FINAL REPORT OF THE NHS NORTHWEST MENTAL HEALTH COMMISSION LISTENING EVENTS, HELD OCTOBER TO FEBRUARY, 2008
CSIP North West Development Centre March 2008 Clare Mahoney Simon Rippon
1
CONTENTS 1.
Acknowledgements
2.
Introduction
3.
Methodology
4.
5.
•
Purpose and design of listening events
•
Participants
•
Data collection and analysis
Findings •
Client groups
•
Service provision
•
Interventions
•
Social inclusion
•
Commissioning and systems reform
•
What is working well in the Northwest
•
What the Northwest is proud of
•
What stakeholders would like to see more of
•
What is not working well
Conclusion and summary recommendations
References Appendix 1
Background to the MHS North West Commission on Mental Health Services
Appendix 2
Listening event programme
Appendix 3
Calendar of events
Appendix 4
Equality and diversity questionnaire
2
1. ACKNOWLEDGEMENTS. CSIP NW would like to thank all those who participated in the Listening Events across the NW, giving not only time but importantly their experiences, perspectives and expertise – often these were very personal accounts of service use and in providing care and support to friends and family members. We would like to acknowledge the work of Amanda Fox, Jan Robinson and other CSIP NW colleagues for their efforts in coordinating, administering and processing the information from the events. 2. INTRODUCTION In June 2007, the NW Strategic Health Authority (NHS NW) commissioned a review of mental health services in the Northwest - the NHS Northwest Commission on Mental Health Services (NWCMHS) (see Appendix 1). The NWCMHS then asked the Care Services Improvement Partnership Northwest Development Centre (CSIP NW) to facilitate a total of 10 listening events across the Northwest. This report provides a summary of the main messages emerging from these events. CSIP NW is one of 8 regional development centres commissioned by DH and NHS Northwest to provide support to organisations in implementing national health and social care policy, and improving outcomes and services. Working regionally and nationally, CSIP NW has a strong set of expertise in mental health and co-ordinates a range of development initiatives which have a focus on mental health. As well as co-ordinating the 10 listening events, CSIP NW has also coordinated a series of themed events and meetings on particular aspects of mental health. Copies of all the reports submitted by CSIP NW to the
3
NWCMHS will available at www.northwest.csip.org.uk from April 2008 onwards. The NWCMHS will report on its findings in September 2008. 2. METHODOLOGY 2.1 Purpose and design of the listening events The design of the listening events needed to be able to facilitate the gathering of the views and perspectives of a range of stakeholders as well as allow for the exploration of critical common issues requiring change across the mental health economy in the Northwest. CSIP NW and the NWCMHS jointly determined that the most suitable method would be a series of big events, or ‘large group interventions’ (LGI) using a modified Open Space Technology. The strengths of LGI and Open Space methodologies were deemed as sympathetic to the task in the following ways:
•
Stakeholders could be brought together as a ‘diagonal slice of the whole system
•
This had the potential to constitute a diverse and visible representation of the complexity of the whole system
•
The agenda for discussion could be set by participants
•
Small group work could be utilised as a core component of the process (Owen 1999)
•
The events themselves could be used as ‘marker’ events, promoting positive ideas about change on which to build in the future
•
They are relatively easy to plan
•
LGIs allow for discussion and debate on issues that cross organisational and community boundaries (Attwood et al 2003)
4
•
They would allow the NWCMHS to promote and explain the scope and purpose of the review to large audiences across the NW.
There are limitations to using Open Space, however, some of which are listed below:
•
The NW mental health economy does not constitute an organisation as such – and consequently stakeholders can be thought of as a community of interest only in general terms.
•
It is generally used as to begin an action-planning process and ideally requires follow through otherwise participants may experience it as a ‘talking shop’.
•
It cannot secure commitments to action unless the right leaders and stakeholders are in the room. ‘Organisationally-based or single stakeholder groups come into their own when commitments to action are needed’ (p116, Attwood et al 2003)
•
Though the process involved some written record keeping, it is not possible to assure data quality. For example, flip-charts of bulleted points are notoriously loose on detail and meaning when removed from their original context.
The programme designed for the Northwest events is attached as Appendix two. 2.2 Participants A total of 10 events were held between October 2007 and February 2008 in various locations in Cumbria, Cheshire, Greater Manchester, Merseyside, and Lancashire (see Appendix three). Invitations were targeted at service users, carers, workers, individuals and groups interested in mental health service provision, mental health wellbeing and related issues.
