10. IJB Report MH Recovery Renewal Sept 22FINAL
North Ayrshire Council · 22 September 2022
Back to Integration Joint Board — 22 September 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Integration Joint Board 22 September 2022 Subject : Recovery & Renewal for Mental Health Purpose : To update for awareness and discussion on the Scottish Government Programme of work for Mental Health Recovery & Renewal investment and service development in alignment with Scottish Government strategic priorities. Recommendation : The IJB receive an update on the programme of work for Mental Health Recovery and Renewal and endorse and support. Direction Required to Council, Health Board or Both (where Directions are required please complete Directions Template) Direction to :- 1. No Direction Required √ 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership 1. EXECUTIVE SUMMARY 1.1 Mental health services in Ayrshire and Arran have continued to work in alignment with the local Ayrshire Mental Health Strategic Priorities aligned to the national Mental health strategic priorities (2019 to 2027) and the ‘Transition and recovery plan for Mental health services’ as outlined by the Scottish Government in response to the pandemic. It addresses the challenges that the pandemic has had, and will continue to have, on the population’s mental health. In alignment with the plan for recovery the Scottish Government have established a £120 million Mental Health Recovery and Renewal Fund. The total amount of investment to date for Ayrshire and Arran is £18,763,480 with further investment announcements awaited in 2022. The Mental Health renewal investment allocated to Ayrshire and Arran recovery and renewal plans for Mental health continue to deliver targeted actions to ensure a whole system response to the presenting challenges of rising demand with new developments implemented over the last 2 years including key developments in promotion of wellbeing, early intervention approaches, meeting increasing demand and assertive waiting list management and reduction of waiting times.
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The total amount of investment to date for Ayrshire and Arran is noted Appendix 1, along with further allocations for Mental Health Services. There remains further investment to be announced this year to distribute the full £120m. The Mental health workforce is expected to increase subject to successful retention of all investment by approximately at least 100 WTE during 2022. 2. BACKGROUND 2.1 Mental Health mobilisation plans have been developed to continue to focus on renewal, recovery, and improvement of mental health services across Ayrshire and Arran. Including tackling the challenges that the pandemic has presented, and the impact this will continue to have, on the population’s mental health in the context of rising demand for mental health care, both as a direct result of the pandemic, the impact on society as a whole as a result of restrictions and the continuing context of social and economic crises. 2.2 The Scottish Government have developed a more detailed programme of work for the Transition and recovery plan for Mental health in the context of the current investments. The Plan outlines 6 key commitments in relation to mental health services. Working with NHS Boards, mental health professionals and service users to: 1. Implement a programme of national support to Boards based on key themes emerging from the remobilisation plans. 2. Focus on supporting all NHS Boards to respond effectively to the anticipated increase in demand in the months ahead. 3. Set out care standards across mental health services which align with the needs and expectations of the people of Scotland. 4. Continue work to improve the quality and safety of services. 5. Modernise pathways into mental health services from primary and unscheduled care services; and 6. Continue critical work to address unacceptably long waiting times. 2.3 Investment and workforce Implications In alignment with the plan for recovery the Scottish Government have established a £120 million Mental Health Recovery and Renewal Fund. The Fund supports the delivery of actions set out in the Mental Health Transition and Recovery Plan to respond to the mental health need arising from the pandemic, and will also benefit the full agenda for mental health and wellbeing in line with the four areas of key need set out in the Plan. This is a significant investment in these services nationally with the planning assumption that this funding will be provided on a recurring basis.
