Mental Health programme Q&A

Qu. Who are you and what is your role in the ICP?

My name is Ciara Stuart and I lead the ICP Mental Health Programme, which aims to bring partners together to improve outcomes for mental health in our city. I am one of the Deputy Locality Directors in the City Locality Team which is part of the Clinical Commissioning Group (CCG). I am delighted to once again be working on this agenda – as for several years I worked in mental health commissioning roles. Working as part of the ICP is very different from my previous roles as it brings opportunities to do things differently in partnership with ICP organisations and most importantly with our citizens. The Programme only commenced this summer, but I am excited about what we can achieve in the coming months.

Qu. Why is the programme so important?

Good mental health is an essential aspect of overall good health for our population. The pandemic has impacted all of us, but the effects have not been the same for everyone. Those whose mental health has been particularly impacted by the pandemic include, the unemployed, those with existing long-term physical or mental health conditions, women, people from minority ethnic and LGBQT+ communities, and older people who are isolated or digitally excluded. We know most of the determinants of mental health are social, not medical. So that calls for responses at all levels, system and society, community and neighbourhood, individual and household. As an ICP we are in a unique position to come together to do things differently; join up services, focus on prevention, and increase support in the community rather than traditional health settings. And, we will with our communities to change things that will make a difference to them.

Qu. What is it like leading this programme of work?

The programme has been running since the summer and at times it can feel overwhelming because of the size of the agenda. However, the enthusiasm and support from partner organisations has been encouraging. The meetings so far have tried to achieve three aims, firstly, getting stuck into actions where we can make some rapid improvements. An example of this is a project led by Alex Julian to engage with our South Asian Communities to understand why they are less likely than other ethnicities to access Primary Care Psychological Therapies. We hope the information will help us change pathways and services to make them more accessible. Secondly, partners are sharing information about their areas of mental health transformation. Shared information and knowledge will help us make connections and work more closely together to ensure mental health is everyone’s business. Finally, we are thinking longer-term; in partnership with the Collaborative for Better Mental Health we are developing the City response to the Prevention Agreement for Better Mental Health.

Qu. How do you promote the programme to citizens and to your colleagues?

We are fortunate that we are working in partnership with the recently relaunched Nottingham City Collaborative for Better Mental Health. The Collaborative is a group of over 100 professionals and 35 people with lived / carers experience who want to come together to help us identify opportunities for greater integration, areas of inequalities and help connect the ICP Programme to our communities. In December, Collaborative members have been invited to attend a series of workshops focused around co-producing an action plan to support the signing of the Prevention Agreement for Better Mental Health; this will guide much of our work going forward. If you would like to join the Collaborative please contact Marie Cann-Livingstone for further information marie.cann-livingstone@nottinghamcity.gov.uk

Qu. What positive outcomes have you seen and where can we improve?

Although the programme is in its infancy, we are already seeing the benefits of bringing people together to share information and ideas. A task and finish group is in the process of being formed to look at options for sharing information about mental health across partners. We also have a project to develop mental health assets to better support social prescribing. At each meeting we make new links and partners are coming together to support each other; during the last meeting Jules Seblin (NCVS) offered to support the identification of further City venues for crisis sanctuaries. We are at the beginning of the journey, but I am excited about what can be achieved.

Take care this winter

Nottingham City Council is asking people to ‘Take Care’ this winter as cases of Covid-19 start to rise.

People should continue to follow the guidance on ‘Hands/Face/Space/Fresh Air’, test regularly for the virus and get vaccinated as soon as possible.

Latest figures show Nottingham now has 309 cases of Covid-19 per 100,000 population, up from 252 cases a week ago. While still below the national average of 416 cases per 100,000, the rising trend shows Covid-19 is still present in our communities.

Launching its new ‘Take Care Nottingham’ campaign, the City Council is urging people to continue to stay safe from Covid-19 – while also taking steps to look after their mental health and wellbeing and making sure they stay warm and well in the colder winter months.

Cllr David Mellen, Leader of Nottingham City Council, said: “Covid-19 cases continue to rise in Nottingham. While we have fewer cases than in other parts of the country, it is important that we all take steps now to reduce the spread of the virus. As we approach the colder winter months, it is more important than ever that we join together to take care of our city and each other.

