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“You do not choose to be

unwell!”

Let’s talk about mental health:

The Oxfordshire Mental Health Partnership

mental health care in Oxfordshire

Executive Summary

July 2020

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Table of contents

Table of contents ... 2

1 Executive Summary ... 3

2 What we heard ... 3

2.1. Resourcing mental health services ... 4

2.2 Complex Needs Services ... 5

2.3 Communication between partners ... 6

2.4 Access to services – distance and information ... 6

2.5 Seldom heard communities ... 7

3 Response from The Oxfordshire Mental Health Partnership ... 8

4 Response from Oxford Health NHS Foundation Trust ... 10

Covid-19

This report was researched and drafted prior to the Covid-19 pandemic.

Healthwatch Oxfordshire continues to listen to people’s experiences of accessing mental health services and support during the Covid-19 emergency and will report our findings to commissioners and the Oxford Mental Health Partnership.

Acknowledgements

Healthwatch Oxfordshire would like to thank everyone who shared their

experiences and opinions of mental health services in Oxfordshire. We are very grateful to services’ users who participated in our surveys and spoke to us during Enter and View visits. We also thank those staff and volunteers of statutory and voluntary organisations for facilitating our visits and for their input to this report.

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1 Executive Summary

This report has been produced by Healthwatch Oxfordshire to inform the

commissioners and providers of mental health services across the county of what we have heard from people accessing services over the past 18 months. These organisations are noted as Oxfordshire County Council, Oxfordshire Clinical

Commissioning Group, and the Oxfordshire Mental Health Partnership comprising of Oxford Health NHS Foundation Trust, Mind Oxfordshire, Restore, Response,

Connection Support, and Elmore Community Services.

The main report builds on previous Healthwatch Oxfordshire work on mental health and brings together information we have gathered from various sources during 2019. Here we report what service users, their family members, carers, and some of those who work in mental health have told us about mental health services in the County. We explored three main areas: (1) what are people’s experiences of mental health services in Oxfordshire? (2) What is working well? (3) What could be improved?

This report reflects the views and experiences of more than 2000 people across Oxfordshire of which over 400 have spoken in detail about their experiences of accessing mental health services in the county.

2 What we heard

The findings of this report reflect many of the themes identified in previous national and local reports including high quality, hard-working health care staff, but identify access problems and delays getting the right care at the right time, resource deficits including funding, staffing, system overload, and challenges ensuring continued access/support to follow up care..

Specifically, in Oxfordshire:

• People value caring, supportive, non-judgmental mental health professionals. • Most health sector staff provide outstanding care despite working with

constrained resources. But…

• Access to services is restricted by limited eligibility thresholds, long waiting times, unequal geographic availability, and travel issues

• Difficult to access specialised services and Complex Needs Service • Limited support when ‘discharged’ from services

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• Some IT equipment and systems used by staff can hinder efficient working, and impact on partnership working

• The physical environment in some services has a negative impact on people’s experience of services as told to us during Enter & View visits The issues and compliments outlined in the full report, whilst not new to the system and services, reinforce the fact that they are widespread and persistent. We believe that it also adds weight to the need for increased resources/funding.

Recommendations

Throughout the research people – staff and service users – have been open about the challenges to delivering a service that meets the needs of all. Our Enter & View visits – 18 in total – have already achieved improvement in services through positive action by staff and organisations in response to recommendations made. The following recommendations aim to address wider challenges related to

Healthwatch Oxfordshire by users and staff over the past 18 months.

2.1. Resourcing mental health services

The prevalence of depression among adults and social, emotional, and mental health needs of young people has increased over recent years in Oxfordshire.1

Despite this, there is a shortfall in funding for mental health services of between £18m and £28m in Oxfordshire compared to other similar areas.2 The Oxford

Health NHS Trust recognises the need to invest in support for mental health staff and services to ensure that service users have access to “the right care in the right place”.3

Increased funding – both capital and revenue - will help to address many of the negative experiences we were told about including:

• Through an increase in the level of service provision across the Oxfordshire Mental Health Partnership, organisations will be able to address limited opening times of some services in the community, offer more activity to patients and service users, and increase the number of people benefiting

1 https://insight.oxfordshire.gov.uk/cms/system/files/documents/JSNA_2019_Ch5_Health.pdf 2 See

https://improvement.nhs.uk/documents/5724/Oxford_Health_NHS_Foundation_Trust_Annual_Repo rt_ and Accounts_2018-19.PDF

3 See Oxford Health NHS Foundation Trust annual report, 2018-19,

https://improvement.nhs.uk/documents/5724/Oxford_Health_NHS_Foundation_Trust_Annual_Repo rt_and_Accounts_2018-19.PDF (page 115).

