improving outcomes for people experiencing mental health crisis Jacqui Old Director of Adult Social Services November 2014."— Presentation transcript:
1 North Tyneside - Improving outcomes for people experiencing mental health crisis Jacqui Old Director of Adult Social Services November 2014
2 Life expectancy & disability-free life expectancy & premature mortality rates Issues of the north east are well understood and rehearsed.All understand the landscape of rising demand decreasing resources.Hold up the mirror of where we areAnd the issue of the scale of the problem we faceHard for many people to know and understand their inequalities for they live with them day in day out.Don`t underestimate the impact of debt on health/wellbeingCrisis care is perhaps the gap between physical health and mental health is most stark.”We know the average age of death for someone who is homeless is 42yrsWe know that homeless people behaviour is more likely to change if they are supported by other people who have been homeless Don’t underestmate the importance of peers.Instead of asking what is the matter with you : what matters to you.Need to build on the assets of the north and build on resilience
3 Context Children / Adult cover 65% of council budget N. East - By 17/ % reduction resourcesNorth East highest level of decrease in spending powerWorrying signs that gap could widen - impact of recessionFlaw in public spending is shown - NHS as an islandLocal government & Benefits seen as easy for cutsConsequences for NHS.Trusts finances/ operational sustainability over next 5 yrsNeed for more granular information on the impact of austerityIncreasing divergence on health inequlaitiesOpportunity to put prevention at the heartMake people a partner in wellbeingTremendous sense of ambition and a case of doing it now.promoting living wagejoint spending power to promote good employmentimproving quality and affordability of housingtrusts are concerned about finances and operational sustainability over next 5 years.. if funding continues what will implications for nhs. cant ignore questions. the flaw in public spending is shown as nhs as island separate sees local gov and benefits as easy for cuts. dangerous consequences for nhs.
4 Challenges in North Tyneside Availability and access toPlace of safety bedsJoint training front line police and mental health practitionersSupported Housing OfferParallel TracksSeparateness of each imitativeExcess use of police cellsfor people with mental health problemsCliff-edge of lost support as children and young people with mental health needs reach the age of 18Out of hour access to crisis beds for young people (17+)Transportation of people with mental health problems in Crisisltc need for care is rising. reaching end of capacity to deliver further. any saving outstripped by growing numbers of those needing care.intentions good but complexit pays to be up front of where we are and honest.made al ist of things that cannot be changed and those that can and surprisingly the cannot was a short list.prevention and integration are key.
5 Emergent Thinking Urgent and Emergency Access to Crisis Care Quality of Treatment & CareService data to track and assureBeds readily availableSingle commissioning budgetAccess to support before crisisUniversal single point of access- Thresholds, GatewaysUniversal ServicesInformation and advicePrimary careRecovery and staying well- Early Intervention/Prevention- Information and Advice- Care and ConnectUrgent and Emergency Access to Crisis Care136 Pathway /Crisis team/ MEAM- Improved services for those with co-existing mental health and substance misuse issuesChronically excluded from servicesAMPHS-4 ThemesAccess to support before crisis pointUrgent and emergency access to crisis careThe right quality of treatment and care when in crisisRecovery and staying well and preventing future crises
6 Access to support before crisis point Matching local need with a suitable range of servicesImproving mental health crisis servicesEnsuring the right numbers of high quality staffImproved partnership working in X localityImprove access to support via primary careBarker report landed without much of ripple debate changer. extensoin of nhs move from means testing no political agreement on it but can aspire to this.
7 Access to support before crisis point Help this person to recover, become more independent and reduce care needsMaximise ways to promote prime interventions to support recoveryDevelop a clear political model of care which has promoting independence for citizens and find some of the care solutions from communities families and individualsget off the treadmill and re-engage your best friend is your community listen to what people are asking for and listen again use common sense and lived experience step away from control
8 Access to support before crisis point Phone for help- divert you to menu of optionsImprove access to support via primary careAwareness of local mental health and substance misuse services and how to engage themFocus on outcomes from our interventionsNew compact with communityWork with ph to make every contact countPCPmove from medical model of support to social model of support.big challenge of today is challenge of ageing, mental health and obesity, lifestyle.Wont find the solution by running medical model.Link health to housing, environment etc. marmott report.
