Agenda item

This report advises the Committee of a proposal under consideration by the eight Kent and Medway CCGs to recommission a single all age specialist eating disorder service for the whole of Kent and Medway. The Committee is  recommended by officers and NHS Medway CCG to agree that this does not amount to a substantial development of, or variation to, the health service across Kent and Medway.

Discussion

Graham Tanner, the Council’s Partnership Commissioning Programme Lead introduced Dr David Chesover, Member of the West Kent CCG Governing body and Martine Mccahon, Senior Commissioning Manager – Mental Health at NHS West Kent CCG. Mr Tanner introduced the report, which advised the Committee of a proposal under consideration by the eight Kent and Medway CCGs to recommission a single all age specialist eating disorder service for the whole of Kent and Medway.

The Committee was informed that the proposed service would be funded by children and young people’s transformation funding from NHS England, in addition to funding from Kent and Medway NHS and Social Care Partnership Trust and from Sussex Partnership NHS Foundation Trust. The newly commissioned service would provide specialist intervention and support service users to return to and maintain good health.

The need to commission a new service was highlighted by the fact that some patients were having to wait up to two years to access existing provision and that the threshold for access to the service was quite high. With effective treatment available, approximately 70-80% of patients would be able to live independently, as long as they had appropriate support. It had been identified that a local population of at least 500,000 was required to enable the delivery of an effective and efficient service. This necessitated the commissioning of a service that covered the whole of Kent and Medway.

Proposals in relation to the new service had been shared with local clinicians and had been revised to take into account feedback received. Six out of the eight clinical commissioning groups in Kent and Medway had now ratified the business case and it was expected that the other two CCGs would ratify it within the next week.         

The Committee was asked to determine whether the proposal amounted to a substantial development of, or variation to, the health service across Kent and Medway. Officers and Medway CCG considered that the proposals did not amount to a substantial development or variation.

Whilst welcoming the new service, a Member was concerned about ease of access to eating disorder services and the geographic location of future services covering the whole of Kent and Medway. The practicalities of families visiting patients needed to be considered and the needs of male patients should also be considered as these were not always recognised in relation to eating disorders. The Member also felt that some GPs did not recognise the seriousness of eating disorders. The representatives from West Kent CCG said that there was an increasing recognition of eating disorders amongst males. The importance of family in helping sufferers of eating disorders to overcome them was recognised by treatment approaches such as the Maudsley Model. It was also important for sufferers to be helped in the early stages of an eating disorder to help prevent the problem from escalating. The Beat eating disorder charity and the support it provided was also mentioned.

Concerns were raised that pressure to be unnaturally thin was caused by media coverage and the fashion industry. In relation to proposals to reduce the number of inpatient mental health beds, it was suggested that such a reduction should only take place if it was still considered appropriate once the new service was in place. The Member of the West Kent CCG Governing Body responded that place based commissioning would consider the range of potential service users and professionals in an area and help provision to be tailored accordingly. In relation to the fashion industry, it was not clear that eating disorders were caused by body image that could be attributed to the fashion industry as such disorders had been around for hundreds of years. The proposed reduction in beds was due to the expectation that better treatment and prevention would reduce the number of patients requiring inpatient treatment. It was anticipated that appropriate intervention could result in an 80% “cure” rate at tier 4 rather than the existing 30% rate. The financial saving generated by a reduced number of beds would then be available to invest in eating disorder services.

In response to whether patients should be able to be referred to eating disorder services by non-GP professionals and whether they should be able to self-refer, it was advised that, while self referral did already take place in some areas, for the time being it was anticipated that patients in Kent and Medway would all be referred via their GP. This would help to ensure that any other associated conditions that the patient might also be suffering from were correctly diagnosed. A Member suggested that access to restorative services should be considered as part of holistic care provision. It was confirmed that public health would monitor throughput. It was anticipated that the average cost of treating a patient would be reduced from £22,000 to £12,000 through early intervention.

With regard to a question about funding of the new service, it was confirmed that the annual funding available was expected to be £2.6 million. This included funding of £950,000 that would be provided by NHS England.

A needs analysis would be used to identify gaps and confirm whether additional support was required in schools. Work was undertaken with teachers to enable them to recognise signs of eating disorders and to facilitate the promotion of health and wellbeing. It was also noted that a Mental Health matters helpline had launched in Kent and Medway.

Decision:

The Committee agreed that the proposal did not represent a substantial development of, or variation to, the health service across Kent and Medway.