We are currently looking at how we improve our Adult Community
Mental Health Services so that we:
- Better meet the needs of our service users
- Improve relationships with primary care and work more closely
with GPs
- Improve the way primary and secondary care work together
- Make sure we are meeting the overall needs of the population of
Manchester
- Make sure resources are in the right areas to meet the needs of
the different areas of the city
- Support staff of all disciplines to utilise their skills to the
maximum benefit of service users
To find out more, please read the
engagement document.
The Adult Community Services Review (CSR) will benefit our key
stakeholders in the following ways:
For service users:
- Services will be better focused on service user need
- There will be dedicated Consultant time for each community
team
- The review will allow us to provide best practice care in our
services
- The introduction of a stepped care model ensures people get the
right care at the right time in the right place
For our staff:
- Staff of all disciplines will be better supported to use their
skills to the maximum benefit of service users
- There will be the development of a Modern Matron-like role
drawn from all disciplines to ensure consistent quality of service
in Community Mental Health Services across the city
For the city's GPs:
- Relationships with primary care will be improved with better
access for referrers
- We will work more closely with GPs by organising services to
support a specific geographic area
- We will improve the way primary and secondary care work
together in the interest of service users.
As part of the key improvements in the way we provide services,
we are considering the use of a Gateway role within the
primary care service. If established this role would assist
service users and referrers by ensuring that service users are seen
by the most suitable service for their needs in a timely
manner. It would also provide support to a small cluster
of GPs and will oversee the transfer of service users to and from
primary care and other pathways.
The following questions and answers give more
information on how we plan to improve our Adult Community Mental
Health Services.
1. How can care be improved? It does
not say in the review
Care will be improved by removing organisational and
administrative barriers which currently prevent service users from
receiving appropriate care at the right time and to meet their
changing needs. The Community Services Review aims to achieve this
by bringing primary and secondary mental health staff together
under clear, community based management arrangements. This will
ensure a patient is seen by the most appropriate professional for
assessment, to meet their changing or on-going needs and who will
help their journey to recovery. This community based system will
prevent a patient needing to be assessed by different people in
different services within the Trust and through the implementation
of the proposed 'stepped care' model, will ensure a service user
always receives the care they need at the time they need it.
2. What response have you had back from GPs, MPs and
City Councillors?
GPs, MPs and Councillors have been engaged within this Community
Services Review process and are aware of these proposals. Feedback
is being received from them as individuals as well as collectively,
and all of these will be considered at the end of the engagement
period. It is only once the responses have been considered that the
Trust will start to develop an implementation plan.
These proposals aim to rectify exactly this issue raised by
LINk, by service users, carers and GP's. We plan to ensure all
community teams are linked into individual GPs, their practices and
commissioning groups to ensure a GP is able to access advice/help
and/or support for their patients affected by mental health issues
in a timely way - directly improving the quality of service the
service users and GP's receive from the Trust.
The Trust is already a major provider of high quality and highly
regarded mental health education and training. We would willingly
work with GP's, practice nurses and any other professionals to
offer increased training and education around mental health and are
keen to do so.
3. GPs are currently frustrated with
the referrals system. It will be helpful to work with the
primary care teams (as laid out in the document) but not
sure how
The proposals aim to make access to appropriate services easier
- for GPs making referrals and for service users needing support
from services. We are planning to remove whole tiers of internal
referral and assessment processes that are frustrating for all
involved, and create delays that result in waiting lists.
4. There are already concerns over
waiting times as blocks are in place at all stages of the system.
How will these be reduced if you are reducing staffing
levels?
The key to these changes as stressed previously is in how the
system becomes more efficient to ensure service users get the
correct care for their needs at the earliest possible opportunity.
By reducing the blocks in the system, we create a more streamlined
and efficient service which therefore enables us to make some
savings. We aim to increase quality, efficiency and at the same
time, reduce cost.
