29 September 2022 – Mental Health Network webinar

This week, we were joined by Jagtar Singh, Chair, Coventry and Warwickshire NHS Foundation Trust who built on learnings from the session last week regarding prevention in the fire service and applied this to the NHS. He spoke of upstream, preventative work in the NHS, for example identifying those at risk of diabetes or obesity, however this is not done in a conscious, national way. Early intervention budgets often get cut and this has a detrimental impact on the NHS.

Secondary prevention involves supporting those with early diagnosis to prevent the issue getting worse and tertiary prevention is about helping those with health problems to stay well. Interventions occur, but not in a strategic, targeted way. Jagtar spoke of informing the public of nearby deaths in the fire service and what could have been done to avoid them, to prevent further deaths. This does not happen in the NHS. There is a need to focus prevention on certain areas to push the message across at every level.

Jagtar gave examples of prevention interventions, including physical health checks on people with LD, suicide prevention, which is a cross-government task, digital offers, self-help tools, immunisation and vaccination teams, mental health first aid, health promotion and smoking cessation.

Jagtar shared a best practice case study around LD, autism and cancer screening and encouraged the group to share similar good practice with the group and the Confed. He spoke of the challenges for the NHS, including measuring outcomes for patients, community and the system, as well as what needs to be considered moving forwards, such as an integrated approach to prevention and health inequalities, how to persuade the government that prevention works and will help the treasury, how to get better funding, how to share good practice and what the role is of the ICB health and wellbeing boards.

"There is a need for efficient and effective projects and services around prevention. We ought to talk about targeting diabetes in the BAME community; however the advice does not resonate, due to a lack of understanding of the culture, and as such is not implemented."

"We also need to talk about youth services, where schools are often keen to work with the NHS, however there is a silos working approach apparent, rather than a coordinated one. The correct foundations need to be place to support working on a national level."

The group discussed the Panorama episode featuring Greater Manchester Mental Health NHS FT (GMMH).

"Some of the content is shocking. How can one be sure this is not happening in his own organisation?"

"How can the board’s oversight be strengthened around the quality of what is happening ‘on the ground’, especially in the more pressured parts of the system, due to the acuity of patients and a lack of registered nurses?"

"We must support one another."

"Some have put on extra help lines due to frightened service users and carers."

A participant spoke of a recent incident regarding a suicide on a ward for which staff are under criminal investigation. They spoke of self-assessments, peer assessments and external assessments, along with walkabouts. "How many are using these tools?"

Another participant spoke of working with GMMH and a significant level of surprise from the top team regarding the programme.

GGI chief exec Prof. Andrew Corbett-Nolan shared how GGI assess assurance:

• GGI favour governance reviews over well led reviews, as well led is slanted to a particular set of conclusions and doesn’t consider whether the systems in place regarding responsibility and accountability are working.
• There is a strong difference between investigations and reviews, in that investigations follow an incident. ACN would not rely on investigations to give an even picture. Organisations with multiple investigation tend to be overreactive and do not look at how the principles of governance are applied.
• Multiple discovery approaches are used, including structured matrices.
• A number of questions are considered, including whether management and

  government have become intertwined and whether the governance competence test has been passed.

• The confidence of staff is investigated, for example by way of a survey on whether

  staff feel action is taken after reporting something.

• The escalation process is considered.
• Attendance at assurance meetings is taken into account. If attendance is regularly

  below 80%, this is a red flag.

• A SIPOC review takes place, considering the inputs and outputs and the process for

  this.

The group went on to reflect on how to create a governance process that considers not only structure but also culture and identifying early warning signs.

Someone spoke of nervousness around extensive board papers and not being able to see the wood for the trees.

"Too much strategic operational detail comes to the board, resulting in an unclear view of potential issues."

Someone else feels culture is central to this. "Staffing is an easy data set to obtain and is a key part of assessing whether adequate systems are in place. Many things that come to the board are months out of date. Monitoring needs to be more immediate."

The group discussed working with GMMH, including sharing bank staff.

"There will always be some rogue staff when employing thousands of people. Given the current and future economic circumstances, it is likely we will see more stress behaviours. One can see these behaviours particularly where there is a high proportion of bank staff on unattractive shifts in secure services. There is no real substitution for excellent leadership and a full complement of staff."

"Is it however possible to recruit a full complement of staff with the right skills?"

"There is a considerate level of uncertainty around guaranteeing the running of safe services to the public with the current availability of staffing."

"There is no traction for the mental health agenda with recent Secretaries of State and using the programme carefully going forward."

"The Greater Manchester ICS has a very low proportion of overall spend in in mental health; significantly underfunded compared with other ICS’s mental health."

"We need to look at the issues raised in the programme around capital and investment."

"Any we cannot ignore the link between patient environment and patient experience."

Someone questioned how many involved in mental health were actually shocked by the programme: "It important to see this through the eyes of the public and service users. There is a need for inward reflection and peer group reflection and not only when issues are raised in the media or via the CQC."

"It is not possible to talk about agency staff in a homogeneous way. Boards should consider what the appropriate percentage of agency staff should be."

"I recommend NHS Professionals. One should not rely on walkabouts for assurance."

"When the board is presented with large amounts of information or data to satisfy the regulator, I recommend this is noted as such in the record. One must look at beliefs and confidence in addition to facts when considering culture."