About The Consultation
Q1. What is the ‘Step up to Great Mental Health’ public consultation?
A. In Leicester, Leicestershire and Rutland, the NHS has a mental health improvement programme known locally as ‘Step Up to Great Mental Health’.
It is designed to improve local mental health services for adults, most of which are delivered by Leicestershire Partnership NHS Trust (LPT).
The proposals in the consultation document have been developed over a number of years - this has been in partnership with staff from all partner organisations, public, patients, carers and stakeholders.
We want to hear from as many people as possible as to their views on the planned investments and changes.
Q2. What does the consultation cover (and not cover)?
A. The public consultation concerns proposals to invest in and improve mental health services for adults in Leicester, Leicestershire and Rutland when their need is urgent or they need planned care and treatment.
The consultation does not cover other mental health services such as inpatient services or services provided to children and young people.
Q3. Who is running the consultation?
A. The consultation is being run by the three NHS clinical commissioning groups (CCGs) in Leicester, Leicestershire and Rutland. CCGs are responsible for the planning and commissioning of health care services for their local area. Commissioning involves deciding what services are needed for diverse local populations, and ensuring that they are provided.
Q4. When does the consultation run?
A. The consultation lasts for 12 weeks, running from Monday 24 May to Sunday 15 August 2021.
Q5. How can I find out more and have my say?
A. We want to hear everyone’s views. We have a dedicated consultation website - www.greatmentalhealthllr.nhs.uk – which has all the information about the consultation including the full consultation document and summary. Importantly, the website hosts the online survey where you can feedback to us your opinions. Please also tell your family and friends about the consultation and encourage them to complete the survey. Printed survey forms are also available.
For up-to-date news on the consultation, you can visit the news page on the consultation website. You can also follow us on social media using Facebook: @NHSLeicester and Twitter: @NHSLeicester #GreatmentalhealthLLR
Q6. How are you helping everyone to take part in the consultation?
A. We are encouraging widespread participation by:
- People can fill out an online questionnaire on our website including an easy read version
- You can telephone us on 0116 295 0750 if you require support to complete the questionnaire or wish to request a questionnaire you can fill in at home. Or you can email beinvolved@LeicesterCityCCG.nhs.uk
- People can attend events and workshops online. All the information is available on our website www.greatmentalhealthllr.nhs.uk/news-meetings-and-events/meetings-and-events/Involving local patient representative groups and voluntary and community organisations
- Printing hard copy consultation documents with a summary which helps to explain the changes in plain English. Our materials will take into consideration the needs of people with any disabilities, such as hearing or sight
- Having versions of the summary consultation document made available in different formats, including easy read, video and large print. The summary documents can be provided in other languages on request
- Promoting the consultation in local media
- Promoting consultation through social media including videos on YouTube
Q7. What about people who cannot access the internet - how will they be consulted with?
A. The Covid-19 pandemic means that we need to consult in different ways, with a much greater reliance on technology than we would have done previously. We recognise and understand how important it is that people who have not got access to the internet are also able to take part. If Covid-19 restrictions allow, we hope to do face-to-face work with people towards the end of the consultation. But we are also working with local TV, radio and newspapers to promote the consultation, as well as local community
Q8. Why are you wanting to change services?
A. We know we need to improve some of our services. We know that some people are waiting far too long for treatment. We want more integrated services, so people's care is more streamlined. This applies to mental health services, and to the links between mental health and physical health services and social services.
We want information, advice and guidance on mental health to be more easily available to support people’s self-care. We also want people to be able to access appropriate mental health care more quickly and easily, in the community, at home, in emergency departments, inpatient services or transport by emergency services. When people do need further mental health support, we want this to be organised around their needs to help them to meet their potential recovery and be a good experience.
Q9. Will more services be delivered locally?
A. Yes. People have told us they want more mental health services delivered locally and designed to work for local needs. We propose to join up more services and base them in local communities. This would allow people to get a better experience of care that meets their needs and places a greater emphasis on psychological care.
Staff will provide care that focuses on the needs of the individual and their goals and recovery. People will not have unnecessary duplicate assessments and won’t experience long waiting times. The joined-up teams will work with the voluntary sector, social care and other physical health services to focus on all of people’s needs.
In our current set-up, many services are not provided in the community and some not at all. There are also long waits for therapy services with people passed between services and professionals, often ending up in the emergency department. We are proposing to organise services around 8 geographical areas with a a treatment and recovery team for adults and one dedicated for older adults in each area.