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2.4 The MH renewal investment allocated to Ayrshire and Arran recovery and renewal plans for Mental health continue to deliver targeted actions to ensure a whole system response to the presenting challenges of rising demand with new developments implemented over the last 2 years including key developments in promotion of wellbeing, early intervention approaches, meeting increasing demand and assertive waiting list management and reduction of waiting times. A Pan Ayrshire service leads meeting with the Scottish Government Mental Health division has been established since April 2020 to enable monitoring of pandemic response in relation to Mental health delivery, engagement, learning, support, and oversight of progress against the Mental Health recovery and renewal plan. 2.5 In addition, non-recurring funding of £1.1m for Ayrshire and Arran was announced on 29th March 2022 to improve the mental health estate and infrastructure to support service efficiency, capacity, waiting times response and patient safety and improve the physical environment for both staff and service users. Criteria for access to the funding should support the delivery of at least one of the following areas: • Quality & amenity of built environment • Person centred delivery • Service efficiency • Capacity and waiting times improvements • Risk management and patient safety With two or more of the following benefits should be delivered: • Fit for purpose spaces which enables the delivery of services in innovative ways which improves models of care in public facing spaces • Ensure spaces and resources make service users feel safe and supported and are co-designed with those with lived experience • Improve accessibility, joint working and access to increase capacity in order to reduce waiting times or increase flow within clinical systems • Support Transformation in the delivery of services in public facing facilities to ensure this enhances access and high-quality care • In outpatient settings, offers access to novel hybrid models of care, both face to face and digital interventions • Improving the safety of service users in appropriately designed facilities • Improved patient pathways and care by co-location of services, work smart principles and increased joint working • Enable staff to have the right equipment, environment and resources in order to offer high Calibre care and feel valued in their roles. Development of plans for this resource aligned to the current estate and infrastructure have been led by North Ayrshire as lead partnership in consultation with East and
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A mental health infrastructure steering group for the programme of work to review and prioritise funding ‘bids’ has been established in alignment with the infrastructure funding allocation to support service leads to enable interim accommodation solutions to be identified and developed in alignment with the timescales established by the Scottish Government facilities funding programme of recovery whilst all partners continue to work on long term infrastructure ambitions described within the Caring for Ayrshire priorities programme. Key areas of development include: • West road refurbishment to enable tailored CAMHS accommodation solutions • Implement proposals for revised use of ward 7B at Woodland view • Extend availability of access to community mental health, learning disabilities and addiction service provision/clinics and group work with appropriate accommodation • Implement and extend scope of Digital solutions 2.6 Communities Mental Health & Wellbeing Fund The Scottish Government also allocated a Communities Mental Health & Wellbeing Fund established with £15 million allocated nationally to support mental health and wellbeing in communities across Scotland. The award for North Ayrshire totalled £407,213. Total applications in round 1 amounted to £1,169,973, leaving a funding gap of £762,760. North Ayrshire Council contributed an additional £353,134 plus £52,999 underspend from the Children, Young People and Families wellbeing framework underspend, providing a total grant pot of £813,345. The fund was distributed by Third Sector Interfaces (TSI) in communities across Scotland. The fund aims to support adult (age 16+) community-based initiatives to help address the impact of distress and mental ill health caused by social isolation and loneliness, as well as addressing the mental health inequalities made worse by the Covid-19 pandemic. 2.7 The fund aims to take a preventative approach and allow communities to develop their own solutions, including developing stronger partnerships. Grass roots, community groups and third sector organisations will be able to benefit from the funds to deliver activities and programmes to help people to re-connect and revitalise communities, building on examples of good practice which have emerged throughout the pandemic. The Fund seeks to contribute to the four key areas of focus from the Mental Health Transition and Recovery Plan:
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• Promoting and supporting the conditions for good mental health and wellbeing at population level • Providing accessible signposting to help, advice and support • Providing a rapid and easily accessible response to those in distress • Ensuring safe, effective treatment and care of people living with mental illness The Fund also seeks to contribute to the following national outcomes from the National Performance Framework: • We are healthy and active • We will live in communities that are inclusive, empowered, resilient and safe • We tackle poverty by sharing opportunities, wealth and power more equally 2.8 The intended outcome of the Fund is to develop a culture of mental wellbeing and prevention within local communities and across Scotland with improved awareness of how we can all stay well and help ourselves and others. The response to the allocation of Wellbeing funding has been critical to the recovery of local communities with a programme of work which has been led and coordinated by North Ayrshire TSI