Agenda item

            The Committee considered the undernoted report:

 

“Relevant Background Information

 

Purpose

 

      To present to the Strategic Policy & Resources Committee a suggested response to the Northern Ireland Executive’s consultation ‘Delivering the Bamford Vision’ and to bring to the attention of Members details of the Executive’s proposals for implementing the findings of the Bamford Review.

 

      Background

 

      In October 2002, the Department of Health Social Services and Public Safety (DHSSPS) initiated an independent review of the law, policy and service provision affecting people with a mental health problem or a learning disability – now referred to as the Bamford Review.  The review produced a series of 10 separate reports between June 2005 and August 2007.  Together these reports contained almost 700 recommendations, many of which have already influenced policy and service developments.  This consultation document represents the Northern Ireland Executive’s response to the Bamford Review.  It sets out the Government’s long term vision for improving services for people with a mental health problem or a learning disability and its proposals for achieving this over the next 10-15 years.

 

Summary of the Consultation

 

      The Bamford Vision

 

      The NI Executive has ‘accepted the thrust of the Bamford recommendations’ and has adopted the Bamford vision, which aims to:

 

·         promote the mental health and wellbeing of the whole community and in parallel decrease the prevalence of mental ill-health through preventative action;

 

·         value those with mental health needs or a learning disability by asserting their rights to full citizenship, equality of opportunity and self-determination;

 

·         provide a legislative framework, based on principles which protects the dignity and human rights of people with a mental health problem or a learning disability; and,

 

·         reform and modernise services in a way that will make a real and meaningful difference to the lives of people with mental health needs or a learning disability and their carers and families.

 

      To make this vision a reality, the NI Executive will seek to provide:

 

‘Person-centred, seamless community-based services, informed by the views of service users and their carers, making early intervention a key priority and protecting and promoting people’s mental health.’

 

      Delivering the Vision

 

      The consultation document explains how the Government intends to deliver the Bamford vision through:

 

·         Coordinating structures across the NI Executive

 

·         Legislative Reform

 

·         Mental Health Promotion and Suicide Prevention (including domestic violence)

 

      It also explains how this will be delivered in the Health & Social Care Sector, with particular focus on:

 

·         Learning Disability and Autism

 

·         Adult Mental Health

 

·         Children and Young People’s Mental Health

 

·         Older People’s Mental Health and Dementia

 

·         Alcohol and Substance Misuse

 

·         Forensic Mental Health Services

 

      Key Actions and Targets

 

      The key actions and associated targets are summarised below:

 

·         Establish the Health and Social Care Task Force by March 2009.

 

·         Establish the Bamford Monitoring Group by September 2009.

 

·         Introduce new mental health legislation and new mental capacity legislation by 2011 and 2014 respectively (to protect the rights of people unable to make their own decisions about their mental health treatment and other health, care and financial and property issues)

 

·         Reviews of inpatient and community based mental health and learning disability services by December 2008 and September 2009 respectively

 

·         The development of Service Frameworks for ‘mental health services’ and for ‘learning disability services’ by December 2008 and September 2009 respectively and the Development of common care pathways with agreed referral thresholds across Northern Ireland by September 2009 (to ensure  more uniform, regionally agreed models of care)

·         Reduce the overall suicide rate by 15% by 2011 (taken from Protect Life –A Shared Vision,  2006)

 

·         Targets in relation to binge drinking and the use of illicit drug taking

 

·                     A number of targets / actions aimed at:

 

-        Reducing long term stays in learning disability and mental health hospitals;

 

-        Improving hospital discharge times;

 

-        Improving community care / at home support and respite packages;

 

-        Improving waiting times, referral thresholds and access to defined services

 

-        Reducing admissions to mental health hospitals; and

 

-                Ensuring that by 2014 no-one will have a hospital as their permanent address.

