Agenda item

To consider the report

1.    To accept the report and support the department's plans to establish a new work model for the Mental Health Service.

2.     To ask the Cabinet Member for Adults, Health and Well-being to contact the Welsh Government's Health Minister to explain the intention to create a new work model and the reasons for that.

3.     A progress report and regular communication between the officers of the Department and the Care Scrutiny Committee on the development of the Mental Health Service was welcomed.

 

An update was provided on the Gwynedd Mental Health Service. The members were reminded by the Senior Safeguarding, Quality Assurance and Mental Health Manager that the Mental Health service had been an integrated team since 1996, and that the Health Board led on the service. It was detailed that the work was being guided by the Together for Mental Health Strategy, introduced by Welsh Government in order to improve the mental health provision available to support individuals in Wales.

 

It was explained that the service had been divided to offer support within primary services for low-level cases, and within secondary services for more intensive cases. It was confirmed that referrals were being received from GPs, before being scrutinised daily to consider if there was sufficient information to make a decision on suitability to receive a mental health assessment. It was noted that referrals were being referred back to the GPs with explanations, if they were not suitable to be referred to the relevant service.

 

It was explained that there were clear responsibilities within the partnership with the Health Board. As the Health Board led the service, the focus was on a diagnosis and medication on their behalf - the medical element. It was confirmed that Cyngor Gwynedd's role as a local authority was to focus on the social elements. It was noted that Cyngor Gwynedd also led on the work under the Mental Health Act 1983. It was emphasised that workers were the service's main resource as they offered therapy and support to individuals to overcome or cope with their illness.

 

It was confirmed that Cyngor Gwynedd employed staff in a number of different roles in order to offer this service, including:

 

·       2 Area Leaders (North and South Gwynedd)

·       12.5 Social Workers

·       9 Support Workers to work more intensively with individuals on care and treatment plans (with a financial contribution from the Health Board to employ them).

 

It was intended to re-model the current multi agency mental health scheme that Cyngor Gwynedd and Betsi Cadwaladr Health Board had, following a consultation with the Head of Adults, Health and Wellbeing Department, Senior Mental Health Manager and the two Area Leaders for Mental Health Services. It was highlighted that there was a need to review the role of the Support Worker within the service and a need to review out-of-county placements in order to ensure that we understood individuals' aspirations to return to the area or not.

 

It was reported that difficulties had arised across Gwynedd and the rest of Wales when local authorities collaborate with the Health Board in order to integrate Health and Social Care, including:

 

·       Lack of clarity about outcomes

·       Calling something a 'partnership' to make it sound better

·       Lack of clarity about organisational drivers

·       Lack of clarity about unstated motivators

·       Being unrealistic and over-ambitious;

·       Not enough attention to practical details.

 

It was confirmed that these general dangers were noted as core barriers by mental health leaders, which prevented them from realising their statutory duties effectively. It was noted that the level of these risks had increased and were having an effect on staff well-being making them feel isolated and not an integral part of the partnership.

 

Details were given on another risk which affected the partnership by confirming that the Health Board used paper-based systems rather than technology systems (such as WCCIS). It was explained that using paper-based systems to collect sensitive data was dangerous and acted as a barrier to information sharing and effective service planning. It was explained that this led to additional risks including:

 

·       Governance risk: regarding secure data management

·       Communication risk: regarding the recording and sharing of current information

·       Role risk: about fulfilling the statutory role outlined in the Social Services and Well-being (Wales) Act 2014.

It was noted that a number of options had been considered for providing these services in the future, including:

 

a)    Continuing in the form of the existing service.

b)    Reviewing a new partnership arrangement for a period of one year, with quarterly meetings to review the arrangement/progress.

c)     Transferring to a separate social care/well-being team/service which coincided with establishing a well-being preventive social pathway for people who used the services.

A strong view was expressed that the current arrangement was unsustainable. In addition, there was a feeling that establishing yet another partnership agreement would not resolve the key issues or indeed mitigate the significant risks identified. The current model offered limited assurances of an effective and secure partnership

 

It was confirmed that a model such as option C above would be most suitable for Gwynedd as it would be a purposeful well-being model and would promote the key objectives. It was explained that these concentrated on:

 

·       Mitigating the current risk due to the poor communication regarding progress and change by the Health Board.

·       Providing greater ownership of well-being, social prescription and the social model of mental health recovery.

·       Providing the opportunity to review services to promote a focus on prevention through greater ownership of primary care.

It was ensured that the information presented in the report was used in order to develop a business case to steer establishing a separate social care mental health well-being service, before creating a report on the further steps that would concentrate on detailed research of the project management process for establishing a separate Social Care Mental Health Well-being Service. It was noted that there had been several attempts to consult with the Health Board's Director of Mental Health to share ideas, plan and agree on how the Council would work with them.

 

In response to the observations and questions from members, it was noted:

 

·       That a number of other authorities, namely Conwy County Borough Council, Wrexham County Council and Flintshire County Council had already decided to establish a separate partnership to the Health Board, and that Anglesey Council was in a similar situation to Cyngor Gwynedd and were considering the future of their services.

·       It was confirmed that robust collaboration was ongoing between the Health Board, Cyngor Gwynedd and the Government by working in partnership. It was noted that some of the other authorities that had brought the joint-service to an end had seen an improvement in the collaboration between them and the Health Board under their new arrangement.

·       It was noted that the aim of Welsh Government was to integrate health and social care. It was explained that although the new model was contrary to that principle it would certainly strengthen the collaboration between both bodies in accordance with the principles of the Welsh Government.

·       It was agreed that collaboration problems had existed for years, even before Betsi Cadwaladr University Health Board had been established. It was noted if the model was not successful, the Department would acknowledge that and would be accountable for this.

·       It was explained that there was a consultation with Social Workers and Support Workers within the service to get their input on the 14 June 2023. It was reported that the majority of those workers welcomed the change with some concerned as they had a good relationship with the Health Board staff. It was shared that the workers were looking forward to the changes.

·       It was confirmed that regular communication was taking place with the other local authorities that had separated from their partnership with the Health Board in order for Gwynedd to learn from their successes and failures before establishing the most suitable model for the future.

·       It was ensured that the process of separating from the Health Board was being programmed and the Care Scrutiny Committee would receive regular updates. It was noted that the Cabinet's approval was needed in order to move forward with the model, but that the department was confident that the new model would be operative by April 2024. It was emphasided that this date was not final and that there was a strong possibility that the timetable of the model would be amended.

·       Details were given on the need to look at the financial costs as the number of referrals to the service were increasing quickly, noting that there was around 2000 more referrals this year compared to 2020.

·       That the Cabinet Member would contact the Health Minister in order to explain the collaboration problems that arise between local authorities and the Health Board.

It was confirmed that separating from the Health Board in this field was not a failure. It was emphasided that the Health Board succeeded to provide excellent medical care for clients and that the model intended to be used in the future would be used in order to cope better with the social aspects of the care.

 

The department was thanked for their work within the mental health care field.

 

RESOLVED:

 

1.     To accept the report and support the department's plans to establish a new work model for the Mental Health Service.

2.     To ask the Cabinet Member for Adults, Health and Well-being to contact Welsh Government's Health Minister to explain the intention to create a new work model and the reasons for that

3.     A progress report and regular communication between the officers of the Department and the Care Scrutiny Committee on the development of the Mental Health Service was welcomed.