Joint Forward Plan Appendix 7

Appendix 7: Detailed Live Well Domain Plans – Feel Well

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1.1 Feel Well – Supporting the mental wellbeing of our population

1.1.1 Mental Health

Why is this important for people in Suffolk and North East Essex?

The best possible mental health and resilience is essential if everyone in SNEE is to live well and age well. Good mental health is defined as a state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community. Like physical health, people can experience both temporary and long-term mental ill-health. Mental ill-health conditions affect around one in four people in any given year, ranging from common problems, such as depression and anxiety, to rarer problems such as schizophrenia and bipolar disorder.

People can experience mental ill health at any age and the implications are wide-ranging. For children and young people, educational outcomes may be negatively affected, which can result in more limited job opportunities. For people of working age, they may be less productive at work and more likely to be unemployed. Among elderly people, they are more likely to be isolated and less active in their community. For people of all ages with mental ill health, it can be challenging to carry out everyday tasks.

Mental ill health can be both a cause and a consequence of social, economic, and environmental inequalities. Mental ill health problems are more common in areas of higher deprivation and poor mental health is consistently associated with unemployment, less education and low income. In SNEE, people living in more deprived areas are more likely to experience severe mental illness, and to be admitted to hospital for self-harm.

Suffolk has an existing all age 10-year 2019-29 Mental Health and Emotional Wellbeing Strategy (#averydifferentconversation) which has a system focus on the broader determinants of health. Further information can be found on Let’s Talk SNEE.

The Southend, Essex and Thurrock Mental Health and Wellbeing Strategy 2017-2021 (being refreshed April 2023) published in 2016, articulated a common vision and ambition for the development of high-quality mental health care, around the commitment to “ensure that everyone needing support in Southend, Essex and Thurrock–including families and carers – get the right service at the right time from the right people in the right way”.

Both strategies have a significant focus on co-production and hearing the voice of service users, families and carers and professionals including detailed engagement and service user involvement. We are fully committed to how we continue to evolve and improve our approach to this in our mental health transformation business as usual and harness the significant contribution that can be made to improve outcomes for our population.

Whilst the ‘Feel Well’ domain covers mental health and emotional wellbeing as a theme, it is important to note that all of the domains supporting the JFP also contribute to mental health and emotional wellbeing as part of the broader determinants of mental health.

The planned development of mental health system collaboratives in Essex and Suffolk in 2023/24 will also provide the system governance and focus to strengthen the delivery of these priorities across partners. Please see section 6.4 Collaboratives for further details.

What do we know about people’s local experiences?

• People want help to self-care and understand the mental health benefits of balance and moderation in their lifestyle choices
• People want to be involved in care decisions, have the same choices and rights regardless of location, and have access to advocacy
• Better signposting is needed to support services including peer support groups, voluntary sector and therapeutic activities including art, singing and exercise
• People want mental health support to be better embedded in primary care and the community. Timely advice and guidance on physical and mental health issues together is needed to improve outcomes
• Access, continuity of care and co-ordination is an issue, better support for finances and social issues is needed on discharge from acute services and organisations should communicate better and use the same terms
• Follow up support after a crisis episode or assessment in ED should be improved. People should have a ‘safety net’ to return into care facilities if needed
• Further support is needed following a bereavement

NHSE have focussed on prioritising mental health and accompanied investment in recent years, firstly with the publication of the Five Year Forward View for Mental Health published in 2016 and latterly the NHS LTP and supporting Mental Health Implementation Plan 2019/20–2023/24. It describes how the ambitions for mental health fit with the broader system planning approach. The NHS Mental Health Implementation Plan sets out how a £2.3bn local investment fund will be used. Key messages include:

• people with a SMI are at risk of dying on average 15 to 20 years earlier than those without, two thirds from avoidable physical illnesses
• early intervention, prevention and self-care are the only ways that lasting change can be achieved. Helping people lead fulfilled, productive lives is a system wide responsibility and all agencies must play their respective part
• stable employment and housing are both factors contributing to someone being able to maintain good mental health and are important outcomes for their recovery
• 20% of older people living in the community and 40% of older people living in care homes are affected by depression
• people in marginalised groups are at greater risk, including ethnically diverse, LGBTQ+ and disabled people, people in the criminal justice system and survivors of trauma

How we plan to make a difference

Ensuring that:

• people maintain good mental health and physical health and are resilient
• people live in resilient and inclusive communities
• people have prompt access to mental health support for themselves and their carers
• people receive the best quality integrated services to achieve recovery and good mental health, delivered in the right way, in the right place and at the right time
• people receive the best care and support when experiencing a mental health crisis

People know how to maintain good mental health and resilience

We will give people and carers information and support to understand potential risks to their mental health and how to maintain good wellbeing. ‘Mind District’ will offer free online support for over 18’s and provide a range of modules and resources from April 2023 in Suffolk. In North-East Essex, the EPUT ‘Therapy for You’ service provides the right information enabling people to identify risks or symptoms early and take action to prevent worsening health or crisis.

The SNEE ICB will support the Feel Well domains in our three Alliances to support projects targeting mental health and emotional wellbeing. In January 2023 in our North East Essex Alliance a range of initiatives totalling £976k was allocated across 24 VCSE organisations across Tendring through Community Voluntary Services Tendring and across Colchester through Community 360 supporting suicide prevention, people with complex needs, tackling loneliness and social isolation. In Suffolk, SNEE ICB has invested £1m in VCSE community organisations via Suffolk Community Foundation to develop the ‘Equity in Mind’ grant programme to develop support alongside existing provision targeting health inequalities like older age, ethnicity, diverse communities, gender, and rurality. In 2023/24 all initiatives will be reviewed and evaluated to assess impact on improved outcomes.

People have access to resources that support and protect their mental wellbeing

The development of a Mental Health Prevention Strategy in 2023 (with Suffolk Public Health) will support people to lead a fulfilled, productive, and positive life. In 2022/23, the Suffolk Public Health team have led a process to allocate £2.5m Control Outbreak Management Fund (COMF) funding to support schemes designed to promote mental health promotion and resilience. In 23/24 these schemes will be implemented, evaluated, and assessed.

Suffolk and Essex County Councils respectively provide information on the range of mental health and emotional wellbeing services that are accessible to the population, and these will continue to grow and be refined.

We will build knowledge, capacity and capability across workforces allowing wider promotion of good mental health and wellbeing. SNEE ICB will work with partner organisations to continue to raise awareness of the importance of supporting the mental health and emotional wellbeing of our employees and population though our three Alliances and the Essex and Suffolk Health and Wellbeing Boards.

We will take a targeted approach, focussing on providing community support to those at greatest risk of low wellbeing. The ‘EPUT Health Outreach Service’ and ‘Refugee Action Colchester Service’ supports marginalised groups across SNEE including refugee and asylum seekers. In 2023/24 we will continue to review the service offer available to ‘hard to reach’ groups to ensure that resources are targeted where needed and respond to changing demand accordingly.

