Agenda item

Sue Mullin (Commissioning Manager, Kent County Council), Ian Ayres (Accountable Officer, NHS West Kent CCG), Colm Donaghy (Chief Executive, Sussex Partnership NHS Foundation Trust), Simone Button (Divisional Director, Children and Young People’s Services, Sussex Partnership NHS Foundation Trust) and Jo Scott (Programme Director, Kent and Medway, Children and Young People’s Services, Sussex Partnership NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Mullin began by giving an overview of Kent County Council’s role in the commissioning and development of emotional wellbeing and mental health services for children and young people in Kent. In 2010, an Ofsted Review had found that the outcomes  for children and young people in care were inadequate, which led to Kent County Council and partners to review all provision, including mental health and emotional wellbeing, and  established a framework for early intervention and prevention services.

(2)       Ms Mullin reported that in July 2011 Kent County Council and NHS Kent & Medway had agreed to align funding in order to jointly commission emotional wellbeing and mental health services for children and young people. Kent County Council led the procurement of emotional wellbeing services and the NHS led the procurement of the CAMHS services. Contracts were awarded in September 2012 for a three year period. Kent County Council aligned funding into the CAMHS service to specifically support provision for Children in Care. It was stated that there was no waiting list for Children in Care and Kent County Council was happy with the provision of services for Children in Care by Sussex Partnership NHS Foundation Trust (SPFT).

(3)       Ms Mullin stated that HOSC on 31 January 2014 was a watershed moment for the commissioners: NHS West Kent CCG and Kent County Council. As a response to the disparity of provision, services and commissioning arrangement identified by HOSC, the commissioners developed, with multi-agency partners, the draft Emotional Health and Wellbeing (EMHW) Strategy for 0-25 year olds in Kent which would go out for public engagement in October 2014. Ms Mullin reported that the new partnership response was a positive approach to improve emotional wellbeing and mental health services for children and young people in Kent.

(4)       Mr Ayres gave an update on actions taken to improve the performance of CAMHS in Kent. SPFT were now compliant with contract standards for waiting times for routine referrals: referral to assessment and assessment to treatment.  SPFT were on track to clear historic backlogs by the end of October 2014. SPFT had completed team restructures and teams were operating close to full capacity.The performance notice served on SPFT by the CCG in February 2014 was fully achieved at the end of August 2014; the CCG were assured that the current contract performance regime could end. He stated that significant progress had been made but further action was still required.

(5)       He reported that NHS West Kent CCG had commissioned Kent and Medway NHS and Social Care Partnership Trust (KMPT) and SPFT to deliver a Section 136 Place of Safety in Kent in Dartford. The Place of Safety replaced arrangements for children picked up by the police under Section 136 to wait in A&E and police custody for inpatient admission. The CCG had introduced Serious Incident reporting, for when children were not housed appropriately, as part of the monthly performance review. 

(6)       On the request of HOSC, a peer review of the performance plan and current model of service was undertaken by Oxford Health NHS Foundation Trust.  Their initial findings were positive but had found that the Common Assessment Framework was a barrier to accessing services. The full report would be available at the end of October 2014.

(7)       Mr Ayres noted that NHS West Kent CCG had been working with Kent County Council, Kent Health and Wellbeing Board, NHS England and Healthwatch Kent to jointly review commissioning arrangements for CAMHS and develop the Emotional Health and Wellbeing Strategy for 0-25 year olds in Kent. Mr Ayres reported that the contracts for existing commissioned services were due to end in October 2015. He highlighted the need for holistic procurement across the tiers based on the learning from previous procurements.

(8)       Mr Donaghy congratulated SPFT staff on their efforts to make improvements. On visits to staff in Kent, he had been greatly impressed with their commitment and motivation to improve care for children in the county. He stated that the SPFT was not complacent and recognised that there was still further work to be done. 

(9)       The Chairman invited Ms Cribbon, local Member for Gravesham East, to speak. She raised concerns about the lack of access to CAMHS services by the Troubled Families programme in Gravesham. Ms Mullin and Mr Ayres stated that they were not aware of any issues relating to the Troubled Families Programme particularly in Gravesham but they would investigate this matter further.

