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From conception to reality: Hertfordshire’s Community Perinatal Team
Following the launch of Wave 2 of the Perinatal Mental Health Community Services Fund, Liz Biggs reflects on her experiences as a commissioner involved in the setting up of a new specialist community perinatal mental health team, following a successful bid by Herts Valleys CCG to wave 1.
Sometimes I still have to pinch myself that we did it. Less than six months after hearing our bid for funding was successful, Hertfordshire’s Community Perinatal Team was taking referrals and supporting women and their families.
We had started early – setting up a Perinatal Joint Commissioning Group that reflected the commissioning system across Hertfordshire – with representatives from the two CCGs and the local authority, including public health and children’s services – even before the call for wave 1 funding applications. That made the process of pulling our bid together easier – we had already developed a commissioning group, meeting regularly, and our ongoing engagement with providers across the system fed into this.
We carried out a mapping exercise of services, providing a comprehensive audit of provision, and identified that we needed a specialist team to provide care and support for women with moderate to severe/complex mental ill health, and a connection between low level community support and high-end clinical support.
We knew a service was needed: figures suggested at least 400 women in Hertfordshire have severe mental health needs in the weeks before and after birth, with another 1,375 having mild to moderate needs.
Perinatal mental health was already embedded as a key priority in our child and adolescent mental health services local transformation plan (LTP), with LTP funding referenced in our funding bid, and now also in our sustainability and transformation partnership (STP) local maternity service plan.
We showed our commitment by holding a conference to raise awareness of perinatal mental health, setting out our ambition to an audience of 100-plus maternity and early years professionals. We funded 120 multi-agency professional places on Infant Mental Health Online (IMHOL) training through the University of Warwick, upskilling the workforce to recognise need and refer accordingly.
Feedback was collated from families and professionals about current levels of need, their experiences of services, and what type of service was needed. It was then about working with providers and partners to pool the information needed to complete the application form, bringing together the vision we wanted to achieve in terms of having a community perinatal team and ensuring we took the needs of our women and families into account and what was identified by our needs assessment.
We’d identified risks and challenges early on – the first: would there be sufficient referrals? Launching a new team, we feared professionals wouldn’t know about it and referrals wouldn’t come in. We should not have worried. The team has been inundated with double the predicted demand – beware. We are currently working with our provider on current demand levels.
Recruitment is always a worry, but internal candidates had been identified by our provider, with the focus shifting on backfilling. Data sharing, IT issues, unsuitable referrals – all risks were mitigated by thinking ahead about agreements and training.
Our service specification was based on need and we had a robust understanding across the system of Hertfordshire and what was going on to support mothers and families. What remained was the challenge of connecting up the system – maternity, early intervention and prevention services through to the specialist mother and baby unit.
We heard the good news in October 2016: our bid had been successful, and within six months the team was in place and accepting referrals. This was down to some amazing people, people with true commitment and a passion for what we were trying to achieve.
The importance of the joint commissioning group I think the importance of our joint commissioning group cannot be overstated. The group was crucial in
- taking the time to consider a future service from the perspective of providers and a whole system approach to the perinatal agenda which had the voice of women and families at the centre,
- making sure it was fit-for-purpose across the Hertfordshire system and that we had a responsive system.
The work continues in our joint commissioning group and we are working in partnership to develop an Outcomes Star for Perinatal to ensure we have a consistent evidence-based tool to support and measure outcomes for our women and families.
We are part of the East of England regional network around perinatal mental health and a subgroup brought together all successful wave 1 partnerships to share their journeys from both practical and operational perspectives.
The multi-disciplinary team is led and managed by our local mental health provider, Hertfordshire Partnership NHS University Foundation Trust, which manages our mother and baby unit, Thumbswood, and has 600 open cases right now. Yes, there really was a need.