People live in resilient and inclusive communities

People have local community services that work together to support their mental health throughout their lives

In 2023/24 we will work in our three Alliances at place to increasingly bring together services that support mental health and emotional wellbeing. This will include social prescribing, local community grassroots services and statutory services including NSFT and EPUT. Through our integrated neighbourhood teams and dedicated NEE and Suffolk Community mental health model governance we will bring conversations and services together.

In 2022/23 the Suffolk Integrated Care Academy has identified mental health as its key theme and several projects (six) will be devised in the East Suffolk Integrated Care Teams to focus on wrapping services around the needs of the individual.

In 2023/24 SNEE ICB will continue working with Essex and Suffolk County Councils on the mental health services that cross health and care. In North East Essex we will continue to implement and review the new supported housing model that is being piloted in North East and West Essex with Essex County Council. In Suffolk we will review our Section 75 Mental Health Pooled Fund arrangements by the end of March 2024 to consider how best to continue to work together to support mental health advocacy and supported housing arrangements.

People have prompt access to mental health support for themselves, families, and their carers

People will have improved access to community- based integrated therapies and support, including for people with the most complex needs, people experiencing racial disparities in services, and carers

From 2023/24 we will achieve a 5% year on year increase in the number of adults and older adults supported by community mental health services.

In 2023/24 the ICB has commissioned more activity from EPUT and NSFT to deliver National Institute for Clinical Excellence (NICE) approved NHS Talking Therapies treatments in support of common mental health conditions. Targets are that 75% of people receive a service within six weeks of referral, and 95% within 18 weeks. The current recovery rate of 50% will be maintained.

In 2023/24 we will work with the EPUT and NSFT NHS Talking Therapies services to better integrate with the new community mental health models, which will include providing services from new community locations including libraries and developing much closer working relationships with PCN’s, Additional Roles Reimbursement Scheme (ARRS) Mental Health nurses and secondary mental health community teams.

People receive the best quality integrated community-based services to achieve recovery and good mental health, delivered in the right way, in the right place and at the right time

People will receive the best quality community based person-centred care

Continuing the roll out of ARRS Mental Health practitioner roles (three per PCN by 2023/24) enabling greater timely support for early mental health presentations in primary care.

Improving access to physical health checks for people with a SMI. By March 2024, health checks and further identified support will help to close the gap in life expectancy (c20 years) between people with severe mental illness and the general population. In SNEE, GP Primary Care (North East Essex) and the NSFT Physical Healthcare Team and Suffolk User Forum (Suffolk) have provided bespoke support including reasonable adjustments to enable SMI service users to access physical health check assessment and interventions.

Continuing to increase the commissioning share of services provided by VCSE organisations to wrap around and support statutory mental health provision. This recognises that some interventions including step up and down from secondary mental health services, peer support and those that promote an individual’s resilience and wellbeing may be better placed with our VCSE sector.

Developing community-neighbourhood based teams and approaches including NHS Talking Therapies, physical health care, employment support, personalised and trauma-informed care, medicines management and support for self-harm and co-existing substance use. Place-based multi-disciplinary teams with improved information/sharing will provide people with greater choice and control over their care and support them to live well in their communities. The ‘new care model’ approach will allow providers to collaborate more closely in planning specialised mental health services. Improved information sharing underpins the new model of care.

Working with NSFT and EPUT we wish to address our employment challenges by growing our workforce with a particular focus on the recruitment of psychotherapists, adult community nursing and community support workers. We also wish to build on work to date to create more joint roles with the VCSE sector within our integrated neighbourhoods and develop peer support worker and care navigator roles. In 2023/24 we will review our progress to date and make further plans in this area in line with our 23/24 NHSE Mental Health Workforce Plan.

In 2023/24 we will fully implement business cases with EPUT and NSFT for the provision of eating disorders and Personality Disorder and Complex Needs services for adults.

Extending NHS Talking Therapies services for people with long- term conditions and increasingly linking physical (WSFT, ESNEFT and community services) and mental health services is a priority. Building on work to date with Diabetes, COPD and Musculoskeletal, in 2023/24 increase support for Cancer and Gastrointestinal areas.

Delivering the Early Intervention in Psychosis (EIP) standard which provides for better future outcomes for those who access timely EIP services. Sustaining the 60% EIP activity standard and achieving a Level 3 EIP NICE- concordance rating inclusive of delivering an At-Risk Mental State (ARMS) provision with EPUT and NSFT by March 2025.

Sustaining in 2023/24 Individual Placement and Support services to help people with severe mental illness into work or meaningful activity that helps improve health outcomes and tackle deprivation.

Women who experience mental health difficulties during the perinatal period will have improved access to timely specialist mental health assessment, peer support and evidence-based treatment by 2024 across SNEE. We will complete business cases with EPUT and NSFT working closely with our three maternity units. See Section 5.4.1 for further details on perinatal support.

People receive the best quality inpatient care, provided locally

SNEE ICB will co-produce a plan by 31 March 2024 to localise and realign mental health and learning disability inpatient services over a three-year period as part of a new national quality transformation programme. SNEE will work closely with NHSE to review its mental health inpatient provision to ensure it is person-centred, recoveryfocused and minimises use of restrictive practices. Service users should have maximum choice and control, and their length of stay minimised through effective interventions. Use of segregation and seclusion will be minimised.

People receive the best care and support when experiencing a mental health crisis

People in mental health crisis and their carers have access to community-based support to help avoid crisis and acute inpatient admission

We will enable this by:

• continuing to work with NSFT, EPUT and system partners to nsure that people facing a mental health crisis, should have access to care seven days a week and 24 hours a day in the same way that they are able to access urgent physical health care. This will increasingly mean building relationships with VCSE and other system partners to provide different interventions and support
• sustaining with NSFT and EPUT 24/7 Crisis Resolution and Home Treatment Teams (CRHTTs) which provide a 24/7 intensive home treatment service as an alternative to acute inpatient admission. People and their carers will have the support they need to avoid inpatient admission and be assessed and cared for in their community wherever possible
• in January 2023 we launched STEAM cafes in East and West Suffolk designed to provide safe places to support mental health and emotional wellbeing presentation. These sites will work with system partners including ambulance and police to provide alternative interventions to admission. We will continue to evaluate and expand as needed these services. By April 2024, in North East Essex we will review and recommission our Colchester and Tendring crisis café service offer based on the needs of our local population.

People who need crisis mental health services will have prompt access

In 2023/24 we will sustain NHS 111 as the single universal point of access for people in mental health crisis, linked to Crisis Resolution Home Treatment Teams. A single point of access will enable a prompt and more co-ordinated response to people in crisis in the community. Focus will continue to improve call response times, providing timely professional support via 111 and reducing the percentage of abandoned calls.

