Agenda item

Dave Holman (Head of Mental Health, Children and Maternity Commissioning, West CCG), Brid Johnson (Director of Operations, Kent, North East London NHS Foundation Trust (NELFT)), Dr David Chesover (Mental Health Clinical Lead, Kent and Medway CCGs) and Nina Marshall (Integrated Service Manager, Kent and Medway Eating Disorder Service, North East London NHS Foundation Trust (NELFT)) 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.   The Chair proceeded directly to questions.  Members enquired about waiting lists, area variations and adequate resourcing.  Mr Holman recognised that demand remained high and that waiting times had not gone down in terms of numbers reported but emphasised that the service was seeing children quicker.  He said that from a commissioning point of view he was confident that the service was doing its best to reduce waiting times and at the same time meet the increase in demand.  Mr Holman said that the offer overall was improving, as requested.

(2)      Mr Holman said that waiting times for neuro developmental provision (NDLD) meant that case complexity may have changed and emphasised that a need for there was a need for local pathways to be clear and any gaps in provision filled.  He said that work was taking place with local authorities to target additional resources that may come through.

(3)      Ms Johnson said that NELFT was commissioned to provide NDLD services countywide and that there was variation in primary care arrangements across the County. She said that four pilots were taking place in general practice areas to speed up the process and said that the change in resources would help make the most difference.

(4)      Dr Chesover said that access was faster than it used to be, with greater numbers being seen.  Additionally, he said that since 2017 the number of complaints compared to previous years had reduced amongst the backdrop of increased demand.  Dr Chesover emphasised that there were lots of reasons for some needs not being met and that they were multifactorial.  He said that the frustrations that the Committee were feeling were also felt in the system.

(5)      Dr Chesover highlighted that much earlier intervention was required across the whole system and was hopeful that this would improve over time.  He said that engagement with education systems was made further difficult by differences in control.  Dr Chesover said that he was seeing less resilience in children and how they sit in society, which was exemplified by children presenting earlier with self-harm.

(6)      The Chair asked how Kent compared to some services outside Kent.  Mr Holman said that children and young people were presenting with more complex needs and that children in crisis are higher.  He confirmed that demand was increasing – 25,000 contacts - but that Kent was not an outlier compared to the rest of the country; reiterating that demand was increasing across the country.  Mr Holman said that he was aware of some services out with Kent closing their books but that in Kent there was a duty to meet the increase in demand and that this would not happen.  He confirmed that this service was comparative against other services in the country in terms of demand and performance.

(7)      A Member enquired about steps for the future, staffing and the four pilots. Mr Holman said that Kent had received £3-4m a year for the county and that this developed the local transformation plan, which had been complemented by NHS England.  He said that this covered a range of services from working in schools, crisis work and working with unaccompanied asylum seekers.  Mr Holman highlighted that he hoped the NHS Long Term Plan would continue to commit additional resource to continue the Future in Mind programme – currently in year three of four.  He said that Kent spent £1.2m in relation to waits – to meet demand but also meet the access target (32%) for the future in mind allocation.  Mr Holman confirmed than NHS England as a result of the funding provide additional scrutiny.

(8)      Ms Johnson said that in relation to staffing there were three areas of challenge – crisis teams, Single Point of Access (SPA) and medical staffing.  She said that they were lucky to recruit temporary staff but that permanent staff was needed.  She explained that an incentive scheme had been created to boost recruitment. 

(9)      Ms Johnson gave an overview of the four pilots and said that they were taking place in East Kent. She said that training was taking place on protocols to pilot the review of medication and practice in Dover and Folkestone.  Ms Johnson said that work was also taking place within Swale and Dartford and that early intervention workers had been put in place.  She confirmed that if the pilots were successful the evidence base would come back to the Local Transformation Board.

(10)   Some Members felt concerned that there was not enough resource to meet demand and questioned if more money was required for the service.

(11)   The Chair, acknowledging the All Age Eating Disorder Service in Kent and Medway report and on behalf of the committee recognised that the service was meeting the needs of young people.

(12)   RESOLVED that:

(a)   The Committee has serious and increasing concerns regarding the ability of the current children and young people’s emotional and wellbeing mental health service to effectively meet the needs of all children and young people with mental health issues in Kent;

(b)  The Chair, on behalf of the Committee, writes to Anne Eden, Executive Regional Managing Director (South East) to express those concerns; and

(c)  The CCG provide an update, including information on the disparities for East and West Kent and plans to reduce such disparity, to the Committee in six months.