with to date, almost 10,500 people directly benefitting from support through funded projects including: • Ayrshire Cancer Support have developed an early intervention and wellbeing support to North Ayrshire residents aged 16 and upwards affected by cancer • St Peter’s Centre Flying Start Toddler group has reopened following the pandemic. They offer classes and experiences that benefit the parents and children under three years who have suffered from social isolation since March 2020, many of whom have had no opportunity to mix with other children. • Cruse Bereavement Care Scotland have set up a support project across North Ayrshire which will provide Early Support sessions for people within the first six months of bereavement, listening and support sessions and a helpline for immediate help and advice. • Touched by Suicide have set up a service to support individuals bereaved by the suicide of a family member or friend. They aim to encourage individuals to reengage with society after covid19, as well as reduce isolation and widen their social circle • Capall Dorcha Theatre Company in collaboration with Seahorse Books and YES, Your Entire Self ran a 6-week "Writing for Wellbeing" course. • YES, Your Entire Self has introduced a range of group within the Largs area, targeting people with mental health challenges. • Mary Davies Trust – Getting There Project was set up to provide the residents of Arran a range of holistic therapies, mostly delivered outdoors, provided by professional therapists, that are designed to support an improvement in mental health and well-being. • CHAP have based a Financial Wellbeing + Inclusion Advisor within the Kilwinning Community Sports Club for 3 days a week and in doing so have seen a significant growth in their referral numbers in this area
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• Kilwinning Community Sports Club / Sliding Doors has started a weekly drop-in session where their mental health professional facilitates an interactive workshop promoting topics around improved understanding of mental health and copying strategies for people to use on their own. • Beith & District Community Council have installed four NHS "Breathing Space" mental health benches on four different sites within the town, providing helpline numbers to support suicide prevention. • Re-emergence of community gardens and men’s sheds across the communities of North Ayrshire following the pandemic has brought a much needed informal, local community approach to supporting people who have been isolated and struggling with their mental health. • The KA Leisure Doorstep Programme, that started in response to the COVID-19 pandemic, has now been expanded into a structured North Ayrshire Doorstep Delivery Support Programme which forms an integral part of the wider Health & Wellbeing Service delivered by KA Leisure's Active Lifestyles Team. • Woodland Wakeup have expanded their service to empower vulnerable adults, as well as children and young people, who are struggling with mental health issues, isolation, low confidence and self-esteem and many other health and wellbeing issues, while giving them ownership of the creation of a support network that can continue long after the programme ends. 2.9 Rising demand & Scale of the challenge The level and acuity of demand has intensified as the mental health, social and economic impacts of the pandemic and the cost-of-living crisis continue to unfold. Over the last two years Mental health services have experienced reported increases in severity of clinical presentations and are supporting seriously ill patients who had previously not had contact with mental health services. CAMHS services are consistently reporting that adolescents of younger than usual age are presenting with severe presentations of mental ill health such as psychosis, suicidality, and severe depression. The Scottish CAMHS Eating Disorders Steering Group has reported a 200% increase in eating disorder referrals in the first quarter of 2021 compared to the same period in 2020. Local examples of increased demand include referrals to CAMHS which are continuing to increase Comparison of Qtr. 1 (April – June) Accepted Referrals
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Despite unprecedented increase in demand CAMHS continue to meet 18-week referral to treatment HEAT target. There has been a 55% increase in referrals to eating disorders, 14% increase in crisis response team referrals, 77% increase in police triage pathway, 26% increase in addiction service caseloads, 50% increase in MHO work with inpatient services frequently operating at 100% occupancy with an increase in the number of young people admitted to adult wards. 2.10 Acute Mental Health Inpatient Services Occupancy in our adult and elderly acute wards has been over the 85% optimum level for most of the pandemic and this trend has continued throughout 2022. 2.11 A significant area of challenge for Elderly Mental Health (EMH) inpatient services remains length of occupancy with a high number of delayed discharges due to lengthy Guardianship processes. Notably 60% of EMH Organic assessment beds are occupied by persons subject to delayed discharge, with many of these Guardianship delay related. This in turn can result in EMH patients with functional presentation to board into an Adult Mental Health (AMH) acute bed, also reducing that capacity. 170 522 595 0 100 200 300 400 500 600 700 Qtr 1 2020/21 Qtr 1 2021/22 Qtr 1 2022/23 90.7% 95.5% 95.2% 98.7% 97.2% 98.4% 75.0% 80.0% 85.0% 90.0% 95.0% 100.0% Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 % OL 207 % increase 14% increase
