Agenda item

(25 minutes)

Sue Poole/Ann-Marie Scott (Healthwatch) to give a presentation on the findings of the CQC work on the experience of accessing health and social care services by those struggling with mental ill health during the pandemic.

The report includes Healthwatch findings and recommendations and the ask from the Board is to respond to these recommendations.

Sue Poole, Healthwatch, gave a presentation on the findings of the CQC work on the experience of accessing health and social care services by those struggling with mental ill health during the pandemic as detailed below:

What did we do?

•  Project was carried out in March 2022.

•  Used online surveys in Bath & NES and Swindon.

•  The majority of data collected during this focused period from an online and paper questionnaire, based on the CQC questionnaire.

•  One to one engagement sessions to gather specific feedback.

•  Attended group meetings/sessions with families and individuals experiencing mental ill-health.

•  Incorporated existing sources of feedback/reports so that people don’t have to repeat themselves (data collected by Local Healthwatch).

•  Ran a Twitter poll.

Key Findings in Bath & NES – what people told us

•  Long waiting lists impacting on the balance between people’s ability ‘to maintain positive aspects of their life v ‘unhelpful coping strategies’. 

•  The support on offer not meeting needs (gaps or lack of options). 

•  Difficulty in getting in contact with services or making appointments.

•  Combination of low expectations and poor previous experience with (perceived) poor attitudes of staff. 

Key Findings in Bath &NES – what organisations told us 

•  People with mental ill health represented 32% of families receiving support from Southside (family support and play). 

•  Challenges with the transition from children’s to adult services. 

•  Lack of social prescribing for children and young people.

•  An increase in number of children and young people showing signs of mental ill health. 

•  An urgent need for more trauma informed services, with a doubling in referrals for specialist trauma therapy from 2021-22. 

•  Gaps in access to clinical mental health services for serious mental ill health among homeless and Gypsy, Roma, Traveller and Boater communities. 

•  Carers tell us they were traumatised during Covid by the burden of caring without support services.

What we found – key findings across the whole BSW area

•  Waiting lists for referrals and support are very long and people felt they ‘get lost’.

•  People feel that mental health services should be preventative rather than reactive and reliant on very high thresholds for receiving care; ongoing support should be provided that is more tailored to the individual.

•  The transition from Children to Adult Services is problematic. The perception is that you have to start again.

•  Carers feel that they are not being listened to and as a result their own mental health is being adversely affected, as well as potentially impacting negatively on the care received by the ‘cared for’ person.

•  Care coordinators are over stretched with a high turnover which further impacts on the unpaid carers’ support and the mental health of the people for whom they are caring.

•  Lack of staff and poor staff attitudes, maybe partly due to pressure on staff resources.

•  Significant increases in referrals and requests for support reported over last year by service providers, especially third sector and emergency services.

•  Feedback about individual services or types of service was very mixed, with voluntary and community organisations providing support services receiving generally positive feedback and the formal health services receiving a far greater proportion of negative feedback.

•  GP services received a very mixed response with a mix of positive and negative feedback. Often responses recognised the lack of resources and staffing as the problem rather than a lack of will or intention.

Gaps In Services

•  There is a gap in services within mental health for people with autism/learning disabilities.

•  It was felt that better support is needed across the area for LGBTQ+ people in regard to mental health services including those who are transitioning their gender. 

•  There is a gap in Children’s Mental Health Services with long waiting lists, little or no support while waiting to be seen, home-educated children are falling through the gaps and children under 5 are not being sufficiently catered for.

•  People with mental health and eating disorders are getting limited support.

•  The rural nature of Wiltshire and Bath & NES meant these areas had unique issues with the bulk of the services not being available outside of the urban areas leading to isolation and a lack of access to services for those in more rural areas. 

•  CQC Feedback processes.  People found the CQC questions off-putting and did not feel able to complete it. The feedback we received showed respondents felt the questions were too formal.

Key recommendations/messages - Clear theme of mental health services being insufficient to meet the needs of the populations of BSW

We recommend:

•  Enable better access to initial mental health services/support: engage early to prevent escalation.

•  Improve transition from child to adult mental health services and develop consistent thresholds to facilitate transition.

•  Involve carers in discussions and decisions wherever possible to achieve the best outcomes for the patient.

•  continue to offer a choice of online/virtual as well as face to face appointments and services.

•  Improve GPs’ use of mental health support and social prescribing.

•  Increase level of services to provide better out of hours cover: mental health crises do not fit a 9-5pm schedule and to ensure provision across rural as well as town areas.

•  Provide better follow-up post discharge to avoid recurrence of issues and make the patient feel supported.

•  Need a central resource library for all services – “Unless you know services are out there it's hard to access them”.

•  Needs to be more engagement with the BAME communities from our investigations there is a reluctance to discuss mental health or access the services.

Board Members raised the following comments:

1.  It was noted that the survey was part of a national CQC project.  In response to a question about demographic differences, Sue Poole confirmed that it was not a scientific survey but a collection of user feedback.

2.  Kate Morton referred to her recent presentation at the Health and Wellbeing Board Development session which outlined Bath Mind’s response to the mental health challenge.  She commented that it would have been useful to align the two presentations to reflect what services were already in place to respond to the comments raised by the CQC survey.  She acknowledged that there was a problem in promoting the available services due to a lack of resources e.g., the 17 wellbeing services that were available in B&NES.  She highlighted the issue of contract frameworks and lack of annual uplifts which impacted the third sector.

3.  Richard Smale commented that the key messages in the report would provide a useful baseline in developing the Integrated Care Board Strategy.  He questioned whether more strategic action could be taken in terms of signposting people to the appropriate support.

4.  It was noted that Avon and Wiltshire Mental Health Partnership (AWP) was currently consulting on its draft strategy, and that it would be useful for the Board to have a further session on mental health led by Mind and AWP.  Sara Gallagher suggested that this should also reflect the student experience.

5.  In response to a question about the local context for trauma informed practice, Kate Morton confirmed that Bath Mind was trying to set up a network.

6.  In response to a question about whether the responses relating to social prescribing referred to a lack of referrals rather than lack of services, Sue Poole confirmed that the key message was that social prescribing was only available for adults and not children.  Laura Ambler confirmed the Integrated Care Alliance was looking at this issue.

7.  Suzanne Westhead welcomed the report and stated, that while not there were no new issues in the recommendations, it was important for all partners to be aware of them in continuing to work together to improve people’s experience in accessing mental health services.

8.  Rebecca Reynolds stated that the priorities in the new Health and Wellbeing Strategy would address mental health and wellbeing and the recommendations arising from this report would help inform the implementation plan.

The Board welcomed the report and recommendations and agreed that the Board receive an update from Bath Mind and AWP to align the work being carried out to meet the needs of people requiring support with mental health with the recommendations within the report.