 

·                           The development or revision of strategies on:

 

-       Promoting Mental Health Strategy and Action Plan by 2009

 

-       Promoting the social inclusion of people with a mental health problem or a learning disability through the ‘Just Like You’ vision by 2009

 

-       Improving access to psychological therapies by September 2008

 

-       Services for people with a personality disorder by December 2008

 

-       Dementia services, including the needs of younger people by December 2008

 

-       Provision of low secure and community forensic placements by March 2009

 

·         Actions and targets in relation to:

 

-        The proportion of HSC spend on mental health services and learning disability services which is spent on community based services

 

-        The number of recipients of Direct Payments.

 

-        Workforce development and planning

 

-        Information and advice services (including improved information systems and management)

 

-        Awareness Raising and Media Campaigns (and specifically Domestic & Sexual Violence

 

      Funding

 

      As a result of the recent Comprehensive Spending Review (CSR), additional funding of £19.75m (2008/09), £23.6m (2009/10) and £44m (2010/11) will be made available for mental health and learning disability services  –  an increase of 12% and 9% respectively.  According  to the document, older people with

dementia will benefit, along with other older people, from increased funding under the CSR to adjust for growth in that section of the population.  For example, funding is earmarked within the £44m package to provide additional respite care packages for people with dementia.

 

      The full consultation document (112 pages), and a 15 page summary document can be accessed at: http://www.dhsspsni.gov.uk/showconsultations?txtid=30219 The deadline for responses is 3rd October 2008.

 

Key Issues

 

      The Challenge

 

      The Bamford Review estimated that within Northern Ireland:

 

·         About 250,000 adults and 45,000 children and young people have a mental health problem;

 

·         About 26,500 people have a learning disability, of whom about half are aged 0-10; and,

 

·         About 20,000 people have dementia.

 

      In 2002/03, a study by the NI Association for Mental Health and the Sainsbury Centre for Mental Health estimated that the total costs of mental illness in Northern Ireland amounted to £2.8 billion or £1,680 per head of population.  In comparison, the total health and social care budget in that year was £2.4 billion.  A clear message from the Bamford Review, and reiterated in this consultation document, is that good mental health should be valued and that it should be a shared responsibility.

 

      Key Themes

 

      In responding to this challenge the Government has proposed a number of actions.  When reading the document, it appears that these have been based on the following underlying principles:

 

·         Person – centred services

 

·         Meaningful user and carer participation in the planning, commissioning and delivery of services

 

·         Early intervention and promotion

 

·         Greater consistency across Northern Ireland

 

·         Greater coordination and integration (seamless services)

 

·         Shift away from large institutional hospital care towards community care

 

·         Decreasing reliance on specialist learning disability services towards improved access and use of mainstream services.

 

      In keeping with the early intervention element of the Bamford vision, the consultation document states that work with children and young people must be seen as a priority.  Other key action areas include older people and dementia, suicide prevention and alcohol and drug abuse.

 

      Belfast City Council

 

      Belfast, as a city with high levels of deprivation, also experiences higher than average levels of mental ill health Belfast.  It is an important policy area and in response to previous Bamford review consultations, Members have expressed concerns about the number of suicides, especially amongst young people and have highlighted the need for a more holistic view of healthcare generally in terms of, for example, encouraging greater participation in sporting activities and in the use of leisure and recreation facilities as methods of improving well-being and ultimately reducing the levels of a number of preventative illnesses.  Members have also highlighted the need for greater emphasis on prevention and participation.

 

      Where appropriate the Council has previously responded to area specific consultations resulting from the Bamford Review.  Where the content was of a technical nature or required knowledge of professional care management in the field of mental health, we provided an acknowledgement letter as a courtesy which typically provided broad support for principles and objectives aimed at improving the quality of life for all.  We have also previously highlighted the high incidence of deprivation within Belfast and its higher than average levels of mental ill health.

 

      Role of Local Government

 

      The focus of the consultation is on how the NI Executive as a whole, and the health and social care sector in particular, intends to address the findings and recommendations of the Bamford Review.  However, the document also states that ‘everyone has a part to play – individual service users, their carers, the independent sector, the wider public sector and the general public’.  Whilst the document does make mention of the role of the voluntary sector, there is no real mention of the role of local government or the contribution that local council services can make to improved well-being.  This omission is pointed out in the attached draft response.

