Agenda item

To consider a joint report by the Head of Adults & Business Services and the Head of Children & Family Services (copy attached) which seeks the Committee to consider the requirement to have an agreed scheme in place for the provision of Local Primary Mental Health Support Services as per legislation, and the arrangements to develop and agree a regional scheme for this purpose.

The Head of Adult and Business Services (HABS) presented a report (previously circulated) for the Committee to agree a joint scheme for the provision of Local Primary Mental Health Support Services (LPMHSS) in North Wales, as required under Part 1 of the Mental Health (Wales) Measure 2010.  HABS introduced the Assistant Director for Community Partnership Development, BCUHB, (AD:CPD) Wyn Thomas who was leading on the scheme on behalf of the Betsi Cadwaladr University Health Board (BCUHB) and the Head of Children and Family Services (HCFS) who was also involved with the scheme. 

AD:CPD gave a résumé of the report. The Measure did not deal with compulsory admission and treatment of people, but dealt with the assessing and receiving of care and treatment within primary and secondary mental health services.  The Measure was to strengthen the role of primary care in delivering effective mental health care and treatment and set out the requirement that LPMHSS would be provided throughout Wales by October 2012.

The Measure was in four parts:-

Part 1 – Local Primary Mental Health Support Services (LPMHSS) (October 2012)

Part 2 – Care co-ordination and care and treatment planning (June 2012)

Part 3 – Assessments of former users of secondary mental health services (June 2012)

Part 4 – Mental Health Advocacy (January and April 2012).

The report presented related to Part 1 of the Measure.

Local Authorities across North Wales were working together with BCU on this Measure.  A number of questions on various aspects of the information contained in the report were raised by members and officers responded as follows:- 

Ø      AD:CPD gave an explanation regarding the levels of staffing.  Conwy and Denbighshire already had in place the structure to assist with the Measure but, for example, Gwynedd did not.  The guidance was for 1 worker per 20,000 population.  Therefore, Conwy and Denbighshire did not require a high number of new staff as the model was virtually in place, whereas Gwynedd required an additional number of new staff.

Ø      AD:CPD clarified that regarding the overall Measure, there had been consultation with various stakeholders, including some service users and the proposed North Wales implementation had been included as part of the consultation.  The draft Scheme and its implementation was a requirement of Welsh Government (WG) legislation and the WG had developed a national service model for LPMHSS. There were service users who were members on the Project Board and, therefore, any information could be passed on from those meetings.  Future engagement of service users was being investigated and a full review was taking place. The Scheme itself would be reviewed on a quarterly basis by the North Wales Mental Health Collaborative.

Ø      The Head of Children and Family Services (HCFS) stated in his experience there had been service users involved as part of the overall process of drawing up the scheme.

Ø      The emphasis of the Scheme was early intervention aimed at preventing service users being admitted into care and an element of any care plans drawn up would include the involvement of close family members and carers for the service users, as per Part 2 of the Measure.  Occasionally, services users did not want family members to be involved.  Whereas some service users with wider support, often felt able to cope if family members were more involved. The best care provided was not only professional but also when included family support as it was the family who noticed changes, however slight, with the service user.

Ø      AD:CPD stated in theory the Measure should alleviate some of the pressure on GP surgeries as the Measure should give GPs quicker access to mental health treatment.  Workers would spend time within the GP Practice assessing and referring cases.  GP accommodation though, could be a problem, as if GP’s could not provide the service within their premises, then the service would have to be provided elsewhere.  The knowledge of both the GP’s and the Practice staff would be improved by working closely with the staff involved with the assessments.  Monitoring of the referrals and demands on the LPMHSS and their associated activities would take place as, if demand increased, there would be service implications.  The monitoring would be carried out jointly by BCU and the local authority.  BCU currently monitor elements within various Measures and the results are reported to the WG.

The Lead Member for Social Care and Children’s Services stated overall the Measure was a good one.  She could see initially that the Service may identify more people as needing these services, particularly with people living longer and the increase in the number of people diagnosed with Alzheimer’s Disease, therefore, she was concerned about the potential cost and how this would be met in future across the region.

The Vice-Chair stated one in four people in the county suffer from mental health problems and GP’s would require training on this scheme.  In response to a question about the qualifications of the workers carrying out the assessments the AD:CPD confirmed that the Health Board would employ primary health workers.  Psychiatric nurses, social workers, qualified therapists etc., who were recruited within defined professions and possessed the required qualifications to carry out the assessments.  They would work in GP surgeries part-time, possibly one day per week and assess a person’s needs.  If a person had more serious mental health needs, a referral would be made.

In response to other questions the AD:CPD advised that:-

Ø      With respect to the take up of beds within the Ablett Unit which was an acute ward, with a limit of six weeks for a service user to have the use of the bed, the occupancy figures were high, 80% and pressure regarding take up of beds did exist. 

Ø      Unllais was a voluntary organisation which gave advice, and undertook training for voluntary sector organisations.  Unllais also dealt with advocacy services and supported a range of other organisations.

Ø      GP’s were being encouraged to prescribe anti-depressant drugs effectively. There was a service in North Wales for people taking prescription drugs to assist them to eventually come off these.  Occasionally, drugs were prescribed in the absence of intervention.

The Chair expressed concern regarding the help offered to carers and questioned whether sufficient help was offered.  The AD:CPD clarified that the Measure did not directly affect carers but that the Carers Strategies (Wales) Measure 2010 which required NHS authorities in Wales to develop Carers Strategies which have to be approved by WG Ministers by the end October, 2012 should ensure that carers needs are met.  The Committee:-

Resolved that :

(a)    subject to the above observations, to agree with the requirement to have a scheme in place for Part 1 of the Measure and the arrangements to develop and agree the regional scheme which has been established;

(b)    the Lead Member keep Partnerships Scrutiny Committee updated regarding the progress with the implementation and the monitoring of the Scheme; and

(c)    an update report of the progress with the implementation of the Joint Scheme be presented at future Partnerships Scrutiny Committee meeting in either March/April 2013.