Agenda item

Dave Holman (Head of Mental Health, Children and Maternity Services, NHS West Kent CCG) and Brid Johnson (Director of Operations for Kent & Medway, North East London NHS Foundation Trust) were in attendance for this item.

(1)          The Chair welcomed the guests and noted that a letter had been received from Greg Clark MP which had been circulated to Members and Guests.  Mr Holman provided a strategic context to the contract, highlighting that previous services had been disjointed and that they were working within the context of the national NHS report ‘Future in Mind’.  This gave the mandate to develop a whole system approach to meeting children’s needs and confirmed that £3/4m resource annually was coming in to the Kent system, rising to £6m in 2021.  Kent has been complimented nationally on its innovative programme of action.   The key rationale is access with a benchmark currently of 32% with a diagnosable mental health condition having access to two interventions; Kent on average achieves 38%, equivalent to 11,500 patients.  North East London NHS Foundation Trust (NELFT) had been awarded the contract a year ago and were given space to transform.  Key achievements have been - a Single Point of Access (SPA), based in Foster Street, Maidstone, electronic patient records, pathways in place and visibility on activity.  Crisis services are also being provided at A&E in relation to triage and pathways. Funding has also been secured from the Department of Health to procure a bespoke child place of safety facility in Staplehurst.

(2)          Mr Holman confirmed a monthly regime was in place to scrutinise performance with levers in place to exercise contract variation, with data visible. 

(3)          Mr Holman said that feedback was becoming more positive and that work with schools was starting to show that the system was working.  The Future in Mind Transformation Board were providing more scrutiny around NELFT.  He confirmed that demand continued to be high and was so across the whole system.  The NHS Ten Year Plan was currently being developed but expectations that the Future in Mind strategy would continue beyond 2020/21.

(4)          Ms Johnson confirmed that 28,000 were needing care and that need was not being met due to current capacity – with work being undertaken in schools and the County Council on early intervention and prevention needs to help address this.  She stated that the SPA was valuable however challenging for staff as it was important to have highly skilled people at the triage stage.  She continued that there was a difference between triage and assessment but confirmed that those needing treatment receive a full assessment.

(5)          Ms Johnson informed the committee about Neurodevelopment and that this area in Kent had been poorly serviced over the years with children receiving care through different providers due to lack of visibility. However, complaints particularly in relation to repeat prescriptions, were still being received.  She stated that staffing continued to be an issue and that waiting times were a challenge as a result.  Limitations on staffing within the County were a concern and the Commissioners were monitoring this.

(6)          Ms Johnson said that out of 1062 patients in June 585 had been discharged with East Kent experiencing a high number of referrals as well as retention from previous months at the same time. This was monitored weekly. 

(7)          Members asked questions on Neurodevelopment and staffing.  Ms Johnson reiterated that staffing was a concern, especially medical staff such as nurse prescribers, and that the most successful recruitment drives had been in shopping centres – attracting potentially ten staff in two days as an example.  Currently there were 80 vacancies across the County and that financial incentives were being explored.  She said that patients valued continuity of staffing and the potential for sub-contracting was being explored.  Mr Holman said that engagement had taken place with private providers who provide NICE guidance in terms of assessment and diagnostics but that was short term.

(8)          Members asked about waiting times, assessment and prescribing.  Ms Johnson said that children do have a face to face assessment but that initially a discussion takes place with the person, referrer or family member and additional staff help to do this. She said that ideally it would be clinicians but to aid low staffing levels administrative staff had received training in mental health first aid for triaging but long-term clinicians should be answering.  The full assessment then takes place after. She confirmed that waits of over 6 months but less than a year were 1794 and over 52 weeks was 700.  Waits from inherited providers were clear and families have been written to, however a date could not be provided for assessment.

(9)          Mr Holman said that another element was waiting times in other parts of the service and that a bespoke piece of work was being conducted on Neurodevelopment with Kent County Council on this which could be shared with the Committee once available.

(10)       Ms Johnson said in relation to prescribing that getting prescriptions in advance to families within the system can be difficult due to staff placement and that families were ringing when they should not need to.  A new piece of work was being established with the CCG and primary care and finding new ways of working to resolve this.  Mr Holman confirmed that pathways were being made easier through enhancing the primary care offer. This was known as Shared Care.

(11)       A Member asked about discrepancies between east and west Kent and future growth.  Mr Holman informed the committee that work was being completed with public health and that this could be reported to the Committee at a future date.

(12)       The Chair expressed concern at 2500 waiting over 24 weeks and did not feel that this was acceptable and hoped that after a year it would not be at this level but understood that workforce was an issue.

(13)       RESOLVED that the Committee:

(a)  noted the report and expressed continued concern at the level of wait for young people despite efforts;

(b)  receives additional written information on waiting times, discharge data and interventions within the month;

(c)  invite the CCG to provide an update in six months including the All Age Eating Disorder Service.