5
Participants were invited via three methods: firstly using the CSIP contacts database, samples of participants were selected via postcode to a radius of 35 miles of the venue; secondly, invitees were encouraged to share the invitation to relevant contacts; and finally information was placed in local press and cascaded onto regional organisations and their networks. It should be noted that this method was not designed or intended to reach the most minoritised or marginalised groups. Participants were then asked to complete a diversity and equalities questionnaire in order to be able to profile the participant demographic. Fig.1
Total
Completed
At event
Online
Fax
attended
Diversity Ques
Manchester
42
37
28
9
0
Warrington
57
33
28
5
0
Preston
88
47
39
8
0
Liverpool
78
44
36
8
0
Kendal
36
32
28
4
0
Burnley
55
39
35
3
1
Fleetwood
31
18
15
3
0
Bury
89
61
53
8
0
Carlisle
31
22
20
2
0
Nantwich
87
55
41
14
0
Total
594
388 (65%)
323
64
1
Analysis shows that almost 600 people from across the Northwest attended, and that 65% completed the diversity and equalities questionnaire, the majority of whom white (Fig 3) and women (Fig 2). Attendees were not postcoded, so it is not possible to track whether attendees were from the same
6
area as the location of the event. Service users and carers were well represented. There appears to have been fair representation from participants across all sectors, particularly by the public sector. Though this might be expected there is also a significant amount of missing data for this question. The majority of participants identified as living in a town or village, rather than rural or urban city. Fig 2: Gender
Fig 3: Ethnicity
7
8
Current service users were only coded as such if they did not also give job details relating to the sector they worked in. Conversely, service users who were in work were not coded as service users, but by their relevant sector. The same rationale was applied to the coding of carers. Fig 4: Service user and carer attendance
Fig 5: Service sector
9
There was a significant amount of “missing” information from the Manchester event because the survey tool did not include a question about place of residence. (Fig 6) Fig 6: Place of residence
2.3 Data capture and analysis Each event included presentations, large group discussions, small round table discussions, and plenary (see Appendix two for detail). Notes from the large group discussions were recorded on flipcharts by one of the facilitators. Participants made their own records of the small group discussions on flipcharts and post-it notes. At each event, all flipcharts and records of discussions were also displayed as a ‘market-place’ or ‘public gallery’ so that all participants could read and comment on the range of discussions that had taken place beyond those that they themselves had contributed to. Participants were encouraged to add further detail and commentary as part of the market place exercise. They were also asked, at most events, to conduct a straw poll as a way of testing opinion in the room. Results from the polls were not included in the data analysis. 10
Each event also provided books for individual and detailed comments. All data from flipcharts, post-it notes and comments books were typed up and printed out on colour-coded paper so as to be able to track the provenance of particular comments to specific events. A thematic analysis was then carried out, using the main themes identified by participants at the events themselves. Themes were coded by hand and summarised (see Section 3). No attempt was made to apply any quantitative analysis to the data. This was for a number of reasons, but particularly because there was little consistency in terms of recording. So for example, an hour-long discussion carried out by eight people may have produced only four summary bullet points, whereas two people discussing a topic for 15 minutes may have resulted in several pages of notes. Finally, it should be noted that some data was missing or spoilt. Specifically this was information that was incomplete (unfinished statements or sentences) from which perspectives could not be inferred. Spoilt data related to “inappropriate comments” – for example: one comment related to the need to see more of question was: “ More Richard and Judy.”
11
3. FINDINGS The main findings were summarised using the following headings: client groups; service provision; interventions; social inclusion; commissioning and systems reform. During each event participants were invited to make 3 votes against emerging themes raised in the first round of discussions. The rationale for this being to establish a rank order for priority statements or themes from the meeting. Votes could be cast as a block or spread across issue/themes. It was stressed that this would serve only to indicate opinion within the room on the urgency/priority areas for change and improvement locally. The summary ranked statements are shown in Appendix Five. In addition, summaries of responses to the following process questions are included: •
What is the northwest most proud of?
•
What stakeholders would like to see more of
•
What is not working well
A long list of most examples of positive practice mentioned during the events is also included under the heading ‘What is working well in the Northwest?’