People in mental health crisis and their carers receive the best quality emergency first response

In 2023/24 SNEE ICB working with East of England Ambulance Service Trust (EEAST) will launch mental health ambulance vehicles and training to ambulance staff across SNEE. Mental health transport vehicles and trained staff will reduce inappropriate conveyance by ambulance or police to ED by providing alternative intervention. Ambulance staff will be trained and equipped to respond to people in mental health crisis. Nurses can improve triage and response to mental health calls and increase the competency of ambulance staff through an education and training programme.

In 2023/24 SNEE ICB will sustain a police triage offer working with Suffolk and Essex Constabularies and NSFT and EPUT, respectively. The services are designed to provide mental health nursing support to police and build stronger working relationships between our police service and mental health Trusts.

People in emergency care settings have full access to mental health assessment and support

In 2023/24 SNEE ICB will sustain an all-age mental health liaison service in ESNEFT and WSFT acute physical hospitals, at Core 24 fidelity standards. Prompt access to the right support can minimise people’s stay in the ED and to have the urgent mental health support they need arranged promptly.

In 2023/24 and 2024/25 SNEE ICB will work with local providers including NSFT, EPUT, ESNEFT, WSFT and VCSE partners to improve capital estate for mental health urgent and emergency care pathways to improve therapeutic environments and patient experience. A range of capital investment has been successfully secured from NHSE to support this including an extra Health Based Place of Safety at the Lakes in EPUT (North East Essex) due for completion in April 2023 and estate improvements to NSFT Inpatient settings at Woodlands and Wedgwood through 2023 to 2025.

We will know we are making a difference because we will see:

• delivery of the ongoing annual NHSE Mental Health Investment Standard (MHIS) providing increased parity across mental health and physical health services investment
• increasing in 2023/24 the proportion of people with severe mental illness receiving a full annual health check and follow-up interventions from 2022/23 reported levels
• increasing in 2023/24 the number of people with severe mental illness accessing Individual Placement and Support (Employment Support) from 2022/23 reported levels
• increase NHS Talking Therapies access targets each quarter throughout 2023/24 from 2022/23 reported levels including supporting those individuals with long term conditions and for those with protected characteristic’s
• delivering Early Intervention in Psychosis services at EPUT and NSFT at NICE standards Level 3 or above by March 2025
• working towards eliminating inappropriate adult acute out of area placements by March 2025 and reducing the days spent in inappropriate out of area placements by adults needing non-specialist acute mental health inpatient care from 2022/23 reported levels
• an increase in coverage of 24/7 adult crisis resolution and home treatment teams, and community support e.g., crisis cafés by March 2024
• increasing access to specialist perinatal mental health care in 2023/24 against reported 2022/23 levels
• a reduction in hospital admissions for mental health conditions by 2026 supported by increased recruitment to primary care mental health practitioners and focus on early prevention and intervention approaches
• trialling and increasing the use of Personal Health Budgets for supporting service users with a SMI by 2026
• from 2023/24 we will achieve a 5% year on year increase in the number of adults and older adults supported by community mental health services reflecting increased recruitment to primary care mental health practitioners and focus on early prevention and intervention approaches

As at February 2023, we have reached the end of the NHSE Five Year Mental Health Long Term Plan covering 23/24. Further targets will be agreed during 23/24 covering 24/25 to 27/28 and will be included in the subsequent refresh of the JFP.

Quote: “Supporting the mental health and emotional wellbeing of our population is a key priority for our SNEE system. Good mental health and emotional wellbeing is achieved by ensuring that individuals, their families, and carers can access the right support at the right time. In SNEE we are committed to working with our partner agencies and service users with experience, to ensure that all parts of the system make mental health everybody’s responsibility and that the broader determinants of mental health are fully considered as part of the solution.”
Richard Watson: SNEE ICB SRO for Mental Health and Deputy Chief Executive.

Case studies

Healthy Together (Suffolk Users Forum) – John’s Story (2022)

The SUF Healthy Together Service offers peer support for people with severe mental health illness (SMI), which includes living with bipolar disorder, schizophrenia, and psychosis, who following a SMI annual physical health check would like or would benefit from additional support to achieve physical health and wellbeing goals.

John was referred to Healthy Together for healthcare follow up appointments, including podiatry care, as his toenails had not been cut for over a year and he found walking painful. We called John the day after his referral from the SPHT and his biggest concern on the day was that his kitchen sink has been blocked for six weeks. Despite him calling his housing provider, he had not been able to get the problem resolved. Following our call to the provider a plumber went out that evening and the sink was unblocked. John was pleased. He had been so upset because the issue had been going on for so long. He’d been unable to use his sink, his dishes were piled up high, and as it was summer, he was struggling the high number of flies in his flat.

Working together we went on and arranged for a private podiatrist to visit John at home. This has revolutionised his life, he is now pain-free and mobile. John has gone on to build a good relationship with podiatrist, growing in self-confidence to arrange ongoing podiatry appointments. With support John has attended other health care appointments and now has more confidence to arrange and attend these by himself. He is now engaging well with his GP and NHS staff in both primary and secondary care.

John told us – “Brilliant work, since you have been on board, we have been chipping away at my healthcare needs and things are moving forward. Before nothing was happening. I’m so happy that you managed to get my sink unblocked as the people I tried to speak to weren’t very nice.”

Refugee, Asylum Seeker, and Migrant Action – Colchester

RA-C/RAMA provides a safe and welcoming community of 12 staff, 83 volunteers and peer supporters to vulnerable migrants from 100 countries living in Colchester. Supporting Asylum seekers, Ukrainians, refugees, those with NRPF, domestic abuse clients and EU late claims form a substantial part of our work.

29-year-old male asylum seeker from Iran had been living in Londonat a hotel for 2 years. The client was then detained to a detention centre within a psychiatric ward under MH section. He had multiple mental health diagnosis and regular DEPOT injections from a CPN. He was transferred to Colchester with no prior warning to either him or his mental health team, arriving with no medications and a DEPOT due. The London Home Treatment Team were due to work with the client on release but closed his case when informed he was in Colchester. The client’s solicitor alerted the RAS team to his whereabouts who were then able to;

• Register the client and take consent
• Assist him to register at a local GP surgery
• Approached the practice manager for assistance
• Reassured the client and take consent for a social care solicitor and raise a case for a return to London
• Safeguarding referrals to both Migrant Help as well as an Outreach referral for extra support
• Safeguarding referral to the accommodation providers to make sure anyone who was sharing his accommodation could also access support.
• Provided bus fare for the frequent trips to GP and our offices
• Ongoing support form casework team and community team

Outcomes for the client

• Registration with local GP
• Agreement of MH Clinical Management of case back to London
• Support from local MH services
• Engagement and support from Migrant Help who have made contact and have seen him at the RAS offices

This case is not an isolated one. On average it takes 4-6 weeks to organise the medication that people need. Issues illustrated here are linked to the lack of care and planning of people’s mental health and these clients are sometimes unable to manage the situation for themselves. They do not necessarily know who their GP is, what their diagnosis is and what medication they have been prescribed. RAS work to support these clients to signpost and navigate the health and care system to access the services they need.

