Agenda item

This report provides the Health and Wellbeing Board with an update to the report presented to the Board on 27 June 2017. The report includes a summary of progress against the Transforming Care (TC) programme and outlines the challenges faced by the TC Partnership over the coming year if it is to achieve the target (agreed with NHS England) that Kent and Medway would reduce their inpatient total to 57 or below by March 2019.

Discussion

The Programme Lead, Partnership Commissioning presented an update to the Board on the progress of the Kent and Medway Transforming Care Programme and set out the challenges faced by the Programme over the next year. The Board was also reminded that the aim of the Transforming Care Programme was to discharge individuals with a learning disability, autism or challenging behaviour from inpatient secure hospitals.

It was highlighted to the Board that the programme had recently entered its third year and over the duration of the Programme, eleven patients had been discharged and three admissions avoided. In addition, it was emphasised that in conjunction with colleagues in Kent, work had begun on a series of housing (accommodation) and support projects, supported by capital funding from NHS England and match funded from the Programme. It was noted that this stream of work would facilitate individuals in inpatient care to return to their community with the appropriate support.

In the context of this work, it was stated that a financial framework had been developed with partners in Kent to facilitate the transfer of funding from central government. However, the Board was advised that it was not clear whether there would be any additional funding at the end of the Programme in March 2019. It was added that the Government had revised its position on the proposed funding model several times.

The Programme Lead, Partnership Commissioning, also drew the Board’s attention to a series of other challenges affecting inpatient numbers, noting that a target had been agreed with NHS England to reduce the inpatient total across Kent and Medway to 57 or below by March 2019. The factors outlined to the Board which had impacted the inpatient total included an increase in the number of individuals being transferred from prison to a secure inpatient provision and volatile child inpatient activity.

With regards to children, the Board was advised that more robust support for children, families and their network of care was needed. The most current inpatient total was seventeen, of which four patients were children. It was noted that Kent and Medway had been identified by NHS England as an accelerator site for children and young people in the Transforming Care cohort and as a result additional funding was being made available.

Whilst noting that it was appropriate to focus on individuals, a Member sought clarification on the statutory responsibilities to support the families of children and young people in secure inpatient services and examples of good practice elsewhere in the country. The Board was advised that Children’s Services continued to provide a range of family support that included support for this complex cohort. It was also stated that national and international research recognised positive behaviour support as a model to train families and carers to develop the tools and techniques to support and respond to an individual appropriately. It was added that currently a training provider was being sought to provide positive behaviour support training for parents, carers and providers. It was suggested that feasibility work was also underway to determine whether it would be possible to pilot a Positive Behaviour Support Specialist team, which would include psychology specialists that would support the trained parents, carers and providers.

In response to a question about access to training for charitable organisations, the Board was advised that a working group had been established which included a number of stakeholders including local charities and voluntary organisations who would have access to the training programme. It was added that the training would be advertised in the Transforming Care newsletter which was widely distributed to residential services, supported living services and supported accommodation services in addition to Medway Voluntary Action.

Whilst a Member was reassured that positive behaviour support was being considered, referring to examples of family experience and emotions when a child or young person was placed into a secure inpatient facility, for example relief and guilt, a Member expressed concerns that further action was needed. In response, it was explained that the NHS England Sustainability and Improvement team had produced a report following engagement with service users and their support networks which set out their experiences. This report had been utilised by the Transforming Care Programme to map against the nine principles detailed in the national service model “Building the Right Support,” which aimed to ensure that appropriate support was available to individuals and families to maintain the person locally. The Board was referred to the case study set out at Appendix 2 of the report, which demonstrated one family experience. 

In response to a concern expressed by a Member in relation to the support provided to individuals within the criminal justice system, the Board was assured that support was provided to individuals. Support extended to helping individuals with comprehension when attending court.

The STP / KMPT Mental Health Programme Director drew the Boards attention to an opportunity for the Transforming Care Programme to link to a new programme of work, encompassing prisoners, to identify new care models for adult secure mental health services. An offer was extended to discuss relevant specialist commissioning and adult mental health secure services.

Further clarification was sought in relation to support for individuals participating in the engagement activity and consultation set out in section 5 of the report. It was explained that in liaison with the Medway NHS Clinical Commissioning Group, an engagement programme was being developed. This would ensure that individuals with learning difficulties, autism or challenging behaviour were engaged.

In response to a question regarding the location of secure inpatient facilities, the Board was advised that before an individual was discharged, inpatient teams, receiving placement teams and parent and carers would discuss an appropriate placement with the individual. As part of this process, work around life planning would be undertaken. It was clarified that there was not one single facility in Medway and that principally, the Transforming Care Programme aimed to support individuals to move back into the community and support them there. It was further clarified that if an individual was identified as at risk, they might be placed at a facility based within hospital grounds, which would enable individuals to live independently with clinical support nearby.

Support was expressed for the inclusion of a dedicated complex care resource within the Transforming Care Programme and in response to a question about the recruitment of the Learning Disabilities Commissioner/ Transforming Care Lead, the Board was advised that this post had now been recruited to.

The Director of Assurance and Delivery, NHS England reassured the Board that NHS England supported the work of Kent and Medway and recognised the challenges. He added that a focus area should be early help and prevention. This was echoed by the Director the Director of Children and Adults Services who also stressed the importance of this workstream and outlined the need to ensure local care and improved support for families.

A view was expressed that central government should be lobbied to support the continuation and funding of the Transforming Care Programme. The Chairman cautioned the need to use appropriate channels to do this and the Board was advised that the Association of Directors of Adult Social Services had made representations to central government and the Director of Children and Adults Services undertook to provide Members with a copy of a letter.

A Member commended the actions undertaken to achieve positive outcomes for individuals.

Decision

The Health and Wellbeing Board:

a)    considered how the Board could promote and engage with this important agenda going forward, offered support, feedback and leadership to ensure the successful implementation of the Medway Transforming Care Plan and supported the Council and CCG to comply with statutory duties; and

b)    agreed for a progress report to be presented to the Board in 6 months’ time.