Agenda item

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 times for treatment which were having a considerable impact on children, their family and friends and their education. 

(6)       Sussex Partnership Trust representatives further explained that when they took over the services, they did not understand the extent of Tier 2 waiting times. SPFT believed that the previous providers had not been used to being performance managed. They explained that there would always be a level of wait for routine assessments as unscheduled urgent and emergency care referrals were prioritised.  As part of their tender, SPFT had anticipated the waiting lists taking three years to resolve which was accepted by the CCG. 

(7)       SPFT confirmed that they were currently underutilising services, in order for staff to get used to working for a new provider and service model. They are demanding from staff a more efficient service than had been previously provided. There have been a number of issues regarding IT, a large exercise has been undertaken to transfer records in Kent onto the SPFT system.  These issues have taken some time and SPFT have kept the commissioners informed. Ms Scott stated that has had a number of conversations with Mr Clark where she had explained that she was going to have no fixed base in Kent in order to enable her to travel to all sites.

(8)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A number of Members raised the importance of early intervention to prevent young people from reaching the point of crisis and the importance of interventions from parents and teachers. CCG representatives agreed with the concerns raised by Members including the importance of early intervention. The CCG had spent a huge amount of time with SPFT to improve their services and it had been made clear to SPFT that they need to demonstrate progress.  NHS England representatives explained that CAMHS was recognised as a national challenge, and they were awaiting a report from the Secretary of State following a national review of CAMHS services.

(9)       One Member referred to the lack of integrated commissioning between tiers 1 - 4 with Tier 2 & 3 services commissioned by NHS West Kent CCG and Tier 4 services commissioned by NHS England. CCG representatives agreed that the separation of the tiers by government was not helpful; an integrated pathway between tiers was required to ensure a seamless service. NHS England representatives explained that the Strategic Clinical Networks were leading on pathway integration nationally.

(10)     Members commented on the perceived lack of GP training in mental health for adults and young people. CCG representatives explained that NHS West Kent CCG had introduced a lead GP for mental health, Dr David Chesover, who had a specialist in-depth knowledge of CAMHS. Dr Chesover was working with GPs in West Kent to build upon their mental health knowledge and skills base. One Member enquired if a GP mental health advocate would be introduced in every CCG and suggested that this could be raised with the Secretary of State.

(11)     Concerns were expressed regarding inequalities in service provision across Kent. CCG representatives explained that historically there had been underinvestment in CAMHS. The CCG were looking at ways to tackle service inequality through investment and commissioning at a more local level. Mr Ayres explained that the CCG would need to work with HOSC and the Health and Wellbeing Board regarding the proposed Section 75 Pooled Budgeting agreement.

(12)     A Member enquired about the maximum length of wait for assessment. SPFT confirmed that the current longest wait for assessment was 26 weeks but explained that the family concerned had not been able to meet the appointments. The majority of young people were seen within seven weeks. Another Member enquired if the NHS West Kent CCG would be discussing CAMHS in a public meeting. The CCG representatives assured Members that they would bring CAMHS to the CCG governing body in March.

(13)     Discussion also included the nature of the IT system used by SPFT and its compatibility with NHS England; collaborative working between KCC, CCGs and boroughs; transitions from children to adult services and transition between providers.

(14)     In response to a question, the Chairman undertook for Dr Eddy to be supplied with a briefing note regarding HOSC’s involvement with the CAMHS contract.

(15)     CCG representatives confirmed that they would welcome the opportunity to report back to the Committee in three months; they announced that they would be taking immediate action from this meeting.

(16)     Mr Chard proposed and Ms Harrison seconded the proposal which was agreed by the Committee and is set out in paragraph (18) below.

(17)     The Committee also thanked its guests for their attendance and contributions today, asked that they take on board the comments made by Members during the meeting and looked forward to receiving a further update in the three months time.

(18)     RESOLVED that this Committee write to the Secretary of State to ask him to assess the adequacy of the current CAMHS service in Kent and that the CCG be asked to identify an outstanding trust to assess improvements that can be to made in the way in which the Sussex Partnership Trust is carrying out the Kent and Medway CAHMS contract and to report back to this Committee.