Category Archives: Carers Lewisham MH Forum

Lewisham Mental Health Carers forum October 2022

Hello fellow mental health carers and readers, been a while since I have been blogging due to working on my new book called “Race, caring and mental health”. This book will be my 2nd release for 2022, the book will reflect how mental illness impacts on carers from ethnic minorities especially black people. I hope to get that book out for November 2022.

Going away from promoting my new book, this is just a quick blog for my Lewisham mental health carers forum. A forum aimed at those caring for someone suffering mental illness.

The speakers for October 2022

Marie Cooper RGN BSc MSc (Florence Nightingale Foundation) – Pallative care “walking the walk”
Evelyn Sample (South London & Maudsley NHS Trust) – Approved Mental Health Professional / Mental Health Act presentation

  • Marie Cooper presents on Palliative and End of Life Care

Marie Cooper who is also the Project Lead for Palliative Care Nursing at St Christopher’s wanted to understand the experience of the carer when its come them supporting a loved one coming to the end of their life. Marie mentioned when it reaches that stage, the term for that person becomes more personal as they see themselves more than just carer. They are perhaps a family member, a loved one, anybody of importance to that person.

Marie mentioned it is really important to hear the voice of the relative or person experiencing their loved ones end of life care. Marie started off by showing a few pictures of hospital rooms.

In her talk it was stated that in hospitals, where someone was visiting a loved one or someone who had died. The experience of walking through the hospital or the bereavement suite makes a big difference in someone life, this will stay with them forever. So the project Marie mentioned was “Walking the walk” as Marie and her colleagues would become the carer as they walk through the wards. They travel right through the hospital into understand the entrance, the experience of what that family might be going through as they visit a loved one who has died. Marie focuses on emotions of that time, some people are rushing to get to where their loved ones are, or the people being there for days waiting and attending to their loved one and what support is there for them.

The overall aim of the project is to improve the experience for the family and the friends, anybody. What they did was they worked with 25 hospitals, those being 25 acute trusts over the past and pre COVID period. They have just done the Evelina hospital for Children with parents, which has been a very powerful experience. That hospital is formed from Guys and St Thomas NHS FT.

As mentioned in her talk, Marie literally walks through the hospital, they do the walking, and this would be a team of four of them. They would visit all the public sites, look at the toilets, look at the phones, look at the cafeteria. They would take photographs and eventually they report back to the hospital to get feedback on improvements. In the end it just gives them a chance to speak to the nurses, the doctors on what their experience of people coming to the hospital in their last days? What’s working well, what would they like to see different.

Marie and her work partners look at four areas, they look at the environment to practical facilities, is it clean? Is it comfortable? Is it hostile? Is it something that they would want to sit in which is accessible? They also talk to families to get their experience e.g. caring for my loved one for many years? Can they still care for them? How much can they be involved in the care of their loved one? Then thirdly, what support is there for that person? Have they got Wi Fi access at that hospital site? Can they get access to food? Can they park? Can they shower? Can somebody be their key person? tell them what’s going on so they can support their loved one? Plus what about the care after death? What care is there for the person after that loved ones dying. So they look at all those four elements as they traveled through the hospitals.

Marie should has a picture slide of waiting rooms at a children’s hospital. The experiences when children die, the memories and all the incredible work in children’s hospitals and hospices around trying to contain those lost memories, and about how to show a child are still being cared for after their passing, through the use of fabrics and cots and other furniture. So that in keeping the personhood of that deceased person relevant and respected that the family might be find helpful and comforting in future.

QUESTIONS FROM CARER MEMBERS

Is there capacity for cultural improvement for the experience of pallative care regarding ethnic minority carers.

Do You get any push back from Chaplin services as hospitals?

I run a carer stall at several hospitals, What can you say to someone who’s going through a difficult time when their loved one has died or is dying?

How can mental health trusts take on the programme? People do not die as in a planned state, but pallative care is a concern due to sudden death or complications from mental and physical health.

One person mentioned that their are two end of life care situations that comes around in different ways. For some people it’s planned that they’re goning to die. Often in certainly adult mental health services, we don’t always know when people are going to die. It is usually quite traumatic and when they do die, either through suicide or premature death, because they’re physically unwell, we are not sure if we have a sort of clear cut response. Often, there’s lots of practical things that we might help families after, but from the presentation there are a lot of things to query.

It was raised that the way carers centers respond to end of life, is that they would not normally stop someone’s membership when they cease to become a carer. Because they know that that’s a really difficult time, and they’re going to need help, sometimes they might keep them for like 18 months after to help them, especially if their caring role has been their full time job and their identity, they would help them sort of replace it with other things, volunteering, getting back to work, that sort of thing. It would be bad pratice to tick a carer off membership if their loved one passed away, but then it is also a decision for the carer.

Are pallative care policies updated at mental health trusts compared to accute trusts?

One person responded I don’t think or I’m not aware that we do have a brief new policy, we have a certain minimum as unfortunately and tragically, a very high disproportion of our service users die prematurely. The experience and impact of death has a huge strain and trauma on the carers health.

As in the past there are a number of our service users who commit suicide and when there is an incident then there is an investigation process that goes into reviewing the care that was provided to that individual.

  • Evelyn Sample presents on the mental health act

Evelyn looked into the role of the nearest relative under the Mental Health Act and how it’s changing in the coming years. She is aware for a lot of carers that the Mental Health Act and the functions of the nearest relative are quite confusing. So she thought that she would talk to us about what the nearest relative rules are and why some people are nominated as the nearest relative. Plus how and what are the rights and responsibilities of the nearest relative and how that might be changing.

