Agenda item

The following expert witnesses will be in attendance:-

Dominic Gardner - Director of Operations - Teesside

Dr. Baxi Sinha - Clinical Director Adult Mental Health - Teesside

Recommendation: - That the information presented at the meeting be considered in the context of the Scrutiny Panel's review.

The Chair welcomed representatives from Tees, Esk and Wear Valley (TEWV) NHS Foundation Trust and Public Health (South Tees) to the meeting. The Director of Operations at TEWV advised that the presentation had been compiled collectively and sought to present a system perspective on the way in which services were currently delivered. In preparation for the meeting the Panel had requested that information be provided on the following areas:-

• The level of resource currently invested by TEWV in reducing opioid dependency / supporting people in Middlesbrough with dual diagnosis.
• TEWV’s experience of working with those addicted to prescribed opioids,
• Relevant TEWV initiatives in place to address it.
• TEWV’s view on the impact opioid dependency is having on children and young people in Middlesbrough.
• TEWV’s view on what interventions are needed to better support people in their recovery from opioid dependency over the next 5 years.

The panel was advised that in terms of the services offered by TEWV in Middlesbrough, TEWV was a provider of Mental Health and Learning Disability Services and was not commissioned to provide Substance Misuse Services or services related to primary Opiate dependence. In the course of providing Mental Health and Learning Disability Services help was offered to persons with dual diagnosis. The definition of dual diagnosis was a co-existing mental health and alcohol and/or drug misuse problems.

In respect of the level of resources invested in dual diagnosis it was advised that regular mandatory training was provided to staff, a dedicated dual diagnosis lead had been appointed within the Trust, dual diagnosis link clinicians and dual diagnosis link champions also worked across a number of teams. In addition these practitioners worked in partnership with the locally commissioned substance misuse services. There was also a Mental Health and Substance Misuse network in place in Teesside and inpatient services/wards often needed to provide detox for patients.

The Clinical Director at TEWV advised that in terms of TEWV’s experience of working with those addicted to opioids it was felt that difficulties were increasing (anecdotal reports) and getting the right help at the right time (in terms of helping an individual addicted to opioids) could be challenging. There was also an association with adverse outcomes including fatalities and the individual often faced a number of difficulties in addition to mental health and substance misuse including issues relating to finance, housing and physical medical conditions.

In terms of the initiatives undertaken by TEWV that were relevant to this field it was explained that a series of Rapid Process Improvement Workshops (RPIW) involving partner organisations in four localities had been held. This had involved Change, Grow, Live in Middlesbrough and TEWV had also initiated the Mental Health / Substance Misuse Network with other stakeholders. The crisis assessment suite at Roseberry Park also received support from the Substance Misuse services and joined up care was provided. Training of inpatient staff in the use and distribution of Naloxone kits would also hopefully lead to a reduction in deaths linked to opiates.

With regard to TEWV’s views on the impact of opioid dependency on children and young people in the Clinical Director advised that colleagues in the field reported that the number of young people physically dependent on opioids in Middlesbrough was small but growing. There were young people that were at risk of developing dependency and for those young people born substance dependent it impacted on their development. Young people were also impacted by parents and significant adults own opioid dependence.

In response to the panel’s query as to what interventions would be needed to better support people in their recovery from opioid dependency over the next 5 years TEWV put forward the following suggestions:-

• Mental Health, Substance Misuse, Primary care (PCNs), Mental Health services especially Psychological interventions to work jointly
• Quick and reliable access to specialist Substance Misuse help especially in Crisis, Crisis Assessment Suite and Inpatient wards
• Single point of access in Mental Health to include Substance Misuse workers for joint triage/joint initial assessment; also Social workers, other colleagues
• Substance Misuse workers to attend joint meetings like formulation, pre-discharge meetings
• Substance Misuse Services to contribute to TEWV’s co-produced Crisis management plans/WRAP plans
• Mental Health services to deliver joint clinics in Substance Misuse premises
• Role of peer support workers across organisations
• Prescribers in commissioned Substance Misuse services to work with TEWV prescribers (at times meds may be given by prescribers in different organisations like GP, Substance Misuse, Mental Health, Acute hospitals etc. with limited sharing of information)
• Pathways for young people at risk of dependency and a way for those already dependent to access timely treatment
• Prescribing substitute treatment for those under 18 years needs further exploring
• Cross fertilisation in terms of training for Substance Misuse and Mental Health services (to each other)

The Chair invited the Council’s Advanced Public Health Practitioner to provide a view from a South Tees public health perspective. The following views were expressed:-

• TEWV’s initiatives have improved the offer for Substance Misuse clients – Crisis Assessment Suite, Rapid Process Improvement Workshops for Dual Diagnosis, smoke free, etc.
• Dual Diagnosis is extremely common amongst TEWV and Substance Misuse service users (in the broader sense of the term)
• Those with a Mental Health diagnosis are at the very top of the ‘needs triangle’
• The majority of people sat below this but were still in need of support
• Collaboration was taking place with TEWV colleagues in terms of Substance Misuse /integrated model, pathways, crisis avoidance, etc.
• Predominantly adult focused in terms of opioids but preventative/Early Intervention was important.
• Work with Young People/transition clients was essential.

Reference was made to the four levels of interventions, as highlighted in the pictorial triangle. Level 4 was the base of the triangle and represented basic services and security, level 3 was the next tier and was defined as community and family support, tier 2 was focused on non-specialised support and the top tier related to specialised services. It was advised that the vast majority of people sat below the top tier but there was a need to stop people from becoming revolving door clients and ensuring crisis avoidance.
 

The panel was advised that one of the other main issues was that currently the majority of the resources invested were concentrated on the very acute services, which people were accessing at the point of crisis. There really needed to be a shift of that resource but one of the difficulties in achieving that was that you still needed to be able to support those at crisis point whilst trying to stop the future flow. Only through investment in the more preventative measures could there be any sort of solution in the long term. There was also certainly a willingness from the different service providers to work more closely together and capatilise on how, through closer integration, the system could perform better with the resources currently available to it.
 

The Chair thanked the representatives in attendance for their presentation and contribution to the panel’s work.

AGREED that the information presented be considered in the context of the panel’s current review.