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Detainments under the mental health act have risen by 17%, and notably Emergency Detentions, Short Term Detentions and Compulsory Treatment orders. There has been an exceptional number of staff associated with enhanced observations across all areas reflecting the acuity of those currently in inpatient care. 2.12 Mental Health Practitioners (MHP) Recent analysis of North Ayrshire MHP activity evidenced approximately 50 contacts per working day. The placement of MHPs within GP Practices has enabled a reduction in inappropriate referrals to secondary services whilst signposting persons to more relevant support. Ayrshire and Arran now have 34.3 wte MHPs in post. 2.13 Access to CAMHS RTT has been sustained throughout the year but demand on services continues to increase. 2.14 During COVID and the subsequent lockdowns the service maintained clinical care via NHS Attend Anywhere and telephone consultant with face-to-face contacts only where necessary. The service is also returning to face-to-face contacts with 69% of contacts (Jan – Jun 2022) delivered in clinic compared to 51% (Jan – Jun 2021). 2.15 Access to Psychological Therapies Performance towards the Access to Psychological Therapies RTT has been achieved twice during past six months. However, although some months are under the 90% standard, the compliance rate is very close. 97% 96% 99% 94% 98% 98% 0% 20% 40% 60% 80% 100% Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22
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2.16 Community Mental Health services (CMHT) In alignment with rising demand and acuity of Mental health presentation complexity there has been a significant increase in referrals to the North CMHT over the last two years without significant increase in staffing, in 2021 there were 1,000 more referrals than 5 years ago, with total referrals to the service 2,670. Workforce capacity continues to be a challenge across all community Mental health services due to increased demand. All services are currently reviewing workforce plans in alignment with Scottish Government Primary care mental health investment. It is important to note however that the Mental Health recovery and renewal plan does not include direct investment for Community Mental health teams other than a welcome investment allocation for increased MHO capacity which has been facilitated through separate investment in Social Work capacity. There are ongoing national and local programmes of work to review models of delivery, workforce plans and core principles and standards for community Mental health services. There are infrastructure challenges and availability of appropriate estate from which to deliver services with future investment needed to address these in the long term. The infrastructure funding allocation will enable short term risks to be addressed, particularly in improving the clinical environment and also to expand the footprint of accommodation in line with the growing workforce. More sustainable investment in infrastructure is required for long term delivery and this will be taken forward in line with Caring for Ayrshire. 2.17 The RISE (Resilience in Stressful Events) Team The team are aligned to the Forensic Mental Health Team a new service launched in January 2022 to support people involved in the judiciary system has received 55 referrals to date and is providing specialist psychological support for those experiencing emotional dysregulation, suicidal ideation, and stress. 88.7% 88.7% 93.7% 88.0% 90.6% 87.8% 60.0% 65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 95.0% 100.0% Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22
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3. PROPOSALS 3.1 Key areas of development & recovery response Development of Mental Health Governance, Leadership Transformation support. The national recovery and renewal plan includes a yet to be defined allocation to increase governance, transformation, and professional leadership support for Mental health services. It has been imperative to develop professional leadership and service improvement to support the programme of recovery and although this fund has not yet been allocated Lead Partnership for Mental health services through the Pan Ayrshire collaboratively agreed Mental Health Resource allocation group have developed a care pathway co-ordinator role (1 WTE) and a multiagency suicide prevention training team (2 WTE) which enable a cohesive approach in delivering training across the system taking into consideration the requirements of local communities for training. In addition to this the Associate Nurse Director for Mental health is currently reviewing professional nurse leadership roles to increase capacity for professional leadership support and governance to reflect the demands of significant service expansion and development within a critically short timeframe. CAMHS, & Community Eating Disorder Services Funding has been allocated in 2021 for Ayrshire and Arran of £2,393,273 for increase of CAMHS, and psychological therapies (PT) workforce to implement new national specifications and national review recommendations. This funding is also allocated to support clearing waiting times backlogs for CAMHS, and PT. Recruitment is currently underway for additional Psychologists, CAMHS and Eating disorders workforce to meet increasing demand. This includes additional workforce for a newly developed neurodevelopment diagnostic and support service and a new CAMHS Unscheduled care service. External capacity from expert Neurodevelopmental Assessment providers has been agreed and contracts signed to allow patients to be referred for ASD assessment. There are assertive plans in place to respond to the Scottish Government announcement on 18 June 2021 £5 million of funding for financial year 2021/22 to respond to the recommendations from the National Review of Eating Disorder Services with £328,213 confirmed for Ayrshire and Arran. There will be a combined anticipated additional workforce of at least 50% for CAMHS, Neurodevelopment, Unscheduled Care and Eating Disorders workforce, including Administration Staff. In complement to this and enabled by significant service development opportunities CAMHS has also increased clinical leadership and quality improvement workforce. The expected service redesign and focus of CAMHS as per the new National Specification, published by the Government in February 2020, clearly articulates the role for Tier 3 specialist services and the accompanying Neurodevelopmental Specification creates clarity around function and purpose of the service.
