Response to The GMMH Working Together Strategy 2022 – 2025

From: CHARM Families For Recovery Support Group, CHARM

To: Claire Watson, Head of Service User/Carer Engagement and Improvement

Dear Claire

Thank you for sending us the draft GMMH Together Strategy 2022 -2025 and requesting our feedback. We have put five main points forward for consideration by the Trust (with further important observations included in the Appendix below) as follows:

Firstly, we were not aware that this Strategy was being reviewed and this is the first time we have been made aware of it. Under these circumstances we do not feel able to provide a detailed response.  Further we believe it has not been fully co-produced and therefore unfortunately excludes our perspectives on important issues that we would have wanted to be included and expressed within the report. 

We think thought should be given to the design and look of the Strategy Document, our reaction was that the photographs do not reflect the multicultural diversity of our community, with too many images of people in uniforms and working within institutional settings. Given the subject of the report more emphasis on images of people with lived experience, carers from different backgrounds in community settings would be more appropriate.

Secondly, it lacks detail, as the report does not include bench marks and milestones. The Strategy does not include important details and information about how the ambitions for the next three years will be met and we feel at a disadvantage in knowing how to determine if the strategy will be successful and how we will know that targets have been met in 2025. To address this we want to see much stronger commitments and concrete proposals on what we intend to do together. To give an example In the “We Will” section on page 19 there are no firm commitments, the Strategy says: 

“we will improve our percentage of carers contacted and sent information within commissioner set time frames.” But what are the figures now? and what improvements do we intend to make? Over what period time? 

We need real commitments from a Strategy Document that can be used as measurements to see if we have succeeded in working together more effectively. In the appendix below we have included an example of a Service User Engagement Strategy from Barnet, Enfield and Haringey Mental Health NHS Trust that does include specific targets and milestones. 

Thirdly, the strategy conflates information about GMMH actions across all of the Local Authority areas it works with and therefore it is not possible to discern what is happening specifically in for instance, Manchester. To give an example in the strategy draft there is a reference to the Crisis Cafe’s and funding various grassroots projects but no details.  Also you mention peer support workers, we would like to know the number of peer support workers there are within the Manchester Local Authority area and especially about those working in the community with CMMH Teams.

Fourthly, there is no reference to the Charter Alliance or the Charter that GMMH signed up to in 2014 that provides a comprehensive set of recommendations for future action re. service user co-production. This should be addressed as the Charter provided a wealth of useful proposals. See Charter here https://manchestercommunitycentral.org/charter-mental-health-services-manchester

Fifthly, we believe that there are many important issues that are not covered in the Strategy that have caused problems with our capacity to work together. In spite of the good will and support of many staff members our experience is that the service has been overwhelmed by the level of demand and the lack of staffing. This has led to unmanageable case loads and very high thresholds for receiving care. Carers feel they are very often filling in these gaps in provision and taking on professional roles themselves.  These challenges could be acknowledged by us within the Strategy, in particular where the Strategy states GMMH will “Continue to work in partnership with service users, carers and the VCSE sector via local arrangements and at a Trust wide and GM level, to achieve Community Transformation with more seamless, holistic care for local people in the place where they need it most.” This is a laudable ambition but with the current challenges we would like to know how it’s going to be achieved with specific examples of actions and timetables.

In conclusion we believe that the publication of this strategy document should be postponed and a new process commenced to really co-produce a Strategy that is owned by all stakeholders and to co-produce the strategy that we can all be proud of and that would hold us all to account in meeting its commitments and aims. We believe it is necessary to start again in drawing up a Working Together Strategy and to develop an open, inclusive, transparent process that can arrive at a more meaningful document. We look forward to your considered response to our feedback and to have further constructive  discussions with you about our concerns.

We would be very willing to assist you in this.

Appendix

Specific Issues with report:

1. We need a “user friendly” document with more visual presentation as the current document uses considerable NHS language and terminology that is difficult to understand.

Here is an example of Service User Engagement Strategy from Barnet, Enfield and Haringey Mental Health NHS Trust https://www.beh-mht.nhs.uk/downloads/patients-and-carers/New%20Involvement%20%20Engagement%20Strategy%20Sept%202020%202022.pdf that uses a much more visual way of providing information and sets out clear milestones for action over a three year period. 

For instance: 

Year One: Recruit 100 Experts by Experience roles and actively work with them on involvement activities in the Trust

Year Two: Develop a service user employed role to support service user engagement

in the Patient Experience Team

Year Three: Develop a service user Non-Executive Director role to sit on the Trust Board

(Barnet, Enfield and Haringey Mental Health NHS Trust)

2. Diagram 1 in the strategy provides a very service centred model with service users and carers having to move between different services rather than being person centred. We cannot see how working in this layered way allows  services to commit to continuity of support from the same key worker or team over the time periods that someone needs help.    

We do not know what the Living Well MDT is. We were not aware that it has been adopted for Manchester and would like to know what it is and what the implications are for funding.

We are very concerned that Carers, Friends, Neighbours and Supporters on the left hand side and Local Community Support, Networks and Groups on the right and are not considered to be central part of providing support (see blue arrows). This diagram shows to us that carers and the community are not seen as centrally important to the ongoing support of the people we support.

