National Study – Older people mental health services

Background – Why are we doing it:

The project is aimed at establishing the position of NHS trusts in relation to provision and commissioning of services for older people who have mental health needs.

Evidence has been accumulating for several years of a failure of services for older people with mental health problems. The Audit Commission’s “Forget-Me-Not” (2000) and “Forget-Me-Not 2002” (2002) demonstrated areas that required improvement. In 2003 national inspection reports by the Social Services Inspectorate “Improving Older People's Services: an overview of performance” and the Commission for Health Improvement, “What CHI has found in mental health trusts”, noted deficiencies in the commissioning and delivery of older peoples mental health services.

The 2003 Commission for Health Improvement Investigation into matters arising from care on Rowan ward found similar local circumstances and systemic problems to its 2000 investigations into abuse of older people at the North Lakeland Healthcare NHS Trust. In 2005 the national review of older people’s services by the Healthcare Commission, Audit Commission and the Commission for Social Care Inspection found that commissioning and delivery of older peoples mental health services were still a cause for concern requiring additional work.

National Directors’ reviews in 2004 (Louis Appleby: The National Service Framework for Mental Health – Five Years On, and Ian Phelp: Better Health in Old Age) both highlighted mental health in older people as requiring particular attention.

Ian Phelp’s 2006 report on the next steps in implementing the NSF for older people (“A New Ambition for Old Age”) emphasised dignity in care (echoing a theme from complaints to Healthcare Commission on mental health care in general hospital wards). Aims for mental health in old age were to secure comprehensive specialist mental health services for older adults, to ensure age-equality in mental health care including the integration of all underpinning programmes of work, to improve skills and competencies of staff in non-specialist services, and to promote mental health as part of active ageing.

“Everybody’s business” (a service development guide for integrated mental health services for older adults) was published by the care services improvement partnership (CSIP) in 2005 with a particular emphasis on informing the commissioning dialogue around older peoples mental health services. “Everybody’s Business” was endorsed by the 2006 White Paper on community services (“Our health, our care, our say”) and the 2006 nice guideline on the treatment and care of people with dementia in health and social care.

Healthcare Commission’s current position:

Older peoples mental health services have already been highlighted within the Healthcare Commission as requiring further attention, and a commitment was made by the Healthcare Commission  to undertake some further work following the publication of “Everybody’s Business”.

In our proposals for the 2007-2008 Annual Health Check we set out our intention to review services for older people with a mental health problem. We have therefore agreed to carry out a national study that will enable us to explore a number of important themes (see below), examine existing data and identify some of the key improvement priorities. The information from this approach will contribute to a national report on older peoples mental health services that will be published in Autumn 2008. 

As part of the study we invited six trusts from around the country to assist us by showing us their services for older people with mental health needs and allowing us to visit to meet with staff, service users and carers, as well as senior staff, to gain a greater understanding of the types of services offered and how well services are meeting needs at present in relation to our main themes of:

• ageism,
• comprehensiveness of services
• safety
• joint/partnership working

The Objectives of the National Study – Shared values
What we want to do:

1. To study the overall performance of NHS mental health trusts with regard to how well they are consciously and systematically addressing the needs of older people with mental health needs, to ensure positive outcomes users and carers of the services including having robust systems and processes in place.

2. To consult, involve, and learn from the experience of older people with mental health needs in order to drive improvement.

3. To focus attention on issues that may be failing to address the needs of older people with mental health needs

4. To publish findings about the overall performance of NHS trusts on services provided to older people with mental health needs on the themes of ageism (user experience), interagency/whole systems working (clinical and cost effectiveness), Rowan Ward issues (safety, health and well-being) and comprehensiveness of services (use of resources)

5. To test out the effectiveness of the use of existing data in determining risks of poor performance and likelihood of good performance

6. To disseminate good practice examples

7. To formulate possible indicators for assessment of older peoples mental health services

Purpose

The purpose of the visit is to:

• gather further information
• test out our understanding of the existing performance data, focusing on the four themes
• gain a greater understanding of performance issues leading to a national report.
  

People who use older peoples mental health services and their carers will be central to the report.

The fieldwork team will consist of two assessors from the Healthcare Commission.

A National Report will be published in the autumn that will include some of the good practice we found as well as some of the challenges faced.

How can you use this to improve your services?

The full interview guide is published so that any Trust or service can use it to cast a critical eye over their own services. It could form part of an internal review, or trusts may want to pair up to peer review each other. Alternatively, having an idea about the questions that we are interested in may help to clarify the challenges and offer insights into how to face them.

Can you still help us?

Yes, there are several ways you can still help.

• You can send us your completed interview guide, or a part of it, we would be very grateful and would use any information anonymously in the report.
• You can send us your “good practice” stories. What is your service doing that excels? What has made a difference?
• We may be able to visit you to discuss any of the themes and use the information in the report.
  

The interview guide.

Older peoples mental health Interview Guide (doc 176kb)(opens new windpw)

Who can I contact if I want to know more?

Julie Meikle will be glad to talk with you.
Julie.Meikle@healthcarecommission.org.uk

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