1.1.2 Suicide Prevention

Why is this important for people in Suffolk and North East Essex?

Every death by suicide can have a devastating effect on families, friends, colleagues, witnesses, frontline staff such as first responders and entire communities. Preventing suicide is a major public health issue and is a priority for health and wellbeing partners in SNEE.

Key government publications include ‘Preventing Suicide in England’ was published in January 2019. This sets out plans to improve the implementation and governance of the National Suicide Prevention Strategy. The key areas remain the same, with the addition of an area focusing on reducing self-harm. The seven key areas are:

1. reducing the risk of suicide in key high-risk groups
2. tailor approaches to improve mental health in specific groups
3. reduce access to the means of suicide
4. provide better information and support to those bereaved or affected by suicide
5. support the media in delivering sensitive approaches to suicide and suicidal behaviour
6. support research, data collection and monitoring
7. reducing rates of self-harm as an indicator for suicide risk

SNEE has a strong system partnership dedicated to preventing suicide underpinned by strategic leadership from the Public Health teams in Suffolk County Council and Essex County Council. Suffolk County Council are currently working on a Suffolk Suicide Prevention Strategy 2022-2025.

Southend, Essex, and Thurrock have an existing suicide prevention strategy, published in 2017. Both will be reviewed following publication of the new National Suicide Prevention Strategy due in early 2023, which is likely to focus on new priority groups and themes.

In support of Suicide Prevention, NHSE has funded a three-year transformation programme from 2019-2022, which focused on SNEE and invested in suicide awareness and support in partnership with providers, local authorities, police, ambulance and VCSE partners, and developed data-informed local responses. The programme aimed to support the government’s national target for suicide reduction.

What do we know about people’s local experiences?

The latest suicide data for 2020 from the Office of National Statistics (ONS) shows a decrease in registered suicides. There were 5,224 suicides registered in 2020 in England and Wales, 8.2% lower than the 5,691 deaths registered in 2019. Around three-quarters of the deaths in 2020 were for men (3,925 deaths; 75.1%), which follows a consistent trend back to the mid-1990s. For females, there were 4.9 deaths per 100,000 registered in England and Wales in 2020. This is consistent with rates seen for more than a decade.

In 2019-21, Suffolk had an age-standardised suicide rate of 10.4 per 100,000 (n=208). This was not statistically different to the regional (9.8) or national averages (10.4). Rates of death by suicide at district and neighbourhood level were like the county average.

In North East Essex for the same period, the age standardised suicide rate was 16.0 per 100,000 (n=138). This is the third highest rate in England. The Colchester area has a rate of 15 per 100,000 (n=76) Tendring 13.8 per 100,000 (48) and Braintree 12.4 per 100,000 (n=48).

We are acutely aware of the higher suicide rate in North East Essex and are committed to prioritising our collective action as a system across SNEE and working in partnership with Southend, Essex, and Thurrock.

In 2022 Suffolk’s suicide prevention was refreshed. This built on the 2020 report entitled ‘Co-production for the Suffolk Suicide Prevention Strategy’, which covered wide-ranging topics including experiences with health and care organisations when reaching out for support, living with suicidal thoughts, supporting others, language and suicide, the need for connection and building co-production.

SNEE ICB will support Essex County Council and Suffolk County Council in 2023-24 to financially contribute to tackling suicide prevention as a system priority and continue the work of the NHSE time limited funding.

Evidence shows that experiencing economic adversity can worsen mental health and is associated with dying by suicide. Unfortunately, it is therefore expected that suicide rates across the UK will rise during the current economic challenges. However, SNEE will aim to reduce this increase by adopting the priorities set out in this plan.

How we plan to make a difference

• There is a focus on evidenced-based interventions to reduce the risk of suicide in key high-risk groups
• There is a reduction in access to the means of suicide
• There is better information and support to those bereaved or affected by suicide
• Support is given to the media to help deliver sensitive approaches to suicide and suicidal behaviour
• There is improved research, data collection and monitoring of suicides
• There is a system-wide focus on self-harm prevention in children and young people and adults, because it is a key indicator of suicide risk

Focus on evidence-based preventions to reduce the risk of suicide in key high-risk groups

We will enable this by:

• identifying high-risk and high prevalence areas through the collection and analysis of national mortality and real-time suicide surveillance system (RTSS) data
• delivering targeted evidenced-based suicide prevention initiatives to high-risk groups
• investigating variation in drivers at national and local level and identifying opportunities for intervention
• promoting and/or delivering targeted training and campaigns to those identified as coming into contact with groups recognised as high risk
• continuing to deliver targeted community campaigns that aim to improve knowledge about how to stay mentally well
• responding to clusters and intervening to reduce the risk of further suicides in specific high-risk groups
• progressing the Suffolk Children and Young Person Suicide Prevention Plan, building on the Mental Health First Aid training offer in schools to:
  • ensure students have robust emotional wellbeing awareness and literacy
  • build a collective of Student Mental Health Ambassadors who are better equipped to support peers
  • better equipping staff to respond to suicide concerns in students

Reduce access to the means of suicide

We will enable this by:

• making better use of data through RTSS to identify potential hotspots, clusters, and emerging means of suicide (such as misuse of prescribed medications) to enable targeted and timely interventions
• developing the role and influence of the Orwell Bridge Partnership Group and monitoring the impact of preventative measures implemented at the site. This includes:
  • working with Highways England to consider further works to the infrastructure to minimise risks
  • working with the Suffolk Rights of Way Team and Ipswich Borough Council to improve the area around the bridge
  • offering Samaritans’ media training to local reporters and editors
  • working with media outlets to change the suicide association with a location, using learning from the Samaritans and other national locations
• working with the rail industry and the Samaritans to reduce rail related suicide deaths

Provide better information and support to those bereaved or affected by suicide

We will enable this by:

• promoting the ‘Bereaved by Suicide’ support service (currently provided by Victim Support) as widely as possible
• ensuring that people with lived experience are part of the review panel to monitor and assess the effectiveness of the ‘bereaved by suicide’ support service
• improving onward specialist counselling support, where appropriate, for those bereaved by suicide, by ensuring clear and accessible referral pathways through to longer term services
• promoting and strengthening referral routes to the Bereaved by Suicide Service to ensure those that are eligible for support are aware of and know how to access services
  • in North East Essex, referrals are primarily from the Essex-wide Essex Wellbeing Service and the Essex Police referral pathway
  • in Suffolk, referrals are primarily from the Coroners Service and NSFT (where appropriate) but also from other routes

