The Health and Adult Social Care Scrutiny Committee of Nottingham City Council met to discuss the Nottinghamshire Healthcare NHS Foundation Trust's Integrated Improvement Plan and the mental healthcare support available through Talking Therapies and Step 4 services. Key decisions included requesting the finalised Integrated Improvement Plan and recommending the development of effective key performance indicators.

Nottinghamshire Healthcare NHS Foundation Trust - Integrated Improvement Plan

Dr Susan Elcock and Jan Sensier from the Nottinghamshire Healthcare NHS Foundation Trust (NHT) presented a report on the development of an Integrated Improvement Plan to address issues highlighted by the Care Quality Commission (CQC). The plan is being phased for effective implementation and focuses on five key areas: Patient Safety and Quality Improvement, Leading for the Future, Finance and Productivity, People and Culture, and Governance.

Key Points Discussed:

• Patient Safety and Quality Improvement: Immediate actions are being taken to address the Section 48 review recommendations, including projects like waiting well, crisis service delivery, and proactive risk management.
• Leading for the Future: Emphasises the need for strong clinical leadership and standardised operational processes.
• Finance and Productivity: Aims to tackle an operational deficit and improve financial management.
• People and Culture: Focuses on staff engagement, retention, and workplace culture improvements.
• Governance: Establishes systematic processes for monitoring and delivering change, including the development of an electronic patient records system.

The Committee raised concerns about the safety of patients placed in private mental health settings like the Priory Hospital, Arnold, and the effectiveness of NHT in gathering patient feedback. They also questioned the timeliness of recognising organisational issues and the balance of resource allocation between local services and Rampton Hospital.

Resolutions:

1. Request the finalised Integrated Improvement Plan and its timetable.
2. Request details on current referral and rejection rates for Local Mental Health Teams.
3. Recommend the provision of a local women-only ward for acute mental health emergency care.
4. Recommend the development of effective key performance indicators.
5. Recommend publicising patient feedback to demonstrate its impact on improvement planning.

Talking Therapies and Step 4 Psychotherapy Services

Lucy Anderson and Kate Burley from the NHS Nottingham and Nottinghamshire Integrated Care Board (ICB), along with representatives from NHT and Vita Health Group, presented a report on the Talking Therapies and Step 4 services. Talking Therapies, commissioned in 2023, aims to reduce health inequalities and integrates community mental health practitioners into Step 4 services.

Key Points Discussed:

• Service Provision: Talking Therapies provides Step 2 and Step 3 services, with referrals to Step 4 for more complex cases. Step 4 services offer a range of therapies for serious and complex cases, with waiting times currently around nine months.
• Community Engagement: The Community Engagement team targets under-represented communities and gathers feedback to improve service access.
• Equality of Access: Efforts are made to ensure services are accessible through various referral routes and formats, including face-to-face sessions and interpretation services.

The Committee raised concerns about the limited information available online about Step 4 services and the capacity and resilience of services. They also discussed the need for longer-term psychological therapy and the impact of the closure of the Centre for Trauma, Resilience and Growth.

Resolutions:

1. Request further information on the closure of the Centre for Trauma, Resilience and Growth.
2. Recommend publishing more information on the Step 4 service offer.
3. Recommend assessing the need for longer-term psychological therapy.
4. Recommend pursuing parity of esteem between physical and mental healthcare needs at the national level.

For more details, you can refer to the Minutes of the meeting.