12
Client Groups People with a diagnosis of Personality Disorder: The key theme within this discussion was the paucity of specific provision for people with a diagnosis of Personality Disorder. Participants highlighted a lack of care pathways and poor integration in mainstream mental health services coupled with a lack of strategic steer at a regional level (i.e. no identified lead for Personality Disorder services/care). Service Users and their Carers: Group discussions on this topic raised the following key points: Services need to identify and share examples of good practice regarding service user and care involvement and training should be provided to all staff to ensure this becomes a reality (i.e. not have a sole focus on involvement workers). Participants highlighted that Mental Health Services should be accountable to service users and need to be asking them what they want and need. There was a throughout the meetings an expression of opinion that those using services need to have a greater level of participation in there care destiny – that personal aspirations, ambitions and needs should be foremost in the discussions of treatment/support plans. A significant point for emphasis being the move to personalised care, individual budgets, and the whole individual commissioning agenda and how commissioners and NHS providers at the clinical/casework and operational levels are preparing for this agenda. Children, Young People & Families: A number of issues were highlighted in the discussions focused on Children, Young People & Families. Key issues raised were:
•
Children with physical disabilities in addition to a mental health problem have great difficulty in accessing current services
13
•
There is a paucity of dedicated and specific perinatal mental health provision for women
•
Current age thresholds for service provision were seen as being too low (i.e. 16 years of age for adult provision)
•
Commissioning needs to be focused on a family approach, with children and adult commissioners working together.
•
Staff that work with children need to be trained to detect and intervene early with children with mental health problems.
Older Adults: A strong theme emerging from the Older Adults group discussions was the view that older adult services needed to be separate from adult services to ensure that the needs of older adults are met; this was described as ‘positive ageism’. The needs of clients with Dementia were frequently raised, with participants highlighting a lack of clarity in Dementia pathways; little or no intermediate care provision; a perceived lack of resources; and the need to increase levels of understanding and skill in the workforce with regards to Dementia. The need for collaborative working between health care, social care and the voluntary sector was also raised as a key issue in ensuring a seamless transition across the care pathway. Asylum Seekers: Participants felt that the asylum situation was unacceptable and that current service provision is not adequate to deal with the presenting need of this group of clients. The provision of a rapid, holistic and integrated centre was suggested as a solution to the current situation. There was comment within certain meetings (Liverpool, Bury, Warrington for example) that the Commission needs to remind the NW mental health system to these demographic changes and signal a need to undertake preparatory changes to strategic commissioning and provider arrangements to ensure needs of new communities in places are recognised and met.
14
Service Provision Day Services: Key themes emerging from these discussions focused on the issue of day centre and day services closures. Participants felt that day services were wanted, needed and valued and provided respite for service users and their carers. Participants also highlighted that where day services had been discontinued, no alternatives had been offered in their place. It was also clear that participants did not feel that day services were sufficiently integrated into pathways of care that supported recovery. Crisis Services: The need for a single point of access that is available 24/7 was the key theme arising from group discussions focused on crisis services. Participants also felt that there was a need for dedicated resources for crisis services to work towards recovery and that crisis services should be integrated into a whole care pathway that is aimed at recovery. In-patient Services: A lack of clarity with regards to the role and function of acute inpatient services emerged as the major theme within these group discussions, with participants highlighting that there was a need to establish and define the place of inpatient services within the whole system of mental health care. Linked to this theme was the issue of recruiting and retaining staff working within inpatient services and the need to value staff experience and skills in this area.
Participants also highlighted the potential impact on inpatient
services if there is a shift in resource allocation to primary care mental health services. Participants from Cumbria were specifically concerned about the proposals to introduce one acute inpatient ward for the Cumbria area. The interface between acute care and newly established Crisis Resolution and Home Treatment Teams was often raised. This was in terms of transition between, access to, availability, out of area placements for treatment.
15
Generally there was an overarching discourse on the disconnection experienced by those using services and supporting people (carers) between these services. Some summary points in terms of inpatient services are: lack of emphasis on recovery based interventions, poor planning for housing, vocational and educational opportunities as well as interventions that support the maintenance of community tenure and re enablement.
Dual Diagnosis Services: Issues arising from this discussion were: the need for a competent workforce, with appropriate skills to deal with people presenting with a dual diagnosis; the need for clarity and consistency regarding practice and pathways and an increased focus on prevention. Criminal Justice Services: A key point that was discussed within this topic area was the overarching need to reduce re-offending rates by addressing the fundamental mental health needs of offenders. The need for equivalence between the services available within the community and within prisons was also raised along with a wider issue regarding the role of the Police within the Mental Health criminal justice system. Participants also highlighted the need for additional awareness training to be provided to the Police Force with regards to mental health. Voluntary Sector Services: Participants discussed the issue of short term funding contracts creating market vulnerability within the Voluntary sector and the issue of voluntary sector services being, in the main, patchy and untested across the region. Participants also felt that Voluntary sector services need to be aware of NHS targets and outcomes required of them. Additionally, a key issue raised was the need to engage with the voluntary sector at an early stage and not as ‘an afterthought’.