 

      To maximise cross-sectoral working, the Bamford Review had recommended the establishment of a Regional Mental Health Promotion Directorate, under a Regional Director, located at the heart of Government, specifically in the Office of the First Minister and Deputy First Minister.  However, while the NI Executive accepted that each Department had a vital role to play in promoting positive mental health, it did not feel that moving the coordinating responsibility from DHSSPS, where it currently sat alongside and is inextricably linked with other healthy lifestyle strategies and programmes, would be appropriate.  The NI Executive believes that the structures it has and will put in place (as outlined in the Investing for Health strategy and suicide prevention strategy) will achieve the co-ordinated action required across Departments.

 

      Following consultation with Departments, a draft response has been prepared for consideration of Members and is attached at appendix 1.

 

Recommendations

 

      The Strategic Policy & Resources Committee is requested to approve the attached response to the consultation document and to approve its submission to the Northern Ireland Executive.

 

Documents Attached

 

      Appendix A: Draft Belfast city council Response to the NI Executive Consultation on delivering the Bamford Vision.

 

Appendix A

 

Proposed Council Response to the Consultation

 

The Northern Ireland Executive’s Consultation: ‘delivering the bamford vision - the response of northern ireland executive to the bamford review of mental health and learning disability’

 

Belfast City Council Response

 

      Belfast City Council welcomes the opportunity to comment on ‘DELIVERING THE BAMFORD VISION - The Response of Northern Ireland Executive to the Bamford Review of Mental Health and Learning Disability’.

 

      The Council is committed to working in partnership to improve the quality of life and well-being of all people living in Belfast.  As a city with high levels of deprivation, Belfast also experiences higher than average levels of mental ill health.  The Council is therefore supportive of efforts to improve mental health and well-being within Northern Ireland and is keen to work in partnership with Government, communities and other sectors to make this happen.

 

      Detailed comment is provided below using the response template provided.  Please note: we have not included comment where questions require specialist knowledge or technical/ professional expertise.

 

Consultation Questions:

 

      The Bamford Vision

 

      Q1.    Chapter 2 sets out a vision statement for delivery of services for people with a mental health problem or a learning disability.  Is this statement acceptable?  If not, what needs to be changed in it?

 

      We welcome the vision to provide ‘person-centred, seamless community-based services’ and in particular the vision that public sector organizations will work better together to promote positive mental health.

 

      BCC is committed to improving quality of life for all. The Review of Public Administration will give councils a new power of wellbeing. It will therefore use this new power to become much more involved in promoting health and wellbeing including mental health and wellbeing. Also through the new duties associated with community planning the council will be able to support greater co?ordination of services in these fields throughout the City.

 

      The council would ask that the role and contribution of local councils be better reflected in the final response document, so as to ensure that potential opportunities to work in a co-ordinated and holistic person-centred manner are identified and availed of.

 

Human rights, Equality of Opportunity and Social Inclusion

 

      Q2.    Chapter 3 deals with human rights, equality of opportunity, social inclusion.  Do you agree that the proposed programme to promote social inclusion is needed? If not, why not?

 

      BCC provides a range of services within communities. We recognize the importance of and are committed to ensuring, equality and social inclusion of people with a mental health problem or a learning disability in the provision of these services.

 

Funding

 

      Q3.    Chapter 4 summarises current health and social care funding for mental health and learning disability services and proposes targets for the proportion of this which should be spent on community services.  Is this the right balance?  If not, what should the balance be?

 

      As local authorities become more involved in promoting health and wellbeing (including mental health) within communities (as envisaged through RPA), this may have implications for funding.  Consideration may need to be given as to how this will be resourced.

 

Structures

 

      Q4.    Chapter 5 describes the groups that have been or will be established to help deliver the Bamford vision across Government.  Are these acceptable?  If not, what changes do you want to see to these arrangements?

