Councillors and committees
Urgent Items authorised by the Chair - Referral from Healthwatch Kingston: Services for people with Emotionally Unstable Personality Disorder
Healthwatch Kingston had submitted a formal written request under statutory powers to the Chair of the Health Overview Panel to consider the specialised provision for people with complex Emotionally Unstable Personality Disorder (EUPD) in Kingston. The letter explained that a number of questions about provision of these services had been made to the Kingston Clinical Commissioning Group (KCCG) but the responses had been unsatisfactory. Currently Kingston residents have no access to specialist services for EUPD unlike other nearby boroughs. Instead a primary care based personality disorder (PD) service is being commissioned. The letter appended information about the engagement with KCCG and South West London and St George’s Mental Health Trust (SWLSTG), the NICE treatment guidelines for EUPD [including Dialectical Behaviour Therapy (DBT) and Mentalisation-based Therapy (MBT)], and the prevalence of both PD and EUPD in Kingston. It is estimated that there are 536 people in Kingston with EUPD
Grahame Snelling, Chair of Healthwatch, Kingston introduced the request. He stated that this was an important topic and Healthwatch were seeking to draw attention to the inequity in service provision for residents of Kingston with this condition compared to those in other boroughs. Whilst several representations to KCCG had been made Healthwatch were not satisfied with the responses received so far. Healthwatch were seeking answers to the following four questions:
· We would like to understand the rationale for the provision of PD services for residents in Kingston and in particular, more complex EUPD.
· “Thrive Kingston” is a 5-year strategy (we are currently approaching the end of year 1) and we would like to know when provision for Kingston residents with complex EUPD will be addressed in the remaining 5 years of the strategy.
· What provision will be made for people with complex EUPD until new arrangements are in place?
· Would the Health Overview Panel consider the link between this and suicide prevention?
Grahame Snelling added that the report considered for the earlier item on Mental Health Services and progression with the suicide and self-harm plans explained the ambitions of the Thrive Kingston strategy and Healthwatch had hoped this group will be represented in that documented in more detail.
Dr Phil Moore began by stating that we do not have a perfect Personality Disorder service in Kingston. He agreed that the prevalence in Kingston of people with EUPD was of the order of 500. Kingston has a number of services in primary care, primary care step-up support and SUN. The CCG recognises that this group of people is not well-served with current services. The CCG is therefore planning to undertake a three months’ demand and capacity review and expects to be in a position to report in April/May 2018 to enable plans to be made for the future.
In relation to the current service provision, the Serenity Integrated Mentoring Project takes people with the greatest need and who are the most chaotic. Police and other professionals undertake regular mentoring for these clients and the approach is based on project developed in the Isle of Wight.
Stephen Bitti, Manager, Healthwatch emphasised that the key concern is that these 500 people are not provided for currently and every other SWL CCG has commissioned this as part of the complex needs service at SWLSTG. He asked for details of what further steps would be provided to this group prior to the outcome of this review?
Gillian Moore, Head of Service Delivery (SWLSTG) agreed that those in Kingston with the highest need are not catered for, but was supportive of the comments made earlier by Dr Moore about the other support and interventions which are available to local clients. She added, however, that whilst the structured clinical management in the clinical support teams can provide more support for people with PD, this will not resolve issues and that psychotherapy and other therapies (DBT and MBT) are needed. People can be admitted to hospital but this was not an optimal treatment and the Trust wished to manage behaviours in a different way. Dr Moore pointed out that a psychology based service is also important to supporting this group.
Stephen Bitti asked again about what can be offered at this point in time. He pointed out that this group was at a higher risk of suicide and self-harming behaviours and he was keen that this year’s commissioning cycle opportunity is not missed. He asked whether any “spot purchasing” is undertaken and Dr Moore confirmed that this did occur. Dr Moore added that it would be possible to make some changes in year.
Kate Dudley (Kingston Carers’ Network) stated that DBT therapy had been available in the past and asked why the decision had been taken to remove this offer, adding that the feedback pointed to the effectiveness of this therapy and good long term results. Gillian Moore confirmed that the expertise is still provided by the Trust but not for Kingston residents. Clinicians recognise the efficacy of this treatment and would welcome the return this provision for Kingston clients.
It was questioned whether, in view of the strong arguments put forward, this service provision could be addressed within the commissioning intentions for 2018/19. Dr Moore pointed out that the CCG was undertaking a review of EUPD services and the outcome was not expected until the Spring. The Chair requested that the CCG reports back to the Panel in March 2018 on an interim basis and the Chair of Healthwatch requested a formal response from the CCG to the four questions raised in the letter early in the New Year.
1. KCCG reports back on an interim basis on the demand and capacity review of the provision of services for EUPD to the meeting on 28 March 2018; and
2. KCCG responds formally to Healthwatch early in the New Year.