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The Mental Health and recovery and renewal investment is also aimed to enable the delivery of unscheduled access to children and young people presenting in Mental Health Crisis and Psychological distress, in School, at ED or in the community. This new service will operate from 7am to 9pm and requires to be based in near proximity to Paediatric in-patient services and ED where a significant number of presentations are referred from. This is not a service, like the Liaison and Crisis Services offered by Adult Mental Health services which can be offered remotely as the clinical need is often associated with risk and distress. Community Eating Disorder Services have nationally been the focus of significant review and recent recommendations have been published with funding to implement them allocated in September 2021. The current model has seen no real time investment in over 12 years and now expansion of workforce is expected with funding in place. The need for physical health monitoring of this patient population means that only a small amount of the work being offered can be done remotely as observations must be conducted. Managing weight restoration is also a face-to-face operation as is mealtime support. Staff for this service require a larger base for the expanding workforce. The new Foxgrove National Secure Adolescent Inpatient Service which will become operational in 2023 is a National Services Division for NHS Scotland commission. The facility is designed and will be built to ‘Medium Secure’ standards and provide assessment, treatment, and care for significantly vulnerable young people subject to restriction and detention. It is therefore critical that this National Service and its Leadership Team have adequate facilities to implement the service in collaboration with other established services on the ACH site. Regional CAMHS Developments (West of Scotland) To support child and adolescent mental health and as part of the Mental Health Recovery and Renewal Fund, Boards within the West of Scotland have been given £6.2m collectively to support the development and implementation of regional components of Child and Adolescent Mental Health Services (CAMHS) ensuring there are also clear links to the new national service provision. Boards are asked to work across the region to establish and improve the consistency of care offered and to do so in a timelier manner. The West of Scotland (WOS) CAMHS region for the purpose of this work consists of NHS Ayrshire and Arran, NHS Dumfries and Galloway, NHS Forth Valley, NHS Great Glasgow and Clyde and NHS Lanarkshire. The Argyll and Bute area have also expressed an interest to join the West of Scotland Region in developing the proposed programme due to the closeness of the geographical area to the West of Scotland and the interconnection with NHS GGC services. Dr Helen Smith our Ayrshire and Arran CAMHS Clinical Director is the Clinical Lead for West of Scotland CAMHS.
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There has been a request to develop a number of services regionally. This includes development of Intensive Psychiatric Care Units (IPCU) and the other areas listed below. There is currently only one regional service in CAMHS in the WOS; this is the adolescent inpatient unit of Skye house. There are no regional community CAMHS services and previous regional work has identified gaps in the liaison services, home intensive treatment teams as well as in supporting the out of hours access to CAMHS. The amount of money assigned to the area of development is below. The figures listed below are for a full year of award. Area for developmental Award for the WOS area Paediatric liaison services £1.5 million Home Intensive Treatment teams £1.5 million Intensive Psychiatric Care Unit £1.6 million Unscheduled Care teams (Out of hours) £1 million Forensic CAMHS/Secure Care/ LD CAMHS £600,000 Total: £6.2 million The planning and project management, information analysis and clinical leadership resources have been identified as the requirements to enable the regional development programme to commence. This will provide capacity to develop more consistent pathways and models of care to support children and young people to access the right support and care through a more networked service approach recognising the flow between local and regional services. Psychological services In addition to the SG Recovery and Renewal Funds focused on clearing PT waiting time backlogs and increasing access to PT, further local and SG funding for specialist Psychology has been awarded to develop and expand psychological provision to local and national strategic priorities of Staff Wellbeing, patients hospitalised due to COVID-19 (Cossette report) as noted above, Modernising Patient Pathways Pain Programme in Primary Care, Weight Management, Maternity/Neonatal/Perinatal, Trauma Neuro-rehabilitation beds and the development of a Trauma-Informed workforce. Most recently, further SG funding has provided a Clinical Psychology post as part of developments toward the Substance Use Medication Assisted Treatment standards, a dedicated Lead Psychology post to an enhanced multi-disciplinary Care Home Liaison team, and two Clinical Psychology posts to expand the Maternity/Neonatal/Perinatal service provision to include Infant Mental Health. The local Veteran First Point Service has received support from the three Partnerships for recurring funding; this sustainability provides a stable platform from which A&A can progress implementation of the SGs Action Plan for dedicated holistic veteran service provision. These developments provide new and expanded pan- Ayrshire psychological provision to patients and staff across all clinical sectors of MH, Acute, Primary Care and Third Sector. The total additional Psychology workforce will be around 28 permanent WTE.
