Councillors and committees
Agenda and minutes
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Venue: Guildhall, Kingston upon Thames
Contact: Marian Morrison 020 8547 4623 email: firstname.lastname@example.org
To consider questions from the gallery on items which are not on the agenda
There were no questions.
Apologies for absence and attendance of substitute members
Apologies were received from Councillors Sushila Abraham, Mark Beynon and Kevin Davis. Councillor Ian George attended as substitute for Councillor Kevin Davis. Apologies were also received from Stephen Taylor, Director Adult Social Care.
Declarations of Interest
There were no declarations of interest.
To approve the minutes of the meeting held on 11 October 2018
Agreed that: The minutes of the meeting held on 11 October 2018 were approved as a correct record and signed by the Chair.
To consider the presentation report about current services, scrutinise and make recommendations
The report from the Kingston Clinical Commissioning Group was in a presentational format and provided a good range of information about the current services. The scope included:
· Present key national and local policies
· Set out current population needs
· Local health inequalities and risk factors
· Outline local responses to the mental health needs of vulnerable groups
· Map of local system of mental health support
· Identify current system challenges
· Focus on place based approaches to addressing mental health needs of children and young people.
The report referred to the 2017 green paper “Transforming Children and Young People’s Mental Health Provision” which highlights new objectives for mental health support teams in schools, a four week waiting time standard and a senior lead for mental health in schools and colleges.
The Children’s and Young People’s Plan, also published in 2017, focuses on outcomes for wellbeing and resilience which are being taken forward in the local Health and Care Plan 2019/21.
Key statistics were set out and included:
· 42,144 people aged 0-19 (24% of the local population)
· 4705 children are living in poverty
· 2735 children with special educational needs
· 54% of children living and attending a school in Kingston are from a minority’s ethnic group
· 76% of secondary children achieve 5 or more A* - C GCSEs
· 98% are in employment, education or training at age 16
The Tiered model of care was introduce in 1995:
· Tier 1 - Early intervention and prevention provided by schools, children’s centres, health visitor, school nurses GPs, voluntary and independent services.
· Tier 2 - early help and targeted services
· Tier 3 - Specialised CAMHS and eating disorders
· Tier 4 - inpatient provision.
The Tier system relates to the Thrive Model which was developed in 2014 by the Anna Freud Centre Consortium in consultation with young people and parents. This promotes coping and self-management before problems become entrenched. It complements the Children and Young People Improving Access to Psychological Therapies Model (CYP IAPTS). The slide on page A10 of the agenda provided a map of the how the Thrive model sits within the local system of care.
The Emotional Health Service is a key part of the service offer and is provided by Achieving for Children (AfC). In the past year referrals have increased by 18%, and rising, and 85% are seen within 8 weeks of the request for an initial appointment. However, there is a significant wait for treatment following the initial appointment eg: Psychology - 4-5 months; Art Therapy - 4 months;
Family Therapy - 6 months. Information about
waiting time data was presented on page A14.
Main challenges facing services locally include:
· Increasing demand for all services increasing waiting times to access treatment
· Increasing demand for Autistic Spectrum and Attention Deficit Hyperactivity Disorder neuro developmental assessments
· Supporting schools to respond to mental health concerns.
The CAMHS Transformation Programme is a 5 year programme to:
· Build capacity and capability across the system
· Rollout CYP IAPTS
· Develop community based eating disorder service
· Improve perinatal care
· Work to better integration ... view the full minutes text for item 25.
To consider the update from Kingston Clinical Commissioning Group
The report was introduced by Dr Phil Moore, Mental Health Lead, Kingston Clinical Commissioning Group. It provided an update on progress with implementing specialist Personality Disorder Service provision in Kingston Borough following concerns raised in November 2017 by Healthwatch Kingston regarding lack of specialist PD services for people in Kingston with Emotionally Unstable Personality Disorders.
The report stated that the CCG committed funding in the 2018/19 to provide an extension of existing PD services and is working with South West London & St George’s Mental Health Trust (SWLSTG) to implement an interim specialist PD service which will be initially Dialectic Behavioural Therapy (DBT) – a form of Cognitive Behavioural Therapy (CBT) for people who experience intense emotions. It has not been possible to appoint clinicians trained in DBT to enable the service to be put in place as quickly as anticipated. In the longer term a service will be commissioned in collaboration with Richmond CCG. SWLSTG is undertaking a review of PD services across SWL and the outcome will inform the final service model.
Current services such as the primary care based Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme and the new Managing Emotions programme are helpful for people with mild to moderate problems. There are also existing secondary services including psychotherapy and the SUN project.
The Panel asked questions on the following areas:
In response to a question about whether service provision is in-patient or out-patient based, Dr Moore explained that in-patient treatment was not generally suitable for people with PD. Later in the discussion Dr Mark Potter, Medical Director, SWLSTG stated that patients prefer individual therapy but group therapy is more cost effective and both are offered.
Dr Potter pointed out that people with PD people impact on all parts of the health system. They are often frequent attenders at A&E and primary care and the Trust is working with the CCG to shorten the pathway. In the past personality disorder was not treated but views and treatments have changed.
In response to a question about how effective treatment can be, Dr Potter explained that personality is difficult to change but interventions can help people to understand the impact of their personality and behaviour on the people around them and people can change as they become older.
Dr Moore added that people with PD need support which can help them manage but this is resource intensive especially for those with severe problems.
Confirmation ... view the full minutes text for item 26.
To consider the minutes of the Health and Wellbeing Board held on 13 September 2018
The minutes of the meeting held on 13 September included the following items:
· Partners’ Updates
· CQC Inspection of Kingston Hospital (rated as outstanding)
· Mental Health Champions
· Kingston Local Health and Care Plan
· Kingston Safeguarding Adults Board Annual report
· Kingston Local Safeguarding Children Board Child Death Overview Panel Annual Report
· Local Safeguarding Children Board Neglect Strategy
· Local Safeguarding Children Board Learning Lessons Review (case 2) Part 2 item
Agreed that: the minutes of the Health and Wellbeing Board held on 13 September 2018 are noted.
Voting: unanimously in favour
Wednesday 13 February 2019
Dental Health Services
Tuesday 30 March 2019
The proposed work programme was discussed.
1. Dental Health Services will be considered at the next meeting on Wednesday 13 February 2019;
2. Suggestions for topics for consideration at the meeting on Tuesday 30 March 2019 be passed to the Chair for consideration;
3. CAMHS is considered further in June/September 2019; and
4. The Chair will meet and discuss with Members of the Panel to plan the work programme for 2019/20.
Urgent Items authorised by the Chair
There were no urgent items.