What this publication is about
This is a summary of the proposals to invest in and improve adult mental health services in Leicester, Leicestershire and Rutland. It includes services needed urgently and for care and treatment that is arranged in advance.
The full consultation document is available at www.greatmentalhealthLLR.nhs.uk
Have your say on proposed changes to mental health services
Mental or emotional health problems represent the largest single cause of disability in the UK. One in four adults experiences at least one mental health problem in any given year. We have been listening to what people want from their local mental health services.
This public consultation sets out proposals to improve and invest in urgent mental health services for adults and, more planned and routine community-based mental health services within Leicester, Leicestershire and Rutland.
This is your chance to find out more about what is being proposed and have your say. This will help the local NHS to understand what the changes would mean for you and help us to make a final decision.
You can read the full consultation document and find out more about what is proposed and why at www.greatmentalhealthLLR.nhs.uk.
Versions of the consultation documents can be provided in other languages and formats,
including easy read, large print and video. These versions can also be found on our website. We can also post out a summary consultation document and questionnaire for you to fill in at home.
What changes are we proposing? We want to:
- Join up and make it easier for people to access mental health care.
- Provide more mental health care locally, including in people’s home, meeting the needs of our communities.
- Coordinate mental and physical health services to improve people’s health and wellbeing.
- Reduce long waits for services.
- Provide high quality care locally close to home, leaving inpatient facilities to care for the most unwell people.
- Work with individuals, their family and carers to assess needs and develop a care plan that meets those needs
- Help people to get the right care, first time, providing a seamless experience with no unnecessary delays or need to continually repeat their story.
- Transfer people to different mental health service without them repeating their story and being reassessed
- Different staff to work together around the needs of people to best support their recovery.
Are we speaking your language?
Versions of the full consultation document can be made available in other languages, and are in easy read, video and large print. These versions can be accessed on our website: www.greatmentalhealthLLR.nhs.uk
About this consultation
What this consultation covers
The public consultation is about mental health services delivered by Leicestershire Partnership NHS Trust. These plans aim to improve support to adults and older people who need mental and emotional support urgently and for community mental health care and treatment planned in advance.
This consultation is being led by NHS Leicester City Clinical Commissioning Group (CCG), NHS West Leicestershire CCG and NHS East Leicestershire and Rutland CCG.
What this consultation does not cover
This public consultation does not cover other mental health services such as inpatient services or services provided to children and young people.
How people need mental health - services to improve
We have listened to what people have told us about their experiences of services and what matters to them.
The feedback has helped us to develop these proposals. People told us:
- I need an easy way of getting help and support at any time of the day or night.
- I need help as quickly as possible and to know that it will be the best care possible to meet my needs.
- I need staff to understand me and my family and friends and focus on my care needs.
- I want to live the best life I can, achieve my goals and live independently.
What changes are being proposed?
Proposals at a glance
| || || |
|Service under consultation ||How it is provided now ||How we propose to provide it |
|Suite of self-help guidance and tools ||Information is currently provided in separate places, is text heavy and difficult to navigate. ||Provided in one place on the Leicestershire Partnership NHS Trust website. |
|Central Access Point ||New service introduced temporarily during the pandemic. ||Singletelephonenumberandonlineaccessprovided24hoursaday, sevendaysaweek,andstaffedbyvoluntarysectorandLeicestershire Partnership NHS Trust staff. |
|Crisis Cafes ||We have 3 Crisis Cafes and wish to increase this to 25. ||Crisis Cafes to be developed in community locations in Leicester, Leicestershire and Rutland offering a safe space. Created by working withvoluntaryandcommunityservicestodeveloparangeofoptions forpeople. |
|Crisis Service ||Provided by Turning Point and |
Leicestershire Partnership NHS Trust, around the clock, taking referrals mainly from GPs and handled by call handlers.
