Agenda item

Mr I Ayres, Accountable Officer, West Kent Clinical Commissioning Group, was in attendance for this item.

1.         Mr Ayres introduced the report and summarised the issues which had arisen in the year since the new contract with Sussex Partnership Health Trust had started in September 2012.  These issues included the realisation that there were more waiting lists than had previously been apparent, with several smaller ones coming to light; the need to move from the previously medically-led model and the need to re-shape the workforce to support this; an underestimate of the level of adjustment needed in changing the culture and transferring staff.  The situation now is better than it was one year ago but there is still much progress to be made, but Mr Ayres assured Members that the service commissioners understood the issues they were facing and were confident of being able to address them fully.

2.         Mr Ayres and Mr Ireland responded to comments and questions, as follows:-

a)         in response to a concern about young people still facing lengthy waits for appointments, Mr Ayres agreed that persistently long waits were unacceptable and said that work was ongoing to assess whether or not the right action was being taken to address waiting times. He said the service had perhaps become over-confident about early successes in starting to reduce waiting times, as demand for services had risen more than had been expected;

b)         concern was expressed about the difficulties of recruiting suitable staff in North West Kent and an opinion put forward that the level of graduate unemployment in the area was surely a resource which could help to ease these difficulties. Mr Ireland commented that the concerns raised about recruitment had all been from Members who represent divisions in North West Kent, where recruitment has the challenge of having to compete with London salaries. This could contribute to the difficulties in recruitment.  Mr Ayres added that recruitment difficulties could also arise from a shortage of suitably-qualified people coming forward or the service provider looking to recruit staff with a skills mix which does not exist. The model of provision could also be contributing to difficulties. It is important to identify the reality of the problem and be frank about addressing it. Future reports to this Committee will look at recruitment in more depth;  

c)         the difficulties being experienced with waiting times in the service should be the subject of the County Council’s scrutiny function. This scrutiny could look at the problems in recruitment and ask if these stem from a reluctance to work with children who are seen as ‘difficult’, and if the profession carries a stigma;

d)         a child’s home environment can impact on their mental health and the way in which any mental health issues are addressed.  Some parents block sources of help, so a multi-agency approach might help in optimising the ways in which a family can be reached and helped;

e)         in response to a question about what powers the County Council has as a customer to enforce standards of service, Mr Ireland explained that the County Council accesses only a relatively small part of the service – only for children in care. The contractual and monitoring role rests with clinical commissioning groups. Moving to a more joint approach and joint commissioning in future would lead to a less medical-based service. Mr Ayres explained the levers available in a contract to address performance. If a provider were to breach the terms of their contract a performance notice could be served upon them, with financial penalties if they do not take account of that notice.  However, using such levers is an indication that the commissioner-provider relationship had already broken down.

3.         RESOVED that:-

a)        the information set out in the report and given in response to comments and questions be noted; and

b)         the comments and concerns expressed by Members, set out above, be taken into account by the commissioning body.