Welcome to the first update of the first carer forum for January. These carer forums are aimed at those caring for someone with mental illness. The forums provided engagement from mental health services to educate and involve carers regarding services provided.

Carers can also network together and slowly build up empowerment. For the month of January we had Lewisham health commissioner Natalie Sutherland talk about the following.

• Her role at the Clinical Commissioning Group
• Why the CCGs merged
• Their focus on mental health
• Pressures on the health system due to corona virus
• Initiatives for families and carers.

Also in attendance were carer members from Lewisham and some from other areas interested in mental health services. We also had a few researchers from universities wanted to speak to carers about their research.

We also had Lisa Fannon who is Lewisham’s public health offical regarding projects their working on. She is there to support the group in as much capacity as possible. Lisa is currently working on a health inequalities review, which focuses specifically on black African Black Caribbean communities and she is involved in getting a lot of research and experience, which is fed through with hopefully some clear actions and recommendations at the end of the review, which spans over 18 months, which could lead to some positive change.

Lisa is aware that often reviews and consultations and surveys and discussions that things do not often change and mental health is a part of that. Lisa also updated the group that as part of the black and minority ethnic health inequalities working group there has a clear outline in terms of actions around mental health for community members.

Lisa repeated that in terms of supporting anything that we may need that help and support, she will be there for us. Lisa also updated on the vaccinations webinar that’s being run by public health and that the panel is unusually predominantly black health care professionals and GPS, which is important due to the high risk of covid deaths on the BAME community.

Others in attendace with South London & Maudsley Public and Patient involvement for Lewisham and Croydon and also an Independant Mental Health Advocate who learns a lot from what carers raise at the forum.

Natalie Sutherland Presents

Natalie opened up her presentation stating that its good to see least how the forum is engaging on whats taking place in the council and around sort of carers initiatives, especially around sort of the inequalities work as well for the BAME communities.

Natalie mentioned that she is the provider Alliance development manager and she works in the NHS southeast London clinical commissioning group, Lewisham Directorate, which probably doesn’t mean a lot to anybody at all, but she just thought that she would update that previously, the employer would have been Lewisham clinical commissioning group. However from April last year, the CCGs merged to become one southeast London, which covers the six boroughs being, Lamberth, Lewisham, Greenwich, Southwark, Bromley and Bexley, so it covers both slam and Oxleas mental health trusts.

The reason that boroughs resorted to merging is to support system wide working to become more streamlined with one single CCG and having direct commissioning across the entire system. So this was put in place to help try and make a consistent approach for all services that take place across the different boroughs. Natalie felt it was quite lucky in terms of SLAM boroughs, which is Lambeth, Southwark, Lewisham and Croydon, but it also did help them to align the consistency with Bexley, Bromley and Greenwich, who also has Oxleas as their sort of mental health provider. So in terms of what that actually means in practice in terms of mental health, there is a mental health central commissioning team, which are based at Tooley Street “Southwark”, although many staff are working from home due to the COVID-19 virus.

The team manage the contracts to ensure the consistency around delivering the mental health investment standard, the long term plan initiatives and just making sure that things are sort of consistency and there’s a core offer between those six boroughs. That means that they manage generally the contracts for South London and Maudsley on behalf of the slam Boroughs, excluding Croydon because they’re part of Southwest London clinical commissioning group, which looks more at the acute services and the management around that.

In terms of the local teams, so the Lewisham Directorate, the CCG has worked more around the community based services so your community mental health teams, your voluntary sector and your social care. So her role specifically is that she sits within the transformation team that supports the system across Lewisham and sort of transforming services specifically around mental health.

She also has the hat on in that she supports, hospital discharge to assess for what they call the care at home Alliance, There are a lot of crossovers in terms of mental health, older adults, as well as adult mental health, that she looks to try and build the connections between to bring those links in towards the commissioning team.

