Examination of witnesses (Questions 440
- 459)
THURSDAY 13 APRIL 2000
MR ANTEK
LEJK, DR
CHRISTOPHER MAYER,
MRS JILL
NEWTON-LIVENS,
MRS PAULINE
PROCTOR, MS
CLAIRE GREGOR
and MS PAT
HOLMAN
440. Is that a fixed point?
(Mr Lejk) Theoretically.
(Ms Holman) 17 and around 18. One of the examples
I was given was a person who had been with the child and adolescent
service from the age of four and coming up towards the age of
17 worked across the child and adolescent service and the adult
service with a consultant psychiatrist. The person is now 18.5
and is just going to move into the adult service. That was one
which worked well, others have not worked so well.
(Mr Lejk) It is not based on protocols, it is based
on conversations between the people who may or may not choose
to co-operate. That is what makes it hit and miss. There is an
interest within the service to look at the idea of a 16 to 23/25
type of model. What we see as the process for moving that on is
actually the HIMP process, the Health Improvement Programme, where
the children's group is chaired by somebody from social services
and involving social services, health, education and a range of
people. We would look to that being the route for driving through
changes in the service.
441. Can I just ask, on the acute beds, do you
have separate facilities for adolescents or do they have to go
to the adult wards?
(Ms Holman) We have not got any in-patient facilities.
Chairman
442. They go outside completely.
(Ms Holman) There have been under 16 years olds in
the acute beds which we do not support. Part of our proposals
for the future, particularly around the major site that we have
the opportunity to re-provide is to look at something like 15/16
to 23/25 year old young person service but we need a community
service that will be linked to that. It is constantly setting
up projects that are in isolation that cause the problem. It is
the integration that is important. We are very confident, I think,
where we have got links between health, social services and education.
There is a scheme for children who are in foster placement that
threatens to break down during school holidays, there is a summer
scheme. During that period of time that is organised jointly between
child and adolescent health services, education and social services.
It has kept a number of people at home. There have been some further
appointments now and a training package put together for looked
after children and you will know a very high level of unemployment
comes at the age of 16, and also homelessness.
Mrs Gordon
443. The National Service Framework does not
cover children and adolescent services. Do you think this makes
it more difficult to plan for continuity of care between adolescent
and adult services? Would you welcome a National Service Framework
specifically for children and adolescents?
(Ms Holman) Yes, to the last because it has proved
useful to have a framework to work within so we can get on and
do it. I do not think it is necessary—to your former question—if
we can keep this approach of working in partnership, if it is
about services working together, people working together and focusing
not on their profession and not on their organisation but on the
person they are providing the service for, then the conversations
I have had with clinicians in child and adolescent services is
no, it does not exclude them. The way we have organised ourselves
within the organisation is such that they are integrated and each
manager has the responsibility for what we call an interface area.
Currently the specialist services management which covers children
and adolescents, drug and alcohol and secure services—because
there is a theme that runs through them—has responsibility
for developing early intervention in the young people services
which means that they have to move into adult and have to be talking
to the adult services.
(Mrs Proctor) If I could add to that. This is bringing
together social services, through the HIMP programme, so some
of the barriers can be overcome and some of the knowledge about
particularly children coming through the care system. I think
we see sometimes the distressed people coming into the mental
health services and that is perhaps a better dialogue than planning
earlier in children's lives. It can lead to the prevention and
intervention which may limit some of the more tragic and dysfunctional
problems you see later on. That is what I see, some of the real
strengths in what we are doing.
444. Do you have a close liaison with education
as well?
(Ms Holman) Yes.
(Mrs Proctor) Social services in its reorganisation,
our local authority also has been through a major reorganisation,
has chosen to reorganise its services so that adult care services
are relating to PCG groups and children's services are relating
to the school pyramids so there is a better facility there. If
you are using the programme planning group, the HIMP groups, you
have got the capacity then to bring together education and all
the relevant authorities for those agencies and for those groups
that the plans are for.
Dr Stoate
445. I was going to ask you questions about
how you involve users but you have covered those issues as well.
I am pleased to see you involve users in planning their achievements
and their care. What I want to come on to, the National Service
Framework—again you have covered some of those issues—I
would like some more specific answers on what impact do you think
the NSF can have on the way you plan services currently?
(Mr Lejk) One of the things about the NSF, from our
point of view, is that it does not contain surprises. It was part
of where we hoped it was all going and it continues the debate.
What it does give us is a focus on delivering. It draws a line
and says "Now get on and implement it." In that sense
I think it forces us to get on with it.
446. You say it forces you.
(Mr Lejk) Yes.
447. Are you a willing partner in this or are
you a reluctant partner in this?
(Mr Lejk) It coincides with what we are doing anyway
organisationally. Because we have just had PCGs created we have
merged three trusts into one with a clear sense of let us reshape
the way the services are provided. We are developing new relationships
with social services. In that sense the NSF gives us a framework
within which to do all that. It coincided very well with where
we were going. I suppose this will maybe jump ahead to the final
question which is about the one message.
Chairman
448. I may not ask you that.
(Mr Lejk) I will steal it from Lionel. The thing that
I am concerned about at the moment I think is whilst there has
been a lot of energy and interest in mental health, it may go
off the boil. What worries me now is waiting lists, waiting lists,
waiting lists. Actually mental health does not get as much of
a mention in terms of regional briefings and so on, and it is
assumed "well everybody is getting on with it are they not,
therefore that is okay". I just want to see there is a national
priority with the drive still there saying "We want to see
evidence that you are moving on" which keeps us on our toes
but it is the thing that reinforces for us that we are doing something
important. That is what the NSF I think gives us.
