Deciding Together Developing a new vision for mental health · Deciding Together Developing a new...

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Newcastle Gateshead Alliance

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Deciding Together Developing a new vision for mental health

Patient, carer and community and voluntary sector event report 23 October 2014 V5

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1. Background Newcastle Gateshead Alliance together with partners in Northumberland, Tyne and Wear NHS Foundation Trust (NTW) are looking to improve services for adults accessing mental health services. Within the structure of the Alliance, the Mental Health Programme Board which includes partners from NTW, other health providers and the community and voluntary sector is driving these improvements to services. One of the tasks of the Board is to develop a model of mental health care that provides easy accessible and high quality care that is:

• Centered on the needs of the service user

• Supports the role of carers

• Focuses on early assessment and intervention at the most appropriate time and place.

To do this, Newcastle Gateshead Alliance are embarking on a public consultation exercise which looks to have a conversation with users, carers, the community and voluntary sector and local communities to gather views and experiences of mental health services. The consultation is designed to be an open conversation with the views, experiences and comments incorporated used to shape and used in the development of future mental health services. During September and October 2014, the first stage of this consultation began with a meeting for service users and carers in Newcastle Carers Centre on 9 July which was attended by 27 service users, carers and representatives from community and voluntary organisations organisations. This was followed by a series of ‘pre-consultation’ conversations. The events were planned by a communications and engagement group, called ‘deciding together’ and the membership includes Health Watch Newcastle and Health Watch Gateshead, representatives of the, VCS service user/carer, the Alliance Clinical Commissioning Groups, North of England Commissioning Support and Northumberland, Tyne and Wear NHS Foundation Trust (see membership at Appendix 1)

2. The conversations Four events were held to gather patient experiences and views and were held on:

• Thursday 11 September – MPH Training and Conference Centre, Gateshead.

• Tuesday 16 September – St James Park, Newcastle

• Friday 26 September – Thistle Hotel, Newcastle

• Tuesday 14 October – Thistle Hotel, Newcastle.

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In total, just short of 100 people attended all four events, with the majority of people attending the event on 26 September. This figure includes carers, service users, patients or members of the voluntary and community sector and not NHS staff or other partners who were supporting the running and facilitation of the events. The event on 14 October at the Thistle Hotel was supported by BSL interpreters, as four people from the deaf community attended the event. It should be noted that NHS staff were in attendance to ensure the smooth running of the events, note take or facilitate discussions only. The clinical staff in attendance were there to provide clinical knowledge and expertise on an as needed basis.

a. Structure of the events In planning the events, the Deciding Together Communications and Engagement Group structured the events to have:

• A brief introduction to set the scene

• Group exercise looking at two case studies of people to identify what mental health services and support was needed – this exercise was designed so people could share their experiences to inform the case study but be ‘one step removed’ from sharing too many personal details.

• The triangle exercise – this exercise asked people to identify where a range of mental health services should be provided:

o locally with a specific service in both Newcastle and Gateshead o locally but only one service for Newcastle and Gateshead o In one location across the Newcastle, Northumberland, Tyne and Wear

area.

• Top three priorities for future services. This format was used at the first event in Gateshead and the St James Park event, although due to lack of time, the triangle exercise was not used at the St James event. In response to feedback, the structure of the event on 26 September was amended to focus on:

b. Updated structure for 26 September:


• Group exercise looking at three elements of services: o Getting in touch with mental health services (Access) o Mental Health services outside of hospital o Mental Health services in hospital

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For each element, people were asked to talk about: o What their experience was (as a user, carer, community group which

supports carers or VCS organisation) o What was the most important positive thing that happened? o What could be improved and how?

• The triangle exercise – this exercise asked people to identify where a range of mental health services should be provided:

o locally with a specific service in both Newcastle and Gateshead o locally but only one service for Newcastle and Gateshead o in one location across the Newcastle, Northumberland, Tyne and Wear

area.