“Winter is a difficult time for many. People may struggle to stay warm – and the darker mornings and evenings can have an impact on our mental health and wellbeing.

“We have to make sure that we all keep ourselves safe – but I would also ask people to think about how we can do more to look out for others. That’s why the City Council is launching a new campaign, asking everyone in Nottingham to ‘Take Care of Yourself’ and to ‘Take Care of Each Other’.”

The council asks people to ‘Take Care of Yourself’:

  • Get vaccinated against Covid-19 (first, second and booster jabs)
  • Stay warm and well in the colder winter months
  • Have the flu jab
  • Ask for support if you are feeling down or anxious

People can ‘Take Care of Each Other’ by:

  • Wearing a face covering in busy indoor spaces to reduce the spread of Covid-19
  • Testing regularly for Covid-19
  • Being a good neighbour, such as to older and more vulnerable people

Lucy Hubber, Director of Public Health in Nottingham, said: “Everyone has worked incredibly hard to keep themselves safe from Covid-19 since the start of the pandemic. We never underestimate how hard it has been for people in our city.

“But we have another winter ahead of us: a time when more people suffer from seasonal flu, colder weather, fewer hours of daylight… and, of course, Covid-19 is still with us. Our ask is that people continue to do everything they can to keep going over the colder months.

“Please get vaccinated against Covid-19, whether you are 12 or 92. Make sure you keep testing regularly for the virus… and never lose sight of simple things, such as wearing a face covering in busy indoor places. It all makes a difference.

“There is also the unseen public health impact that Covid is having – especially on people’s mental health. That’s why it is important to not only look after yourself, but also make sure you are looking out for other people this winter.”

More information on the council’s response to Covid-19 can be found at www.nottinghamcity.gov.uk/coronavirus

Vaccinations

People are urged to come forward for their Covid jabs. In Nottingham, the Forest Recreation Ground vaccination centre is open most days from 8.30am to 7.30pm (it closes at 3pm on Mondays and Wednesdays). You can go there for:

  • Your first jab – there are staff who can talk to you about any concerns you might have
  • Your second jab – if it’s eight weeks since you had your first jab
  • Your booster jab – it it’s six months and one week after your second jab

You can turn up without an appointment, but the centre is seeing higher demand and some longer waits at the moment so you also have the option to book a time slot. Click here to make an appointment: Book your Coronavirus Vaccination.

Testing

As we are move into the darker autumn and winter months, the times of local asymptomatic testing centres (free, rapid, Covid-19 testing when you don’t have symptoms) have changed:

  • Hyson Green Community Centre (open Tuesday-Friday, 8am-5pm and Saturday, 9.30am-2.30pm)
  • Bulwell Market Place (open Mondays from 9am-3.30pm)
  • Clifton Leisure Centre (open Wednesdays from 9am-3.30pm)
  • Smithy Row (open Saturday and Sundays from 9am-3.30pm)
  • Trinity Square (open Thursdays and Fridays from 9am-3.30pm)

Tests can also be collected from local pharmacies or ordered online to be delivered to your door. Please note if you are collecting a box of tests from a local pharmacy – you will now need a QR code. Find where to get rapid lateral flow tests – NHS (test-and-trace.nhs.uk for further information.

Please remember, if you are experiencing symptoms of Covid-19 or have a positive rapid test, you must urgently take a PCR test – you can simply book a test by visiting www.gov.uk/get-coronavirus-test or by calling 119.

Face coverings

We are asking people to keep following ‘Hands, Face, Space and Fresh Air’ while the pandemic continues.

Face coverings in particular help to reduce the spread of the virus. People in Nottingham should wear a face covering in busy indoor spaces, such as:

  • In shops and supermarkets
  • In theatres and concert venues
  • When moving around pubs, cafes and restaurants
  • On public transport
  • In council venues

Keep warm and Well

High energy bills are a worry to everyone, but it’s important to stay warm.