Evelyn reminded us that she is a mental health social worker, which means she is an “Approved Mental Health Professional (AMHP)”. Now the approved mental health professional historically has been as A role that was exclusively for social workers. Since 2008, it has been possible for non social workers, nurses, occupational therapists, psychologists to have that role.

Evelyn feels what is really important is that people have information about the role of the nearest relative, because what happens as an AMHP is that you are assessing someone under the Mental Health Act, either you’re planning an assessment that’s going to take place in the community or you’ve been asked to assess someone who’s already an inpatient in the mental ward. This could be because they have come in as an informal inpatient, and they are now having a mental health assessment on the ward.

The function of the nearest relative is to provide a safeguard under the mental health act. So in order to ensure that people have person/patient interests and also they have the person’s well-being considered. The nearest relative has an important role other than the doctors who are involved in making recommendations for detention, or the amp who is employed by the local authority to also act as a safeguard.

The idea is that the nearest relative is intended to be the person who is thought to be closest to the patient, and who therefore knows them best, and is able to, to act in their best interest.

When the Mental Health Act was originally devised in the early 80s (1983), the current Mental Health Act, used as a sort of table for identifying new relatives. That table now seems quite outdated so therefore there was a proposal to change the act so that people can actually choose the nearest relative. Evelyn mentioned they have a system where the nearest relative ( Section 26 of the act). says if you are the husband or wife or civil partner of a person, then generally you will be the nearest relative. Then the table goes on from there.

Husband, wife or civil partner
Son or daughter
Father or mother
Brother or sister
Grandparent
Grandchild
Uncle or aunt
Nephew or niece

The issue is that it is a rigid order that is set out in the law that determines who is the nearest relative? And currently, the amp and the patient have little to no say over that.

The proposal is that under the Under the new Mental Health Act that’s coming in; Mental Health patients in advance of mental health assessments, when they have “capacity” to do so will be able to nominate their OWN nearest relative and choose the person that they think will best reflect their their wishes, and will act in their interests.

So this change is going to be significant in the legal situation, assuming that the The bill has not yet gone through Parliament, which is about increasing the patient’s choice, and enabling patients to be more involved in the decisions around there care and treatment.

QUESTIONS AND STATEMENTS FROM MEMBERS

Sometimes the nearest relative is usually the carer or friend. So when it comes to the nearest relative, could it not be changed to “The nearest relative or carer?”. Because sometimes the nearest relative might be 100 miles away.

Can the nearest relative refuse because of bad history with their parents, whether they’d been abused and they just they just basically have cut links can they refuse if they were contacted?

Do you have any like sort of queries or concerns regarding the new changes to the mental health act? and the second question on is there like a list somewhere on like the duties an AMHP that could be tailored to how they deal with unpaid carers?

Lewisham Mental Health Carers forum March 2022

Welcome to another quick update from my carer forums that I host. The forums are aimed at friends, families and unpaid carers who care for someone suffering mental illness. Here is the update from my Lewisham mental health carer forum for March 2022.

Speakers

Annie Dransfield – Carer Author of the book Releasing the Compassion.

  • Annie Dransfield presents.

Before I update on Annie’s presentation. I am developing a carer author circle, I only started the group this week for carer’s week and it is a little quiet, but the group has started. There are at least 5 to 6 of us and evetually we will try our best to support each other and promote the cause of caring.

Annie mentioned that her son was born with a lack of oxygen, which resulted in him having cerebral palsy down his left side and having special needs. She didn’t realise that she was a carer at that time, because it never crosses your mind, she just knew that she has a baby, and he needs looking after. Everyone knew he needed a lot of care and attention, and needed to find out how they were going to deal with the cerebral palsy.

In fact it wasn’t that severe that he needed to be in a wheelchair, but as he got older, due to the complications at birth, he was also diagnosed with schizophrenia. So, all through these years that she has been caring, she has come up against a lot of injustices. These injustices drove her to write the book.

Ann just felt it was a constant battle when you are caring and that you’re dealing with every single aspect of a person’s life. So you’re dealing with so many organisations like benefits, like Social Security, like housing, all these things, every single aspect of a person’s life. One of the bigger challenges was her son getting into debt quite often and having to deal with the banks. The banks seemed to not be too carer friendly and this made life very difficult for Ann and her son.

Ann was very involved with Leeds partnership NHS Foundation Trust. She was a governor for the mental health trust, but this all started when her son became more unwell. As Annie has been caring, she got involved with care support groups. She then got onto different boards, anything to do with caring, carer involvement, parent participation, participation groups, then she became a governor for the leads and York partnership NHS Foundation trust. Annie then became a trustee for carers UK, which she has just since retired.

Annie feels that she has got more of an understanding of the complexities due to expericing all the injustices that she has had to deal with for 43 years. In the end it prompted her to write the book. It’s been bubbling up inside of her for three years. She felt that she had to get this message out, even if it’s just to give hope to new carers that can pick up some hints and tips from the book.

The book “Releasing the Compassion: An expose of the threat that is binding the hands of our community’s most needed carers” is intended as a learning resource as well for NHS students in mental health. It’s intended as a learning resource for professionals like corporate independent businesses e.g. the banks.

You can buy Annie Dransfield’s book on the link below

https://www.waterstones.com/book/releasing-the-compassion/annie-dransfield//9781919606309

  • Questions and comments from carer members

How can we protect our loved ones from financial problems and abuse?

