Agenda item

In attendance for this item: Brid Johnson (Director of Operations, Essex and Kent NELFT), Gill Burns (Service Director Children, NELFT), Christy Holden (Head of Strategic Commissioning (Children & Young People), KCC)

In virtual attendance for this item: Jane O’Rourke (Deputy Director, Kent Children’s & Maternity Commissioning Team, K&M CCG), Stuart Collins (Director Integrated Services – Early Help and Preventative Services Lead, KCC)

1.    Ms O’Rourke introduced the paper, highlighting key areas:

a.       The number of children presenting in crisis continued to increase, rising from an average of 85 children per month before covid-19 to an average of 140 per month. That reflected national trends and there was a system wide steering group that met every two weeks to address the issue.

b.       Key areas of work included improving patient flow through the system, strengthening community support, recruiting an Associate Director of Pathways (Complex and Crisis Care), and an expansion to the NELFT crisis service.

c.       The Tier 4 provider collaborative had invested in increasing their provision.

d.       The number of children experiencing anxiety continued to rise.

2.    Mr Collins spoke about the collaborative work underway between the CCG, NELFT and County Council. He explained that the HeadStart Kent contract was coming to an end in June 2022 though several activities would continue until August 2022. The sustainability of that contract was under review, as elements of the work were being carried out elsewhere. A full report would be presented to the Children, Young People and Education Cabinet Committee and would be shared with HOSC members.

3.    A question was asked around why there had been such a delay in providing additional inpatient beds at the Kent and Medway Adolescent Hospital (KMAH). Ms Burns responded that it was the result of building material shortages and not related to staffing constraints. It was hoped they would open in the next 2-3 weeks. There were an additional six beds – three would be for short stays and three for longer stays. Clinical work had continued in the meantime including increased work within individual’s homes.

4.    The Chair asked about the Emerge expansion into Darent Valley Hospital, Maidstone Hospital and Tunbridge Wells Hospital, as referred to in the agenda report. He asked whether such support was already offered in East Kent or whether it would be rolled out in due course. Ms O’Rourke explained the volunteer support offer was being trialled, and once the impact was known it would be rolled out accordingly.

5.    There were questions around the use of art, music, gardening and other activities as a form of treatment. Ms Burns confirmed therapies in those areas were in use, though she said their value was perhaps not communicated enough. A large piece of work on the outside garden area was about to commence.

6.    The agenda report (page 51) highlighted that Mental Health Support Teams (MHSTs) would be in 51% of Kent and Medway schools by 2023/24. A Member asked what support would be available to the remaining 49%. Ms O’Rourke explained that different interventions would be commissioned to engage those schools.

7.    A member asked whether demand was rising faster than capacity could cope with and if this affected service performance. Ms Johnson explained the service was continuing to look at the most effective way of investing in treatment at home earlier in a patient’s pathway. Three of the additional beds at KMAH would be ringfenced to 72-hour stays, but it was recognised that an inpatient bed was not always the right treatment. The service was looking into what more could be done locally for patients with eating disorders as there was no inpatient facility nearby.

8.    On patients being placed far from home, Ms Burns reflected that the phrase “local beds for local people” was of course the ideal but was more complex and depended on the individual case. Some patients required specialist or secure provision – for example for some eating disorder treatments there were only a few beds available across the country. Ms O’Rourke explained that Kent and Medway had been proactively working to respond to such issues by speaking to regional and national teams, increasing capacity for the long term and strengthening community teams.

9.    A Member had heard from SENCOs that accessing support was all but impossible. Ms Burns advised she had recently met an MP and some local schools to discuss the issues being faced. She offered to take any specific issues up outside of the meeting.

10. A Member reflected on the bleak situation facing young people, from coming out of the pandemic to facing a cost of living crisis, on top of a pre-existing crisis in places such as Thanet. Ms O’Rourke explained that bespoke services were available and there was a huge piece of work underway looking at multidisciplinary roles in primary care including non-clinical ones, expanding the neurodevelopmental pathway pilots, and ensuring individuals knew how to access services.

11. On recruiting and retaining staff, Ms Burns acknowledged there was a challenge with recruitment. She spoke of additional investment in clinical roles and more senior professionals, as well as joint roles with Adult Social Care to improve transition, and the need to bring in trainees for long term sustainability.

12. A Member asked whether it was too early to tell if the increases in young people experiencing anxiety was a short-term concern or a covid-legacy of a cohort of individuals who would always require support. Ms Johnson explained there was no clear trajectory, but they were working to improve early interventions, including considering how the school nurse service could assist. Ms Burns noted it was important not to over-medicalise anxiety as it was also a natural reaction.

13. A Member asked about hidden demand. Ms Burns noted the new Integrated Care Board (ICB) was undertaking a piece of work looking into specific groups. For instance, it was known there was an increase in young men with eating disorders. Communities provided an opportunity for holistic support but how could this be strengthened? Work was underway with the voluntary sector. The ICB had a health inequalities workstream.

14. A Member said that 24 hour coverage from the crisis team was not their experience. This would be taken up outside of the meeting.

15. The Committee were grateful for the comprehensive report.

RESOLVED that the report on Children & Young People's Emotional

Wellbeing & Mental Health Service be noted and the Kent & Medway CCG be invited to provide an update at the appropriate time.