Q10. How will these new community teams improve things?
A. The establishment of the community treatment and recovery teams will help bring many improvements. Each community treatment and recovery team would offer a service seven days a week, within working hours. A flexible approach would be taken to weekend cover, once the need is assessed. These teams working, alongside other targeted expertise, will help improve the experience and care including:
- Reducing waiting times for treatment and support
- Improving support for individuals with a personality disorder
- Improving services for people of work age and older people
- Expanding Perinatal Services (for the time immediately before and after birth)
- Developing a new maternal outreach service
- Improving experience of individuals with potential psychosis
- Reducing the wait for diagnosis of dementia
- Providing community rehabilitation support to help people
- Supporting recovery from complex psychosis
The consultation website and document have full details about all the proposed changes.
Q11. With more -care provided online, will there be consideration of how the service user wants to receive support?
A. Virtual, or online, appointments will only happen when appropriate. We will absolutely continue to offer face-to-face appointments. However, we have learnt a lot from Covid-19 whereby we can see the benefits of introducing care online for some people on some occasions. Sometimes this will mean face-to-face but sometimes this will mean virtual appointments are most appropriate.
Q12. Provision of information online is an issue for quite a lot of people, they need other methods.
A. In terms of web products there is a web based offer, it’s in conjunction with the Central Access Point, so people who would rather, can use the telephone to access support. It is strengthening services available locally, but we recognise that lots of people prefer not to access information online.
Q13. MDT teams are a great idea, but sometimes they don’t get right level of person in MDT they then feel it’s not working for them and give up.
A. In developing Multi-disciplinary working, we are acutely aware that we need to bring together people with a range of skills and competencies to genuinely deliver the care that people need. We are committing to not trying to move people into a process not right for them
Part of the idea of working together is to share skills out and learn from each other to provide more skilled intervention with people. Working as a team they will all be holding in mind the needs of the individual.
Q14. What is changing with urgent and emergency mental health services?
A. Some of our planned changes for urgent and emergency care have been put into practice already. The Covid-19 pandemic meant that we had to make some quick changes so that we could continue to provide patient care. One of these changes was the creation of the Mental Health Urgent Care Hub at the Bradgate Unit, on the site of Glenfield Hospital, to assess people in crisis and treat them quickly. Another was setting up the Mental Health Central Access Point - a 24/7 phoneline (0808 800 3302) which people can call for mental health support for themselves or others.
We have also set up an Acute Mental Health Liaison Service, now based at the Leicester Royal Infirmary. We invested in bringing together existing teams to work as one team in the emergency department and on hospital wards, providing support to people round-the-clock.
The consultation looks at several other areas in which we are seeking to further improve care. These include services provided by police triage cars, Crisis Cafes and the Crisis Service. The consultation website and document have full details about all the proposed changes.
Q15. Has dealing with the Covid-19 pandemic changed the need for these proposals?
A. The pandemic has only strengthened the need for these proposals. It has highlighted where we need to quickly make changes. Indeed, some services have already had to adapt quickly in response to the pandemic, with some service user appointments for example being held on line rather than face-to-face. There have been some specific new service offers put in practice areas such as a Central Access Point and Mental Health Urgent Care Hub. The way some services have had to adapt have in some cases improved the offer for people needing mental health support.
Q16. Is the consultation simply a way of cutting services and/or jobs?
A. We are investing in mental health services. Our only consideration in this is to improve mental health care and services for people in Leicester, Leicestershire and Rutland, and improve people’s mental health and wellbeing. We are seeking to provide services that are more accessible and appropriate to people’s needs and this will mean certain services will need to be provided in a different way, in a better way. There are no plans to cut services or make staff redundant.
Q17. How will this affect people’s travel to the places where they receive care?
A. Generally we want to provide more services in the community, closer to where people live, rather than in hospital. In this way we would expect people to have to travel less in order to receive those services. We would also expect to continue to deliver some contact virtually (online) taking away the need to travel on those occasions.
Q18. How is it real consultation if you have already implemented some of the changes?
A. During the Covid-19 pandemic we learned a lot and responded by making temporary changes to the way services were accessed and provided. Some changes were needed nationally to keep patients safe, but are part of a longer-term plan to improve care for service users. We have a statutory duty – and a moral duty -– to publicly consult on these temporary changes to understand views from our communities. We genuinely want to hear people’s views on these proposals and the impact of the changes on service users, people, their family and loved ones.
