Agenda item

Kent and Medway CCGs have agreed to the procurement of a Kent and Medway Neurodevelopmental (ND) Health Service for Adults (18+) which will improve quality and value for money and is fully supported and identified as a priority need by the Sustainability and Transformation Partnership (STP) and NHS Long Term Plan (2019). The primary purpose of the proposed Kent and Medway ND pathway is to reduce the health inequalities and improve the quality of life for Medway residents with Autistic Spectrum Conditions (ASC) and/or Attention Deficit Hyperactivity Disorder ADHD.

Discussion

The proposals aimed to improve and enhance specialist services for those with autism and Attention Deficit Hyperactivity Disorder (ADHD). Services would be enhanced and improved with there being no service reduction. Existing services for autism were not compliant with legislation and NICE guidelines and were therefore not meeting the needs of the local population. Patient experience was poor with there being increased clinical risk and risk of deterioration in health where conditions were not managed effectively.

In relation to autism, there was currently no pre-diagnosis or post-diagnosis provision in Medway and no pre-diagnostic support for ADHD. Patients being assessed and treated currently had to travel to London. Kent had undertaken engagement work with health professionals and the public to consider how provision might be developed and similar engagement was planned for Medway. A Kent and Medway Complex Autism Service had been piloted. This was helping to avoid the needs of patients escalating, through the provision of locally based community services. The proposals had been supported by NHS Medway Clinical Commissioning Group’s Commissioning Committee and were deemed to be the most appropriate way forward.

Members of the Committee made comments and asked questions as follows:

Diagnosis of Patients – It was suggested that patients currently had to travel too far for services and that waiting times were too long. The Committee was advised that a number of innovations were being considered in relation to diagnosis. A pilot was currently taking place in Kent. Services could be provided quicker at lower cost and without reduction in quality. It was agreed that local provision was needed.

Finances – It was confirmed that the service cost of £2.87 million contained in the report was the annual cost for one year in Kent and Medway. In response to a question about service redesign, Members were told that although there would be pathway redesign, the substantive parts of it would not be changed. Assessment and diagnosis would be made available locally with services being co-designed and produced.

Availability of Providers – In response to a question about availability of providers and staff, there had been some market testing in Kent, including a  pre-procurement market engagement event. Multiple providers had attended and there had been significant interest. Providers were starting to upskill their workforce with there being a number of locally accessible providers. An existing provider currently commissioned to provide autism services in Kent was also able to provide ADHD related services.

Substantial Variation, timescales and transition – It was suggested that such a change to a health service would normally be a substantial variation, whether a reduction or as in this case, an increase in provision. However, in this case it would be appropriate for the Committee to consider not determining the proposals to be substantial in order to ensure that service improvement could take place at pace in the context of patients facing lengthy waits to receive a diagnosis. It was asked how quickly the changes could be made and whether there would be a transition plan for those moving from children’s to adult services. It was also suggested that increased investment in children’s services would be beneficial. The Committee was advised that should Medway and Kent both agree that the proposals did not amount to a substantial variation, the new service should be in place by March 2020.

Work was being undertaken to monitor and develop priority criteria for children waiting for services and similar work would be undertaken in relation to adults. A report to consider how to address a backlog had been submitted to the CCG Commissioning Committee in the autumn. The backlog had risen due to a number of new patients being identified having increased in the last two years from two a month to six a month. Additional funding had been agreed to clear the backlog. This backlog related to ADHD with there currently being no backlog for autism assessment. It was considered that contract performance and management would be easier once a local, rather than a London based provider, was delivering services. There had already been substantial investment in neurodevelopmental pathways, including for under 11’s and 11 to 18’s. However, some people with autism / ADHD did not present for diagnosis until they were adults.

Decision

The Committee:

i)     Determined that the proposals did not amount to a substantial variation to the health service in Medway.

ii)    Considered and agreed the outline proposal for engagement/consultation as detailed in section 5 of Appendix 1 of the report.