• Top three priorities for future services. Again following feedback from the event on 26 September on the added value of the triangle exercise, plus the positive and engaging conversations from the first exercise, the structure of the event on 14 October has been changed to give people more time to concentrate on the three areas of services – access, services in and outside of hospital.

c. Updated structure for 14 October


• Group exercise looking at three elements of services: o Getting in touch with mental health services (Access) o Mental Health services outside of hospital o Mental Health services in hospital

For each element, people will be asked to talk about: o What their experience was (as a user, carer, community group which

supports carers or VCS organisation) o What was the most important positive thing that happened? o What could be improved and how?

• Top three priorities for future services

3. What we found out – the emerging themes Case studies and top priorities

Interestingly, despite the change in structure, eight similar themes emerged from the case studies and the priorities for future services. These are:

• Whole person approach o Mental health problems don’t happen in isolation. Treat the person first, not the

illness. o Patients are the experts in their own care –involve and empower them to make

joint decisions with their healthcare professionals and their families. o Understand and treat the whole person – the mental health issue is just one part

of the person - e.g. do they need practical advice to support them that would help alleviate issues (finance advice, housing support etc.)

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o Services should follow the patient, not the other way around. o Treatment should be a continuous cycle from accessing services, treatment,

through to discharge and aftercare – have ongoing support and consider a ‘buddy’ system.

o Improve in-patient discharge planning. o Some people don’t have a home or a community or a safe house to go to – what

happens to these people? They also need a personal approach. o Meaningful choice for people with specific needs (e.g. hard of hearing, sight

impairments etc. with a whole person approach should mean when a specialist clinician recommends a therapist for someone with specific needs, the therapist is able to meet their needs For example, working with a BSL interpreter is not necessarily the most appropriate way for some deaf people.

o Deaf people have missed vital information and there are gaps in education. A deaf person needs more time and information explained to them about their condition.

• Support for carers and families o Carer and family support, both in a one to one and group settings are key to the

treatment and recovery of the patient (links back to whole person approach). o Support everyone in the family to prevent others being affected. o Mental health, just like other illnesses, affects everyone in the patients’ life. o Couples counselling is important but this should be widened to include families. o Transport is important for families, carers and the patient for ongoing treatment.

If you rely on public transport, visiting can take several hours and be expensive.

• Access to treatment o The role of the GP as most people’s first port of call is important – need GPs

trained in mental health issues. The initial response a patient gets shapes their experience through the system.

o Access to services should be fast, quick and simple. o Access to services for the deaf community is compromised by the lack of

support and complicated information that’s given to people on appointments etc. This information is overly complicated which in a lot of cases, discourages deaf people to attend appointments or access services. More awareness of how to communicate with deaf people is needed across the NHS.

o Easy, accessible medical assessment in a crisis o Effective crisis prevention and quick initial response and diagnosis. o Need to have one place; one contact number for people to have for when things

happen. o Access to a safe place if something happens - ‘a mental health casualty’. o Services should be as close to home as possible with some available at home. o There should be good care for all but cultural difference need to be rigorously

observed. o Criteria of who can access services needs to be revised.

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o Make information available to everyone on where services are and for patients already in the system, clear information about who to contact if they are in crisis.

o Clear, easily understandable information should be widely available to everyone which will support prevention and reduce stigma.

o Use of community and voluntary organisations and teams and alternative therapies to provide services and support for people reduce stigma. This needs to be made more ‘formal’ and part of the treatment plan.

o People need different types of beds and support. o Ensure CATS team early discharge co-ordinator post remains. o Expand acute day services. o Decrease waiting times for cognitive behavioral therapy. o Keep all inpatient beds within Newcastle.

• Good environments o Wherever people are treated, environments need to be friendly, homely and

positive but with that suitable for individual needs. o The places people receive treatment should not be called ‘asylum’ as this gives

negative messages to the patient and their family. o Access to a safe place, at whatever time of day is important. o Best environment isn’t always a clinical setting. o Having all mental health service users together isn’t always beneficial to

recovery. o Important to get location of treatment right, not everyone wants to be close to

home – what’s right for them? o In-patient care should be locally accessible – patients’ needs their families

around them to help recovery and treatment. o All information on conditions, support etc. should be available in BSL.