What is that lasting power of attorney or warranty?

I think if with COVID, there was ripe opportunity for some fraudulent behaviour to go on, because people couldn’t leave their house. They did put measures in place and other post office did saying you could nominate someone to go and collect your money

I cannot wait to order your book. I can also say I have experience in trying to deal with banks and the problems of them struggling to secure the debts of someone suffering mental ill health.

Lewisham Mental Health Carers forum February 2022

Welcome to my February update of my Carers forum for Lewisham by former mental health carer Matthew McKenzie FRSA. This forum allows those who care for someone suffering mental illness to get togther, network, gather information and get engagement from Health & social care services. I also allow for particular speakers on carer empowerment, carer’s rights, advocacy, campaigning and discussions.

For february our speakers were

  • Charolette from Healthwatch Lewisham
  • Cath Collins from South London & Maudsley
  • The new Lewisham service user network
  • Plus Wendy Dewhurst who is the General Manager for Lewisham Community Services (SLaM)


Charlotte Bradford from Healthwatch Lewisham presents

As you can probably tell from my previous blog posts, Healthwatch tends to listen and engage with my carer groups every so often. I am thankful for healthwatch to also help promote my carer groups to spread the word. Charlotte who is a project officer from Healthwatch Lewisham remembered attending one of my carer groups before Christmas, and this is her first into 2022. Charlotte oversees a number of different reports that healthwatch Lewisham produce on a yearly basis.

The most recent one that they published on their website is the digital exclusion report. Healthwath Lewisham spoke to a number of residents to hear more about their experiences over the past 18 months with accessing health and social care services. This will help Healthwatch Lewisham look at what their priorities will be for this year. Plus they will be focusing on the next report where they will be conducting a number of interviews on visits to care homes.

  • Cath Collins – carers social worker updates the group

Where ever I go and engage mental health carers I often ask if their mental health trust have a focus on unpaid carers. It really helps if there is a designated person whose role it is to focus on unpaid mental health carers. Over in Lewisham, we have a social worker whose job it is to focus and support unpaid carers. Cath Collins is employed by Lewisham council, but works closely with South London & Maudsley NHS trust.

I am glad we have Cath to update our carer members over in Lewisham. Cath mentioned that as of this moment for inpatient mental health services for Lewisham particularly on the wards they are going through a process called the “Triangle of Care” audit, which is a very good practice when it comes to supporting the mental health carers.

In a nutshell, it was put together by a carer (Alan Worthington). The triangle of care policy is kind of like a checklist. So you have the six key areas to check whether you are mental health carer friendly on your inpatient NHS wards in your services.

All five wards at the (SLaM) ladywell unit are going through their submitted assessments, these being the home treatment team assessment, although she is still waiting on the psychiatric liaison team to submit theirs. Basically it is all about making them think on how they support carers. These things could be : –

  • How do they evidence that?
  • How can we how can they prove that they do that?
  • What information do they give people?
  • How do they involve people in the assessment of the person who needs support.
  • If the staff are carer aware and that they know about the needs of carers and the impact of caring?
  • Do they have a lead in their team who supports carers?

So the triangle of care audit is really thorough and even though it seems like an exercise it’s been really good. Cath mentioned it’s really sort of good practice on going on some of the wards and in some of the teams it’s helped them to highlight and really think about visitors be it the mothers, partners, brothers and sisters who come to the wards who support someone in hospital.

Cath also reminded my carers group about the carers support session that evening, which is run in conjunction with Carers Lewisham.

  • Linda from Lewisham service user network presents

Our next speaker to the carers forum was Linda Amoakohene who is the Sun Project Lead and Senior Occupational Therapist. Linda works for the Lewisham personality disorder service. She is also leading on the Lewisham service User network which is part of the Lewisham personality disorder service.

Linda was here to tell us a little bit about a new project. Even though it is new it actually was launched in October 2021. So they are still relatively new. The project is open to really anyone in the community of Lewisham who may be having some mental health difficulties. It doesn’t have any particular mental health labels even though the service Linda is providing is sitting within a specific service the personality disorder service, the project is actually available to anyone in the community in Lewisham. So whether you identify yourself as a carer or a patient of South London and Maudsley or just a patient of a GP or a member of the community. It is open access.

The Service User network is a peer support group. So people who attend the group come to get support when they’re in crisis, or perhaps they are struggling with things that impact on their mental health. So people end up self referring where they can come as often or as little as they like. Linda also mentioned that they don’t have to be under the South London and Maudsley NHS services to access the project, they could just be under the GP. There are also leaflets about the project or people email the team, and then they will send you the link to self refer to the project. So once the person self refers, they then make contact with the person on the phone, to find out a little bit more about them.

At the team they then complete something called a “Crisis and support plan”, which is basically applied to help someone think and plan, especially when things are really tricky. This can lead to questions on what sorts of things help or don’t help. This is so people basically go away with something that they can sort of use in a dynamic way, whenever they need it.

As of this moment, the project has got three groups a week, and they’re happening online. They might launch a face to face group since the COVID situation is obviously changing, and the government rules are relaxing, but they may still maintain some of the health requirements because COVID hasn’t gone away, and they still want to protect lives.

I thought to ask Linda a Carer question : Where I was happy about the new project and service, but I was interested in what support will be provided to unpaid carers.