 (10)    Members of the Committee then proceeded to ask a series of questions and make a number of comments. Mrs Allen thanked the Chairman for having CAMHS on the Committee’s agenda. She stated that the reports would be circulated to the relevant committees.

(11)     A number of comments were made about commissioning and the importance of the tender specification and accurate data. In response to a specific question about the lack of a waiting list for Children in Care, Ms Mullin explained that Kent County Council had a duty to monitor and record data accurately for Children in Care. When commissioning the services for Children in Care, it had been easier to determine the resources required for the service as the prevalence and need had been accurately recorded by the Council which had resulted in a lack of a waiting list for Children in Care. Mr Ayres acknowledged the importance of accurate data and early procurement. He was reviewing all NHS West Kent CCG’s contracts to ensure data was being collected, monitored and recorded accurately. He commended Kent County Council’s approach to data collection.

(12)     A Member noted and welcomed the inclusion of the Healthwatch Kent report on Tier 2 and 3 services in the Agenda papers. Mr Inett explained that Healthwatch Kent would like to undertake further work to look at Tier 1 and 4 services and how changes to Tier 2 and 3 services were implemented as the report was written during a period of change. Patients, their families and carers had highlighted to Healthwatch Kent the difficulty in building relationships with the service provider and their staff due to high turnover of staff. Mr Inett stressed the importance of consistency as part of future CAHMS commissioning. Mr Ayres thanked Healthwatch Kent for their report. He stated that he was keen to work with Healthwatch Kent in the future particularly with the Emotional Health and Wellbeing Strategy for 0-25 year olds in Kent. He acknowledged that changes to service providers and staff resulted in a lack of knowledge transfer.

(13)     A Member enquired about the increase in the number of actual referrals received and the decrease in the number of contacts and caseload. Ms Scott explained that the Trust was implementing the model they had tendered for; in order for the model to work the caseload needed to be reduced. The Trust had a finite resource and was concentrating on those clients who were ready to be discharged in order to reduce the caseload. The number of planned contacts had reduced as the number of emergency referrals was higher than expected which took clinicians away from routine referrals.

(14)     A further question was asked about the seasonality of referrals and long term reduction in referrals. Whilst there was a planned long term reduction in referrals; it was noted that referrals to CAMHS services across the UK dipped over the summer holidays and spiked in September and October. It was explained that many referrals came from school during term time and significant transition points for young people occurred in September and October. Mr Ayres noted the significant reduction in the numbers waiting for treatment since August 2013.

(15)     Concerns were expressed about transition. Ms Button made reference to the Commissioning for Quality and Innovation (CQUIN) scheme in which providers can earn incentive payments of up to 2.5% of their contract value by achieving agreed national and local goals for service quality improvement. She explained that as part of the contract refresh for 2014/15 SPFT and KMPT had been set a joint CQUIN to improve transition arrangements between children and adult services. The Trust was actively working with KMPT to improve transition; there had been successful partnership working with KMPT’s Early Intervention Psychosis service. She stated that the Trust was keen to provide services for young people up to the age of 25. Mr Ayres reported that transition was part of the Emotional Health and Wellbeing Strategy for 0-25 year olds in Kent.

 (16)    A number of comments were made about crisis resolution and Kent Integrated Adolescent Support Service (KIASS). Ms Button highlighted the success of the Trust’s home treatment service which was able to offer intensive support for young people in crisis at home seven days a week. The service had helped to reduce pressure on the limited Tier 4 inpatient beds. With regards to KIASS, the Trust was looking to broaden and develop partnership working.

(17)     The Scrutiny Research Officer read a statement from The Rt Hon Greg Clark MP. Mr Clark expressed his gratitude to HOSC, NHS West Kent CCG and Sussex Partnership NHS Foundation Trust for all their work to improve CAMHS services in Kent.

(18)     RESOLVED that the guests be thanked for their attendance at the meeting, that they be requested to take note of the comments made by Members during the meeting and be invited to submit progress reports to the Committee within six months and at the end of the financial year.