Agenda item

The Associate Director of Performance Delivery, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) introduced the report which provided the Commission with information on proposals for the provision of the Community Personality Disorder Service and the current position regarding the service. It further provided Members with the consultation paper and information regarding Borderline Personality Disorder, Complex Cases Services and Lifeworks.

Observations and questions were raised and discussed including:

·         The representative from HealthWatch noted that Lifeworks would continue in Cambridge and wanted to know if this would draw money away from the county and Peterborough. The Associate Director of Performance Delivery responded that there had been a choice whether or not to keep a specialist personality disorder service and there was a commitment to keep this going.  The arrangement to continue Lifeworks in Cambridge would not affect the proposals.

·         Members referred to pages 20 to 34 of the report and the Impact of the Proposed Changes and asked for further context regarding the scale of the personality disorder issues in the City. Members were informed that Borderline Personality Disorder affected roughly 1% of the population and was the one which was most common. There would be roughly 55 people in Peterborough accessing the service. Distribution of resources had been based on population figures.  Community locality teams would continue to work with people.

·         Members noted that the timescales following outcomes of the consultation were to be confirmed and were concerned that there was no deadline. Members asked if there was further detail on the timescales. Members were advised that the outcomes would be presented to the Clinical Commissioning Group (CCG) Board meeting on 30 September. Responses would be collated shortly and the formal decision would be made by the CCG in conjunction with CPFT on 30 September.

·         Members noted under Lifeworks that the redesign of Complex Case Services (CCS) aimed to increase the capacity from an approximate caseload of 70 service users to about 240. Members wanted to know if this was because there had been an increase in cases or if it was part of a developing plan to focus more on people who were of higher risk. The Associate Director of Performance Delivery stated there was no increase in the prevalence, but it was about trying to provide a specialist service to a greater number of people. Previously there had been a small group of people receiving intensive long-term help. The new system represented a more expanded system based on a greater evidence base.

·         Members wanted to know if all partners were working closely in partnership with the CPFT to help develop and take this proposal forward. Members were informed that the CCG and the GP mental health leads had been involved in developing the process.  The consultation had gone out widely to many stakeholders such as A&E, Police, Probation and others who came into contact with service users. A project group was being established to develop proposals to further develop the service enhancing the support post-discharge in order to provide longer-term support. If adopted, these proposals would require additional funding.

·         Members referred to pages 32 and 33 of the report and the Peterborough tables, the section on Crisis Work.  Members noted that the proposed service was that ’55 clients would have access to two full-time advanced nurse practitioners running a team of up to four people county wide’.  Did this refer to county-wide clients or Peterborough clients as it was listed under Peterborough? The Associate Director of Performance Delivery stated that this was a typing error and the figures referred to Peterborough clients only.

·         Members were concerned that the Scrutiny Commission had not automatically been included in the consultation and that it had not been widely advertised. They therefore asked why there was not greater visibility of the proposals. The Associate Director of Performance Delivery apologised for this but was not sure why this had not been referred to scrutiny beforehand. He stated that he would be happy to arrange a further meeting with himself and one of the clinical team for Members of the scrutiny commission to provide more information.

·         Members asked which service users had been contacted as part of the consultation. The Associate Director of Performance Delivery stated that all current service users of the specialist service had been written to directly and the consultation had been put on the website.  All the clinical teams within the CPFT had been informed so that they could raise awareness with any clients that they were working with.

·         Members asked if there was scope for increasing the scheme in Peterborough. The Associate Director of Performance Delivery stated that this was a funding issue and the scheme could theoretically be increased if there was more funding available.

·         Members stated that the proposal did not seem to be integrated with other services such as social care. Members were informed that the Trust was an integrated Trust and that there was a social worker working within the team and there was contact with social care and mental health leads in Peterborough.

·         Members stated that there was no identification of key outcomes for this group of service users and was presented as a crisis plan.  Was this the intention?  Members were advised that the proposal used the payment by results care plan clusters for the outcomes which was very much an outcome-orientated model. The outcomes were about trying to avoid crisis by using occupational therapy and psycho-education, such as providing service users with information about their condition and utilising psychological interventions.

·         Members asked what the position was with regard to the end of the ‘sit in’ regarding the proposed closure of Lifeworks at Tenison Road, Cambridge. Members were advised that an agreement had been reached that Lifeworks at Tenison Road would continue for a period of no longer than five years for two days a week to current and new service users. Part two of the agreement was to set up a joint working group across Cambridgeshire and Peterborough to develop an agreed model which would provide users with a long-term safety net. This would therefore not affect any other proposals unless further developments presented a better way to do things.

·         Members asked when there would be a review period of the proposals. Members were informed that services were reviewed annually regardless but the recommendations which came out of the consultation would be those which were adopted and would be reviewed annually.

·         Members followed up responding that the program would need at least a few years to assess the impact. The Associate Director of Performance Delivery responded that this was indeed true and individual outcomes would be taken into account.

ACTION AGREED

The Commission noted the report and requested that the Associate Director of Performance Delivery report back to the Commission with the outcomes of the consultation and the proposals that would be presented to the CCG Board on 30 September.