Agenda item

Mr I Darbyshire, Senior Associate, Kent and Medway Commissioning Support, Ms C Infanti,  Strategic Commissioning, Children’s Services, Ms L Reid and Ms S Button, Sussex Partnership NHS Foundation Trust, and Ms L Kavanagh, NHS Kent and Medway, were in attendance for this item.

1.         Mr Darbyshire introduced the report and explained that it followed on from the update given at the Committee’s previous meeting.  He introduced the visiting speakers, who were present in response to the Committee’s request that representatives from the service provider attend to answer Members’ questions. Aservice model and performance data from Sussex Partnership NHS Foundation Trust were tabled.

2.         Officers and visiting speakers responded to comments and questions as follows:-

a)         do Kent’s arrangements, service level agreements and targets differ from those of any other local authority the Trust works with?  Ms Kavanagh responded that the model of support used in Kent is comparable to that used elsewhere, and had been based on known examples of best practice from elsewhere.  Ms Reid added that the ‘Right from the Start’ model, which aims for early assessment and quick progress, had been developed by the Trust and previously used in Hampshire.  In Kent, this model has been implemented faster than it had been anywhere else.  The service specification and key performance indicators are similar to those of all the Trust’s other clients;

b)         concern was expressed that, as the service had stopped using the homeopathic hospital at Tunbridge Wells, and other services may have insufficient staff to cover, young people with eating disorders may be allowed to drop out of the system.  West Kent may, in effect, be subsidising services in Sussex. Ms Button explained that a major service transformation had increased the staffing and resources in West Kent to ensure that the range and number of staff available there is sufficient to meet local demand.  The staffing model used at the homeopathic hospital is one of large teams arranged in hubs and satellites to cover a large area, offering maximum accessibility and choice, delivering services locally via methods that people want, eg via GPs, schools, youth hubs, etc.  There are sufficient resources to ensure that any gaps, eg staff sickness, are covered;

c)         The questioner remained unconvinced by the responses given to points a) and b). Ms Kavanagh added that Sussex is able to provide a faster service now as its model was established five years ago and has thus had more time to bed in and deliver shorter waiting times, so its speed is not at the expense of services in Kent.  Kent can benefit from the experience gained in Sussex and the lessons learnt in establishing its model;

d)         one speaker stated that he would not wish to take on the contract for CAMHS in Kent as the service has historically had such a poor reputation.  As KCC is judged by the outcomes which it achieves, the delivery of a good service is more important than the model used to deliver that service, and Kent should be given the CAMHS service it deserves. What is needed is fast improvement;

e)         how does the inherited backlog of cases in Kent compare to those of other authorities the Trust has worked with? Ms Reid replied that the backlog had been larger than expected, but the Trust intended to deliver a very good service and was alert to the challenges ahead;

f)          how long did it take to turn around the service in Sussex? Ms Reid replied that it had taken 18 months to reduce the waiting list in Sussex when the Trust had worked there five years ago.  From this, it had learnt much. Good models and performance indicators are vital for measuring progress.  It is intended that Kent’s progress will be faster than that achieved in Sussex.  The initial cultural change is the slowest part and can take more than a year to achieve;

g)         how does the level of resource in Kent compare to that in Sussex and Hampshire? Ms Button replied that the Trust had found fewer staff in West Kent than they had expected but had addressed this by some recruiting as well as transferring some from East to West Kent.  In North and West Kent, there is much competition with London to recruit specialist staff, including emergency out-of-hours staff.  The target is to reduce the waiting time for an initial assessment appointment to 4 – 6 weeks by July 2013, and there have already been signs of progress towards this.  There is no waiting period for young people needing emergency appointments; 

h)         another speaker expressed a lack of confidence that the service in North West Kent could deliver the reduction in waiting times shown in the trajectory charts in the report, which seemed to show aspirational rather than realistic targets.  Many adolescents drop out of the system while they are waiting to be seen. Ms Button sought to reassure Members that the increased staffing levels in West Kent will reduce waiting times, and the Trust’s model will ensure engagement with young people who drop out.  The model allows young people to choose how and where they want to be engaged.  Ms Kavanagh added that the NHS could see clear dissatisfaction with the service as it was, hence the re-procurement of the service.  The trajectory charts were not aspirational but were realistic and could be achieved by July 2013; 

i)          another speaker supported the views already expressed and the lack of confidence around reducing waiting times in North and West Kent.  If the times stated are not achieved by July 2013, this Committee will hold the Trust to account.  Ms Kavanagh replied that it is important to have a realistic picture of waiting times in different areas of the county so the scale of the challenge can be seen.  The wait between referral and starting treatment is currently 8 – 12 weeks.  The aim is to provide equitable resources and an equitable experience for all young people across Kent, regardless of area. To this end, all eight Clinical Commissioning Groups share the same responsibility, working to the same specification and same targets;

j)          does the fast-track of urgent and severe cases create a two-tier system? Ms Button explained that young people in crisis have priority and do not have to wait for an appointment.  There is some prioritisation for those whose needs are assessed as ‘less severe’, but apart from these cases, the Trust ensure that those who have waited the longest are seen first. It is important to treat each case in the best and safest way possible.  Ms Kavanagh added that the Trust ensures that parents know what to do and how to contact the service to seek more urgent attention if a young person’s circumstances change; 

k)         a speaker commented that the tables showing numbers waiting and the length of wait, in the papers tabled at the start of the discussion, are not clear and do not help Members’ understanding of the picture.  In the chart which lists figures for each area, neither Sevenoaks nor Tonbridge and Malling are represented, and the correlation between these figures and the trajectory charts in the report is not clear.  Ms Button explained that the towns and areas listed do not relate strictly to administrative districts but are the names of area teams (in which, Sevenoaks and Tonbridge and Malling come under T2 Tunbridge Wells and T2 Maidstone, respectively). She undertook to re-supply the Committee with the same data broken down by administrative districts; and  

l)          Members asked that a further update report on the CAMHS service be made to a future meeting of this Committee so progress can be closely monitored.

3.         The Cabinet Member, Mrs Whittle, commented that a key issue for KCC was to recognise and resource the need for early intervention, which it was seeking to do via the Young Healthy Minds initiative. Services will be commissioned jointly, and aspirations and goals also need to be jointly held.  Joint referrals and assessments will ensure that every patient receives the most appropriate service for their needs.  The backlog of cases needs to be cleared before the service can be sorted out.  Today’s discussion has been useful in indicating the need for additional investment.

4.         RESOLVED that:-

a)         the information set out in the report and given in response to Members’ comments and questions be noted;

b)         a further update report on the CAMHS service be made to a future meeting of this Committee: and

c)         the information and clarifications requested by Members, ie data on waiting times and numbers broken down by administrative district, and a comparison of resources available in Kent, Sussex and other south east regions be circulated to Members of the Committee following this meeting.