Q19. Urgent Care Hub glad you did it and it is carrying on?
A. Through Covid-19 we introduced the Mental Health Urgent Care Hub. We now wish to consult on making this permanent. The hub is at the Bradgate Unit on the site of Glenfield Hospital. It’s difficult to replicate an urgent care hub in multiple places. However the hub is part of a much wider improvement of urgent care services, with community crisis teams supporting people in their own homes. In addition, the support of crisis cafes will also help people in neighbourhoods.
Q20. Treatment and recovery teams for older people, what help will Rutland have?
A. Through these plans we would ensure that older adults have their needs met by staff with the right expertise. We would move from six older people-focused community mental health teams to eight focused Community Treatment and Recovery Teams.
Q21. Crisis Cafes worked very well in Northamptonshire, one in Rutland is important to us.
A. Over the next four years we are proposing to have 25 crisis café across Leicester, Leicestershire and Rutland. Through the consultation we are asking people where the new Crisis Cafes could be located and what should be provided in them.
Q22. Where are the mental health cafes set up?
A. We currently have three Crisis Cafes. Two are located in Leicester, one at St Martins House, 7 Peacock Lance, Leicester LE1 5PZ and the other at The Involvement Centre and Café, which is just located off the main reception area of the Bradgate Unit on the site of Glenfield Hospital. The third is located at the Emporium, Green Close Lane, Loughborough, LE11 5AS
Q23. I am involved with people long term with serious mental health. Lack of staff in mental health team, due to the training long and turnover of staff is quite high. How will you staff these ideas?
A. It is well documented that there are workforce challenges across the NHS. From an organisation point of view we are working with local and regional education establishments to provide a better route for individuals at university or college to move into clinical and non-clinical roles. We are building partnerships with the education to establish different training packages and deploy different roles in community health services across a range of different skills. We are looking at training needs for the next 3-5 years to bring people with the necessary skills through the system from nurses to people with a psychology background. We are also working with the community and voluntary sector to see what skills are available. For example in our proposal the crisis cafes will be predominantly led by the voluntary sector, working hand in glove with professionals.
We are also bringing teams together through these plans to work as Multi-disciplinary Teams (MDTs). We have had challenges locally largely due to professional teams not working their best work together. When bringing teams together there will be a diversity of roles, less reliance on one professional and there will be more flexibility e.g. pharmacists, psychologists and nurses working together.
Q24. Do you have to go through the GP or is general help available?
A. You can self-refer to talking therapies: https://mychoice.leicester.gov.uk/Services/2597/VitaMinds-IAPT-Impr
Please visit their website where there is more information on getting support for your mental health www.greatmentalhealthllr.nhs.uk/find-support/
In addition for support when the need is urgent, we have introduced a Central Point of Access. It is a place to contact 24 hours a day, seven days a week, whether by phone, text massage or using British Sign Language or interpretation facilities. The number is 0808 800 3302.
Q25: Should we just keep the current services as they are?
A. During our engagement with stakeholders, service users have told us that our services are fragmented, difficult to access and not always available in the right place and delivered in the right way. Service users told us that they want to see services that are integrated, that they can access locally, that they want to receive the right support first time, move between services without starting again, and step up and down as needed. Service users said they are often waiting in some services to be accepted by another due to long internal transfer waits. They often have to tell their story many times.
Some of our staff tell us that they feel overwhelmed by their high caseloads and that we need to improve the way we support people to help to reduce caseloads, offer better experience for people using services and eradicate the lengthy internal waits for some patients. Staff also tell us that the way services have been organised in some areas is largely continuation of historic structures rather than to meet real need. This leads to unfair and sometimes unbalanced resource management.
Our regulators have told us that we have some long waiting lists and underperform against national targets. We have also been slow to introduce new modern models of integrated care, where different parts of the health and care sector work closer together for the benefit of service users.
We believe this all adds together to a strong case for change.
Q26. Is there any detail we can get on the commissioning of culturally sensitive services?
A. We need to consider how we do this as a wider system. As a system we are committed to look at health inequalities and we intend to in part use this consultation process to push forward improvements that will improve inequalities we know exist. This will develop over time and the conversation is ongoing. But we do need to work together to meet needs of individuals in communities.
Q27. How can we address stigma and cultural issues?