In terms of the Mental Health Alliance, she hopes that most people have heard about the Mental Health Alliance. And if they haven’t, it’s just around organizations working together in partnership to improve the access experience in the outcomes of care and support in the borough around mental health. From October last year, the Mental Health Alliance expanded to not just include adult mental health, it now includes Child and Adolescent Mental healths services, and mental health in older adults. So in terms of the CAMS element, the main crossover is through what they would call tier four.

in terms of the work that’s going on around the community transformation piece, there is around sort of changes around sort of building and changing the way that IAPT is running and in psychological support that is provided in primary care mental health service in trying to sort of bring in to bring in a single point of access to be able to look at sort of a triage of referrals, to also look at the wider determinants of mental health, and also sort of building in the voluntary sector, whether it’s peer support, whether it’s employment support, whether it’s social prescribing, and what may be needed. Now, this is a core offer that, as Natalie mentioned before, they joined a southeast London CCG, that they will also have those core offer elements that is available into those boroughs.

Still its important to mention what is happening localy, that is on place to sort of take place locally and they do have the voluntary sector. So Bromley Greenwich and Lewisham mind, have employed mental health providers and peer supporters. In terms of the carers sort of import into that, Natalie feels like COVID pandemic has sort of put a lot of things of what they would have like to have done on hold as a result and a lot of that does include the engagement and the development of the services just as they sort of focus on the crisis.

So what they would like to do is to develop a dashboard and also to understand everything that takes place across mental health, which would also include the impact of carers within that and sort of the carers mental health as well as sort of the people that they support. They also want to establish, or develop and build on sort of the community links for the service user and carer advisory group, and established some communications and engagement network that we can test these pilots and sort of the feedback and the evaluation and have that iterative process as we go through on the transformation piece.

CARER QUESTIONS

One carer was trying to understand the idea of the CCGs boroughs mergeing, Natalie fed back about the integrated care systems, because she worked on a project with the healthy London partnership on for mental health transformation board. She helped to draw up the diagrams for integrated care systems.

Another carer asked a challenging question on how are the integrated care systems actually going to be implemented? When you’ve got funding in different places, and certain parts get cut once the pots where we were told they’re being increased, but they’re just not gonna be back to what they were 10 years ago?

Natalie responded that we have only emerged within the last year and are still sort of building up. Details are still being worked through. So while we are a southeast London CCG there is also the integrated care system and now healthier southeast London that operates and they have their own Chief Operating Officer.

Natalie will aim to get back to us on that, but in terms of the way they function, Natalie agreed. Even though they have integrated commissioning teams, we’ve been quite lucky in Lewisham that we have been operating. So the commissioners work across the CCG and the council at the same time for us in terms of the way that we deliver things. Natalie continued to feed back that the way that they also operate in Lewisham is through what they call the “Lewisham health and care partnership”. So as part of that is Lewisham Council, southeast London CCG essentially but also, the Lewisham, specific, Lewisham and Greenwich NHS trust, South London & Maudsley and also the primary care network. So that being “One health Lewisham” e.g. the GP Federation’s and they are the ones that will overseen the strategic vision for developing and sort of implementing those plans across Lewisham.

A carer quickly responded on the question of “Do you have any public participation in this implementation plan?”

Natalie responded that in terms of implementation, they did do engagements on groups for mental health specifically. They have sort of attended the service user and carer advisory forums (chaired by SLaM public & Patient Jane Lyons), or there’s been some forums through “Bromley Greenwich & Lewisham MIND”. There’s also is a patient reference group to which there are local residents, on board to help deliver those plans.

There is also for older adults the dementia Action Alliance, and a project or a work plan within that for sorting out CCG governance. This involves accountability roots, as well as developing outcomes and dashboards and key performance indicators on how the CCG would demonstrate that things move forward.

Natalie warned the difficulty in maintaining links was the result of COVID, a lot of the people have had to sort of stop the work to focus on COVID. The impact that that has had, whether it’s been through staff members being down because they’ve had to self isolate, or whether, changing services to make sure people have been kept safe. So move things from face to face to where they can go online in the first place.

Even people within the CCG, herself included could be redeployed at any time to sort of deliver the vaccine program that’s taking place across southeast London.

Another carer pressed a lengthy discussion on how funds would provide a quality health service.

