Agenda item

LaurettaKavanagh (Director of Commissioning for Mental Health and Substance Misuse, Kent and Medway PCTs), Paul Absolon (Social Care Commissioner for Mental Health, Kent County Council), Erville Millar (Chief Executive, Kent and Medway NHS and Social Care Partnership Trust),Marie Dodd (Executive Director of Operations, Kent and Medway NHS and Social Care Partnership Trust), John Hughes (Director Community Recovery Services, Kent and Medway NHS and Social Care Partnership Trust), Mark Fittock (LINk Governor), Cate Boland (LINk Development Worker),Di Tyas (Deputy Clerk, Local Medical Committee), and Dr James Kelly (Local Medical Committee) were present for this item.

(1)       This section of the meeting built on the meeting in June (Minute 3, 11 June 2010) when hospital based mental health services were considered. As then, Lauretta Kavanagh, as lead commissioner for mental health for Kent and Medway Primary Care Trusts, provided an introductory overview. She indicated the summaries of the Live it Well mental health and wellbeing strategy which had been provided for Members at the start of the meeting in addition to the information contained within their Agenda. This strategy had the support of the three PCTs in Kent and Medway along with Medway Council and Kent County Council.

(2)       She explained that the strategy took a twin-track approach, that of promoting mental health and improving access and outcomes. There were three areas where large scale transformation was envisaged. The first was to increase the confidence and ability of primary care professionals in dealing with mental health. The second was to redesign community services so there was less reliance on hospital based services; the vital role played secondary care was acknowledged, but this redesign was aimed at enabling secondary settings to deal with the more severe cases more effectively. Thirdly there was a need to develop currencies and tariffs in mental health to shift from the current block contract to payment by results.

(3)       As Chief Executive of Kent and Medway NHS and Social Care Partnership Trust (KMPT), the largest provider of mental health services in the county, Erville Millar provided an overview of the range of community health services available. He explained that increasingly self-referral to services will be seen as important as GP referrals. The Increasing Access to Psychological Therapies programme (IAPT) was increasingly important. Among the other services available, there was also the Early Intervention in Psychosis Service that was aimed at the 14-35 age group, the First Response Intervention Service (FRIS) as the first line of assessment and the 24/7 crisis services which looked to prevent admission to accident and emergency departments wherever possible.

(4)       Mark Fittock, a LINK Governor, introduced a draft version of a LINk report into mental health services and which Members had before them. Mental health problems affected 1 in 4 of the population and LINks had difficulty getting to grips with the subject and the service available. He explained that LINks felt that although KMPT had there own user group, there needed to be better public/service user engagement with KMPT. Overall, the findings of the LINk report were reflected by the recent Care Quality Commission (CQC) survey of people who use community mental health services.

(5)       On the subject of user involvement, Paul Absolon from Kent County Council explained that there was heavy investment in user forums and there was a high level of input into the Live it Well strategy. More users could be involved if there better tie up with KMPT, he suggested.

(6)       There was a lot of discussion surrounding the CQC service users report. KMPT expressed respect for the report and it is used as a guide to focus improvements but indicated that the results were based on less than 1% of the patients seen by the Trust. Some Members expressed the view that a stronger response to the survey would have been welcomed and one Member indicated that Kent County Council was often judged on the basis of smaller survey samples. KMPT indicated that their own local surveys provided better results. From the perspective of the commissioners, Lauretta Kavanagh explained that a number of successes had been achieved by the Trust and there was work ongoing on an action plan to improve. There was also a move towards systems that would capture patient data in real time. By way of context, James Sinclair from KMPT explained there was a need for more local initiatives in order to involve service users and improve, but that the Trust delivered services from 117 sites and this made getting consistent quite a complex process.

(7)       From the perspective of General Practice, Dr James Kelly from the Local Medical Committee explained that he shared the concerns expressed by Members around capacity in the future when GPs will be expected to handle local commissioning as well as continue to see and treat patients. However, GPs were closest to patients and their needs and currently 90% of mental health treatment activity was carried out in primary care, but only 20% of the funding for mental health went to this sector. However, this also meant that GPs gave a high priority to mental health and were in a good position to act as effective gatekeepers to services. One challenge he saw was in the need to move away from the current block contract system, which made services difficult to decommission, and enable a range of providers to enter the market.

(8)       Responding to a question on the adequacy of inpatient mental health services, the perspective of the commissioners was that there were enough beds to meet the need and that work was going on with the Trust and GPs in East Kent to approve a business case to reduce the number of acute beds by 20 by 2012. A number of conditions had been set the Trust to ensure adequate community provision was available before this could happen. Erville Millar explained that within KMPT bed occupancy was around 93-97% capacity and so there were times when there were pressures. In order to reach the goal of reducing the number of beds by 20, work was being done to reduce length of stay from the current 23-25 days.

(9)       Connected with the issue of acute mental health services, Lauretta Kavanagh explained that there was ‘section 136’ suites adjacent to acute mental health wards where there was liaison with the police and there was currently an education programme underway to raise awareness within the police of the range of options regarding the best way to handle a member of the public with mental health care needs with whom the police would come in contact.

(10)     In response to a particular point around Mother and Infant Mental Health Services, the service was commissioned from KMPT and Erville Millar explained that the service had been commended by the recent Ofsted report and CQC and that the Member was quite right in indicating that the importance of identifying physical phenomena which may be contributing to mental health phenomena was crucial not just to this service but right across all mental health services.

(11)     Regarding mental health services for members of the armed forces, it was explained that the same services were available and better access guidance was followed. Information on the mental health service needs of servicemen was just beginning to be collected.

(12)     The issue of Child and Adolescent Mental Health Services (CAMHS) was raised by a number of Members as a topic that needed to be looked at urgently, in particularly those services for 17 year olds where there was a transition from CAMHS to adult mental health services.

(13)     There was also a discussion on forensic mental health services. Representatives from KMPT explained that secure services involved a heavy investment in monetary terms, and as a proportion of the mental health spend. It was explained that the average length of stay in a medium secure setting was 2 years and for a high secure setting, 7 years. For low secure settings in Kent, the average was 21 days. In these latter settings it was explained that there was balance to be struck and often the challenge was to prevent people entering, rather than preventing people leaving. In response to a specific question about one site, Erville Millar explained that Hucking Hill House was no longer used for rehabilitation for forensic services.

(14)     As a final point, Lauretta Kavanagh explained that 3 public awareness campaigns around mental health were planned.