NHS Kernow Clinical Commissioning Group
NHS / Health Body
Action Planned
NHS Kernow CCG, CFT and Cornwall Council are undertaking a review of the Cornwall dual diagnosis policy and the interface between Addaction and CMHT. The review of the strategy and comprehensive development of the implementation plan will be completed by the end of July 2019. (AI summary)
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Dear Mr Davies
Prevention of Future Death Report following inquest into the death of Paul Matthew Gillam
Thank you for your Regulation 28 Report to Prevent Future Deaths pertaining to Paul Matthew Gillam. NHS Kernow Clinical Commissioning Group (CCG), Cornwall Partnership NHS Foundation Trust (CFT) and Cornwall Council (CC) have agreed to complete a single response to the Regulation 28 Report in order to demonstrate commitment to the actions that are being taken to address the identified concerns.
In the Regulation 28 Report you have identified the following actions to be taken in relation to the matters of concern:
1) To review the operation of the Cornwall dual diagnosis policy and the interface between Addaction and CMHT
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2) To review the development and implementation of the delivery plan concerning the relationship between CMHT and Addaction.
3) To consider how best to encourage a closer working relationship between CMHT and Addaction
In order to provide our response we would like to confirm the commissioning arrangements linked to the actions:
NHS Kernow CCG commissions the services of CFT who operates the community mental health teams (CMHT). CC commissions the services of Addaction.
These commissioning arrangements are defined in contracts which stipulate a requirement to undertake joint working where necessary. However, as you have noted, there have been issues with the interface between the CMHT’s and Addaction services signalling concerns in relation to joint working.
In order to support this multi-agency joint working there is a Cornwall and Isles of Scilly Dual Diagnosis Strategy for Adults covering the period 2016 - 2019. This is a multi-agency co- produced strategy that has been developed by members of Safer Cornwall and providers of services. The purpose of this strategy is to assist with the delivery and experience of integrated and inclusive service delivery for people with co-existing mental health and substance misuse problems, and their associated complex needs. However, as acknowledged in the strategy, there are challenges to creating a culture of shared responsibility which can leave people struggling to gain access to evidence based interventions as well as targeted support for substance misuse.
A multi-agency steering group has been set up to review the strategy and develop an implementation plan. The steering group consists of key organisations (including CFT and Addaction) and is being supported by the commissioning organisations. The steering group will report progress into the Mental Health Crisis Care Concordat who will report to Safer Cornwall. The Crisis Care Concordat is a national agreement between services and agencies involved in the care and support of people in crisis and sets out how organisations will work together. These arrangements will ensure the review of the strategy and its implementation, as well as appropriate oversight of progress and effectiveness. Key to the strategy is the safe and timely sharing of information and communication between organisations that specifically include CFT and Addaction, as well as other organisations involved in supporting individuals with co-existing needs.
Progress to date includes an exceptional Crisis Care Concordat meeting which was held on the 22nd January 2019 and which was well-attended by the relevant statutory organisations and providers. The purpose of this meeting was for providers to agree a way forward and specific actions were identified to complete the strategy review and develop/implement a robust multi-agency implementation plan. There have since been two multi-agency steering group meetings with the third meeting taking place on 1 April 2019. It is expected that the review of the strategy and comprehensive development of the implementation plan will be completed by the end of July 2019. The process will involve the reviewing of current active cases to ensure learning and improvements are being made for people whilst this work is being undertaken.
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In order to further strengthen monitoring arrangements both commissioning organisations are reviewing contractual expectations to ensure engagement with the review, development and implementation of the dual diagnosis strategy.
I hope that this response provides you with reasonable information that we are committed to and are already working closely with all partner agencies to take measures to prevent future deaths as set out in the Regulation 28 Report.
We have sent a letter to the Coroner’s officer to share with the family to invite them to be involved should they wish to do so. Mr Gillam’s father has confirmed that he does not wish to be involved at this time. We would like to repeat our offer to make contact should he want to do so in the future. We are aware that this response will be shared with him and I do hope that this information will provide him with assurance that actions are being taken in relation to the concerns’ identified in relation to his son’s death. We would like to extend our sincere condolences to him and the family.
