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Attached - Home @ Bradford and Airedale Teaching Primary Care Trust

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Attached - Home @ Bradford and Airedale Teaching Primary Care Trust ...

    AIREDALE & NORTH BRADFORD PCTS PARTNERSHIP

    MENTAL HEALTH PROVISION UPDATE AIREDALE LOCALITY

1. Introduction

    The purpose of this report is to summarise findings so far on current mental health service provision within the Airedale Primary Care Trust (APCT) locality. It does this by briefly describing known commissioned services from the Bradford District Care Trust, services that are commissioned from the non-statutory sector within the Aire Valley as well as those services currently provided by the Primary Care Trust (PCT).

2. Primary Care Mental Health Provision

    Most primary care mental health is currently managed by General Practitioners and practice staff within the locality.

    The majority of statutory primary care mental health provision is currently commissioned from the Bradford District Care Trust and essentially consists of a counselling service currently based within the psychology department at Airedale General Hospital. This service is partly commissioned from the Care Trust by Craven, Harrogate and Rural District PCT to provide some practice based counselling with the Craven District. The counselling provision across the Aire Valley is limited and inequitable to practice based populations but provides a respected and invaluable service to primary care and secondary care mental health services. As the counselling service is managed within the psychology department there is much involvement of the psychologists regarding development and provision of counselling therapy services within primary care and the department also takes referrals direct from practices.

    Within Airedale PCT, exists a clinical nurse lead in mental health whom provides two sessions (one day) of clinical practice to Kilmeny surgery in Keighley. This role provides assessment of need and treatment within the practice for adults suffering from mental health issues that do not require enhanced care (care program approach) and where the client does not require referral to secondary care. The clinical nurse lead may direct the referral to more appropriate services. The clinical nurse lead also manages and assesses referrals for the Graduate Mental Health Workers (two) who provide guided self help clinics within the Aire Valley. These clinics, accessed by both primary and secondary care, currently run from Kilmeny surgery and Bridge House community mental health team. Other services provided by the graduate mental health workers include mental health promotion across the locality as well as supporting the clinical nurse lead in education, psycho educational groups, advice and service development within the PCT. The clinical nurse lead has become the centre point for mental health issues, clinical governance and development within the PCT.

3. Secondary/Tertiary Care Provision (statutory)

    All other provision of local statutory mental health services are commissioned from and provided by the Bradford District Care Trust (BDCT) under a service level agreement with the PCT. The Care Trust has current responsibility to provide services to children, adults and older people suffering from all mental health problems and existing arrangements across the Bradford District are in place to provide specialist treatment to people whom are unable to receive appropriate care from the Care Trust. This is with the exception of C:\convert\temp\63691799.doc - 1 -

psychiatric intensive care and insufficient capacity for admission in which case ‘out of area

    treatments’ are dealt with on an individual basis currently funded by the PCT. There are

    current agreed plans for a new inpatient build within the Airedale General Hospital site that

    will include provision of psychiatric intensive care beds under the direction of the care trust.

The existing services within the care trust currently consist of the following:

? Two acute in patient wards within Airedale General Hospital for adults.

? Two older peoples’ wards (over 65) within Airedale General Hospital.

    ? Three local community mental health teams for adults (CMHT), one in the Bingley

    locality, one in the Keighley locality and one for the Wharfe valley locality.

    ? Park View in Keighley, still houses some social service staff yet to join the local

    CMHTs.

? A psychotherapy service based at the Moorlane Centre in Burley in Wharfedale

    serving the Aire and Wharfe Valley locality.

    ? An inpatient rehabilitation ward at the Moorlane Centre in Burley in Wharfedale

    serving the Aire and Wharfe locality.

? A community rehabilitation team in Burley in Wharfedale serving the Aire and

    Wharfe locality.

? A child and adolescent community mental health service based in Keighley.

    ? An assertive outreach team currently based in Keighley serving the Aire and Wharfe

    locality.

? Access to both clinic based and CMHT based consultant psychiatrists.

    ? Three older peoples’ mental health teams providing functional and organic

    community mental health services across the Aire & Wharfe locality (two of these

    are currently based within the Airedale General Hospital site due to estate issues)

    ? A drug & alcohol service based in Keighley serving the Aire and Wharfe locality.

    ? North Bradford and Airedale crisis resolution service currently based in Bradford

    providing a 24 hour service, seven days a week for secondary and primary care

    referrals.

    ? Within Airedale General Hospital there is also a Mental Health Therapy unit who’s

    remit was to provide a therapeutic approach to those clients requiring more

    intensive therapy, the therapeutic centre acting as a base for A&E and hospital

    liaison as well as a crisis telephone line and an out of hours Community Psychiatric

    Nurse (CPN) service (9-5 Saturday & Sunday). The occupational therapy service for

    inpatients is also based within the therapeutic centre. These services are currently

    providing a minimal service and it is not yet clear of their actual and future provision.

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4. Non-Statutory Sector

Various organisation within the non-statutory sector in the Aire valley, are commissioned

    by the PCT to provide services to the community relating to mental health issues. These

    primarily appear to be therapeutic approaches to the community and up to date

    information on these services is still being gathered. There appears to be little recent

    performance management or service level agreement monitoring procedures in place.

    ? Versa a Keighley based organisation currently providing counselling services to

    the community. Referrals are taken from any source and a small charge is made to

    the client for the service. The counselling service within the Care Trust has been

    previously involved in helping Versa with policy and governance issues.

    ? Relate A nationally renowned service providing individual and couple counselling

    to the community. Recently the PCT has also commissioned a sexual abuse

    survivors group for women (the lily project) and a similar group for men (the shed

    project) which is currently being evaluated but initial findings are very positive.