16
GP’s/Primary Care Workers: Key issues that were raised in relation to GP’s and Primary Care Workers were: •
Mental health training is not mandatory for GPs and other practice staff
•
Primary care staff should participate in providing mental health care within the stepped care model
•
A more holistic approach to health care is required within primary care (encompasses individuals physical and mental health)
•
The focus in primary care should be on prevention, early detection and early intervention. Interventions
Complementary Therapies: The main issues arising from discussions on complementary therapies were that there are currently government initiatives that support complimentary therapies within mental health care (e.g. New Ways of Working) but it is important to use this guidance as a lever to increase the use of these therapies. The use of direct payments was also seen as a potential lever to increase the use of complimentary therapies, although it was highlighted that there needed to be an increase in awareness and understanding of complimentary therapies and their place within mental health care. Psychological Therapies: Access to psychological therapies was a key theme within this discussion area with participants highlighting long waiting times and a lack of provision within community settings as barriers to access. Participants also highlighted that a shift in focus, towards quality outcomes and not quantity outcomes was desired. That there needs to be a view of commissioning provision beyond Cognitive Behavioural Therapy; often people presented perspectives on requirement for talking therapies that included broader person centred counselling/therapy
17
approaches. However this needs to be aligned to NICE Guideline and similar evidence based analysis. Social Inclusion Self-Directed Care: In relation to Self-directed care, participants were clear that this was a very important element of service users recovery as it places individuals at the centre of care and increases choice. However, it was also highlighted that a cultural shift is needed to ensure that Self-directed care is embedded into routine assessments and care planning, and that staff and service users should be supported in delivering this agenda. In addition, comments relating specifically to individual budgets highlighted that NHS care needs to be included as part of individual budgets. Employment & Housing: Issues raised by this group discussion were focused around the need to help people to get back to and stay in work; reducing the stigma of mental health within the workplace and the provision of quality housing, with this being included as an integral component of care planning. Wellbeing & Recovery: Themes emerging from the discussion on Recovery were; the need to look at recovery as an individual process and not a model; the need for person centred planning to be started early, i.e. within primary care and for services to find ways to increase involvement of the public in recovery not just those who are experiencing distress. This was linked to an issue raised regarding the need for a further shift from the medical model to a well-being approach to care. The emphasis on moving to a preventative model for those already using care services and a model to keep people well (those that aren’t needing care services) was often raised. There were discussions on how able and prepared
18
the system (the NHS Commissioners and Providers) is in responding to the health and social inequalities experienced by those in care services. In terms of the wider health and social policy arena this is perhaps a key challenge.
Stigma & Discrimination: The overarching theme arising from this discussion was the need to combat stigma by raising the profile of mental health within local communities. Returning to and maintaining work was also a key theme, with participants highlighting difficulties in the current ‘Return to Work’ schemes and the perceived lack of understanding regarding mental health issues by Job Centre Plus staff and potential Employers. Commissioning In relation to commissioning, key issues that were raised in discussion groups were: •
Competitive tendering can result in service destabilisation, particularly where short term contracts are being utilised (i.e. less than 3 years)
•
A tension between national targets and local needs exists, that commissioners are unable to reconcile within current budget allocations
•
A lack of commissioning resources, capacity and competency across the North West impacts on the commissioning process
•
Strategic development is fractured and uncoordinated, which leads to a postcode lottery, as there is a lack of co-ordination and networks that span PCT and local authority boundaries
•
Commissioners currently do not receive feedback from front line services and service users and their carers. In addition, service evaluation costs are not always included in service budgets
•
Commissioning
systems
do
not
currently
support
Third
Sector
organisations to become ‘procurement-ready’.
19
•
There was a concern among participants about the fact that NHS services are being privatised and this results in a focus on profit, which can exploit vulnerable people.
•
Commissioning for health and well-being has a long way to go What is working well in the Northwest
•
Age Concern timeout groups (Nantwich event).
