Agenda item

Helen Greatorex (Chief Executive, Kent and Medway NHS and Social Care Partnership) and Vincent Badu (Director of Transformation (Integrated Older People’s Services), Kent and Medway NHS and Social Care Partnership) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Greatorex began by explaining that she and Mr Badu were in new post; Ms Greatorex had been working for the Trust for four months and Mr Badu had joined the Trust two weeks ago. She stated that she had been really impressed with the Trust and the opportunities for improvements.

(2)       Ms Greatorex reported that she had three immediate priorities. The first was the reduction in private bed use. She explained that on her first day at the Trust there were 76 patients in private beds, in locations as far away as Manchester and Hull, which was costing the Trust over £1 million a month. She stated that she had set a target of no more of 15 private beds being used by 1 November and the Trust was currently using 21 private beds. She noted that there had been positive feedback from families of patients who had been repatriated.

(3)       Ms Greatorex stated her second priority was to improve Section 136 detention and roll out Street Triage across Kent and Medway, a programme where mental health professionals worked with police officers to divert and support people at risk of Section 136 detention. She noted that she had already had constructive dialogue with the Police & Crime Commissioner and the Assistant Chief Constable. She noted that her third priority was to carry out a thorough review of Older People’s Services to ensure high quality, evidence based, person centre care was being provided.

(4)       Mr Badu stated that he had been appointed the Director of Transformation at the Trust and had previously been a Director at the Sussex Partnership NHS Foundation Trust focusing on Section 136 detention and Older People’s Services.  He noted the importance of good quality care being provided to older people whilst in a crisis and supporting those who can be treated at home. He reported that he had spent the last two weeks travelling across Kent and Medway to see the delivery of services and engaging with partners and stakeholders.

(5)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about the Trust’s collaboration with other organisations in relation to Section 136 detentions. Ms Greatorex explained that only 20% of people who were detained, under Section 136, required inpatient admission; 80% of people had another issue such as alcohol or drug use. She stated that the Trust had a strong partnership with the Police; she highlighted that from April 2017 people detained under Section 136 could no longer be taken into Police Custody.   She noted that the Trust needed to work more closely with local authorities to offer support to people who were intoxicated. Mr Badu added that mental health practitioners could help reduce demand by triaging and signposting intoxicated people to alternative services. He noted that intoxicated people were challenging to assess; it was not appropriate for a person who required acute care to be held in custody or admitted to a mental health unit. He stated the need to develop a better pathway for intoxicated people.

(6)       A number of comments were made about Crisis Resolution Home Treatment (CRHT), A&E Mental Health Liaison services and emergency readmissions. Ms Greatorex noted that the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness led by Professor Louis Appleby had only been published the day before and the Trust had not been able to analyse the data yet. Ms Greatorex stated that CRHT was used to support patients in a community setting and the Trust was looking to review and strengthen the CRHT team. She clarified that six local authority areas of the county did not have 24/7 liaison psychiatry cover within their emergency departments and there was only one 24 hour A&E Mental Health Liaison service in Kent which was based at Maidstone Hospital. She stated that the Trust was working with Commissioners to improve Mental Health Liaison services which could reduce pressure on A&E and private bed spend. Ms Greatorex explained that the Trust believed that the majority of service users who were admitted in an emergency following an inpatient stay were those patients with a personality disorder. She stated that there was not currently a proper care pathway for patients with personality disorders and it was priority of the Trust to redesign the pathway. She noted that it was not helpful for people with personality disorders to be admitted to hospital and if admission was recommended that it should be no longer than 72 hours.  Mr Badu explained that the services users who experienced delayed transfers of care tended to be older people who required additional health or social care interventions; the Trust was working closely with Adult Social Services and residential facilities.

(7)       A Member enquired about the grant bid for the peer-supported open dialogue (POD) model, the work streams in Appendix A and the definition of  cluster eight service users. Ms Greatorex announced that the Trust had been awarded the grant; the POD approach was a non-medicalised model developed in Finland in the 1970s which focused on what the service users and their families wanted. Ms Greatorex apologised for work streams 4, 8 and 11 being missing from Appendix A. She stated that Cluster 8 service users were people with personality disorders; they were defined as part of the national clustering of diagnostics.

(8)       The Chairman invited Mr Inett and Ms Duggal to comment. Mr Inett enquired about the challenges of working with eight CCGs and how the Trust works with partners to support people with mental health problems who are well known in the community. Ms Greatorex explained that the CCGs recognised the difficulty of working with eight different commissioners in Kent and Medway. She stated that the Sustainability and Transformation Plan (STP) process had been very helpful for her as a new Chief Executive to meet with all of the Accountable Officers and Chief Executives. Ms Greatorex noted that people with personality disorders were often known to the police, emergency departments and voluntary organisations. She reported that people with personality disorder were currently receiving a poor service from all partners as services were not aligned; however she stated that it was easy to resolve, with a small investment, the pathway could be transformed. Ms Duggal congratulated the Trust on the progress made so far and looked forwarded to working with them as part of the STP process.

(9)       Members enquired about the reduction in beds following the 2013 adult inpatient bed review, the recruitment of Community Psychiatric Nurses (CPN) the treatment for overseas patients and the upcoming CQC inspection in January. Ms Greatorex explained that the Trust now had 174 beds following the 2013 review which met demand; she highlighted that 30% of patients had a primary diagnosis of a personality disorder and they should not be admitted for any longer than 72 hours. She noted the importance of reinforcing the CHRT, as part of the clinically led improvements, to support patients with a personality disorder to be treated in a community setting. Ms Greatorex reported that there was a national shortage of Community Psychiatric Nurses; the Trust was using Golden Hellos and Retention Recognition schemes to recruit and retain CPNs. Ms Greatorex stated that a translator or worker was identified to meet the needs of overseas patients as part of the care planning process.  Ms Greatorex explained that the CQC would be re-inspecting the Trust on 16 January 2017. She noted that she had recently reread the 2015 report and the Trust had undertaken an enormous amount of work following the inspection particularly around staffing. She highlighted the innovative Multi-Disciplinary Team which had been implemented on the wards since the inspection.

(10)     RESOLVED that the report be noted and KMPT be requested to provide an update to the Committee in January.