Agenda item - Formal Public Involvement

This is the part of the meeting when members of the public can formally ask questions of the Board or present a petition.  These need to be notified to the Board by 12 noon 28 February 2018. Contact the Secretary to the Board at tom.mccolgan@brighton-hove.gov.uk

 

56.1    Petition

 

Ms Jackie Madders submitted the following petition (on behalf of Mr Kapp who was unable to attend). The petition was signed by 5 people.

We the undersigned petition Brighton & Hove Council to end the crisis in primary care by adopting a policy of medication to meditation, by mass-commissioning mindfulness courses that teach self-care, funded by the Better Care Fund, so that GPs can prescribe them instead of antidepressants to treat the epidemic of depression and addiction.

 

Background information to the petition:

 

1.    The root cause of the crisis is not shortage of money, but a toxic system where GPs and nurses don’t want to work, because they can only over-prescribe drugs which generally do more harm than good.

2.    Before 1980, when antidepressants started to be mass-marketed, mental disorders (called ‘nervous breakdowns’) were rare (less than 1 in 1,000) Now, 1 in 10 adults are on antidepressant medication, numbering 30,000 in the city of Brighton and Hove, and 6 million in England.

3.    This proves Robert Whitaker right, who published ‘Anatomy of an epidemic’ in 2010, saying that the root cause is the medication given to treat it.

4.    The Improving Access to Psychological Therapies (IAPT) programme was launched in 2006 to ‘end the Prozac nation’ but antidepressant prescribing has since more than doubled from 30 to 65 million monthly prescriptions annually, mostly against NICE guidelines, which say that talking therapy should be the first choice of treatment.

5.    Like street drugs, medication has harmful and addictive side effects, making patients go round in a revolving door, overwhelming primary care, and causing the crisis in A&E and GP surgeries, and burning out GPs (who now retire at an average age of 55) and nurses (for whom there are now more than 30,000 vacancies)

6.    The solution is for the Council to mass commission the NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week course, so that GPs can prescribe them, instead of having to prescribe antidepressants, breaking their Hippocratic oath ‘do no harm’ and making them feel so guilty and ashamed that they burn out and have to take early retirement at an average age of 55.

7.    The Better Care Fund (BCF) was enacted in 2013 to create Community Care Centres as mental A&Es to treat vulnerable patients, personified as Rachel, (65, depressed and in sheltered accommodation), and Dave, (40, alcoholic and homeless), for which the city has been allocated over £20m pa since 2015, which is enough to treat 20,000 Rachels and Daves annually.

8.    However, in answer to a public question at the HWB on 13.6.17, no Community Care Centres have yet been created, and no Rachel or Dave has yet been treated, which is a scandal. For further details see paper 9.118, and other papers on section 9 of http://www.reginaldkapp.org

 

 

56.2    The Chair gave the following response:

Thank you, and Mr Kapp, for the petition.

 

As you are aware from previous questions you have put to the Board, the CCG have already commissioned mindfulness services. The Better Care Fund has very strict criteria for what it can and cannot be used for. A report will be coming to the Board to update on the use of the fund and I hope you stay for this. As we have already submitted the Better Care Plan to NHSE, which has been accepted, we are not in a position to change it.

 

56.3    RESOLVED: The HWB agreed to note the petition.

 

56.4    Deputation

 

            Dr Tredgold and Dr Aston presented the following deputation:

 

The Effect of Reductions to the Social Care Budget – A Survey of GPs

Is the present level of spending delivering the services people need? GPs in Brighton and Hove have told us that lack of Social Care may result in unnecessary hospital admissions and delay discharges. But how does this really affect patients and the GPs trying to car for them? Demand for Social Care is rising but the budget to meet it is failing. A survey of all Local Authorities undertaken by the Association of Adult

Social Care Services (ADASS)

(https://www.adass.org.uk/media/5994/adass-budget-survey-report-2017.pdf) states the problems. The need for Social care is rising each year - as the numbers of the elderly and the disabled rise. The costs of Social Care are rising – due to the rise in the National Living wage and Statutory Duties. Since 2010 Council budgets have been reduced each year. They are forced to make savings each year.  (Brighton and Hove Policy Resources Committee agreed this February to make further savings in the Community Care budget (savings that they say mean reducing demand and diverting people from publicly funded services). Many councils were ‘close to collapse’ in 2016/17. They were saved by an improvement in the Better Care Fund and being able raise extra funds for Adult Social Care. But the ADASS report makes it clear that this additional funding only temporarily eased the problems. They are clear that the resources Social Care needs are not being met. Only 9 of the 138 Directors who responded to their survey (4%) felt fully confident of being able to deliver their statutory duties in 2018/19.

