Agenda item

In virtual attendance for this item: Louise Clack (Programme Director, Mental Health Urgent and Emergency Care K&M ICB), Dr Adam Kasparek (Psychiatry Liaison Consultant, Deputy Clinical Director of Acute Services, KMPT) and Matt Tee (Executive Director for Communications and Engagement, ICB)

1.         Ms Clack explained that in Summer 2022 the Kent & Medway Integrated Care System had been awarded capital funding ringfenced for safety improvements to the mental health urgent and emergency care pathway. The proposals set out in the paper were to change the current Section 136 (S136) pathway and the existing Health Based Place of Safety (HBPoS) base and estate. The changes fell under the “Kent and Medway Mental Health and Emergency Care pathway transformation programme”.

2.         Due to a tight turnaround for the submission of the bid there had been no opportunity for formal consultation. Those informally consulted included SECAMB, Kent Police and those with lived experience. The ICB were actively engaging key stakeholders and intended to take the proposal to public consultation in the near future.

3.         Members were informed there had been a reduction over time in the use of S136 suites, largely due to investment in a police advice line.

4.         The ICB wanted to reduce the amount of time service users spent in a place of safety and improve their overall experience. It was also hoped the changes set out in the report would improve the recruitment and retention of staff.

5.         A Member noted that there were currently 5 places of safety across 3 sites (2 in Maidstone, 2 in Canterbury and 1 in Dartford), and the proposal was to maintain 5 places but all at 1 Maidstone site (Priority House). Maidstone had been identified as the most suitable location due to its accessibility and affordability. Ms Clack confirmed that capital works would be required at Priority House to make room for the additional places.

6.         Asked if the Home Treatment team had the power to admit and prescribe, Dr Kasparek confirmed they did.

7.         Asked about accessibility for friends and family, it was explained that a place of safety was used for a timely assessment of need for a period of up to 24 hours (with a possible extension by 12 hours). Visiting was therefore rare and often not appropriate. The Pre-Consultation Business Case included a travel impact assessment. Under the current system, patients were taken to the HBPoS with immediate availability, regardless of where they resided.

8.         The current estate was outdated and lacking in resilience, it also did not meet recommended standards and best practice. National standards for HBPoS recommended that each suite had access to fresh air as well as offering a bedroom, a de-escalation space and access to a lounge area. Dartford and East Kent suites did not have access to fresh air and only offered one room that was not purpose built. Some service users had described the suites as worse than being in a prison cell.

9.         In terms of usage, 2 years ago there had been over 150 patients each month. In December 2022, that had reduced to 55. It was hoped that number would reduce further as improvement work on the mental health pathway continued.

10.      Asked about the Crisis Resolution & Home Treatment team, it was explained that there were 5 locality teams across Kent & Medway. The team provided planned interventions as well as urgent assessments, which could cause conflict. A revised home treatment model was planned which would separate those areas of responsibility, establishing a Rapid Response team and an Enhanced Home Treatment team. The intention was for them to be multi-disciplinary, including pharmacists, pharmacist technicians, social workers, psychologists and dedicated occupational therapists.

11.      Mr Tee explained engagement both planned and underway. In what was a sensitive area, pre-established organisations such as Mind would be involved as well as direct contact with previous service users. Mr Goatham from Healthwatch confirmed they had been contacted in relation to the consultation and sharing existing experiences. A Member suggested Housing Associations be approached as part of the consultation.

12.      A Member asked how police officers considered if a person needed to be detained under S136 powers. If a police officer had concerns that someone may have a mental health disorder and be at risk to themselves or others they could execute their right to have a doctor’s assessment. Police officers had access to a phone line for advice if required. They would then transfer the person to a S136 suite.  A social worker would arrange for a doctor’s assessment. The time taken between detention and assessment could be a few hours, as the social worker would need to identify and wait for 2 trained doctors to arrive. However, within 1 hour an on-site doctor would attend and review the patient, and a registered nurse would offer therapeutic interventions.

13.      The proposed centralisation of S136 suites sought to streamline the process by having the required personnel operating from one site. A centralised list had been created of personnel who could undertake assessments.

14.      Most cases took place out of hours, when there was a reduced complement of Approved Mental Health Practitioners (AMPs). Another benefit to centralisation was that rather than have staff travelling across the county between the three current sites, there would be a dedicated team located alongside the HBPoS.

15.      A Member raised concerns that only 5% of Mental Health Act assessments were completed within the nationally and locally recommended 4 hours, and did not feel mental health attracted the same attention as physical health. They were concerned about the proposal to reduce HBPoS localities from 3 to 1.

16.      The Chair accepted those concerns and noted that the proposals were dependant on securing enhancements at the Maidstone site. The consultation would also be particularly sensitive. For those reasons he recommended the changes were substantial.

RESOLVED that

               i.        the Committee deems that proposed changes to places of safety are a substantial variation of service.

              ii.        NHS representatives be invited to attend this Committee and present an update at an appropriate time.