Support the media in delivering sensitive approaches to suicide and suicidal behaviour

We will enable this by:

• providing briefings to ensure that media partners are better informed about suicide prevention and support services available so that better information can be included in reporting
• promoting community campaigns and messages of hope to support people’s wellbeing and mental health
• encouraging the media to support the principle that suicide is ‘everybody’s business’ and to play their part by reporting suspected suicides responsibly
• developing a community of practice to embed collective learning, generate evidence-informed communication activity, and support the media with clear guidelines to use

Support research, data collection and monitoring

We will enable this by:

• further developing RTSS systems in both Essex and Suffolk by:
  • gathering real-time information to inform cluster responses and targeted suicide prevention interventions
  • improving data quality and exploring broader information, such as health data and intelligence from prevented suicides
  • working collaboratively with regional and national teams to support the development of national data and a unified RTSS system
• working with neighbouring authorities to ensure seamless identification of clusters along borders and implementing response plans that work in an integrated way
• producing annual suicide audits based on nationally published mortality data to ensure longer term trends are monitored and prevention activity responds to need
• working with the Essex and Suffolk Coroner Offices to map RTSS data with the confirmed Coroners verdict data, ensuring accuracy of real time suicide information
• using the two Essex Public Health 2023 applied research collaborations (University of Essex’s Suicide Profiles Research Project) and the National Institute for Health and Care Research Applied Research Collaboration (NIHR ARC) to support best practice across SNEE

Embed a system-wide focus on self-harm prevention in children and young people and adults, because it is a key indicator of suicide risk

We will enable this by:

• developing a self-harm action plan to support a longer-term system approach to reducing self-harm
• delivering training and resources to improve understanding and awareness of self-harm and promote the support available, targeting teaching and pastoral support staff, parents/carers, and clinicians
• ensuring the Children and Young People’s suicide prevention work prioritises awareness and reduction of self-harm among young people
• utilising existing toolkit resources for children, young people, adults and older adults that can be adopted for SNEE (i.e., the wider Essex toolkit)

We will know we are making a difference because we will see

• Age standardised suicide rates in Suffolk not rising above England or regional averages by 2028 (Suffolk current position at the England average)
• Age standardised suicide rates in North East Essex reducing downwards to those of England or regional averages by 2028 (current North East Essex position as a national outlier)
• SNEE ICB investing in a twelve-month dedicated suicide prevention role in North East Essex hosted by Essex County Council from April 2023
  • the role will review annual suicide data and RTSS suicide reports, identify recommendations and focus attention on the factors driving higher rates of suicide within key groups and local communities
• An agreed SNEE cluster response protocol is in place by 2024, which will ensure a timely and coordinated response to clusters of suicides
• 100% of people reported to have been bereaved or affected by a suspected suicide will be provided with information about support services available by 2025
• An increase in the knowledge, training and confidence of general practitioners and primary care staff around suicide prevention practice from 2025
• All interventions applied to identified high risk groups will be based on nationally recognised best practice by 2028
• A system wide self-harm plan in place by the end of 2023, with actions delivered by 2028

Quote: “Every suicide is a tragedy that causes devastating impacts on families, friends, and broader communities. Seven out of ten people dying by suicide are not known to Mental Health Services, which demonstrates that the factors leading to someone taking their own life are complex and multi-dimensional. This is why Suicide Prevention, although led by Public Health teams, requires a system wide approach across SNEE. We will continue to work in partnership to ensure that these avoidable deaths are prevented at every opportunity.”
Sara Dunling-Hall, Consultant in Public Health (Suffolk Public Mental Health & Health Care Public Health)

1.1.3 Addictions

Why is this important for people in Suffolk and North East Essex?

Everyone in SNEE should be able to live a healthy life with good physical, mental and social wellbeing. Health inequalities should be reduced and the prevention of ill health prioritised.

Current Picture

Addiction is a common problem and is defined as not having control over doing, taking, or using something to the point where it could be harmful to you. It is possible to be addicted to many things though typically we associate it with tobacco, alcohol, drugs, or gambling.

Addictions can be generally classified into those which are related to a substance, including drugs and alcohol, and behavioural addictions.

Behavioural addictions are addictions in which a person compulsively undertakes a certain action or behaviour on a repeated basis and with a total disregard of negative consequences that may impact a person’s well-being, health, or financial situation. Unlike a drug or alcohol addiction, there is no particular substance that the person is addicted to.

Support for those struggling with addictions is available through specialist drug and alcohol services, smoking cessation services and gambling support services.

The National Drug Strategy was published by the Government in December 2021. Local Authority Public Health teams are charged with working in partnership with system partners to develop a collective approach to achieve the ambitions within the Drug Strategy, closely monitored and regulated by the Office of Health Improvement and Disparities (OHID). The Drug Strategy sets out ambitions to:

• break drug supply chains
• achieve a generational shift in the demand for recreational drugs
• deliver a world-class treatment and recovery system
• local partnerships and accountability

The misuse of drugs (and alcohol) impacts on individuals, families and communities across Suffolk and places demand on our statutory health, care, and criminal justice services.

In 2020 the Commission on Alcohol Harm published a report ‘It’s Everywhere’—Alcohol’s Public Face and Private Harm”. The report describes:

• alcohol harm to individuals and those around them e.g., children and family life
• alcohol is a major cause for ill health, early mortality, and disability among those aged 15 to 49 in England, a range of conditions are caused or exacerbated by alcohol, including cancer and mental ill-health
• the burden alcohol misuse places on public services and the economy – in England, the total cost of alcohol was estimated to cost the NHS £3.6 billion, while alcohol-related crime in England and Wales was estimated to cost society around £1.4 billion per year

What do we know about people’s local experiences?

Drinking over 14 units of alcohol a week in England has reduced from 25.3% in 2011 to 2014 to 22.8% in 2015 to 2018. The East of England was statistically similar to England for 2015 – 18 (23.1% compared to 22.8%).

Suffolk has a significantly lower rate of alcohol-specific deaths (7.9 per 100,000) compared to England (10.9 per 100,000) whereas the rate in Colchester and Tendring was statistically similar (at 8.3 and 13.7 per 100,000 respectively).

Suffolk had the fourth highest prevalence of smoking in adults (16.1%) out of the eleven local authorities in the East of England. Smoking prevalence in SNEE was statistically similar to England (13.9%) and the East of England (13.7%). Ipswich was the only LTLA to present a significantly higher smoking prevalence (20.7%) compared to the East of England (13.7%).

How we plan to make a difference?