 

But the really important questions are: What does it actually mean to patients and GPs if they can’t access Social Care? How often do the difficulties GPs have mentioned to us occur? To try and find out we sent a survey to 124 GPs in Brighton and Hove – 47 responded. All but one had experienced patients having problems because of difficulties with Social Care provision – over half had experienced these weekly, another third monthly. All but three had experienced patients being admitted to hospital unnecessarily because of limited Social Care resources – a fifth weekly, a half monthly. A large majority had experienced patients whose discharge had been delayed. For a quarter this had occurred weekly. A third were aware of Council plans to further reduce the Social Care budget in 2018-2020. A large majority thought that further reductions would severely worsen patients’ health outcomes and safety. Eighteen GPs then gave their own comments and these give a clear picture of the difficulties they and their patients are having. GPs have experienced difficulty in getting a response to their requests and difficulty in getting adequate support. Their feeling of frustration is palpable – and, too, their feeling of shame that the system of which they feel a part should have failed their patients. The pressures on the NHS and Social Care are now so great that some GPs have said to us ‘at what point should care professionals declare the system is no longer safe or sustainable and resign?’ The patients are suffering and it is probably the most vulnerable who are suffering the most - the ones with the least voice to speak up.  Some have been discharged without adequate social care; some have been unable to get care at home and have reluctantly been admitted to hospital. In the worst instance there was no care for a retired teacher with cancer who wanted to die at home. He had to be admitted. He died within 24 hours having spent most of that time on a trolley. As The Argus stated, ‘this should be a wake-up call to us all’.

 

Social Care desperately needs more resources.

 

Signed by: Dr Jane Roderic-Evans, Dr Judith Aston, David Jones, Dr Anne Miners, Dr Yok Chang, Dr Richard DeSouza, Dr Tim Worthley.

 

56.5    The Executive Director Health & Adult Social Care noted that the ADASS survey was a national survey, and so wasn’t directly referring to Brighton and Hove. The Director said that it was a challenging situation, and the Authority was working closely with health colleagues. Budgets for Adult Social Care had been cut nationally since 2010, with a 5% cut in Brighton and Hove, but there was growth with an additional £4.6m being put into the budget for 2018/19. All referrals to adult care are triaged and no one who is prioritised has to wait more than 13 days for an assessment. A report would come to the June meeting of the Board to address the issues raised in the deputation.

 

56.6    Councillor Page said that at the recent Budget Council meeting councillors were informed that over the last year there had been fewer requests for social care support, and yet demand was rising with an aging population who had complex needs. He asked if there were performance indicators to quantify the needs of the residents and how they access support. The Chair suggested that that could be addressed in the report which would come to the next meeting of the Board. The Executive Director Health & Adult Social Care agreed.

 

56.7    Councillor Barford suggested that some of the issues could be down to perception, as in Brighton & Hove the budget for social care had increased. The government needed to provide a sustainable funding model, as the Council had put over  40% of the General Revenue Fund into the adult social care budget which was not sustainable. Councillor Barford suggested that understandably social care support was sometimes confused with continuing health care which is funded by the CCG not the council, which is why further integration is important to ensure people get the best outcomes no matter who provided the funding.

 

56.8    Mr Supple said that as a GP it was hard to know what was funded by Social Care and what by Community Services, and it was important to establish who commissioned what service if solutions were to be found. Mr Supple referred to the example given in the deputation of the person with cancer and, whilst accepting he did not know the full details of the case, suggested the problems were to do with provision of community services rather than social care. Community Services were commissioned by the CCG.

 

56.9    The Chair said that when the Clinical Commissioning Groups were established one of the rationales behind it was to allow GPs to commission the services they felt were required. It was therefore ironic that GPs were coming to the Health & Wellbeing Board (HWB) to complain about services they had the power to commission but thinking they were delivered by Adult Social Care. He said it was a complex situation and the HWB was established to integrate the different services. Dr Tregold asked who was responsible for provision of the services and who GPs should complain to, and was advised it was the CCG.

 

56.10  RESOLVED: That the deputation be noted, and a report on the issues raised would come to the next meeting of the Board. 

 

Public Question

 

56.11  Two Public Questions had been received.

           

(1)  Amanda Bishop asked the following question:

 

In relation to the Big Care Conversation I note some respondents reported concerns around mental health waiting lists and risks to suicide. I note that Brighton & Hove have 50% higher suicide rates than the national average. But these are 2013/2015 reported figures.  Do you think (or know) if this has increased, and what steps areyou taking to ensure respondents concerns in this area are being prioritised, resulting in less suicides and better mental health care?

