Issue - meetings

To consider a report the Joint Commissioning Lead (Mental Health), NHS Stockport

People with learning disabilities, their carers and the Valuing People Partnership Board have expressed concerns regarding access to psychiatry for people with Learning Disabilities (LD), particularly during crises.  These concerns were brought to the attention of the Health Scrutiny Committee at its meeting on 16 October 2012.  The Committee requested further information on the issues and the actions set out for addressing them.

This report will identify the issues raised by the Valuing People Partnership Board, carers and service user representatives and set out how commissioners will resolve them.

The Scrutiny Committee is asked to discuss and note the report.

Officer contact: Gina Evans (NHS Stockport), 0161 426 9900, ginaevans@nhs.net

Joint Commissioning Lead, Mental Health, NHS Stockport, submitted a report (copies of which had been circulated) providing an update on progress with addressing the concerns raised by the Scrutiny Committee and the Valuing People Partnership Board about the level of psychiatric support available to residents with learning difficulties.

The report detailed proposed actions to improve the service provided to service users. This included:-

·         agreement in principal for the recruitment of a full time psychiatry consultant specialising in Learning Disabilities (LD) covering Stockport and Tameside;

·         re-focussing of the Learning Disability Health Multidisciplinary Team through the recruitment of specialists and providing greater clinical leadership through the LD consultant  to ensure greater focus on assessment, interventions and specialist support;

·         development of a Crisis Response Unit;

It was stated that these changes were in advance of the wider service changes likely to arise from the ‘Making Choices Having Control’ review of disability services.

The Chair reported that he and Councillor Porgess had received correspondence from service users and their carers in relation to the services under discussion.

Councillors asked questions and made comments including:-

·         There were particular problems encountered by service users with autism and related conditions, particularly when having to access services and assessments in Sheffield. There was work ongoing to redesign certain elements of the Autism Service to make them more suited to client need as previous provision, such as the crisis service had not been well used. Many of the concerns raised about autism would be the subject of further work around this service.

·         An increased focus on early intervention was welcomed and progress had been made since the matter was considered in October 2012. The recruitment of a specialist LD Psychiatry consultant would assist in increasing capacity although it was recognised that this was a very specialist field and recruitment may be a challenge.

·         There were plans for greater joint working and commissioning around disability services more generally.

RESOLVED – (1) That the report and progress with enhancing the provision of Learning Disabilities Psychiatry be welcomed.

(2) That the Joint Commissioning Lead, Mental Health, NHS Stockport be requested to submit a further report to the relevant Scrutiny Committee in 12 months’ time outlining progress with the proposed changes to the provision of Learning Disabilities Psychiatry and the impact on outcomes.

(3) That the issues connected with the provision of Learning Disabilities Psychiatry be referred to the appropriate Executive Councillors and the Health & Wellbeing Board.

This item has been placed on the agenda at the request of Councillor Paul Porgess.

Representatives of the Council, NHS Stockport and the Pennine Care NHS Foundation Trust have been invited to the meeting to provide an update on issues relating to psychiatry services for those with Learning Difficulties.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

The Chair reported that this item had been included on the agenda at the request of Councillor Paul Porgess.

Councillor Porgess reported that in his role as Chair of the Valuing People Partnership Board, he had become aware of the concerns of parents and carers about the psychiatric support available to those with complex learning difficulties, and in particular the perceived lack of co-ordination between providers that was leading to episodes of mental ill-health becoming more severe than would otherwise have been had there been earlier intervention and prevention. Councillor Porgess also cited a number of examples.

Mary Edwards (Stockport Advocacy); Gina Evans (Joint Commissioning Lead, Mental Health, NHS Stockport); Barbara Mitchell (Service Manager, Stockport Learning Disability Partnership); and Dr Sudhir Salujha (Lead Consultant, Adult Psychiatry, Pennine Care NHS Foundation Trust) attended the meeting to provide an overview of the services available and to answer questions from councillors.

In response to the concerns raised by Councillor Porgess, it was stated that people with learning disabilities could access psychiatry that was commissioned for three programme activities (one session for an out-patient clinic, one session for home visits and a session for admin, research) and that was now staffed by one psychiatrist. It was recognised that this was not ideal, and that alternative support through mainstream Mental Health Services and out-of-hours emergency services was limited and difficult to access.

It was also stated that the Joint Protocol in place to respond to those patients with learning difficulties presenting with mental health problems would require a presentation with a co-morbid mental illness before admission to an acute ward. In many cases, this was not necessarily the most appropriate treatment especially in emergencies when non-medicalised interventions may be more effective. It was commented that patients often had difficult in receiving an even before a co-morbid diagnosis might be possible.

The shortcomings in the service had been recognised, and in response it was planned to establish a specialist Learning Disability Psychiatric Consultant post, although this needed to be seen against the background of a significant shortage nationally of Learning Disability Psychiatric specialists. It was emphasised that issues around access to learning disability psychiatric services needed to be considered in the context of the whole resource available for learning disability specialist health support.

Councillors asked a number of questions. The issues raised included:-

·         The increased prevalence of co-morbid mental health conditions for those with learning disabilities.

·         Demand for learning disability mental health services in Stockport was likely to be ‘average’, although other areas of Greater Manchester did not receive as much specialist support as Stockport.

·         Waiting lists for access to mental health services for those with learning disabilities could be up to six months, which could lead to significant further strain on individuals and families in the intervening period.

The Chair then summarised the issues highlighted in the debate:-

·         Improving access to emergency/ out of hours mental health services for those with learning disabilities;

·         Improving access to learning disability mental health and psychiatry services more generally;

·         Whether the issues raised needed to be considered as part of the wider Learning Disabilities Review; and

·         Recognition of the need to reshape the total learning disability mental health service resource to be more preventative and better able to respond to crises.

RESOLVED – (1) That Mary Edwards, Gina Evans, Barbara Mitchell and Dr Salujha be thanked for their attendance and presentation.

(2) That, in light of the key issues highlighted by the Scrutiny Committee, the Joint Commissioning Lead, Mental Health, NHS Stockport be requested to investigate options for re-designing the mental health services for learning disabilities and to submit an update report to the January 2013 meeting, including further information on the waiting lists for accessing psychiatry services and benchmarking data.