To receive a presentation from the CCG that provides an overview of the strategic aims for mental health, key programmes of work and priority areas.
The Chairman renewed his welcome to his NHS guests and invited them to outline their roles and responsibilities for Members.
Sue Braysher advised that the CCG had been increasingly focused on the move towards the creation of a single Kent and Medway CCG by April 2020 if the application to NHSE was successful. The new single CCG would be responsible for strategic commissioning across Kent & Medway which would include specialist Mental Health services. Dartford, Gravesham & Swanley Integrated Care Partnership will (from April 2021) be responsible for ensuring that Mental and Physical Health and Wellbeing services meet the needs of the population.
Adam Wickings introduced himself as the Deputy Managing Director, West Kent CCG and the Senior Responsible Officer for Mental Health for Medway, North and West Kent CCGs. In that latter role, his responsibilities were focussed on ensuring that more CCG funding was spent on Mental Health care, and within that category, that a larger proportion of resources were devoted to Children’s Mental Health care.
Members received a PowerPoint presentation from the Deputy MD entitled ‘Children, Young People and Adult Mental Health strategic aims, key programmes of work and priority areas’, which covered four key areas:
Kent Mental Health Needs Assessment 2019
· Mental Health is defined as a state of well-being in which every individual realises his/her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his/her community (World Health Organisation 2003);
· Mental illnesses are as varied and distinct as physical illnesses, with a variety of causes and treatment. They typically group into two main types, Common Mental Illnesses (with a prevalence of 1 in 4 of the population) or Severe Mental Illness such as Psychosis (with a prevalence of 0.5-1 in 100 of the population);
· 50% of lifetime mental illness begins before the age of 14 (Kessler R, and Berglund P 2005);
· 75% of lifetime mental illness begins before the age of 24 (Kessler R, and Berglund P 2005);
· Both poverty and exposure to ‘adverse childhood experiences’ (ACE) contribute and exacerbate a person’s mental health (state of mind) and can lead to mental illness (a clinically diagnosable condition that requires treatment);
· Exposure to four or more ACE’s gives a person a 60% chance of having a mental illness that requires specialist treatment;
· Social Isolation and loneliness also increase the likelihood of depression, multi-morbidity and use of adult acute mental health services;
· There are a range of protective factors such as employment, education and social connectedness that can keep people well and improve their resilience.
Five Year Forward View and Long Term Plan for Mental Health
· Children and Young People (CYP) – 35% of CYP with a diagnosable mental health condition to access treatment each year by 2020/21;
· CYP Eating Disorders – Community Eating Disorder teams for CYP to meet access and waiting time standards;
· Early Intervention in Psychosis – Expand capacity so that 50% (moving to 60%) of people experiencing a first episode of psychosis start treatment within two weeks of referral with a NICE recommended package of care;
· Crisis and Acute Care – 24/7 CRHTT’s (Crisis Resolution and Home Treatment Teams) as an alternative to acute inpatient admission, reduce the number of Out of Area Placements, use of All Age Liaison services;
· Community Care – Increase access to Individual Placement Support, deliver integrated physical and mental health provision for people with SMI (Serious Mental Illness) in line with national ambition;
· IAPT (Improving Access to Psychological Therapies) – Meet the IAPT access, recovery and waiting time standards, commission additional psychological therapies with the majority of the increase integrated with physical health;
· Perinatal – Increase access to evidence-based specialist perinatal mental health care, commission additional or expanded specialist perinatal mental health community services;
· Suicide Prevention – Develop plan to reduce suicides (against 2016/17 levels) in line with national ambition to reduce suicides by 10% by 2020/21.
CYP Progress to date in Dartford, Gravesham & Swanley (DGS)
· The CYP Local Transformation Plan across Kent & Medway funds services in DGS for young people to explore and better manage the thoughts and actions associated with self-harm, services that connect young LGBT+ people, and provides a safe space and educational resources in schools concerning good mental health;
· Primary Care Mental Health and Wellbeing service in DGS supports people from age 16 to improve an individual’s mental and physical health and wellbeing through support, information and skills to build a healthy, independent life;
· From March 2019 waiting times for first assessment to secondary care children’s mental health services, have continued to slowly improve despite rising demand. At present [September 2019] all emergency and urgent referrals are seen within the referral to treatment (RTT) standard target of 18 weeks;
· North Kent (DGS and Swale) were successful in becoming one of only a few national trailblazers in developing Mental Health Schools Teams (MHSTs) to be operational from January 2020. The MHSTs will work directly in and with 32 schools across DGS and Swale;
· 50% of CYP (some 2,730 in DGS) with a diagnosable mental health condition accessed treatment in 2018/19, against a standard of 32%. Kent and Medway STP as a whole, achieved an access target of 47.7%, placing Kent and Medway as the 5th best performing STP nationally.