•
Memory clinics in the community
•
Admiral nurses
•
Service user empowerment
•
Hospital facilities in Chester
•
Alcohol and drug services on Wirral
•
Alcohol liaison in A&E
•
Person centred planning
•
Links with adult learning and colleges
•
Beacon projects
•
Dedicated workforce
•
STR role (Warrington event)
•
Workplace – work life balance charter
•
Modernised day services in Halton and St Helens
•
Involving service users in tendering process
•
Criminal liaison in St Helens and Liverpool
•
Primary care
•
Challenging traditional practice
•
Self-referral
•
Well-being centres
•
Improved CPA – personalised assessments and service delivery
•
Direct payments
•
Liverpool Aspergers group
•
Local voluntary sector networks (Carlisle event)
•
Service user and carer voice is being heard
•
Clinical services are good once they are accessed
20
•
AIMS project
•
CHESS Carlisle
•
People becoming more open about mental health problems
•
CPA
•
Personality disorder therapeutic community
•
Patient Rights, Cumbria
•
CSIP/NIMHE (Fleetwood event)
•
Multi-disciplinary teams working with relatives and care services
•
Commissioner support for holistic recovery, prevention and early intervention services
•
ADHD service Blackpool
•
Dedicated clinical psychology services
•
Stratford resource centre
•
Enhanced day care services (dementia)
•
Supported accommodation
•
Support for carers
•
Cumbria joint-commissioning (Bury event)
•
Dedicated people
•
Self help groups and co-ordinator, St Helens
•
Keeping people out of acute services, St Helens
•
Mental health worker attached to every GP surgery
•
Partnership working
•
Salford Primary Mental Health Team (Manchester event)
•
Zion Centre
•
Longsight/Moss Side community project
•
CMHTs
•
Phobic charity
•
Beacons adult mental health project – East Manchester
•
Dual diagnosis training mental health and drug services
•
Specialist midwifery team
•
Rapid access to psychological therapies
•
Joint working in CAMHS
•
Information-sharing between schools and health
•
Direct payments 21
•
Imaginative use of resources (Liverpool event)
•
Assertive outreach
•
Voluntary sector
•
Mental health “champions”
•
Early intervention
•
Listening to service users and carers
•
Self-help groups and circles of friends
•
Pet therapy
•
More investment in services for older adults in Tameside and Glossop
•
Take up of direct payments in Cheshire (140 people)
•
Clued in
•
Keeping the Family in Mind/Barnardos
•
‘Family’ work
•
Psychotherapy services – good quality but not enough of it
•
Recovery and progression group (Knowsley)
•
Health and wellbeing for severe and enduring
•
CAMHS (Wirral)
•
Criminal justice teams in Knowsley, Wirral, Liverpool
•
Stepped care (Chester): ie no waiting lists
•
Southport psychological service
•
Good communication between primary and secondary care (Liverpool)
•
Caring outreach services (Preston event)
•
Tameside welfare rights service and joint work with CMHTs
•
World mental health events
•
Joint working
•
Staff at grass roots level
•
Mental health services generally working in an integrated way
•
Early intervention in the treatment of dementia (Preston, South Ribble, Central Lancs)
•
Mental health awareness education
•
Commitment from learning disability practitioners (Burnley event)
22
The Northwest is most proud of…(in no order of preference)
•
User and Carer Involvement
•
Voluntary Sector care [particularly housing and day services]
•
Family Rooms
•
Progress in gender specific services
•
Partnership working [across voluntary sector, private and public sectors]
•
Social Inclusion initiatives
•
Dedicated, hard working staff
•
Recovery model [including the use of Wellness Recovery Action Panning (WRAP)]
•
Increase in use of Direct payments
•
Service users and staff training together
•
Team Working
•
Expert Patients Programme
•
Alternative approaches to care
•
Volunteers The Northwest would like to see more of…
•
Preventative work [including an increase in mental health promotion, support to stay in work and mainstream services]
•
Collaborative working between agencies [e.g. health, education, social services & the voluntary sector]
•
Support for people to manage direct payments & individual budgets
•
Better access to specialist services
•
An increase in Psychological Therapies
•
Joint commissioning [across voluntary services, primary care, adult and children’s services]
•
Real service user involvement
•
Appropriate levels of IT support for front line staff
•
Less target driven services and more emphasis placed on quality
23
•
Increased choice of interventions [move away from medical model and increase use of complimentary therapies]
•
Cross discipline training
•
Wellbeing Centres
•
Support for Carers
•
Involvement of Voluntary Sector [including providing them with support and investment]
•
Transparency of commissioning process
•
Social prescribing What is not working well….
