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Mental Health and Learning Disability Strategy

Our plans for 2025 to 2030

Contents

  • Foreword
  • Background
  • Our Ambition
  • Our vision and Trust Objectives
  • Describing NCICs Approach
  1. Culture, Kindness, Inclusion and Understanding
  2. Shared patients, partnership and policy
  3. NCIC Innovations
  4. Integrated Governance
  5. Organisation of roles
  • Associated Partners, teams and Standards

Foreword

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I am extremely pleased to introduce North Cumbria Integrated Care NHS Foundation Trust’s (NCIC) first Mental Health and Learning Disability Strategy. It is an uncomfortable truth that in the past health care systems everywhere have evolved in such a way that seemed to believe it is possible to divide and separate out a human-beings’ health needs. In reality all our health problems are inter-related, complex and impactful on our lives whatever those health needs are and what we call them.

Looking forward we should all recognise that services and systems may have developed in this way with reason. However, in a world where 1 in 4 of us will suffer from a mental health problem, and where that those with mental health problems and learning disability die 10 to 20 years before the rest of the population, NCIC must reflect this in everything we do too.

Our strategy starts with some background about the relationship between mental and physical health problems, and those patients with mental health problems and learning disability in physical health care settings.

I want to share with you some additional points of reflection and awareness.   

Did you know that the CQC already inspect acute and community trusts to scrutinise how they provide mental health and learning disability care and support for patients across all our services?

This includes people:

  • With diagnosable mental health conditions
  • With co-morbid conditions
  • Who are inpatients for physical health reasons
  • Who have or develop mental health needs.

The evidence the CQC collect in relation to mental health care informs their judgement for each core service and at provider level. They use the evidence to inform the ratings at core service level, for well-led and at overall provider level (CQC 2020).

It is worth thinking about this from Cumbria’s point of view. Were you aware that rates of learning disability and mental health problems are increased in rural areas? (House of Commons Committee Report 2023, OFNS, Nicholson R)? Did you know that in the UK suicide rates increase the further north you go, and in Cumbria as part of the North West and North East our rates are the highest, upwards of double that seen in places like London? (OFNS). We should all be alert to the fact that suicide rates double in patients diagnosed with serious and chronic physical health conditions, such as ischemic heart disease, low survival cancer, and chronic obstructive pulmonary disease (OFNS, Nafilyan et al).

Our strategy sets out five key areas that represent our approach to achieving high quality care, every time for our patients with mental health problems and learning disability.

I would encourage you all, once you have read and thought about our approach, to reflect personally on your own skills, values and attitudes towards our patients whom have challenges with their mental health and or learning disability.

I commend NCICs Mental Health and Learning Disability to us all.

Thank you.

Professor Dr Sam Dearman
Consultant Psychiatrist & Strategic Lead for Mental Health & Learning Disability.

Safe, high quality care, every time, for our patients with Mental Health needs and Learning Disabilities.

Background

Roger Cable.jpgMental health impacts physical health and vice versa, so a collaborative and integrated approach is essential to improve quality of care and outcomes for all our patients (Treat as one, Achieving Parity of Esteem). The simple truth is that where people have co existing mental and physical health problems, those health problems have less favourable outcomes compared to if they existed alone. This is why in NCIC we must make mental health and learning disability everyone’s business.

Mental health problems occur in 30-60% of inpatients and out patients and 5% of all emergency department visits are mental health related (Royal college of psychiatrists, British Association of Accident and Emergency). According to the Kings Fund 12 to 18 % of all long term conditions are linked to poor mental health, approximately 4 million people in England, leading to poor health outcomes and poor quality of life. 

Pregnant and post-partum women who suffer from perinatal mental health problems account for one in four maternal deaths (Treat as One). The NHS England document: Improving the physical health of people with severe mental illness January 2024“People with severe mental illness face one of the greatest inequality gaps in England.” Life expectancy is 15 to 20 years shorter that for the general population and the disparity largely due to preventable illnesses.

The NHS England Core20PLUS5 document outlines the approach to address these inequalities.  Improving mental health care of people in the acute hospital is a national NHS England priority, in parallel with acute care and by achieving this, NCIC can make a substantial difference to the quality of life of people with mental health problems, reducing morbidity and mortality. There is evidence (Parsonage and Norris) that good mental health care can reduce overall health care costs and length of stay.

“It’s all in your head” by welcome book prize winner neurologist Dr Suzanne O’Sullivan is an excellent account of medically unexplained symptoms, in which she outlines an empathetic and holistic approach to managing these conditions. The investigation of medically unexplained symptoms is thought to cost the NHS 3 billion pounds a year according to the King’s fund and such investigations are often of limited value and can even be harmful.

NCIC already has a number of services in place to help manage the needs of people with mental health care needs and learning disabilities. Our strategy will serve to optimise these services, identify and address the gaps in provision and just as importantly will empower all clinicians in NCIC to contribute to managing the mental health of all patients in parallel with acute care.

The phrase “no health without mental health” still holds true.

Dr Roger Cable
Consultant Psychiatrist and Clinical Lead for Mental Health and Learning Disability.

Our Ambition

To become a nationally recognised centre for excellence for integrated rural and coastal medicine and care.

Our vision and Trust objectives

Our 6,500 strong workforce is led by clinical and support staff who are driven by our values to provide safe, high quality care every time, Our NCIC way. We are passionate about our values of kindness, respect, ambition and collaboration and want NCIC to be a great place for everyone to work.