The carer pointed out that when we compare the numbers of funding in Lewisham against Southwark and Lambeth, we have more people in the population with mental health issues. She felt her understanding is the distribution of resources as done on a headcount solution. Therefore Lewisham is already at a disadvantage in that area. The other area where Lewisham is at a financial disadvantage is surrounding boroughs to Lewisham, which is Lambeth, Bromley, and Southwark and Greenwich, missing the others, they tend to have better revenue streams coming into them for the local authorities in terms of their business rates, because they’ve got more business units. So their finances are better. So they can deliver more from the the local authority perspective. So that’s another lose area for Lewisham.

The carer then continued to point out that also each experiment regarding certain groups with specific health needs like, maybe older population, a younger population. If those two factors are considered, we’re in a lose lose situation, once again. So where do we go to when you go to do your outcomes, you’re going to get a higher failure rate. The other areas where Lewisham struggles as a borough is that doesn’t have a major hospital like guys, or St. Thomas’s or King’s College, which allow SLaM or other major institutions to give funds, when they want to do research, pilots and etc. It seems those boroughs get the top pick and Lewisham is like back at the bottom. This is because the funding is lacking there and everything it’s going to go back then to the proper carer? The carer continued stating that she does not know how much more she can shoulder. It’s like, Where’s the support for us carers? Where it’s not relying on the voluntary sector? Because we’re all worn out in Lewisham.

Natalie mentioned that she did agree with the challenges and we there needs to be a balance. Natalie thinks it is only a matter of time before the NHS is going through some sort of reorganization.

The last question came from a carer member who attended a southeast London CCG meeting yesterday about vaccinations. He was just curious on when does carers, unpaid carers fit into the vaccinations, because the reason why he asked was that he knows a lot of carers who are under the age group who are looking after their parents with dementia, who are suffering in silence because they haven’t been vaccinated yet. They are really worried now about passing on any any infections to the person they’re caring for.

Another question was on the BAME community, the carer felt that those from the BAME community were meant to be more vulnerable than others, but nothing had been said about when are they going to get vaccinated? Or what kind of vaccination they are going to get.

Lisa the Lewisham Public Health representative stepped in and mentioned the question on BAME vaccination was important. Lisa wanted to signpost members to some information In that, Lewisham public health are aware that due to information communication that the community receives by social media, WhatsApp groups, email information, and other communications is for Lewisham take up on vaccination is low,

Lisa continued that within their team, they are working really hard to give specific information about the vaccine to all of our residents. They are going to be working on targeted communication to Lewisham’s black Asian minority ethnic communities. They are going to give factual information to support young people making their own informed decisions regarding vaccinations.

A carer member responded about a particular meeting they went to yesterday, and it was interesting about what Lewisham health services are doing. But they still feel that the unpaid carer was just being ignored. Unless that when you become a patient, then they will get some support. It seems services are not interested if you’re a carer and you’re looking after someone with dementia who’s already vulnerable, then you are suffering in silence as much as the person who’s got the mental health issue or you because you’re not sure where you stand.

Due to a vaccination webinar Lisa felt that it’s really helpful to hear all of this feedback and if she can offer in some help ahead of the webinar, she will pass this information on to panel members at the event. It will be an hour session, but she will make sure that because in the event they will have some pre questions that came from last time, she will make sure that its included with a response to the carer members queries.

RESEARCH PRESENTATION

At the January carers forum, we had a number of researchers who joined to give some information. One researcher Emilie Wildman talked about a study that she is doing for part of her PhD. She is a PhD student at King’s College London and the focus of her research is all about carers. The study is very relevant to mental health care specifically. So a bit of background to the study in many health conditions, including mental health, she knows that people living with the conditions will often be supported by a close family member, relative or friend. These people are referred to as informal carers and we also know that in some relationships, that can be difficult periods that might include episodes of disagreement upset, and in some, in some cases, behavior from one person to another. The study is looking to speak with carers who have experienced any type of aggressive behavior from the person they care for.

There were some interesting questions from members of the forum although I was overjoyed to see more research directed towards the carer experience. I am hoping more research can link into changing policies and services.