|People would self-refer or be referred from their GP through the Central Access Point and be assessed in four hours if need is urgent and in 24 hours if less urgent. Up to three home visits a day could be offered. Also, people would be helped to be discharged from an inpatient facility with specific support in the community and at home. |
|Triage Car ||Operates 10pm to 2am, taking calls from police incidents and providing support to manage situations.Callsaremanagedby staff operating the TriageCar. ||Operates 8am to 2am,and would also provide support to ambulance crews.Calls would be managed by the Central Access Point,leaving operations staff to support incidents. |
|Mental Health Urgent Care Hub |
|New service introduced temporarily during the pandemic. ||Sustain service long term. Located at the Bradgate Unit, taking referrals from emergency services, GPs and health and social care professionals. People with specific mental health needs would be quicklyassessedandtreatedwhentheirneedisurgentandtheydo not need support from the emergencydepartment. |
|Acute Mental Health Liaison Service ||New service introduced in April 2021. Previously provided by Mental Health Triage Team, Frail Older Persons Advice and Liaison Service, Liaison Psychiatry and PsychoOncology ||Create an Acute Mental Health Liaison Service by joining together the existing teams and basing them at Leicester Royal Infirmary, near the emergency department, to support people efficiently. Also support inpatients. Service available 24 hours a day, seven days a week. |
|Working with the community to provide more mental health services locally ||Various services delivered outside of hospitals. Often not working together to help people. Many of the services have not seen people in their local area. |
Long waits for therapy services, with people passed between services and professionals, which has contributed to some people becoming more unwell.
|Bring together services into eight teams working in local areas supporting adults and working alongside eight teams to support the needs of older people. These teams will be supported by staff with experience in the care of: |
- women who want to conceive a baby supporting them pre- conception to 24 months after birth
- Individuals with complex needs associated with a personality disorder
- Individuals who have had a first presentation of psychosis
- Individuals with complex needs that require enhanced rehabilitation and recovery support individuals who are difficulties with their memory
improving mental health care when the need is urgent
Advice and guidance are key components of mental health support. There is a lot of information out there and we would bring this all together in a single place online. This would help people to find the information they need and receive further help.
Introducing a Central Access Point
When individuals need more help we recognise it is important that there is a place to contact 24 hours a day, seven days a week — whether by phone, text message, or using British Sign Language or interpretation facilities.
In April 2020, during the first wave of the Covid-19 pandemic, a new contact point was introduced in Leicester, Leicestershire and Rutland to help people who wanted support with their mental health. We are proposing on continuing this service. Anyone needing mental health support for themselves or others can call this service on 0808 800 3302.
Strengthening the role of Crisis Cafes
Crisis Cafes offer a safe space where people can get help if they are experiencing a mental health crisis. There are currently 3 Crisis Cafes. Over the next four years we would open a further 22 Crisis Cafes in Leicester, Leicestershire and Rutland. Through this consultation we want to know where people would like to see these located.
Improving the Crisis Service
When individuals are in a mental health crisis and need help in their homes we have a Crisis Service that can help them. During the Covid-19 pandemic improvements were made to the Crisis Service, enabling people to seek help directly through the Central Access Point without needing to contact their GP. This gave them easier access to a specialist, if needed. The most urgent assessments would be completed in four hours. Those with less urgent needs would be assessed within 24 hours.
The police may need to help individuals whose mental health is contributing to their behaviour. Sometimes mental health expertise can help people through such incidents.
A Triage Car that has police and mental health practitioners working together to support people has been in place for some time. We propose to increase the number of hours the car operates and work with ambulance crews as well as the police.
Introducing a Mental Health Urgent Care Hub
There are times that individuals need more intensive support. During the Covid-19 pandemic, we introduced a Mental Health Urgent Care Hub. We now wish to consult on making this permanent. The Hub is at the Bradgate Unit, on the site of Glenfield Hospital. People are referred to the Hub by emergency services, social care or health professionals. It is staffed by mental health practitioners who have the expertise to treat people of all ages; this includes mental health nurses, support workers, and consultants. The Hub is
an environment specifically for people with mental health needs that don’t need physical health support provided in an emergency department.
Introducing an Acute Mental Health Liaison Service
When individuals with mental health needs go to the emergency department for help, it is important that mental health expertise is available to them. An Acute Mental Health Liaison Service launched in November 2020. We invested in bringing together existing teams to work as one team in the emergency department and on hospital wards providing support to people. The service is available 24 hours a day, seven days a week, helping adults with mental health problems.
