North Devon Link Service Public Consultation Document

1. Purpose of Document

The aim of this document is to outline the proposal for the redesign of the North Devon Link Service, to ensure everyone who has a stake in the service understands the rationale for the proposals and the approach taken to engage on their implementation.
It is intended to inform North Devon Link Service users, stakeholders and other interested parties of service background information, rationale for the proposal and engagement and consultation to date and next steps.
The consultation process is an attempt to involve North Devon Link Service users, stakeholders and other interested parties in the development and implementation of the final decision for the future of the North Devon Link Service.

Our preferred proposal is to redesign the North Devon Link Service to become a community offer that continues to meet the needs of people with varying levels of support, in a wider variety of accessible community settings across Northern Devon. We will continue to run the current service whilst those other services are set up, to ensure no one is left without the support they currently receive.

2. Background Information

1. The North Devon Link Service was originally established in 1992.
2. All four services are based in buildings owned by Devon County Council.
3. The staff are employed by Devon County Council but managed by Devon Partnership NHS Trust.

2.1. North Devon Link Service before March 2020 – before Covid-19 pandemic

1. The four Link Centres in North Devon located in Barnstaple, Bideford, Holsworthy and Ilfracombe are for people over 18 experiencing a wide range of mental health difficulties from slight depression to people in specialist mental health services.
2. The staff work within a recovery model which means they treat everyone as an individual, focussing on strengths and empowering people to make choices about their own life to give hope for the future.
3. The service provided was mostly drop-in sessions where people could socialise, make friends, and get support from staff to talk over any concerns or difficulties. Planned wellbeing, therapeutic groups and community outreach for people struggling to leave their home was also provided as capacity allowed.
4. There was no charge for the service.
5. The North Devon Link Service was completely open access with no referral criteria.There was no referral form and referrals were made directly to the service either by e-mail or phone. People could refer themselves or ask a Health or Social Care Professional or any other services or individuals to refer them.
6. The Managers of the centres told us that they play a key role in keeping people well, prevent people accessing other health and social care services and enable the Community Mental Health Teams to be confident that ongoing support is provided without their ongoing involvement.
7. Each centre had different opening hours and days and were open between 10 and 37 hours per week.
8. In other parts of the county, including other rural areas, the same mental health and wellbeing needs are successfully met by a range of voluntary sector and community activities and services.

2.2. North Devon Link Service since March 2020 – during the Covid-19 pandemic

1. At the start of the Covid-19 pandemic, the buildings were temporarily closed in line with government guidance and the service moved to a virtual support service, mostly by telephone.
2. Referrals for the service that were delivered by the North Devon Link Service before March 2020 were temporarily ceased on 23rd November 2020. Virtual support continued to be delivered to people already using the service.
3. Since December 2020, alongside the virtual support to existing service users, North Devon Link Service staff have been delivering support to people newly referred to and assessed by the North Devon Mental Health Social Work Team (Devon Partnership NHS Trust) to enable them to live as independently as possible.
4. Some support has been provided face to face in peoples own homes, in rooms in community buildings and in open spaces in the community.
5. As of September 2021, whilst Devon remains a Covid-19 enhanced response area, the four buildings remain closed.

3. Rationale for Proposals

3.1. Information considered so far to help inform the proposals

1. In 2019, Devon County Council and Devon Partnership NHS Trust agreed to review the four Link Centres in North Devon. The purpose of the review was to establish a clear picture of activity that was being undertaken in the service, and to ensure we were supporting people to achieve the outcomes they wanted. We also wanted to ensure people were able to access the right support for their needs, for example if they were Care Act eligible or eligible for mental health services.
  The findings of this review were:
  - Centre staff are committed and passionate about what they do.
  - Centres tell us they provide a recovery service to people from across the mental health spectrum from little or no mental health need to those who meet the secondary mental health threshold.
  - Long term attenders of up to 20 years plus.
  - Most people were between the ages of 41 and 65. The service did not meet the needs of young people.
  - Little consistency across the centre.
  - 11% of people who access the service had an eligible social care need.
  - 43.25% of people who access the service were in receipt of another DPT service.
  - Community Mental Health Teams made nearly half of the referrals.
  - Inequity of service across Devon.
  - No admission or discharge criteria and no outcome focus or KPIs attached to the service.
  - Many of the group activities can or could be met in the community.
2. Many activities that were identified in engagement as being of benefit such as help with filling out forms, access to IT, arts and crafts, cooking, therapeutic groups and classes and the opportunity to talk about problems also exist in the Community and Voluntary Sector.
3. Since March 2020, the beginning of the Covid-19 pandemic, the support has been provided mainly by telephone. As with other services across Health and Social Care, a review of the impact of Covid-19 on the service was undertaken.
4. Service user feedback received as part of this review was very low so cannot be viewed as representative of all service users, however, of that received, the majority appear to be in the service because they are lonely or socially isolated.
5. The proposal taken forward from the review was to implement good practice changes to the existing provision of services, ensuring consistency across the four centres. A project group including Link Centre staff was established to start the work. Progress stopped when the service delivery changed because of Covid-19.