Linda responded at length that this group is for anybody, they don’t identify carers or service users

  • Wendy Dewhurst from South London & Maudsley presents

Wendy apologised for being a little late due to just catching up from coming off another online meeting. Wendy introduced herself as the general manager for community services in Lewisham, which essentially means that she has the day to day oversight and operational management for all of the services in the community. So that’s the primary care teams, community mental health teams, early intervention, low intensity and the personality disorder. Wendy has been in the role about a year and a half and during that time, She has taken all services through the transformation into the new model, which they are now trying to embed an implement, which is an ongoing process and is not going to happen overnight. However they have certainly seen some good results, particularly at the front end.

Wendy answered a few questions from group, where she fed back concerns about access to mental health services. Currently, the access is by the GP, although she is in the process of setting up a mental health advice line which should be operational, hopefully in the next month, where people that have any sort of concerns can talk about a mental health crisis. The service will be manned by the mental health charity MIND.

So if following a conversation with someone who mans that line and they feel that the person needs a service then they can put you directly into that team. So it will be a sort of option for self referral. Wendy thinks that there will be some people that maybe don’t want to engage with statutory services like GPS and maybe don’t trust particular services, so it’s another option to get that much needed support and they very keen on being able to process self referrals. This so SLaMs (South London & Maudsley) primary care mental health teams have something in Lewisham, which is where they can provide the most appropriate treatment that’s the least intrusive.

So it’s an intervention that services which involve psychology, Occuptional therapy and mental health advisors from MIND. Where they will work in an alliance, SLaM will work with the local authority and Bromley, Lewisham & Greenwich Mind.

Wendy mentioned they have an enhanced multidisciplinary team, where they work very closely with the GPS in the primary care team, and the GP tends to remain as the responsible doctor. The enhanced multidisciplinary team and the consultant will focus more on serious mental illness and longer care term needs where maybe patient might be subject to CPA (care Programme approach), still the move is that CPA is going to not exist going forward.

Wendy gave a talk describing the CPA where it has certain sorts of conditions with it. This is where you have to review every six months, you have a care coordinator, social worker and psychiatrist. Although what they found is that so often people that were on CPA, all the care was focused on that, and people that didn’t have CPA might not have got the same level of care. So what they want is for everybody to have the same level of care, irrespective of of what what that is, so has the same rights.

  • Final update from Cath Collins

Cath reminded us that our mental health NHS trust has a carer’s strategy called the family and care strategy. This is what they are doing in Lewisham and are trying to make it Lewisham specific. So things that are in the carer strategy as a whole will be relevant. So making sure the wards and the crisis services adhere to that good practice of the triangle of care. There’s another priority about young carers, identifying those 18 and under who are caring for their parents or brothers and sisters. Other things like making that SLaM’s carer information is up to date and relevant for mental health carers.

Lewisham Mental Health Carers forum November 2021

Carers Lewisham

Welcome to a brief november 2021 update for my Lewisham mental health carers forum. The forum is an online forum and provides engagement for those caring for someone suffering mental illness. The speakers for November 2021

Li-ying Huang – South London & maudsley Pharmacist
Raymond McGrath – Lead Nurse : Integrating our Mental and Physical Healthcare Systems (IMPHS) for Mind & Body Programme

Li-Ying Haung presents on the importance of medication.

As we all known medication and mental health can go hand in hand, there are times when patients struggle with medication and unpaid families and carers feel there is a lack of information and engagement regarding medication.

Continue reading

Lewisham Mental Health Carers forum October 2021

Welcome to a brief update of my Lewisham Mental Health carer forum for October 2021. I know I am behind in updating people about my carer forums, but I have mainly been busy working on my 2nd book. I am glad to say the book “Experiencing mental health caregiving – unpaid carers” has been published and can be bought on Amazon.

For the October carers forum, the following speakers were

  • Martin Crow – Business Manager – Lewisham Safeguarding Adults Board
  • Cath collins (carer support officer) – Triangle of care
  • Eunice Adeshokan (Matron Acute Inpatient Services) – Carer engagement at Ladywell Unit
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Lewisham Mental Health Carers forum September 2021

Welcome to the September update of my Lewisham mental health carer forum 2021. As a note, the carer’s forum is an engagement group aimed at those caring for someone who suffer’s mental ill health.

Since the carer’s forum focuses on carer’s from Lewisham, we tend to get engagement from mental health services of South London & Maudsley NHS foundation trust. I am grateful for the support our local NHS trust gives to families and carers. It is important that families, friends and carers remain that strong link in coping and recovery.

The speaker’s for September were

  • Leonie Down – Lewisham Head of Occupational Therapy and Partnerships Lead from South London & Maudsley
  • Ros King – Regional carer lead for London from NHS England
  • Charles Malcolm-Smith – People & Provider Development Lead from NHS South East London CCG (Lewisham)

Leonie Down presents on the importance of Occupational Therapy

As mentioned earlier, South London & maudsley prides itself on the engagement and involvement of those who use it’s services and those who care for patients. It was great to have Leonie engage with our carer group on the importance of Occupational therapy.

Leonie stated her talk on how occuptional therapy can help people manage their routines at home, and also occuptional therapy helps look at the physical health component and ways for people to adapt to disability. Leonie presented an example from The World Federation of occupational therapists (WFOT).

“Occupational therapy is a client-centred health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement” (WFOT 2012)

Leonie admitted the defination was a bit wordy, but it does encompass the fact that it’s about activity and occupation and that’s the medium through which Maudsley NHS deliver their interventions.

