Agenda item

[To receive a report on Mental Health Services and the Covid-19 response] 

Andrew Moody from Black Country STP Mental Health Commissioning introduced the presentation on Mental Health Services and the Covid-19 response.  When the pandemic started, they had setup twice weekly meetings of a group titled, the Black Country STP Mental Health Group.  These meetings brought all the partners together who were involved in providing Mental Health Services.  It was a forum which acted as an oversight and planning group which could make decisions.  It took financial decisions on where budgets provided from the Government, for the response to the pandemic, were allocated.  The appendix to the report provided with the agenda for the meeting detailed how the money had been used. 

Mr Moody commented that a number of wards and places of care had been closed during the pandemic due to a patient or staff member testing positive for Covid-19.  This had naturally had an impact on the capacity of Mental Health Services and the ability to provide access to inpatient facilities.  One of the ways they had responded to the challenge was by commissioning additional capacity.  He felt that they had responded quickly to the challenge and had sourced additional providers to meet the demand.  

Mr Moody remarked that communications during the pandemic were key.  Messages from Government and NHS England were being received regularly and it was important that these messages were sent to the appropriate people through the right channels as efficiently as possible.  The Black Country STP Mental Health Group had been a useful forum for problem solving and finding practical solutions.  PPE was one of the problem areas which they were able to effectively solve.  For all the challenges of Covid-19, they still had to continue their normal day to day work.  He cited the example of the improvements being made in perinatal health, for which there was currently a Community Transformation Programme.  It was therefore important to balance the response to the pandemic with ensuring that mental health services as a whole were continuing.  

Mr Moody commented that they had realised early on that Covid-19 was disproportionately effecting people in the Black, Asian, Minority, and Ethnic Community.  The Black Country Voluntary Services Group had been established, which met on a weekly basis and brought non-statutory partners together with other key partners such as the Police and Public Health.  The group helped to connect with people who ordinarily it would be a struggle to reach.  The pandemic had acted as a catalyst to make quick decisions that normally would have taken longer to have made.  The pandemic had helped to establish relationships which had proved beneficial to groups who had perhaps struggled to connect in the past.  At the end of the first lockdown it had been universally agreed to continue with the group.

Mr Moody remarked that the Black Country BAME Mental Health Steering Group had been established during the course of the pandemic.  Tackling inequalities across the system was one of its main aims.  It had been a very positive group. 

The Director of Operations of the Black Country NHS Healthcare Foundation Trust presented a slide on how Mental Health Services responded to the Covid-19 pandemic.  He informed the Panel that they had immediately established robust Incident Management arrangements.  They had developed new ways of working, delivering clinical care by using a blended approach of telephone/video and face-to-face consultations.  They had reconfigured inpatient wards to enable safer management of Covid-19, to reduce transmission.  This had been a challenge due to the aging nature of many mental health hospitals.  Isolation due to Covid-19 was clearly not going to be good for mental health, this had meant PPE and other infection prevention measures had been essential. 

The Director of Operations of the Black Country NHS Healthcare Foundation Trust remarked that they had implemented a robust gateway process to prevent unnecessary hospital admissions.  There had been an increase in admissions since the Covid pandemic.  They were discharging patients, but more people were then admitted.  They had worked with stakeholders to develop a 24/7 crisis telephone line to support or prevent people from going into crisis.  The crisis line had been setup in 3-4 weeks, when in normal times it probably would have taken months.  They had robust Outbreak Management arrangements, one of the challenges with this was Track and Trace and finding the index case, which was difficult.

The Director of Operations of the Black Country NHS Healthcare Foundation Trust outlined the enhanced links with Primary Care and PCNs, which included IAPT, (Improving Access to Psychological Therapies Services) working with practices.  The Trust had developed a comprehensive Health and Well Being offer for staff and other partners.  The resilience of staff was key.  Risk assessments of all staff had taken place and in particular for those most at risk and those from a BAME background.  Lateral flow testing had been rolled out to all staff.  The Trust were playing a key role in the STP (Sustainability Transformation Partnership) Vaccination programme and were making excellent progress in vaccinating their staff.  Visiting had been one of the issues, because it had to be stopped unless in exceptional circumstances and then under strict risk management. 

The Director of Operations of the Black Country NHS Healthcare Foundation Trust remarked that managing inpatient capacity had been a key feature of their work during the pandemic.  They had needed to quickly reduce occupancy in wards to improve safety and the ability to distance staff and patients.  They had reconfigured their wards into red/green areas and utilised the practice of patient cohorting.  When required, they had redeployed staff from other areas to ensure hospitals were appropriately staffed.  The CCGs had commissioned additional inpatient capacity from other providers.  The weekly multi-agency meetings had helped smooth the links between the NHS, private, third sector and the local authority. 