3. We have identified Communication Issues as one of the main challenge facing carers. Carers are reporting not receiving replies to enquiries, requests for support within reasonable timescales or at all, messages not passed on/ or phone is not picked up. Further, communication between professionals and teams is problematic for carers as important information is not relayed between staff, particularly between hospital and community based services.

4. In a report GMMH submitted as part of a report entitled Participation of mental health service users and their carers: Some European Examples (pages 16 – 19)  http://recherche-sante-mentale.fr/docsenlien/participation-GCS-EN.pdf?fbclid=IwAR2Z5CNBN2-k-Sm5wIOg8GVaEhzzX3THmgVgqrum9D41L5VwsVjmjyd4c64 compiled by The French World Health Organization Collaborating Centre for Research and Training in Mental Health (WHOCC Lille, France) from information provided in late 2020 and mid 2021 the following information was provided:

Description of the experiences Greater Manchester Mental Health (GMMH), NHS Foundation Trust, England

Statutory: Public mental health service

Engagement as a pathway to recovery

6000 employees in 150 locations

200 active volunteers

50 volunteer Peer Mentors including Carer Peer Mentors*

34 paid Peer Support Workers,

100 supervisors (local staff – it could be a clinician, a psychologist… – who guide volunteers users/carers in their role and are the first point of contact).

We think this kind of information should be provided within the strategy as it provides concrete information about current levels of service user participation. For instance there were only 34 peer support workers out of a workforce of 6,000 in 2020. Has the numbers increased, where are these workers based? Are any of these peer workers placed in the community with CMHT’s? How many of them are based in Manchester?

What are Carer Peer Workers?

5. Other comments from our members:

• “I didn’t get a sense of inclusion either as a carer or user of the service, there is only one person of colour portrayed in the brochure. It does not make to me think the service has a commitment to equality, inclusion and people of colour.”

• “The text/font so small makes me give up reading it – it feels like it is intentional” 

• GMMH statement about the Principles of working together section “However, we do not always work together in the best way possible, recognising different skill mix, to support peoples’ wider health and social care needs. Working Together is not easy.” Doesn’t say what the action how that is going to be different, change. We need specific commitments that can be measured otherwise too vague.

• As a carer I didn’t feel I was a contributor to this although there is a lot talk of Carers/Carer Act  “Launched our Hidden Carers Campaign to help carers and staff recognise when someone is a carer. Often people do not recognise themselves/others as carers, and will refer to them as family members/friends. Our campaign encourages everyone to think and open up conversations whatever people want to call themselves, so that information flows and service users receive more personalised care, and carers receive the support they need in their own right. Yet no voices/stories/account of Carers or indeed how they interpreted the service.” We also thought this was patronising to family members. Many carers we know feel that they are not heard and in some experience that their input is discouraged. In other cases carers feel they are invisible to the service.

• “I think a flaw in the draft is often what a lot of organisations do to their detriment is not put in the flaws/weakness/areas to improve what could be done for staff, carers and users as a whole. A more holistic approach of the service interaction, engagement.There is no timescale, action, proposed target to work to improve. When you are most vulnerable is when you dig deeper to the resources and/or look at change to go forward. So I am sceptical of brochure that acts as if everything is going well. Where’s the funding, the challenge in that if there is any space to participate, contributions from all involved?”

• I also wanted to see a new approach to complaints and the value of it and response to the action and intent. The Strategy says: “Continue to learn from complaints and incidents through involving service users and carers in the learning that takes place and not just the investigations themselves, actively sharing learning across the organisation, with our partners and commissioners.”I want to know how this is going to be done.

• Same with : Learn from our experiences of being a national Patient and Carer Race Equality Framework site and use this learning to improve access to mental health support for people from Black, Asian and Minority Ethnic communities. What does this mean in real terms? It’s just words. 

• There are massive gaps in this glossy document. Are staffing levels to improve? Care cannot be holistic and inclusive without the time and space to achieve this. Top down, medical model needs a radical overhaul. 

• Peer support is welcome but where does this fit in to services, and can it be independent of the trust? Is it only acceptable from trust identified workers or are less formal peer support networks to be validated and accepted?

Also:

• “too wordy but lacks substance and detail”.
• “hard to read, not enough diagrams etc”
• “no real examples of numbers and time limits of when they want to implement things.”
• different services across the GMMH boroughs, Bolton good?, Salford good?, City of Manchester – ?  Using the good practice examples as evidence of general progress covers up where action has not been taken
• no mention of “recovery” or what this means?
• no specific mention of community services 
• understaffed, staff leaving in droves
• revolving door – how many times service users are hospitalised, this tells us how bad the community support is
• carers/families and voluntary groups such are on the outside of that diagram! Should be in the middle!
• no joined up working of professionals with carers or even themselves ie. psychiatrist making bad decisions about meds which the carer knows will impact badly on Service User.
• no mention of lack of beds – people are sectioned now and still in the community waiting…
• It talks of support for carers in there… information we should be given, our rights under the Care Act and support for our own health,  we aren’t given anything
• no actual examples or soundbites from actual service users or carers about the service
• Barnet example – easy to read, has figures to show what they have done.