Agenda item

Adult Autism and ADHD Pathway Development and Procurement

This report, which gives an update from the Kent and Medway Partnership for Neurodiversity on the procurement of community services. Attached is a completed substantial variation assessment questionnaire for the Committee’s consideration.

Minutes:

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.

Supporting documents: