Council and democracy

Best Value Review of Mental Health of Older People - Sept 03

The outcome of this Best Value review indicated that older people with mental health needs could be helped to remain living independently at home longer by:

• Improving the quality of service by integrating health and social care staffing resources within Community MH teams for older people
• Commissioning specialist home care
• Extending the use of specialist equipment
• Support informal carers better
• Establishing intermediate care facilities
• Reviewing and reshaping day and respite care

A reference group which includes Adult Care Services and Hertfordshire Partnership NHS Foundation Trust managerial and operational staff, two consultant psychiatrists, representatives from Age Concern, Carers in Herts, Alzheimer’s Society, Quantum Care and Leonard Cheshire, supports and oversees the implementation of the review.

A major component of the work so far has been to involve users and carers in discussions. The reference group is keen to see locality forums established across the county.

The Audit Commission Report indicated that of all the people with dementia in the county (currently 11,094) 11 per cent require one intervention a week, 50 per cent one a day and 34 per cent require interventions continually or intermittently throughout day and night.

Users of services must not be discriminated against because of their age. This means that some people over 65 will continue to receive a service for adults, while the needs of younger people with dementia would be best met within a CMHT for older people where staff have the specialist expertise.

The review had considered a variety of models for integrated teams. Overall the consultation has supported the view that in order to ensure that the service users and their carers receive the best possible service, all social care for people whose primary need is a mental health one (rather than one caused by physical ill health, frailty or disability) should be located within Community Mental Health teams. Following the consultation we are now working towards creating these specialist teams. It was agreed by the council’s Cabinet that the teams would be placed within Hertfordshire Partnership NHS Foundation Trust, with seconded staff from Adult Care Services, developed around a model based on single line management, co-location, shared files, a single point of access and agreed referral routes.

We plan to have the fully integrated Community Mental Health Teams for Older People in place by April 2005.

This approach is in line with the National Service Framework (NSF) for Older People (Standard 7), which was published after the conclusions of the BVR, which also requires organisations to provide “comprehensive, multidisciplinary, accessible, responsive, individualised, accountable and systematic” services for older people with mental health needs.

During the Best Value review, and in subsequent consultations, users and particularly carers have said consistently that they want easier access, more information, and better communication between professional staff. Both said they wanted a specialist service that continues to meet their needs from diagnosis through the entire progression of their condition. So, in May 2003, it was decided that everyone whose primary need is a mental health one (including substance abuse and personality difficulties) would receive their services from one of the new specialist, integrated teams.

What needs to happen meanwhile?

We will continue to build on work already in hand:

• Establish closer networks with users and carers.
• Develop a vision and strategy for future services.
• Agree referral and allocation rates.
• Participate fully in developing the single assessment process.
• Identify how intermediate care can make a positive impact for people with mental health needs.
• Create opportunities for Community Mental Health team staff to build on existing networks with primary care and colleagues in acute trusts.
• Address ‘delayed transfers of care’ in mental health units.
• Work with the staffing review group in Adult Care Services to identify mental health tasks, and the resources required, in time to influence the allocation of the 2004/5 budget allocations.
• Agree the model of future CMHTs for older people to include composition, location, commissioning arrangements.
• Agree workloads and capacity.
• Propose organisational and management structure.
• Develop an Human Resources plan and strategy, in co-operation with the trade unions.
• .....and find a new name for the Teams!

Published September 2003


For more information or if you have any questions please contact Sally Hickman, Development Manager on 01727 897796 or email sally.hickman@hertscc.gov.uk