The Health Scrutiny Committee met to discuss mental health and learning disability services provided by Hertfordshire Partnership University NHS Foundation Trust (HPFT), and to agree the Committee's work programme for the coming year. The committee agreed to write a letter to the Secretary of State regarding funding for adult acute mental health beds, and requested a future update on child and adolescent mental health services (CAMHS).

HPFT Update on Mental Health and Learning Disability Services

The committee received an update from representatives of the Hertfordshire Partnership University NHS Foundation Trust (HPFT), including Karen Taylor, Chief Executive Officer, David Evans, Chief Strategy and Partnerships Officer, and Emma Wadey, Chief Nursing Officer, regarding mental health and learning disability services.

HPFT provides mental health and learning disability services across Hertfordshire, Essex, Buckinghamshire and Norfolk, with 4,500 staff supporting around 40,000 service users. The trust also delivers integrated health and social care, working in partnership with Hertfordshire County Council.

Demand for Services

HPFT has seen a 25% increase in demand from young people since COVID-19, particularly for attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) assessments, with waiting times of up to two years. There has also been a 20% increase in demand from adults.

Councillor Dee Hart asked about young people being sent outside the county to access mental health services. Emma Wadey, Chief Nursing Officer, HPFT, responded that very few are, but that the exact number could be provided to the committee.

Councillor Liz Needham, Vice-Chair of the Audit Committee, asked if the increased demand was a result of the pandemic. Karen Taylor, Chief Executive Officer, HPFT, confirmed that modelling had predicted an increase in demand due to the pandemic.

Mental Health Urgent Care Centre

HPFT has opened a new mental health urgent care centre at the Lister Hospital, serving Hertfordshire and West Essex, with plans to open another at West Herts Hospital. The centre supports around 230 people a week who are experiencing a mental health crisis.

Mental Health Support in Schools

HPFT currently supports 42% of Hertfordshire schools and aims to reach 100% by 2029, in line with the NHS 10-year plan.

Adult Mental Health Beds

HPFT has 98 adult beds across Hertfordshire, against a benchmarked national number of 160. The trust is working to address this, with plans to open another 16 beds this year. Karen Taylor, Chief Executive Officer, HPFT, stated that capital funding is needed to open a bigger unit to accommodate all the need for Hertfordshire in the future.

Neil Tester from Healthwatch Hertfordshire asked about the possibility of unlocking strategic commissioning to help unlock funding. Karen Taylor, Chief Executive Officer, HPFT, responded that there is no current capital plan against which to bid, but that the trust will keep trying to get funding.

Learning Disability Services

HPFT is creating a new dedicated learning disability inpatient unit this year, reducing the number of beds from 16 to 8 as a result of the Transforming Care programme¹.

Assertive Outreach Services

HPFT has a clear line of around 250 people with high needs and support is in place for those individuals.

Data

Councillor Richard Roberts asked about the consistency and dates of the data presented in the report, particularly regarding suicide rates. Karen Taylor, Chief Executive Officer, HPFT, acknowledged the inconsistencies and explained that the data sources used were the latest available from public health national data sets. Emma Wadey, Chief Nursing Officer, HPFT, added that Hertfordshire has very low suicide rates nationally, but that every death is one too many.

Support for Staff

Councillor Chris Lloyd, Vice-Chair of the Health Scrutiny Committee, asked how HPFT is supporting the mental health of its own staff, given the increased workload. Karen Taylor, Chief Executive Officer, HPFT, responded that the mental wellbeing of staff is a key priority, with numerous programmes in place to support them.

Key Challenges

Karen Taylor, Chief Executive Officer, HPFT, outlined the three key challenges for HPFT:

• People with drug and alcohol coexisting conditions with mental illness
• ADHD and ASD and neurodiversity
• Maintaining an absolute rigour on ensuring that people with mental illness and learning disabilities get the support they need

Successes

Karen Taylor, Chief Executive Officer, HPFT, highlighted the opening of the mental health urgent care centre and the work done with Cherry Tree Cottage for children looked after as successes of the past year.