Leonie has worked as an OT for around 30 years, a lot of people ask her, what’s an OT do? So she often responds that it’s about supporting people to do the things that makes them feel better. So it’s very much about what people spend their time doing, what people feel, what activities that make people feel feel better, make them stronger in themselves, plus setting their direction towards recovery. As an OT, it’s a degree that they have three years in training as an occupational therapist, which ultimately equips them to be able to understand the needs of each individual. These could be what strength and barriers might be around the person or being able to access activities that make me feel better, and that could be multifaceted.

Leonie then presented on the following, where how can service users benefit from OT. The following points were explained.

How OT promotes self-expression, creativity and the development of hobbie

Where OT can improve / develop

  • feelings of self-esteem and confidence
  • level of self-awareness, understanding and insight
  • ability to manage health conditions and ADLs
  • social interaction and communication skills
  • coping strategies and self-management techniques

How OT supports the development of roles, responsibilities and routine, as well as identifying and working towards goals

Promotes healthier lifestyle choices and greater levels of physical activity

Increases the chances of an earlier discharge and the likelihood of them being able to remain safe and independent in the community

Improves the patient experience and wellbeing.

Leonie then moved on to present the work being done in Lewisham regarding OT, where they are trying to work with as many social inclusion partners as possible. So one half is Lewisham community connections, where people are helping those using the services navigate through to something that they can be doing to help their health.

The other aspect of OT in Lewisham, is very much about trying to co-produce and co-deliver a program of groups. Which is for people that that may benefit from the environment that involves other people. This is because other people, from the same environment can learn or hear different insights, which can lead us to start making sense of our own experiences and possibly develop tools to become self reliant.

There was then a Q&A session from carer members of the Lewisham MH carer forum.

Ros King from NHS England speaks about ICS changes

Ros King kindly engages with my carer groups when she can, so today she was invited to speak about the important of Integrated Care Systems. Ros started explaining about NHS England and how it is a huge organization and can be very complicated. Ros mentioned how NHS England is basically the body that sets health policy with the department of health and social care. Such policy helps plan for what the health service will be focusing on where It also holds allocated budgets. The budgets are then allocated down to CCGs where Ros explained that there has been quite a few changes.

It was explained that a couple of years ago, the responsibility was around Clinical Commissioning Groups, and NHS improvement was concerned with providers, so acute trusts and some changes were implemented which led to a merger to become NHS England & Improvement.

Ros then explained a bit about The national teams and the regional teams. Where there are seven regions across England. As in other countries just NHS England we have Wales, Scotland, Northern Ireland, which have different arrangements.

Ros talked about the London region and what sits within the London region, where there are five integrated care systems. These being Southwest London, southeast London, North Central London, northeast London and northwest London. Ros joked that she really hopes nobody has any questions around which CCGs sit within such ICS because that would take some time. Ros talked about how the CCGs have merged to cover such regions around London.

Ros moved on to talk about how NHS England & Improvement would demand lots of information, especially very complicated information about how the CCGs and providing trusts were performing in all sorts of areas. Such requests for information could be at a very short notice because those at NHS England & Improvement have to feed this info back to the organisation.

Ros felt there has been a lot of changes as to whilst regions do still have accountability, So if an acute provider in Lewisham, has really serious concerns and risks about performance of the quality of the services they’re providing, then it is still very much NHS England regional team responsibility to manage and try and work with the provider to improve.

The idea is rather than an acute provider struggling with performancing issues, they should learn from other providers and network together. Still, NHS England has commissioned a lot of things, but now only comission small amount of services which are specialist services. These will be transferred out into ICS.

Ros then talked about how they manage complaints around a primary care service. So GPS, dentist, ophthalmologists, pharmacists and so on. Such complaints would come in to NHS England depending on the complaint e.g. if you have a complaint about any of those services, it would come through to NHS England, or if you had a complaint about a service that was commissioned by your ICS, or your CCG, that would go into the CCG or directly to the organization that’s providing the service.

Charles Malcolm-Smith presents on ICS at a local level.

I had a lot of support from engagement representatives of NHS South East London CCG where Greenwich, Southwark and Lewisham CCGs had organised what to present to carers and also who can support Ros Spink’s presentation.

In the end Charles who is the people & Provider Development Lead from NHS South East London CCG (Lewisham) continued the presentation.

Charles talked about what integrated care system changes that are in the pipeline and how they are designed to work together better. With all the talk about health and social care needing to work better with physical and mental health services, community acute services and primary care, it’s all about the different parts of the system working together and this is about structural change.

It was explained that we have had integrated care systems for a while, but their status had changed from the sustainability and transformation partnerships, where they became ICS even though it is still a partnership status, with the health and social care bill now making ICS statutory organisations. Charles explained that there will be four building blocks to do an ICS. So the ICS for southeast London will have an integrated care partnership board and this is the alliance of organizations that represent across southeast London. These will include the NHS organisations, local authorities and made up of the chairs of the trust.

Elected representatives and elected leadership from each of the local authorities as well as the representative director from Adult Social Care, children, young people services, Healthwatch and voluntary and community sector organizations. Charles reassured us that in southeast London, there aren’t any private sector organizations involved in the partnership since there were a lot of questions from members about privatisation creeping in.

Charles talked about how the Integrated Care board brings the NHS together so it brings commissioners and providers around the table. Charles mentioned it was an important development because the last couple of decades, it has always been a commissioner and provider that were split causing queries with contracts. although there will still be commissioning and providing but the approach to it will be about joint planning. So there will be working together more closely than before.

