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ITEM EX12 - ANNEX 2

EXECUTIVE – 28 OCTOBER 2003

INTEGRATION OF MENTAL HEALTH SERVICES: OUTCOME OF CONSULTATIONS

Public Consultation Report

Introduction

1. The Project Initiation Document for the Integration of Mental Health Services identified the need for public consultation to enable service users, carers and other interested people to comment on the proposals. The proposals cover the integration of mental health services and the commissioning of services for adults of working age in Oxfordshire. These proposals include the establishment of joint commissioning arrangements and a ‘pooled budget’, through the use of the Health Act (1999) flexibilities.

 

2. The Public Consultation took place at the same time as the Staff Consultation (May – September 2003).

Method

3. A representative group from the Integration Project Board was convened to agree the consultation document and the process for the consultation.
   
   
4. The consultation was undertaken by the Project Board on behalf of Oxfordshire County Council, Oxfordshire Mental Healthcare NHS Trust, South West Oxfordshire Primary Care Trust and Thames Valley Strategic Health Authority.
   
   
5. It was agreed that the Joint Partnership Unit would co-ordinate the consultation and receive comments and feedback via email, post and telephone. It was agreed to circulate the document widely using previous OMHT consultation mechanisms as a framework together with the use of flyers and advertising. A reminder letter and feedback form was sent in August to request responses by 5 September. It was also agreed to hold 3 evening (7 – 9 p.m.) public meetings in the county (Oxford City, Banbury and Didcot).
   
   
6. A further 2 public meetings were arranged at Oxford and Henley on Thames in response to public requests.
   
   
7. The Voluntary Sector also convened 2 Open meetings in Oxford, one hosted by Oxfordshire Mental Health Matters and one by Oxfordshire MIND.

Review of Effectiveness

8. Overall the consultation document was well received by the public, however concerns were expressed about the distribution process.
   
   
9. The first meeting was held on 26 June. This was the Open City Meeting organised by Mental Health Matters, Oxford. 10 people attended this meeting. Further meetings were held across the county.

• 30 June in Oxford when no members of the public attended,
• 10 July in Banbury, when no members of the public attended,
• 14 July was a Voluntary Sector meeting held at Oxfordshire MIND, the 21 July meeting was held in Didcot and 4 members of the public attended.

10. A further 2 meetings were held following requests from the public. The first was on 28 July in Oxford when 13 people attended and the final meeting was held on 5 August in Henley on Thames when 10 people attended.
    
    
11. The same format was used at each meeting.

• Senior Officer Representatives from Oxfordshire County Council, Social & Healthcare Directorate together with the Director of Modernisation from the SW Oxfordshire Primary Care Trust attended each meeting.
• A scribe also attended each meeting.
• Copies of the Consultation Document were available.
• An outline sheet was produced to assist with the presentations
• An informal approach was adopted which encouraged a wide range of questions from the attendees.

Didcot Meeting

12. Key Themes: Two main themes based around concerns about the impact of integration on current staff and any associated impact on service users. The other concern was for more clarity on the pooled budget and how it would work especially for the voluntary sector.
    
    
13. A small number of people attended this meeting but the focus of the concerns were on the implications of the integration on the current staff and the new management structures which would be put in place. Questions were also asked about the impact on clients and the range of hospital services and day services, which are currently provided. The effects of the integration on the voluntary sector also raised concern, together with the tight deadline for the project. Concerns were also raised about the process of ‘pooling’ the budgets and the impact on services, staff and service users. Questions were also asked about the pressures on mental health services and whether the ‘pool’ would be used to reduce the overall financial deficit in the health sector leaving mental health services worse off.

Oxford City Meeting

14. Key Themes: The major concern was for more details of both the financial aspects (including the pooled budget) and the management structures for the proposals and their impact on service users and staff. The other concerns expressed were around the need to ensure the ‘social model of mental health’ was not lost through integration, together with the need to provide effective transitional arrangements for children and older adult services work.
    
    
15. A wide range of people attended this meeting – 13 members of the public and a broad discussion took place about the impact of the integration on service users. In particular concerns were voiced about a possible shift of emphasis from the social model of care to a more medical one. This led into a number of questions about the age band used for the integration project together with the services for young people and older people and the need to have good transitional arrangements.
    
    
16. A number of people raised concerns about the process of the consultation and in particular the lack of details for both the financial and organisational changes which were being proposed.
    
    
17. Questions were also asked about the implications for staff and which policies and procedures would be affected in the integration process. Questions were also asked about any changes in the ‘base’ for members of staff and whether there would be any personnel changes which would affect service users.

