3rd October 2019

Attending: Terry G, Dick & Hazel L, Kevin M, Rod C, Dianne W, Margaret I, Tim & Francis W, Brian L, Norma Y, Rod , Michael .

Guest Speaker: Sandra Brookes Executive Director of Service Delivery and Service User Experience and Complaints at the HPFT.

Dick welcomed Sandra to her first visit to the group and suggested she begin by telling us a little about her background before we get into a more detailed question and answer session about Service Delivery.

Sandra Brookes

Sandra began by saying that while her job title is one of the longest around, the role consists of two main aspects. The first is to focus on the customer’s experiences of the service (both service user and carer). The second is to gain effective feedback of those experiences from which real learning/improvement can be based.

Sandra went on to say that she qualified as an Occupational Therapist in 1986 in Yorkshire and became most passionate about recovery and people achieving their full potential including both physical and mental health. In Yorkshire she was involved in the Community MH Team, MH rehabilitation and Social Care.

She moved to Harrow in their Acute MH Team and then Old People Services moving up in the profession and later into management.  She has worked as a Director in the London Borough of Hillingdon and has experience of managing Primary Care Services across 5 North London Boroughs

Sandra said that she moved to the HPFT some 5 years ago. She was MD for the South West Business Unit Managing Adult Care Services in West Herts, including IAPT and rehab.

Then she moved on to manage a wide range of services in the East and North Herts Business Unit including services for Old people, Children, The Recovery College and numerous others but not Forensic Services or Learning Difficulties.  When requested, she explained the term forensic as services designed to address the MH needs of individuals in the criminal justice system.

Sandra became the Deputy Director in March 2018 and was appointed as the new Director in April 2019 .

In answer to the question “what so far has been your biggest challenge” she outlined the increase in demand for services across the board but in particular in child and adolescence services which currently has the least resources allocated to it.  There is a general increase in the population and an increase in the number in the older category (not dementia) but they contribute only a small amount to the increase in demand.  To address this increase in demand, she went on to say that her key aim is to get the right resources in the right place at the right time.

When asked If money was the issue Sandra replied that there has been an increase in investment this year together with a transformational bid for some additional £4 million if accepted will allow some specific additional work. So no,  money was not the key issue.

When asked about staff turnover (currently some 15%) this is an issue and the HPFT is looking at various schemes to improve recruitment and retention.  The comparison with other Trusts shows that Herts is has slightly higher turnover affected also by the cost of living and nearness to London. Choices to increase pay are not so simple.  Terry suggested that becoming a learning organisation (where training and development is readily available and encouraged to help staff develop and progress their careers) would help retention. 

Sandra clearly stated that the Government has not trained enough Social Workers and Nurses so the pool from which they select is diminished. This has required that the HPFT looks beyond the traditional job skills to find new ways of organising the skills mix where some roles require more common sense than the current extensive professional skills mix. 

Discussion went on to the role of King Fisher Court and described its numerous suits as a Place of Safety.  In particular its 136 suite is used by the Police for individuals with MH needs instead of their custody suite.  It was accepted that the numbers going there are high and not all have MH needs.  To address this there are now MH practitioners advising in the Police Control Room and also in “Street Triage teams”.

Different approaches are being sought as too many people with drink and drugs issues are being picked up.  They cannot be assessed until they detox (overnight), and are overloading the resources available.

Sandra, with high hopes, went on to describe a new initiative “The Trailblazer Scheme” aimed at early support and links to specialist services in schools.  Four teams across the county are being set up and while it may not reduce demand, early intervention and support to school children that can be stepped up as necessary will be a positive first step and increase their future wellbeing.

Dianne, when asked, described the lack of services available for those with long term enduring conditions from the Hemel Wellbeing Centre. She felt that things have become worse since they moved from St Pauls.  They appear to be in a mess with many staff leaving there are too few staff and too few adult services.  Lack of care coordinators is an unresolved difficulty even after years of us giving detailed feedback.

Core services such as home support, day services and outreach teams have mostly gone.  Her loved ones are of an age to have also developed physical health difficulties.

Discussion included the observation that most of the group have loved ones with long term enduring conditions that means they are not going to recover.  This group is often referred to as the “forgotten ones”. 

Margaret was happy to report that, while her son was one of the forgotten ones, after being transferred out of county to Brent he is now receiving better services than before when he was in Herts.

Sandra reported an increase of work within primary care aimed at providing support to this group but things will not improve overnight.  Kevin M stated that the third sector had taken on some of this workload (paid for support) and suggested that there could also be an increase in Peer Support Workers who are currently overworked but effective.  Sandra replied that they are looking at this aspect with MIND.

The suggestion was made that the Trust identifies the number of service users who would fall in this ‘forgotten one’ category particularly where their carer’s are in their late sixties and seventies as many in this carers group are.  Terry suggested that such a statistic would be a good starting point for making the case for greater investment in support to this group of service users beyond our hitherto ignored pleas.

Discussion went on to describe talk about carers health needs.  Clearly we are all getting older and the burden on them is significant.  Norma Y, believed that there was insufficient support available. Unlike perhaps for those with Dementia. (Age UK work with Dementia issues but not Mental Health)

Francis raised her personal experiences of inconsistencies derived from staff changes/moving on.  This is likely to elicit a non-response from service users.  Non-attendance at meetings with services are more likely in this group of service users (for many reasons) =. This further denys them support from the service.

Dick suggested that over his 27 years experience of this carers group, services appeared to work for say 80% of Service Users  while the other 20% were left out.  Care in the Community has delivered the same sort of percentages as does Personal Budgets.  He went on to say that the 20% if addressed would probably cost more to help than the 80%.

Kevin asked that given changes in Health Commissioning and Parity of Esteem, is it going to get better?

Sandra answered yes and stated that more will be done locally to support GPs and help them work together.  They have developed a 2 to 3 year plan to expand on this eg diagnosis of dementia has been helped by training GPs with a simple diagnosis tool (but not for early onset dementia)

However, it is recognised that not all services can be developed locally.  Some 20% will always require specialist services not available locally.

Agenda items

Apologies: Zib L, Carolyn G, Angela T, Ann R, John I.

Minutes of last meeting 5th September 2019

Dicks Quiz will be Saturday 5th October (Dick clarified some queries about this event)

Will Davies of CIH will be our next speaker on the 7th November

Sam Slayter will be our speaker in January on the second Thursday ie the 9th

Any Other Business

Dick to attend the HCC Scrutiny Committee.  They want to know more about the work going on for Suicide Prevention/reduction and the programme ‘spot the signs’.

Date of next meeting: –7th November 2019 speaker Will Davies of CIH about advocacy