 

      Q5.    In particular, are the proposals to establish a Bamford Monitoring Group acceptable? If not, what arrangements do you want to see to ensure that Government is challenged by stakeholders?

 

      It will be important to ensure that local government with its developing role in health and wellbeing is able to liaise with and have effective input to these various groups.

 

Promoting Mental Health Strategy

 

      Q6.    Chapter 6 describes the work proposed to update the cross-Departmental strategy and action plan for promoting mental health.  Are these acceptable?  If not, what changes do you want to see?

 

      There is no mention of the role or possible future role of local government within the strategy and action plan.

 

      BelfastCity Council is committed to working along with other agencies to achieve the regional target of a reduction in the overall suicide rate by 15% by 2011(taken from Protect Life –A Shared Vision, published in October 2006). In this regard the council provides representation at officer and member level on the Belfast Prevention of Suicide and Self harm steering group and associated working groups. We are currently establishing a multi agency group to produce protocols aimed at dealing with potential clustering of suicides within communities. The council is keen to provide a civic leadership role in this regard.

 

      Local authorities provide a range of services which can impact on people’s mental health – leisure / parks / community services etc. They operate a range of community based services and facilities which would be well placed to be involved in the promotion of mental health and wellbeing within communities.  Councils are also major employers (Belfast CC employs approx 2500 employees) with a duty for the health and wellbeing of their employees. They also enforce health and safety at work legislation in a range of workplaces, and therefore have the potential to influence good working practices and subsequently the mental health of other workers.

 

Legal Framework

 

      Q7.    Chapter 7 describes the work proposed to develop new mental health law and capacity law within a common framework.  Are these acceptable?  If not, what changes do you want to see?

 

      No Comment

 

Health and Social Care Sector

 

      Q8.    Chapter 8 identifies a range of issues that need to be addressed within the health and social care sector to deliver the Bamford vision.  Are these issues acceptable?  Are there any other issues which should be added?

 

      The Council would welcome ongoing dialogue about the future use of facilities in the city in order that opportunities for shared and integrated facilities can be availed of for the benefit of local communities.

 

Care Pathways and Accessing Services

 

      Q9.    Chapter 8 identifies the need to agree common care pathways for people accessing the range of mental health and learning disability services.  Do you agree that this is needed?  If not, what should be done to address the problem?

 

      No Comment

 

Services for People with a Learning Disability

 

Q10. Chapter 9 identifies a range of issues that are being or will be addressed to improve services for people with a learning disability.  Are these acceptable?  Are there any other issues which should be added?

 

      No Comment

 

Services for Adults with Mental Health Problems

 

      Q11.  Chapter 10 identifies a range of issues that are being or will be addressed to improve services for adults with mental health problems.  Are these acceptable?  Are there any other issues which should be added?

 

      No Comment

 

Services for Children and Young People with Mental Health Problems

 

      Q12.  Chapter 11 identifies a range of issues that are being or will be addressed to improve services for children and young people with mental health problems.  Are these acceptable?  Are there any other issues which should be added?

 

      Whilst the Council cannot comment on clinical aspects of mental health care, we are committed to delivering better services to children and young people.  The Council runs a Youth Panel which engages directly with young people, and is also working to develop coordinated and consistent responses to meeting the particular needs and challenges faced by young people.  The Council has a number of facilities, such as community and leisure centres, and operates a range of programmes and initiatives which taken holistically contribute to improved health promotion and well-being.  It is therefore important that other services and positive contributions to health promotion and well-being which exist outside the traditional Health and Social Services field are taken into account. 

 

Services for Older People with Mental Health Problems or Dementia

 

      Q13.  Chapter 12 identifies a range of issues that are being or will be addressed to improve services for older people with mental health problems or dementia.  Are these acceptable?  Are there any other issues which should be added?

