Dear Mr Andrew Cox

Response to Regulation 28 Report to Prevent Future Deaths – Michael John Owen Cox

I am writing in response to the letter and above-named report (received 20 June 2019) following the inquest into the death of Mr Michael Cox. Your report highlights some of the specific issues that are presented when people with complex needs (often relating to drug and alcohol use, and issues of mental ill health) move from bespoke assessment/treatment services and into mainstream and longer-term placements. Michael Cox’s case demonstrates that there is a real need for more and better accommodation-based services featuring care and support that is capable of meeting needs such as his. Much work is presently happening in Cornwall in recognition of the fact that existing service provision does not always meet the needs of the most complex individuals in the county. Below, I have listed some of the contemporary initiatives that are underway to address this shortfall. I hope that you will appreciate the effort that is being made to ensure that in future, people will benefit from the services that they need, staffed by people with the skills and capacity necessary to cater for them. Strategic work – identifying and recognising the issues. The Cornwall Community Safety Partnership has developed a draft multiagency Cornwall Complex Needs Strategy (2019-23) to improve the approach to partnership working and provision in Cornwall, including for people with complex needs related to mental health and drugs/alcohol. The strategy includes recommendations to develop a more coordinated multiagency approach to support this group of people, and a system of accommodation provision with access to care and support that meets the needs of those at different stages of recovery. The draft multiagency Cornwall and Isles of Scilly Adult Mental Health Strategy (2019-24) also identifies the need to improve access to specialist support for those with a dual diagnosis of both mental health and drug/alcohol problems. It highlights the need to improve the pathway for people to receive a social care assessment and to access appropriate care and individualised support, and commits to exploring future opportunities to develop appropriate accommodation to meet the needs of those with complex and enduring mental health conditions. The national Making Every Adult Matter (MEAM) approach helps local areas to design and deliver better coordinated services for people experiencing multiple disadvantage. Cornwall has been Mr Andrew J. Cox Acting Senior Coroner for Cornwall and the Isles of Scilly Cornwall Council

By email only: cornwallcoroner@cornwall.gov.uk

Your ref: AJC/LJB

Date: 21 August 2019

Information Classification: CONTROLLED selected as a MEAM pilot area, and strategic and operational partners are currently working together to agree and develop the most appropriate method of delivering MEAM in the county. Case studies have recently been reviewed, and it has been determined that people with issues of mental ill health, drug/alcohol issues, people displaying aggressive/violent behaviour, schedule one offenders, people with convictions for arson, and people who have had multiple previous evictions are key cohorts that the system is currently failing to properly support. System redesign – addressing the issues. For the assessment and care management phases, a multiagency operational dual diagnosis steering group was formed in November 2018. The group is focused on strengthening the interface between secondary and tertiary mental health and drug/alcohol services, and identifying barriers that prevent multiagency joint working. This work is intended to ensure that no individual (including those in residential care and accessing care and support in the community) is excluded from any service, and to improve the referral pathway between mental health (such as Community Mental Health Teams) and drug/alcohol services (such as Addaction). For the delivery of services and support, a complex needs system model has been proposed, which will be implemented by the Cornwall MEAM Strategic Board. The model includes the expectation that multi-disciplinary team meetings take place where people have multiple needs, that a lead professional is identified to ensure that the person is linked to all appropriate support, that creative solutions are considered including links to community assets, and that there is a clear escalation route for any cases where appropriate support and/or accommodation has not been identified. Social care and accommodation with care. A strategic task and finish project including Adult Social Care (ASC), NHS Kernow Clinical Commissioning Group (NHSK), Cornwall Partnership NHS Foundation Trust (CPFT), Housing Strategy and Partnerships, and the Drug and Alcohol Action Team, as well as other partners, is currently being established to take forward recommendations in relation to social care and accommodation to ensure that the available provision is meeting people’s needs. This task and finish project runs until April 2021, during which time it will work on the following.  Prevention - review and recommission of the ASC and NHSK jointly-funded and externally- commissioned prevention services that provide support for people in relation to preventing crisis, self-management of health and wellbeing, and increasing independent living skills.  Domiciliary care – review of the needs of people assessed as eligible for social care related to mental health and/or drugs/alcohol and the approach to commissioning domiciliary care for this client group by ASC and CPFT.  Supported housing - work with providers of housing in Cornwall in order to understand the needs, availability and gaps in supported housing provision for people with mental health/complex needs in Cornwall. A clear strategic approach will be agreed by the task and finish group regarding the development of specialist supported housing for people with mental health and/or complex needs in Cornwall. The project will include analysis of demand and supply, and a profile on the housing requirements,

Information Classification: CONTROLLED including required locations and types of accommodation. A review will take place regarding the current residential/nursing care home and supported living provision to better understand the gaps and shape the market to meet needs. The work required to shape the market following this is expected to go on beyond April 2021. (Timescales for this are to be confirmed). I hope this letter reassures you that the gaps in current service provision have been identified, and that work is planned to ensure that people with mental health and other complex needs in Cornwall receive access to appropriate accommodation with care and support. Please let me know if you have any questions or if further information is required.