Submission - Jersey Care Model - Mind Jersey - 31st December 2019

Health and Social Security Scrutiny Panel review of Jersey Care Model – Mind Jersey response

1.0 Background

Mind Jersey is the island's leading mental health charity. Every year we help hundreds of islanders by providing family/carer and peer support, residential accommodation and a growing  number  of  services  for  children  and  young  people.  The  charity  welcomes  the opportunity  to  contribute  to  the  latest  Scrutiny  review.  It  was  actively  involved  in  the development  of  the  earlier  Mental  Health  Strategy  in  2016/17  and  continues  to  work constructively – albeit at times as a critical friend – with Health and Community Services (HCS).

The level and extent of consultation and engagement with the senior team from HCS has been both consistent and most welcome. So, too, is the high level of commitment and priority given to investment in mental health where we have long campaigned for it to be afforded parity of esteem.

Public  recognition  of  the  importance  of  mental  health  is  a  major  step  forward  and demonstrates how much perceptions have changed over the last few years.

One in four of Jersey's population, and one in ten of children and young people, are currently experiencing some form of mental health problem. Half of all mental health problems have been established by the age of 15, rising to 75% by the age of 24. It has been estimated that only a third of the people who need it actually access any kind of support and, when they do, they don't always get what they need – there is a long way still to go.

There is an urgent need to improve life expectancy in people with mental ill health by redressing  the  inequality  between  mental  and  physical  health,  not  least  through  the development of targeted screening and health promotion programmes.

Changing the way in which islanders can access services, with more of them being provided in the community and addressing sometimes long waiting times, are also key priorities to be welcomed in the proposed new model of care.

2.0 Is the Jersey Care Model is appropriate for the Island?

The major thrust of the model is to promote the transfer of services into the community where islanders can access care closer to home. This is a significant and very welcome objective; but it is one that will need to be backed up by considerable investment in existing and additional services, whether provided directly by the Government or through third party charities and agencies.

It could be that some of this resource will become available from unpacking' the hospital, but there can be little doubt that new and additional resources will be required, not least in the transition phase when there will almost certainly be double – running costs.

The model quite properly confirms the overwhelming evidence that prevention and early interventions can make all the difference, whether in adult (18-65), older people (65+) and most obviously in children and young peoples' services. This approach applies equally to securing and maintaining good physical and mental health. Nipping things in the bud' before they escalate can reduce suffering, save resources and take some of the escalating pressure off secondary services.  

The challenge will arise in securing and allocating funding for this priority, where it will compete with many other demands and where some of the dividends will only become apparent years down the line – well beyond the usual four year political cycle.

3.0 How will the model be delivered and by whom?

Genuine partnership working will be essential if the model is to work. This must involve primary care providers and most obviously General Practitioners. There is considerable scope for other professionals – including Pharmacists, Dentists, Community nurses and Social care providers as well as third sector partners – to do much more away from traditional in and outpatient settings.

Genuine multi-disciplinary teams, working out of integrated primary care hubs or surgeries, could transform how significant volumes of care can be delivered away from the hospital.

With encouragement GP's could become part of enlarged clinical teams that span the primary and secondary care sectors where they could be attached to given specialities. General practitioners with special interest (GPwSI), working in collaboration with practice nurses also linked to key hospital specialists and departments, could provide an invaluable resource in the community. There needs to be a renewed focus on delivering care predicated on the skills and experiences that professionals possess rather than the uniform they might be wearing.

Mind Jersey would be delighted if, in each of the larger primary care practices, there were a number of GP's with interest and expertise in mental health working collaboratively with Community psychiatric nurses (CPN's).

Most islanders, quite rightly, have high regard for their GP's. But if they are living with a chronic or long term condition accessing these services as readily and as often as they should can be a real challenge.

There is a pressing case for this most vulnerable group of islanders, often living in relative poverty, to be afforded preferential access to primary care services without undermining the existing system of co-payments.

Changes in how GP's operate, and are funded, will be crucial and potentially the most complex issue to resolve. There can be little doubt that delivery of the model will require a realignment of at least some of the resources currently held in the Health Insurance Fund (HIF). Securing these changes will take time and the ability to overcome some long term and previously entrenched resistance.

4.0 The implications of the model on the delivery of health services.

Mind Jersey is supportive of the proposed model. It will require significant changes in how and where key personnel are deployed, the tasks they may be required to undertake and how they are managed. But in a small island, with a strong sense of community and a vibrant voluntary sector, it should be possible.

