Agenda item

LaurettaKavanagh (Kent and Medway Director of Commissioning for Mental Health and Substance Misuse, NHS Kent and Medway), Bob Deans (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust), David Tamsitt (Director Acute Services, Kent and Medway NHS and Social Care Partnership Trust), Justine Leonard (Director Older Adults and Specialist Services, Kent and Medway NHS and Social Care Partnership Trust), and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(1)       In introducing the item, the Chairman reminded Members that this was the third meeting looking into the topic of reducing accident and emergency attendances. He explained that his intention was to circulate a draft report drawing on the findings of all three meetings and the discussion around the preliminary findings presented at the 6 January meeting for Members’ comments as soon as was practical.

(2)       One Member referred to recent media reports around national findings of differing levels of accident and emergency at the weekend compared to weekdays meaning the subject was an important and topical one.

(3)       The broader context of mental health was set out by representatives of the NHS. One in four people will suffer from a mental health problem at some stage in their lives, and on any given day the number was one in six. There was a need to raise the profile of the issue and reduce the stigma attached to it. The continuing interest of the HOSC and other Committees at Kent County Council was commented on positively by health colleagues. Similarly, the recent report on mental health produced by the Kent LINk was referenced as a useful contribution to the subject of mental health.

(4)       This broader context translated into a major challenge for the health services, particularly as physical and mental health problems were often experienced by people simultaneously, sometimes complicated by alcohol misuse. The preventive health and wellbeing agenda involved a whole range of sectors, including employers. The valuable role Borough/City/District Councils played in providing such services as housing and leisure could not be underestimated. There were good examples of partnership working, including the Live it Well strategy produced by local NHS commissioners, Kent County Council and Medway Council and the work between KCC and the NHS on dementia prevention. Third sector providers also had a key role to play. In responding to a specific request from a Member of the Committee, representatives of NHS Kent and Medway and Kent and Medway NHS and Social Care Partnership Trust present at the meeting undertook to produce a series of bullet points about how each sector could contribute to improving mental health across the community and make the report available to Members of the Committee.

(5)       In terms of mental health services along the urgent and emergency care pathway, there were two services in particular which NHS representatives brought to the attention of the Committee: Crisis Resolution Home Treatment Teams and Liaison Psychiatry.

(6)       Crisis Resolution Home Treatment Teams were the first port of call and took referrals from a number of sources, including the ambulance service, GPs, and community hospitals. These teams were able to provide care in people’s homes and so prevent unnecessary admission to an acute hospital.

(7)       A general principle applied to mental health staff called on to provide out of hours cover was that they should have transferable skills. This would enable referrals to be handled more effectively. Concerning GP out of hours services, a representative of the Kent Local Committee explained that most of Kent was covered by the service provided by South East Health, but that the GPs were not necessarily local to the County. This might mean that not knowing the patients histories, and where they were risk averse, sending a patient to A&E might be seen as the safer option.

(8)       It was also explained that there was a double pressure of GPs to reduce A&E attendances. As part of emerging Clinical Commissioning Groups, they took part in producing plans to this end. As providers of primary care, part of the Quality Outcomes Framework (QOF), which were a set of indicators that determined part of a GP practices income, looked at the reduction made in A&E attendances. There was also a financial drive for Commissioner and Provider NHS Trusts to improve urgent and emergency care. The QIPP Programme (Quality, Innovation, Productivity and Prevention) included such measures as improving the diagnosis of dementia in general hospitals and reducing the use of antipsychotic medicine.

(9)       The point was made that A&E can be the right place for people with mental health problems and can enable the right physical and mental health diagnosis to be made.

(10)     Liaison Psychiatry services looked to make secondary care mental health services available in A&E departments. The service is fully implemented in East Kent Hospitals NHS University Foundation Trust and has led to a reduction in admission through A&E as well as reduced length of stay of those patients who are admitted and have mental health needs. NHS representatives indicated the reference to the well regarded Rapid Assessment Interface and Discharge (RAID) service in Birmingham mentioned in the background Note by the Committee Researcher. It was explained that the service in East Kent had been visited by the people establishing the service in Birmingham and was a chance to share good practice. The NHS locally was looking to expand the service 24/7 across the whole County. In response to a specific question, a representative from KMPT explained that there had been no recruitment or retention problems relating to the Liaison Psychiatry service in East Kent and they were positive the same would apply in both Dartford and Gravesham NHS Trust and Maidstone and Tunbridge Wells NHS Trust.

(11)     In response to a specific question about whether elderly people were assessed for dementia as a matter of course when they arrived in A&E, Dr Allingham explained that this did depend to an extent on where a patient was being sent from and who received them and more generally related to the quality of the paperwork. The requirement for a second assessment of dementia was getting less, and the paperwork relating to the Liaison Psychiatry service in East Kent was very good. In addition, more forward planning of care plans and Do Not Resuscitate (DNR) requests meant there were decisions made ahead of time not to send a person to hospital.

(12)     One Member raised the forthcoming changes in policing arrangements. Representatives of the NHS explained that no analysis of the impact of the changes had been made, but highlighted the good joint working between the NHS and police in the area of mental health which had been developed. Much effort had been put into providing education and training of people in the police service. There was also more co-location of mental health staff where people with mental health needs were likely to be. Liaison and diversion services were present at all custody suites with the aim of keeping people out of the criminal justice system.

(13)     In response to a query, the Committee Researcher provided clarification that the additional information requested by Members on Minor Injuries Units provided for them by Kent Community Health NHS Trust related to those services provided by that Trust only. The Researcher undertook to provide information about the other services.

(14)     The Chairman explained that for this, as for other items, the recommendation to simply note the report was a useful procedural device but proposed a fuller recommendation.

(15)     AGREED that the Committee note the report and thank KMPT and NHS officers for their comprehensive and constructive input.