 

56.12  The Chair gave the following response:

 

Thank you for your question. The most recent information on suicide rates is for the period 2014-16. I have been given some data which will be reported in the minutes and also I have a printed copy of this response for you to take home today. The Brighton & Hove rate was 14.4 per 100,000 people compared with the England rate of 9.9/100,000. The suicide rates for 2013-15 were 15.2/100,000 and 10.1/100,000 respectively. Brighton & Hove has historically had a high rate of suicide.  The gap between the national and local rates narrowed significantly between 2001-03 and 2010-12, when the local rate fell from 18.9 to 12.6/100,000, but this trend has levelled off over the past four years. The national rate has remained between 9.2 - 10.3/100,000 since 2001-03. The Five Year Forward View for Mental Health has set a target for all areas of a 10% reduction over the four years between 2017-18 and 2020-2. A local multi-agency suicide prevention steering group oversees the suicide prevention action plan. Priorities within the plan include;

•        Analysing local information, including Coroner’s records and emergency services information.

·         Continuing professional development for clinicians

·         Reducing rates of self-harm

·         Support for people in high risk groups

·         Action at high frequency suicide locations

 

56.13  Ms Bishop asked the following supplementary question:

 

Why do emergency hostels in the city not have suicide prevention information or notices available to vulnerable residents, and will the Board commit to getting this resolved?

 

56.14  The Chair asked Mr A Hill (Acting Director of Public Health) to respond. Mr Hill said he didn’t know exactly what information was available in different locations, but thought that it would be appropriate for such information to be available in homeless services and so he would check to see what was provided.

 

56.15  Councillor Penn said that Public Health had a suicide prevention strategy, which they were looking to update. This was a very important issue, with suicide being the biggest killer for men under 45 years of age, and need to not only target the most vulnerable but the public in general. It was important for people to know how to support those at risk of suicide, and said that Grass Roots had produced an app on that issue, and encouraged people to download it to their phone. Councillor Penn noted that many public toilets had information about sexual health, and suggested it would be useful to have information on suicide and self-harm too.

 

56.16 Mr A Hill said the City did have a suicide prevention strategy, and the action plan was available on the Council’s website, and confirmed that an item on that would be brought to a future meeting of the Board.

 

56.17  Mr C Clarke agreed that information on suicide prevention should be available in public places. He said that the CCG would have a modest uplift from its national awards in what it could commission on mental health next year, and some of that would be spent on suicide prevention and mental health in children and young people. Many mental health support services would be re-procured in 2018/19, and the specifications on those services would come to the Board in June.

 

 

56.18  (2) Mr Daniel Harris asked the following question:

I’ve read the big health and care conversation report and note that homeless people were mentioned in this report just 8 times.

There were almost 2800 conversations, I also sadly note that this survey managed to get just 15 people either homeless or affected by homelessness to respond. More people affected by homelessness died in Brighton and Hove in 2017 than responded to this survey. We know homeless people use A&E services 5 times more than the average Brighton and Hove resident so what steps will the council take to rectify this social injustice and ensure the voices of those truly affected by homelessness are reflected in this report?

56.19  The Chair gave the following response:

Thank you for your question.

 

The Big Health & Care Conversation is being reported here later today and I do hope that you stay for that item or pick it up later on the website. The Big Health & Care Conversation is not finished, it is such be viewed as a brand of activity that we will use as needed. The Big Conversation represented a focused period of engagement; however, we continue to engage with service users, carers and the public routinely as part of our ongoing commissioning and service delivery, which includes targeted work to ensure that the voices of marginalised and vulnerable groups are sought and heard appropriately, and that feedback is used to shape and improve services. It is important to note that this is not the only engagement and service user feedback mechanism we use. Our work directly with homeless or insecurely housed people includes ways to systematically seek their views and feedback, and to ensure these are used to change and improve services. For example we have contracted a Patient Participation Group at the Arch. The Board is aware of the health and care needs of those who are not only homeless but are vulnerably house. The Board helped secure the specialist GP provision within the city when the Practice Group withdraw its contracts and the Morley Street service was at risk. At the last Board we also supported the work that is being done through the Housing First initiative and have secure additional resources to support this service. It is through these longer term contacts that we can help address these needs. For example, having fast track provision for those that were seeking housing, to health and care provision, which may be of secondary importance to those individuals at that time.

 

The report that is coming to the Board today was requested by the Board, as the first phase of activity comes to an end.

 

56.20 Mr Harris asked the following supplementary question:

 

GP services are being closed down, and there has been an increase in people requiring mental health support. Can the Board ensure that those people get the correct advice?

 

56.21  The Chair said that the HWB received a report at their last meeting regarding support available for those with mental health issues.