  • Make sure your main living room is heated to at least 18°C
  • Wear extra layers of clothing whether you are inside or outside
  • Eat at least one hot meal every day and have plenty of warm drinks
  • Keep moving and stay as active as possible

Warm Home Discount: find out if you qualify and how to get the discount www.gov.uk/the-warm-home-discount-scheme

Get tips on staying warm and well from www.nhs.uk/keep-warm

Get the flu jab

You’re much more likely to catch the flu at this time of year. It’s unpleasant for anyone but for some people, flu can be much more dangerous or even fatal. You can protect yourself with a free flu jab if you are older, pregnant, a child aged 2-4, a carer, living in a residential or nursing home or living with a long-term health condition like heart problems, kidney or liver disease, diabetes and more. Contact your GP to get your free flu jab or for full details on who is eligible visit www.nhs.uk/flu

Mental health and wellbeing

Fewer hours of daylight in winter can affect our mental health. It is important that we take steps to look after ourselves:

  • Make the most of the daylight hours – try to get out for a walk every day
  • Exercise regularly and eat well. It doesn’t have to be anything particularly strenuous – doing housework, gardening or going for a gentle walk. Make sure you have a balanced diet with plenty of fruit and vegetables
  • Try to connect with other people in person, on the phone or with messages. Talking through things that are worrying you can be really helpful

If you feel that you need to reach out for help, we have some excellent services in Nottingham:

  • Turning Point is a dedicated mental health helpline that offers practical and emotional help as well as online support. Visit www.turning-point.co.uk
  • NottAlone is a new website with local mental health advice & help for young people in Nottingham and Nottinghamshire, all in one place. If you are aged under 25, are a parent or carer, or a professional that supports young people, you can find information, advice and where to go to get help locally. Visit www.nottalone.org.uk

Be a good neighbour

  • Help out vulnerable neighbours or friends during cold snaps: check if they’re warm enough and have enough food or medicine if they are struggling to get out of the house.
  • A little can go a long way – checking in on elderly neighbours can really give them a boost. Sometimes it’s a few minutes’ company they need as much as picking something up from the shops.

Innovative Primary Care Psychological Medicine service in South Notts makes a difference to patients’ lives

A psychological treatment service, rolled out across the South Nottinghamshire Integrated Care Partnership in 2019, is offering hope to people with high levels of complex persistent physical symptoms

Primary Care Psychological Medicine (PCPM) is an innovative service delivered by mental health liaison professionals and allied health professionals providing patients holistic care for persistent physical symptoms where:

  • their presentations are too complex for Increasing Access to Psychological Therapy (IAPT) providers
  • the physical nature of their main presenting symptoms and complex diagnoses make them unsuitable for core mental health services
  • the lack of a medical explanation for their symptoms makes it difficult for physical health specialists to provide effective interventions

PCPM also forms part of the assessment and rehabilitation pathway for post-COVID service. This fulfils the specific NICE guidelines on rehabilitation services that should be available to people with post-COVID syndrome

Before the service was introduced, patients were being seen by various specialities in their individual silos without any overarching assessment or treatment plan that combined their whole presentation, from both a mental and physical health perspective.

Persistent physical symptoms can be painful, life-limiting, disabling, distressing and increase dependency on others, and can mean multiple GP appointments, outpatient visits and even visits to an emergency department. The PCPM service provides active management of the patient in the community, working in a person-centred way to help patients understand the connection between their physical and mental health, provide treatment, promote self-management and deliver a better experience and outcome for the patient.

And the results speak for themselves. PCPM patient Jane, who has struggled with multiple physical and mental health issues over a number of years, has been receiving care from the whole multidisciplinary team, says: “It’s a unique service. The team saved my life. I feel like a jigsaw and the pieces are being slotted in by each member of the team and slowly, one day hopefully soon, this jigsaw will be finished.”

As well as improving patient health and wellbeing, as seen in Jane’s story –  https://www.youtube.com/watch?v=eEpJqdkinGg&t=1s, Patient Reported Outcome Measures (PROMs) have been used to understand the impact of the service and support the patient in assessing their own symptoms and progress. In all domains of the PROMs, statistically significant improvements have been seen and sustained after discharge, and this has continued despite Covid. The project has also had a dramatic impact on Emergency Department and inpatient activity in this group of patients:

  • Inpatient activity reduced by 72.7%
  • Emergency Department and Urgent Care Centre activity reduced by 74%
  • Outpatient Department activity reduced by 51.3%

Project lead Dr Chris Schofield, Consultant Liasion Psychiatrist at Nottinghamshire Healthcare NHS Foundation Trust, says: “The ‘whole team’ approach in integrating mental and physical health and primary and secondary services is effective and this service has delivered impressive results, including improved patient outcomes and reduced primary and secondary care attendance.