 

      Whilst the Council cannot comment on clinical aspects of mental health care, we are committed to delivering better services for older people.  The Council, in collaboration with other agencies and older people themselves, is initiating dialogue and supporting programmes aimed at enhancing older people’s quality of life.  This work may provide opportunities for raising mental health issues and improving services and access.  The Council has a number of facilities, such as community and leisure centres, and operates a range of programmes and initiatives which taken holistically contribute to improved health promotion and well-being.  It is important that services such as these, which exist outside the traditional Health and Social Services field, are also considered and utilised where appropriate.

 

Services for People with Mental Health Problems and Addiction

 

      Q14.  Chapter 13 identifies a range of issues that are being or will be addressed to improve services for people with mental health problems and addiction problems.  Are these acceptable?  Are there any other issues which should be added?

 

      The council is keen to work in partnership to improve the health and wellbeing for all the people and communities of Belfast.  As referred to above, we operate a range of facilities and services that contribute positively to well-being.

 

Departmental Actions

 

      Q16.  Appendix 1 summarises the actions being taken by Departments other than DHSSPS to improve services for people with a mental health problem or a learning disability.  Are these acceptable?  Are there any other issues which should be added?

 

      The Council’s Parks and Leisure Department would concur with the evidence provided by the recent Mencap Sports Strategy about the value of sport and physical recreation as a primary health improvement tool.

 

      The Council’s Parks and Leisure Department also welcomes the target of increasing by 2017 the number of people with a disability who regularly participate in sport and physical recreation in Northern Ireland by 6%.  The Belfast Physical Activity and Sports Development Strategy recommends that Belfast City Council should appoint a development officer for activities for disabled people.

 

Forensic Mental Health Services

 

      Q15.  Chapter 14 identifies a range of issues that are being or will be addressed to improve forensic mental health services.  Are these acceptable?  Are there any other issues which should be added?

 

      No Comment

 

Equality

 

      Q16.  Appendix 1 summarises the actions being taken by Departments other than DHSSPS to improve services for people with a mental health problem or a learning disability.  Are these acceptable?   Are there any other issues which should be added?

 

      Q17.  Appendix 3 describes the outcome of the equality screening exercise. Do you think that the proposals outlined in the Executive’s response to the Bamford Review are likely to have any adverse impact on equality of opportunity or on good relations with regard to the Section 75 categories of people?

 

      Q18.  If you believe there are likely to be adverse impacts on any of the Section 75 categories of people, can you suggest any ways in which they could be reduced or alleviated in the proposals?

 

      Q19.  Are you aware of any other equality implications likely to arise from the proposals?

 

      The Council would draw attention to the need to support the community as it emerges from 30 years of protracted violent conflict and the impact this has had on mental well-being.  We believe that it is the duty of all policy-makers and service delivery agencies to acknowledge the deeply divided context within which we work and to contribute in a meaningful way to developing better relations within our society.  This will not only enhance general well-being but will also contribute to government objectives of building community cohesion and developing a more shared society.

 

General

 

      Q20.  Are there any other comments you wish to make?

 

      The Council has previously highlighted the need for a more holistic view of healthcare generally, in terms of, for example, encouraging greater participation in sporting activities and in the use of leisure and recreation facilities as methods of improving well-being and ultimately reducing the levels of a number of preventative illnesses.

 

      We particularly endorse an emphasis on prevention and participation

 

      High quality open spaces play a role in improving physical and mental well being.  The Council provide a wide range of open spaces in the city and hope to have a positive effect on health statistics by providing opportunities for everyone to take part in all sorts of recreation.

 

      The Council’s Parks and Leisure Department would ask that consideration be given to the potential for other government departments and agencies to work with the council to develop facilities for people with a mental health problem or a learning disability.  These could include sensory gardens or specially adapted playgrounds within council parks or open spaces.”

 

            During discussion in the matter, several Members expressed the view that there were limited facilities provided for people with learning difficulties, particularly young adolescents, and this needed to be addressed, with additional resources being targeted at that area.  In addition, the key actions outlined in the consultation document should have meaningful targets.

 

            After discussion, the Committee approved the proposed response and agreed that it be forwarded to Groups in the City who dealt with self-harm in order to seek their views thereon before being submitted to the Northern Ireland Executive.