To receive any questions, statements or petitions from the public, notice of which has been given in accordance with Procedure Rule 14.

A public question was received from Mr Bill Ross, Chair Strettondale PPG in relation to the number of children self-harming, the rise in suicides amongst young males and loneliness in old age (copy attached to signed Minutes).  The following response was provided by Professor Rod Thomson, Director of Public Health:

Given the reported number of children self-harming, the rise in suicides amongst young males and loneliness in old age:-

1a. What plans has the Board developed for health & social care services to address these issues in Shropshire?

Our suicide prevention strategy highlights as a priority raising awareness of the risks/symptoms of self-harm and connecting early support given the association between people who have taken their lives by suicide and history of self-harm.  We have identified men as a high-risk group for suicide and the Suicide Prevention Action group are currently designing targeted interventions aimed at high risks groups.  We have a full action plan (currently being updated for 2018/19) for different aspects of suicide prevention which focuses on;

·           Eliminating stigma for talking about suicidal thoughts/self-harm and promoting seeking early help

·           Raising awareness of risks and symptoms for those with suicidal thoughts or who self-harm to health and care professionals to assist with earlier identification and connecting to timely and appropriate support.  Awareness raising to also be targeted to others who are most likely to engage with higher risk groups as well as to the wider population

·           Provision of dedicated and tailored support for people bereaved by a suicide death

A social prescribing programme has been developed to respond to some of these challenges.  It works by using a formal referral pathway into health-promoting community interventions, targeting patients with social or behavioural factors that pose a risk to their health. The initial contact includes one to one support from a social prescribing advisor (trained in behaviour change), along with data recording and governance. People referred to the advisor are then connected to local community interventions that address their concerns and health needs.  The community interventions are quality assured and outcomes reported back to the prescriber.  Social prescribing has been developed to address multiple health needs, from long term conditions to mental health and also social needs such as loneliness and isolation.

There is as self-harm mitigation pathway and toolkit which is now available along with a suicide prevention strategy that is being developed across both Shropshire and T&W. These have been underpinned from a Children and Young People’s (CYP) perspective with the Storm Training which is a skills and mitigation training. Mental Health First Aid (MHFA) training to anyone who works with CYP continues to be delivered. MHFA for adults is also available via Joint Training.

Shropshire Schools and Mental Health Services along with other practitioners are part of the Anna Freud Project for improving Mental Health and schools links.

There is a PSHE curriculum in relation to emotional health and well-being that is also in place.

1b. What are the timescales for implementing those plans?

The prevention strategy is due to run until 2021 with the Prevention Action group meeting quarterly to review actions and monitor progress. 

Social prescribing has already been implemented at 10 GP practices across the county, with another about to start delivering imminently and two further practices in development.  It is envisaged that this programme will continue to be developed at more practices over the coming year.

1c. What mechanisms are in place for measuring the success or otherwise of such plans?

Monitoring by the suicide prevention action group who report to the Shropshire Mental Health Partnership Board. The social prescribing programme is being measured in a number of ways to determine its effectiveness on multiple factors, this includes measuring reductions in health services utilisation, changes in clinical risk factors, self-reported measures on whether or not issues and concerns have improved, measures around loneliness and isolation, measures on physical activity and patient activation measures (PAM) to establish how capable those who are part of social prescribing are at managing their health conditions and needs once the intervention has been delivered.

Anna Freud project will be evaluated through the Anna Freud Centre. The training is evaluated on an on-going basis.

In relation to Q2

We are also looking at a social prescribing model for Children and Young People (CYP) particularly addressing loneliness and isolation in 16-25 age group but this had yet to be mapped out.

We are also looking at implementing a “train the trainer” model for themes such as seasons for growth, bereavement and loss programme for CYP this will be dependent upon the availability for the training next financial year.

In addition to the item at point 1:-

2. What is the next major initiative to be implemented?

Although there is much being designed and developed, the most immediate initiative to be launched will be roll-out of a wallet sized prevention “z-card” which will include concise information on who to contact if in crisis (both for adults and children) and to be subtle enough to be concealed in a pocket if necessary – these will be distributed initially in areas with high footfall of risk groups (such as pubs, clubs, sports venues, farmers markets etc).  It is intended that this information should also be available digitally and to work with web developers to ensure it is high in search results in various search engines.

Other programmes have already been undertaken such as undertaking a review of the range of local services which can support the wider determinants of why a person may choose to take their own life have been undertaken (including debt, relationship difficulties, bullying, long term conditions, carer stresses etc) to raise awareness between agencies of what is available locally and to aid in signposting.  This is also linked to programmes such as Social Prescribing and the work within schools.

2a. When will it be implemented? A target date please; not just “as soon as xxxx is completed”

The implementation of the z-cards is planned for Winter 2018.

2b. Who is responsible for the implementation?

Shropshire Suicide Prevention Action group

2c. What difference will it make to the health & well-being of the population?

Targeted information on who to contact if in crisis or if concerned about someone else will be more readily available.  We recognise currently it may not always be obvious who to turn to if having suicidal thoughts so by providing discreet cards that can be put in the pocket and referred to when needed we aim to reinforce our message of not being alone and that help is available.  Our ambition is that by having access to this type of resource it will provide opportunity for those in crisis to speak to someone and to access immediate support.

2d. How will you measure its success?

Still to be finalised however, metrics discussed include monitoring numbers of z-cards taken from different locations, local suicide statistics, qualitative feedback where possible. Independent evaluation of the social prescribing programmes is under weigh; review of referrals to statutory and voluntary sector and reduction in suicides and self-harm.

A public question was received from Mr John Bickerton, local resident in relation to Care Closer to Home (copy attached to signed Minutes).  The following response was provided by Dr Simon Freeman, Accountable Officer, Shropshire CCG and Dr Julie Davies, Director of Performance and Delivery, Shropshire CCG:

Dr Freeman informed Mr Bickerton that there was an assumption that Care Closer to Home would be funded from the retention of 80% savings from the reduction in emergency admissions over 3 – 5 years.  In relation to the MLU, it was stated that women were choosing not to use the rural MLUs so were travelling to Telford or to the Obstetric Unit.

Dr Julie Davies explained that if they got the strategy right it would attract more doctors, nurses and carers to the county.  She explained that some patients choose to travel out of county however.  Updates would be given as the strategy was progressed to ensure it provided the desired effect.

It was agreed to take Agenda Item 10 (Wellbeing and Independence Contract) next.