There were many questions from carer members on if the Local Care Partnership board will debate the importance of unpaid carers and include them in their decisions.

This concludes the brief update of my Lewisham mental health carer forum for September

Lewisham Mental Health Carers forum August 2021

It has been a long time coming since I have been so busy on writing my 2nd book which is title “Experiencing mental health caregiving – unpaid carers”. I have decided to take a break on my book and do another blog update. As usual I host many carer support groups and carer empowerment forums. This blog post is an update of my Lewisham carer forum.

The speakers for August were Denis Muganga who is the Service Manager for Lewisham In-Patient MH Services and works at South London and Maudsley. Denis is also deputy head of nursing at the mental health wards in Lewisham.

Denis spoke about Reducing Prone Restraint on Lewisham Acute wards. Many families and those caring for loved ones are often worried about the risk of restraint on mental health wards. Once a patient is in the care of mental health inpatient services then it is out of unpaid carers hands and we have to take a step back.

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Lewisham Mental Health Carers forum July 2021

Welcome to the July 2021 update of my Lewisham mental health carers forum. The forum focuses on engagement for families and unpaid carers who care for someone suffering mental ill health. The ‘cared for’ does not actually have to be using mental health services, but it is important there is a platform for unpaid carers to learn about mental health support, understanding mental health and what is available for carers themselves.

Speakers for my July carers forum were:

Phoebe Averill – PHd Student at Kings College
Polly Pascoe – Lewisham CCG
Carla Fourie – SL&M director of social care

  • Phoebe Averill presents on her latest study.

First to speak was Phoebe Averill who is a PhD student at King’s College. She is working with South London & Maudsley NHS Trust (SL&M) on a research study and she wants to hear carer member’s thoughts and also invite anyone that might be interested in taking part in the research study. She is looking at safety of care in the community mental health services. Phoebe gave my forum a bit of background information about what the problem is. Basically safety in general hasn’t really been given much attention in mental health services. Historically, when you compare it to kind of physical health care services, where we’ve now got quite a good idea about how we can make care safer, what types of interventions and strategies might be needed. Still, there is a small kind of body of research and interventions coming out more recently. These are mainly focused on inpatient mental health services and unfortunately community mental health services have been a little bit left behind, even though that’s where the majority of people who are actually receiving care.

In recent figures, people were using community mental health services rather than inpatient services. So it’s really important that safety is kind of better understood in the community context, so that strategies can be developed to make the services safer. And that’s what she is trying to get started with this research research. Pheobe is currently trying to speak to family members and carers of adults who are using community based mental health services, to find out a bit about what they think about what safe and unsafe care means in this context, because it’s not really well understood. This is due to the types of safety issues that the carer is worried about in relation to the person that they support.

The way the study works involves speaking to her in a either a one to one interview or group discussion with other carers if there was interest from several people in taking part. And there aren’t really any right or wrong answers. It’s really just about hearing carer’s point of view. Carers have so much knowledge about the person that they support and their experiences of care. And it’s just really important that their views are incorporated into any efforts to, to make services safer.

  • Questions from carer members.

One question was focused on the issues of patient’s age. The carer felt that a 75 year old patient does not have the same issues you’d have with a 25 year old and they were curious to know, what Pheobe would be doing for older adults when it comes to community work? Especially for the carer because there’s a lot of issues with older carries with physical issues. How will the research be monitoring those patients or those carers?

Pheobe responded that unfortunately for this study, we’re only looking at sort of general adult services. So we’re Other than older adult services, like you mentioned, it’s not because it’s any less important. It’s just that at the moment, there’s the most kind of research knowledge in adult in adult safety. so future studies would be needed to look at older adults, because there’s like you mentioned, there’s lots of really important safety problems there.

  • Statement from myself

After some debate I mentioned that one thing in regards to research is that whatever is found out could lead to recommendations, usually, most research initiatives tend to recommend some findings that will have this influence services. A lot of people feel research is done for either funding on does not solve service issues, but I pointed out researchers are not in charge of mental health services.

  • Polly Pascoe – Lewisham CCG Presents

Polly spoke about her work within Lewisham Borough Council and southeast London CCG. Her role is it was called integrated Commissioner for mental health pathways. In essence, one of her key roles is getting us to use future systems across mental health care, while it’s occurring across healthcare in general, her focus is on mental health especially within Lewisham. This is kind of where we’re hoping to head moving forwards. The previous system, that being health and social care worked separately regarding statutory and voluntary. Such as Provider sectors were working separately and sometimes even competitively where age groups were handled separately, and such services provided different levels of focus and funding. Conditions were often handled separately, and there was a strong focus on outputs as in numbers, rather than changes necessarily. So there used to be a strong focus on reaching particular targets, on how many people were seen and how many people were funded by CCG.

Now Lewisham CCG have made some definite headway in Lewisham to becoming much more integrated in the way we do things. Of course it’s a journey. So we’re certainly not there yet. Still, Polly was sure a lot of people will have experienced a number of different frustrations around how the system’s working. She feels we are becoming a more integrated health and social care system. Where we are working much more closely with our sector providers. It’s not just the big players e.g. (SL&M), Lewisham CCG is also connecting into our community organizations and age groups do remain relatively distinct. Often the way we do things will mirror that which isn’t always appropriate until the impacts of concurrent issues are understood. So we do have a clearer idea of how different conditions work with each other, but they are still seen often as separate conditions.

