AIREDALE & NORTH BRADFORD PCTS PARTNERSHIP
MENTAL HEALTH PROVISION UPDATE – AIREDALE LOCALITY
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
? 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
? A child and adolescent community mental health service based in Keighley.
? An assertive outreach team currently based in Keighley serving the Aire and Wharfe
? 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
? 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
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
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).
? 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
voluntary sector bodies already focusing on the BME community. C:\convert\temp\63691799.doc - 4 -
? Develop clear pathways of access and care through the creation of a gateway
? 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
? 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
? 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
? 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
SIMON LONG 13 DECEMBER 2005
ASSISTANT DIRECTOR OF COMMISSIONING
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Fourth version of the Aire Valley Options Paper.
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