The insights of those with lived experience are used to shape services. The focus given to addressing addiction and unhealthy behaviours within an area of SNEE will be proportioned to the need. Our three priorities are:

• children, adults, and older people avoid the dangers of tobacco
• people with serious gambling problems receive high quality specialist support
• people are able to avoid or reduce alcohol and drug related harm

Children, adults, and older people avoid the dangers of tobacco

People live in a healthier smoke-free environment

By 2028, we will have demonstrated progress towards the national smokefree 2030 target for a smoking prevalence rate of below 5% in the general population.

By 2028, we will have delivered regular multi-media campaigns, backed by local community interventions to reduce the prevalence of smoking and passive smoking, and promote smoking cessation, targeted at communities with higher smoking prevalence.

By 2023/24 we will have commenced a programme in Suffolk to support employers of routine and manual workers to implement smokefree policies and to encourage and provide access to stop smoking services for employees and foster a change in attitudes to tobacco smoking.

People who smoke have advice and support they need to stop

By October 2023 public health messages on vaping as a smoking cessation aid will be incorporated into online and traditional information sources and the use of e-cigarettes (or vapes) to manage nicotine dependency will be supported by specialist smoking cessation services.

In line with the requirements of the NHS LTP, by 2024 all people entering hospital as inpatients in acute mental health or maternity services will be asked about their smoking status. This status will be recorded and those who smoke will be referred on an opt out basis to specialist smoking cessation services provided under the Tobacco Dependency Treatment Programme.

By 2024, specialist support will be provided to pregnant people and their partners to stop smoking; following carbon monoxide screening, those with elevated levels will be referred via an opt-out system for specialist support.

By 2024, we will have introduced local Smokefree Pregnancy Champions into maternity services to lead action on reducing the prevalence of smoking in pregnancy.

By 2024 we will increase support for people with mental health conditions to stop smoking through interventions in acute settings and in the community that are tailored to the needs of people with mental health problems.

In 2023/24 we will introduce a programme of work to identify the groups (such as people with mental health problems and routine and manual workers) in areas with the highest smoking prevalence and target resources proportionately and effectively to reduce smoking prevalence and the harm from tobacco in these communities.

By 2024/25 we will have introduced a programme of work with partners that aims to reduce the availability of and demand for illegal and illicit tobacco.

People are able to avoid or reduce alcohol and drug related harm

People know the risks of misusing drugs and alcohol and can keep themselves safe

By 2024/25 we will have delivered awareness campaigns to help children and young people understand the risks of alcohol and drug misuse in collaboration between health and care services.

By 2028 we will have delivered at least four local health improvement campaigns to promote less risky drinking and drug use, and to prevent harm. Campaigns should integrate health and care, and be based on, and target, local population needs. They should include societal attitudes to drugs and alcohol.

By 2025/26 we will have delivered a training programme to health and care professional to develop their ability to identify and offer Alcohol Identification and Brief Advice to people who are most at risk of alcohol-related ill health in line with NICE recommendations in all adult health, social care, and criminal justice settings.

By 2025/26 we will have delivered a programme to reduce the misuse of prescription drugs including, but not limited to raising awareness of potential harms.

People who have misused drugs or alcohol have high quality care and support

We will ensure that findings and recommendations related to addictions and health behaviours from authoritative bodies such as Safeguarding Boards, Domestic Homicide Reviews and the Coroner are implemented as appropriate.

By 2024/25 we will have put in place effective mechanisms to ensure seamless continuity of care from hospital settings to specialist drug and alcohol community services.

By 2025/26 we will have increased the proportion of people who take up treatment in a range of personalised community-based integrated drug and/or alcohol recovery and support services by 13% in line with the national drug strategy target for Suffolk. Treatments include detoxification, prescribing for relapse prevention, psychosocial interventions, and safe supply/use of drugs.

We will increase access to harm reduction initiatives such as naloxone and needle exchange across a range of settings, targeting those people at highest risk to prevent avoidable illness and deaths to reduce the number of drug and alcohol related deaths in line with national targets (local targets from OHID awaited).

We will work to ensure alignment of services that support people using substances to better integrate treatment, manage risk for individuals and their families and local communities building on good practice developed in some parts of SNEE.

We will improve access to specialist support for people with co-occurring drug/alcohol and mental health problems.

We will provide support for the carers and families of people who misuse drugs or alcohol to enable harm minimisation on affected others and increase caring capacity.

We will seek to fully understand and meet the needs of underserved groups and people with protected characteristics, including women and people from ethnic minority backgrounds.

The housing needs of people with alcohol and drug problems, and their families and carers where appropriate, will be assessed at the right time, to prevent homelessness or to help them move on to a suitable home. People recovering from drug or alcohol misuse will have access to range of suitable housing provision, information, and advice.

People with drug and alcohol problems will have support from their peers through further development of communities of recovery that support people with drug and alcohol problems, and which address issues of stigma, isolation, employment and training opportunities, mental and physical health, and housing. Peer support is particularly effective for people in marginalised groups and communities.

Children and young people with greater vulnerabilities will have access to integrated specialist drug and alcohol approaches building on the system wide approach to working with children and young people who have experienced or are at risk of adverse childhood experience. Support for vulnerable groups such as Looked After Children, care leavers, those not in education, employment of training and victims of sexual assault, abuse, or exploitation, recognises and tackles the complexity of their needs.

We will improve access to treatment and support for adults experiencing multiple disadvantage – including combinations of homelessness, addiction, mental ill health, domestic abuse, and contact with the criminal justice system.

People with serious gambling problems receive high quality specialist support

People will get the specialist help they need

By 2029 we will expand NHS specialist clinics, and integrated working to help more people with serious gambling problems. Over 400,000 people in England are problem gamblers and two million people are at risk. Expansion of services for people with serious gambling problems will help prevent and treat these issues.

We will know we are making a difference because we will see:

• by 2028 smoking-attributable mortality will have reduced from 2017-19 rates and will have remained below the England level
• by 2028 we will have halted the rise in alcohol-related mortality and maintained mortality at below England level
• by 2028 we will have halted the rise in deaths from drug misuse and maintained mortality rates at below England level
• by 2028 smoking attributable hospital admissions will have reduced and will be maintained at below England levels
• by 2028 the rate of smoking at the time of delivery will have reduced to 6% or less in line with national targets
• by 2024/25 all smokers who are inpatients in acute and mental health settings will be referred to smoking cessation services on an opt out basis
• by 2028 smoking prevalence in adults will have reduced and will be approaching the national 2030 smokefree target of 5%
• by 2028, smoking prevalence in adults in routine and manual occupations, will have reduced to below 15%
• by 2028 the proportion of people who successfully complete alcohol treatment will have increased to at least the England rate (36.6% at 2021)
• by 2028 the rates of successful completion of drug treatment (opiates) will have increased to 7% from the current rate of 6.1%
• more people who successfully complete gambling addiction programmes

Quote “There are many reasons why addictions begin, and we know that the strain of managing an addiction can seriously impact on a person’s life, work, and relationships, and on those of the people around them. We commission services to support those who experience issues with alcohol and substance misuse and to help people to stop smoking.”
Cllr Andrew Reid, Suffolk County Council Cabinet Member for Public Health and Public Protection and Chairman of Suffolk Health and Well-Being Board.