“It perfectly fits the new ways of working emerging from the Primary Care Networks, in line with ICS aspirations. Overall, it’s a great example of integrated care, bringing together primary, hospital and community care, and helping us deliver a more holistic approach with patient need at the centre.”

Designate Chief Executive announced for Nottingham and Nottinghamshire Integrated Care Board (ICB)

NHS England and NHS Improvement has today recommended the appointment of Amanda Sullivan as Designate Chief Executive for the Nottingham and Nottinghamshire Integrated Care Board (ICB).

Following a robust recruitment process, Amanda will take up the post as soon as the Health and Care Bill 2021 receives Royal Assent.

The Bill will put Integrated Care Systems (ICSs) on a firm statutory footing, empowering them to better join up health and care, improve population health and reduce health inequalities. 

Dr Kathy McLean, Chair Designate of the ICB said: “Amanda’s extensive experience means she is perfectly placed to drive forward our shared purpose of every citizen enjoying their best possible health and wellbeing. Having worked in the NHS for 30 years and with her background in midwifery, Amanda is a compassionate leader who is driven by the values of our NHS.
 
“These continue to be changing and challenging times for our health and care system. With Amanda at the helm, I have every confidence we will achieve better collaboration, better care and better outcomes for our population.”

The Health and Care Bill 2021, which contains a series of measures to formally establish Integrated Care Systems (ICSs), is currently at Committee Stage receiving a detailed examination following its second reading. Each ICB will hold a substantial budget for commissioning high quality patient care and have the authority to establish performance arrangements to ensure this is delivered.

Amanda said: “I’m honoured to be appointed to this role for Nottingham and Nottinghamshire and realising our vision of a new health and care approach for our citizens. We have a strong, rich history of partnership working. Our response to the Covid-19 pandemic has further demonstrated the power of collaborative working across the NHS, local authorities and voluntary and community sector.

“I feel privileged to work for the health service and incredibly proud of our colleagues who have worked relentlessly over the past 18 months. Together, we will make an impact where it’s needed most.”

We are hiring – join our exciting team

We are recruiting for several Changing Futures roles over the coming months hosted within our partner organisations.
Find out more about Changing Futures here.

We are currently advertising for:

  • Strategic Commissioning Manager hosted by Nottingham City Council. Details of the role and how to apply here
  • A Programme Director who will oversee the delivery of the Changing Futures programme. This role is hosted by Nottinghamshire Healthcare NHS Foundation Trust. Details of the role and how to apply here
  • Severe and Multiple Disadvantage Practitioner – specialising in primary care hosted by Nottingham City General Practice Alliance. Apply here.
  • Severe and Multiple Disadvantage Practitioner – specialising in mental health hosted by Nottinghamshire Healthcare NHS Foundation Trust. Apply here.

Watch this space as we will be advertising for a Strategic Commissioning Manager, hosted by Nottingham City Council. We will promote this and other roles via Twitter @ICPNottmCity, so follow us to be the first to hear about future opportunities!

Changing Futures

We are excited to announce that through our programme to support people who experience severe multiple disadvantage (SMD) we have been accepted onto the Department for Levelling Up, Housing and Communities (formerly the Ministry for Housing, Communities and Local Government) Changing Futures programme. We have received over £3.5 million to support people experiencing SMD in Nottingham.

Opportunity Nottingham have supported people facing SMD in Nottingham City since June 2014. The project was set up to deliver support for eight years until June 2022.

Opportunity Nottingham will stop taking referrals permanently at midday Friday 29 October 2021 and will close end of June 2022. Changing Futures will be the offering for the city going forward. It will be delivered as a partnership, made up of statutory and voluntary organisations across Nottingham City, and led by the Nottingham City Integrated Care Partnership. Find out more

We are recruiting for several Changing Futures roles over the coming months hosted within our partner organisations.

We are currently advertising for:

  • A Programme Director who will oversee the delivery of the Changing Futures programme. This role is hosted by Nottinghamshire Healthcare NHS Foundation Trust. Details of the role and how to apply here:
  • Severe and Multiple Disadvantage Practitioner – specialising in primary care hosted by Nottingham City General Practice Alliance. Apply here.
  • Severe and Multiple Disadvantage Practitioner – specialising in mental health hosted by Nottinghamshire Healthcare NHS Foundation Trust. Apply here.