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Psychological services have been able to work with digital solutions during the pandemic, however, still require rostered access to clinical spaces within service areas of practice and to facilitate therapeutic group work. Primary Care Mental Health It is the vision to create a Mental Health and Wellbeing service for Primary Care that is consistent across Ayrshire and Arran. Work will continue over the next few years to develop detailed plans. It is the ambition that by March 2026, the service will be a multi-disciplinary team composed of Mental Health Practitioners, Community Link Workers and Occupational Therapists. Self-help Workers, Enhanced Psychological Practitioners (EPPs), Administration and other roles will also be under consideration as detailed planning is completed. At present, the multi-disciplinary team offers a triage and assessment service predominantly for adults (although younger age ranges are available within some areas). At present there is limited scope for treatments. It is the anticipation that as staff levels rise, the age range and treatments offered will expand to all ages and a limited range of short treatments. Online treatment options and group sessions are areas that will be explored alongside more traditional psychological therapies. There are great benefits to having these roles working directly in GP Practices, however, as the team grows in numbers so too will the space requirements. The first year of funding (2022/23) for the Mental Health and Wellbeing in Primary Care Service is still awaiting allocation and will focus on the recruitment of Mental Health Practitioners whilst taking time to scope subsequent years of funding and actions in greater detail. Community Mental Health Social Work & MHO Team A Mental Health Officer test of change has been implemented during 2020/21 that had separated the Mental Health Social Work service into two distinct teams – Mental Health Officer (MHO) Team and a Care Management Team. It demonstrated the inherent benefits of this two-team model approach particularly around the increasing workload across both teams and the significant increase in Mental Health act work. This test of changed proved invaluable during 2021 in relation to Mental Health Act workload. Funding has now been allocated to ensure the permanency of this model with recruitment underway to substantiate the service moving forward. Additional Investments National Mental Health Strategy Action 15 Ayrshire and Arran have received additional £1.08m MH Strategy funding for action
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15 during 2021 and have recruited additional occupational therapists based in Primary care settings, additional nurses for Unscheduled care to uplift capacity for elderly mental health and Police Scotland Pathway due to increasing demand and to introduce a new Scottish Ambulance Pathway. In addition, the development of a new Alcohol and Drug service has been established with an MDT model, including peer recovery workers. An allocation for prison, custody, and justice services, has enabled the recruitment of an additional specialty doctor and speech and language therapist with police custody recruiting nurses via available monies. The funding allocated has enabled a total increase in workforce of 35.8 WTE. Further to this the Community Forensic Team were also successful in gaining Action 15 funding to develop a Court Distress Intervention service (called RISE). This functions as a sub-team operating under the Forensic Team umbrella and monies were granted to allow the recruitment of a total of 9 WTE staff. Additionally, there has been investment in a Distress Brief intervention service funded with £300,000 of MH strategy action 15 funding. This service launched in 2021 with Penumbra commissioned to provide trained staff to deliver a compassionate response to anyone 16 years and above presenting with distress. Contact is made with the person within 24-hours of referral with the offer of compassionate community-based problem-solving support, wellness, and distress management planning, supported connections and signposting for a period of up to 14 days – connecting people to the supports that help them over time. PAN-Ayrshire Unscheduled Care Mental Health Services Following significant Action 15 investment and service redesign Unscheduled Mental Health services have relaunched with Adult Liaison, Elderly Mental Health Liaison, Alcohol and Drug Liaison, Intensive CPN team (previously CRT) and Mental Health ANPs all being delivered under a single remit. This will allow more flexibility across the service as well as enhancing working relationships within the service. New shift patterns have been adopted within Adult Liaison and MHANPs which enables MHANP cover 24/7. There has been a 10% reduction in mental health presentations to the Emergency Department when comparing Jan-June 2021 to Jan – June 2022 following the opening of the Flow Navigation Centre. In addition, Unscheduled Mental Health Care services has introduced an Ambulance pathway to complement the long-standing and effective Police Pathway. The new Alcohol and Drug Liaison Team replaces the previous Alcohol Liaison Team as well as the Non-fatal Drug Overdose Pathway. This team was launched on the 1st April and operates 7 days a week 9-5.