    ? Roshni Ghar An Asian women’s centre focussing on mental health and well being

    providing support, education and advice individually and within groups as well as

    complimentary therapies. Established ten years ago this service has enjoyed

    support from staff within the Bradford District Care Trust which has recently been

    withdrawn. Roshni Ghar is currently offering reduced services due to financial

    difficulty and lack of management/service support.

    ? Cruise Offering bereavement counselling.

    ? Crossroads Mental health offering support to carers of people with mental health

    difficulties.

Clearly there are other voluntary/non-statutory organisations commissioned by the PCT

    that also offer support to users of mental health services or provide some emotional

    support to the community alongside statutory services; the above are those currently

    known that are specifically for mental health issues.

Out of Area Treatments

Should appropriate treatment not be provided by the care trust (e.g. psychiatric intensive

    care) or there is insufficient capacity to accept an admission, the Care Trust applies to the

    PCT to fund out of area or private treatment. The procedure for this request has been

    established between the PCT and the care trust.

Within this financial year there have been at least 8 placements out of area, two

    placements which have been ongoing for several years. During quarter three this has

    been reduced to two placements (both long term). The total estimated cost to the PCT at

    the end of quarter 3 will be approximately ?257,421. This figure is based on placements

    currently known.

Issues arising on initial findings

    There is very little primary care based mental health services within the Aire and Wharfe

    valley. Particularly in the Wharfe valley, the community mental health team have focussed

    much of their services on the needs of clients that could be seen in primary care should a

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service be available. This, in turn, affects the capacity to deliver a service to those

    suffering from a more severe and enduring mental health problem. Counselling is minimal

    and patchy across the area and formal cognitive behaviour therapy only exists with the

    care trust psychology department and not within primary care. The individual practices

    have managed a majority of those requiring mental health support in primary care.

Self help though available is minimal and only currently based within one GP practice.

Social inclusion and Citizenship does not appear to be developed within primary care

    mental health, only within existing developments in BDCT.

There has been no movement in developing community development workers for black

    and ethnic minorities (BME) for mental health within the PCT.

There has been no development of gateway workers (though it could be argued that the

    clinical nurse lead provides this service in one practice).

Traditionally, secondary care services have enjoyed a good relationship with primary care

    within the Wharfe and Aire valley though due to depleting resources, particularly within

    adult mental health, this has at times been strained and development within primary care

    kept to a minimum.

The clinical nurse lead has been the only senior clinician providing mental health services

    and advice with the exception of the GP lead in mental health. This clearly has affected

    the capacity to develop further mental health services within primary care.

Service level agreements for other commissioned services require both updating and

    formal procedures for monitoring agreed provision, need to be in place. There is little

    known currently about the services commissioned from a majority of non-statutory bodies.

The care trust is currently proposing a restructuring of community mental health services

    across the Aire valley (paper attached). This has generated much anxiety within service

    users and carers as well as primary care and discussions need to be taken forward

    regarding this (actioned).

Recommended Actions

    ? The development of a primary care mental health service providing counselling,

    CBT, clinical governance, advice and sign posting to primary care. This will provide

    a formal contact and identity for mental health professionals within primary care and

    support existing work.

    ? Further development of guided self help and mental health promotion across the

    Aire and Wharfe Valley

    ? Development of social inclusion project within the PCT locality.

    ? Initiate plans to work alongside the Focussed Implementation Site project to

    develop community development workers within the locality and consequently focus

    on the BME community needs. This may also provide needed support for existing

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? Develop clear pathways of access and care through the creation of a gateway

    worker service.

    ? Review of current hospital based services within the BDCT, particularly focusing on

    the therapeutic centre, review of A&E liaison and CPN out of hours service in

    relation to the Crisis Resolution Service (currently taking place).

    ? Review of all Service Level Agreements, particularly the non-statutory sector and

    re-initialising a formal procedure for both SLA monitoring and performance

    monitoring. This must include a review of governance and capability within these

    commissioned services.

? Review of ‘out of area’ (OAT) treatment procedure and the establishment of clear

    lines of Care Program Approach (CPA) responsibility for those already in OAT to

    ensure monitoring and return to locality.

    ? A needs assessment to be undertaken, alongside the Bradford District Care Trust

    and primary care practices, for capacity and development of adult and older

    peoples community mental health services.

    Initiated developments (following first review of mental health provision)

    ? The clinical nurse lead and graduate mental health workers are currently further

    developing self help across the Aire and Wharfe Valley. Initial plans are being

    developed to create self help clinics within the Wharfe Valley region in primary care

    and move the self help clinics at Bridge House in Bingley, into primary care with

    added support from the psychology department.

    ? An initial principle has been agreed with the care trust, to explore and propose a

    plan to move counselling services into the PCT and develop a primary care mental

    health service. This will create a platform to assess need and consequently

    develop mental health services within primary care across the PCT, particularly

    focusing on capacity building, improved skill mix and generate the further

    development of social inclusion, educational support and a gateway/improved

    access service

    ? Re-establishment of GP/practice mental health lead meetings, creating a forum for

    planning mental health development and information sharing across primary care

    and commissioned services.

? Discussions are now planned with the PCT, primary care and the care trust to

    explore the proposals of re-situating community mental health services (Aire Valley

    options paper).

    ? The crisis resolution service is now being reviewed alongside the A&E liaison and

    CPN out of hours service to redesign a more streamlined model of urgent care in

    mental health.

    SIMON LONG 13 DECEMBER 2005

    ASSISTANT DIRECTOR OF COMMISSIONING

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Appendix 1

Fourth version of the Aire Valley Options Paper.

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