Agenda item

Karen Benbow, Director of System Commissioning at Kent & Medway Clinical Commissioning Group; Jane O’Rourke, Associate Director, Kent Children’s & Maternity Commissioning Team at Kent & Medway Clinical Commissioning Group and Gill Burns, Director, Children’s Services at North East London NHS Foundation Trust (NELFT) were in attendance for this item at the invitation of the committee.

1.    The Chair began by highlighting the covering report in the agenda, which explained about the closure of Cygnet Hospital, Godden Green. The closure of the tier 4 in-patient mental health unit followed a serious incident which was under investigation by the service commissioner, NHS England. A report would be brought to HOSC for scrutiny once that had concluded.

2.    The Kent and Medway CCG had provided a written update on Children and Young People's Mental Health Services, provided by North East London NHS Foundation Trust (NELFT) which encompassed the period April to September 2020.

3.    Karen Benbow provided a verbal update and briefed Members on the Kent and Medway CCG’s responsibilities in the commissioning arrangement with NELFT.

4.    Jane O’Roukeprovided an overview of service developments. She noted that whilst there had been an increase in demand since the onset of the pandemic, service delivery had continued on a face to face and virtual basis. She added that communication with partners had expanded, which had included crisis support and signposting services with schools and families. Mrs O’Rouke reassured the Committee that case risk assessments had been undertaken and that an increase in the complexity of cases had been noted by practitioners.

5.    Gill Burns provided details of NELFT’s adaptations which had ensured business as usual operation during the pandemic. She gave an overview of governance arrangements, as well as highlighting that robust clinical assessment was in place to determine whether digital or face to face support was required for a patient.

6.    Mrs Burns informed the Committee that towards the beginning of the pandemic, the level of referrals had slowed down but in the last three months they had never been higher. The provider had met this increased demand through additional staff as well as asking staff to work weekends and evenings. She also highlighted the increased complexity of cases which was reflected in the increased use of Section 136 suites. She reflected that whilst the service was facing unprecedented demand, it was not in crisis. The provider and CCG had been successful in securing additional funding for the winter period which would help fund additional staff to support the crisis team.

7.    Mrs Burns confirmed that NELFT had taken over the provision of the Kent and Medway Adolescent Hospital (KMAH), a tier 4 mental health service for young people. The March 2020 transfer included 11 in-patient beds and the transfer of 56 staff. Work was underway to build a bespoke S136 suite on site, which was due to complete in late December. She noted that the closure of Cygnet Hospital, Godden Green had led to a reduction in tier 4 beds for children and young people in Kent, which was putting pressure on the system. The long-term aim was to have “local beds for local children” and that patients are not placed out of area unless for a specific need.

8.    Mrs Benbow, Mrs O’Rouke and Mrs Burns responded to comments and questions from the Committee, including the following:-

a)                when asked about the caseload data, Mrs Burns stated it was accurate that there were a number of children waiting more than 52 weeks for neuro developmental assessment. There were no children waiting longer than 18 weeks for mental health assessments. The incumbent system in Kent was complex and since taking on the contract NELFT had worked hard to reduce waiting lists for neuro from 4 years to 2 years. However, the volume of current referrals would likely see this progress halted. Mrs Benbow added that both short and long-term commissioning actions were required to reduce waiting times further, such as the commissioning of additional assessments and cleansing waiting lists. Mrs Benbow noted that the development of the Care Navigator role was important to advance service improvements. Mrs O’Rouke added that successful bids had been made for school support teams in Kent;

b)                Mrs Burns clarified the situation of clinical triage at the front door – all referrals are triaged within 48 hours of being received, and those patients requiring crisis assessment would be seen within 4 hours; and 

c)                asked to clarify the meaning and rationale behind the term “cleansing the waiting list”, Mrs Benbow clarified that this was a data exercise. Mrs Burns explained that any patients waiting more than 52 weeks for treatment (a small percentage of the overall number) are included in an exception report each month. If there had been a lack of engagement from the young person and their family, there would be repeated attempts to contact them before closing their file. In other cases, the child may have been duplicated on more than one waiting list.

9.    It was RESOLVED that:

a)    the report on Children & Young People's Emotional Wellbeing & Mental Health Service (Tier 3) be noted and Kent & Medway CCG be invited to provide an update at the appropriate time; and

b)    the closure of the inpatient unit at Cygnet Hospital in Godden Green be brought to HOSC once the investigation had concluded.