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from services. This will help to reduce waiting times and deliver a more equitable access to services across the county / nearer to home.

• Increase staff recruitment by addressing high staff turnover. We hear from service users that this not only causes people uncertainty but often means they have to repeat their mental health story. With more funds,

recruitment challenges could be addressed - offering improved employment pay and conditions to permanent staff.

• Investment in IT and physical infrastructure that will support more efficient working for staff, improved information sharing across the partnership so creating a ‘seamless service’, and improve the users’ experience of attending services both in the community and in acute services4 .

Recommendations for action:

Strengthen the Oxfordshire mental health system and services for both adults and children by lobbying local MPs and national bodies to:

A. Redress the inequality in commissioning funds available to Oxfordshire. Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care System (BOB) who have prioritised Mental health – their priority must be to raise the funding levels in Oxfordshire to comparable levels across the BOB ICS.

B. Ensure adequate funding across the Oxfordshire Mental Health Partnership in recognition of the value and essential services that the voluntary sector partners provide to the people of Oxfordshire.

2.2 Complex Needs Services

Some people with complex mental health needs or requiring specialised support said they experienced delays in accessing treatment because of initial uncertainty in identifying a suitable service or because they had been referred multiple times between services. One person with a personality disorder said:

I don’t seem to fall into criteria to receive support from current services (AMHT don’t think I’m mentally bad enough & [psychological therapy service] won’t take

me on as BPD is too complex!) (Service user, multiple services)

Recommendations for action:

a. Review and increase the capacity of the Oxford Health NHS Foundation Trust’s Complex Needs Service5 to deliver appropriate and timely support to all people.

4 See Healthwatch Oxfordshire Enter & View Reports

https://healthwatchoxfordshire.co.uk/enter-and-view-reports/

5 See Oxfordshire Complex Needs Service

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b. Provide appropriate options for alternative support while people are waiting for treatment.

2.3 Communication between partners

One of the key purposes of the OMHP is to deliver a seamless service to the people of Oxfordshire. We heard that this is not always so. People told us that they often have to repeat their story, that integrated working does not always work for

service users or staff, and that IT equipment and the physical environment of services can have a negative impact on the person using the service.

Recommendations for action:

To improve people flow through the mental health system, continuity of care, and peoples’ experience the Oxfordshire Mental Health Partnership must:

a. Review and strengthen structures and practices for information sharing and communication between OMHP providers/partners.

b. Review and strengthen information-sharing within the partnership including on service users (within GDPR constraints) between hospital wards and voluntary organisations.

c. Oxford Health NHS Foundation Trust should review the current level and effectiveness of their IT systems supporting their community adult mental health services. They should involve staff and service users in this review.

2.4 Access to services – distance and

information

We often heard that services were sometimes difficult to access due to

geographical distribution (Oxford or city centric), access to transport to services, working patterns, waiting times, delivery days / times, and during transition from Child and Adolescent Mental Health services to Adult mental health services. We also heard that often there is a paucity of information available locally about services.

“Henley is on the border in the middle of 3 different counties. We just fall through the gaps as everything is in the centre of the county or the north.”

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“If the state of any individual's mental health has reached the point where they have 'qualified' for professional support, this is needed quickly - and not to be told they will have to be added to a minimum 6 month waiting list for therapy.”