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National Strategic development Overview 2022 The programme of work for Mental Health recovery and renewal is being delivered against a backdrop of significant strategy development and underpinning Scottish Government investment. A new Mental Health and Wellbeing Strategy is currently being developed with an ambition to ensure that this is evidence based, data and intelligence driven, outcomes focused, underpinned by equality and human rights, and informed by lived experience with a focus on wellbeing and prevention. It is intended that this will enable a clear vision to meet changing Mental Health needs over the coming years considering social factors and inequalities that may impact a person’s mental health and wellbeing. In the Strategy, the approach to supporting the workforce will be laid out building upon the principles and actions set out in the National Workforce Strategy for Health and Social Care. Following on from the Strategy’s publication, a more detailed Workforce Plan will be produced for 2023. Mental Health services in Ayrshire and Arran are contributing the national workforce benchmarking exercise which is continuing to analyse and compare workforce data for Scotland and across the wider UK. This has focused on inpatient and community mental health service provision with an analysis of provision and activity reported within adult/older mental health and children and young people’s mental health services. Key findings during 2021 from this work have demonstrated that there is greater inpatient capacity per capita, strong utilisation of video consultations, impact of Covid-19 seen across adult/older adult and children and young people’s mental health services. The mental health workforce analytics for secondary specialist Mental health services have shown that although service models differ between Scotland and the wider UK there are greater workforce numbers reported per driven by good access to inpatient services with a strong nursing skill mix evidenced in contrast to wider UK dataset. There is however considerable variation seen between Health Boards. North Ayrshire as the Lead HSCP in Ayrshire and Arran will continue to contribute to the national benchmarking work which will be instrumental in further developing workforce plans linked to recovery and renewal. This work will be instrumental in the development of community mental health services where recent caseload analysis exercises have demonstrated a significant workforce gap to meet current service demands. There are other national programmes of strategic development currently underway and including: • Mental health Law review • A new Suicide prevention strategy • ACE’s & Trauma Strategy • Self-harm Strategy
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• MWC Strategic plan development 3.2 Anticipated Outcomes • Delivery of care standards across mental health services which align with the needs and expectations of the people of Scotland. • Continue to work to improve the quality and safety of services. • Modernise pathways into mental health services from primary and unscheduled care services; and • Continue critical work to address long waiting times and improve access to services. 3.3 Measuring Impact National and local programmes of work are underway to improve the data set for Mental health services including delivery against national quality indicators for Mental health and development of local performance dashboards and KPI’s in alignment with Mental health strategic priorities and plans. CAMHS has commissioned Benson Wintere, a workforce scenario planning tool to develop a live dashboard of referral activity, caseload, and workforce analysis to enable improved targeting of workforce resources to areas of locality priority. Ayrshire and Arran continue to perform well compared with the rest of Scotland against national targets with CAMHS continuing to meet 18-week referral to treatment HEAT target and psychological therapies very near to meeting this target consistently. The waiting time compliance for access to Psychological Therapies (PT) in April 2022 report was 88.9% against the 90% standard. The new Mental Health & Wellbeing Strategy will be outcomes focused. The draft outcomes have been split into 6 categories: addressing the underlying social factors; individuals; communities; population; services and support; and information, data and evidence. 4. IMPLICATIONS 4.1 Financial The financial allocation is noted in the content of this report. It is important to note that not all national commitments have yet been allocated. The Primary Care investment for year 1 has still to be allocated alongside other intentions which have not been announced to date. These include another phase of funding for psychological services. The SG are undertaking a spending review which may have implications for further funding in 2022/23.