•
Deficits in services
•
Constant reorganisations which blight systems and services
•
Over-emphasis on targets, some of which are not relevant locally
•
Inequitable access to some services – post-code lottery
•
Privatisation
•
Stigma and discrimination
•
Joint-working across agencies
•
Service pathways into and out of specialist services
•
Direct payments
•
Dominance of the medical model and the marginalisation of social inclusion outcomes for housing, education, employment, physical health
•
Inpatient services – ‘they contain but they do not treat’
•
Lack of investment in training and support for staff
•
Transitional arrangements between child and adult services
24
4. CONCLUSION An enormous range of views and experiences emerged from participants during the Listening Events, as well as many common and shared themes. Service user and carer involvement, social inclusion, recovery and wellbeing, older and young people’s needs, access to services and care pathways, are all frequently mentioned concerns. A framing by specific diagnosis shows that personality disorder, dual diagnosis, substance misuse, dementia and people in crisis, were mentioned at nearly all events. Systems reform issues most often cited were at the level of the population in terms of commissioning, and at the level of the individual in terms of personalisation and self-directed care. Themes that appear to be under-reported included the needs of minoritised groups, particularly service users and carers from black and minority ethic communities, women, parents, people not in settled accommodation, lesbian, gay and transgendered people. Similarly some key legal and policy issues were scarcely mentioned - the Mental Health Act for example. Issues of personal and public safety were significant. In some instances, participants described how the Care Programme Approach (CPA) could be used more positively to reduce risk and reduce issues of stigma and exclusion. Personal safety in acute inpatient settings remains a matter of serious concern, raised most by participants with direct experience of using services. There is a substantial array of positive practice and a great deal of commitment to build upon. For this reason the report includes a long list (but not all those mentioned) of practice examples. Some of the most commonly articulated recommendations made by participants to the NWCMHS include: the need to recognise the importance of drawing upon the strengths and assets of the NW mental 25
health economy; the importance of addressing service deficits at the same time as reforming and ‘modernising’ systems and care pathways; making services accessible to those who need them most; putting the individual at the centre while at the same time responding proactively to ensure access for the most marginalised groups; and finally, importantly, challenging the medical paradigm so that it does not overwhelm and dominate social inclusion, social justice, recovery, prevention and well-being approaches.
26
References Attwood M, Pedler M, Pritchard S and Wilkinson D (2003) Leading Change: A Guide To Whole Systems Working. The Policy Press Owen H. Open Space Technology pp233 – 244 in Holman P and Devane T (1999) The Change Handbook: Group Methods For Shaping The Future. Berrett Koehler
27
APPENDIX ONE: BACKGROUND TO THE NHS NORTH WEST COMMISSION ON MENTAL HEALTH SERVICES Mental health services across the North West like services across the country are ‘patchy’. There are some excellent examples of good service but these are not a common experience. The National Service Framework has delivered change over the past few years but we now need to look at what comes next to drive services forward and to find ways of dealing with the significant issues that seem to consistently resist change. This is a major opportunity locally and nationally to refresh the ambition for services and the levers to help achieve them. What is the Commission? This Commission or review team has been set-up by NHS North West, the North West strategic health authority to review mental health services across the region and provide a report and recommendations by September 2008 It is not a detailed and systematic review as undertaken by bodies like the Health Care Commission or the Mental Health Act Commission but will identify critical common issues; look for things that are consistently causing problems or proving difficult to respond to; seek out the things that are consistently resistant to developing services and look for new ways to address them. The fundamental goal of the review is to enable services to progress farther and faster and to try to achieve a step-change in service delivery. What are the underpinning principles? We do not want to duplicate either the work of the Healthcare Commission, the Mental Health Act Commission or any other body. We believe that the people currently involved in services know what good looks like and can help to define what would be much better. Our starting point is to listen first then analyse carefully and finally be prepared to think outside the box to find new ways of improving mental health services for the better. We know that here are lots of views to be heard but we are clear that none are more important than those of the people who use services or their carers. How will we go about this?
28
Our first six months will be spent gathering information and listening to people through the following four workstreams. We will hold listening events within health communities across the region to which all stakeholders will be invited. We will hold specific listening events focused on hard-to-access groups. We will set-up an information gathering group to look at what information we already have and we will issue an open invitation to attend any group that want to talk to us about services. We will then analyse the information gathered through these routes to determine what are the critical issues and start to think about how we can address them. What is the timetable for this work? • •
•
From September 2007 to February 2008 we will be primarily gathering information through the means outlined above. During March to April 2008 we will be collating and analysing that information, determining preliminary findings and sharing these with our Reference Group. The reference group will be made up of service users and carers as well as national and local stakeholders who will help us to ensure that our work has a wide input. From May to July 2008 we will be sharing preliminary findings through structured small events to test them with a wide range of interested parties. In August 08 we will finalise our draft report and hold informal discussions with the Strategic Health Authority before formally presenting our report to them in September.
We anticipate that our report will frame an agenda for action across health and social care from 2008 to 2012. The success of this work will depend as much on the engagement of stakeholders as it will on the dedication and ability of the Commission itself. How can I get involved? If you would like to have your opportunity to tell us what you think please either invite us to come along and meet with you or your group or send us your thoughts in writing. Email us: mh.commission@northwest.nhs.uk Write to us: NHS North West Commission on Mental Health Services Room 451, Gateway House Piccadilly South Manchester M60 7LP Telephone us on: 0161 236 2352 or 0161 2
29
APPENDIX TWO:
LISTENING EVENT PROGRAMME
PROGRAMME FOR THE NHS NORTH WEST MENTAL HEALTH COMMISSION LISTENING EVENTS A message from the Commission: “THE WORK OF THE COMMISSION WILL INFORM THE WAY MENTAL HEALTH SERIVCES ARE DESIGNED AND DELIVERED IN THE NW, IN CITIES AND TOWNS, AND IN RURAL COMMUNITIES. THIS IS YOUR CHANCE TO TELL US WHAT YOU THINK WE NEED TO KNOW.
