Agenda item

The Chairman advised that External Services Select Committee (ESSC) had previously heard from partners at its meeting on 22 February 2022 about the pressures being faced when dealing with mental health attendances at Hillingdon’s Accident and Emergency (A&E) department.  Members had heard about the huge amount of time that the police had spent in A&E waiting for action to be taken in relation to a patient that had been detained by them under Section 136 (s136) of the Mental Health Act 1983. 

DCI Saj Hussain, Public Protection in the West Area Basic Command Unit (BCU) - Metropolitan Police Service (MPS), advised that Sergeant Jason Wright ran the Mental Health Team for the West Area BCU and PC Brooke Dunlop was an operational officer within the Mental Health Team (which had been established in 2018). 

Mr Richard Ellis, Joint Lead Borough Director at North West London Clinical Commissioning Group (NWL CCG), advised that this was a partnership issue which provided partners with a collaborative opportunity.  Since the ESSC had met in February 2022, progress had been made. 

Mr Ellis praised the work of those services involved in dealing with mental health crisis including the police, London Ambulance Service and Hillingdon Hospital.  He noted that there had been a 25% increase in demand for mental health beds in 2021/2022 and that the West Area BCU was the busiest area in London with 20% of their calls relating to mental health (1,500-2,000 calls per annum - about 475 of these were s136s, with the remainder being voluntary attendances at hospital).  Since the start of the pandemic, there had also been a 40% increase in the number of s136 detentions undertaken by the police where the individual had to be taken to a Health Based Place of Safety (HBPOS).  It was noted that around 60% of people presenting in mental health crisis were previously unknown to partners – this caused partners a significant challenge. 

DCI Hussain advised that, although there had been a year-on-year reduction in the number of s136 detentions between 2018 and 2020, the pandemic had then prompted a significant increase in 2021.  This had since reduced back to 2018 levels.  Although no definitive reason for the increase had been identified, it was thought to be linked to issues such as the rising cost of living and isolation. 

Members were advised that around 43% of those who were detained under s136 were subsequently discharged.  Effort was being made to focus on this group to then reduce the number of hours that the police spent in A&E as well as reduce the number of people detained on a s136 who did not require inpatient mental health care.  On average, each s136 took 12 hours and 16 minutes of police officer time (around 4,000 police officer hours per year equating to about £80k-£120k).  Although approximately 30% of s136s used a HBPOS and 70% went to A&E, DCI Hussain advised that not everyone in mental health crisis needed to go along the s136 pathway.  

Sgt Wright advised that the West Area Mental Health Team included six officers, one of which looked at demand on police services from repeat users.  Records were checked for recurring names which were then risk assessed and consideration was then given to police intervention, protective factors and risk factors.  Once the risk had been managed, the information was logged on the system to be able to manage the situation better in future if it happened again (look back and plan forward).  The police were aware of some data gaps and were now looking at the patient journey and any blockages, barriers or challenges. 

Sgt Wright noted that demand started to reduce in the autumn of 2021 and, if the reduction was sustained, Hillingdon would outperform London as a whole.  In 2018 there had been 4,400 s136s across London and 6,600 in 2022 (a 50% increase); in Hillingdon there had been 291 in 2018 and 283 in 2022 (a slight decrease). 

The partnership work that had started with Central and North West London NHS Foundation Trust (CNWL) prior to the pandemic to reduce the number of s136s was being continued.  Ms Vanessa Odlin, Managing Director for Hillingdon and Mental Health Services, Goodall Division at CNWL, advised that there had been an increase in demand for services but no increase in the resources available to deal with this demand.  However, capital resources had been made available so consideration was being given to building additional capacity whilst staying within the criteria attached to the funding. 

Ms Odlin advised that there had been some investment in alternative options for those in mental health crisis.  These facilities included 24/7 single point of access and five step down beds (which could also be used as step up beds) - it would be important to ensure that everyone was aware of these facilities.  She noted that there were still 36 acute adult mental health beds available at Riverside (for Hillingdon residents) and 17 beds available for older adults in the Woodland Centre.

DCI Hussain advised that partners needed to take a reflective approach that sought to improve care.  The Crisis Care Concordat (CCC) for the West Area (including Hillingdon) was being set up and would provide the opportunity to reflect and prevent escalation into crisis.  As MPS mentoring had ceased in 2021, a more holistic reaction to risk had been created which looked at what had happened before and then agreed interventions with partners.  This approach had been in place for approximately 18 months and had looked at around 1,800 incidents.  The focus had been on patient care as the first priority and reducing demand as the second priority. 