Adult Progress to Date
· The CCGs and KMPT (Kent &Medway Partnership Trust) worked collectively to deliver an enhanced perinatal mental health service to ensure increased numbers of women accessed evidence based treatment. NHS England funded Mother and Baby Inpatient Units nationally, including one based in Dartford for residents in Kent and Medway and surrounding counties;
· The Early Intervention in Psychosis access standard of 50% was being met, for service users referred with suspected first episode psychosis allocated to, and engaged with, an EIP care coordinator within 2 weeks of receipt of referral;
· Kent and Medway have submitted a bid for national transition funding monies for additional workforce and training for Crisis Resolution Home Treatment teams, and four Safe Havens across Kent and Medway as an alternative to attending A&E and Core 24 (24/7) Liaison Psychiatry services at Darenth Valley Hospital (DVH) which currently ran a 8am to 11pm service 7 days per week;
· The all age Eating Disorder service was meeting the 95% standard for urgent referrals to have an initial specialist assessment undertaken, and appropriate treatment commenced within 7 days for both CYPs and adults;
· North Kent Mind delivers nature-based interventions for people with mental health conditions, including through the North West Kent Countryside Partnership – Ecology Island in Dartford;
· 9 suicide and self-harm awareness courses had been held across DGS with over 100 participants.
Key Developments 2019-2021
· Medway, North and West Kent have agreed an Aligned Incentive Contract (AIC) with Kent and Medway Partnership Trust (KMPT). An AIC is an alternate contracting and payment mechanism that provides an opportunity for partners to agree a shared agenda to make progress in key areas.
· The AIC approach promotes collaboration and transparent working and prepares the way for both an Integrated Care System which incentivises activity and reduces costs across the system as a whole. It also prepares for an Integrated Provider System, supporting providers to collectively develop and implement local visions of prevention, and out of hospital care with a focus on primary and community based provision.
· The AIC approach is being explored with other mental health provider contracts such as NELFT (North East London Foundation Trust) for children and young people’s services.
· Each CCG had to meet the Mental Health Investment Standard (MHIS) by which their 2018/19 investment in mental health services rises at a faster rate than their overall programme funding. To enable CCGs to develop key priorities during the next 1-2 year period, four programmes of work had been identified, each with a Head of Commissioning and Clinical Lead, to drive forward those changes across West and North Kent as follows:
· (1) Children and Young People – continued increase in perinatal provision locally, consistent approach to accessing services across Medway, North and West Kent, continued collaborative work with key health, social care and voluntary sector partners to implement the CYP Local Transformation Plan;
· (2) Local Care – better integrate mental health within local care initiatives across Medway, North and West Kent and strengthen clinical support to patients, including focus on increasing number of physical health checks for people with serious mental illness, in line with national standards. Improve pathway between primary and secondary health services, to enable mental health to be at the forefront of local integrated health and social care multi-disciplinary teams, providing person-centred multi-disciplined care;
· (3) Crisis Care –develop consistent approach to a crisis care pathway across Medway, North and West Kent, including a focus on the role of Liaison Psychiatry in both acute and community fields, 24/7 CRHTTs in line with national fidelity staffing scales, development of Safe Havens as alternative to A&E treatment, working with STP to identify and resolving challenges related to Section 136;
· (4) Dementia and Older Adults - review existing pathways between primary and secondary care to develop a pathway to enable the dementia diagnosis rate across Medway, North and West Kent to move in line with 67% national standard.
· Proposed changes to Acute Adult Mental Health services across Kent and Medway to include a redesign of clinical care pathways, and re-location of older adult inpatient wards to existing modernised inpatient facilities;
· Development of a Community Dementia Intensive Support service across Kent and Medway;
· Development of an updated IAPT (Improving Access to Psychological Therapies) services model to better enable local services to integrate with physical health services, and collectively meet the needs of people with anxiety and depression and long term conditions.
In response to specific questions from Members, the Deputy MD West Kent CCG and the DGS ICP Programme Director confirmed the following points:
· There was no evidence of a direct connection between air pollution and mental health conditions, but the subject remained part of the national NHS discussion on overall ill-health;
· Work was being undertaken by CAMHS (Child and Adolescent Mental Health Services) and NELFT providers to develop a better co-ordinated all years pathway of services for mental health patients, from childhood to adulthood, including addressing the effects of autism in children, young people and adults;
· The development of Safe Havens across Kent and Medway for patients in need of crisis care would, in time, relieve the current burden on hospital A&E facilities and the strain on police resources dealing with patients in the community;
· The new ‘Canada’ model 111 telephone service was now staffed by expert clinicians on call 24/7 and connected to all PCNs (Primary Care Networks) across Kent and Medway to provide the public and patients with an enhanced level of service, including dealing with mental health issues;
· IAPT (Improving Access to Psychological Therapies) service in Kent and Medway formed part of the drive to spend more on mental health treatment across the county. A principal aim was to provide increased levels of spending and care provision by CAMHS and NEFLT providers in the primary care environment; rather than the previous NHS policy of prolonged treatment in the secondary care environment; which often came too late to enable patients to recover fully;
· Better and increased interface with schools aimed at early diagnosis, was a key element of IAPT services for children and young adults. The avoidance of medication as the sole or even primary care path for such young people suffering from mental health issues was another crucial factor in treatment;
· IAPT services offered practitioners a more diverse NHS career path, and enabled CCGs and Trusts to develop a more diverse work force. The challenge for the latter bodies was the retention of such staff in the long-term, and every effort was made to do so, including at Darent Valley Hospital (DVH).
The Chairman thanked his NHS guests for a comprehensive presentation and for responding to Members questions on mental health issues and the current themes being developed by CCGs and Trusts across Kent to improve and increase service provision to patients suffering from mental health issues.