Agenda item

8.1

Present for this item were Heather Burns, Deputy Director of Mental Health, Learning Disability, Autism and Dementia Transformation, NHS South Yorkshire Integrated Care Board) and Josie Soutar, Managing Director of Sheffield Flourish. Ms Burns introduced the panel present for the session:

• Sarah Batty, on behalf of Synergy
• Helen Steers, Director of Strategic Partnerships, Voluntary Action Sheffield
• Mike Hunter, Medical Director and Deputy Chief Executive, Sheffield Health and Social Care
• Nicki Doherty, Deputy Chief Executive and Director of Business Development Partnerships and Strategy, Primary Care Sheffield
• Tim Gollins, Assistant Director, Access, Mental Health and Safeguarding, Sheffield City Council
• Mark Cobb, Clinical Director, Sheffield Teaching Hospitals
• Carmen Tulley, Mental Health Lead, Sheffield Teaching Hospitals
• Jeff Perring, Medical Director, Sheffield Children’s
• Margaret Lewis, Chief Executive, Sheffield Mind

8.2

The Board were advised that the session had been planned to provide and update them on the challenges faced in mental health care in Sheffield, and to share the lived experiences of those experiencing mental health issues. This would be done via a series of videos, and an art exhibition that could be viewed during a break later in the meeting. The session outcomes were explained, and the Board were referred to the Health and Wellbeing Resource Pack that had been provided for reference. 

8.3

A video entitled ‘Mental Health and the Impact on Whole Health in Sheffield’, introduced by Dr Steve Thomas (Clinical Director, GP and Chair of Sheffield MHLDDA Delivery Group), was played on screen for members of the Board.

8.4

In order to showcase the positive work that had been carried out across the city over the last 12 months, a video montage was shared on screen, showing mental health support offered by different services across Sheffield.

8.5

The Board was advised of the four key strategic priorities in the Mental Health and Wellbeing Strategy, and the eight proposed priorities identified in the Sheffield Place Plan.

8.6

Josie Soutar introduced a video entitled ‘What Could Make Sheffield a Mental Health Friendly City?’ which consisted of a number of short videos that aimed to share the voices of people within Sheffield.

8.7

The meeting paused for a refreshment break and exhibition.

8.8

The next session of the meeting aimed to provide Board members with an understanding of the perspectives of those speaking in the video montage by hearing from the providers present.

8.9

Chris Gibbons, Public Health Principal at Sheffield City Council, re-iterated the importance of interactions between physical health and mental health, and noted the financial this impact this had on the National Health Service and on the quality of life of people and communities. He added that from a data point of view, improvements were needed to link up data to create a more ‘person-centred’ view. Mental health was a particular determinant of disability in Sheffield, and a key issue in Sheffield was the inequality and prevalence of these conditions in more deprived areas of the city. Data also suggested that the ability of people to live with long term physical and mental health conditions was skewed towards the more affluent areas of the city.

8.10

Mr Gibbons noted that since 2015, there had been an increase in both adults and children of anxiety and depression that scaled with deprivation, and similar trends had been observed around healthy life expectancy. Austerity and cuts to services had not helped, but longer-term decisions about allocation of services within acute hospital care provision and primary care preventative services had also contributed. For anxiety and depression in young people, there had been a tendency to blame individual factors such as social media/mobile phone use among young people, but this was also due to larger structural issues, particularly around the rising prevalence of adverse childhood experiences. Mental health was a significant component of multi-morbidity, including pain, anxiety and depression, and there were rising multi-morbid populations in Sheffield, skewed towards ageing and poorer populations. There was a dose response relationship between increasing physical health conditions, notably poor respiratory health, and the likelihood of having mental health conditions. Suicide was an area that combined both qualitative and quantitative data to give a proper intelligence-led suicide prevention plan.