• Co-ordinated services o Joined up compassionate services between agencies – it shouldn’t be the

patient’s responsibility to make sure everyone knows their situation. o Fill the gap between primary and secondary care. o Fill the gap for people who need help, but are not yet ‘in crisis’ o Open conversations between service providers that include the patient. o Out-patient services need to be more joined up with in hospital care and what’s

available in the community – e.g. Sunderland IRT model. o Use expertise in the community and voluntary sector to support patients before

crisis, after discharge and provide aftercare. o Consider a ‘Case Manager’ concept to ensure consistency of care. o Make the patient and the family aware of what services are out there. o There should be a menu of services for patients and carers which is kept up to

date. o Ensure support groups etc. are accessible by everyone – these are not

accessible by the deaf community and therefore can increase isolation for people after discharge.

o Work with the community and voluntary sector to provide a holistic approach to mental health.

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o Common and shared knowledge and understanding of how mental health services function to avoid false, incorrect information being given.

o Clear signposting for patients so they know who to contact when. o More Innovative approach on working together by different agencies – not

competing

• Quality o Service equality for everyone – a lot of work is required to provide high quality

services to BME and deaf communities and those with visual impairments. o Respectful and focused on recovery and outcomes, delivered by well trained

staff. o Agreed and consistent quality and standard of care agreed across all

organisations that they sign up to. o Open and honest monitoring of services. o Education and training for the deaf community is poor. Staff in all areas of the

NHS including CCGs should have deaf awareness training – this basic training is needed.

o Maintain and aim to improve standards but be aware that change can be unsettling for patients.

• Be bold o Think outside the box – look at what works in other areas and try it here. o Consider new approaches to care which include widening who and what patients

can have access to as a matter of course. o Work together to reduce the stigma of mental health. o Look at the language that used – this can increase the stigma of how other

people perceive people with mental health issues. Also consider language that patients hear – ‘crisis’, ‘intervention’ are negative words and need redefining – change to ‘here to help’, ‘safe place’, ‘supporting you’. Crisis means different things to different people.

o Reduce the stigma of mental health by having clear messages to make people question their own behaviour. This will help people identify when they have a mental health issue but not be scared to seek help. This should include advertising campaigns similar to stop smoking and exercise.

• Investment o Be open and honest about the increasing need for mental health services. Invest

in education programmes in general. o Invest in the right number and quality of clinical staff who understand mental

health services. o Prevention agenda is hugely important. o Access to properly trained and professional staff who receive ongoing training –

also important that all staff are aware of mental health issues – e.g. admitted to hospital for another condition and how this can affect someone.

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o Sufficient resources to respond to individual need. o Training more GPs in mental health services.

4. Questions on service elements – access, outside and in hospital 26 September and 14 October Below are the notes from the three questions discussed at the two events:

a. Getting in touch with mental health services (Access)

o What their experience was o “How do you get access to mental health services?” Getting your foot in the

door is really difficult, particularly is it’s not a crisis. o CAT team need a wider remit. o Vicious cycle of trying to get help but get moved from service to service. o Reactions of staff is important – when a patient is in crisis staff should remain

calm and not portray a sense of urgency or give the impression that this is a major mishap. If not, this can make the patient more anxious.

o On the other hand, crisis team and GPS showed no urgency to patients’ problem – this shows an inconsistent approach.

o One organisation mentioned that they were unable to show urgency. They have a waiting list so if someone rings in crisis there is nothing the organisation can do other than put person on waiting list.

o Too much responsibility put onto the patient after discharge to manage their

own health afterwards.

o Left to “get on with it”.

o One user described how he was “forced” into recovery because the service refused to re-admit him when he was struggling after discharge. They expressed concern that some service users would not be able to cope as well as he did.

