York MCN Meeting:
18th June 2019
Developing a safe sharing space:
Introducing the documenter role...
Systems Changers lead Paul Connery explained that this is about how we capture what we see in the system – and reflecting it back across the network.
The documenter Chris Titley said it was crucial that everyone felt comfortable with what was being recorded. If they didn’t want something to be recorded make that clear. The notes on the website could also be amended.
Guidelines / Safety Rules (from Feb 2019):
Openness and honesty
Treat every view with dignity
Every view is valid
Generalise examples where possible
It was suggested that we should be mindful of language and phraseology. For example, the language around suicide had been standardised in order to prevent stigma – instead of saying someone committed suicide – which has criminal connotations – use the more neutral the phrase died by suicide. Similar updated language might apply in other areas covered by the Network.
Themes from frontline staff...
It is harder to get flexibility across the system. MEAM has grown from 5 to 35 with new remit. That is positive, but we are not yet prepared for this workload.
Need a system that has flexibility built into it, rather than through favours and relationships.
Now the network is well underway, is it time to work on some solid examples of where things need to change?
Local area coordination team are looking at systems change. Members were asked to share their current top 3 issues.
Top 3 barriers in the system
1) Stalemates between statutory services
– who should find funding for care and support? Leads to delays, people being bounced between services, causes distress and a feeling of being a burden on the system.
Examples – between adult mental health services and adult social care teams, or alcohol and mental health teams.
2) Referral processes
– rigid and time consuming, long forms, too inflexible to take more pragmatic approach in time-pressed moments, duplication.
Examples: children’s safeguarding and housing have single aspect point referrals, long forms. Impact – people are left waiting for decisions, things can get a lot worse very quickly.
Good example of an improvement – the arrangement with the mental wellbeing access team. They have a two page form which is easy to fill in. A phone call to discuss a referral with them prevents filling in a form only for it to be bounced back. And the system is relatively quick – a 3-day response if urgent, 28 days if not, with regular updates.
3) Navigating the housing system
– for people who are homeless, at risk of homelessness, or being rehoused.
Housing options and registrations departments deal with things separately and don’t always communicate. There is confusion and duplication, different messages going to individuals.
Policy is quoted at people using a lot of jargon, and people are made to feel stupid. It’s confusing and humiliating.
But that same policy is open to interpretation. Some members of the team look at it in black and white, leaving little room for compassion and individual circumstances.
There is some fantastic work going on in those areas and a lot of these teams are dealing with high demand and a lack of resources. But we need to understand where these behaviours are coming from.
What is the situation with dual diagnosis? Someone with substance misuse and mental ill health won’t be treated by the mental health team while they are abusing a substance (particularly alcohol).
We need to challenge senior strategic leaders. Services are under massive pressure and many are slipping through the gaps – people with extremely challenging lives. Navigating the system is hard for professionals, impossible for many service users
Signposting The York Pathways team (absent) – recorded the problem of signposting near the end of the working day. An issue goes to the crisis team and duty responder, inconsistency whether crisis team will pick up, different response each time from the emergency services.
“We all recognise there are significant challenges for all agencies. We need to think differently. It works well when agencies come together. The Network comes together to consider housing needs, and be prepared to be more flexible.”
An MCN resource The team mentioned a number of York organisations doing good work including:
The Haven – mental health support
Reshape – a charity preventing sexual offences, working with offenders
City of York Council is creating a resource – Live Well York.
This website could also bring together resources. Should each of us start future meetings with details of new services they’ve come across?
Connecting the network The Local Area Coordination Team has professionals working in connecting roles across the system. “We can take referrals from any part of the system. A single point of contact offers advice as to where a service user can be referred.
What are the conditions that create good practice?
Suggestion: writing case studies when things went right.
For example, at the Local Area Coordination Team…
identified relationships built with each other
worked as a team – professionals and individuals
‘communication was key’ dealing with alcoholism and autism
everyone was willing to bend rules and processes so we could meet service users where they needed to be met – coupled up on home visits, showed flexibility when services didn’t offer home visits.
The security guard question
Discussing the need for a person-centred response, the network centred on the reaction by service users to the presence of a uniformed security guard.
"Security in West Offices make themselves known – it can trigger bad behaviour."
"Power imbalance is a big problem across professional service."
"We want an honest conversation – won’t get it with security guard, barriers go up."
"The council needs security with potentially violent customer. Staff need to be protected."
"Job Centre used to have barriers, and people would react against them, punch them.
They were removed, and it hasn’t caused more violence."
"I spent a lot of time in children’s centres, prison – can be just the uniform that triggers."
"We don’t have security people – there are incidents but our people are trained to deal with them It breaks down barriers and builds relationships."
Flows of influence...
Catherine shared a Flows Of Influence diagram. MCN members were invited to draw links between the organisations and commissioners to show the directions of influence.
Housing and homelessness
It was revealed that a lot of change had taken place in the housing sector in York: ‘new strategy, new people, good opportunity to influence’. Some observations from the discussion that followed included:
"Housing policy has a duty to prioritise vulnerable people; MCN people are vulnerable"
But if someone is seen as having made themselves ‘intentionally homeless’ that duty can be withdrawn
"Have to question whether some in this group can always demonstrate intentionality"
Is the housing waiting list points system disadvantaging people with mental health and addiction issues?
There is a ‘hidden homeless’ population in York that is not visible to services
The link between having a support worker and your housing shouldn’t be linked. As things stand if you stop being engaged with a support worker you could lose your home.
The meeting recognised the importance of bringing people with lived experience to the fore.
It was suggested that network members ‘capture people’s story once a month. Share the stories with senior managers. Makes it tangible and real. These issues can be very abstract if you are not meeting with people every day ’
One group member said: ‘Some of these stories can be compelling. They struggle to come together as a group and articulate their needs. The network needs to think about early intervention. The success of network will be persuading people we can intervene early.’
Reflection time - what people said:
The discussions have highlighted we have a lot of work to do on collaboration and partnership working across the network before we go out to the wider system.
The diagram is helpful – it shows how many areas we have to influence. We all recognise the challenge. It would help to share what we all know.
I wonder how different today would have been if everybody had been here – the housing commissioner, public health commissioner, CCG. It is disheartening when we meet rarely.
Maybe meetings are too long and too far apart. More regular, shorter meetings might work. Hard to get momentum.
The power of stories – there are lots of assets out there, like filmmaker Kev Curran. How do we bring this all together?
I am the Tees Esk and Wear Valleys NHS Foundation Trust representative, but TEWV’s huge. I work for social care, we have 89 different teams – it’s a responsibility to talk for one big agency.
How do we work together better? We recognise that some of the network aren’t going to come on the journey now, we should look to put together a coalition of the willing.