Greenwich Council

Agenda item.

Update report from Oxleas NHS Foundation Trust - Mental Health

To consider the attached update report from Oxleas NHS Foundation Trust.


In presenting the report the Deputy Chief Executive Officer (DCEO) of Oxleas provided an update on the integration of adult and learning disability services into a single service provision, which was initiated as of April 2017.  That the integrated service would look at the person as a whole, which would bring greater benefits for all patients including those with long term health and mental health issues.  The integrated service would reduce duplication in assessments and treatments with a single care record which would enable each healthcare professional to see what other Oxleas treatments and services the person was receiving. 


She continued that this year, the trust had had to find 3.8% national efficiencies and the Care Commissioning Group (CCG) were also seeking efficiencies in light of their own financial challenges.  The DCEO Oxleas acknowledged the valuable contribution by the Royal Borough of Greenwich and the Lewisham & Greenwich Trust in relation to the care and support offered by Oxleas.


In response to Members’ questions the DCEO Oxleas confirmed that the majority of the Trusts budget was provided by the CCG, though NHS funding, with the exception of a few specific areas of provision.


In respect of the local efficiencies required by the CCG in some services for patients with long term conditions, the DCEO Oxleas responded that Oxleas clinicians were working with the governing body of the CCG, to ensure that there was clarity on the impact on patient care.  She continued that a reduction in finances was not ideal but that she was confident that the areas identified would not see a significant reduction in the quality of service provision and that Oxleas were looking to secure as much of the savings as possible through savings in management, administration and buildings costs.


The DCEO Oxleas confirmed to Members that Oxleas was the first Trust to become fully no smoking and patients were given a range of support mechanisms to stop smoking. 


Members noted the high percentage of positive patient feedback but questioned what the percentage meant in real terms of numbers of people, exampling 3% could be 3 people or 300 people.


The DCEO Oxleas noted that there were figures in the paper but that further analysis could be provided. She confirmed that the feedback was gained from patients and family members on discharge and that she would provide Members with a breakdown of the numbers of people who responded.

 Action: The DCEO Oxleas


In respect of the transitional arrangement, for young people moving to adult service provision, the DCEO Oxleas informed Members that this was a substantial area of work supported by collaborative working between young people and adult services clinicians.  The exact age at which a young person transitioned from one service to the other was dependant on the individual and services seek to be as flexible as possible and did not have an ‘18th birthday’ cut-off. There was at least a six-month transition period of joint working, involving both sets of services with the young person, their parents or carers and friends.


The DCEO Oxleas responded to Members’ question about medication that she was unable to comment on any trends relating to the use of psychiatric medication within primary care but for Oxleas services, the trust offered a combination of treatments, including talking therapies, alongside medication.  Psychological therapy was considered a very valuable tool and there was a desire to be able to provide more.  She noted that there were some patients who could find it difficult to take their medication regularly and for these patients, long acting depot medication was available, which could be effective for up to a month.


Members raised the question as to the number of police and armed forces personnel who approached the service with PTSD (post-traumatic stress disorder) and how were they are assisted.


The DCEO Oxleas responded that Police officers referred themselves through the usual channels, as individual. As for the armed forces, there was a protocol in placed for referrals.  She confirmed that she would provide the available information to Members, directly.

 Action: The Deputy CEO Oxleas


In respect of staffing, the Deputy CEO Oxleas, stated that there were vacancies across all services, although these were decreasing. Further, Agency spend was being reduced month on month and She confirmed that she would provide Members with details of the spend figures in respect of agency staff.

 Action: The Deputy CEO Oxleas


The DCEO Oxleas continued that the recruitment of Band 5 Nursing staff and District Nurses was on of the biggest staffing challenge for the Trust.  Further, the trust had responded by increasing the number of Band 4 Nurses and Band 6 Nurses so that the wards were fully and safely staffed. She assured Members that the safe staffing of each ward was kept under constant review by the director of nursing and her team and by the trust executive and she assured that the Trust was continuing to focus on employing Band 5 Nursing staff. 


In respect of the staff survey and specifically the figure relating to staff bullying the DCEO Oxleas responded that a lot of work had been undertaken to identify the issue and no evidence of bullying could be traced. She assured Members that any assault, by a member of staff, patient, family or visitor would be recorded.  There was also a zero tolerance policy and families and friends had been asked not to attend wards where their behaviour was not appropriate.


The DCEO Oxleas confirmed that until 2015 the Trust had been the best performer at staff engagement.   This position changed at about the same time that the Trust took on a large number of staff from the prison services who were disengaged and unhappy at their previous contracts.  She advised that a Staff Survey was due to be conducted in the new year.


The Deputy CEO Oxleas assured Members that new staff would not be opted out of their NHS contracts. 


Members asked what action was being taken to challenge, re-educate and reduce the stigma associated with mental health and encourage people to seek assistance.


The Deputy CEO Oxleas confirmed that reducing the stigma of mental health was an important issue and the Trust supported the national campaign on this as well as adopting a local approach. 


Further, the Trust had put in place a range of services to ensure that people approaching them with mental health concerns were also assessed for any physical issues and follow up action was taken, where necessary, by the relevant physical health service.  Work was also underway in Oxleas to deliver the Commissioning for Quality and Innovation (CQUIN) national goals, which would support the Trust in enhancing the assessment and treatment of the physical health needs of patients with longer term mental health problems; she agreed to provide Members with details of this scheme.


Action: The Deputy CEO Oxleas


Resolved –


That the update report from Oxleas NHS Foundation Trust be noted.

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