Agenda item

Dr. Barbara Beats (Assistant Medical Director Older Adults, Kent and Medway NHS and Social Care Partnership Trust (KMPT)), Justine Leonard, (Service Line Director for Older Adults and Specialist Services, KMPT),Evelyn White (Associate Director Integrated Commissioning, NHS Kent and Medway),Linda Caldwell (Lead Commissioner Older People, NHS Kent and Medway), Bob Deans (Chief Executive, KMPT), Helen Buckingham (Deputy Chief Executive and Director of Whole System Commissioning,NHS Kent and Medway), Sara Warner (Assistant Director Citizen Engagement, NHS Kent and Medway)and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(1)       An overview of the proposals was provided by a representative of the NHS group present which was drawn from the commissioners and main current provider of services, Kent and Medway NHS and Social Care Partnership Trust (KMPT). It was stated that the care of older people with mental health needs and dementia in particular was a high priority for the NHS locally and the proposals being developed were in line with both the national dementia strategy and the recent KCC Select Committee report on dementia. The proposals were a whole systems development which meant that commissioners were working on the proposals with the main and other providers. In summary, the proposals were to close the equivalent of 2 wards and use the savings to reinvest in home treatment services and the dementia crisis service.

(2)       The Committee was further informed that due to over capacity 1 ward had already been closed with no impact on the service and so they were looking to close 1 more ward of 16 beds, taking the total down to 45. The services were to be pump primed so they were in place before any further reduction in acute beds. The home treatment service, which was composed of multi-disciplinary teams, was ready to go. Kent County Council was to commission the dementia crisis service on behalf of the NHS as this would ensure it was aligned with social services. In addition there were already 13 Admiral Nurses across Kent. Preliminary work on service redesign had resulted in three viable options around the future location of acute mental health beds for older people, but if other viable options were put forward during the consultation, they would be considered.   

(3)       The Chairman drew attention to the recommendations put forward by the NHS, which could be found on page 229 of the Agenda that the Committee note the progress made in delivering improved outcomes for people with dementia in East Kent and the intention to go to public consultation. He then asked for additional questions and comments from the Committee.

(4)       One specific question related to the use of anti-psychotic medication and recent reports on its inappropriate use. The response was given that there was a drive across Kent and Medway to reduce their use, and it was going down. However, the levels would never go down to zero as there were cases where there was good clinical evidence for their use.

(5)       There were a number of points raised around equality of provision, and the argument made that provision would vary as different areas had different needs. However, best practice was being shared and the model proposed for East Kent was similar to that introduced in West Kent.

(6)       This overlapped with questions raised around the services available for people with different mental health needs, such as those with organic as opposed to functional health needs. The response given was that this was a false dichotomy to an extent as many patients had a range of different needs. In response to a precise question, the average length of stay for those with functional mental health problems was 49 days, and for those with organic mental health problems, such as dementia, was 55 days.

(7)       The role of carers was raised and NHS representatives explained they were crucial. Keeping people with dementia in their own homes, which included care homes, was proven to improve their quality of life and the West Kent model involved working with carers and social services to design services which would allow this to happen.

(8)       One major area of concern was the potential problem of causing unintended consequences to the detriment of the NHS as a whole through carrying out what were individually positive acts. The example of using independent sector providers to carry out cataract operations in the recent past which had led to financial problems in the acute sector was given of such a situation. Allied to this was concern around transition to the new service being carried out poorly as a result of attention in the health economy being focused on the broader structural changes underway in the NHS.

(9)       The response referred back to the points made about the plans being drawn up with a view to aligning the whole health economy. The observation was made that where people were on acute wards but could be treated more effectively elsewhere, this was good for the acute sector as well as the patient and health economy more generally. However, it was acknowledged that while there were few fixed long term costs within the health economy, there were short and medium term ones. NHS commissioners explained that in the current system 2% of the commissioning budget was set aside to provide a non-recurrent source of funding to cover the costs of change. At present this amounted to £54 million being set aside, and this was likely to be comparable to sums available in the future under the new system.

(10)     RESOLVED that the Committee thank its guest for attending today’s meeting and looks forward to receiving the consultation paper in due course. Members of the Committee are invited to form a small sub-group to further inform the consultation process.