o Focus needs to be on ‘earliest intervention’. o Good – GP sorted patient out with mental health team quickly. o “GP changed the subject when I tried to talk about my mental health” o Inconsistent approach from GPs. o “Police came to my house and shouted at me. I was ignored and laughed at

in A&E” o The information deaf people are sent about appointments is too complicated –

they need plain English words, easy to understand so they don’t rely on relatives or worse still, don’t go to appointments because they are too embarrassed to help to understand their letters

o Staff working in mental health services are dedicated and committed to their jobs. This makes it easier for patients – but this needs to be across the board.

o Some service users become volunteers in the community – this should be encouraged to help more vulnerable people.

o Mental health is a 24 hour thing – it doesn’t work normal working hours to suit when services are open.

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o What could be improved and how? o First contact

o Treat patients with respect. Mental health issues are no different to any

other illness.

o Access needs to be fast, simple and easy.

o Stigma affects all levels and ‘badges’ people. Well educated an empowered people are vulnerable too and need help. When first contact is made staff need to be friendly, kind, humanistic and be on the side of the service user so the service user can learn to trust them, be reassured and not feel alone.

o Waiting lists - people are not getting help until they absolutely need it. Being treated too late - when an assessment is complete does the assessor know what is in the normal range and do they know when to send the patient back to their specialist rather than keep them waiting for a service that potentially isn’t specialised enough?

o How quickly a patient can get into the services is often dependent on how good their GP is.

o Not easy to access service o Long wait to see psychiatrist – over three months for one person and one

person described waiting over a year.

o The difficulty of accessing services as a deaf person is huge. There is no

appreciation from community and hospital services about the needs of a

deaf person.

o Correct diagnosis is crucial but is for whatever reason, sometimes difficult.

o Transition from children’s to adult services so people don’t get lost in the

system.

o Crisis o Dealing with crisis - Sometimes service users face a “crisis” where they

might need some extra support for the next 8-9 weeks but it takes 8-9 weeks

to get referred to a service – by which point they no longer need the support.

o Ability to immediately access help during times of a short-term 2-3 hour

“crisis” Making the language clearer and not using jargon

o CVS organisations supporting the health service.

o Need a flow diagram of what do when someone is in crisis – who to contact,

single point of access – but would that work?

o Improve the systems of communication on crisis intervention and the overall response of the Crisis Team especially when referral does not meet the team’s criteria.

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o Consistency

o Consistency of treatment/support from the emergency services. o Getting the right service once patients are in the system. o Consistency in approach of agencies to patient situation. o Money needs to follow the patient, not the other way around o Deaf people want and need to build a relationship with an interpreter when

attending appointments etc. Current contract doesn’t let this happen. o Integrated care between health and social care organisations. o Consistency of staff so patients can build trust and relationships and not

have to repeat their story. o Align IT systems so information on patients can be stored centrally and

shared.

o Support o More regular one-to-one work o Positive messages from staff patients come into contact with (nurses etc.) to

encourage people to feel better and have a positive outcome. o Peer support “Care Navigator” to help navigate through the system o Up to date information about what services are available

o Directories with services are out of date as soon as they are published.

o Third sector organisations should and could be used to much greater

advantage.

o Text facility for deaf people to access all health services as standard.

o Support carers to make informed decisions – they feel responsible.

o Primary Care o Access to primary care mental health services is poor. Some services might

not refer to them as know too long a wait (perceived to be 4 to 8 months.) o GPs should have knowledge of services in other areas. o Commissioners need to ask providers to do things differently to meet the

needs of patients – not the other way round. o GPs need to have ‘standard’ of dealing with people – your pathway depends

on how your GP is. o Needs to be better communication between GP and mental health services. o Better understanding at GP level for things like ADHD. Need more than 7

minutes for an appointment – sometimes it’s difficult to start the conversation. o Go through ‘flowchart’ of how you’re feeling to find out your issues and if you

need referred to mental health services. And explain this to the patient. o GPs need to listen to Carers – they are closer to the patient than anyone

else. See them separately if needed.

