Agenda

To receive apologies for absence and to note the attendance of any substitute members.

Members are asked to declare any disclosable pecuniary or affected interests and the nature of that interest, including the existence and nature of the party whip, in respect of any matter to be considered at this meeting.

Any Member with a Disclosable Pecuniary Interest in a matter should withdraw from the meeting when the matter is under consideration and should notify the Democratic Services Officer in attendance that they are withdrawing as they have such an interest. If the Disclosable Pecuniary Interest is not entered on the register of Members interests the Monitoring Officer must be notified of the interest within 28 days.

Any Member with an Affected Interest in a matter must disclose the interest to the meeting.  There is no requirement to withdraw from the meeting when the interest is only an affected interest, but the Monitoring Officer should be notified of the interest, if not previously notified of it, within 28 days of the meeting.

The Panel has invited the following people to provide an overview of local mental health services, current priorities and pressures:

Nadia Barakat, Director for Mental Health, NHS Frimley CCG,

Aidan Jordan-Lewis, Transformation Manager (Mental Health and Learning Disabilities) Bracknell Forest, NHS Frimley CCG

Heema Shukla, Consultant in Public Health, Bracknell Forest Council

The following items form the evidence pack for this review which is part of the Overview and Scrutiny work programme (Overview and scrutiny work programme | Bracknell Forest Council (bracknell-forest.gov.uk).

The review will take place over a series of meetings. Some meetings will be open to the public and others may be closed. This will be determined by the nature of the session and the sensitivity of the information being shared. The priority will always be the effectiveness of the review. The Panel may produce interim reports as well as a final report capturing good practice, learning points and recommendations.

The final report will be published here: Scrutiny reviews and responses | Bracknell Forest Council (bracknell-forest.gov.uk)

Describes the background to and the scope of this review into access to mental health services.

Provides an overview of the approach for this review.

The NHS Long Term Plan makes a renewed commitment to improve and widen access to care for children and adults needing mental health support.

It aims to:

·       transform mental health care so more people can access treatment by increasing funding at a faster rate than the overall NHS budget – and by at least £2.3bn a year by 2023/24

·       make it easier and quicker for people of all ages to receive mental health crisis care, around the clock, 365 days a year, including through NHS 111

·       expand specialist mental health care for mothers during and following pregnancy, with mental health assessments offered to partners so they can be signposted to services for support if they need it

·       expand services, including through schools and colleges, so that an extra 345,000 children and young people aged 0-25 can get support when they need it, in ways that work better for them

·       continue to develop services in the community and hospitals, including talking therapies and mental health liaison teams, to provide the right level of care for hundreds of thousands more people with common or severe mental illnesses.

Milestones for mental health services for adults:

·       New and integrated models of primary and community mental health care will give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and support them to live well in their communities by 2023/24.

·       By 2023/24 an additional 380,000 people per year will be able to access NICE-approved Improving Access to Psychological Therapies (IAPT) services.

·       By 2023/24, NHS 111 will be the single, universal point of access for people experiencing mental health crisis. We will also increase alternative forms of provision for those in crisis, including non-medical alternatives to A&E and alternatives to inpatient admission in acute mental health pathways. Families and staff who are bereaved by suicide will also have access to post- crisis support.

·       By 2023/24, we will introduce mental health transport vehicles, introduce mental health nurses in ambulance control rooms and build mental health competency of ambulance staff to ensure that ambulance staff are trained and equipped to respond effectively to people experiencing a mental health crisis.

·       Mental health liaison services will be available in all acute hospital A&E departments and 70% will be at ‘core 24’ standards in 2023/24, expanding to 100% thereafter.

More details on mental health in the NHS Long Term Plan can be found here:NHS Long Term Plan » Mental health

The NHS Mental Health Implementation Plan 2019/20 – 2023/24 is here:NHS Mental Health Implementation Plan 2019/20 – 2023/24 (longtermplan.nhs.uk)

This 2016 report from the independent Mental Health Taskforce to the NHS in England recommends eight principles to underpin mental health reform:

·         Decisions must be locally led

·         Care must be based on the best available evidence

·         Services must be designed in partnership with people who have mental health problems and with carers

·         Inequalities must be reduced to ensure all needs are met, across all ages

·         Care must be integrated – spanning people’s physical, mental and social needs

·         Prevention and early intervention must be prioritised

·         Care must be safe, effective and personal, and delivered in the least restrictive setting

·         The right data must be collected and used to drive and evaluate progress

The full report is here: The Five Year Forward View for Mental Health (england.nhs.uk)

A summary of the BHFT Mental Health Strategy 2016 – 21.