9 2. Recovery and staying well Divert people away from formal care through good info and advice servicesDevelop the right level of preventative interventions in order to help people at the right timeService model of the future will be radically differentChanging the model of care from one of paternalism and protective interventions to one which promotes independence and manage risk with customersInstead of asking what is the matter with you - what matters to you.CarersJoint planning for prevention of crises
10 2.Recovery and Staying Well We will not assess person in crisis until we have given them the opportunity to recover/rehabNever make long term decision in middle of crisisDevelop the right set of interventions that prevent long term placementWhat is the practice and interventions that workIs Reablement /recovery delivering cost effective outcomes ?
11 3.Urgent & emergency access in crisis 136 PathwayProcess mapping workshops held with key partners across all areasIssues raised in the mapping workshops brought together in partnership meetings to agree actions required.MEAMImproved services for co-existing mental health substance misuse issuesGetting costs down before - not building costs upMeamThe pilot was established as it was recognised that in every local area people with multiple needs and exclusions are living chaotic lives and facing premature death because as a society we fail to understand and coordinate the support they need.Evidence shows that by working together local services can develop coordinated interventions that can transform lives.In North Tyneside there is an operational panel that meets every two weeks. It includes representation from Adult Social Care, Probation, Housing, North Tyneside Recovery Partnership Stonham Depaul and Thirteen. Others agencies are invited if the needs of the individual indicate they would be able to support the individual. The panel identify support that can be provided using existing resources in North Tyneside. This is often achieved by services working in a more flexible way to meet individual needs.So far there have been twenty cases discussed at the panel.Most of the cases have had a housing need. This can be particularly significant if someone is homeless or sofa surfing when trying to arrange other support such as mental health support or drug and alcohol treatment. It is difficult to complete or even prioritise treatment or support if you do not know where you are going to sleep that night.In North Tyneside we are working slightly differently to some other areas. The MEAM co-ordinator has a predominately co-ordination role and the case responsibility remains with the professional agency who has submitted the referral. If this is not appropriate, another agency is identified to be the keyworker. This allows an ongoing MEAM service.The MEAM strategic board guides the operational work. It will analysis the evidence from the pilot and identify necessary changes to systems to embed the learning from the pilot across all the partners. The operational panel highlights gaps and issues in services to the board to inform this.136 PathwayAddress improvements in early intervention and mental health crisis services Undertaken mapping led by CCG to review the existing Sec 136 pathway, currently analysing findings Multi agency involvement Inform model going forward – taking into consideration and working with partners within NTW who are piloting closer working with police based on a street triage model Make the model a local oneConcordat progress so farProcess mapping workshops held with key partners across all areas: Social Care, Police, Ambulance / Transport, A&E providers, Crisis Teams.Issues raised in the mapping workshops will be brought together in partnership meetings to agree actions required.On track to sign up to declaration by the end of December 2014 and action plan by the end of March.
12 4. Quality of Treatment and Care Commissioning team with eye on the ball and team who are much more forensicCommissioning that allows for beds to be readily and locally available in response to urgent needCommissioning provision for under 18 year olds that ensures local provision for young people in urgent needSingle budget- commissioning for adults.Proper sense of partnership.Review police use of places of safety under the Mental Health Act 1983 and results of local monitoringService User/Patient safety and safeguardingStaff safetyPrimary care responseTeam that develops a subtlety to ensure money is well spent with right interventionstart to commission for whole child and adult.why does it not happen . no public body has whole responsibility. still tendency not to invest saying not responsibility. activity tariff in nhsNeed to create year of care tariff to have combination of health and socail care staff. no one has responsibility for whole person. bring physical mental and socaial into one system.strengthen peoples rights to the system for single point of contact across system, right to carers respite, right to be a home, right to sign off support plan. stornger rights in nhs constitution. what is people entitlement to care. local job is the how. go with the grainas oppose against it.
13 4. Quality of Treatment and Care Effective joint performance framework – Create system that gives clarity and purposeSufficient amounts of service data info that we can track and provide assurance that services are workingBuild intelligence so we have an informed approach to strategic and operational decision makingResponse Timescales/Esculation/Bed avaiability/ AMHPsFocused on managing demand and cost- Know weekly if they are meeting needTimescales for health and social care services to respond to policePolice officer trainingTimeliness of assessmentsUnderstanding of roles and responsibilities and arrangements for escalationchanging cultures and transforming as important on moneyeasy to say workforce and fall into trap of not thinking of component parts.
14 So where we have got to ?A shared perspective - joint statement about how public services will work togetherAgreed set of principles and good practiceSwitched into different gear. Not the solution but good focus and start.Recognition that we can`t do this in isolation – interdependencySystems leadershipThank-you