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mental health provision review
The Chairman welcomed Mr Ivan McConnell (Director of Commercial Development and Transformation - Kent and Medway NHS and Social Care Partnership) and Mr Malcom McFrederick (Interim Director of Operations - Kent and Medway NHS and Social Care Partnership) to the meeting.
Councillor Roger Truelove, Lead Member for the review, explained that the Committee were reviewing mental health care. This session would be focusing on acute care, with a further session on care in the community at the next meeting.
Members then asked the following questions:
How are acute mental health services in Kent commissioned, provided and funded?
Mr McConnell explained that Kent and Medway NHS and Social Care Partnership were the primary provider of secondary mental health care across Kent and Medway. They were commissioned by Clinical Commissioning Groups (CCGs) across Kent to provide a range of services, including acute adult in-patient and care in the community services, older adult in-patient and care in the community services, forensic services which includes individuals detained under the Mental Health Act, as well as services commissioned directly by NHS England.
He explained that children and adolescent services were provided by the Sussex Partnership Trust, and there was a range of separate providers across Kent for substance misuse treatment. There were also a range of accredited providers for low-level primary care psychological therapies. The Kent and Medway NHS and Social Care Partnership currently provided the higher intensity Level 3 and Level 3 + services for individuals on the edge of crisis.
Where are the three centres of excellence to be located following the decommissioning of 'A' block at Medway Maritime Hospital?
Mr McConnell advised that there was still a 16-bed acute adult unit and a 16-bed acute older adult unit at Medway Foundation Trust. The three centres of excellence would work on a hub and spoke model with the hubs located in Dartford, Maidstone and Canterbury. He undertook to provide a document with further detail on the new arrangements. He stressed that acute mental health care was not just about the provision of beds and it was vital that people were able to be treated in the community. The new arrangements would create hubs of multi-disciplinary teams who then provided appropriate services within the communities around those hubs.
How could individuals access the services?
Mr McConnell explained that there were a number of routes through which people accessed the mental health services: primarily this was through GP referrals, but also detention by the Police under the Mental Health Act, transfers from Accident and Emergency departments, older adults requiring physical treatment who were then referred for mental health treatment, and patients with current crisis plans who require assistance from the crisis team.
Where were the forensic teams located, and what is a care plan?
Mr McConnell advised that there were in-patient services at Maidstone and Dartford and community forensic teams work directly with the Police and Probation Services. The Police have a custody and liaison service and are required to work with individuals to ensure they are provided with the right care. He also explained that a new sexual assault referral centre was now operating in Maidstone.
Mr McFrederick advised that a care plan listed the interventions appropriate to the individual, who they should contact in the mental health team and what action they should take if they feel like they are having a crisis. The plan will set out the steps they need to take and help them to cope better.
How do you maintain continuity with patients in custody?
Mr McConnell explained that there were approved mental health practitioners who assess a patient in custody at the initial stage and custody liaison nurses and psychiatrists who would work with the patient to assess their mental capacity to stand trial.
What in-patient services are being provided at Dartford, Maidstone and Canterbury?
Mr McConnell advised that there were currently 160 adult beds across Kent with proposals to increase the number of beds to 174 across the three hubs. There were currently 150 older adult beds, but these were subject to a separate consultation.
What assessments have been made on how Swale residents can access these centres of excellence? What assessment has been made of user-groups views and how have they been reflected in the proposals? What are the staff/patient ratios and is staffing adequate?
Mr McConnell offered to provide further information on the consultation and the responses. He explained that the number of beds provided was in-line with the requirements set by Public Health and the Primary Care Trusts based on a number of factors, including travel time. He stressed that acute mental health care was about provision of a range of community-based services, recognising the need for adequate beds which should be used as a last resort. He explained that there were a number of interventions which would not have to be based within hospitals, including the pilot of the street triage service, which offered a local response and could treat an individual without the need for in-patient services.
Mr McFrederick explained that they were required to publish staffing numbers including staff/patient ratios and they would be announcing these figures shortly using the Hurst model as a nationally recognised tool for workplace planning. Mr McConnell stressed that the nature of acute mental health care meant they had to base staffing numbers on an average as no day was the same; patients would require different levels of care and would be admitted for different lengths of time.
What are the challenges for our residents in accessing mental health services?
Mr McConnell acknowledged that travel was an issue for individuals and carers, which needed further consideration. A transport plan was being introduced which would provide some free transport options but this needed to be better publicised. He considered that further thought should be given to optimal ways to provide the services without the need for additional funding. There was a protocol in place with GPs regarding response times, and there needed to be better information for GPs and individuals on the 24/7 access to services.
How are you taking into account users views?
Mr McConnell listed a range of engagement groups including service user and carer engagement forums and carer groups and welcomed suggestions for other ways in which they could engage with residents.
How well briefed are the out-of-hours service in mental health referrals for the Swale area?
Mr McConnell considered that this was an area for improvement and considered that the MedOCC system in Medway worked better. He explained that there was work being undertaken to agree an urgent response process. He explained that issues regarding information governance did create problems and placed constraints on the service provided, as patient consent was required to share data across services. A trial was being piloted in Dartford to improve communication issues, particularly regarding information available to ambulance staff.