Mind Jersey is proud of the Family and Carers service it currently offers. Carers are given practical and emotional support, including representation in multi-disciplinary meetings and yet carers – and not just those supporting loved ones with poor mental health – are seldom heard and can often be ignored by health and social care professionals. We believe that service users and their families should be much more closely involved in the design and delivery of services.

The charity is an active member of the Carers' Partnership group and helped drive the development of the Carers' strategy and we continue to campaign strongly for the introduction of a local Carers' Law.

Whilst it is understood that significant additional investment made in the primary care and voluntary sector needs to be carefully monitored and allocated, as part of a more rigorous commissioning process, care must be taken to ensure that this process is proportionate and not burdensome, especially in regard to smaller charities where investment in infrastructure has been modest and their capacity to engage in complex data collection and reporting is limited.

5.0  The potential impact on patients in respect of quality of service provide and any financial implications.

The new model has real potential to transform how, where and by whom care can be delivered. Improved access and reducing waiting times are understandable and laudable ambitions. But they must not be delivered at the expense of quality. They also need to be delivered at no additional direct cost to patients in an environment where it is very likely that the existing system of co-payments will need to be maintained. This will require some new thinking about how patients with chronic or long term conditions (diabetes, COPD, persistent mental illness) who should be seen more regularly and consistently can gain access to enhanced primary care without incurring additional expenditure.

6.0  Possible effects on the current and future health sector workforce

Securing and retaining a stable, well qualified and motivated workforce – be it deployed in the public, private or charitable sector – will be fundamental to the success of the proposed model. Whilst managing change can be challenging, it is likely that a significant proportion of the workforce may welcome the opportunity to develop new or extended roles and work as part of much stronger multi-disciplinary teams that span the current primary/secondary divide.

With an ageing population and increased longevity there can be little doubt that the number of health and social care workers, wherever they are deployed, will need to increase significantly.

The potential to recruit and potentially retrain local residents as health and care workers should be a real priority. There will also be a need to continue to secure input and expertise from further afield. Securing these workers – in a highly competitive market – and housing them in an environment where immigration is often a hot political issue, will be a challenge.

Commitment to the continued professional development of staff to keep them up to date, provide them with new and additional skills and also to retain them will be essential.

7.0 The proposed Jersey Care Model in the context of the future hospital and other health facilities on the Island.

Whilst securing a stable workforce is paramount, equal priority will need to be attached to providing an attractive and appropriate environment in which they can to perform their tasks. It is also acknowledged that much of the current health estate is in need of significant and urgent investment and this is never more so than in relation to existing mental health facilities. Inevitably this will take time, and will need to be phased, but it is very important in the drive to provide a new hospital – and the significant capital investment that this will require – that mental health requirements are not forgotten.

Mind Jersey believes strongly that these services should be co-located, wherever the final site is agreed, on a single health campus. Investment will also need to be made, on a basis yet to be determined, in some of the primary care facilities if they are to accommodate additional activity and larger multidisciplinary teams.

8.0 We need a whole community approach to secure effective delivery of the plan

Whilst the Government of Jersey, and HCS in particular, has prime responsibility for delivering this plan, neither can do it alone nor in isolation. A new spirit of partnership and co-operation is required and Mind Jersey is committed to work constructively with the statutory services, and other partners, to implement many of these priorities. All Government departments should have one eye on wellbeing when making decisions.

There's little point in investing very significant sums in health and community services – to help people when they are unwell – if, at the same time, we are not working hard to make sure that everyone has a safe place to call home and that they are supported in their places of work or in school through the promotion and maintenance of good physical and mental health and wellbeing.

Initiatives, such as social prescribing, have real potential in helping shift at least some focus away from the medical model which is still all too prevalent in Jersey. Partnership working with Jersey Sport, as an example, in the promotion of healthier lifestyles could bring significant improvement to many islanders' mental health and sense of wellbeing.

This means that the Government of Jersey needs to bring together a cross-governmental strategy that involves all organisations providing services to Islanders. This should include sustained investment in prevention and early interventions delivered through strategic partnership with the voluntary and community sector where there is often latent talent, experience and capacity.

Only when we truly accept that all areas of our lives are impacted by and can affect our mental health, and start looking at all of this as part of one picture, will we really get to grips with one of the most pressing issues of our time.

9.0 About Mind Jersey

Mind Jersey is a small and independent local Mental Health charity affiliated to Mind UK. Its vision is of a society that promotes and protects good mental health for all and treats people with experience of mental distress, fairly, positively and with respect. The charity provides support and help so that people can take control of their mental health and live full lives.