Henley-on-Thames Meeting

18. Key Themes: Concerns were raised about the need to include the more remote rural areas during any consultation. Concerns were also expressed around the impact on current staff and the need to have details about both the management structures and the pooled budget proposals. Details of funding processes for the voluntary sector organisations were also raised.
    
    
19. This meeting was attended by 9 members of the public. Wide-ranging questions were asked of the panel.
    
    
20. It was emphasised that better communication processes needed to be established, especially in the Henley and South areas. This would ensure that service users were included in any proposed changes to mental health services. It was suggested that there is a perception that Henley is affluent which often led to it being forgotten as it was ‘out on a limb’ and able to cope. The recent changes to mental health provision in the south are still being developed and this should be reflected in these proposals. Questions were also asked about the staffing arrangements and the consultation process for staff. In particular the difficulties when recruiting staff in the area and the need to retain current staff.
    
    
21. Questions and concerns also centred on the need for transparency about the budgets and how the ‘pooled budget’ would be established and how it would operate in these proposals.
    
    
22. The other area of concern was about the need to fully engage with the voluntary groups and their expertise and networking for these proposals.

Voluntary Sector Meetings

23. Key Themes: The focus of concerns were around the continuity of a ‘social model of care’ through integration, together with clear and transparent details for the proposed pooled budgets and the management structures. The voluntary sector were keen to be fully involved in the discussions and planning for both the current and future integration work in the county. It was strongly expressed that the integration proposals would need to continue and develop the very successful Training Programme provision, which is provided by Oxfordshire County Council.
    
    
24. The first meeting took place on 26 June when 13 people attended. At this meeting discussion took place about the ‘model of care’ which would be used by the integrated teams and how this would operate with the mix of nurses and social workers currently employed.
    
    
25. Questions then followed around the involvement of service users in the changes and the need to reduce the gap between hospital and community settings. Concerns were expressed about the focus of social work on an individual’s life rather than a specific episode of care and whether this holistic approach would be lost in the integration proposals. There was a specific request to have follow-up meetings to address the concerns raised.
    
    
26. The second meeting was arranged by MIND on 14 July. At this meeting a range of questions were addressed and included questions about the staff affected and particularly the funding available now and in the future for the voluntary sector contracts. There were also concerns about the current valuable training and whether it would be continued in the same way.
    
    
27. Concerns were also raised about housing issues, which were felt to be crucial to discharge planning. This work would need to involve the voluntary sector to develop creative solutions within an agreed strategic approach through a range of organisations. It is also necessary to address the provision of respite care for vulnerable adults and the provision of transport, especially in the rural areas of the county.
    
    
28. A range of questions was asked about funding issues, including the different contractual arrangements and the need to ensure continuity for service users and providers. More information was requested on the pooled budget proposals and its management.
    
    
29. Overall the main points were to establish a Partnership Board and for it to set a strategic direction with a clear commissioning focus which would be inclusive of users and carers with appropriate resource to support it. It was also felt essential to communicate and inform the voluntary sector on the proposals at an early stage and seek to reduce the bureaucracy and duplication currently experienced.

Written Feedback

30. A total of 46 written responses have been received. Of these 40 have agreed to the proposals for joining up mental health services and 35 responses of support have been received for the proposal that SouthWest Oxfordshire Primary Care Trust should undertake the lead role for the commissioning and the management of the pooled budget.
    
    
31. The responses received have broadly followed the issues raised at the public meetings.

• The need to involve staff fully in the secondment and re-organisation process together with the responsibilities for professional Social Workers was highlighted. This included the provision of essential training and professional development programmes for both the statutory and voluntary sectors.
• The communication process for the project and the need to involve people, especially from the voluntary sector, in any future work.
• A number of concerns were raised around the ability of organisations to work together, especially the 5 Primary Care Trusts and the proposals to work in 3 localities – north, city and south.
• How the needs of rural communities would be addressed through these proposals.
• Housing issues were raised a number of times and particularly their impact on the discharge of patients.
• Other areas of comment included questions about the ‘boundaries’ of the county of Oxfordshire, particularly for South Northamptonshire and Wiltshire and how services would be commissioned out of county. The need for clear and transparent commissioning processes, together with the need for impartial and transparent decision-making processes was also emphasised.
• It was felt that the commissioning and contractual arrangements should reflect the needs of local areas and not compromise client ‘choice’.
• Responses also highlighted the need for clear and robust mechanisms for complaints, accountability and scrutiny through the integration proposals, which should clearly identify the continuing responsibilities of the County Council.
• Concerns were also expressed over the transitional arrangements for Children’s and Older Peoples Mental Health Services and for clients with learning difficulties and dual diagnosis.