Case Study

Supporting Communities of Drug and Alcohol Recovery in Suffolk

Peer support is an invaluable tool to support people to maintain their recovery and reduce harm from substance misuse. An effective example of this is the Recovery’s Got Talent Programme, initially funded through the Recovery Grant Scheme and now part funded through income generation from their activities. The Recovery Grant Scheme awards small grants to financially assist in developing projects that will improve and sustain the recovery of clients engaged with, or who have completed drug and alcohol treatment and rehabilitation.

The programme is led by people in recovery via a steering group supported by a dedicated worker from the specialist drug and alcohol treatment service. The group plan and put on an annual celebration of recovery – ‘Recovery’s Got Talent.’

The show is now in its sixth year and has provided people in recovery from addictions a platform to showcase their talents from poetry performance, singing dancing and even stand-up comedy. As a direct result of meeting due to Recovery’s Got Talent, a group of talented people in recovery have now formed the ‘East Coast Poets’ who meet virtually every week and have been invited to perform their poems and stories at the Theatre Royal and the Primadonna and SaxFest festivals. People state that finding a meaningful use for their time is one of the hardest aspects of sustaining recovery from addiction and preventing relapse. The creative communities of recovery which have developed across Suffolk as a direct result of the success and appetite for Recovery’s Got Talent provide this.

1.1.4 Trauma and Abuse – Safeguarding Children and Adults at Risk

Why is this important for people in Suffolk and North East Essex?

We want to ensure all children, adults, families, and communities across SNEE are safe and free from all types and forms of abuse and harm. Safeguarding refers to the processes of keeping people safe from all types of abuse and promoting their wellbeing, where a child or adult is unable to protect themselves from abuse. Safeguarding within SNEE ICB is a whole system multi-agency approach that crosses all ages, places where people live and work, communities, and systems.

What do we know about people’s local experiences?

SNEE ICB works in collaboration with the Suffolk Safeguarding Partnership (SSP), Essex Safeguarding Adults Board (ESAB), Essex Safeguarding Children Board and the Southend, Essex & Thurrock Domestic Abuse Board and Suffolk Violence Against Women & Girls Board to safeguard those members of our communities most at risk of harm and learn lessons from reviews to prevent future harm. However, there is high level of underreporting particularly of domestic and sexual violence and abuse. Improved data intelligence is needed to better understand the number of people who may require support to enable us to make evidence-based recommendations to inform the commissioning of services to meet these needs.

Together with our partner agencies, education services and voluntary sector we will focus our work in three key areas:

Safe at Home

Domestic abuse takes place between family members or intimate partners regardless of gender or sexuality. It can consist of psychological, physical, sexual, financial, emotional abuse and so-called ‘honour’ based violence. Domestic abuse offences in our area have increased every year since 2015.

Two thirds of all child sexual abuse (CSA) reported to the police is perpetrated by a family member or someone close to the child. CSA in the family is linked to a range of negative outcomes over the whole of the life course, including poorer physical and mental health, lower income, relationship difficulties and further violence and abuse.

In a national study it was reported that 16% of children aged under 16 experience sexual abuse during childhood. There are currently 185,000 children aged under 16 living in SNEE; 16% would represent nearly 30,000 children.

For families to receive support and services to help keep them safe we have front door systems that receive and process all safeguarding referrals. Across SNEE referrals into our front doors are increasing monthly.

Safe in our communities

Preventing and reducing Serious Violence Statutory Guidance (which includes Sexual Violence) was published in December 2022 placing a responsibility on us to carry out a Health Statutory Needs Assessment (SNA) and develop a local strategy that reflects the voices and lived experiences of our communities inclusive of all genders and identities.

Safe Safeguarding Systems across SNEE

The Liberty Protection Safeguards (LPS) were introduced in the Mental Capacity (Amendment) Act 2019 and will replace the Deprivation of Liberty Safeguards system. LPS will deliver improved outcomes for people within SNEE who are or need to be deprived of their liberty. We must ensure liberty is protected where this is in a person’s best interests and in line with legislation.

Case reviews are carried out where it is suspected that abuse or neglect may have contributed to a death or serious injury. Within SNEE we embed learning from reviews, both local and national, into our systems to enable effective safeguarding procedures and workforce development.

Children and young people in care including unaccompanied asylum seekers within SNEE should receive their health assessments within statutory timescales. Currently these timescales are not being met.

Children and young people within SNEE are being placed in unregulated care settings. To ensure their wellbeing and meet the health needs of these children and young people we need multi agency strategic oversight and planning.

Children and young people who experience adversity and trauma are at high risk of poor physical/mental health and emotional wellbeing, substantive increases in adopting anti-social and health-harming behaviours, including serious violence, poor attendance/exclusion at school, and decreased educational attainment Adults who face multiple disadvantages because of trauma and adversity are four times more likely to have addictions, fifteen more times likely to take their own life, and three times more likely to be absent from work.

How we plan to make a difference

Our safeguarding work will focus actions around our three priority areas:

Safe at Home

to effectively support families experiencing domestic abuse all healthcare services will:

• have a domestic violence and abuse policy
• have a lead person responsible for the response to domestic violence and abuse
• will train their staff on how to recognise the signs of possible domestic violence and abuse, including the support of alleged perpetrators of abuse, how to enquire sensitively and safely, the importance of confidentiality, and the organisation’s process for responding to disclosure

It is essential to address domestic and sexual violence and abuse from a ‘life course’ perspective. This approach explicitly acknowledges the impact of early abuse on later risk, the implications of abuse on the whole family and the value of primary prevention of abuse. SNEE will promote the regular sharing of data, not just from police, to raise awareness and assess the need of the population to ensure adequate services are commissioned.

SNEE will work to improve the multi-agency front door services so that they create genuinely joint, challenging, rigorous decision making every time there are concerns that a child or vulnerable adult may be suffering significant harm by:

• open dialogue commencing in Essex, with NEE as a driving force, with our statutory partners in establishing joint multi-agency accountability for safeguarding starting with consideration of the development of a MASH or similar front door
• recommendations from the review of our Suffolk Multi Agency Safeguarding Hub (MASH) health team completed in 2019 are progressed

Safe in our communities

Health Strategic Needs Assessments (SNA) will be completed under the Serious Violence Duty and a strategy developed that will reflect the voices and lived experiences of the communities within SNEE. The SNA and resulting strategy will be published by the 31st of January 2024.

Safe Safeguarding Systems across SNEE

We have appointed LPS leads across the ICB. Their role is to take on the implementation of LPS across SNEE and ensure system readiness. They will complete the LPS Maturity Assessment Framework. To ensure that the principles of Mental Capacity Act (MCA) are embedded within practice and seen as business as usual across the SNEE system.

