Agenda item

Karen Benbow, Director of System Commissioning, Kent and Medway Clinical Commissioning Group (KM CCG), Andy Oldfield, Deputy Director Mental Health and Dementia Commissioning (KM CCG), Vincent Badu, Deputy Chief Executive/ Executive Director Partnerships & Strategy, Kent and Medway NHS and Social Care Partnership Trust (KMPT), and Dr Rosarii Harte, Deputy Medical Director (KMPT), were in attendance for this item.

1.         The Chair welcomed the Committee’s guests from the NHS, who proceeded to provide an overview. The report in the Agenda updated the Committee on the way the Trust had managed the Covid pressures, outlined the transformation programme in the context of significant financial investment, and provided a summary of changes to St. Martin’s.

2.         Members were also informed that the move from Cranmer Ward to Heather Ward had been timely as it was a better environment for infection control. The biggest pressure of Covid was on outreach and community services rather than inpatient beds. Demands on the inpatient bed stock had been managed so that a ward was able to be made available for Medway Foundation Trust.

3.         It was reported that the Covid pandemic had impacted some groups more than others, with an increase in dementia presentations, and a greater impact on children and adolescents, those with Autism Spectrum Disorder, as well as those with co-morbidities. There had also been an increase in domestic violence. While there were always times of extreme pressure, placements had always been found and there had been no need to go out of the County. In response to a specific case raised, it was explained that there were other barriers to accessing services than simply the availability of beds.

4.         One of the main areas of discussion with the Committee was on financing. It was explained that the £51m available came from different funding streams. £12.6m had been ringfenced for estates; money for capital investment came with a timetable. The health economy had to attain the Mental Health Investment Standard, and this meant an increase in the resource directed to this area.

5.         The local work formed part of a national programme where community mental health was a priority under the mental health long term plan. NHS colleagues described it as a once in a lifetime opportunity to shift from a situation where patients were steered to align with services to one where care pathways were built around the patient. There was an oversight group which had the involvement of Kent and Medway Councils as well as third sector and voluntary groups. There were patient engagement activities across all four Integrated Care Partnership (ICP) areas.

6.         Clarity was provided that the bed number of 246 referred to in the report took into account the temporary reduction of 15. It was also explained that Member comments on the use of the word temporary had been taken on board, and that legal advice had been sought and that it was down to local discretion.

7.         Bed use had been analysed by the NHS. Some individuals had been admitted to inpatient wards for less than seven days and this indicated they could be better supported in the community without a hospital stay. Home treatment teams were available, and the service worked very closely with the police on section 136 referrals. There was a 24/7 patient flow team which assisted with flow both in and out of hospital, addressing access and discharge barriers where necessary.

8.         The issue of housing growth was raised by Members and the impact this would have on the need for more inpatient beds questioned. It was explained that the bed modelling would hold to 2024 and demographic growth was factored in. The NHS view was that the shift to a community-centric service with additional support like primary care practitioners, would mean the need for people to access inpatient beds would reduce even further over time, helping the sustainability of the service. Work was also ongoing with public health colleagues on the preventative workstream. However, more work was needed on the longer term and NHS colleagues undertook to report back on this in due course.

9.         In response to a specific question, it was confirmed that the complexities in Medway and Swale had been recognised and work was starting in those areas first.

10.      RESOLVED that the Medway HASC and Kent HOSC consider the closure in the broader context of the proposals to reconfigure mental health services more widely.