(Ms Holman) What was in the NSF that we had not had
before was the organisational standards. Some of the things about
"You will get on and provide this type of service",
there is not a surprise about that but it has acknowledged the
importance and the time it takes to invest in education if we
are going to deliver services differently in a different way and
perhaps using different ranges of clinical expertise. It acknowledges
the vital importance of information and having single information
systems that people know how to use. So I can have information
about somebody who is referred to this wonderful 24 hour service
at 2 am in the morning, not that I am driving around Suffolk or
a clinician is driving around Suffolk wondering who they are going
to and what will happen. Those we have not had before, that is
important. It stopped some of the arguments and debates about
who this person belonged to. "I am a GP. This is mental illness,
they must be your's" and "I am secondary care, very
special, there is hardly any of me. This has to be your's, GP."
We do not have to do that, what we have to do in secondary care
is make sure that primary care services are clinically equipped
to manage. We have to be clear about those that we are going to
share care with and clear about those who can return or who need
to stay in secondary care. There is not a huge amount of extra
resources and it is divided up amongst us. It means what we have
got we could use better. If it is going to take five years because
of the lead in time to develop psychological therapy, we can show
we are working on it. It is not that nothing is happening, it
is that we are properly investing in it today for the clinicians
of the future and this new skill mix in a team.
Mr Amess
449. A few quick points of information. Can
I ask the Chief Executive how much money, roughly, did you save
from the merger of the three trusts?
(Mr Lejk) £1.4 million.
450. Secondly, was it seven primary care groups?
(Mr Lejk) Yes.
451. Have any been balloted to become trusts?
(Mr Lejk) One of them is in the process of consulting
on becoming a trust in October.
452. Then you mentioned this unit in another
county and you said there is a six week waiting list.
(Ms Holman) Yes.
453. Is that six week waiting list for everyone?
(Ms Holman) Yes.
454. Can you tell us something about your staffing
circumstances?
(Mr Lejk) Yes. Knowing you would ask the question
we did a quick snapshot on 1 April this year to see what vacancies
had been for more than three months, obviously there is always
potential turnover but where we had a vacancy for more than three
months, interestingly one consultant, three nurses, two health
care assistants and one physio. Now that is low.
455. It is.
(Mr Lejk) It does not reflect the national situation.
I think there are a number of reasons for that, I would like to
think some of it is about being an attractive place to work. I
know some of it is about being an attractive place to live.
456. Yes.
(Mr Lejk) Certainly, we do not have the same kinds
of problems about recruiting as Newcastle do from an inner city
point of view, Suffolk is a very pleasant place to live. It is
close to Cambridge, therefore from the academic linkages' point
of view there are the education connections. I think it has been
getting worse, I know it has been getting worse but it is still
okay. We do find sometimes we have to go out to more than one
interview to fill some posts. As with the national trend we are
observing that there are problems but certainly we feel fortunate
in not having a struggle. There is a flip side to that which is
not a big issue but it is something that can make a difference.
There is a danger that we end up with not enough turnover of people
and that we end up with people who stay for a long time and are
not willing to develop new practice. Also, I would say that whilst
what I have described reflects our recruitment to our current
establishment, that does not mean necessarily that establishment
is where we would like it to be, if we had more money we would
want more posts.
Mr Amess: Thank you for that information. Actually
the point about turnover is a point that regularly used to be
made in schools when I went round. It is not exactly the case
at the moment. I endorse, Suffolk is a wonderful county in which
to live. It is a nice contrast for the community.
Chairman: Better than Essex.
Mr Amess
457. Finally, Mr Lejk, the £700 million,
can you give us some idea how much you have got, what it has been
spent on?
(Mr Lejk) I think this year we are looking at about
£250,000 specifically earmarked from the modernisation fund
for mental health and another £160,000 going towards secure
which is going directly to a trust in Norfolk which provides secure
care across the patch. What we are doing is looking at what we
get through the health service but we are joining it up also with
what is going through social services. There is money coming through
from the mental health grant and rather than think of them in
separate pots, we put them together and we hand them over to the
joint group that is developing the implementation plan for mental
health and they prioritise accordingly. We are trying to join
up what we do with new monies. Unfortunately, what is different
between us and Newcastle is the health system, we have been in
deficit up to now so we are not reaping as many rewards for the
new money as we would like to but we are clearing away our deficit.
458. That is good. Nothing really to meet your
dream of having this unit where there is slack to deal with it.
(Mr Lejk) To be honest, I would argue that we would
not know what to do with it. No, that is not right. Now is not
the time to spend lots of new money, what we could do with is
investing, particularly in training and education and development
of new people for the future so that as things come along in two
or three years' time then we can seriously do with some new money
that we could use to recruit people.
(Ms Holman) Do you want to know the priorities?
459. Please.
(Ms Holman) That is not sufficient to implement the
National Service Framework, that is quite clear. The three theme
priorities that were chosen were to invest in the advocacy service
and a carers' project specifically for mental health, that was
one priority; to invest in the primary care team time that I described
earlier, GP and nursing research associate and to invest in assertive
outreach but earmark a percentage. We cannot, in a rural area,
have single assertive outreach teams everywhere so where we have
large towns we will have an assertive outreach service. Where
we have got rural areas we will put one or two mental health workers
into the community mental health teams and then the standards
go right across the county. That will not be enough to provide
the 24 hour service that is currently being described in the NSF.
We have to organise it, what we will invest in year one, year
two and year three and build it up gradually.
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