3.2. Local and national strategy and developments that have informed the proposal

1. The Care Act (2014) governs the way Local Authorities work and sets out responsibilities including the need to work with communities to provide or arrange services that help to keep people well and independent. Local authorities should also provide or arrange a range of services which are aimed at reducing needs and helping people regain skills.
2. There is opportunity to build on the innovative ways that people have been supported during the pandemic by bolstering and reshaping short-term enabling support in communities across Devon and supporting people to live as independently as possible. The service delivered before the pandemic wasn’t promoting the independence of as many people as possible.
3. This is not a cost saving exercise. Any savings made if this proposal is implemented will be reinvested in the Community and Voluntary Sector to provide support in communities across Northern Devon.
4. There is a national focus on improving and developing the way we deliver community mental health services, including national investment and the introduction of the Community Mental Health Framework.
5. We want to ensure all community mental health services, including those currently offered from the Link Centres, meet the needs of people in their own communities. The health investment in the Community and Voluntary Sector across Devon, Torbay and Plymouth from national funds (£3.65m over the next 3 years) to support community mental health framework implementation, whilst not linked to this consultation, demonstrates the national and local commitment to that aim.

3.3. Options considered

1. No change. The service will continue to have no referral or discharge criteria, no measure of performance or focus on outcomes for individuals. This option will, result in ongoing inconsistency across the four centres and the service will not be suitable for people who do not want a group day service setting or people who are unable to travel to the towns.
2. Re-instate the project work that was started following the 2019 review. To implement good practice changes to the existing provision will result in referral and discharge guidance, some consistency across the service and some performance measures. However, the model of service delivery will remain the same and will therefore still not be suitable for people who do not want a group day service setting or people who do not have means of travelling to the towns.
3. Redesign the North Devon Link Service (Preferred option). To develop a community offer that continues to meet the needs of people with varying levels of support, in a wider variety of accessible community settings across Northern Devon. To continue to run the current service whilst those other services are set up, to ensure no one is left without the support they currently receive.

4. Aims and objectives for the redesigned service

1. The following proposal was developed for the redesign of the North Devon Link Service with engagement on this proposal running between 16th August 2021 and 13th September 2021:
  - Redesign the North Devon Link Centre Service from a building-based model to short-term enabling support for those with a statutory need, working with people in their community to achieve what matters to them.
  - Invest in the local Community and Voluntary Sector to support people who do not need this level of support.
2. The service user response rate to the engagement questionnaire was around 60% by post, e-mail and on the Devon County Council Have Your Say webpage. The feedback was reviewed, considered and themes gathered.
  - The overwhelming reason for attending the North Devon Link Service was to receive support and guidance around mental health and as a place to meet people and combat loneliness – for many it was both reasons.
  - Most people attended the drop-in part of the service, closely followed by classes and groups. Some people attended both.
  - Three quarters of responses told us that they received virtual support by phone during the pandemic.
  - It is acknowledged that most people said they would like to see the buildings stay open but some responses included seeing more services in the community.
  - Service users also provided information in free text about their personal reasons for using the North Devon Link Service which was really valued.
  - Around 45 responses were received from stakeholders with 30 of those from Ilfracombe.
  - The majority of responses told us that they refer to/use or recommend the North Devon Link Service for support and guidance around mental health and as a place to meet people and combat loneliness.
  - Stakeholders referred to/used or made people aware of drop-in, Community Support and classes and groups fairly equally.
  - Stakeholders have said that they would like to see the North Devon Link Service buildings stay open but have also suggested services that they would like to see in the community such as services for younger people, outdoor activities, holistic treatments and support and more mental health support group to help people gain self-esteem and confidence.
3. We have listened to feedback from the engagement and the concerns raised and have therefore changed the proposal to that set out in this document
4. The redesigned service will, in the first instance, be for new people accessing the service who have an assessed eligible need under the Care Act 2014.
5. Those people who currently access the support provided by North Devon Link Service will be offered an assessment or review to identify how their needs can be met by an alternative service, whilst continuing to receive virtual support.
6. This interim period of the two services running in tandem will allow us to identify what development and investment is needed in the Community and Voluntary Sector and develop alternative and future services with people who may be using the services.
7. This proposal will develop in line with the Community Mental Health Framework which will help local systems address inequalities in mental health care and strengthen relationships with local community groups and the Voluntary and Community Sector.
8. The revised proposal will help us to identify what alternative services are required and develop them accordingly.
9. This proposal will mean that people who are currently using the North Devon Link Service will be assessed or reviewed to ensure we are meeting their needs. If they are assessed as being eligible for social care support from Devon Partnership NHS Trust related to their mental health, they will receive a service from existing Link Service staff to increase independence, build confidence and manage everyday life.
10. An alternative service will be offered to people who are assessed as not having a social care need related to their mental health, which might be in the Community and Voluntary Sector. This proposal ensures that nobody will be left without a service they need.
11. It is proposed that the service will extend to be more accessible to the people of Northern Devon, by offering personalised one-to-one support for those with an eligible social care need. For those without an assessed social care need, we will connect to local community and voluntary groups that continue to support people with their mental health.
12. To support this approach and allow us to reach people across the whole of North Devon in their own communities, it is proposed that the Link Centre Service will no longer be delivered in the current four buildings.

5. Consultation Process

1. The service user and stakeholder consultation will start on Thursday 23rd September 2021 and will run until Friday 22nd October 2021. This follows the engagement phase which ran from 16th August 2021 to 13th September 2021.
2. It is recognised that service user and stakeholder face to face meetings would be most appropriate for this consultation process. However, the Director of Public Health Devon and Devon County Council Corporate and Legal Services have advised that with cases of Covid-19 expecting to remain high and with Devon being classified as an Enhance Response Area, we should not undertake face to face public meetings.
3. A copy of this consultation document will be sent to all North Devon Link Service users with a stamped addressed envelope to provide the opportunity for written feedback either by post or e-mail.
4. The consultation document will be published on the Devon County Council Have Your Say webpage with the opportunity to tell us your views on the proposal or give alternative suggestions by emailing NDLSConsultation-Public@devon.gov.uk, or you can submit your views via our online questionnaire (now closed).