Agenda item

In attendance: Dave Holman (Associate Director of Mental Health, Children’s and Maternity Commissioning, West Kent CCG) and Gill Burns (Director Children’s Services, NELFT).

1.    The Chair welcomed the guests to the meeting and thanked them for the informal briefing that had been held the previous week for HOSC and Children, Young People & Education (CYPE) Cabinet Committee Members. The briefing provided an opportunity for Members to hear about the Children and Young People’s Mental Health Services as a whole. He reminded HOSC that the Committee would only be scrutinising NHS elements of the contract at today’s meeting.

2.    Mr Holman explained that the report was similar to a new quarterly report that was sent to Kent MPs, an arrangement that had been well received. Overall, the report showed a picture of continued rising service demand against recruitment difficulties. A Single Point of Access (SPA) had been procured two years previously and the CCG budgeted over £2m a year for that to help reduce the waiting times for general mental health conditions.

3.    For general mental health conditions, NELFT were meeting the Referral to Treatment (RTT) standard (18 weeks) by about 82% which compared favourably to other counties. Figures in relation to Neurodevelopmental (ND) referrals were less positive. The recent CQC SEND inspection had provided an opportunity for partners to carry out a deep dive and achieve greater clarity around what the issues were.

4.    There were between 6,000 – 7,000 children on the ND waiting list, mainly for diagnostics. He explained that a key driver for that was parents wanting their child to have an Education, Health and Care (EHC) Plan in school. In order to meet the demand, the following action was being taken:

a.    A new ND pathway was being led by Dr Chesover to collate a whole new way of improving access to information for children as part of their universal offer in schools. A draft pathway was scheduled for April 2020 with implementation by the end of July 2020.

b.    In relation to the waiting time for current patients, there would be a period of crossover whilst dealing with those waiting under the current system and those under the new system (as per 4a). There had been an initiative piloted in Canterbury which had been well received.

5.    The Canterbury pilot saw families and professionals coming together to discuss options for co-production and modelling of the service. It demonstrated the importance of early information in order to reduce the number of parents requesting a diagnosis. A key element to this was a handbook which would continue to be developed as well as shared with all those on the waiting list. The intention was for the Canterbury pilot to be rolled out across the county.

6.    Mr Holman felt the system needed to change its culture, away from diagnostics to meeting need.

7.    The current ND waiting list was being prioritised in order to meet the needs of the most vulnerable first. At the same time, the CCG Board were being approached for more funding to get the whole waiting list down.

8.    Mr Holman drew attention to the Contract Performance Framework in the report. It showed that for Apr-Oct 2019 Kent and Medway were above the national average for the percentage of children and young people with a diagnosable mental health condition that were able to access treatment. In addition, all urgent cases were being seen within contract timeframes. Mr Holman said this was testament to the hard work of NELFT.

9.    Members were informed that NELFT were taking over the operation of the Woodlands Unit from South London and Maudsley NHS Foundation Trust (SLAM). The Unit provided 14 short-term inpatient beds. Currently children were placed outside of Kent or at the Adult unit “Littlebrook” run by KMPT. NELFT were proposing to build a 136-bed suite specifically for children at the Woodlands site before the end of the year. Whilst there would always be a requirement for inpatient units and out of county placements for some complex cases, the preference was for home-based intensive support.

10. Ms Burns echoed the success highlighted by Mr Holman, and updated the Committee that between January 2020 to date, the service had received the highest number of presentations to their crisis team they had ever seen.

11. Ms Burns explained that sustained demand for the service had been challenging. NELFT had embellished their offer at the front door and those requesting ADHD diagnosis would be spoken to straight away to ensure that that pathway was right for them. Where children did not meet the criteria for a diagnosis the service would offer parents and carers Positive Behaviour Support.

12. In terms of workforce, Ms Burns explained NELFT were operating with a 22 – 26% vacancy rate. Agency and bank staff provided cover. However, internal performance reports demonstrated that more staff had been staying than leaving over recent time. She felt the key was attracting the right skilled people for the job.

13. Ms Burns said she was proud of the joint work between NELFT, the CCG and KCC and that each partner recognised the service required a collaborative model.

14. The Committee discussed the underlying causes of the sustained high demand for children and young people’s mental health services. Whilst a changing society was expected to have played a part, it was unknown what national studies had been undertaken into the area.

15. Ms Burns said the removal of stigma around mental health was a positive change. But the language (such as depression, anxiety and self-harm) was becoming normalised from an early age and its use was socially acceptable. Social media was a contributing factor, as was the “need” for a diagnosis from parents and carers. Looked After Children, who could be placed in countless homes over a small number of years, faced particular challenges.

16.  A Member questioned the use of the phrase “national standards” for waiting times. He stated the NICE standards were 13 weeks. Ms Burns confirmed the 18-week national standard they worked to was based upon the standard NHS contract.

17. Looking at the figures used on page 22 of the report, Members questioned the worsening performance in terms of time between Referral and First Assessment for NLDS, and also the variation between east and west Kent. It was explained that the figures were a mixture of those coming into the service and those that were on the historic waiting list and that there was a concerted effort to get the latter cohort treated.

18. The data demonstrated an increase in the Looked after Children caseload. A proportion of those were from London Boroughs. Mr Holman was unsure on the number of asylum seekers included in the figures, but this information would be circulated to the Committee.

19. In terms of combatting the rising demand, Mr Holman explained that this was a system wide issue and that one action was for Mental Health Teams to go into schools. He offered to bring demand and financial projections the next time they visited the Committee.

20. The Chair thanked the guests for attending, and was keen they return to the Committee with an update on the various planned activities for 2020 (the draft pathway being implemented, the rollout of the Canterbury pilots, the changes to the Woodlands Unit, as well as the new care model). He was keen for the Committee to be updated on the outcome of those interventions, though accepted Woodlands may not have had sufficient time to fully establish itself by that point.

21. RESOLVED that the report be noted and the CCG and NELFT are requested to return to the Committee with an update at an appropriate time.