The Children’s Commissioning Manager for Wolverhampton CCG said that initially in lockdown one, CAMHS (Child and Adolescent Mental Health Services) referrals had reduced.  From September there had been a steady increase in referrals to the CAMHS single point of access, the point where all referrals were triaged to either specialist CAMHS services or the service run by Base 25.  The emotional health and wellbeing service had needed to adapt to Covid and so they now offered a blended offer.  There was a face to face option available for the people that wanted to or had to be seen in a physical environment or alternatively a telephone / digital method.  She was however frank with the Panel in stipulating that young people had struggled with digital engagement as much as adults.  There were however some young people who had adored not having to leave their home and to be able to seek the therapy they needed from their own bedroom.  She thought the blended offer would continue into the future.  Additional resources from the local authority had been provided to Kooth (an organisation that offered emotional and mental health support for children and young people aged between 11-24 years).  The additional resources related to extra support for care leavers as part of a digital platform. 

The Children’s Commissioning Manager for Wolverhampton CCG commented that there had been a general challenge of digital poverty and access to data to engage with services.  In the past children had found it easier to engage with services due to free Wi-Fi being available in so many different locations.  With the onset of the pandemic free Wi-Fi had been far more difficult to find.  She thought this was an important point to consider as part of a model moving forward into the future.  The crisis team had been working on a face-to-face basis rather than a digital platform.  Base 25 for under 11’s had also been offering more of the face-to-face option.   The 24 hours a day seven days a week helpline was also a service for Children and Young People. 

The Children’s Commissioning Manager for Wolverhampton CCG stated that NHS England had asked them to increase their access for young people to 35%.  In Wolverhampton this target had not quite been met, the actual total last year was 34%.  She thought there had been a problem with data input and she was confident that they would reach the target.  December has been particularly busy compared to normal.  The Mental Health Support Teams in Schools were being rolled out and they would be fully operational from 21 January 2021.  There were now educational mental health practitioners ready to begin their roles in the teams, after a delay due to Covid-19.   They were looking to increase the Mental Health Teams once they had been reviewed.  By 2024 there would be comprehensive Community Mental Health Services for children and young people up to the age of 25. 

The Children’s Commissioning Manager for Wolverhampton CCG articulated that since Covid-19, one of the real areas for which there had been an impact was the Eating Disorder Service.  There had been a doubling of the number of referrals into the service.  She spoke on the matter of learning disabilities and autism; they were supporting people to keep out of Tier 4 or the Criminal Justice system.  Demands for ASD (Autism, Spectrum Disorder) diagnosis had increased.  She asked if the Tier 2 staff providing emotional health and wellbeing support for young people could be placed on the priority vaccination list.  She had noticed that Covid-19 was having a bigger impact on staff sickness levels than earlier in the pandemic. 

The Director of Partnerships for the Black Country Healthcare NHS Foundation Trust presented a slide on working in partnership during the Covid-19 pandemic.  She stated that early on in the pandemic they had offered mental health support to their staff, which had now been extended to other partners including acute Trusts, nursing homes, Social Care and Public Health.  For people working in ITU (Intensive Therapy Unit), stress levels were very high, but there was also stress for people in other areas.  There was also the general stress which Covid-19 had brought into people’s personal lives and having to live with the lockdown restrictions.   She spoke on the Transforming Community Mental Health Services programme, which was a national programme.  The programme brought much needed investment in the community to support people with severe mental illness.  Over the next three years it was the intention of the Trust to take big steps to transform the Community Mental Health offer across the Black Country. 

A Panel Member referred to the Scrutiny review which had taken place on Adult Mental Health Services a few years prior.  She was not sure as to what progress had taken place since the time of the review’s conclusion, on the level of preventative work taking place to stop people going into acute crisis.  During the Scrutiny review it had been clear people were not getting the intervention they needed for weeks, by which time they had either got worse or had improved through some other means.  She was concerned that waiting times for talking therapies had not improved since the few years had passed from the Scrutiny Review. 

The Programme Director for Mental Health Integration and Transformation responded that prior to Covid they had been meeting the IAPT target rate in regard to access, for a first appointment within two weeks.  Since Covid because many people were referred through Primary Care and there had been a reduction in access to Primary Care, they had seen a substantial decrease in access to IAPT Services.  The Transforming Community Services Programme had been delayed due to Covid-19.  The initial rollout was intending to take place in Wolverhampton.  The ambition during the course of the next twelve months, staring in April 2021 was to provide a much more joined up service between Primary Care Services and Specialist Community Services.  He appreciated the Panel Member’s frustration, which he shared, that they had not moved forward to the extent they had hoped.

The Head of Service for Children’s Strategy and Partnerships commented that from a Children’s perspective their whole emphasis was on supporting children and young people at the lowest level to try and prevent escalation through into Tier 2 Services, such as Base 25 and certainly into CAMHS.  Throughout the whole of the Covid-19 pandemic they had been undertaking huge amounts of work to support the City’s children and young people.  Two surveys had been completed for children’s life in lockdown.  The WV Holiday Squad had been moved to an online platform.  They had commissioned additional detached work through Base 25.  Base 25 had also run campaigns to support young people in adhering to guidelines throughout the pandemic.  Mental Health awareness week had taken place.  There was also the HeadStart Offer which had increased throughout the pandemic.  In addition they had tried to work with the Schools on the offer that was available through Schools and this was an area that they continued to work on. 

