Agenda and minutes

Apologies were received from County Councillor Stewart Jones, Councillor Julie Robinson, and Councillor Jennifer Mein.

Members are asked to consider any pecuniary and non-pecuniary interests they may have to disclose to the meeting in relation to matters under consideration on the agenda.

Councillor Kerry Lloyd declared a non-pecuniary interest in item 4 as the Deputy Director for Nursing and Care for NHS Cheshire and Merseyside Integrated Care Board and Councillor Fiona Wild also declared a non-pecuniary interest in item 4 as employed by East Lancashire Hospitals NHS Trust.

Resolved: That the minutes of the meeting held on 12 July 2023 be confirmed as an accurate record.

Mairead Gill-Mullarkey, Head of Adult Social Care Mental Health Service, Lancashire County Council, Laura Walsh, Director of Operations – Central and West Lancashire, Emma McGuigan, Chief Operating Officer, and Amy Hartley, Deputy Chief Nurse and Quality Officer, Lancashire and South Cumbria NHS Foundation Trust (LSCFT) attended the committee to provide an update since the item was last seen on 1 February 2023.

It was reported that the Community Mental Health Transformation Programme (CMHTP) was the single largest investment in mental health services seen in recent times. With the aim to develop a new model of care set out in the NHS England Community Mental Health Framework, to enhance community-based support for people living with moderate to severe mental illness and complex needs.  Delivery of this programme through the strengthening of local partnerships across providers, with local authority-funded services and the Voluntary, Community, Social, Faith and Enterprise (VCFSE) sector.

A copy of the presentation is set out in the minutes.

Comments and queries from the committee were as follows:

·  In terms of a link between the CMHTP and suicide prevention work in the community, the lead psychiatrist was the suicide lead within LSCFT that worked in the community and the practitioners in the community mental health teams were involved in the suicide prevention strategies. It was recognised that this would need to be strengthened as part of the new community mental health model and with the introduction of Integrated Neighbourhood Teams, to have a suicide lead locally.

·  LSCFT had recently met with the Chief Constable of Lancashire Constabulary. It was confirmed that there were no intentions to withdraw or introduce stringent measures to police response to mental health crisis in Lancashire. It was acknowledged that these calls did use a lot of police resource and Lancashire was above the national average of police involvement. As the mental health provider, LSCFT had a responsibility to ensure that they offered alternatives to police colleagues so that they were only intervening when they were needed. It was highlighted that there was a clinical model being rolled out called "Street Triage", which  saw a mental health practitioner attending a call with the police so that there was an expert on hand and decisions were made jointly. Early pilots indicated that patients were directed to the best mental health services quicker and easier and a reduction in A&E attendance. This would be rolled out across the Integrated Care Board (ICB) but was being held back by recruitment.

·  Regarding concerns about the safety of practitioners lone working in the community, it was established that there was an existing lone working policy, and a risk assessment required to be completed before a practitioner attended to assess what support was required. Staff had lone working fobs and apps and procedures were in place to notify where staff were and who with, and how to escalate matters if required.

·  It was reported that community mental health teams did not in-reach into A&E, as there was a mental  ...  view the full minutes text for item 4.

Fiona Inston, Public Health Consultant, Marie Demaine and Lee Harrington, Senior Public Health Practitioners, and County Councillor Michael Green, Cabinet Member for Health and Wellbeing, Lancashire County Council attended the committee meeting to present an update on Happier Minds, one of the key priorities for the Public Health team.

The Happier Minds programme is a partnership and system leadership approach to addressing five key strands of work: 

1.  Emotional health and self-care 

2.  Loneliness and social isolation 

3.  Dementia 

4.  Alcohol and drug use

5.  Self-harm and suicide 

This report focussed on alcohol and drug use, and self-harm and suicide across Lancashire.

Self-harm and suicide figures from 2019-21 showed that the rates in Lancashire were higher than the national average and North West (rate of 13.5 per 100,000 (a count of 425 people) compared to a 10.4 national and 11.4 in the North West per 100,000). The rate in males was high at 20.4 per 100,000 (count of 318 people) compared to 15.9 per 100,000 for the national average.

