Discussion:
The System
Programme Lead for Learning Disability, Autism and ADHD, Kent and
Medway Partnership for Neurodiversity, introduced the report which
provided an update on a new proposed adult autism and ADHD care
pathway. Attached to the report was a completed substantial
variation assessment questionnaire for the Committee’s
consideration. Reference was made to the significant increase seen
nationally in referrals for autism and ADHD in adults as well as
children. It was explained that the proposals did not include a
reduction or negative impact for patients although the significant
demand which continued to exceed the capacity within the service
would remain a challenge.
Members then
raised a number of questions and comments which included:
- Support
before diagnosis – concern was raised that too much
emphasis was being put on support before diagnosis, rather than
speeding up the diagnosis process. In response it was explained
that a large proportion of the population were neurodivergent and
identifying people and supporting them to self manage and access
services without the need for a diagnosis was important. Often
support needed before and after diagnosis remained the same.
Therefore focussing on meeting the needs of the person which led to
the referral rather than focussing on the diagnosis itself, was
vital.
- Foetal
Alcohol Syndrome Disorder (FASD) – in response to a
question about whether FASD was included within the pathway it was
confirmed that within children’s discussions, this was often
looked at, however, it had not been raised in the context of
adults, and this would therefore be taken away and explored.
- Data
– in response to a query it was confirmed that the chart in
the papers was not complete due to the high demand. Over 31,000 referrals had been made in a two year
period and so information on this was still being
processed. However it was confirmed
that approximately 7000 of the referrals related to Medway
residents.
- Change in
providers – in response to a question about changes in
providers, it was explained that under new procurement legislation,
this service was being procured under the Right to Choose which
would result in a larger number of providers being available but
with greater oversight being built in with assurance around
consistency in approach through an accreditation process. In
relation to the community offer, it was explained this was
currently provided by a number of organisations and it was
therefore intended to bring this together, with intensive support
services remaining the same. Services would continue to be
delivered locally and providers would be expected to have a
footprint in Medway.
- Gender
– in response to a query about why more females were being
referred compared to males, it was explained that there had been a
perception that ADHD was prominently apparent in males but that was
in fact not the case, but it did typically present in different
ways between men and women. There was much more awareness in
neurodiversity amongst females and that is what was likely to have
caused the escalation in female referrals.
- Links to
mental health needs – in response to a question about
whether there was any linkage between neurodiversity and mental
health needs, it was explained that for many coming through the
pathway they had co-existing mental health needs and so there were
strong links with KMPT and the mental health pathways to ensure
there was no disadvantage for being neurodiverse.
- Waiting
times – in response to a concern about waiting times and
how they compared to other areas, it was explained that the waiting
times were significant which reflected the significant demand and
this was experienced on a national level. Kent and Medway was
experiencing some of the longer waiting times but they were not out
of kilter with other areas. Equally, medication reviews were taking
two years which was also much longer than it should be and work was
underway to improve the interface with primary care colleagues and
to make the process more streamlined in the new pathway.
- Current
provider – in terms of any risks to the resilience of the
current provider to manage up until the end of the existing
contract, it was explained that they had raised their concerns and
the relationship between provider and commissioner was strong with
meetings held 3 times a week and action plans being developed and
delivered collaboratively.
- Source of
referrals – in response to a question about the sources
for referrals, it was explained that referrals were predominantly
from GPs, primary care and mental health practitioners with some
from social care professionals.
- Kent HOSC
decision – in response to a question about why the Kent
Health Overview and Scrutiny Committee had decided that the
proposals did not constitute a substantial variation (SV), it was
explained that there had been debate on this issue but it was
decided that as the proposals were about enhancing and improving
services, whilst recognising demand remained a challenge, it had
decided that the proposals were not an SV.
- Funding
concerns – in response to a concern about the resource
available for providers to manage the demand it was clarified that
the Integrated Care Board (ICB) funds each assessment and
diagnosis, which presented a financial risk to the ICB. The
intention was therefore to maximise output by investing as much as
possible in community support offers.
- Medway
involvement – assurance was provided by the Assistant
Director, Adult Social Care that Medway was fully involved in the
proposals and developments as were people with lived experience to
help shape proposals.
- Positive
change – the view was given that the change, although
positive and welcomed, was a substantial variation as patients
would experience change even if that were improved. It was noted that this was a difficult area with
challenges and there was a desire for the Committee to be a part of
that journey. It was suggested that the Committee and the ICB
consider it to be a ‘light touch’ SV, enabling the much
needed improvements and developments to continue at pace.
Decision:
a)
The Committee noted the update from the Kent and Medway Partnership
for Neurodiversity, as set out in the report and at the Substantial
Variation questionnaire, attached at Appendix 1 to the report.
b)
The Committee agreed that the proposals did constitute a
substantial variation or development in the provision of health
services in Medway.