Our vision: "Safe, high, quality care for our patients every time"

Our values:

Kindness - Kindness and compassion cost nothing, yet accomplish a great deal
Respect - We are respectful to everyone and are open, honest and fair - respect behaviours
Ambition - We set goals to achieve the best for our patients, teams, organisation and our partners
Collaboration - We are stronger and better working together with and for our patients

Our Trust Objectives:

 Our Patients

We will be clinically led to deliver the best possible care

and health outcomes for our patients and service users

 Our People

We will provide a great place to work
 

 Our Partners

We will work in collaboration with our partners to build integrated
and sustainable health and care services for the future

 Our ‘Pounds’

We will make the best use of our limited resources and
become financially and environmentally sustainable

One team, delivering outstanding connected care.

*Our business objectives are set each year in line with our Corporate Strategy.

Describing NCIC's Approach 

NCICs Mental Health and Learning Disability strategy sets out to support and improve the quality of care of our patients with a broad range of mental health problems and learning disability through five tactical arms:

  1. Culture, Kindness, Inclusion and Understanding
  2. Shared patients, partnership and policy
  3. NCIC Innovations
  4. Integrated Governance
  5. Organisation of roles

Our aims are interconnected and complementary, they are designed in such a way that NCIC has enough expertise, support and oversight such that the needs of our patients are seen holistically. At the same time they emphasise the right understanding: that mental health problems and learning disability is everybody’s business, every time and should never be seen as something that other services or professionals should consider completely separately.

Aligning to the Trust’s objectives in the Corporate strategy, which are defined above, this strategy has been produced through an extensive process that has considered NCICs improvement plans and regulatory requirements, consultation and discussion with experts, feedback from staff and patients from consultation exercises in developing NCICs wider Clinical Strategy as well as listening to our partners. Useful for all, our strategy is here to give visibility and direction to our organisation, teams and staff. 

1. Culture, Kindness, Inclusion and Understanding

NCIC recognises the needs of anyone with mental health problems and learning disability is our business with an attitude of inclusion and kindness for our patients and our colleagues.

How we will get there:

  • Lead and promote learning and campaigns based on local knowledge and need as well as supporting regional and national efforts.
  • Listen to departments about their experience and what they would like to do better, offering where possible bespoke learning arrangements for routine and newly needed training.
  • Provide a high visibility, legitimated professional collective for mental health and learning disability support managing central issues well and promoting the work as everyone’s business.
  • Provide a high quality staff health and wellbeing offer that includes crisis and more routine support.

Role model the approach to knowledge, skills and attitudes that we expect from ourselves and each other.

2. Shared patients, partnership and policy

NCIC works in partnership with our patients, their families and careers as well as other providers to ensure the right holistic care for our patients.

How we will get there:

  • Improve our provider interface arrangements to ensure smooth and well informed transfer and sharing of care at all times.
  • Establish, review and renew high quality partnership service level agreements for those aspects of care requiring very specialist provision such as that in relation to the Mental Health Act 1983 that include KPIs, quality controls and reporting arrangements into NCIC.
  • Provide an enhanced policy design and review process ensuring those policies in scope of mental health and learning disability are clinically led on a multi professional and specialist basis whenever needed.
  • Co-produce the design and oversight of the services into NCIC that are commissioned at regional level such that they specifically meet the needs of patients in Cumbria.

Support the national, regional and local agenda on suicide prevention and the identification of people at risk of suicide by improving our understanding and skills. 

3. NCIC Innovations

NCIC innovates with roles, ways of working, processes, use of data and learning approaches to improve everyone’s understanding and care for our patients with mental health and learning disability needs.

How we will get there:

  • Lead on and advocate for enhanced and compassionate care environments with needs of patients with mental health needs and learning disabilities.
  • Co-design aspects of routine performance governance in all departments such that mental health and learning disability appears as part of business as usual in all departments.
  • Provide multi-professional “Walk throughs” assessments and recommendations for departments helping them understand their services from the perspective of those with mental health needs and learning disability.
  • Capitalise on excellence from educational colleagues using evidence based best practice to improve our training and learning offer for routine learning as well as learning from significant event.
  • Respond flexibly when need arises to support clinical areas and services to address emerging mental health and learning disability challenges with bespoke learning and improvement approaches tailored to the situation and the needs of those services to maximise impact and engagement.

Hold provider interface forums in addition to robust governance systems that consider solutions to more engrained challenges we all face, encourages innovation and promotes partnership working across the NHS and third sector in North Cumbria.

4. Integrated Governance

NCIC provides systems and processes with well-informed and meaningful ways of monitoring and describing what we do to provide care and support for our patients with mental health and learning disability needs.

How we will get there:

  • All operational areas will be supported by the creation of composite, meaningful KPIs.
  • Creation of a central performance oversight describing NCIC as a whole in terms of mental health and learning disability for both internal quality control as well as immediately available data for external partners and regulators.
  • Monthly oversight meeting bringing together data driven reports that are supported by qualitative narrative and patient stories.
  • Quarterly strategic meeting summarising the operational position and reviewing the central performance system.

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5. Organisation of roles

Health includes Mental Health, which is every bodies business embedded in all care in NCIC. In addition NCIC provides a series of professional roles, services and support that it are well-led, well-connected, visible and valued.

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How we will get there:

  • Create a sense of connection, wider professional community and visibility for those with specific roles and services in these areas in NCIC
  • Creation of a clinically led central team that represents the significant extent of mental health and learning disability activity for coordination and direction across all directorates and collaborative whilst maintaining the position that this remains everybody’s business throughout the organisation
  • Establishment of an external advisory group of partner professionals to advice and support NCIC such as for Child and Adolescent Mental health and Learning Disability
  • Become the central vehicle for centrally driven improvements as actively seeking external review and recognition for the good work we do

Associated partners, teams and standards

Partners and teams:

Standards and associated documents:

References: