This report seeks to inform and update the Committee on the proposed service improvement to the Section 136 (Mental Health Act 1983, as amended 2007) pathway and health-based places of safety (HBPoS) for the adult population of Kent and Medway.
Members considered a report on the proposed service improvement to the Section 136 (Mental Health Act 1983, as amended 2007) pathway and health-based places of safety (HBPoS) for the adult population of Kent and Medway.
The following issues were discussed:
· Ambulance conveyance – it was clarified that an interim arrangement with a mental health ambulance provider to convey people from a S136 place of safety to onward care or home was in place. A three-year contract for a bespoke Mental Health Ambulance conveyance service was currently being procured under a full Tender process. SECAmb did not currently convey people from a S136 Place of Safety to onward care or home and it was confirmed that this would continue with the new proposed arrangements.
· Capital funding bid – in response to a query about this process, Members were advised that the Trust had worked closely with NHS England on the bid and the process had been relatively straightforward. There had been a ceiling on bids and the Trust felt they had received as much funding as was possible.
· Staffing levels – whether the savings from the proposals should be used to recruit more staff or increase the number of beds was queried. Members were advised some of the savings would be on agency staff who were currently needed due to the dispersed structure. There would also be efficiencies as a result of medical staff and Approved Mental Health Professional (AMHP) staff not having to travel across sites. The projected savings would be realised but these could fluctuate, and the actual figure would be reflected in the final business case. In terms of beds, the places of safety were rooms where people could stay for 24 hours. There was no plan to increase capacity as service improvements had reduced demand.
· Mental Health nurse/Police pilot – the Committee was informed that lessons had been learnt from the pilot, the most significant of which was the need for police to have quicker access to clinical advice. There was now a 24/7 clinical advice helpline which the police could access, which had led to a 50% reduction in S.136 cases.
Mental health investment in Medway – assurances were sought that the mental health needs of Medway residents would be met, that the proposals would be delivered, and a consistent service provided. The lack of detail in the report about when projects would be delivered was also criticised and reference was made to the history of mental health services moving out of Medway, generating a lack of trust in some cases. How long the new system would take to be embedded was also queried and an assurance was sought that the proposals would satisfy demand in Medway.
Members were advised that the new investment would allow patient pathways to be enhanced and there would also be other improvements such as a new crisis house in Medway. There had already been additional investment in psychiatry services in the Emergency Department and additional funding for 1 year for the Sunlight Centre and a safe haven in the Emergency Department from August. There was also a wider mental health transformation programme for Kent and Medway.
Members were assured that the future proposals were tangible and had timelines attached to them. The report mainly focused on consultation on the places of safety proposals and included some other service improvements. There had been no intention to mislead about deadlines.
· Crisis houses - Members were advised that a crisis house was being procured in Medway, with the possibility of three more within Kent and Medway, for use by the Medway population No locations had been identified for the latter but if a suitable site was found in Medway, then one would be located there.
In response to a query about what model would be used and the length of the contracts, it was clarified that crisis houses were improvements to the system but were not part of the S136 pathway proposals. The model selected was delivered by the voluntary sector with KMPT gatekeeping access and in reaching as an when needed. It would be a maximum of a 7-night stay with close working with the mental health provider. Two four bedded crisis houses were being procured with a 3-year contract and a five bedded 1-year contract. A philanthropist had offered to buy a property in Kent or Medway and give this to the voluntary sector to operate as an additional crisis house.
· Rationale for proposal to locate in Maidstone – Members were advised there were a variety of reasons why Maidstone had been chosen. 50% of Medway service users detained under S136 were currently conveyed to Canterbury, with the remainder to Maidstone or Dartford. The timescales for the original bid had been tight and the bid had been reviewed with partners after funding was received and the advantages and costs of the different options were examined. Locating the health-based place of safety unit in Maidstone meant it could be co-located with a mental health in patient unit, in line with best practice. The site also had outdoor space, which would provide better care. Options in Medway were considered but they did not offer co-location. The Assistant Director Adult Social Care assured Members that her team had been involved in this project and did not have concerns and felt there would be no impact on Mental Health Act assessments. Kent Police also supported the proposals.
· Custody suites – the point was made that custody suites could be used when there was no health place of safety capacity but this very rarely happened and only under exceptional circumstances when an individual was displaying extreme violence and aggression – the Emergency Departments were the default HBPoS when KMPT HBPoS were full Police custody suites were not the best environment for someone with metal health issues and prevented the police from concentrating on their main role. As mental health practitioners were in short supply, what would happen if staff could not be recruited was queried. In response, Members were advised this was why a co-located place of safety was planned. This would allow the police needed to concentrate on their job. The Clinical advice helpline had been well received by the police and had reduced S136 cases. A centralised site meant clinicians would be on hand to help with assessments and there would be a better environment for de-escalation. Police custody may be appropriate in very extreme circumstances if a person was violent and needed to be restrained, but this rarely happened now. Centralisation would lead to a more robust service and require less staffing.
· Mental health services in Kent and Medway – a request was made for figures showing the percentage of Medway users of each mental health service, in order that a comparison could be made across other authorities in Kent.
The Committee agreed to:
a) note the consultation on the proposed health-based places of safety (HBPoS), to be taken into account in the Decision-Making Business Case (DMBC) to support and inform the decision making within the Integrated Care Board.
b) request a briefing paper showing the percentage of Medway users of each mental health service.
c) request an update on the wider mental health transformation programme in Medway to a future meeting.
d) welcome the decision of the Integrated Care Board to use a private mental health ambulance service and recommended this as the preferred model, so as not to increase pressure on SECAmb.