Agenda item

To Committee will receive information from the CCG on a proposed new model of service for mental health rehabilitation services.

The Principal Program Lead for Mental Health for NHS Dorset Clinical Commissioning Group presented a report, a copy of which has been circulated and appears as Appendix ‘C’ of these minutes in the Minute Book.

The Dorset Clinical Commissioning Group and Dorset Healthcare Trust carried out a review of Mental Health (MH) Rehabilitation Services. These services provided for people who had severe enduring mental illness and a range of other complex issues.

It was highlighted that the review was fully co-produced with Dorset Mental Health Forum, Local Authorities and other key stakeholders who had an interest in MH Rehabilitation and complex care pathways such as homelessness and MH assertive outreach.

The Committee were informed that the number of people in Dorset who experienced serious mental illness was expected to increase to 7,882 by 2020/21. Of this population, 20% (approximately 1,500 people) would require rehabilitation and 1% (approximately 79 people) would require inpatient rehabilitation.

It was explained to the Committee that the proposed model for MH Rehabilitation Services contained a combination of community resource and hospital care. Furthermore a combination of care inside and outside of hospital was required. This model was a blended model that would be delivered by a mix of NHS and third sector providers.

In developing the proposed model a view seeking exercise was undertaken. There were 144 respondents which included service users, carers, staff and 26 other agencies that worked with MH services. The proposed models were then taken back to the same service users who said they felt they’d been listened too.

It was explained that the preferred model would include a high dependency unit, a community rehab unit in the east and west of the county, a community outreach team and supported housing. It was highlighted that the CCG had not looked at accommodation before as part of health but in considering the MH pathway they found people needed accommodation. It was proposed that a wider piece of work on MH housing would be beneficial.

The case for change included a belief that people who require rehab or complex care should be able to access support and treatment in the community and in hospital when necessary, should have a better experience of treatment and support in community settings and receive better outcomes. They should not be placed out of area for longer than necessary and should be able to access treatment and ongoing support in a variety of settings within their community.

The proposals are anticipated to provide benefits including a reduced number of out of area placements, better use of in-county inpatient facilities with shorter admissions, appropriate exit routes into a range of accommodation and a blended model of bed provision which is more cost effective than purely NHS bed provision.

The review was moving into the NHS assurance stage which required advice and support from the Committee. This would be followed by public consultation if required and then implementation. The Committee agreed that public consultation would not be required because carers, service users and their families had been engaged during the view seeking stage. They also agreed with Dorset Council’s view that the proposals could be viewed as service improvement.

A number of questions were raised and discussed by members including:

·         Details of the view seeking exercise;

·         Details of the preferred models cost implications;

·         That there needed to be a wider conversation on out of area MH Rehabilitation and the use of section 117;

·         That a strategic business case was being developed and that officers could provide the Committee with more detail of the finances at a later date;

·         The benefit of widening access to MH Rehabilitation Services;

·         The potential to cause stress to the person and their family by placing them out of area;

·         That following the reassurance process a strategic outline case would be bought back to the Committee;

·         The impact supported housing has on individual tenancies;

·         The details of the estate work were underway;

·         That the timescales for an individual’s rehabilitation differ and are very personal;

·         That being admitted to MH services is often a relief, although the experience of those placed out of area can be different.

RESOLVED that:-

(a)  Endorsed the review findings and proposals to develop a more community-based Rehab model of care;

(b)  Supports the intention to go through NHS Assurance with the proposed bed changes;

(c)  The proposals do not need to go out to public consultation.