5. Too many service users are currently
in the Community Mental Health teams (CMHTs) and assertive outreach
teams. The three year aim to step down in the model will not
benefit most people in that system. They will either remain within
the workers' already stretched caseload or be discharged and then
be re-referred within six months
The proposals will ensure all service users have their care
reviewed regularly to ensure they are receiving support appropriate
to their needs. If people need ongoing care they will receive this.
If they can be better supported by other parts of the mental health
pathway, they can step up or step down within the services we
provide. There will always be a checking process to ensure people
are getting the right care at the right time.
The overall resource proposals have been sized to take account
of the current demand on secondary care services.
6. Another concern is with people
displaying their first psychotic episode. Under the new model it
will take too long to refer people to the level they
need.
We propose to develop a Gateway Worker role whose primary role
will be to work closely with GPs to ensure referrals go to the
right part of the service first time, every time. This will include
Early Intervention Services (there are no changes to the current
Early Intervention Service which is provided by Rotherham Doncaster
and South Humber NHS Foundation Trust (RDASH) and not Manchester
Mental Health and Social Care Trust although we work very closely
together) as well as other primary and secondary services and
should improve our response times.
The planned Gateway Worker role would have a positive impact on
this.
7. There are also massive pressures on
beds, and this will not be going away. The new system will put a
further squeeze on inpatients and there is nothing within the
proposals that will address this.
The proposals explain how the Trust will ensure people get the
service they need quickly if their needs are changing. This
includes ensuring people are supported earlier, and therefore
without the need for an inpatient bed in some cases, if they begin
to show early warning signs that their mental health may be
deteriorating. There is nothing in these proposals which would
increase demands for inpatient admission.
Improved community service provision will reduce pressure on
inpatient beds by preventing some patient's health from
deteriorating to the point an inpatient bed is needed.
These services will also be able to facilitate people's
discharge from inpatient wards by ensuring that work on, for
example, accommodation issues is undertaken early to ensure it does
not lead to unnecessary delays in discharge.
8. Regarding the Gateway Worker, I'm
concerned that they may stop people getting from primary care to
secondary care services.
The role of the Gateway Worker will be to liaise with GPs to
ensure referrals go to the right part of the service to prevent
delays and ensure people get the right service quickly. These roles
will be regularly reviewed and assessed to ensure they are adding
value to the whole mental health pathway and do not prevent access
to the appropriate level of service provision. This includes direct
informed referral to secondary care following initial
assessment.
9.Service users are confused at about
suggestions to changes to CMHTs following on very soon after
changes within North Manchester. The feeling is that this should be
managed better.
The Trust accepted that some service users in the north of the
city may have had notification about 18 months ago about possible
changes to their care co-ordinator when teams merged. This only
affected the north service users and although we acknowledge that
there may be some potential for confusion, we believe it is
important to inform all service users about the proposed community
services review.
10. Emphasis is being put on third and
voluntary sector services picking up need where it is less severe.
However, the Trust needs to make sure that they are not considering
their changes in isolation. Large cuts to Adult Social Care funding
mean that current third and voluntary sector organisations are
either going to cease existing or significantly reduce the services
that they provided.
The Trust is aware of the situation in Adult Social Care and
does not expect or plan to make any changes in isolation or without
clear plans to mitigate impact on service users. However, we also
hope that changes in Adult Social Care will not be made without
considering the impact on the mental health and wellbeing of
service users in Manchester and we will continue to engage with all
our partners to ensure any proposals are assessed collectively.
We are already lead provider for third sector organisations who
offer improved access to psychological therapies proving this is
the area we expect to focus this issue.
We engaged with staff and service users in November and we have
responded to their comments through a leaflet sent out in December
2011. Click here
to read the leaflet.
A specific date for implementation is yet to be set but it is
likely to begin in early-2012.
If you have any comments please e-mail communityservicesreview@mhsc.nhs.uk
.
You can also find out more or share your feedback by
contacting the Adult Mental Health Care Group General Manager Mike
Sinnott by telephone on 0161 291 6924 or by e-mail at mike.sinnott@mhsc.nhs.uk.