Joining up support for vulnerable groups
There are individuals who are particularly vulnerable who need mental health support, but for various reasons do not access it. There are currently three teams working with vulnerable groups, including homeless people and individuals that present in the criminal justice system. We propose to bring these teams together into one dedicated service to help more vulnerable people access the care they need.
More about the proposals
This public consultation is seeking people’s views on:
working with the community to provide more mental health services locally
People told us they want more mental health services delivered locally and designed to work for local needs. We propose to join up more services and base them in local communities. This would allow people to get a better experience of care that meets their needs and places a greater emphasis on psychological care. Staff will provide care that focuses on the needs of the individual and their goals and recovery. People will not have unnecessary duplicate assessments and won’t experience long waiting times. The joined-up teams will work with the voluntary sector, social care and other physical health services to focus on all of people’s needs.
This is intended to be delivered through:
New Community Treatment and Recovery Teams
We have a number of teams working separately, with some work being duplicated or triplicated, and long waits as people are passed between different teams.
We want to bring together a number of teams into a Community Treatment and Recovery Team, working in eight areas. These communities will be based broadly on district council boundaries in Leicestershire, the City Council and Rutland County Council boundary. Professionals with different expertise would come together within the teams to provide care and treatment focused on individuals’ needs.
Alongside these eight Community Treatment and Recovery Teams there will be eight teams targeting the specific needs of older people. Each Community Treatment and Recovery Team would offer a service seven days a week, within working hours. A flexible approach would be taken to weekend cover, once the need is assessed.
These teams will help improve the experience and care including:
Reducing waiting times for treatment and support
Currently, more than 300 people have been waiting over a year for therapy and support. We would bring together expertise into the new teams, reorganising the way therapy is provided and investing additional money to recruit more staff. This is expected to reduce waiting times and improve people’s experience.
Improved support for individuals with a personality disorder
Individuals with a personality disorder have had particularly long waits for treatment and support with only a small number of people each year able to get targeted therapy.
We would invest in over ten additional staff to create a greater range of treatments to support the different needs of individuals with personality disorders. We would support the majority of individuals within the new Community Treatment and Recovery Teams. Additional therapy would also be offered to individuals who are the most unwell. We expect people to have better outcomes from their care, an improved experience and quicker access to support.
Improving services for people of work age and older people
We want the experience and health outcomes for people needing routine mental health treatment and support to improve. We want the right expertise provided to people at the right time, in their local area that focuses on their needs. We would bring together different teams that have not always worked well together and provide additional investment to create eight Community Treatment and Recovery Teams organised to support local communities.
We would also ensure that older adults have their needs met by staff with the right expertise. We would move from six older people-focused community mental health teams to eight focused Community Treatment and Recovery Teams These teams would work locally in partnership with the wider Community Treatment Recovery Teams.
Expanding Perinatal Services (for the time immediately before and after birth)
In line with health systems across England, we would invest in our Perinatal Service (before and after birth) over the next two years. This would support women with moderate to severe perinatal mental health difficulties to access specialist psychological therapies in the community. This would be available for those women from pre-conception to 24 months after birth; an increase on the current 12 months’ care. This investment would allow us to double the size of the Perinatal Team.
Developing a new maternal outreach service
We would develop a new service to support women who have, or are, experiencing trauma and loss in relation to their maternity experience. Currently, women have limited access to specialist care if they are suffering from Post-Traumatic Stress Disorder relating to a traumatic birth or previous experience of childbirth that has been triggered by a current pregnancy. The service would be provided by Leicestershire Partnership NHS Trust, working closely with Leicester Hospitals’ midwifery team. The service would be provided both in clinics and in the community. The actual locations have not been decided – we want to hear your thoughts through this consultation.
Improving experience of individuals with potential psychosis
There is an existing service focused on assessing and supporting individuals from 14-64 years of age who have potentially experienced first symptoms of psychosis. This is called the psychosis intervention and early recovery service (PIER) which currently works separately from other services.