How confident are you that GPs have the professional diagnostic skills? Is there enough professional capacity in mental health? Is 174 beds really enough?
Mr McConnell explained that GPs see a large number of people with mental health issues, and a range of training events were being scoped to improve GPs understanding of mental health. It was important for GPs to make referrals as mental health issues are difficult to diagnose and it is a specialist area. An education programme had been piloted in West Kent involving two consultants delivering sessions in specific mental health topics for GPs, which had received excellent feedback. GPs have access to a consultant via a mobile number, and a protocol was being developed to enhance the speed of communication between GPs and mental health specialists.
Mr McFrederick advised that there was a variation of professional availability across Kent with some recruitment difficulties in West Kent and around London. He considered that achieving Foundation Trust status could provide more flexibility regarding pay, as they were currently bound by the national pay structure.
Mr McFrederick explained that staffing was at a safe level and he was confident that, subject to improvements to community care services, the number of beds was right at the current time. He considered that more intermediate beds would be highly beneficial enabling the current beds to be used for acute cases. He considered that this may be a service that an alternative provider could provide and it would be a lower cost than acute care beds. There had been a 100% increase in demand over the past year in Kent and Medway for older adult care, and work was needed to improve the care in the community and the way it was delivered.
Mr McConnell explained that there was currently one crisis house in Kent, and more consideration needed to be given to looking at how we could increase the provision by working with the right partner agencies.
There was currently a mix between agency staff and directly employed staff, which Mr McConnell considered was the result of recruitment issues, rather than retention. However, a number of agency staff were employed over long periods of time, so there was a degree of continuity of staff within mental health teams.
There was some discussion on the overlap and potential for fragmentation of adolescent mental health services when the individual approaches 18; safeguarding issues; and how the transition pathways could be improved. The Committee agreed to consider children and adolescent mental health services at a future meeting.
What are the response times and does Swale have more or less provision than other areas?
Mr McConnell explained that they used a call categorisation approach and cross-cover was provided by mental health practitioners across Kent. He advised that there was a similar level of resource provided across Kent.
How are assessments made on whether residents should be able to access community facilities rather than acute ones?
Mr McConnell explained that all individuals known to the team have a care plan, and they are expected to be active participants in setting out their plan. This plan would set out the crisis point when the individual would require acute care.
How do you ensure the wellbeing of your staff?
Mr McConnell acknowledged that it could be a challenging and emotional environment and staff were provided with physical and mental health support, which they could seek informally or formally, and confidentially if needed. He considered that team de-briefs were very important for staff to discuss any issues.
How is the availability of acute mental health provision publicised and communicated to residents?
Mr McConnell considered that communication was an area for improvement. There was some positive communication steps taken including the Buddy App and some developing on-line engagement tools for adults. He considered that the website needed to be improved to put more resources on-line and sign-post services. He welcomed suggestions on improvements to communication.
How does the service try to get mental health taken seriously? What methods are employed to overcome stigma?
Mr McConnell considered that there needed to be parity between physical and mental health, and recognition that many patients with mental health illnesses also experience physical health issues. There was a Kent-wide anti-stigma campaign launched by Kent County Council, raising awareness for staff and service users, and the Live It Well library which was a national initiative. Service users attend Board meetings to input into the future of the service. A video had been produced for Kent Police officers to raise awareness about the signs of mental health. He welcomed suggestions for better communication or other ideas for raising awareness.
Are substance misuse individuals treated in different ways?
Mr McConnell explained that there were multiple providers of services for substance misuse treatment. The NHS Kent and Medway Social Care Partnership currently provided some community-based detox services and in-patient services. The in-patient detox programme lasted four weeks and was very intensive. He stressed that continuity of key workers for patients was fundamental and more consideration needed to be given to what services were provided for patients after being discharged as there was a high rate of relapse.
What is your budget and what is the difference between this year's budget and last year's? What are the pinch points and what was falling off the edge? What is your relationship with the CCGs?
Mr McConnell advised that their budget was £167m across Kent, which included funding from NHS England and was comparable with other providers. He explained that in the next financial year they would have three separate contracts with East Kent, North Kent and West Kent. He advised that they had an excellent relationship with the Lead Mental Health Commissioner in the CCG for North Kent but considered that it was important to work with the CCGs and build good working relationships. He considered that the complexity of the services and the different needs of communities across North Kent could create tensions.
What should Local Authorities' role be?
Mr McConnell considered that districts authorities have an invaluable role and suggested particular areas for consideration, such as the Integration Pioneer funding and how this could be used; improved use of data systems including sharing of information across housing and benefits; engagement with CCGs on Better Care Funds; attendance at Urgent Care Groups; inputting into how CCG funding is spent; awareness training for staff; and supported housing ventures.
What choice was available to residents as to where they access care?
Mr McConnell explained that 2015/16 would see the introduction of mental health choice. Residents could choose where to access care currently but there needed to be better information about what this means and the choices available to them.
If the acute care beds are full do patients get diverted elsewhere?
Mr McConnell advised that the patient would be taken to the nearest hospital with a bed available and would then be moved back to their closest hospital as soon as a bed became available. On occasions patients were moved out-of-area but this could also mean to beds supplied by private hospitals.
The Chairman thanked Mr McConnell and Mr McFrederick for attending the meeting.
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