Agenda item

Malcolm McFrederick (Executive Director of Operations, Kent & Medway NHS & Social Care Partnership Trust) and Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Thanet CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr McFrederick began by giving a general update to the Committee about the Trust’s financial and staffing position, the CQC inspection and the Trust’s plans and support for integration.

(2)       Mr McFrederick explained that the Trust had a planned deficit for this financial year and was in contract negotiations and sign-off with the CCGs and NHS England for the next financial year. He reported that the Trust has a rolling programme of recruitment and was working towards a more therapeutic model of staffing with therapists, psychologists and psychiatrics which had helped to decrease the ward staffing deficit by half in East Kent. He noted that it was challenging to recruit in North Kent particularly in Dartford as bordering Trusts paid a London weighting allowance. He reported that a sustainable model for the East Kent Liaison Psychiatry Service had been developed with the East Kent Hospitals University Foundation Trust (EKHUFT) which had led to a reduction in the hours of operations; NHS West Kent CCG and NHS Dartford & Gravesham CCG were looking to introduce a Liaison Psychiatry Service. He stated that the Trust was in discussions with Kent Community NHS Foundation Trust (KCHFT) about using the Knole Centre, Sevenoaks as a stepdown facility. The Trust had withdrawn from providing the specialist neurological rehabilitation inpatient services at the Knole Centre as it predominately provided physical health services.

(3)       Mr McFrederick stated that the CQC published its report in July 2015 following an inspection in March 2015. He noted that there were a number of outstanding services and a number of areas in which the Trust needed to improve including the variable quality of care particularly for older adults. The Trust had developed a quality plan which was monitored by the Trust Development Authority, the Care Quality Commission and local CCGs. The plan was divided into three areas for action: internal operational activities such as the embedding of medicine management to be completed by April 2016; capital spend to make improvements to estates regarding Section 136 suites and seclusion rooms by October 2016; and increasing bed capacity for younger adults and Psychiatric Intensive Care Units (PICU). He noted that the Trust was in discussions with East and West Kent commissioners about commissioning additional young adult and PICU bed capacity.

(4)       Mr McFrederick reported that the Trust was engaging with and supporting local heath economies’ plans for integration; the Trust was adjusting their community models to fit with local requirements. He noted that the Trust was benefiting and improving its relationship with Kent County Council (KCC) under a joint working Section 75 agreement; 250 KCC staff had been seconded to the Trust to provide an integrated mental health service in Kent.

(5)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A number of comments were made about the CQC Inspection Report and Quality Improvement Plan. Mr McFrederick stated that the Trust was rated as ‘requires improvement’ under the effective and responsive measures due to an increased demand for acute inpatient care, which was exceeding the 174 beds commissioned by the CCGs, resulting in a number of patients being placed outside Kent and Medway. He reported that the CCGs and the Trust were involved in remodelling the demand on beds and a proposal for 16 additional beds was being considered by the CCGs.  He noted that the Trust was rated as ‘requires improvement’ under the safe measure due to the size of 136 suites and seclusion rooms not meeting the latest size regulations. Other actions to be taken to improve safety included reducing the caseload to at or below recommended level for the community team of nurses and social workers in Dartford, Swale and Thanet and developing relationships between psychologists, psychiatrists, nurses and GPs in South Kent Coast to improve referral into and discharge out of the Trust’s services.

(6)       Mr McFrederick reported that the Single Point of Access Service, a single telephone contact number which enabled clients, carers and those experiencing mental health crisis to access mental health care, would from April 2016 be staffed by clinically trained staff who would be able treat and facilitate the onward coordination of care and accept urgent referrals from patients, carers, 111 service, GPs and the Police. He noted that as part of the Trust’s internal assurance process, CCGs had carried out CQC style inspections which had been useful particularly in North Kent. He confirmed that the additional locum consultant in the Liaison Psychiatry Service had been made permanent subject to the Royal College of Psychiatry approval.

(7)       In response to a specific question about inpatient mental health capacity, Ms Carpenter explained that commissioners in East and West Kent were looking to commission additional bed capacity, in the short to medium term, to reduce the number of patients being placed out of county.  She noted that a long term strategy would be included within the Kent and Medway Sustainability and Transformation Plan. Mr McFrederick reported that since the 174 beds currently commissioned by CCGs were modelled, there had been an increase in demand; there were currently 23 patients placed outside of Kent and Medway. He stated that the Trust was working with CCGs to look at the effectiveness of inpatient care using national benchmarks; the Trust was at or below average for the length of stay and delayed transfer of care and was under commissioned for adult inpatient beds. He noted that the Trust also had a Crisis Resolution Home Treatment Service which provided an alternative to inpatient admission for individuals who were suffering with acute mental ill health. He reported that the Trust was working with the Police to reduce the number of Section 136 detentions under the Crisis Concordat; Kent and Medway had more Section 136 detentions than Birmingham and only 20% of detentions resulted in inpatient admissions. He highlighted the importance of preventing service users who were known to the Trust going into crisis.

(8)       A Member enquired about provision for young people, transition and young people in care. Mr McFrederick stated that the Trust provided services for younger adults aged 18 – 65 and older adults aged over 65. He noted that the CCGs had offered a Commissioning for Quality and Innovation (CQUIN) payment to the Trust and Sussex Partnership NHS Foundation Trust to improve transition between the two services. Ms Carpenter reported that the requirements of vulnerable groups such as Looked After Children and Unaccompanied Asylum Seeking Children was being developed as part of the service specification for the NHS Children and Young People’s Mental Health Service.

(9)       A number of comments were made about morale and engagement with KCC. Mr McFrederick explained that there had been a major improvement in staff satisfaction last year which had been maintained in the current year. He reported that staff were disappointed when improvements were out of their control such as capital investment and the IT system. Mr Scott-Clark stated that KCC’s Public Health team was working with the Trust to become smoke free; there was a high prevalence of smoking amongst mental health service users. Mr McFrederick noted that through the Section 75 agreement with KCC, a dedicated Approved Mental Health Professional (AMPH) service had been developed to deliver a 24/7 service which had been recognised by the CQC as an area of innovation and good practice. He stated that he welcomed the opportunity to present an update to the Committee and looked forward to engaging with the Committee more frequently in the future.  He noted that the Five Year Forward View for Mental Health had recently been published and there was an expectation that there would be a higher profile and additional targets for mental health.

(10)     RESOLVED that:

(a)          the report be noted;

(b)          KMPT be requested to submit a written briefing about CQC style inspections carried out by the CCGs; the timescale for the six key areas of improvement and which area of the Quality Improvement Plan they sit under; and the number of out-of-county placements for the Committee’s meeting on 8 April;

(c)          KMPT be requested to present an update to the Committee in June;

(d)          Ms Carpenter be requested to liaise with colleagues and arrange for a written briefing on the Five Year Forward View for Mental Health and the implications for Kent to be submitted to the Committee for its meeting on 8 April.