Agenda item

The purpose of this paper is to provide Members with an overview of the CQC inspections into services delivered by Kent and Medway Mental Health NHS Trust, and offer assurance that progress is being made to improve services.

Discussion:

The Director of Transformation and Partnerships and the Chief Operating Officer & Deputy Chief Executive from Kent and Medway Mental Health Trust (KMMH) introduced the report which provided an overview of the outcome of the Trust’s recent inspection by the Care Quality Commission (CQC) and an update on progress being made.

Members then raised a number of questions and comments, which included:

• Actions taken – in response to a question on why the Trust had not addressed some of the issues identified by the CQC ahead of the inspection, given they had already been aware of them, KMMH representatives explained that some of the findings related to community mental health services models of care and waiting times which had been worked on for 18 months and a refreshed model was now in place to address these issues. Where health and safety issues had been raised, such as mandatory training, steps had been put in place to address those immediately and there were now standard checks and polices in place to reflect that.  The CQC had also identified concerns around risk assessments and it was explained that the Trust had been introducing a new risk assessment centred around patients in a more holistic approach.
• Long waiting lists - The Trust representatives explained that KMMH had not accounted for the large numbers of patients that would come through their system for lower or medium level intervention that would need to be delivered by an organisation outside of KMMH and the lack of planning for this had caused large waiting lists. One of the immediate actions that needed to be addressed following the CQC inspection was that the Trust needed to assure itself that people waiting for a response were not at risk and had had their needs adequately assessed. Due to the volume, at the time of the inspection the Trust could not and therefore immediately implemented ways to assess people to ensure patient safety.
• All age mental health contract – concerns were raised at the ability of KMMH, given the context of the CQC outcome, to manage the children’s mental health and the all age eating disorder service, both of which were being transferred to KMMH to create and all age mental health service contract. The KMMH representatives explained that improvements had been made to waiting lists, stating that at the point of the inspection of Medway services, 466 patients were waiting over 90 days to be seen, which had since reduced to 199 and regular checks were in place for those waiting longer periods of time to insure interventions where put in place where necessary. In addition, the average wait for Medway patients was 52.3 days, which was one of the lowest waits across Kent and Medway and the average wait for the new risk assessment and care planning was around 21 days for Medway patients. In relation to the transfer of services, the Committee were advised that staff currently working in the service under NELFT (the current provider) would be transferring to KMMH, therefore skill set would also transfer to the Trust, however, the Committee remained concerned and suggested that they formally write to the ICB regarding those concerns.
• Leadership capacity – concern around the effectiveness of the Trust’s leadership was raised, particularly in the context of taking on extra services and it was asked how the Board was reacting to the challenges. The KMMH representatives explained that the Trust recognised there was a lot that it needed to address as an organisation.  An independent review had been undertaken and its findings and recommendations had been fully considered by the Board. It was confirmed that the current Chair was reaching the end of the amount of time in which she could act as Chair and therefore recruitment for a new Chair was underway. It was also stated that the Board’s main priority and focus was on the response to the CQC inspection and improvements to services. Members remained concerned and suggested that the Chief Executive and a Board Member of the Trust be invited to the next meeting to address the Committee’s concerns in this regard.
• Places of safety – in response to a concern that the Trust had been detaining people for too long under the Mental health Act in places of safety, it was confirmed that this was addressed within a week of the Trust becoming aware that this had been happening.
• Trust rebranding – Members criticising the spend on rebranding the Trust from KMPT to KMMH. In response the Trust representatives explained that it had been undertaken in response to feedback from patients and stakeholders around the previous name, KMPT, being meaningless to them.
• Phasing of improvements – concern was raised about the phasing of addressing the issues and that the suggested timescales were too ambitious.  In response the KMMH representatives explained that transformation was continually being monitored. It was reiterated that the inspection had occurred when the transformation had already begun and that progress was monitored regularly, several times a week.  Equally, it was acknowledged that transformation of culture and embedding new ways of working would be a longer term piece of work.
• Co-production of transformation – the KMMH representatives confirmed that transformation plans had been co-produced with services users, lived experience groups and voluntary sector partners and they undertook to share findings from engagement with Members.

Decision:

a)    The Committee noted the update from KMMH, as set out in the appendix.

b)    The Committee requested that the Chief Executive of KMMH and a member of its Board attend the January meeting of the Committee, noting that regular attendance of the Trust at future meetings was likely.

c)     The Committee agreed it would consider sending a formal letter of concern to the ICB regarding the lift and shift of the all age mental health contract from NELFT to KMMH