USERS, CARERS, FAMILIES,
COMMISSIONERS, PROVIDERS, FRONT-LINE STAFF ARE ALL ASKED TO CONTRIBUTE. WE NEED YOU TO TELL US WHAT WORKS WELL, WHAT DOESN’T AND HOW THINGS NEED TO IMPROVE”
What is the event about? The Strategic Health Authority – NHS North West – has set up a Commission to review mental health services across the region. As part of their work they have asked CSIP to manage a series of Listening Events. This is one of a number of listening events across the region which CSIP have been asked to organise. The events are one way of asking people for views on local services. All the information will be given the Mental Health Commission Team to help them in making recommendations for change. It is also a way to gather information on what is working well. What will happen during the event? The event will be very flexible as we want to see that everybody has an opportunity to talk about their views and ideas. We will ask you to discuss views and ideas with other people in small groups.
30
There will be people to organise the discussions (facilitators) and help us keep to time. There will be plenty of time for people to stop and think – to decide which discussion they want to join. In the afternoon we will ask you to join cluster groups based on where you live - that is, in a city, town or a village. We want to do this as often where you live depends on the kind of service you might receive. I might have things I want to talk about that are private or personal – what should I do? You can speak directly to a member of the MH Commission who will be present through out the day. There will also be Testimony Books at the meeting in which you can record your views privately. What happens to the information I give in the meeting? All the information you give will be anonymous – we are interested in your views but will not put your name or details against any statements made – unless you ask otherwise. The information from all the meetings will be given to the Commission Team for them to consider for the report and recommendations. It will be looked at alongside al the other information they are gathering over the next six months What if I need help during the meeting? There will be people to offer support should you need it - CSIP staff will make themselves known to you all at the start of the meeting. You are free to take a break when you need to. Refreshments will be available throughout the day. What if want to contact the Commission? For more information about the Commission, contact mh.commission@northwest.nhs.uk or 0161 236 2352/2039
31
The Listening Event - How it will work. 10.00 – Arrive & Refreshments etc. 10.30 – Welcome & Outline for the day & Rules for Working Together. 10.40 – Introductions to the NHS North West Commission for Mental Health Services. 10.50 – Burning Issues This is an opportunity for you to raise ANY issues or topics for discussion in the day which you would want the Commission to know about. We will then look to see if the issue or topic is within the remit of the commission – If it’s not, we will ask the commission to take it away for consideration. If it is it will put it forward for a table top discussion. 11.30 Table Top Discussions and the 3 big issues… People are invited to meet at tables to hear about the issue you have raised, to talk about their views and experiences of the issue. We ask that someone keeps notes of the discussion too. When it’s nearly time to end, you will be asked to find up to 3 big issues from the discussion that you want to go forward to the market place and voting poll after lunch 12.30 1.00pm
LUNCH Reconvene – Market Place & Voting Poll.
1.15pm - Let’s talk about Mental Health Services. We want you now to think about the future of services and mental health in the NW. To do this we’d like you to talk about 4 areas 32
• What is working well for you ? • What’s NOT working well and why is this? • What are you proud of in local services? • What would you like to see more of? 2.15pm – Come together to look at the information & where to next. Close
33
APPENDIX THREE: CALENDAR OF EVENTS Manchester
22nd October 2007
Warrington
31st October 2007
Preston
9th November 2007
Liverpool
15th November 2007
Kendal
26th November 2007
Burnley
3rd December 2007
Fleetwood
7th December 2007
Bury
21st January 2008
Carlisle
28th February 2008
Nantwich
8th February 2008
At each event there was representation from the NWCMHS, variously as follows: John Boyington, Colin McKinless, Julie Cullen, Terry Lewis, Jenny Popay, Max Marshall.
