076/2013: Street Triage Pilot – 29 October 2013

Executive Summary and recommendation:

North Yorkshire Police has been nominated as a pilot force by Dept of Health to conduct a limited pilot scheme over twelve months to assess the benefits of on-street mental health triage services (“Street Triage”). NYP has been allocated up to £200K non-recurrent funding to conduct this trial. It is proposed that the scheme would commence in December 2013, for one year only.

The Street Triage Pilot is proposed to emulate a similar scheme being run with Cleveland Police area, which is delivered by the Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust.

Analysis of data indicates that Scarborough has the second-highest prevalence of detentions under s. 136 Mental Health Act (MHA) 1983. Whereas York experiences significantly higher demands in this regard, Scarborough falls within the geographical boundaries of TEWV. By selecting Scarborough as the pilot site, NYP will benefit by capitalising on TEWV’s experience of delivering a comparable scheme in Cleveland.

During the pilot, it is proposed that two Community Psychiatric Nurses will be available seven days per week for deployment between 15:00 – 01:00hrs. They will be able to provide an on-street first assessment of any concerns officers have regarding the mental health of people involved in incidents, with a view to ensuring the most appropriate course of action is taken. Additionally, they will be available to offer advice regarding mental health issues. This should help minimise the need to detain under s.136 MHA) and help people receive the care they need when suffering a mental health crisis. The Street Triage nurses will also conduct patient follow-up meetings to give support and help ensure the correct agencies are engaged.

This paper requests approval to progress implementation of the pilot scheme by:

• entering into a Memorandum of Understanding with Dept of Health
• agreeing service specification with TEWV
• acquisition of a vehicle for use by the Street Triage team for use in connection with the delivering the service

Police and Crime Commissioner decision:

Approved

Signature Date 29 October 2013
Title Police & Crime Commissioner for North Yorkshire