Challenges included the quality of data, which was numerical. Therefore, officers were taking an audit of the Coroners Service to get more detail about an individual including occupation.

Regarding Drug and Alcohol data, the target number of adults in structured treatment was exceeded by May 2023, and young people by March 2023.

A copy of the presentation can be found in the minutes.

Comments and queries from the committee were as follows:

·  It was confirmed that the Public Health Team were working in partnership with LSCFT, Blackpool and Blackburn with Darwen Councils, and the provider Change Grow Live with a joint protocol for mental health and substance misuse. Practitioners met regularly at multi-disciplinary teams where cases were brought forward. There was an additional intervention called Changing Futures which was a program brought forward by government.

·  Local suicide supporters' network Amparo sat on the Local Prevention Group and attended quarterly meetings.

·  The Licencing Act 2003 had four licencing objectives which did not include Public Health. The team were lobbying to add an additional licencing objective to include this point.

·  Dual-diagnosis partnership work was an ongoing piece of work which was being re-written to include new partners such as housing and hospital services including community services.

·  It was noted that there was new work beginning around attempted suicide, however, the scale was unknown.

·  It was reported that 100% of people were in drug and alcohol treatment within three weeks of them requesting it. The team provided funding for residential detox and rehabilitation services in the county. Furthermore, 'From Harm to Hope' saw an additional £4 million grant to the main grant of funding from the government as part of a 10 year strategy, which enabled recruitment of 100 new workers last year and additional workers this year including non-medical prescribers, clinical and assistant psychologists, nurses, and recovery workers. There had been a challenge recruiting dual-diagnosis social workers with only two being recruited through agencies. However, three apprentice social workers were being trained who  ...  view the full minutes text for item 5.

County Councillor Lizzi Collinge provide a verbal overview of the Health Scrutiny Steering Group from 24 May 2023 as seen in the agenda papers.

County Councillor Collinge also provided the group with an update from the most recent steering group meeting on 5 September 2023 regarding the NHS Enhanced Acute and Rehabilitation Stroke Services. The ICB had taken the decision to indefinitely pause the business case in its third year in order to recover the deficit it had inherited during the change from Clinical Commissioning Groups. This was as well as a significant increase in the original costs assigned to the estates work and the activity modelling the business case was based on, where there has been a significant increase in the number and complexity of strokes, and the number of stroke mimics. As a result, the following will not be delivered within year:

·  24-7 hyper acute care that comes with the implementation of Acute and Comprehensive Stroke Centres

·  Unable to move to 7 day working for inpatient rehabilitation – delayed discharges, increased LOS

·  Delays in growing own workforce and staff retention

·  Delays in developing specialist Stroke Orthoptist services – greater risk of falls, reduced uptake of rehabilitation, delays in patients' long term recovery 

The NHS Stroke team explained that they would use this time to revisit their business case to ensure it was still feasible due to changes in financial landscape, activity, and interdependencies.

Resolved: That the report of the Health Scrutiny Steering Group be received.

The committee received a report which provided information on the work programme for the Health and Adult Services Scrutiny Committee and Health Steering Group work programmes.

Resolved: That the Health and Adult Services Scrutiny Committee and Health Steering Group work programmes be agreed.

An item of urgent business may only be considered under this heading where, by reason of special circumstances to be recorded in the minutes, the chair of the meeting is of the opinion that the item should be considered at the meeting as a matter of urgency. Wherever possible, the chief executive should be given advance warning of any member's intention to raise a matter under this heading.

There were no items of urgent business.

The next meeting of the Health and Adult Services Scrutiny Committee will be held on Wednesday 25 October 2023 at 10:30am in Committee Room 'C' – The Duke of Lancaster Room, County Hall, Preston.

It was noted the next meeting of the Health and Adult Services Scrutiny Committee would take place on Wednesday 25 October 2023 at 10:30am in County Hall, Preston.