Agenda item

Dan Leveson (Director of Places and Communities, Thames Valley Integrated Care Board) and Rob Bale (Chief Operating Officer for Mental Health and Learning Disability, Oxford Health NHSFT) have been invited to present a report with an update on Adult and Older Adult Mental Health Services in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Dr Lola Martos (Consultant old age psychiatrist and Clinical Director Oxfordshire, BaNES, Swindon & Wiltshire Mental Health Directorate, Oxford Health NHS Foundation Trust); Catherine Sage (Associate Director, Adult & Older Adult Mental Health and Partnerships Oxford Health NHS Foundation Trust); Dr Rob Bale (Consultant Psychiatrist and Chief Operating Officer for Mental Health and Learning Disability Oxford Health NHS Foundation Trust); Jess Wilshire (Chief Executive, Oxfordshire Mind); Matthew Tait (Executive Delivery Officer, Thames Valley ICB); Karen Fuller (Director of Adult Social Care, Oxfordshire County Council); and Bhavna Taank (Head of Joint Commissioning Live Well); were invited to attend in order to present a report with an update on Adult and Older Adult Mental Health services in Oxfordshire.

The Chair welcomed the officers and set out the context for the item, noting that it formed part of the Committee’s agreed work programme and responded directly to the motion passed by Full Council in December 2025, requesting further scrutiny of mental health services.

The Oxford Health NHS Foundation Trust (OH) Chief Operating Officer for Mental Health and Learning Disability outlined the national and local context, explaining that adult mental health services continued to experience sustained increases in demand, rising clinical complexity, and significant workforce pressures. Referrals to adult mental health services had increased year‑on‑year, with a growing proportion of people presenting with complex trauma, co‑existing substance misuse, neurodivergence and social needs such as housing instability. These pressures had affected flow through services and contributed to challenges in meeting waiting‑time expectations in some pathways.

The Associate Director for Adult and Older Adult Mental Health and Partnerships provided further detail on community services and access. The Community Mental Health Transformation Programme had been central to current service redesign and aimed to strengthen multidisciplinary working, improve access, and embed voluntary and community sector support within neighbourhood‑based models. While investment had supported the development of new roles such as peer support workers, officers noted that recruitment and retention of experienced mental health professionals, including nurses and consultant psychiatrists, remained challenging and continued to place pressure on teams.

Members queried waiting times for assessment and treatment, particularly for adults with serious mental illness and for older adults accessing memory services and dementia pathways. The OH Consultant Old Age Psychiatrist and Clinical Director acknowledged that demand for older adult mental health services, including memory assessment, had increased substantially, reflecting demographic change and greater awareness. She advised that this had led to longer waits in some areas, but emphasised that work was under way to streamline diagnostic pathways, strengthen links with primary care, and ensure that people received meaningful support while awaiting formal diagnosis.

The Committee explored the operation of crisis services, including crisis resolution and home treatment teams. Officers explained that crisis services were under sustained pressure, with high demand and increasing acuity, but that the Trust remained committed to supporting people safely in the community wherever possible. The Executive Delivery Officer for the Integrated Care Board highlighted the importance of system‑wide coordination, noting that pressures in mental health services had impacts across the wider urgent and emergency care system. Partners were working together to manage demand, improve flow, and reduce the need for admission where safe alternatives existed.

Members raised concerns about inpatient capacity and delayed discharges, particularly for older adults with mental health needs and dementia. Officers confirmed that delayed discharge was often linked to wider system factors, including availability of social care, appropriate housing, and community support. The Head of Joint Commissioning – Live Well explained that joint commissioning arrangements sought to address these challenges by strengthening community provision and improving alignment between health and social care, but acknowledged that progress was constrained by workforce availability and funding pressures.

The Committee asked how the experiences of older adults and carers were being reflected in service design. The Chief Executive Officer of Oxfordshire Mind described the voluntary sector’s role in supporting people and carers to navigate the mental health system and highlighted feedback consistently received from carers about fragmentation and the difficulty of understanding who to contact at different points in a person’s care. She emphasised the importance of integrated, person‑centred pathways and of recognising carers as partners in care.

Workforce wellbeing and sustainability were then discussed. Officers described ongoing efforts to support staff through supervision, training and flexible working, while recognising that sustained pressure had an impact on morale and retention. Members emphasised the importance of ensuring that staff wellbeing was treated as integral to service quality and safety, rather than as a secondary consideration.

Members also questioned how inequalities in access and outcomes were being addressed, particularly for people living in rural areas or from disadvantaged communities. Officers confirmed that identifying and tackling inequalities was a core focus of service development and commissioning, with data used to highlight variation in access and outcomes and voluntary sector partners playing a key role in reaching underserved groups.