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o Ongoing access o Particularly hard to re-access services once you have been discharged.

o Understand the capacity of the voluntary sector as a key provider.

o The service is not just about beds.

b. Mental Health services outside of hospital

o What their experience was o ‘not the best’ o Communication between all health agencies and the patients is poor. No

joined up approach. o Good experience with community mental health team – sincere, empathise,

listened, given plenty of time. o Good support from crisis team for patient and family. o Good support from community and voluntary sector organisations but

funding for these is at risk. o EIP – continuity and excellent support, community service and staff good. o Community health trainers in Newcastle to help people with their fitness

(physical and mental) o Mixed response from Crisis Team initially, but no support/aftercare. o A strong relationship with a GP means a positive experience through the

pathway from identification to discharge. o “No help from the NHS, had to go to the voluntary sector”. o How do we help people who refuse to engage with services

o What could be improved and how? o It’s about the person

o “Global, Holistic, Individual Care”. That everyone is an “individual with individual needs”. Current mental health services don’t deliver this.

o Discharge planning that suits the patient o Involvement of patients in their care plans/empowerment o Look at whole patient, not just their mental health issues. o Collaborative pathways to provide the best service locally for people. o Still remains unknowns about BME communities – prevalence, cultural

barriers, stigma, where is support and how good is it? Lack of understanding about BME communities cultural needs.

o Don’t make assumptions about people – they are individuals, they don’t wear a badge.

o Treat the family as well as the patient o Are there other issues that patients have that need to be looked at or may

affect their mental health issues e.g. long term health condition, other relationships etc. – one sad story of woman who had mental health issues. She became pregnant and her baby was taken from her – although an individual case – are things like this the right decision for everyone involved?

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o Communication/Education o Communication with staff and patients. o Joined up conversations between agencies and between Newcastle and

Gateshead CCGs. o Telephone contact with people that patients need. o Education rather than training for key staff – GPs, practice staff, schools,

employers etc. to reduce stigma and increase understanding o Training and understanding of mental health issues with other services,

police, social workers etc. o Explain to patients about their medication, possible side effects, how they

may feel etc., to alleviate worries. o Make sure people know what services are available and how to access

them. (suggestions included give information at first point of contact, ‘care navigators’ assigned to GP practices, buddy system (as suggested at another event), training for all staff, directory of services)

o Investigate Bristol’s mental health model as this has proven to be successful.

o Access

o Access to secondary care with real choice o Tom Carpenter centre closed – ‘this was a lifeline’ – no follow up to where

care would be provided. o Skylite picking up groups but profile of service users has changed so people

are being turned away. o Boundaries shouldn’t exist been primary and secondary care. o People trying to access services are compromised as they are unwell. This

should be recognised. o Why do people have to ask for services – why are they so difficult to

access? o Navigating the system as a carer is really difficult so must be really difficult if

you have issues and are unwell. o GPs don’t have information on what mental health services are available so

can’t signpost to the most appropriate care. o Criteria – shouldn’t be so rigid – patient story of patient not meeting the

criteria so couldn’t access services. o Make sure patient sees the right team, first time. o Crisis team is overstretched so unable to respond to everyone who needs

them. Need more crisis teams. o How can a family help their loved one if they don’t want to access services?

o Ongoing access/support

o Getting in touch with services after discharge and the responsibility of all referrers to contribute to improving this situation.

o More social prescribing. o Gap in emotional support as this isn’t provided by crisis team.