At Lewisham CCG they are certainly moving towards a focus on improving outcomes, but they do still have quite a heavy target focus. Those targets are becoming more appropriate as Lewisham CCG move forward. What they are heading towards is a future system where health and social care workers one, and Lewisham CCG are focused on the individual rather than on our kind of organizational boundaries, let’s say, Lewisham CCG want to move between statutory and voluntary services. So between the NHS Trust’s and then any services working in community to be visible, Lewisham CCG don’t necessarily want people to feel they’re being handed off to different places all the time. And they want people to have their personalised journey where movements between that journey feels very seamless. They also want to move to an all age approach where the CCG see the individual as experiencing certain things throughout their lifetime.

So this is also moving beyond comorbidity, not just recognizing people’s potential health issues, but understanding wellness, and looking at their life, and how the CCG can ensure that the way of living and that the way people around them, treat them and work with them ensures optimum wellness, rather than just the absence of ill health, which is one of Polly’s key findings on commissioning and delivery. So this is the way that the CCG design and make services happen. Lewisham CCG deliver those services to people where it is outcomes based and focused. So we want to move away from numbers of people, and move towards the difference we make to people. So that’s the kind of very much that future system Lewisham CCG is working towards. Polly admits she has one very small part to play in a really huge system. And, in essence, this is kind of where she sits in and amongst everything else. Her area is primarily adults and older adults. So she continues to do look at these two areas, predominantly for herself and her team.

  • Carla Fourie – SL&M director of social care presents

Carla started off talking a bit about herself and when she was appointed in February this 2021, although some people will say that they sure they saw her prior prior to this year and that’s true. She started on secondment with the trust last year literally just a few weeks before the initial lockdown. Eventually the role was made permanent, and she applied for it. She was then formally appointed in a full time role in February this year. Carla looked at putting the slides together and thinking about how she could describe what her role is at the trust, she decided, looking at kind of the role to group it into four key categories. As the most senior social worker in the trust, she works closely with NHS trust board and she works closely with SL&M senior managers, to bring a social work perspective, to the NHS trust. So when we look at our multi professionals within the trust, we’ve got our doctors or nurses and OTS, etc.

In the end Carla’s role is to bring the social worker perspective at a the senior level, she has also the responsibility to work across the trust with the different local authorities, and to ensure that SL&M avoids working in silos, so there is partnership working, and to ensure that the Social Work offer is provided to people with mental health needs, and to help people become in terms of prevention. Her other role is also that trust wide responsibility for safeguarding so the heads of adult and children’s safeguarding reports to her including the areas for domestic violence and abuse, prevention agenda. She also has a trust wide responsibility for the mental health laws that include areas such as mental health capacity, Human Rights Act, etc. In terms of just tying back to the social work, leadership role, apart from working closely with a board, she also has the responsibility to ensure that our social work workforce, social workers that’s directly employed by the trust, are also professionally well supported.

Carla spoke in terms of support to carers and families, where she thought, were important just to highlight again, on a slide where the work at that the trust is doing overall, in terms of manpower strategy, and that’s very much also founded on the triangle of care, where SL&M sees the carer very much as a partner in the care that SL&M provide. There’s a lot of information that SL&M has developed as a trust and under the leadership of Gabriel Richards, who leads strategically on the carer’s agenda. SL&M has got a carer’s charter that is highlighted. SL&M also provides information in their families and carers Handbook, and also information leaflets, posters shown in the blog regarding carers rights under the care rights, writing, carers assessment. SL&M also has information about confidentiality and sharing of information.

SL&M also provide information to nearest relative where we have useful nearest relative leaflets as well on what is provided to carers. One of SL&Ms duties is to try To ensure that ‘cared for’s relatives are informed and consulted with, particularly when there was a Mental Health Act assessment under Section two of the mental health act. The approved mental health professional has a duty to inform the nearest relative under Section three, where the relative has the power to object to someone being detained to a loved one being detained under the Mental Health Act. The nearest relative can also ask for an IMHA, which is an independent mental health advocate to see the patient and the nearest relative can request a mental health assessment, which she thinks sometimes nearest relatives not everyone is aware of that in certain circumstances where it’s been really difficult or challenging to access for whatever reason. So whilst the local authority is to consider the assessment under the Mental Health Act, or the rights and powers of a nearest relative. The nearest relative can write to the associate hospital managers to request for discharge. Sometimes that’s out here too, but in circumstances where they’re responsible clinician disagrees from a clinical point of view, they can roll that request up to the hospital managers who will review that decision as well.

An nearest relative can also appeal to mental health health tribunal, and they’ll set up some circumstances where nearest relative feel that they are not able to take on this role, because it does have a lot of power and responsibility with it. And sometimes some families feel that if someone that’s been identified as a narrows relative that may impact on relationships with their loved one.

This concludes our Lewisham MH carers update for July 2021

Lewisham Mental Health Carers forum June 2021

Welcome to the June update of my Lewisham mental health carers forum. For the month of June my MP Janet Daby who attended to speak to unpaid carers and update us on what Lewisham has been doing for unpaid carers since carers week 2021.

Also in attendance was Jo Power who is the Liaison Officer for the Parliamentary and Health Service Ombudsman.

Cath Collins – Carer support worker presents on her role.

Before Janet spoke about unpaid carers, I felt it important that Cath Collins had a chance to speak about her role and her passion to support mental health carers. Cath Collins used to work for SL&M as a carers support officer, but is now employed by Lewisham council, but in a similar role.