Next week we will be advertising for a Strategic Commissioning Manager, hosted by Nottingham Coty Council. We will promote this and other roles via Twitter @ICPNottmCity, so follow us to be the first to hear about future opportunities!

A day in the life of a Paramedic First Contact Practitioner

Kay Gallimore is the Paramedic First Contact Practitioner trainee for Byron PCN. She was appointed by Primary Integrated Community Services (PICS) and assists GPs with the care of residents in six care homes across the Torkard surgery area of Hucknall.

Primary Care Network Paramedics support GPs and work as part of an integrated care team. A team of 14 Paramedics across seven Primary Care Networks (PCNs) are supported by Carol Pape, Lead Paramedic within PICS. They work as a team to integrate the role in the wider health and social care system, share good practice and develop in line with Health Education England’s roadmap of education for practice.

Kay’s role is one of many new and exciting positions and services, which are being developed in general practice and the community that make it easier to access a wider range of help from general practice, closer to home, by phone or online. This is part of the NHS Long Term Plan to offer people more choice and more joined-up healthcare.

Here Kay shares a day in  her working life…

Diary for a day in Hucknall: Tuesday 12 October 2021

I start at 9am and after grabbing a quick cuppa I’m down to business. Most care homes don’t appreciate a telephone call or a visit before 10am because they have the huge task of administering medicines to residents after breakfast. I use this time in the morning to check my emails and look for updates on tasks I’ve already started.

10am Today I’m going to Sherwood House – a home set in beautiful surroundings which I just love working in.

I’m responsible for undertaking a ward round for all the residents in my patch. This is generally in the form of a face-to-face visit one week, and then a telephone ward round on the weeks in between visits. I’ll try and pop over if someone needs examining though, rather than relying on a telephone consult. Visiting helps me have a visual idea of how someone is doing and it’s good for the residents as they get used to seeing a regular face. Being familiar helps break down barriers so hopefully they can talk to me openly about any issues. I like to think they see me as a friendly face, even if it is behind a mask!

I don all my PPE and sit down with Senior Carer, Rachel, (see main photo) and because this a relatively small home with only 14 residents, we spend time talking with each of them individually. Continuity of care in this way helps me build a great rapport between staff, carers and residents.

Rachel and I talked with a resident about their end of life care. We ensured all the correct anticipatory medication was in place and that the resident was comfortable, and that we are having regular communication with family. Its feels good to be involved in making sure the resident is comfortable. Being trusted and involved in this way also allows the GP time to catch up on other responsibilities.

I also took and recorded residents’ weights and blood pressures to identify any new issues as part of their personal care plans.

The Wi-Fi isn’t strong enough so I then ‘hot foot ‘back to surgery to task the GPs for medication and review.

It’s now 11:30 – time for a quick coffee. I grab some lunch as whilst writing up my patients’ needs as there’s a patient-focused multi-disciplinary team (MDT) meeting soon.

1pm – I log on to the MDT meeting with my video off – no-one wants to see me eating! I listen out for any useful information and contribute if I can. This is very strange – talking to a computer is never easy.

2:30pm – I start another care home review: this time I’m on the phone to Buddliea House. After exchanging pleasantries, we concentrate on the residents who need reviews and agree who may need a follow up visual exam. Whilst in front of System One I can input useful details and confirm test results to Senior Carers. I always try to speak to the same Carer each week as they are the ones who know the residents well.

Many Carers will take observations which are helpful, but generally I like to go and see the resident for myself to ascertain any problems. It becomes clear that I need to see a resident who has become more confused. Lots of my residents have a multitude of medical issues and many have dementia. They can be very challenging to deal with and its often upsetting to see them in crisis. I hope I can make life a little easier by getting them the help they need sooner. It’s clear I can’t change everything, but the contacts and connections I’ve made will go some way to helping these residents in their twilight years.

Its approaching 4pm and after going out to see the resident at Buddleia House, I go back to the surgery to send their urine sample off and write up my findings. I then debrief with the GP – it’s a good time for me get my concerns across to them and invariably a good educational part of the day for me too. I also work closely with Pharmacists, Dieticians and Nurses here at the surgery too and we have good working partnerships.