The Head of Service for Children’s Strategy and Partnerships stated that there was a significant offer of emotional wellbeing services across the City, but the missing link was that not everybody knew what was available.  There was presently not a single place where the information was available, and it was difficult to navigate around the system.  This was something which they were working on and a group was starting next week to look at a single platform to show the services available.  He referred to the Wellbeing for Education Return Grant, which was given by Government and specifically aimed at Schools.  They had decided to cluster schools together and provide them with mentoring and support through their educational Psychology Team focusing on how they could support children and young people with mental health issues.  There were Mental Health Support Teams in Schools along with the HeadStart Offer. 

The Head of Service for Children’s Strategy and Partnerships referred to an Advisory Teacher within education that specifically focused on personal, social and mental health matters.  The Council’s School Improvement Team continued to have conversations within Schools about what activity they were completing in terms of checking in with children throughout the pandemic.  He concluded by commenting that there was considerable work taking place outside of statutory services.  He praised the work being undertaken by community and voluntary groups.  He cited the faith groups that had helped to deliver food parcels as an example. 

Two representatives from the Youth Council presented to the Panel on the results of their survey they had completed at their Youth Council meeting earlier in the week.  A copy of the results of the survey are attached to the signed minutes.  Reading and communicating with friends were the two responses that were most common in response to the question of what they had been doing to keep happy and positive during Covid-19.  Exercise and music also featured in the response.  In response to the question of what support and advice Schools had offered for their emotional wellbeing during Covid-19, a common response had been “none” or “not much.”  A couple of people had responded that they had been signposted to websites or to speak to tutors. 

The Youth Council representative in response to the question about whether Social Media had made things better or worse during the pandemic, commented that it was a mixed response.  Some people had responded that it had made things better as they were able to keep in contact with friends better and access information about Covid-19.  Others had felt it had made things worse, citing being afraid of becoming addicted to the medium or an unnecessary distraction from Schooling.   In response to the question regarding whether they knew of any influencers or trend setters in the public domain that could help with general wellbeing, she said there had been a range, but with an emphasis on the digital platforms YouTube and TicTok.

The Youth Council representative stated that health services could do a lot more in the use of Social Media, Websites, Schools and Colleges to communicate with young people.  Some people had commented that the language being used was too formal for them to engage with.  Others had commented that Social Media was not utilised enough and therefore the messages were not reaching the people that needed them the most. 

The Youth Council representative on the final question from their survey, which asked for any comments or experiences regarding emotional wellbeing and mental health services in the City, commented that many people had said they needed more support in Schools for mental health.  In addition, Outreach Services needed to be designed better, with more input from younger people.  There were comments raised about anxiety, which meant some people found it difficult to approach the system and so thought needed to be given to make it less daunting and more information on accessibility.

A Panel Member asked for the information which had been relayed by the Youth Council to be forwarded to the Cabinet Member for Education.  The Head of Service for Children’s Strategy and Partnerships commented that the information from the Youth Council survey had been shared with Cllr Dr Michael Hardacre, the Cabinet Member for Education and Skills.  They would be continuing to work with Schools and the Youth Council to ensure the key messages were relayed. 

The Children’s Innovation Lead talked about the prevention work taking place with children and young people, a key part of this work was underpinned by #YES, the Youth Engagement Strategy.  The strategy focussed on being healthy and being connected.  One of the positives of the pandemic was the increase in engagement with young people participating in various youth forums, with some new groups having been established.  They had also recently established, the Youth Partnership Strategic Board.  This board had overall governance responsibilities for the various youth groups in the City and had its own commissioning budget.  Emotional wellbeing had been a key area of focus in Children’s services with a particular focus on anxiety and loneliness in the pandemic.  They worked closely with the voluntary and community sectors.         

The Children’s Innovation Lead commented that the results of the two surveys had showed generally that children weren’t coping too bad.  What had been alarming though was the level of parents saying they needed support.  This was echoed by the information gathered from the voluntary sector.  As a consequence of the results of the surveys, a comprehensive parenting offer had been established.   The Children’s Commissioning Manager for Wolverhampton CCG added that they had also been alerted to the need for a parenting offer through their own work. 

The Chair stated that there was an issue in parts of the City with a lack of digital equipment for children and young people.  He also raised whether there was a nominated person at each school fully trained in providing emotional wellbeing and mental health support.  He added that it was important that this individual cascaded down to the pupils the services available.  He asked if emotional wellbeing and mental health was reported on at Governors meetings.   The Head of Service for Children’s Strategy and Partnerships responded that a report would be completed for the Children and Families Together Board covering the areas the Chair raised, which could then be shared with the Health Scrutiny Panel.  The Wellbeing for Education Return Grant was critical to the support provided.  The Chair also suggested a meeting with the Chair of the Children, Young People and Families Scrutiny Panel to discuss the subject further.  

The Chair and Vice Chair on behalf of the Panel thanked all the contributors for their input during the item.