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  • Agenda item
  • Agenda item

    Review of St Martin's Hospital, Canterbury

    Minutes:

    Caroline Selkirk (Managing Director, NHS East Kent CCGs), Andy Oldfield (Head of East Kent Mental Health Commissioning, NHS East Kent CCGs), Vincent Badu, Executive Director of Partnerships and Strategy, Kent and Medway NHS & Social Care Partnership Trust (KMPT)), and Dr Matthew Debenham (Consultant Psychiatrist and Deputy Medical Director, KMPT) were in attendance for this item.

     

    (1)  The Chair welcomed the guests and invited them to outline the proposal for change at St Martin’s Hospital, Canterbury.

     

    (2)  Mr Oldfield explained that the CCG were proposing changes to the provision of acute adult mental health services across Kent and Medway, with a particular focus on how that could impact on St Martin’s Hospital in Canterbury.

     

    (3)  The proposed changes, based on best practice as well as service improvement around treating people outside of hospital unless they had to be there, would see a reduction of 15 acute inpatient beds across the KMPT estate – around 6% of the total bed base.

     

    (4)  The Committee referred to the previous HOSC update on 1 March 2019, when the proposal was for a reduction of 9 beds. Since then, a review of patient flow had been undertaken and it was decided additional beds could be closed without impacting the service (as some patients would not be admitted to hospital but be supported within their community).

     

    (5)  NHS England/ Improvement has advised that they believe the change constitutes a substantial variation of service.

     

    (6)  Members questioned if the CCG were confident that the 15 mental health beds were surplus to requirement. They were unclear why the aim to improve the estate and service delivery justified the reduction in the number of inpatient beds.

     

    (7)  Dr Debenham confirmed that the Trust was already not at capacity, and sometimes there were just 77% of beds in use – this represented just a 6% reduction so there would still be flexibility in the system.

     

    (8)  Mr Badu explained that the Trust had looked into the patient population that accessed acute beds. The evidence demonstrated there was a significant proportion of patients that were admitted for less than 7 days, which the Trust considered to be clinically inappropriate and that the individual’s needs could be met in a different way.

     

    (9)  The Committee were advised that in some cases, admitting patients to hospital could actually do more harm than good and that in the drive to do something, perhaps the best support was not always chosen because of a lack of alternative options (e.g. support within the community).

     

    (10)               The CCG explained that there were a number of other service developments underway around mental health, and whilst they were just addressing HOSC about specific changes to St Martin’s Hospital, the proposal should not be considered in isolation. Examples of other developments included community services, creation of safe havens, and crisis support.

     

    (11)               Mr Badu explained three projects that had been developed to improve the effective and more efficient use of inpatient capacity:

     

    a)    Reduce the length of stay for older people to be in line with recommendations. KMPT had seen 102 average days compared to the recommended 73.

     

    b)    Develop alternative support to inpatient treatment;

     

    c)    Extend and improve the Patient Flow Team so that it operates 24/7 and build on appropriate discharge planning.

     

    (12)               The Chair understood the need for HOSC to be consulted on the specific St Martin’s proposal. However, she felt that should the change go to public consultation, it should not be considered in isolation. The Trust and CCG would have to explain what they were doing, and how patient’s treatment would be better because of the changes.

     

    (13)               Mr Inett told the Committee that Healthwatch Kent had worked closely with the mental health community and overall the approach was understood. However, the issue was around the complexities of communicating the support options available.

     

    (14)               Ms Rickard, from the Local Medical Council (LMC), expressed concern that those patients with moderate mental health needs fall between the cracks. She also questioned if the prolonged length of stay for adults in acute beds reflected that community support services were not in place. Mr Badu explained that the issues varied depending on age, but generally he accepted that primary care support needed to improve, as did the interaction between primary and secondary services.

     

    (15)               The Committee felt that the changes discussed represented more than just a site reconfiguration, they were around a reconfiguration of mental health services across Kent and Medway.

     

    (16)               Ms Selkirk accepted the points made by HOSC and would take their comments on board.

     

    (17)               RESOLVED that

     

    a)    the Committee deems the proposed change to St Martin’s Hospital (west) to be a substantial variation of service.

     

    b)    Kent and Medway NHS and Social Care Partnership Trust (KMPT) and East Kent CCG be invited to attend HOSC and present an update at an appropriate time.

     

    Supporting documents: