Agenda item

This report sets out a submission from the Kent and Medway Mental Health NHS Trust (KMMH) on the work that is underway in response to the Care Quality Commission (CQC) review and on the work that is underway within the Trust to ensure a safe transition of the Children and Young People Mental Health Services (CYPMHS) and All Age Eating Disorders (AAEDS).

The report also sets out a submission from the Kent and Medway Integrated Care Board (K&MICB) providing an update from the ICB’s perspective on the transfer of Children and Young People’s Mental Health Services (CYPMHS) and All Age Eating Disorders Services (AAEDS) to KMMH.

Discussion:

The Chair of the Kent and Medway Mental Health Trust (KMMH) Board introduced the report which provided a submission from the trust on its work in response to its Care Quality Commission (CQC) inspection and in its preparedness for the safe transition of the Children and Young People mental health Service and All-age eating disorder service. The report also included a submission from the Integrated Care Board (ICB) regarding the transition from the perspective as commissioner.  The Chair detailed the context in which KMMH was operating which included challenges of increased demand, workforce pressures and models of care that required modernisation. She highlighted that the CQC had acknowledged KMMH as a learning organisation and one with a strong ethos of compassionate care. In relation to the transfer of services she confirmed that a robust plan was in place with strong oversight by the Board.

The Chief Executive of KMMH (KMMH CE) added that the concerns raised by CQC had all been identified by the Trust and had been areas the Trust was already focussing on to improve but this included things such as fundamental redesigns of pathways and transformation of community mental health services which would take time to get right but the Trust had been and remain open and transparent about where it finds itself as an organisation and its direction of travel. The external independent reviews had reinforced the Trust’s learning culture and one of continuous improvement. In relation to the transfer of services, she highlighted the opportunity that having children and adult mental health services provided by the same organisation provided in terms of improved transition arrangements and experiences for young people and they were working closely with the ICB and NHS England to prepare for and shape the service.

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

• rebranding – in response to criticism that the Trust had spent £250k on rebranding, it was confirmed that although the Board had approved a spend of up to £250k for rebranding, the Trust had actually only spent £90k. The rebrand had felt important in order to reflect the Trust’s ambition and accountability and providing a coherent model of change.
• Leadership and organisational changes – concern was raised about the impending changes to leadership with the Chair soon to be standing down and being replaced with a joint Chair across the KMMH Board and Kent Community Healthcare NHS Foundation Trust (KCHFT). In response the Chair explained that NHS England had strict rules around maximum years of tenure. Chairs were not permitted to be in post for over 10 years and as the current Chair was approaching the end of her 6^th year she could not complete another term. In addition, the Trust had a shared ambition to improve outcomes for people with long term conditions with community services and so by appointing a joint Chair, it enabled the two organisations to work with a more strategic and aligned focus, while maintaining focus on embedding improvement in the separate organisation.
• Capacity to take on other services – concern was raised of KMMH’s ability and capacity to safely take on the addition services, in the context of the improvement journey required and increasing demands. The Chair confirmed the Trust had reflected greatly on the impact taking on the services would have, both positive and negative but had concluded that the benefits in being able to develop and operate all age pathways were significant.  The risks were being rigorously monitored on a regular basis by the Executive and the Board and there had been strong working relationships with the current provider (NELFT) in preparing for the transfer.
• Procurement process – in response to comments around the process followed in transferring the contract the ICB Chief Executive (ICB CE) confirmed that the process had been legally appropriate and that he had commissioned an external review into all procurement processes undertaken by the ICB and would report back on this when concluded. He added that compared to national figures the ICB was spending around 2% more than the average on acute services and 2% less than the average on mental health services, which needed rearranging overtime. He added that in relation to this contract, a readiness assessment had been undertaken and there was confidence of a strong go live date of 1 April 2026. There would be work to do around the services being inherited, for example the current provider was operating with approximately 50% locum and interim doctors, however staff were being moved over as part of the service and so continuity of care would be protected.
• ASD and ADHD – reference was made to the frustration and struggles children and young people were having due to the waiting times for neurodiversity assessments which for many were running into several years. The importance of children understanding who they are was emphasised and how important diagnosis was in helping with that. Reference was also made to the lack of accessibility for working parents to support groups and sessions which were held during the working day. The KMMH Chair acknowledged the frustrations and undertook to report back on the neurodiversity pathways and transformation opportunities to a future meeting, supported by the ICB CE.
• Working with the voluntary community sector (VCS) – reference was made to the role of the VCS and the Trust representatives acknowledged the important asset provided by VCS organisations. The Deputy CE of KMMH explained they were working alongside VCS at the front door, supporting the trust in service delivery and helping to signpost as necessary and reduce waiting lists.
• Did not attend (DNAs) – reference was made to DNAs and how the Trust managed those. It was confirmed that new referrals were usually the highest rate of DNAs and the most challenging as the patients were not yet known to the service.  Daily meetings had been introduced to track DNAs and where appropriate doorstep checks were carried out to make contact with an individual deemed at risk.

Decision:

The Committee noted the submissions from KMMH, as set out at Appendix 1 and from the ICB, as set out at Appendix 2 and:

• Agreed to send a formal letter of concern to the ICB about the transfer of the children and young people mental health service and the all age eating disorder service to KMMH.
• Requested to be provided with a set over-arching metrics and timelines of the improvements and changes to be made to the service
• Requested a copy of the onboarding schedule of the transfer of services
• Welcomed the opportunity of future visits to services as offered by KMMH.