Agenda and minutes

(1)       RESOLVED that the Minutes of the meeting of 29 November 2013 are correctly recorded and that they be signed by the Chairman.

(1)       The Committee noted that Cllr Pauline Beresford had replaced Geoff Lymer as a District Council representative on this Committee.

(1)       A Member expressed concern that the report detailed proposed changes to the service which would take effect from April 2014.  It was suggested that the Scrutiny Research Officer liaise with the service to produce a note in advance of the next meeting detailing the types of symptoms and treatments for musculoskeletal and orthopaedic conditions; the reduction in the rate of injections given for low back pain and any implications this may have had.

(2)       RESOVLED that this Committee notes the reports and looks forward to a further update on the re-design of Musculoskeletal and Orthopaedic Care Pathways at the Committee’s meeting in March.

Dave  Holman (Head of Mental Health Programme Area and Sevenoaks Locality Commissioning, NHS West Kent CCG), Ian Ayres (Accountable Officer, NHS West Kent CCG), Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England), Steven Duckworth (SEC Strategic Clinical Networks and Senate, NHS England), Lorraine Reid (Managing Director - Specialist Services, Sussex Partnership NHS Foundation Trust) and Jo Scott (Programme Director - Kent and Medway Children & Young Peoples Services, Sussex Partnership NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. The representatives of Sussex Partnership NHS Foundation Trust (SPFT) began by setting out a short chronology and update on progress. SPFT took over the management of the service in September 2012, transferring 274 staff via TUPE arrangements from the seven previous providers, into a single Kent and Medway team. SPFT have created four hubs in Kent, three of which are fully staffed in Medway and Swale, South Kent and East Kent. Recruitment for the West Kent hub is continuing, and they have recently moved into their new offices.

(2)       SPFT inherited the service with a legacy of extremely long waits. Young people referred before April 2013 have all been seen and external waiting lists have also been reduced to six weeks. An Out of Hours service has been established across Kent and Medway outside of routine working hours. The demand for this service has been much higher than expected with 150 Out of Hours assessments a month. Routine referrals have been delayed as a result of unscheduled urgent and emergency care referrals.

(3)       SPFT highlighted two significant challenges: Common Assessment Framework (CAF) referrals and Tier 4 inpatient admissions. The current CAF process restricts access to universal services (Tier 1) making it easier to be referred unnecessarily to higher tiered services. SPFT are signposting back 23% of CAF referrals to Tier 1 which makes families feel like they are being rejected by CAMHS who only provide Tier 2 & 3 services. Commissioning for Tier 4 inpatient mental health beds has been transferred to NHS England. There is a national shortage of these beds with young people waiting in acute hospitals until a Tier 4 bed becomes available. 

(4)       The Chairman then invited The Rt Hon Greg Clark MP to speak as a guest of the Committee. Mr Clark thanked the Chairman for the opportunity to address the Committee. Mr Clark expressed his concerns regarding the adequacy of CAMHS in Kent, and in particular the Tunbridge Wells area. He had been contacted by a number of constituents who were concerned about long waiting times, the standard of communication from SPFT and the lack of a single point of referral.

(5)       Mr Clark also expressed concerns that the waiting lists had been under-declared under the previous contract holder and data was missing from the performance report. Mr Clark added that there were further issues surrounding staffing levels, transition to adult services and waiting  ...  view the full minutes text for item 14.

Ivan McConnell (Director of Transformation and Commercial Development, Kent and Medway NHS and Social Care Partnership Trust), Angela McNab (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the Committee’s guests and asked them to introduce the item.

(2)       Ms McNab updated the Committee on the progress of the plan following the conclusion of the Kent and Medway NHS Joint Health Overview and Scrutiny Committee (JHOSC). She reminded Members that Medway Council’s Health and Adult Social Care Overview and Scrutiny Committee had subsequently referred the decision to the Secretary of State for Health. After an initial assessment by the Independent Reconfiguration Panel, the Secretary of State confirmed that the reconfiguration could proceed.

(3)       Kent and Medway NHS and Social Care Partnership Trust (KMPT) had continued to move forward with implementation of the plan. One new ward had been opened at the Dartford Centre of Excellence site which had enabled the closure of the younger adults ward at Medway Maritime Hospital before Christmas. The remaining ward at Medway Maritime Hospital was to close as soon as possible once the additional bed capacity in Kent and Medway had been increased. The new ward in Dartford provided better facilities for patients including private bath rooms. Enhanced transport support had been provided for relatives and friends over the holiday period. KMPT had met regularly with service users during these changes and had received positive feedback. In addition, KMPT were recruiting to the enhanced Home Treatment and Crisis Teams. A key aim of KMPT was to reduce the use of crisis wards over time with improved community and home services; enhanced psychiatric liaison and street triage teams with Kent Police.

(4)       In November, KMPT began piloting a new personality disorder service in Medway. If successful, they planned to role out the intensive day service across Kent and Medway. The outcome of the pilot was already looking very positive. 15 patients had been involved in the pilot; these patients had historically had multiple presentations leading to Section 136 or acute admissions. Since the beginning of the pilot, only one patient has had a presentation.

(5)       KMPT were developing plans to enhance the number of beds with the introduction of 14 additional beds across Kent and Medway. The KMPT Board had agreed the capital spend to facilitate additional bed capacity at the Maidstone site. Discussions were taking place with regards to a capital build (new build) or a modular build to facilitate the additional beds.  KMPT would shortly be starting the refurbishment of Dudley Venables House in Canterbury which would increase acute care and improve accommodation. This facility was due to re-open in June or July.