(Service user, CMHT)

Recommendations for action:

a. The Oxfordshire Mental Health Partnership, in order to achieve commitments by the NHS Long Term Plan to deliver services closer to home, should review where and when their services are delivered across the County and fill gaps where the location of services is a barrier to access.

b. The Oxfordshire Mental Health Partnership should support the establishment of mental health therapists in Primary Care Networks thus providing timely initial support to people closer to home and increasing access to services in the community.

c. Oxford Health NHS Foundation Trust must review the transition process and support for children and families from Child and Adolescent Mental Health services to Adult Mental Health services to improve the experience of the child and listen to and respond to the views of the family.

d. Oxfordshire Mental Health Partnership should review their communication with the community to ensure that information for service users and the public is freely available locally both in paper form and electronically.

2.5 Seldom heard communities

Healthwatch Oxfordshire have heard from different ‘seldom heard’ communities over the past 18 months but acknowledge that the voice of the Black, Asian, and Minority Ethnic community is unlikely to be reflected in this report. We are currently working with representatives of recently settled and new and emerging communities to understand their experiences of mental health services. It is also the responsibility of the OMHP to engage with these communities to ensure

equality of access to services that are appropriate and planned with input from the community.

Recommendation for action:

a. The OMHP must commit to engage with the BAME communities and co-design services for that are accessible and appropriate to these

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3 Response from The Oxfordshire

Mental Health Partnership

3 August 2020 Dear Rosalind

Thank you very much for attending the Oxfordshire Mental Health Partnership (OMHP) PMG governance meeting, on the 15 July to discuss the draft Healthwatch report on mental health services in Oxfordshire. As chair of the partnership, I am writing this letter on behalf of OMHP to give you our formal response to the report alongside the response from Nick Broughton, CEO, Oxford Health NHS Foundation Trust (OHFT) dated 8 July.

OMHP welcomes the report, we support the recommendations and agree with Nick Broughton’s comments. The Healthwatch report recommendations include:

● Increased funding for mental health services: reduce waiting times, increase staff recruitment and investment in IT infrastructure.

● Increase capacity of the complex needs service.

● Strengthen communication and information sharing between partners.

● Improve access to services: geographically, transition between age groups and information. ● Commit to engage with BAME communities.

As Nick mentioned in his letter the report specifically reviews OMHP and not wider mental health services in Oxfordshire such as TalkingSpace Plus, the Children and Adolescent (CAMHs) partnership, older people and specialist mental health services such as eating disorders and forensic services. We therefore request the name of the report is changed to reflect this.

As you are aware the report was conducted prior to some additional funding being awarded to OMHP. Due to historical underfunding the OCCG has invested money which acknowledges demographic growth and inflation. Whilst not completely meeting service needs it does enable the partnership to focus on the challenges, we jointly face, in realising the transformation necessary to deliver the NHS strategy for mental health. We have also received money through the Long-Term Plan/Mental Health Investment Standard. Services previously set up in 2019 and funded with non-recurrent funding now have ongoing funding. This includes the Oxford and Banbury Safe Havens, additional Oxfordshire Mind Wellbeing workers embedded in the AMHTs, the Response FACT team, the Connection Support embedded worker

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in the inpatient social work team, Connection step down house, the Mind primary care link workers and money to reduce the Elmore waiting list and capacity. Elmore is part of the complex needs pathway and this additional money will help to improve flow through services. Transformation funding was dedicated to setting up crisis care services and a county wide Crisis Resolution Home Treatment Team. During the COVID pandemic Elmore successfully set up a new High Intensity User service to support people who frequently use the Emergency Department with the aim of reducing presentations. Additional money for one of the Stepdown houses and two embedded housing workers has been provided by OCC (waiting for contract). A bid was also recently made to NHS Charities Together for continuation funding for the second step down house. All of the above funding helps us to address some of the areas of stretched resources and we hope this improves people’s experiences of mental health services.

We acknowledge the need to strengthen communication between partners so that people do not need repeat their mental health story. Work is progressing in that area with the development of a ‘passport assessment’ which is being added to Care Notes. During COVID all services moved over to digital support work except supported housing projects, which had skeleton staff teams at the start of the pandemic and the safe havens which remained open. This included the Oxfordshire Recovery College which developed a range of digital courses within 5 weeks of lockdown. The use of digital technology has been positively received by people who use our services. Oxford Health ran a large project at the start of the pandemic to equip Oxford Health teams with new laptops to support them working from home. The investment in IT also included new IT equipment for third sector embedded workers to enable them to be able to access OHFT systems and Care Notes easily wherever the workers were based. OHFT worked fast to get new systems up and running during COVID and this will benefit mental health services going forward. Learning from COVID is that a mixed model of virtual and face to face support will continue. Virtual support will hopefully help those who live in geographically remote areas of the county. Though we do recognise the challenges of the spread of resources which are primarily based in areas of deprivation.