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o Services to help reduce isolation. o Access to services at support for carers in everyday life and in a crisis. Need

to value and respect views of carers. o Training for staff to understand issues. o There are no support services that are easily accessible to deaf people after

discharge – all the groups are for hearing people. This means deaf people are at higher risk of isolation. Need to work with existing groups to build this in.

o Integrated teams between mental health and social care services. o After accessing the system, there is no information on what other services

are available and how to access them. It’s all done in isolation. o More community provision to reduce inpatient beds.

c. Mental Health services in hospital o What their experience was

o “Absolute hell” o “It is containment not care” o Environments are important to treatment and recovery – stimulating,

interesting, and accessible. o Visiting hours and accessibility for loved ones helps to aid recovery. Some

places are not easily found or easy to travel too which adds to distress for the patient and the family.

o Being discharged into an unfamiliar area can be distressing – e.g. discharged in Morpeth but not familiar with the area.

o Waited too long for assessment. o No positive experiences and know this is the same for others. o CAMHS won’t see people aged 19 – are they children or adults and who can

they go for help? o Not good – access to mental health services out of hours is bad – mental

health doesn’t just operate 9 – 5. o Waiting time after initial assessment is too long and stressful for patients and

their carers. o Access to counsellors is difficult for deaf people – there are none available

who understand BSL or the deaf community needs. These specialist counsellors are not funded by the CCG as they are seen as outwith normal services.

o There are good informal relationships between staff but this isn’t carried through to discharge.

o ‘Impossible to get to Hopewood Park’ – travel time is really bad and affects carer. In turn, patient feels isolated and this isn’t good for recovery.

o Not good to have acute/move on and rehab in same location

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o What worked well? o Moving from the ward to Hopewood then Elm House was really positive.

o What could be improved and how? o Access

o Early intervention. o Beds within own area not have to travel outwith area. o Joining up referral schemes o Staff patterns should fit in with the service users life, ways of life – not be

restricted to 9 to 5pm workdays. o The Advanced Directive is ten years old – this needs updated. o Access to services for deaf people is really poor –the letters or information

patients receive is overly complicated and too wordy – reading age of deaf people is different to their real age. This may result in patients inappropriately asking family members to interpret or the deaf person not attending an appointment.

o A list of on call interpreters is key to support deaf people. Accessing services is difficult enough without having a communication issue as well.

o Don’t have separate Newcastle and Gateshead facilities. o People need consistent level of nursing care. o ‘Move on’ wards could be provided differently. o Best practice – what do other people do? Can we learn? o Travel times for carers to visit patients are huge and not understood – issues

for both patient and carer. o Tramwell Unit – environment not great but staff are really good. Patients

need more interesting things to do to alleviate boredom.

o It’s about the patient

o Treat the whole person and their family re accessible visiting hours and places. It’s difficult for relatives to travel to another area.

o Need stronger relationships between inpatient and outpatient services and care so it’s easier for patients.

o Don’t just medicate people – what other alternatives are out there? o Know the patient, not just the condition – what do they like, what are their

interests etc.? This all helps to build a relationship between patient and staff but also make the person feel some worth. This makes a difference to their wellbeing and interacting with others.

o Staff and resource o Staff don’t have enough time to see every patient – they have too much

admin and form filling, rather than seeing, talking and treating people. o One episode of no waste being taken away and lay for four days. o Need continuous care with same clinician, not constant change of staffing.

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o Ongoing access/support o Regular contact between patient and carer is important. Carer needs to be

part of treatment/care plan. o Discharge people into an area they know and make sure they have a

support network. o Discharge procedures are poor there is no clear and easy transition process

for patients. o Deaf Awareness Training and education is of paramount importance when

using all services – deaf people are entitled to the same level of service as everyone else.

o Discharge plans need to be looked into as soon as the patient enters the hospital, not just when they are being discharged.

o Can supported nursing be done differently – does this have to happen in hospital?

o Community/Shared house or move on facility from hospital would be good.

5. The triangle exercise This exercise was completed at the first event in Gateshead and the event at the Thistle Hotel on 26 September. Participants were asked to look at the triangle below and discuss where services should be provided. Examples of services included – high dependency unit, acute beds, rehabilitation beds and psychiatric intensive care units, amongst others.

It should be noted that some participants commented on the unfamiliarity of the terms used and not knowing the difference between, for example, community crisis beds and crisis beds.

