Agenda item

Vincent Badu (Director of Transformation (Integrated Older People’s Services), Kent and Medway NHS and Social Care Partnership Trust) was in attendance for this item.

(1)       The Chairman welcomed Mr Badu to the Committee. Mr Badu began by providing an update on patient flow and Section 136 activity. He reported that the Trust had reduced the use of private beds to 0 by the end of December. He stated that there had been an increase in referrals at the start of 2017 particularly for male patients which had led to breaches to single sex accommodation and the use of external placements. He noted that four male patients were currently placed outside of the Trust in psychiatric intensive care unit (PICU) beds. Two of the patients had dementia and required specialist PICU beds; the Trust was refiguring beds to create additional capacity for male patients and it was hoped that one of the males would be repatriated within the next couple of weeks.

(2)       Mr Badu reported that Kent had a high level of Section 136 activity with over 1000 detentions in 2016; only 20% of those people required an acute mental health bed.  The Trust was working closely with the Police, CCGs and acute trusts to support and prevent detention for the remaining 80% through alternative methods such as street triage, the introduction of mental health nurse to provide clinical advice to SECAmb call handlers and reviewing the pathway for people with personality disorders.

(3)       A Member enquired about the changes resulting from the Police & Crime Bill. Mr Badu explained that one of the proposed measures in the Bill would prevent young people being detained in police custody unless in exceptional circumstances which would be known as a never event. It was also anticipated that a police officer would have to seek professional mental health before detaining a person under Section 136. He stated that this advice would be provided through the Trust’s Single Point of Access team, mental nurses being co-located with police and SECAmb call handlers and street triage. He reported that two street triage pilots were planned for Thanet and Medway which had been identified as areas of high activity. The pilot would see a mental health practitioner and a police officer responding to Section 136 call outs and looking to offer alternatives to detentions were possible.

(4)       A number of comments were made about Thanet Community Street Triage pilot and Mental Health Triage Nurse. Mr Badu explained that the CCGs were supportive of the street triage pilot and it was due to be formally signed off and mobilised in February. Both the Trust and Police had identified staff for the pilot who would undertake joint training. He stated that under the Crisis Care Concordat there was a specific target to reduce Section 136 which was currently not being met; the pilot had a target to reduce detentions by 25%. He noted that the pilot would be operational on Saturdays, Sunday and Mondays, as these days had been identified as having the highest level of activity based on the Trust’s data. He anticipated that if the pilot demonstrated its value, funding would continue. He highlighted that since the introduction of a mental health triage nurse at the SECAmb control central in November, it had helped to support the reduction of ambulance deployments, A&E attendances and Section 136 detentions; and improve partnership working. He also reported that the Trust was working together to access additional funding for joint suicide prevention training.

(5)       In response to a specific question about stigma and patient flow, Mr Badu explained the importance of tackling stigma through raising levels of awareness and making people feel comfortable to seek help. He stated the Trust was working on a number of initiatives with primary care to help patients, families and carers to seek advice at an early stage. He noted that the Trust was implementing measures to improve patient flow. He reported that the CQC had recently undertaken a full inspection of the Trust; the Trust had received positive feedback at the end of the inspection about changes made following the previous inspection in 2015 including improvements to care planning, engagement with patients and families and supported discharge into the community at the Frank Lloyd unit and Littlestone unit.

(6)       A number of comments were made about the placement of older people out of area and the peer-supported open dialogue programme. Mr Badu explained that it was exceptional for older people to be placed out of area; the Trust was looking to repatriate one of the patients as quickly as possible and were working with and supporting the family of the other patient who required a specialist dementia PICU bed which was provided by a limited number of specialist providers. He noted the Trust had recently introduced seven day working; senior clinicians were volunteering to come in at the weekends, to review medication and care of patients and discharge them if they were well enough to go home, to improve patient flow and reduce delays. He reported that the Trust was continuing to implement the open dialogue programme and were keen to access and bid for additional funding with partners.

(7)       A Member enquired about commissioning. Mr Badu explained that the majority of the Trust’s services were commissioned on contract by the CCGs; a number of specialist services were commissioned by NHS England. He explained that CQUINs were available from commissioners which enabled the Trust to receive additional resources if they delivered specific improvements to services. He highlighted the use of a CQUIN in East Kent which had resulted in the implementation of a named nurse for patients in care homes to provide expert advice and support. The Chairman invited Patricia Davies, Accountable Officer for NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG to comment. She explained that NHS West Kent CCG was the lead commissioner for mental health in Kent but all Kent CCGs were interlinked with the Trust and had the responsibility to fund them.

(8)       In response to a specific question about the Trust’s joint strategy with the police to improve response to people in crisis,  Mr Badu explained that the strategy was due to be signed off at the next meeting of Executive Liaison Group which included the Trust’s Chief Executive, West Kent CCG’s Accountable Officer and Kent Police’s Chief Constable.

(7)       RESOLVED that

(a)       the report be noted;

(b)       KMPT be requested to provide an update in July with information about the street triage pilot, the updated Crisis Care Concordat and the CQC inspection report;

(c)        KMPT be requested to share the joint strategy with Kent Police, to improve the response to people with crisis, following sign-off for the Executive Liaison Group.