The Chair specifically raised the issue of the Warneford Hospital redevelopment project, noting its importance to the future configuration of adult and older adult mental health services in Oxfordshire. The Committee asked for clarity on the current status of the project, its relationship to wider mental health strategy and service transformation, and whether there continued to be risks or uncertainty that might impact patients, staff or service planning.

In response, the Chief Operating Officer for Mental Health and Learning Disability explained that the Warneford redevelopment remained a live project within the Trust’s estates and capital planning framework. He advised that the redevelopment was intended to support modern, therapeutic models of inpatient care and to bring ageing facilities up to required standards, but acknowledged that progress had been affected by national capital constraints, wider construction pressures and the complexity inherent in redeveloping a live clinical site.

The Executive Delivery Officer for the Integrated Care Board added that the Integrated Care Board remained engaged with the Trust on the Warneford project at a system level. The redevelopment formed part of broader system planning for mental health infrastructure and that assurance processes continued through established governance routes. While recognising Members’ concerns about timescales, he emphasised that capital decisions were subject to national processes and affordability considerations and that these factors were outside local control.

The Associate Director for Adult and Older Adult Mental Health and Partnerships confirmed that, in the meantime, services at the Warneford continued to operate safely and that interim mitigations and maintenance arrangements were in place. Clinical risk and patient safety were kept under regular review and that service planning did not assume early delivery of the redevelopment until formal approvals were secured.

Members welcomed the clarification but stressed the importance of transparency and ongoing communication with the Committee, given the Warneford’s strategic role in Oxfordshire’s mental health system and its significance to staff morale, recruitment and service user confidence.

Discussion returned to crisis and inpatient services more broadly. Officers described sustained pressure on crisis pathways and inpatient beds, noting that high acuity and complexity were increasing length of stay and affecting flow. The Head of Joint Commissioning – Live Well explained that joint commissioning efforts focused on strengthening community alternatives and improving discharge pathways, but acknowledged that system‑wide capacity constraints continued to present challenges.

Concluding the item, the Chair reflected that the session had illustrated both the scale of the challenges facing adult and older adult mental health services and the importance of sustained, system‑wide action. Members agreed that continued scrutiny would be essential, particularly in relation to waiting times, workforce capacity, crisis provision and the experience of older adults and carers.

The Committee AGREED to issue the following recommendations subject to any necessary minor amendments by the Chair and the Health Scrutiny Officer offline:

1. That system partners treat equity of access as a core performance objective, with explicit action taken where neighbourhood-level variation is identified, including: addressing gaps in crisis alternatives and Safe Haven coverage, and ensuring that any neighbourhood-based models benefit rural and more deprived communities as effectively as urban areas.

2. That system partners treat co-production as a core performance objective for development and delivery neighbourhood mental health centres. It is recommended that there is an inclusion of local councils, local members and local voluntary sector working with lived experience families at any neighbourhood level included in the work programme. 

3. That access standards for adult community mental health services are applied in a clinically meaningful way. It is recommended that there are clear safeguards to ensure that: early contact does not displace therapeutic continuity, that data definitions are consistent across teams, and that performance management reinforces quality and outcomes, not just speed of access. 

4. For collaboration amongst system partners to identify what is needed locally for the implementation of the new government guidance on key workers/named worker for personalised care and on implementation of the Patient and Carer Race Equality Framework. 

5. For collaboration amongst system partners on reducing/preventing out of area placements to include independent clinical reviews, and family/patient input on sustainability of long-term institutionalisation for every patient. It is also recommended that there is a review that includes patients, families, and the voluntary sector to determine whether community placements are working well as a safe and conducive home setting protective against worst outcomes.
6. For any performance targets for access to physical health checks for mentally ill patients to be met. It is recommended that there are timely and regular physical health checks for those with comorbidities, and to also include a check-up of their long-term conditions.
7. For collaboration amongst system partners to call for a clear national strategy to enable local systems to deliver a community mental health centre in every community; for mental health investment to be placed on a statutory footing; and for there to be support for expansion of section 75 agreements for pooled budgets or other clear mechanisms and levers for the local integration and shared ownership needed. It is recommended that local system partners call for national support to move to multi-year funding for commissioning of the voluntary sector, and that there be clear timely arrangements for the delivery of the Modern Service Framework for mental health. 
8. For collaboration among system partners to ensure that transitions from children’s to adult’s mental health services are as smooth and supportive as possible, with a view to ensure that patient need is at the heart of any support provided in the context of transitions.