Part 1 – Unrestricted facts and advice to the PCC

1. Introduction and background
   1. Dealing with incidents where mental ill-health is a contributory factor is estimated to occupy around 20% of policing time. However, in-patient places in mental health care environments have reduced by approximately 9% since 2011. This is likely to further increase demands upon the police.
   2. It is recognised by a number of professional bodies, including the Independent Police Complaints Commission, Her Majesty’s Inspectorate of Constabulary and the Royal College of Psychiatrists that detention in police cells is counter-productive and unhelpful to achieving satisfactory patient outcomes, as it gives the impression of criminalises vulnerable people at a time of crisis.
   3. Currently, North Yorkshire is the only county that has no dedicated provision for s.136 MHA detainees. This was highlighted by the Home Secretary during her speech to the Police Federation of England and Wales in May 2013. This intervention helpfully focussed attention on North Yorkshire to improve delivery of effective mental health services.
   4. North Yorkshire Police is pivotal in facilitating the collaboration of partners in NHS mental health and hospital trusts, Yorkshire Ambulance Service, North Yorkshire County Council, York City Council and NHS commissioners to rapidly enhance service provision in this area.
   5. At the end of June 2013, North Yorkshire Police was selected by Dept of Health as one of four additional pilot forces to deliver mental health street triage services. The pilot attracts up to £200K non-recurrent funding for the service, which (if this proposal is accepted) will be delivered in two tranches in 2013/14 and 2014/15, subject to agreement through a simple Memorandum of Understanding with Dept of Health.
   6. During the pilot, two Community Psychiatric Nurses will be available seven days per week for deployment between 15:00 – 01:00hrs. They will be able to provide an on-street first assessment of any concerns officers have regarding the mental health of people involved in incidents, with a view to ensuring the most appropriate course of action is taken. Additionally, they will be available to offer advice regarding mental health issues. This should help minimise the need to detain under s.136 MHA, and help people receive the care they need when suffering a mental health crisis. The Street Triage nurses will also conduct patient follow-up meetings to give support and help ensure the correct agencies are engaged.
2. Matters for consideration
   1. Trials of Street Triage services in Cleveland and Leicestershire have shown the effectiveness of Community Psychiatric Nurses working alongside the police to provide advice and guidance to both officers and patients. This has helped patients get the treatment they need and reduced the number of police detentions under s. 136 MHA.
   2. TEWV has considerable experience of managing Street Triage services in Cleveland, and are ideally positioned to work in partnership with NYP to deliver the service in the Scarborough area. This would complement advanced plans to imminently open a Healthcare-based Place of Safety at CrossLaneHospital, Scarborough.
   3. Delivery of the scheme for the duration of the twelve-month pilot has been costed and falls within the £200K funding envelope.
   4. Within the initial proposal to Dept of Health, budgetary provision of £29.5K was made to fund use of the nurses’ private vehicles to attend incidents, and for mobile telephony and sundry costs. However, discussions with NYP’s Head of Transport indicate that it would be more cost-effective to procure a vehicle for their use.
   5. It is proposed that NYP procure a Vauxhall Zafira for use by the Street Triage Team. Using figures provided by NYP Transport Dept, and based upon 20,000 miles usage within the trial, the following in-year costs for the duration of the pilot apply:
   6. Based upon 12 months / 20,000 miles
      • Annualised capital cost = £2,317
      • Revenue cost p.a. = £3,642
      • Total Year 1 cost = £5,959
   7. Provision of a suitably specified vehicle will facilitate the work of the Street Triage Team by providing a workspace for the team that will enable the discrete interview / on-street assessment of people in crisis. As a consequence, this is expected to reduce demand upon NYP resources by minimising detentions under s.136 Mental Health Act. Furthermore, it represents a significant reduction in costs versus the original proposal to utilise nurses’ private vehicles for the task.
3. Other options considered, if any
4. Contribution to police and crime Plan Outcomes
   1. Agreement to the Memorandum of Understanding with Dept of Health will unlock the mechanism to release the first tranche of funding (£65.5K) to NYP towards the end of 2013, with the balance payable in April 2014. In turn, that will enable advanced plans for the pilot scheme to be advanced towards delivery.
   2. Procurement of a suitably specified, unmarked Vauxhall Zafira people carrier will provide a platform for delivery of the service by the Community Psychiatric Nurses at a considerable saving against the estimated cost of paying expenses for use of their private vehicles during the pilot period. At the end of the pilot, NYP’s Head of Transport indicates that the vehicle will be subsumed into the wider fleet.
   1. Reducing Harm – by working with health partners to improve service provision to vulnerable people
   2. Putting People First – by assisting Response Officers in managing situations involving sufferers of mental ill-health, and providing mechanisms to enable follow-up contacts and appropriate signposting towards long-term solutions
   3. Delivering More With Less – by maximising use of available funding to focus on new and innovative joint service delivery with health partners
5. Consultation carried out
   1. Whilst no local service-user consultation has been conducted, there has been extensive consultation with TEWV and Cleveland Police to ensure the benefits of the Street Triage pilot can be realised. Nationally, its profile has been raised through the media (e.g. Panorama, Locked up for being ill?, 12th Sept 2013) and news reporting of crises in mental health services.
   2. Internally, there has been consultation with the Head of Transport, Health and Safety and Legal Services to consider options and implications.
6. Financial Implications/Value for money
   1. The estimated cost of progressing the pilot is £199K, against a funding provision of £200K. Therefore, at a high-level, the pilot is projected to be cost-neutral to NYP.
   2. The benefits of the pilot, if realised, will help drive down demand on policing services resultant from mental ill-health in the Scarborough area. A baseline position is being prepared to help quantify those benefits over the duration of the pilot.
   3. The MoU does not contain any restriction on utilising the funding for capital expenditure.
7. Legal Implications
   1. The MoU and associated Service Specification have been forwarded to Legal Services, and has been approved by Jane Wintermeyer.
   2. The proposal has been submitted to the regional procurement team as part of a single tender action request which was approved by the Regional procurement director/head of procurement and category management.
8. Equality Implications
   There are no adverse equality or diversity implications in respect of the request to progress this work. A full community impact assessment and equalities impact assessment will form part of the analysis.

Public Access to Information

The Police and Crime Commissioner wishes to be as open and transparent as possible about the decisions he/she takes or are taken in his/her name. All decisions taken by the Commissioner will be subject to the Freedom of Information Act 2000 (FOIA).

As a general principle, the Commissioner expects to be able to publish all decisions taken and all matters taken into account and all advice received when reaching the decision. Part 1 of this Notice will detail all information which the Commissioner will disclose into the public domain. The decision and information in Part 1 will be made available on the NYPCC web site within 2 working days of approval.

Only where material is properly classified as restricted under the GPMS or if that material falls within the description at 2(2) of The Elected Local Policing Bodies (Specified Information) Order 2011 will the Commissioner not disclose decisions and/or information provided to enable that decision to be made. In these instances, Part 2 of the Form will be used to detail those matters considered to be restricted. Information in Part 2 will not be published.

Is there a Part 2 to this Notice –NO
Originating Officer Declaration – Author name: T/Insp Bill Scott, Collar number: 760