8 July - Mental Health Network - Governance during the COVID-19 pandemic

This week’s meeting was joined by Prathiba Chitsabesan and David Lockwood from NHSE/I to update on child and adolescent mental health and the national picture.

Prathiba shared that health inequalities is high up the agenda and is a huge programme of work which is taking place in NHSE, with all organisations being asked to use the patient and rated quality framework to review data to support and improve pathways. They have also asked to prioritise schools in areas where they will have the biggest impact.

There was a discussion around the average length of patient stay. NHS Benchmarking shows on a much higher average length of stay at 65 days compared to in Canada and Australia where it is only 10 or 11 days by comparison. The point was made that this means the budget is being spent on a model which can actually potentially do harm to young people given the risk of restrictive practice.

Prathiba shared this is very much a priority, as an inpatient bed costs £250k per year and they can see that this could support 100 young people with this. Prathiba said NHSE/I are looking to lead a QI programme around reducing restrictive practice, improving diagnosis and reducing length of stay and out of area placements. They will look at different examples around the country at what works well and what needs to improve, for example GIFRT shows that increasing staffing reduces length of stay and from NHS Benchmarking increased use of clinical psychologists can reduce length of stay. They will also support the system to start asking more questions including piloting the clinical utilization review.

Prathiba and David were asked about waits in the community setting, and the impact of COVID-19, seeing more young people waiting between first referral and treatment.

Prathiba shared that approaches currently are to use digital tools and other agencies to support young people in the community when they are presenting with milder mental health problems. There is also a vision for this be a more standard offer recognising that innovation and utilisation of other services can also reduce pressure on specialist services and the workforce, as well as preventing escalation of acuity. David added that a focus is on improving access and reducing waiting times, and they are looking into a range of models and initiatives which will support both of these endeavours.

Part of the discussion was spent reflecting on the new secretary of state in post and the publication of the health and care bill. The big question was whether it would help or hinder chairs of mental organisations to be better stewards. Points were made about the central control emphasised in the bill and concerns that the division between the ICB and ICP seem further apart and the ICP appearing to be another version, albeit larger in scale, of the health and wellbeing board. Concerns were aired about the ICB being more top down than bottom up.

The NHS Confederation has prepared a member briefing on the health and care bill which is available here.