The transition between age groups and services is an issue we have prioritised. With the new OHFT Service Director role covering all age mental health services in Oxfordshire, we hope to develop a better and seamless transition between CAHMs, adult and older adult services.

We recognise the additional work going on in BAME communities, are carefully thinking how we can support this and are currently planning how best to commit to engage better with BAME communities. We appreciate the report acknowledges the powerful interaction between the third sector and NHS. It mentions that most health sector staff provide outstanding care despite working with constrained resources. We believe it is really important that as a partnership we always look to continuously improve how we do things, and the way we work. Both for people who use our services and those who work within them.

Thank you for taking the time to hear our views. We look forward to working with you closely in the future.

Yours sincerely

Lesley Dewhurst

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4 Response from Oxford Health NHS

Foundation Trust

Trust Headquarters Warneford Hospital Warneford Lane Headington Oxford OX3 7JX tel: 01865 902769 www.oxfordhealth.nhs.uk Chief Executive’s Office Carol Ball

Business Manager Healthwatch Oxford

Sent via email carol.ball@healthwatchoxfordshire.co.uk 8th July 2020

Dear Ms Ball

Draft of Healthwatch Oxfordshire’s Mental Health Report, ‘Let’s Talk about Mental Health.’ I have asked Dr Rob Bale, Clinical Director and Vanessa Odlin, Service Director, for

Oxfordshire BaNES Swindon & Wiltshire Mental Health Directorate and Lesley Dewhurst CEO of Restore and Chair of the Oxfordshire Mental Health Partnership (OMHP) Partnership Management Group (PMG) to review the findings of Healthwatch Oxfordshire’s draft report and co-ordinate our response.

Oxford Health Foundation Trust (OHFT) and the OMHP would like to thank Healthwatch Oxfordshire for sharing their report with us. However, we note that the report specifically considers the adult services in OHFT and the OMHP and limited review of Children

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Space Plus (TSP) and the wider mental health services on offer within Oxfordshire. Therefore, we respectfully request that the report recognises that Oxford Health NHS FT and the OMHP are only part of mental health services and are not representative of the full mental health support on offer within Oxfordshire. We would also welcome the report being shared with system partners (Oxfordshire CCG (OCCG) and Oxfordshire County Council (OCC)) to enable us all to work towards a whole system approach to mental health in Oxfordshire.

We wholeheartedly support the principles of the recommendations and we wondered if it would be helpful to share our transformation plans for our mental health services with Healthwatch Oxfordshire as a critical friend. Of interest and concern to both OHFT and the OMHP is in relation to engagement with the BAME communities, our organisations are committed to engage and co-design services that are accessible and appropriate for BAME communities which will be a focussed piece of work over the next few months.

The report suggests the mental health services are under resourced; the Trevor Shipman review in 2018 found that investment in mental health services in Oxfordshire are

considerably lower than comparator areas. OHFT and OCCG have been transparent about the commitment to work together to address this and to work towards the Long-Term Plan ambitions, which aim to address the gaps that have been highlighted within the report. Following the completion of this report and over the last 5 months there have been some significant investments into mental health; both through a settlement from OCCG in relation to historical underfunding as well as investment through the Mental Health Investment Standard. Whilst this starts to address the historical underfunding in mental health, we are continuing to strive for parity of esteem with mental health services. We are hopeful that these investments start to support the gaps in the services described in the report and make a difference to patient’s lives.

Thank you for this report and for seeking our views. Vanessa, Rob and Lesley look forward to welcoming Rosalind Pearce from Healthwatch Oxfordshire to the OMHP Partnership Management Group next week on 14 July.

Yours sincerely

Dr Nick Broughton FRCPsych Chief Executive

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