This has led to a high number of individuals being sent to other teams for a duplicate assessment of need. In the future PIER and the new Community and Treatment Recovery Teams would work closely together. We expect that this would allow individuals’ needs to be assessed once and for people to be offered the right support for their needs first time.
Ongoing care would be seamlessly provided.
Reducing the wait for diagnosis of dementia
We have a Memory Service that supports the diagnosis of dementia. During the Covid-19 pandemic it was essential to introduce a temporary new way of providing the service. This included supporting people online ensuring they were kept safe and stayed physically well. It also provided additional advice and guidance to GPs enabling them to support
their patients. We believe that these have been helpful ways of supporting people who do not need or want to be seen face-to-face. We are now consulting on this change to understand the impact of providing online contact through our wider services permanently.
Providing community rehabilitation support to help people recover from complex psychosis
We have historically supported some individuals with complex psychosis and other severe and enduring mental health difficulties in inpatient services. Some people could have their needs met in a community setting. During the Covid-19 pandemic we temporarily invested and introduced a community team, called the Enhanced Recovery Team, which supports rehabilitation in the community, for those people that could benefit. We now propose to expand this service and the Enhanced Recovery Team would work with the Community Treatment and Recovery Teams offering consultation and support.
How are the improvements being funded?
There has been a national commitment of significant investment in improving mental health services. We want to both reorganise services to make them work better together and make a multi-million pound investment to strengthen them. The combination of this investment and reorganisation is expected to enable significant improvements to services improving the health and wellbeing of people.
How we arrived at the proposal
We have continuously involved patients, service users, carers, staff and other stakeholders in a conversation about health services since 2014. Specific engagement on mental health services was undertaken between November 2017 and May 2019, adopting a phased approach.
The engagement on mental health services has included:
- hearing from more than 1,000 people across Leicester, Leicestershire and Rutland
- four week-long workshops attended by 84 staff, service users, carers and people from other agencies, and a further 48 face-to-face and online sessions with staff, service users, carers, the local authority and the voluntary sector
- 207 online responses and more than 90,000 social media posts
- feedback used to co-design key features of the proposed new services
- new service proposals reviewed by the East Midlands Clinical Senate
- ongoing engagement with service users, family, carers and staff is continuing throughout the Covid-19 pandemic.
Ensuring equality of care
As a legal requirement, but also as a moral duty to people, we have tried to get in touch with everyone who has an interest in the proposals and encourage them to get involved.
We did an equality impact assessment at the beginning of 2021, so that we could make sure that we were making it easy for everyone to take part and we weren’t unintentionally excluding anyone. We will keep looking at this throughout the consultation so that we can do something about any gaps. The initial assessment, which considered the requirements placed on the NHS through the Public Sector Equality Duty, will be reviewed and revised at the end of the consultation.
How to get involved
This consultation will run from Monday 24 May 2021 to Sunday 15 August 2021. We want to know what you think about these proposals to improve some adult mental health services in Leicester, Leicestershire and Rutland. Please fill in the questionnaire in this document. You can also:
- Find out more about the consultation, what is proposed and why on our website at www.greatmentalhealthLLR.nhs.uk. The website will also have details of consultation virtual events and meetings. You can complete the questionnaire in this document or on the website
- Telephone us on 0116 295 0750 if you require support to complete the questionnaire or email beinvolved@LeicesterCityCCG.nhs.uk
- Email us your views at beinvolved@LeicesterCityCCG.nhs.uk
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What happens after the consultation ends?
All the feedback we receive from the consultation will be independently evaluated by an external organisation.
The organisation will also do a review half-way through the consultation and advise the CCGs if there are communities that are not being reached. If the review shows gaps, then we can adjust our communication plan to address them.
A final report of findings from the consultation will be sent to the three CCG governing bodies in a public meeting and the feedback from the public
consultation will be considered and taken into account in any decisions they make.
All decisions will be made public after the governing board meeting. Leicestershire Partnership NHS Trust would then undertake further work with service users, their families and carers, and staff running the service to co-produce the improvements.