A. When addressing stigma we need to work in partnership with communities to tackle this in the right way and by working with local leaders, especially on cultural sensitivities. It needs to be a 2-way process, and some areas are already working on this approach such as local communities working closely with GP practices.
Q28. How are the improvements being funded?
A. There has been a national commitment of significant investment in improving mental health services. We want to both reorganise services to make them work better together and also make a multi-million pound investment to strengthen them. The combination of this investment and reorganisation is expected to enable significant improvements to services improving the health and wellbeing of people.
Q29. Where’s the voice of public and patients in all this?
A. The NHS has been talking to people about changes to mental health services for a number of years. All this feedback has helped shape the proposal. Our engagement has included hosting public events, attending community meetings, running stakeholder meetings, consulting with our service users and staff, meeting MPs and councillors, and online engagement.
Q30. What engagement activities did you carry out to help you arrive at the proposals?
A. We have continuously involved patients, service users, carers, staff and other stakeholders in a conversation about health services since 2014. Specific engagement on mental health services was undertaken between November 2017 and May 2019,. The engagement on mental health services has included:
Hearing from more than 1,000 people across Leicester, Leicestershire and Rutland
Four week-long workshops attended by 84 staff, service users, carers and people from other agencies, and a further 48 face-to-face and online sessions with staff, service users, carers, the local authority and the voluntary sector
- 207 online responses and more than 90,000 social media posts
- Feedback used to co-design key features of the proposed new services
- New service proposals being reviewed by the East Midlands Clinical Senate
- Ongoing engagement with service users, family, carers and staff that is continuing throughout the Covid-19 pandemic.
Q31. How will you ensure that the proposals are inclusive in terms of religious and cultural needs? Have you taken advice from people working within BAME sectors?
A. During our engagement period, we have spoken to diverse communities across Leicester, Leicestershire and Rutland and have actively sought the views of those seen as being traditionally under-represented. We will ensure our consultation is representative of all the communities we serve. We have a legal and moral duty to do so. An initial equality impact assessment has been undertaken to ensure that there would be fair access for everyone, avoiding inadvertently excluding any particular groups of people.
Q32. Why haven’t you consulted before on these proposals?
A. We have been engaging with patients, service users, carers, staff and other stakeholders in a conversation about health services for many years. We have used all this feedback to help advance the proposals that are being put forward as part of this consultation. Our plans are now at the stage where we are ready? need to hold a formal public consultation.
Q33. Have you consulted Members of Parliament (MPs) on your plans?
A. We have shared our long-term plans with local MPs. We will continue to do that and hope to gain their full support for the proposals we have developed.
Q34. How was the community engagement used in development of this consultation?
A. We have involved service users and carers right from the beginning in our developments of this consultation. We wanted to understand from the ground up what people wanted. During wide scale engagement we asked people what excellent would look like to them. Once we had generated a set of guiding principles (i.e. easy access, 24/7 access when needed, not bounced around, not having to tell their story many times) workshops brought staff and patients together. This model was taken forward to design the proposals. We have involved a wide range of people including local members, politicians, charities, organisations, service users, public and carers. We are very interested in co-producing our services with people.
Q35. How have faith leaders and organisations not necessarily associated with mental health been involved?
A. To ensure all community voices are heard, we are working closely with over 30 community groups, charities and faith groups from a wide range of backgrounds across Leicester, Leicestershire and Rutland. This work will help us to reach out to people effectively ensuring voices are captured in the consultation feedback.
Consulting During a Pandemic
Q36. Will Covid-19 affect the consultation?
A. We are changing the nature of the consultation due to Covid-19. The pandemic has meant we have moved from a plan of face-to-face meetings to online virtual meetings. The advantage of this is that we will be able to stage more presentations and hear from more members of the public.
Aware of the restrictions imposed by Covid-19, we will be working with the voluntary and community sector and faith leaders, recognising the important role that they play in liaising with their local communities to make sure as many people as possible are able to take part in the consultation process and in many different ways.
We are also working with a range of other organisations to ensure that information is available in local communities and people see information in local publications, on radio, TV and in newspapers.
Q37. Why are you consulting now during the Covid-19 pandemic?
A. In order to achieve the service changes desired, we have a legal obligation to consult on the proposals. Furthermore, we know that public consultation will only improve the proposals being put forward. The longer we continue to deliver services in the way we are today, the more we are letting service users down and the more costly it becomes.
