Agenda item

The report provides an update on the work of Kent and Medway NHS and Social Care Partnership Trust (KMPT).

Discussion

The Street Triage pilot had contributed to a 19% reduction in use of Section 136 detentions in Medway under the Mental Health Act. The service had been running for nine months and there would now be a detailed evaluation with a view to making it permanent.

The Care Quality Commission (CQC) had previously raised concerns about the quality of service provided by the community mental health team at Canada House in Gillingham. The CQC had found caseloads to be too high, with these having been halved since the comprehensive inspection undertaken in January 2017. KMPT was also focusing on employing substantive staff and ensuring that clear care pathways were created. However, a further CQC visit in January 2018 had found that there had not been enough progress made and the CQC had therefore issued a warning notice to KMPT. A further engagement meeting between KMPT and the CQC had taken place to discuss progress and it was considered that good progress was now being made.

Medway had been chosen as an area to pilot a Personality Disorder Pathway due to the relatively high number of people with a personality disorder in Medway. This work was important to help people with a personality disorder to stay in the community. The Rosewood Unit, a mother and baby mental health facility, was about to open in Dartford. This would be the first time for many years there had been such a facility in Kent and Medway.

A Committee Member expressed her disappointment with the CQC findings. She was also concerned that people were struggling to access services and that even GPs were sometimes not clear what provision was available or how to access it. The Member was also concerned that patients were not being monitored effectively following discharge and considered it to be unacceptable that provision for patients with a personality disorder had previously opened and then shut again, with patients not having had an inadequate service for two years. The Member also asked for clarification of whether patients of no fixed abode were able to access Canada House.

The Chief Executive of KMPT agreed that the concerns highlighted were unacceptable. KMPT was building consistent leadership and standard setting. Caseloads had been reduced from 80 to 40, which was considered to be a manageable level. The number of patients being referred by GPs was challenging with only 40% of referrals requiring KMPT services but it being necessary to see all referrals in order to evaluate them. It was acknowledged that the single point of access created had not worked as intended. Staff were now clear about patient referral pathways. It was confirmed that people with no fixed address would be able to access the Canada House service and that KMPT had a responsibility to help this group.

A Member considered the Street Triage programme to be very good. He asked whether it was sustainable and if funding was dependent upon KMPT, Medway NHS Medway Clinical Commissioning Group and Kent Police. The Member also asked if there was confidence that the new Personality Disorder pathway would be successful.

The Committee was advised that it was KMPT’s responsibility to ensure the success of the Street Triage service and that there was confidence that this would be achieved. A business case was being developed to evidence the benefits of the service. Completion of this was anticipated by the end of August. In relation to Personality Disorder, some patients had already had good experiences and there was confidence that the new model would be a success. It would be a bespoke model built around the needs of Medway.

Work was taking place to enable local care to be provided as far as possible. It was important to put sufficient resources into GP services to support GPs to, where practical, resolve issues immediately. There were parts of the country where this was already taking place.

A Member commented that he was aware of a resident with mental health difficulties, who after visiting their GP, had been provided with a good service by text message. He also asked the Chief Executive of KMPT whether she could see advantages or disadvantages of the development of a Kent and Medway Strategic Commissioner. The Chief Executive acknowledged the need and desire for services to have a local focus but she considered that there was currently some unnecessary duplication in the system. Given the focus on local care and looking at the healthcare system as a whole, there was the potential for significant advantages to be realised.

Decision

The Committee:

i)     Noted the contents of the report and provided comments.

ii)    Requested that a visit to the Brenchley Unit in Maidstone be arranged for Members of the Committee.

iii)  Requested that further information be provided to the Committee in relation to provision of services for people of no fixed abode.

iv)  Requested that the Business Case for the Street Triage service be circulated to the Committee when available.