Agenda item

This report provides an update to the report presented to the Health and Wellbeing Board on 3 July 2018. The report also looks more holistically at wider impact of the Transforming Care Programme on systems and processes within the Medway Health and Social Care economy.

This report sets out an update to the Kent and Medway Transforming Care (TC) inpatient numbers; a summary of current challenges and difficulties in delivering TC in Medway and a summary of key tasks and issues facing Medway in 2018/19 and beyond.

Discussion:

The Programme Lead, Partnership Commissioning provided an update on the Transforming Care Programme (TCP). The Board was reminded that the aim of this programme was to improve services for people with learning disabilities and autism who display behaviour that challenges, including those with a mental health condition. The TCPs overarching aim had been to reduce hospital admissions and support more people in the community whenever possible. The Board’s attention was drawn to three main areas:

1.    The achievements of the TCP (set out in section 3 of the report), which included:

·         securing additional funding for a programme of Positive Behaviour Support Training. A specialist virtual Positive Behaviour Support Team was also being piloted from January 2019;

·         putting in place specific services to support individuals with autism, including the Kent and Medway Community Autism Service;

·         establishing a new Kent and Medway Operational Group to ensure accelerated delivery and oversight of the Programme and to support the delivery of the NHSE Children’s Accelerator Programme; and

·         securing several NHS England grants of £10k and £15k to support named individuals on discharge.

2.    The remaining challenges (set out in section 4 of the report). It was explained that Medway’s inpatient numbers had declined from a high of 20 in November 2016. This was partly due to preventing repeat admissions through the use of Care and Treatment Reviews (CTRs) and Care, Education and Treatment Reviews (CETRs). It was explained that as part of the review, Multi-Disciplinary Teams (MDTs) had been convened within 24/48 hours of an individual being identified as at risk to consider the best intervention to prevent them from being admitted to hospital. However, outside the control of the TCP, in the last 12 months, owing to additional patients from within the criminal justice system and challenges with supporting child and adolescent discharges, inpatient numbers in Medway had remained static at 16. Another difficulty was the reclassification of Mental Health (MH) patients in hospital (i.e. patients who are admitted to a MH bed but have a diagnosis of LD or autism when they are in hospital).

3.    Key future actions (set out in section 6 of the report) included the development of an “At Risk of Admission” register to enable proactive steps to be taken to identify who might need support and provide it as soon as possible. It was explained that this was very complex and that further work was needed to develop the criteria to determine what individuals would be added to the register, how individuals would be removed from it and what consents from the individual would be required. Additional actions arising from the NHS 10 Year Plan were also summarised.

Members raised a number of comments, including:

Multi-Disciplinary Teams (MDTs) - Concerning a question regarding MDTs, the Board was advised that these Teams were considered to be effective. There were some areas for improvement, for example it was explained that engaging with education had been challenging. The Board was advised that 100% of children were known to education before crisis, but were not necessarily known to health or social care. It was noted that a children’s lead had been identified. The Programme Lead for Partnership Commissioning would be meeting with secondary school head teachers to understand what schools could do to support the TCP and how the TCP could support schools, including signposting to further information.

Diagnosis and referral - With reference to a question about diagnosis and referral, it was explained that CTRs were carried out by a panel of people. This included an independent expert by experience and a clinical expert. The experts were able to challenge the system to ensure the right decision on intervention was made. If further clinical investigation was deemed to be required, this would be instructed.

Treatment pathways - Concerning a question in relation to treatment pathways in Medway, the Board was advised that with respect to neurological conditions, such as Attention Deficit Hyperactivity Disorder (ADHD) and Autism, there were clear pathways to specialist support via GP services. However, for other conditions more work was needed on pathways for care. The TCP specialises in providing support for people with a learning disability and/or Autism who display behaviour that challenges, including those with a mental health condition, individuals with a diagnosis outside this remit would be signposted to relevant services but their treatment would not be followed up by the TCP.

Medway Community Healthcare (MCH), Child Health Service contract transition – A Member expressed concern on behalf of headteachers in relation to this Service, in particular waiting times for assessment and he requested an update on how previous concerns that had been raised were being progressed. The Director of Public Health undertook to provide Members with a briefing note addressing the concerns raised.

The Board was advised that the TCP had predominantly engaged with secondary school aged children or above and only one younger child had come into contact with the Programme. From a clinical perspective, the Director of Children’s Services at NELFT explained that children and adolescents who had neurodevelopmental conditions would experience peaks and troughs throughout their childhood, adolescence and adulthood which was considered difficult for clinicians to convey to families. Through the CETR process, the system works very hard to put in place the best interventions for the individual to prevent escalation to the hospital environment. But, sometimes it was considered that there was a system wide lack of understanding of the presentation of neurodevelopmental conditions.

“At Risk of Admission” register - In response to a question on this register, the Board was advised that a project officer was currently being recruited to develop an options appraisal that would be presented to Kent and Medway Transforming Care Executive Board. This appraisal would consider how this register could be developed and delivered, keeping in mind the complexities raised. 

Decision:

The Health and Wellbeing Board:

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

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