Q38. How likely do you think that this consultation will fulfil the requirements of a lawful public consultation?
A. Consulting during a pandemic has shown us how technology can be used to involve and engage the public on a range of issues. In the context of health service planning, we have adapted and adopted new ways of working to exercise our statutory functions. The use of technology to hold meetings, share information and recordings of meetings, and enable a wider reach across communities has provided additional methods and opportunities to consult or provide information to individuals to whom the services are being or may be provided. We also hope to stage face-to-face events towards the end of the consultation if Covid-19 restrictions permit. This consultation will fulfil the statutory duties and common law obligations placed on the CCGs.
Q39. Lot of detail on how to promote where services will be on the internet. How is this being promoted by other methods. I do worry if all on-line. How will you engage with people from a non-digital route?
A. The proposal to bring information together into one place in a single place online is only one small aspect of these proposals. Consultations and interactions on line are an additional way of providing services and may only be appropriate for a small proportion of service users, depending on their needs.
After the Consultation
Q40. Will you change your plans due to the consultation if the public share ideas that could improve your plans?
A. All views obtained through the consultation will be considered within the context of the proposals. At the end of the consultation, we will develop a ‘decision-making business case’ which will articulate how we have taken account of the public’s views. It is really important to us that our plans reflect the needs of the local population, while taking account of the National and local health economy and strategy.
Q41. What happens if you don’t get the support for the proposals through the consultation?
A. The consultation is not a referendum. The purpose of the consultation is to see if there is anything we’ve missed and to understand the impact on services users, carers, staff and the public. This is about checking our plans with the public and ensuring it makes sense to you and how they could be improved.
Q42. We’ve heard all this before and nothing changed, so what is different this time?
A. Mental health problems represent the largest single cause of disability in the UK. One in four adults experiences at least one diagnosable mental health problem in any given year, and the life expectancy of people with severe mental illnesses can be up to 20 years less than the general population. Both nationally and locally, there is a real commitment to improve mental health services, which would be achieved through these proposals. The plans have been carefully worked up based on years of engagement with service users, local people, staff and stakeholders. The public consultation will now allow us to hear people’s views on a clear set of proposals.
Q43. What’s plan B if this doesn’t work or happen?
A. We do not want to guess the outcome of the public consultation. Firstly, let’s hear the views of everyone with an interest in the future of mental health care in Leicester, Leicestershire and Rutland, and, secondly, let’s then assess what people have told us. Once this process is complete, we will be in the best position to make decisions.
Q44. Will we be able to have a breakdown of consultation responses, with where the response originated from, and when would a breakdown be supplied?
A. All the responses we receive from the consultation will be independently analysed and evaluated. The responses provided by the public are anonymous. However, the questionnaire does ask people to provide socio-demographic and equality data. This is optional. Where people have provided this information, the Report of Findings will include a full breakdown of this data. The final Report of Findings will be received by the three CCG governing bodies and discussed in a public meeting in autumn 2021. The papers for this meeting will be publicly available.
Q45. How do you know you are reaching all of the communities through the consultation?
A. All the feedback we receive from the consultation will be independently evaluated by an external organisation. The organisation will also do a review half-way through the consultation and advise the CCGs if there are communities that are not being reached. If the review shows gaps, then we can adjust our communications and engagement plan to address them.
Q46. What happens after the consultation?
A final report of findings from the consultation will be sent to the three
CCG governing bodies in a public meeting and the feedback from the public consultation will be considered and taken into account in any decisions they make.
All decisions will be made public after the governing board meeting. Leicestershire Partnership NHS Trust would then undertake further work with service users, their families and carers, and staff running the service to work up the improvements.
Q47. We are bombarded with famous people talking about mental health but this overlooks the difference in terms of mental health and mental illness.
A. Mental health is not the same as mental illness, although poor mental health can lead to mental and physical illnesses. When we have good mental health, we are resilient, can handle life's challenges and stresses, have meaningful relationships and make sound decisions.
Q48. Carers are stressed out I don’t know one carer who is not on medication.
A. The level of stress of being a carer does impact on the mental well-being of the carer. With these proposals we are not only tackling the condition of the person needing care, but the family and community that surround that person.
We are also thinking more broadly about well- being people to ensure that people don’t reach the point where they are acutely unwell. We are also strengthening links between physical and mental health, as it is impossible, if you are physically unwell to feel well psychologically. We aim to promote whole person wellbeing rather than just the physiological wellness.