(6)       KMPT were working with service users and carers to clearly define the term Centre of Excellence. They were looking at the range of professionals and interventions that service users would have access to at all Centres of  ...  view the full minutes text for item 15.

Ivan McConnell (Director of Transformation and Commercial Development, Kent and Medway NHS and Social Care Partnership Trust), Angela McNab (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(1)       Mr McConnell introduced the presentation.  He explained that the transformation programme was a clinically led programme, delivering a clinical strategy. The programme aimed to provide the right care at the right point by the person with right skills. A multidisciplinary team would work with the individual to provide medical and psychological interventions; nursing, carer and occupational therapy support and enable interactions with social services.

(2)       KMPT outlined the four key aims of the clinical strategy which were:

1. Provide excellent community services close to home or close to home as possible, reducing the number of people who inpatient need care. Where necessary community services would support the length of stay being as short as possible

2. Better service integration and partnership working. KMPT were working with commissioners to enhance primary care mental health support. They were embedding community nurses within GP practices, educating and training nurses and GPs. David Chesover, NHS West Kent CCG lead GP for mental health, had been working with two West Kent consultants to deliver schizoaffective and bipolar disorder training to GPs. They were hoping to roll this out across the county.

3. Improve quality and dignity in services including a high quality therapeutic environment and the promotion of mobile working as demonstrated by the street triage pilot and the police custody liaison services.

4. Expand and enhance the specialist services, where appropriate, to potentially provide those across a wider geographic area.

(3)       The clinical strategy was a benefit-led approach for inpatient, planned care, urgent care/crisis and dementia programmes. In re-designing pathways, KMPT have identified the need to better communicate and engage with patients, demonstrate what the trust has delivered; enhance partnership working and learn from previous experience.

(4)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. One Member had attended the KMPT Board meeting on 30 January 2014 and was concerned that safeguarding was not discussed. In the board papers, a target was set for 80% attendance by KMPT practitioners when invited to a Child Protection conference. It was reported that in Margate and Thanet there was only a 32% attendance rate. Ms McNab explained that safeguarding was absolutely critical.  She explained that at the board meeting, they were unable to drill down into detail. Instead this issue would be picked up by the board’s Quality Committee who would investigate why staff felt it is not imperative to attend. Ms McNab offered to write to Mr Chard about this issue.

(5)       Members expressed concerns that KMPT’s existing service provision had not improved beyond adequate. They felt that KMPT should concentrate on the basics before introducing the transformation programme. Ms McNab explained that KMPT were making changes  ...  view the full minutes text for item 16.

Ian Ayres (Accountable Officer, NHS West Kent CCG) was in attendance for this item.

(1)       Mr Ayres kindly offered to stay for this item and answer Members’ questions. A number of questions were raised about the possibility of decommissioning the Patient Transport Services. Mr Ayres accepted that the position with NSL Kent, the current provider, was not good and gave an assurance to the Committee that improvements would be made. Mr Ayres explained that there was a real threat in lead up to Christmas that the service could have lost its provider; the service has now been stabilised. The CCG were meeting with NSL Kent to reassess the contract on current activity including the vehicles and staff required to meet the peaks of demand. Additional funding had been secured to reassess the contract; external analysis of the current contract found that the money available and the services expected to be provided were out of balance.

(2)       Mr Ayres acknowledged that the problems encountered with both providers: Sussex Partnership NHS Foundation Trust (CAMHS) and NSL Kent had been partly caused by incorrect information about service usage being given during the tendering process. Mr Ayres explained that under the previous provider a block contract was awarded which had led to a lack of record keeping on service activity. With the move to payment by results contracts, a key lesson has been learnt by the CCG about the importance of undertaking a year of recording service activity before going out to tender. The CCG would look to decommission the service if performance targets were not met under the terms of the reassess contract.

(3)       Members enquired about the recent CQC Inspection Report. Mr Ayres acknowledged that the criticisms within the CQC report. He explained that the unannounced inspection took place in the same week as new manager started with NSL Kent. After due consideration the CQC decided to allow the service to continue; as it believed that the CCG and NSL would be able resolve the issues and make changes. Mr Ayres explained that the recommendations made by CQC had been implemented. The most significant recommendation, the Disclosure and Barring Service checks on staff, had been completed with the exception of staff on long term sickness absence. One of the Members requested the Scrutiny Research Officer to circulate the link to the CQC report.

(4)       In response to a specific question about NSL Kent staff taking strike action it was explained that the GMB trade union members of NSL Kent’s staff had voted to take strike action but had not yet called a strike. The vote was taken before new local management was introduced.

(5)       There was a discussion about alternative providers for Patient Transport Services. Mr Ayres explained that there were a limited number of providers and it would take a minimum of six months for a new provider to be put in place. Further, the commissioning of a Kent and Medway wide service had put an unhelpful complexity into the system.  ...  view the full minutes text for item 17.

(1)       RESOLVED that the Committee notes the reports and looks forward to an update at the April meeting. 

(1)       A suggestion was made for the Committee to look into the provision of dementia services in Kent. It was recognised that these services were delivered by a number of non-NHS organisations including Kent Fire & Rescue Service and the voluntary sector. The Scrutiny Research Officer was asked to provide a scoping document for discussion at the next meeting of the Committee.

(2)       RESOLVED that the Committee note the report.