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4.2 Human Resources There are significant workforce expansion implications associated with recovery and renewal, with increased workforce capacity and new service developments launching both nationally and locally. A national workforce plan is currently being developed and Ayrshire and Arran Mental services are currently developing workforce plans in alignment with SG expectations for recovery and renewal delivery and local strategic plan priorities. 4.3 Legal None 4.4 Equality/Socio-Economic The recovery and renewal plan for Mental health reflects the aim of improving access to services and reducing health and social inequalities to improve mental wellbeing for all. 4.5 Risk There are risk factors associated with successful delivery of the recovery and renewal plans including: • Pace of change and services developments within defined timeframes to successfully access SG funding – access to Transformation and leadership capacity to maintain progress and pace. • There are elements of non-recurring funding (including Infrastructure) for which sustainability plans need to be identified • Timing of financial allocations is often later in the financial year which prohibits effective forward planning and assertive recruitment programmes • Infrastructure challenges – access to suitable estate, digital/IT solutions, and HR capacity • Workforce supply, training, and access to specialist professional disciplines – attraction of national workforce is a necessity to avoid destabilise the current workforce supply within Ayrshire and Arran 4.6 Community Wealth Building Mental health recovery and renewal plans promote the principles of community wealth building and building community capacity particularly in the area of financial investment in local grass roots community initiatives. 4.7 Key Priorities Recovery and renewal plans align to both local HSCP strategic plan priorities and the Mental health Ayrshire conversation priorities alongside national strategic policy developments.
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5. CONSULTATION The recovery and renewal plans have been developed and updated locally through the following forums: • Pan Ayrshire MH strategic programme board • SG engagement sessions • Covid recovery ‘Silver’ group for Mental health services • MH Governance group • HSCP Health & Care Governance group • Strategic planning groups An engagement officer has been recruited to support the delivery of the CAMHS recovery and renewal plan with further engagement officers to be recruited for adult Mental Health and Learning disabilities services Caroline Cameron, Director For further information please contact Thelma Bowers, Head of Service, Mental Health, thelmabowers@north-ayrshire.gov.uk Appendices • Table 1 – Investment NHSAA
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APPENDIX 1 Mental Health - Recovery and Renewal Fund Priority Funding Area 21/22 Funding £ 21/22 Actual Spend £ Amount carried forward to 22/23 £ Basis CAMHS - Split as : 1) CAMHS Specification £1,091,463 2) CAMHS age 25 £623,402 3) CAMHS Waiting List £311,701 4) Psyc therapies waiting list £366,707 2,393,273 585,292 1,807,981 Pan Ayrshire Eating Disorder Service 328,213 328,213 Pan Ayrshire CAMHS IPCU 121,697 - 121,697 Pan Ayrshire CAMHS - Intensive Home Treatment 147,512 - 147,512 Pan Ayrshire CAMHS - LD 51,629 - 51,629 Pan Ayrshire CAMHS - Out of Hours Unscheduled Care 86,294 - 86,294 Pan Ayrshire CAMHS - Liaison 129,073 - 129,073 Pan Ayrshire CAMHS - Neurodevelopmental 225,693 - 225,693 Pan Ayrshire Psychological Therapies - tranche 2 285,598 - 285,598 Pan Ayrshire Dementia - Post Diagnostic Support 95,016 - 95,016 North HSCP Pharmacist and Technician recruitment 69,128 69,128 - Pan Ayrshire Wellbeing in Primary Care 40,122 - 40,122 North HSCP Infrastructure (non recurring) 1,106,337 - 1,106,337 East Ayrshire: 358,467 South Ayrshire: 340,657 North Ayrshire: 407,213
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Mental Health – Other Funding Allocations Funding Area 21/22 Funding 21/22 Actual Spend Amount carried forward to 22/23 Basis Cossette 103,320 53,505 49,815 Pan Ayrshire Perinatal and Infant Mental Health 425,862 191,344 234,518 Pan Ayrshire Innovation Funding 311,055 283,555 27,500 Pan Ayrshire Action 15 - original allocation 2,296,044 1,702,218 593,826 Pan Ayrshire Action 15 - Supplementary allocation 314,242 10,538 303,704 Pan Ayrshire MHO 68,000 North HSCP