We will focus on the lessons to be learnt by health from the local and national safeguarding review recommendations. We will do this by:

• focusing on good practice and sharing when things went well
• ensuring that all necessary actions relating to health take place
• listen to families and professionals to learn from their experience
• use risk assessments effectively and take appropriate action
• implement effective multi-agency working
• value challenge, supervision, and scrutiny

Initial Health Assessment (IHA) review meetings are in place, and we will continue to explore the system issues and processes to improve and maintain compliance with national requirements.

Designated Professionals for Looked After Children will continue to explore and support health assessment provision for the increased numbers of separated migrant children placed into SNEE.

Having trauma informed workforce, policy, and practice across SNEE ICB will reduce the negative impact of trauma experiences supporting better mental physical health outcomes for our population.

We will know we are making a difference because we will see:

Safe at Home

Domestic abuse: Each health care service in SNEE will measure itself against the four quality standards as set out in NICE quality standard QS116. These will be reported to the SNEE Designated Team quarterly though the safeguarding reporting framework.

• asking about domestic violence and abuse
• response to domestic violence and abuse
• referral to specialist support services for people experiencing domestic violence or abuse
• referral to specialist services for people perpetrating domestic violence or abuse

Our ambition is to reduce the prevalence of domestic abuse and sexual violence, regardless of who they affect and our commitment to support all victims / survivors of all genders and identities. We will do this through our safeguarding partnerships and board, supporting existing strategies such as education in schools on healthy relationships. By 2024 we aim to have a data sharing and reporting framework that provides regular data intelligence of domestic and sexual violence and abuse. This will be used to guide thecommissioning of services to support victims and raise awareness of domestic and sexual violence across our system.

Effective front doors to safeguarding- this will be monitored by the SNEE Designated Safeguarding Team and reported through our existing governance and reporting structures in SNEE:

• dialogue with partners in Essex is placed on the agendas in our multi-agency partnership forums
• an outcome framework for Suffolk MASH and KPIs for the MASH Health Team will be developed that measure feedback to providers, participation in strategy discussions and parity with partner agency functions within the MASH
• an annual audit plan is being developed for the MASH including, re-referrals, professional challenge where a differing of opinion exists between agencies, and service user feedback

VCSE providers in SNEE have implemented to use of trauma cards which will facilitate and aid easier, seamless disclosure across our system. University of Suffolk has been commissioned to benchmark trauma informed training and practice across the system to improve consistency, take up and longer-term tracking of the impact of trauma
informed practice.

Safe in our communities

Serious Violence Duty- this will be measured by the following objectives for the ICB:

• To ensure processes and information sharing agreements are in place to facilitate the sharing of relevant anonymous health data and information to inform the problem profile/strategic needs assessment for Suffolk and Essex (for example, number of violent injuries treated within NHS urgent care settings). This will be achieved by September 2023
• Support the development and implementation of a Suffolk strategy and an Essex strategy to identify and mitigate the risks identified and agree an approach to preventing serious violence, managing related health problems, and improving wellbeing/resilience of the community. This will be achieved by January 2024
• To ensure that there is appropriate commissioning within SNEE ICB to prevent, treat and manage serious violence as set out in the strategy. This will be achieved by January 2024

Safe Safeguarding Systems across SNEE

LPS will be measured by the following:

• LPS lead post across Suffolk and Essex is in post and linking in with all health providers/ICB ensuring they are on track with implementation using the measure of the LPS Maturity Assessment Framework
• the principles of the MCA to become “business as usual.” MCA bespoke training sessions for Primary care will be delivered by an external trainer in 2023 across SNEE, 13 half day sessions. The aim is to ensure that at least one clinician from each GP practice attends the training

Lessons learnt from reviews. In collaboration with our safeguarding partnerships and health care services in SNEE we will use the evidencing the impact framework to monitor and evidence that lessons are being learnt and embedded into practice. This will be co-ordinated by our SNEE Designated Team and reported to the relevant safeguarding partnerships.

The outcome is to ensure children and young people within SNEE receive their health assessments within statutory timescales. This will be measured by a review of compliance against statutory timescales.

The outcome is to ensure that child and young people within SNEE placed in unregulated care receive multi agency strategic oversight and planning. This would be measured by a designated nurse for LAC to provide strategic health input where children are placed into unregulated placements.

VCSE providers in SNEE have implemented to use of trauma cards which will facilitate and aid easier, seamless disclosure across our system. University of Suffolk has been commissioned to benchmark trauma informed training and practice across the system to improve consistency, take up and longer-term tracking of the impact of trauma informed practice.

Quote: “It has been said that the true measure of any society can be found in how it treats its most vulnerable members. We will continue to work in partnership across the ICB to raise awareness of abuse and support those who have experienced trauma through the life course. Safeguarding is the golden thread that runs through everything we do. This JFP reflects our ambition to ensure the population of SNEE ICB are safer at home, safer in our communities and protected by our safeguarding systems.
Fiona Ellis OBE (Co-founder and CEO of Survivors in Transition

Case Study

Jack’s Story

As a result of work completed by the Designated team domestic violence notifications from the Police are now shared and added to health records but this has not always been the case. Below is a real local case study which clearly demonstrates the significant benefits to this process.

Jack is a 4-year-old boy with speech delay, his Mum and Dad’s relationship is an abusive one with at least 2 domestic violence Police notifications attached to his health record. His speech therapist (SALT) was due to see Jack and was reviewing his records before the appointment when she noted the domestic violence notification, she also noted a recent MASH entry to his record which stated following the Police involvement a safeguarding referral had been made to consider the risk to Jack following his dad’s violent outburst towards his Mum. The outcome from the MASH was that Mum had been spoken to and confirmed the relationship had ended and Dad was no longer having contact with Jack, MASH then made the decision that there was no need for social care involvement. However, it was noted on the MASH entry to the health record that if professionals had evidence the relationship had resumed a further MASH referral should be made.

During the speech therapy appointment, they discussed what Jack did at the weekend and Mum explained they’d had a lovely time with Dad at the beach.

Following some advice from the Named Nurse the SALT was clear she would need to discuss this with Mum after the appointment without Jack present when she was able to explain her concern and the need to make a further safeguarding referral. Mum understood the need for this and appreciated the therapist’s honesty. Between the SALT and MASH, they agreed a safe time for MASH to contact Mum to discuss the concerns (ensuring Dad was not with her). She was then supported by social care to safely separate from Dad and move to a new area.

This identification of ongoing risk and Mum’s consequent safe separation from Dad was as a direct result of the sharing of information from Police into health records and the clear outcome MASH had recorded for health professionals to see. It demonstrates excellent partnership working between the SALT and MASH putting the safety and wellbeing of Jack and his Mum as a high priority.