It can be viewed online here:

Mental Health Strategy 2016 – 21, Berkshire Healthcare NHS Foundation Trust

This document was created in April 2021 by mental health services to provide an overview of NHS polices and commitments, as well as local priorities and current programmes. It contains a list of local providers and third sector organisations, which was correct when it was compiled in early 2020.

This dashboard helps monitor progress against the delivery of the Five year Forward View for Mental Health and the NHS Long Term Plan and is published on a quarterly basis.

The August 2021 data for Quarter 4 2020/21 shows that East Berkshire CCG is above the national standard in the following applicable measures:

·         % of children and young people accessing support by NHS funded community services (at least two contacts)

·         Improving Access to Psychological Therapies (IAPT) recovery rate: % of people that attended at least two treatment contacts and are moving to recovery

·         IAPT recovery rate for Black, Asian or Minority Ethnic groups (terminology under review)

·         IAPT % of people receiving 1st treatment appointment within 6 weeks

·         IAPT % of people receiving first treatment appointment within 18 weeks of referral

·         % of people who started treatment within two weeks of referral - all ages

East Berkshire CCG is below the national standard in the following applicable measures:

·         % of children and young people with eating disorders seen within one week (urgent)

·         % of children and young people with eating disorders seen within four weeks (routine)

·         IAPT access rate: proportion of people with depression/anxiety entering NHS funded treatment during reporting period

·         % of people on GP significant mental illness (SMI) register receiving full physical health cheque in primary care setting 

Full results can be found here: NHS England » NHS Mental Health Dashboard

Details of what East Berkshire CCG spent in 2019/2020, taken from the East Berkshire CCG Annual Report Summary 2019/2020.

What we spent

·         We serve a population of 466,055

·         The CCG spent £632.2m

·         Equivalent to £1,338 for every person registered with our practices

·         £328.2m is spent on acute hospital services:

o   £239.2m Frimley Health NHS Foundation Trust

o   £27.9m for Royal Berkshire NHS Foundation Trust

·         £85.3m spent on community and mental health services with Berkshire healthcare NHS Foundation Trust

·         £51m prescribing spend

Social prescribers are employed across East Berkshire and take a holistic approach to someone's health and wellbeing and where appropriate, can connect residents to activities and support in the community that may benefit them. They enable patients to self-manage their health and social needs more effectively, therefore reducing the need to make contact with Primary Care and reducing hospital admissions.

In Bracknell Forest, a team of five social prescribers have supported hundreds of people, aged 18 to 96, who have either contacted them directly, or been referred into the service by local GPs. The key organisations they referred patients to include Friends in Need, Signal4carers, Mind and Samaritans.

In light of COVID-19, members of the team have also helped hundreds of Bracknell patients on the NHS shielding list.

(extract from the East Berkshire CCG Annual Report Summary 2019/2020)

The Social Prescribing Service can be accessed here: Social Prescribing Service - Public Health Portal - Bracknell Forest Council | (bracknell-forest.gov.uk)

Commentary from 2017:

The vast majority of people receiving treatment for mental health problems are seen within primary care:

·         81% first come into contact with mental health services via their GP and continue to receive support from their GP throughout the period they are in contact with secondary care services;

·         90% of people receive treatment and care for their mental health problem solely in primary care settings;

·         it is estimated that one third of GP appointments involve a mental health component.

Integrated models of primary mental health care are being developed that can deliver effective support to prevent a greater number of people from requiring secondary mental health care, ensure that people have targeted access to relevant physical healthcare interventions and support them to maintain recovery following discharge from secondary mental health care. As part of this expansion, the General Practice Forward View committed to the introduction of 3,000 new mental health therapists co-located in primary care

Secondary services are those which patients are referred to by their GP, A&E or other organisations and offer more specialist support. Secondary care can include community mental health teams, hospital care or support from other mental health service providers.

(extract from NHS Bracknell and Ascot CCG Commissioning for Value mental health and dementia pack, January 2017)

Access to GPs is part of access to mental health care. This review will not cover access to GPs in depth and recognises the GP Access Project currently being carried out by Bracknell Healthwatch. Further details of the project are provided in this video of the Health & Wellbeing Board, 8 September 21, starting at 23 minutes

BBC news article including data on referrals pre and post pandemic:

 'NHS abandoned me after I tried to kill myself' - BBC News

Sky News article states almost 40 per cent of young people with mental health problems are waiting longer for treatment than NHS guidelines allow. In 2020, almost 31,000 children were referred to Children and Adolescent Mental Health Services (CAMHS) but 38 per cent of them had to wait longer than 18 weeks to get their first assessment.

Almost 40% of young people are waiting too long for mental health treatment | UK News | Sky News

Around one in six children unhappy with mental health in Bracknell | Bracknell News