Adult Acute Mental Health Bed Pressures

Councillor Seamus Quilty BEM raised the issue of adult acute beds, and asked how much the independent sector beds are costing the trust. Karen Taylor, Chief Executive Officer, HPFT, responded that it is costing £16 million a year, and has been as high as £20 million. Councillor Quilty asked how much would be saved if HPFT had its own beds. Karen Taylor, Chief Executive Officer, HPFT, responded that it would cost about half that amount to run their own beds, saving about £8 million.

The committee agreed to write a strong letter to the Secretary of State in support of funding for adult acute mental health beds.

Mental Health Urgent Care Centre Access

Councillor Jon Claydon asked how access to the Mental Health Urgent Care Centre is managed. Karen Taylor, Chief Executive Officer, HPFT, responded that there are multiple routes in, including referrals from GPs, walk-ins, ambulance, and police. She added that additional crisis houses are being opened in Hertfordshire to provide respite and support.

Differences in Service Provision

Councillor Aaditya Kaza asked if there was anything particular or unique to Hertfordshire compared to Buckinghamshire, Essex, or Norfolk. Karen Taylor, Chief Executive Officer, HPFT, responded that the tremendous joined up working between HPFT and Hertfordshire County Council for learning disability services and for mental health is a real strength.

Staffing Numbers

Councillor Simon Marlow asked how many of the 4,500 HPFT staff are based in Hertfordshire and how many are patient facing clinical staff. Karen Taylor, Chief Executive Officer, HPFT, responded that around 3,500 are Hertfordshire based, and that the vast majority are clinical facing.

First Episode Psychosis Treatment

Councillor Simon Marlow noted that the target for people with a first episode of psychosis beginning treatment is only 60%, and asked why this target is so low. Karen Taylor, Chief Executive Officer, HPFT, responded that this is a national target, and that HPFT has flagged that this should be higher.

The committee agreed to invite HPFT back next year, and to consider what more they can do to support and highlight the work that HPFT is doing.

Health Scrutiny Committee Work Programme 2025/26

The committee discussed the Health Scrutiny Committee Work Programme 2025/26 and agreed to the following:

• To look at the items for the March meeting, including feedback from patient experience and the ICB changes.
• To write a letter to the Integrated Care Board (ICB) reminding them of their responsibility to provide up-to-date contacts.
• To request an update on Mount Vernon.
• To include the gambling harms report on the agenda.
• To request an update on CAMHS.
• To expedite the phlebotomy item and move it further up the work programme list.
• To send an email to the ICB to investigate phlebotomy waiting times.

Councillor Nigel Bell, Leader, Labour Group, asked for an update on Mount Vernon, and also on the gambling harms report. Tim Parlow, Head of Scrutiny, responded that there was no update on Mount Vernon, but that work was ongoing. He added that he would work with public health to get the gambling harms strategy into the schedule.

Councillor Jon Claydon picked up on the point about generative AI use by NHS trusts, and asked whether there had been any response from Chief Information Officers (CIOs) about what systems may be new. Tim Parlow, Head of Scrutiny, responded that there had not.

Councillor Dee Hart raised concerns about phlebotomy services in the borough of Broxbourne, with residents waiting three weeks for a routine blood test. Councillor Gordon Nicholson, Broxbourne Borough Council, seconded this point.

Councillor Wendy Rouse raised a query as to how she could pass on a complaint from a consultant who is concerned about delays and increased costs due to changes in lab systems.

Councillor Richard Roberts concurred with the thoughts about phlebotomy services, and stated that it was an issue countywide.

Councillor Miriam Swainston welcomed the scrutiny proposal around new GP surgeries, and stated that there seems to be a disconnect between what the district valuer for the NHS and ICB are willing to pay and what developers say they can afford to provide it for.