5pm comes around too quickly but two ward rounds ticked off today. Yippee!

BAME Health Inequality Q&A

Interview with Clive Foster

Qu. Who are you and what is your role in the ICP?

My name is Clive Foster and alongside Donna Sherratt, I lead the ICP programme which aims to reduce inequalities in health outcomes in black, Asian and minority ethnic (BAME) communities. Although that’s not my only job, I keep myself busy with several other roles! Most people know me as Senior Minister at the Pilgrim Church in The Meadows where I lead on social justice campaigns. I am also the founder of the Nottingham Windrush Response Project. I am passionate about promoting equality, inclusion, and diversity across public sectors and chair the black BAME subgroup of the Nottingham Together Board.

Qu. Why is the programme so important?

The Nottingham City Integrated Care Partnership has a clear priority target to reduce health inequality amongst the BAME community. This programme is so important because of the inequalities that exist – the Covid pandemic has identified the clear disparity gaps in health inequality. The BAME community has been disproportionally affected by Covid. It is important that those who are most marginalised and discriminated have fair and equal access to health services and consequently reduce the health inequalities affecting our diverse communities. Whatever we can do to alleviate this is critical to ensure that the quality of health for the BAME community is positively addressed.

Qu. What is it like leading this programme of work?

It is very exciting to lead this programme alongside Donna Sherratt from Small Steps, Big Changes who brings great expertise to the health inequalities agenda. Working alongside members of the BAME community who are passionate about health inequalities within the ICP programme has been a very humbling to experience. I believe it is important to lead by allowing for new and diverse voices to be heard and it is great to facilitate co-production solutions between the BAME community and leaders from ICP partner organisations to reduce health inequalities in Nottingham.

Qu. How do you promote the programme to citizens and to your colleagues?

We work with a group of black, Asian and minority ethnic leaders and influencers who communicate the agenda for this message to their wider networks and congregations. Also, Donna and I are actively involved in speaking at other events within the health sector to promote the importance of this work and speaking to community groups within Nottingham. We encourage people who attend our monthly meetings to talk about this work in their own organisations and networks.

Qu. What positive outcomes have you seen and where can we improve?

We have seen the acknowledgement of co-production between the BAME communities and leaders from the ICP partner organisations to deliver solutions which will reduce health inequality. Having honest and open dialogue which is respectful yet at the same time challenging, bringing the benefits of creating realistic solutions to drive down health inequalities. We have seen a willingness of different and diverse communities come together on projects to reduce health inequality. We have also shared best practise learning because of the pandemic to support communities. 

It has been good to see the emergence of the faith communities involved in this work both from the Nottingham Majority Black Led Churches and the Nottingham Council of Mosques. There has been greater acknowledgement of the inequalities that exist on the health agenda and the willingness to put investment towards finding solutions.

We have made some good progress this year but there is still lots of work to do! The commitment shown by ICP partners and leaders from the BAME community to work together to achieve our objectives convinces me that we have got what it takes!

Covid Vaccination Programme: Inequalities Small Grants Fund for Communities

While there is rapid progress in delivering covid vaccinations to the citizens of Nottingham and Nottinghamshire, there remain inequalities in take-up by some groups and communities that the Nottinghamshire Local Resilience Forum (LRF) are seeking to address.

The role of community and voluntary organisations in the progress made so far has been significant. From local spontaneous community action supporting neighbours, to organised and pro-active communications and messaging by special interest groups. The Forum want to recognise these contributions and identify further opportunities to support community groups – to encourage the take up of the covid vaccinations by those in groups where vaccination rates are lower.

Applications for up to £500 can be made using the Application Form for Inequalities Small Grants Fund for Communities which will need to be submitted to Jade.farrell@nottinghamcity.gov.uk

Allocation of the fund will be prioritised based on activities which will reduce inequalities in vaccination take up for one of the following:

  • Geographical communities experiencing lower take up than the general population (information about these communities is available from Local Integrated Care Partnerships*)
  • Black and minority ethnic communities
  • Clinical extremely vulnerable people
  • People with physical, mental or learning disabilities facing barriers to take up
  • Other groups facing barriers to take up, such as due to communication needs, or visual or hearing impairments