Agenda item

To provide an update on Lancashire Care Foundation Trust’s (LCFT) and partners’ progress in making improvement on the actions identified within the Care Quality Commission inspection report, the outcomes of the external review undertaken and the discussions and recommendations made at the special meeting of the Committee on 24 January 2019.

Mr Andrew Bennett, Executive Director for Commissioning, Integrated Care Partnership introduced the item and advised that the Partnership had a clear sense of concern of the issues within the mental health care system and the impact of those issues on patients and their families. He introduced the new Chief Executive Officer of Lancashire Care NHS Foundation Trust (LCFT), Caroline Donovan who presented the report to the Committee.

Ms Donovan advised that a new leadership team had been put into place and that there had been many improvements made since May 2019 when the results of the external review had been published and the latest Care Quality Commission (CQC) inspection was undertaken of the Trust. The CQC inspection outcomes, which had been published in August 2019, had rated 10 of 14 of the Trust’s core services as ‘good’, two as ‘requires improvement’ and two as ‘inadequate’. It was noted that the most concerning judgements related to the adult acute mental health care pathway.

In relation to the CQC inspection findings, Ms Donovan cited the lack of specialist mental health beds across the region as a key determinant of the previous poor performance and highlighted that new beds were being created in Preston to be opened in February 2020, and a business case was being prepared for a further mental health facility with additional beds on the Fylde Coast for later in 2020.

A further key determinant was the community provision and it was noted that LCFT was working closely with the local clinical commissioning groups, the Integrated Care Partnership and the local authority to invest in expanding staffing and to introduce a 24/7 crisis team and a community crisis house in Blackpool. Ms Donovan also highlighted the importance of changing the leadership culture, managing performance and engaging with partners and the voluntary and community sector and reported that strong improvements had already been demonstrated. However, the level of improvement that could be achieved was limited until the opening of the additional beds and additional staff being in place and fully trained.

Members raised concerns that the latest CQC inspection results had not shown improvement in the key mental health pathways and further commented that assurance had been provided by LCFT representatives on a number of occasions previously that improvements would be made. In response, Mr David Eva, Chair, LCFT advised that he had been in post for approximately three years and had also been given the same assurances previously. He advised of his commitment to ensuring the promised improvements happened. Ms Donovan added that, previously, there had been no additional investment to carry out the required improvements, however, a partnership approach had been taken and additional funding had been allocated in the last few months to increase spend on beds and additional staffing, the two issues which were fundamental to achieve improvement. The decisions taken within the last two months addressed the causes of the problems, which had not been previously addressed by any provider or commissioner.

In response to questions, it was noted that the additional funding had been provided by the whole system and that the Lancashire and South Cumbria Integrated Care System had made a decision that identified mental health service provision as the highest priority. Ms Donovan added that improvements had already been made to the 12 hour wait time in Accident and Emergency and reductions in the waits for Section 136 and that improvements would be incremental and continue to be made.

In relation to the two warning notices issued to the Trust, Ms Donovan advised that they were in relation to the length of wait for patients in the Mental Health Decision Unity and the wait in the Section 136 facility. She reiterated the cause as a lack of beds and that improvement would be sustained once the additional beds were in use. There was a Mental Health Improvement Board in place to monitor improvement, and although some improvement could be immediately seen, other areas for improvement would take a substantial amount of time.

The Committee referred to the CQC judgement that services were ‘not safe’ and queried what the judgement meant for patient care. Ms Donovan advised that 50% of mental health trusts received a ‘requires improvement’ judgement for ‘not safe’. However, she emphasised that the new leadership team was fully operational and had a record of driving improvements in similar trusts. She added that there were significant challenges relating to recruitment of staff and in particular consultants, noting the impact of a lack of investment over a number of years.

Reference was made to a previous recommendation of the Committee, that LCFT to establish better links and engage more with the voluntary, community and faith sector. In response, Mr Eva advised that engagement was vitally important and the Trust was involving the sector wherever possible. He referenced the work to introduce crisis houses as an area in which there had been a large amount of engagement with community groups.

At the request of the Chairman, Dr Arif Rajpura, Director of Public Health advised that people in crisis was a real issue which needed addressing quickly. He referred to the extension of the Psynergy pilot and the introduction of crisis cafes in the near future and a crisis house for short term crisis support. He added that crisis services were being redesigned jointly across the system and that there had been an increase in collaborative working and improved engagement since the previous meeting of the Committee. He noted that issues remained, but that the direction of travel was positive.

Ms Karen Smith, Director of Adult Services was invited contribute to the discussion and advised that services felt more controlled than previously and that the issues and what action needed to be taken to the address the issues had been identified across the system. There remained a number of significant issues which had already been referred to such as bed insufficiency and the challenges ahead could not be underestimated.

Representatives from the Fylde Family Support Group were invited to give an overview of current concerns from within the community and voluntary sector. It was reported that the historical problem of patients accessing drugs and alcohol in the Harbour remained and that substances hindered recovery significantly. In addition, despite a general feeling of improvement, the 24/7 crisis telephone line was not always answered, there was also a feeling that vulnerable patients in the Harbour were not being suitably protected with an example given of bank accounts being emptied by less vulnerable patients and concerns remained that action was not being taken quickly enough to help those patients that could not wait 18 months for all the improvements promised to be made.

Ms Donovan advised that she would investigate the issue of alleged drug and alcohol use in the Harbour following the meeting as it had not been previously brought to her attention. She highlighted that Blackpool had one of the highest rates of drug and alcohol death in the country and that LCFT was working with Public Health in order to provide stronger joint working on the issues. She added that it was upsetting to hear that a vulnerable patient in LCFT’s care had been exploited and highlighted that the region required special mental health beds for patients with learning difficulties to provide them with a safe space. Finally, in response to the concerns raised by the community she acknowledged that the crisis line was not always answered due to a lack of staff, however, work was ongoing as quickly as possible to ensure cover was always provided.

The community representatives added that engagement had improved and that they were working with Dr Rajpura and LCFT to contribute to local strategies. They also praised the work of Pysnergy and the proposals for a crisis house and crisis café. Reference was made to the period of time following discharge from an inpatient facility when people were often most at risk of causing harm to themselves and noted a programme in Bradford where patients were provided with peer support for up to four months following discharge.

In response, Ms Donovan noted the importance of peer support and that support from people with lived experience was often required by patients. She added that work was ongoing to increase peer support opportunities in the area and that the programme in Bradford would be investigated.

In relation to Children and Adolescent Mental Health Services (CAMHS), Mr Bonson advised that historically CAMHS had performed well in Blackpool due to a commitment to expenditure, however, there were shortages of staff in certain specialist areas which had caused delays to treatment. Dr Rajpura highlighted the importance of investing in youth services and having peer support on offer for young people.

The Chairman concluded the item by summarising the discussion and noting the improvements made to date. The Committee agreed that a further report be provided in six months that specifically addressed:

·         The implementation of the recommendations of the external review report.

·         The progress in establishing the Crisis support including the crisis café and crisis house and the 24/7 crisis line.

·         The issue of drugs and alcohol in the Harbour – the extent of the problem and the action taken to address it.

·         The number of new beds opened and how many more were to be opened.

·         That the report be a joint report provided by LCFT, Blackpool Teaching Hospital NHS Foundation Trust and any other applicable partners.