8.11

Dr Mike Hunter acknowledged the need to do more outside of the specialist context to upstream and understand trans-generational trauma. He shared a presentation that outlined the vision and strategic aims and priorities of the Sheffield Health and Social Care NHS Foundation Trust. This meant working in partnership and getting more ‘upstream’ to engage and understand the wider determinants of health rather than dealing with the consequences ‘downstream’. Among the priorities this year were to recover services and improve efficiency in the post-pandemic period, and to be committed to continuous quality improvement. Dr Hunter outlined the successes and explained how they were linked to challenges and the future direction. Partners within the primary care network had been brought together: this included, amongst others, primary care providers, multi-provider teams and mental health practitioners.

8.12

Nikki Doherty noted that contributors had been empowered to provide an innovative model, which had invested in the voluntary sector in an equal way to allow them to do what they do best. There had been much focus on the development of relationships, and shared trust within the contributing organisations.

8.13

Dr Hunter added that a national programme for the development of physician associates in mental health had been led, which had been beneficial in relation to promoting the physical health of people with mental health problems. An apprentice-based model for clinical associate psychologists had been developed that helped to make the profession more accessible. Building the workforce was noted as a challenge, and the difficulty of recruiting and retaining the workforce across the NHS. This was a constant stream of work, and was being carried out locally, nationally and internationally. Vacancy rates were coming down. There was the challenge of allocating money to improve buildings, particularly in mental health services and primary care settings. An internal Quality Improvement collaborative had been built to look at waiting lists and access to care, and work had been carried out with voluntary sector partners which had resulted in significantly reduced waiting lists. He outlined the ambitions, which were to put ‘person-centredness’ at the heart of everything, and to view the whole of the person’s need rather than via one service. There was also a commitment with partners to integrate pathways across Sheffield and South Yorkshire services, across a full age range.

8.14

Professor Mark Cobb explained that Sheffield Teaching Hospitals had been on a process to fully engage and to begin to change its culture and approach in caring for those with mental health needs, and caring for people as a whole. He noted that during the last 12 months over the five Sheffield Teaching Hospital sites, care was provided to over 37,000 people with varying mental health needs. A leadership team had been set up to take this challenge forward. He outlined the challenges, including providing a pathway to those who presented with a mental illness, particularly those with persistent physical symptoms.

8.15

Carmen Tulley noted that there was a lack of alternatives to Accident and Emergency. Most services were ‘9am to 5pm’, with most cases of mental health crisis presenting outside of those hours. The workforce in Accident and Emergency was predominantly doctors and nurses who had often not had sufficient training in supporting those with mental health difficulties. There was also a lack of hospital beds on specialist wards, leading to admissions on general wards that were less equipped.

8.16

Professor Cobb outlined the barriers faced by Sheffield Teaching Hospitals, and their vision for mental health, which included person-centred care, responding to needs with kindness and compassion and the fostering of an integrated approach.

8.17

Dr Jeff Perring explained that Sheffield Children’s was the provider of the Tier 3 Child and Adolescent Mental Health Service (CAMHS) for Sheffield, and Tier 4 CAMHS for South Yorkshire. He highlighted some of the developments that had been undertaken: growing the integrated services, working with partners, developing the workforce and engaging with service users. It was hoped to build on the work already undertaken to improve access to services, whilst also addressing inequalities in access. It was also important to continue to develop the workforce so that CAMHS was inviting and had career development opportunities that helped staff to progress their career.

8.18

Helen Steers noted that there were over 3,500 Voluntary, Community and Social Enterprise (VCSE) organisations offering multiple types of support in local communities, including support with mental health, physical health, confidence building, food supply, income maximisation, employment and skills, housing issues, isolation and identifying vulnerable people, early years, dementia, end of life and frailty. It was important to create a single meeting space to support people and build community strength. This support was often provided in a single setting. VCSE support aimed to build on the positive work in communities, to help people understand and access opportunities, and connect marginalised communities. Enabling community data and insight held by these organisations was useful to target support. VCSE organisations worked with the statutory health and social care system to build successful partnerships. They aimed to provide people with more ownership of their health outcomes, bridge the gaps in policy and delivery, and extend reach through culturally appropriate support. They had a unique advantage of drawing in different types of investment into the city, and were able to provide early alerts when things started to go wrong for residents.