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This made it difficult for people to fully understand and complete this task, and the results are not fully reliable. Many people commented that they didn’t mind where services were based, and understood that sharing office bases for example could save money, but wanted the delivery of those services to be local. Comments on the triangle exercise included: o Thinking about beds is clinical thinking and a bit narrow. We’re also not meant to

be thinking about beds. Beds should be secondary to person based thinking. o Services should be flexible around the needs of the person. Person should not be

put in a certain bed. They should be in a bed with services and staff moving around them, not the person moving between services.

o We are looking at providing services regionally here. This is not person centred when that is what you want to do.

o The terminology of “local” and “home” needs to be reconsidered. Sometimes the negative influences of home means that is not the right place for a patient to be. Better to talk about a “Community of Choice” than “in the Community”

o It is important also to understand that “where” community rehab is geographically is only on a par with “who” provides the service and how good/appropriate/expert they may be at that.

These comments, together with the majority of people wanting all services locally but the reality of this being achieved influenced the decision to remove this exercise from the final event on 14 October. Feedback on where participants thought services should be delivered is in Appendix 2.

6. Next Steps From the events so far, we have a plethora of in-depth, valuable information to help shape the full consultation exercise. This information will be considered in depth and how it might be used for the next phase of public engagement and consultation, and the issues and themes will be incorporated. The Consultation Institute, an independent body, will provide oversight of the consultation processes to ensure best practice. The draft timescale for the consultation events is shown below. Please note that these at the time of drafting this report are not confirmed and are subject to venue availability. Confirmed dates and venues will be widely circulated prior to the consultation starting.

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Event Timetable - Consultation Period Wednesday 12 November 2014 – Monday 9 February 2015 6

Date Time Event Wednesday 12 November

11am – 12am Launch event Assembly Rooms, Newcastle Upon Tyne, NE1 5XU

12pm – 4pm Market stalls Thursday 20 November

10am – 1pm Market stalls Gateshead Civic Centre, Regent Street, Gateshead, NE8 1HH

Thursday 04 December

1pm – 5pm Market stalls Newcastle Central Library – Bewick Hall, 33 New Bridge Street West Newcastle upon Tyne, NE1 8AX

Wednesday 14 January

10am – 1pm Market stalls Gateshead Civic Centre, Regent Street, Gateshead, NE8 1HH

Saturday 17 January

10.30 – 2.30 pm Participating budget event – ‘How do we spend the mental health money?’ Life Conference & Banqueting, Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP

Thursday 22 January

1pm – 4pm Market stalls Life Conference & Banqueting, Centre for Life, Times Square, Newcastle upon Tyne, NE1 4EP

Thursday 29 January

4pm – 7pm Market stalls Assembly Rooms, Newcastle Upon Tyne, NE1 5XU

Engagement methods for the consultation process Marketplace stalls For example: one issue/theme per stall. An opportunity for discussion and to capture feed back – public, carers, community and voluntary sector organisations Survey Self-completion – paper and online (paper survey will be included in the back of the consultation document) Focus groups Pack provided, CVS offer for activity. Particular focus on protected characteristic groups. Workbook (self-completion version of the focus group pack) Provided to existing groups and networks allowing them to hold own discussion on issues and provide a feedback report. In-depth interviews Targeting specific groups for more in-depth one-to-one discussions. Attendance at existing community groups and fora Patient groups, community fora, engagement board meetings etc. Social media - Facebook, Twitter where available through CCG and partners.

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Overall timeline

Date Key activity July 15 2014 Planned discussion NTW/CCG’s/LA’s July 29 Planned discussion – Stakeholders (If an

agreed solution emerges this could be a more specific element of the following consultation)

August, September, October Pre-engagement events with stakeholders, carers, users, patients and VCS

September and October Consultation planning and approvals by relevant organisations

October Sign off of case for change and consultation strategy by Mental Health Strategic Forum

October Sign off of case for change and consultation strategy by Alliance governing body or delegated powers of the executive

Wednesday 12 November

Consultation starts

Tuesday 16 December Mid consultation review with Consultation Institute

Monday 9 February 2014 Consultation ends (13 weeks) could extend into February if required

February 2015 – May 2015 Consideration of feedback by organisations and representatives Consideration of models of care Consideration of consultation process and outcomes if a short further period of consultation is required

Mid-March – May 2015 Pre-general election period – purdah begins

May 11th 2015 Begin 6 week final consultation on a preferred model is required.