Prevention of Future Death Report following inquest into the death of Paul Matthew Gillam
Thank you for your Regulation 28 Report to Prevent Future Deaths pertaining to Paul Matthew Gillam. NHS Kernow Clinical Commissioning Group (CCG), Cornwall Partnership NHS Foundation Trust (CFT) and Cornwall Council (CC) have agreed to complete a single response to the Regulation 28 Report in order to demonstrate commitment to the actions that are being taken to address the identified concerns.
In the Regulation 28 Report you have identified the following actions to be taken in relation to the matters of concern:
1) To review the operation of the Cornwall dual diagnosis policy and the interface between Addaction and CMHT
Page 2
2) To review the development and implementation of the delivery plan concerning the relationship between CMHT and Addaction.
3) To consider how best to encourage a closer working relationship between CMHT and Addaction
In order to provide our response we would like to confirm the commissioning arrangements linked to the actions:
NHS Kernow CCG commissions the services of CFT who operates the community mental health teams (CMHT). CC commissions the services of Addaction.
These commissioning arrangements are defined in contracts which stipulate a requirement to undertake joint working where necessary. However, as you have noted, there have been issues with the interface between the CMHT’s and Addaction services signalling concerns in relation to joint working.
In order to support this multi-agency joint working there is a Cornwall and Isles of Scilly Dual Diagnosis Strategy for Adults covering the period 2016 - 2019. This is a multi-agency co- produced strategy that has been developed by members of Safer Cornwall and providers of services. The purpose of this strategy is to assist with the delivery and experience of integrated and inclusive service delivery for people with co-existing mental health and substance misuse problems, and their associated complex needs. However, as acknowledged in the strategy, there are challenges to creating a culture of shared responsibility which can leave people struggling to gain access to evidence based interventions as well as targeted support for substance misuse.
A multi-agency steering group has been set up to review the strategy and develop an implementation plan. The steering group consists of key organisations (including CFT and Addaction) and is being supported by the commissioning organisations. The steering group will report progress into the Mental Health Crisis Care Concordat who will report to Safer Cornwall. The Crisis Care Concordat is a national agreement between services and agencies involved in the care and support of people in crisis and sets out how organisations will work together. These arrangements will ensure the review of the strategy and its implementation, as well as appropriate oversight of progress and effectiveness. Key to the strategy is the safe and timely sharing of information and communication between organisations that specifically include CFT and Addaction, as well as other organisations involved in supporting individuals with co-existing needs.
Progress to date includes an exceptional Crisis Care Concordat meeting which was held on the 22nd January 2019 and which was well-attended by the relevant statutory organisations and providers. The purpose of this meeting was for providers to agree a way forward and specific actions were identified to complete the strategy review and develop/implement a robust multi-agency implementation plan. There have since been two multi-agency steering group meetings with the third meeting taking place on 1 April 2019. It is expected that the review of the strategy and comprehensive development of the implementation plan will be completed by the end of July 2019. The process will involve the reviewing of current active cases to ensure learning and improvements are being made for people whilst this work is being undertaken.
Page 3
In order to further strengthen monitoring arrangements both commissioning organisations are reviewing contractual expectations to ensure engagement with the review, development and implementation of the dual diagnosis strategy.
I hope that this response provides you with reasonable information that we are committed to and are already working closely with all partner agencies to take measures to prevent future deaths as set out in the Regulation 28 Report.
We have sent a letter to the Coroner’s officer to share with the family to invite them to be involved should they wish to do so. Mr Gillam’s father has confirmed that he does not wish to be involved at this time. We would like to repeat our offer to make contact should he want to do so in the future. We are aware that this response will be shared with him and I do hope that this information will provide him with assurance that actions are being taken in relation to the concerns’ identified in relation to his son’s death. We would like to extend our sincere condolences to him and the family.