Health and Adult Social Care Scrutiny Panel - Thursday, 7th November, 2024 6.30 pm

November 7, 2024 View on council website  Watch video of meeting or read trancript
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Summary

The meeting received presentations about mental health provision in the borough from the Director of Community Mental Health and Learning Disability Services at Oxleas NHS Foundation Trust, and about social care provision in the borough, and the commissioning of those services, from the Integrated Director of Commissioning for Adults in Greenwich. Both presentations were noted. During the discussion of commissioning, panel members stressed the importance of plain english in reports, providing specific examples of successful initiatives, and of celebrating the work of frontline social care staff.

Mental Health

Lorraine Regan, the Director of Community Mental Health and Learning Disability Services at Oxleas NHS Foundation Trust made a presentation about mental health services in Greenwich.

She said that there has been a 37% increase in the number of people accessing secondary mental health care services since 2020. She said that around 1% of these patients attend the emergency department at the Queen Elizabeth Hospital each month.

She said that the demand for services provided by Oxleas' ADAPT team has been particularly high. The ADAPT service works with people who have Anxiety, Depression, Personality Disorder, and Trauma.

She described a range of initiatives that have been undertaken to try to reduce the number of people referred to secondary mental health care. These include:

  • The introduction of Mental Health Hubs, which aim to bridge the gap between primary and secondary care by providing a no wrong door access point for mental health services, and a holistic approach to assessing and meeting patient's needs.
  • The provision of Mental Health Practitioners in Primary Care Networks to provide expertise in GP surgeries, relieving pressure on GPs, and building relationships between primary care and mental health services.
  • The redesign of the ADAPT pathway to provide a clearer core treatment offer, and a time-limited service that aims to avoid patients being contained in services without treatment.

She said that clinicians have been refocused to deliver treatment, and that anecdotal evidence suggests this has been well-received by patients, because people like certainty. They like to know that they've got a clear plan for their job.

She said that the biggest causes of concern to clinicians are housing and drug and alcohol issues, because they are the most tricky to deal with.

She described how the Time to Talk service has been working to improve access to mental health care for specific communities, including faith groups, and said that work was underway to reduce the over-representation of young Black men in crisis services.

Integrated Commissioning

Lisa Wilson, the Integrated Director of Commissioning for Adults in Greenwich, gave a presentation about the commissioning of adult social care in Greenwich.

She said that Greenwich Council's health and social care budget is around £300 million per year, and that this excludes staffing and in-house services.

She described the Council's vision for the commissioning of adult social care as being about transformational change in the way we deliver our services for residents. She described this as a move from buying services to working with partners, addressing inequalities, and delivering the services that residents want. She said that this change had been informed by residents, staff and partners, and that it was important to get to the communities that are not being represented in our services at the moment.

She gave the following examples of successful initiatives:

  • The Joint Carers Strategy was developed by working closely with carers to understand their needs. This has led to initiatives such as the Greenwich Carers Centre and the Carers Partnership Board.
  • The new Assistive Technology Enabled Care (ATEC) service will provide digital technology devices to enable people to continue to live independently at home. This includes things like sensors to detect falls and devices to monitor vital signs. She said that the new service was unique because it was integrated from day one, meaning that people will get access to the support they need, whether it's a health need or a social care need. She said that residents were closely involved in the design of the service, and that she will invite Kit Collingwood, the Digital Lead in the borough, to return to the Panel in January to share case studies about the service's impact.

She said that the Council's vacancy rate in adult social care was 8%, lower than the national average, and that 48% of its care workforce come from outside the EU, indicating a high level of diversity in the workforce. She said that work is underway to ensure that care workers are paid a fair wage, including increasing the use of the London Living Wage in council contracts.

Panel members said that although the Council's vision for social care was really amazing it had not shown it as well as we could, because the report had presented high-level aspirational statements without backing them up with evidence. For example, the statement that the Council's health and wellbeing strategy takes a life-course approach with a focus on enabling our residents to live well and experience their best lives was described as meaningless, because it doesn't actually say anything. Panel members requested that future reports include more plain english, specific examples of work that has been done, and stories from residents who have benefitted from the council's work.

A member of the public, Elizabeth Muncy, asked why the Source at 65 Septhorpe Road in Horn Park was only open for six hours a week, despite strong demand from the community. She described how parents and carers were desperate for access to timely services that stop people becoming iller than they need to be. She said that the service, which is delivered by Oxleas, is only open to patients registered with a Greenwich GP and that there appears to be no provision for under 18s, despite the presence of a qualified nurse practitioner. She described how practitioners are working without reliable internet access, and how she had struggled to get an appointment with her own GP.

Councillor Lolavar said that neighbourhood health plans will be reviewed by the Panel at its next meeting on 23 January 2025, and that this will be an opportunity to get more detail about what is happening at the Source.

Ms Wilson responded that the service is being redesigned in response to resident feedback and that this includes increasing the number of hours the service is open for, working to enable residents of Lewisham to access it, ensuring reliable internet access, and providing more consulting rooms.

Ms Muncy said that the service should also be made accessible to under 18s, to address the poor mental health of young people, and that there was a need for more community space on the Horn Park estate.

Ms Wilson said that under-18s will be considered as part of the redesign of the service. She also described how the service had been used to support people who had been brought to the country under certificates of sponsorship to work in social care, and that the Council was working with the police and the Salvation Army to ensure that these workers are properly supported, and are not being exploited.

Commissioning of Future Reports

The Chair noted that the Panel had previously requested an item about the financial decisions made by the South East London Integrated Care Board (SEL ICB), and asked Councillor Mark Murray to provide more detail about what the Panel wants to know so that it can be discussed at the next meeting on 23 January 2025.

Councillor Murray said that the proportion of the overall health budget spent on mental health has gone down, and that he wants the ICB to explain why they have made this decision, what the consequences will be, and what their future plans are.

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