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Appendix 1 Deciding Together Planning Group membership • Steve Nash, Chairperson and Coordinator of Voluntary Sector Advisory Group (Planning

Group Chair )

• Alistair Cameron, Team Leader, Launchpad

• Chris Piercy, Executive Director of Nursing, Patient Safety & Quality, Newcastle Gateshead Alliance

• Rachel Head, Champions’ Support Worker, Healthwatch Newcastle

• Caroline Latta, Senior Communications and Engagement Locality Manager, North of England Commissioning Support

• Caroline Wild, Deputy Director, Partnerships, Northumberland, Tyne and Wear NHS Foundation Trust

• Joe Lewis, Mental Health Carer Involvement Worker. Gateshead Crossroads

• Rebecca Eadie, Senior Commissioning Manager Mental Health (Process Lead), North of England Commissioning Support

• Anthony Gowland, Provider Management Mental Health, North of England Commissioning Support

• Stuart Dexter, Chief Executive , Tyneside Mind

• Alison Thompson, Patient Carer and Engagement Lead, Newcastle North and East Clinical Commissioning Group

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Appendix 2 Feedback themes from the triangle exercise a) Locally with a specific service in both Newcastle and Gateshead:

Assessment o Older people assessment and treatment (organic) o Older people assessment and treatment (frail/functional) o Adult acute assessment and treatment o Early intervention in Psychosis teams. o Street triage o Initial response

Beds o Community respite beds o Crisis beds peer led o Community rehabilitation beds (often third sector or LA) – could these be called short

breaks/thinking time? o Rehab beds – close to home as possible – need to think about terminology used. o Adult community crisis beds Other ‘beds’/services o Recovery houses (Staying well houses) o Crisis House o Drug and Alcohol Services. o Complex Care (rehabilitation) o Supported accommodation for drugs and alcohol o Local Recovery Houses o Local PICU assessment centre Support o Move on (rehabilitation) o Older people – should be treated at home for as long as possible even if assessment is

needed. o Healthwatch and VCS provision o Community Mental Health Teams o Self-harm/liaison services o Crisis and Home Treatment Teams o Independent Advocacy navigation o Counselling o EIP o Floating support – what are the links CCG/LA and potential use of the Better Care

Fund? o Support from religious groups o Long term support at home

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b) Locally but only one service for Newcastle and Gateshead:

Assessment o Adult Acute Assessment and Treatment o Early Intervention Psychosis Team o Mother and baby assessment units

Beds

o Clinically Led crisis bed Other ‘beds’/services

o Ridley Villas, Byker Housing Rehabilitation

o Complex care (rehabilitation) o Move On (rehabilitation)

Support

o Older People (challenging behaviour) o Crisis and Treatment Teams o Assertive Outreach Team o Memory Assessment Service o Criminal Justice Link Team o Service users to be involved in actions/where to go. o Therapy led inpatient services

c) In one location across the Newcastle, Northumberland, Tyne and Wear area:

o Psychiatric Intensive Care Unit (PICU) o High dependency unit o Learning Disability Treatment Unit

d) Services not placed in the triangle

o Dual diagnosis (learning disability/substance) – NTW wide o Therapy led inpatient services/beds – NTW/Alliance wide o Complex care – patient could be managed in generic health and social care setting with

more specialised care nearby - NTW/Alliance wide. o High dependency unit – NTW/Alliance wide o Community crisis beds (clinical) – Alliance/local within Newcastle and Gateshead o Recovery beds o Move On (Rehabilitation) o Transport Service o Respite for carers and families

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