34
APPENDIX FOUR: EQUALITIES AND DIVERSITY MONITORING FORM
DIVERSITY OF REPRESENTATION AND INVOLVEMENT & EQUITY IN ACCESS TO OPPORTUNITIES AND SERVICES Government legislation and policy directives have identified six main strands of equality: gender, race, age, disability, religion & faith, and sexual orientation. CSIP-NW is committed to ensuring that its work and activity is shaped, influenced, informed and benefitted from by all sections of our communities. This means that we need to establish Who is informing our strategies, work programmes and evaluations? Who benefits from our work programmes? Are there particular sections of our communities we are not involving and reaching? To answer these questions, we would welcome your participation in this exercise by completing this Equal Opportunities Monitoring Form. Your name does not appear on this form, and the person(s) collecting the form will not be recording the information. This is to ensure anonymity. Responses to all the information asked for is voluntary, but the more information we have the better we can evaluate the extent of diversity and involvement of all sections of our communities in our work. Where there are any significant gaps in representation the Equalities team within CSIP North West will work closely with staff within the centre to improve representation. Thank you for your help and support in completing this form.
35
EQUAL OPPORTUNITIES MONITORING FORM Event/Meeting Name: Your Details: 1 GENDER Female Male Do you identify as Transsexual or Transgendered? 2 ETHNICITY WHITE: British
Irish
Another White Background (please specify:
Pakistani
Indian
BLACK OR BLACK BRITISH: African
Caribbean
Another Black Background (please specify:
CHINESE OR OTHER ETHNIC GROUP: Chinese
Another ethnic group (please write in:
MIXED BACKGROUND: White & Black Caribbean
White & Black African
ASIAN OR ASIAN BRITISH: Bangladeshi Any other Asian Background (please specify:
White & Asian
Another Mixed Background (please write in ...
2b) REFUGEE / ASYLUM STATUS Do you identify as a: Refugee Asylum Seeker 3 SEXUAL ORIENTATION Heterosexual Bisexual Lesbian Gay Another sexuality, please specify:
36
4 DISABILITY: Do you identify as Having a Disability IF YES, are your support needs around: Communication (sight/hearing/speaking/understanding) Learning Difficulties Physical Mental Health Mobility Another disability: please write in 5 RELIGION/FAITH None Atheist Buddhist Christian (e.g. Church of England, Catholic, Protestant ‌ please describe: Hindu Jewish Muslim Sikh Another faith/religion, please specify: 6
AGE
15 years or younger 16-25 26-35 36-45 46-55 56-65 66-75 Over 75 7 LANGUAGE Preferred Language or Language Format, please describe
8 ROLE Current Service User Past Service User Carer of a Service User Employed Advocate on behalf of Service Users Provider of Services,
Voluntary Sector Independent Sector Public Sector
please give role or professional background: Commissioner of Services, please specify A trainer or university course provider, please describe
37
Another role, please describe
9 WOULD YOU DESCRIBE THE PLACE THAT YOU LIVE AS Urban City Rural Town or village
38
APPENDIX 5 : SUMMARY OF PARTICIPANT VOTING TO IDENTIFY PRIORITIES IN LISTENING EVENTS.
A. Burnley: 1. Need to see a change in culture in commissioning/providers – move to more recovery based services/opportunities, outcomes. 2. Older peoples services for MH needs. 3. CAMHs and transition issues – pathways too stilted and not smooth B. Bury 1. More holistic opportunities for people – social support, complimentary therapies, psychological therapies etc 2. Options for people from BME groups – access, uptake and relevance of services 3. Commissioning – need for a new approach to commissioning what’s need for users C. Carlisle: 1. Stronger user involvement in service development and redesign 2. Commissioning of services for recovery, inclusion and prevention 3. Doing more on prevention and promotion D. Fylde: 1. Workforce development to see changes in attitude, more prevention approaches and helping against stigma 2. Self directed support – personal budgets. 3. Commissioning process – more outcome focused – on social achievement, work, housing as a result of MH input
39
F. Kendal: 1. Crisis and urgent support services – location, when delivered by whom, 2. Inpatient facilities – availability, location etc. 3. Involving users in services – determining care and also in changes. G. Liverpool: 1. Strengthening user voice in aspects of care 2. Recovery and inclusion, Stigma issues 3. Day services / Day time supports
H. Manchester: 1. Community Services and access to urgent and crisis support 2. More day time activities/opportunities and support outside of hospital 3. Focus on recovery and inclusion. I. Nantwich: 1. Dementia service – access, focus and range. 2. Crisis and inpatient type services – need redoing. 3. Social inclusion – including recovery, housing and employment/vocation – needs more attention in MH J. Preston 1. That crisis services, out of hours support needed developing and refining. This included reference to day service support 2. Dementia services 3. Carers needs are responded to – respite, involvement, information etc.
40
K. Warrington: 1. Strengthen joint commissioning 2. More on health promotion and preventative approaches – not just psychiatry 3. Developing workforce – more on new skills for new approaches. END.
41