8.19

Ms Steers noted the challenges for VCSE organisations, including dealing with different support needs and limited resources. There were vast disparities across different communities, and it was important to work together to reduce competition when applying for funding. Commercial procurement processes could undermine the collaborative work undertaken and reduce the sustainability of the local VCSE organisations. A move to a more sustainable model of funding would be welcomed.

8.20

Tim Gollins explained that in April 2023, social worker staff had been transferred from Sheffield Health and Social Care back to Sheffield City Council, and that this process had been successful and effective. There were challenges ahead in terms of allocation and review of cases. Recruitment and training of staff was being developed that aimed to help address the challenge of waiting lists. He noted that interface points were a focus for improvement. Other improvements to note included a new information, advice and guidance platform, a high functioning First Contact Service, and Muli-Agency Safeguarding Hub. He also noted the strong partnership between the Integrated Care Board and Sheffield Teaching Hospitals.

8.21

Mr Gollins noted the five key challenges/mitigation:

• Improving statutory performance by focussing on leadership and support;
• Embedding wellbeing centrally into the assessment and supporting the planning process; via the practice development programme;
• Balancing the risks faced by people in the community with risks of delayed hospital discharge, utilising appropriate funding;
• Using expertise to help people remain independent by focussing on prevention and early intervention; and
• Maintaining focus on prevention whilst also delivering on statutory duties.

He noted the broad challenge for recruiting to specialist social work roles, expanding commissioning specialist services, embedding continual practice changes, demystifying mental health, focussing on psychological and relationship based societal impacts rather than medics and pharmacology, and focus on self-help groups within communities.

8.22

Members made various comments and asked a number of questions, to which responses were provided as follows:-

• Community based support was important, including particular support for children and young families, via schools and other methods.

• Contributions to this review were valued, and it was important to celebrate what was working well. It was also important to note difficulties faced around accessing mental health services and the effect this had on general wellbeing. Funding and access to services was a challenge.

• Mental health as a constraint to employment was an issue to be considered.

• Staff needed support in working across systems. The staff transformation process was developing, and organisation clashes and upskilling requirements were being addressed via a series of workshops and conversations. It was important to create a culture where learning could be shared in order to help achieve objectives.

• There were some system issues to work on and to invest in, in order to prevent long term conditions and save money.

• There was a good delivery workforce programme in place, which would improve with partnership working.

• A common theme was that people often didn’t feel their voices were heard. Systemic co-design and co-production were at the centre of this review to ensure that it was carried out thoroughly, and extensive engagement across the city formed part of that vision.

• The approach of continuous improvement was welcomed, and it was noted that there would be difficult conversations around priorities and allocation of resources, and that all views would be valued.

• The review was an opportunity to improve care, consider how interventions were working, and to focus on greater levels of need and make improvements.

• Using community and voluntary sector funding effectively was an important factor to consider, and enabling better partnership working within communities. Understanding the links between mental and physical health was important when allocating funding, and considering other linked factors, such as housing needs.

• Embedding the work of VCSE organisations into the review and recognising their input into the process was important.

• The health care landscape had become fragmented; physical and mental health had become separate, as had adult and children’s health. It was important to utilise expertise and learn from each other as partners in this process. This was an opportunity to learn in different ways and begin to understand how complexities and risks were managed, as well as work collectively to improve wellbeing.

8.23

Heather Burns summed up the discussion and asked Board members to prioritise mental health delivery, and to complete pledges based on reflections from what they had heard. She added that, by working in partnership, outcomes could be improved across the city.

8.24

The Board thanked those in attendance for their contributions.