Ms Odlin advised that CCC meetings were already held at a NWL level but that action was being taken to set this up locally.  She stated that a Crisis House with five crisis beds (run by Comfort Care) would be opening in the autumn of 2022.  Access to the Crisis House would be via referral and it would have strong links to partner organisation and be staffed 24/7.  Mr Ellis suggested that consideration be given to getting organisations such as Mind involved in initiatives such as the Crisis House.

A task and finish group was being set up to look at the possibility of a street triage provision (which would see the inclusion of a clinician working with the police on the ground).  In terms of resourcing, consideration would need to be given to the use of existing experienced staff to undertake the street triage role and then backfilling their posts.  Police officers and partner organisations would also benefit from having generic skills such as Mental Health First Aid.  The group would be able to look at gaps, understand the proposal and identify what was needed.  Mr Ellis suggested that consideration be given to including the service user perspective. 

In addition, the Cove Crisis Café was open seven days a week from 2pm to 10pm and residents and non-Hillingdon residents were able to self-refer (the hours had been reviewed to reflect demand for the service).  The HBPOS at Riverside comprised two rooms which were used by the police for s136 detentions and was not reserved for Hillingdon residents (the Section 136 Suite).  Detentions usually lasted no longer than 24 hours.  Sgt Wright would provide Members with further information to identify the number of patients detained under s136 in the Section 136 Suite on multiple occasions.  He noted that some patients could be sectioned multiple times in a single day.

CNWL awaited the outcome of a bid to NHS England (NHSE) for winter funds to support a street triage facility.  DCI Hussain advised that alternatives needed to be strengthened and suggested that a dedicated vehicle would be a preventative measure to help divert patients away from HBPOS and A&E.  Mr Ellis stated that there was an increasing prevalence of mental ill health and that there was a post-Covid opportunity to say to NHSE and the Integrated Care Board (ICB) that this would be an innovative approach to managing these issues.  Some of the resources needed would be new and some could be a redirection of existing resources. 

Mr Ellis advised that the ICB was still in the early stages.  However, it would be important to have the statutory and voluntary sectors around the table with a single pot of money and a single set of skills.  Examples of best practice elsewhere (such as Westminster) would need to be drawn upon. 

Ms Tina Benson, Chief Operating Officer at The Hillingdon Hospitals NHS Foundation Trust, advised that the current A&E department was small and fragmented with only one cramped room for individuals in severe mental health crisis.  She noted that being in A&E with police officers was possibly the worst place for individuals in mental health crisis.  Each patient needed to be reviewed holistically as there were instances when they appeared to be in mental health crisis when in fact it was a physical health issue. 

Ms Kirsty Farrell, Clinical Services Manager & Trauma Service Lead at THH, advised that THH staff had been working closely with the police and CNWL.  There had been an increase in mental health issues arising across the board and the lights and noise associated with A&E meant that it was not the right place for a crisis.  The number of mental health patients in A&E at any one time could sometimes go into double figures which could be difficult if one patient went into crisis as it could have a ripple effect. 

Ms Farrell advised that the High Intensity User Team, comprising Hillingdon Health and Care Partners (HHCP), CNWL and THH, provided intervention in the community for high intensity users.  This work had reduced the number of intense user attendances and had resulted in the team winning an award. 

Members were advised that the plans for a new hospital were progressing.  The new development would include a single emergency floor and work continued with CNWL to establish the most efficient, practical and valuable use of the proposed space. 

The Chairman advised that mental health would be considered at the North West London Joint Health Overview and Scrutiny Committee (NWL JHOSC).  He would raise the issues discussed with Members of the JHOSC.  Whilst it was useful to take stock of the current situation and the positive action that was being taken / proposed, he asked that partners come back to a future meeting in 12 months to provide the Committee with an update.  In the interim, he requested that he and Councillor Nelson be provided with an informal update in six months.  It was also agreed that he and Councillor Nelson also be invited to observe a CCC meeting. 

RESOLVED:  That:

1.    Sgt Wright provide Members with further information to identify patients detained under s136 in the Section 136 Suite on multiple occasions;

2.    the Committee receive an update at its meeting in June 2023;

3.    Councillors Denys and Nelson be provided with an informal update in six months;

4.    Councillors Denys and Nelson be invited to observe a CCC meeting; and

5.    the discussion be noted.