Cath spoke about what she is employed to do and what she has been doing. Her remit is with the adult community mental health team. So she does not work with CAMHs, the children, adolescent teams, the older adults. She spoke about how we have primary mental health care teams in Lewisham, which is part of a new transformation of services, that should be aligned to GP practices.

Cath also spoke about having community teams where people have a longer period of support who suffer from serious long term mental health conditions. She mentioend we also have specialist teams in between, which are Early intervention services, which is for people in the first episode of psychosis, regardless of what age they are SL&M also have a personality disorder service.

Cath’s remit is to work with the teams to look at several things where one of them is to look at the information that they give to families and carers. These being are they getting the national up to date information? Other things focus on is such info good information about diagnosis? how to care for someone with a specific diagnosis? being involved in discussions around the care? If not, then why not? and how we could work on it?

With advice and information service, Cath reminded that they have got a group tonight, which is a mental health care support group where people can attend and speakers will go through important topics.

Janet Daby section.

I consider it very important MPs and those who lead on social care engage with those who are vulnerable in the community, especially if the group is grassroots and self-led. I am sure there are reasons why representatives would not want to speak to vulnerable groups, but those reasons are very few and far between.

It is also a two way thing, not only is it important for MPs to link with unpaid carers, but also unpaid carers understand the importance of forming relations. Too often I hear from unpaid carers that they are in an urgent situation and wish for counsel, which is fair. However I wonder in the back of my mind if something could have been done before things got out of control. It might be usually up to carers to keep their ears to the ground and find out what is really in store for them, even if they have the unpleasant task of trying to hold health and social care leaders to account.

Janet mentioned that Carers Week, which took place this year from 7 – 13 June, is an important opportunity to recognise, value and support unpaid carers. She felt that the Government must properly fund respite breaks so carers can put their own needs first, and ensure they can continue to provide vital, life-saving care and support. She knows that this is something that both Carers UK and the Association of Directors of Adult Social Services have been calling for.

Janet remains concerned that until there is long-term investment in social care, unpaid carers will continue to be overwhelmed. After a decade of cuts to local government, £8 billion has been lost from adult social care budgets and too many families have been left to cope without the support they need.

The Government first promised to publish its plans to reform social care over four years ago. Despite repeated promises, Ministers have still not brought forward any legislation, new funding, details, or timescales for reform. The recent Queen’s Speech, setting out the legislative agenda for the year ahead, was absent of any detailed plans.

Janet continued speaking to our group about being happy to attend and meet with us even if it was more than once a year. She spoke about her plans and concerns about the SL&M’s Ladywell unit and her plans to raise queries and questions with the chair of SL&M. I asked questions about Lewisham’s focus for carers and how those who lead on social care could engage with our group where Janet mentioned a few people. As a group we have been struggling to get engagement from those who lead on social care, but in other areas of London it seems easier to get that engagement, other carers have mentioned it is not worth the hassle, but I feel it is important to get such engagement even if they respond with bad news. Nothing is worse than being ignored and left to try and support others going through isolation, exhausting and feeling they are not being heard.

Jo Power Ombudsman presentation

Jo spoke about The Parliamentary and Health Service Ombudsman and the focus was on Who they are, what they do. Jo spoke about how the Ombudsman works and makes it’s decisions. Basically the PHSO was set up by Parliament to provide an independent and free complaint handling service. It is the final stage for complaints about the NHS in England.

The PHSO staff considers on the following.
– can they investigate?
– should they investigate?
Other factors include
Suitable complainant
Time limit
Legal remedy
Another organisation that could be involved.

Jo also spoke about how the PHSO gave’s evidence in the form of.
– Hearing from both sides
– opportunity to tell the PHSO what lay behind clinical decision making
– clinical records
– CCTV, phone records
– witness statements/visits/interviews

There was also an explanation about how the PHSO investigate complaints. As they look to see if what happened was in keeping with relevant regulations, standards, policies and guidance or established good practice. If it wasn’t, the PHSO look to see how significant the shortfall is and the impact that it has had and, if it has caused hardship or injustice, if that has that already been remedied by the organisation.

The PHSO also work with the following organisations.

Stats and figures were given for the carers group to digest from 2018/19

112,262 enquiries received
82,998 enquiries resolved through advice or re-direction

28,841 complaints handled by casework teams
24,183 complaints were not ready for us
5,658 decisions were made including:
746 investigations upheld
871 investigations not upheld
3,597 assessment decisions
444 resolutions

The PHSO also updated us on what they have been doing recently. As from last year they ran a public consultation to get people’s views on the draft NHS Complaint Standards. The consultation generated a lot of interest and feedback. On 24 March 2021 they published a report that set out the responses they received and explained what they did and the changes they made in response to the feedback.

There was a long Q&A session regarding the PHSO’s work and how the focus can be influenced by unpaid carers. This was the short update for my Lewisham’s mental health carers forum for June.

Lewisham Mental Health Carers forum March 2021

Welcome to a brief update of our March mental health carers forum for the borough of Lewisham. The carer’s forum is chaired by unpaid carer Matthew Mckenzie who runs many engagement and peer groups in South London aimed at families and carers who care for someone suffering mental illness or mental distress.

The speakers for the month of March 2021 were

British Institute of human rights.
Wendy Dewhirst SLaM new Community manager for Lewisham.

BRITISH INSTITUTE OF HUMAN RIGHTS PRESENTS.

It is clear that unpaid carers have rights, otherwise we would not have the ‘Care Act 2014’, but what is not clear is how unpaid carer rights are linked into human rights. This is why I am linking carers to understand more about human rights.

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