Agenda item

King’s College Hospital NHS Foundation Trust (KCH) will update on: 

a)  The mental health crisis care upgrade plan for King’s Denmark Hill Hospital  - including 6 million capital spend (paper enclosed)

b)  Mental Health Crisis pathway meeting, led by the CCG,  with a focus on King’s Denmark Hill emergency department (paper in first supplemental agenda)

c)  KCH will provide a brief overview of some of the early recruitment work they are doing ahead of the current strategy development to address staffing retention and recruitment

The chair invited the following presenters to introduce themselves:

·  Harvey McEnroe, Deputy Director of Operations, Acute and Emergency Care

·  Caroline Gilmartin, Director of Integrated Commissioning, NHS Southwark CCG

·  Rod Booth, Head of Mental Health and Wellbeing, NHS Southwark Clinical Commissioning Group and Southwark Council

·  Sean Cross, emergency consultant psychiatrist , Slam based at King’s Denmark Hill

The Deputy Director explained that the work on recruitment would come to a following meeting. The chair invited speakers to address the first two items on the agenda:

a)  The mental health crisis care upgrade plan for King’s Denmark Hill Hospital - including 6 million capital spend (paper enclosed)

b)  Mental Health Crisis pathway meeting, led by the CCG, with a focus on King’s Denmark Hill emergency department (paper in first supplemental agenda)

The Emergency Consultant Psychiatrist explained that the upgrade at King’s emergency department at Denmark Hills for people experiencing Mental Health distress is a result of several years of planning and a significant step change in providing better provision. Patients will come through with a combination of physical and mental health problems, as well as only mental health problems; it is a place for people with both issues, with two dedicate suites. In minors there are three suites.  

The Head of Mental Health and Wellbeing said that the regular crisis pathway meetings are very useful. This group is now termed the Mental Health Taskforce. The Deputy Director of Operations said the Mental Health Board is there for senior oversight.

The chair invited questions:

Members asked how SLaM and King’s work together. The Emergency Consultant Psychiatrist said the national policy position is to move mental health crisis care  to emergency departments and now we are seeing mental health care being taken up by acute settings and hospitals; this is a welcome shift. He said as well as delivering his clinical role he also leads the partnership on mental health, physical health and wellbeing across the Academic Health Partners (including King’s College Hospital Foundation Trust, Slam, and Guy’s & St Thomas' Hospital Foundation Trust).

Members asked if the emergency department is are looking to improve the 4 hour target to make it more person focused and asked what happened to people? The NHS staff responded that there is a liaison team of Mental Heath nurses who offer rapid assessments and  offer the offer best care dependent on need. There are a range of mental health crisis and appropriate responses:   some people are psychotic and need impatient care, other needs include non - toxic overdose. About 10-15% of people presenting need admittance. Some will go to out-patient  GP care and IAAPT.

Will people be triaged and sent to a GP if crisis care is not needed?  If people make it to emergency then significant mental health barriers have to be overcome so all people get an assessment. People are more likely to minimise problems on presentation.

Members asked when and where people will be seen. Rapid assessment means 30 minutes. We are looking to meet that throughout the week, 24 hours a day. When we are up to capacity with all the suites then we will be on the pathway for consistently delivering rapid assessments. The problem that really arises  for people who need inpatient care as there is not enough provision and flow.

Member asked what happens to people who need a bed but have to wait? A member commented that when she visited there were no mental health beds available. She asked if there  has there been an improvement in provision of beds? The consultant psychiatrist said  this is a continuing difficulty. People are kept with care while we try to find a bed. The solution is really located in providing  better mental health provision; but while we are running at 100% capacity plus, we will not have those beds. We need 85% capacity to cope with surges. The average wait is 14 hours, but finding a bed can take one and a half days. It is not uncommon to come across up to 3 people waiting for places - though not all in King’s emergency department.

The Director of Integrated Commissioning said that delivering more bed provision is not ideal; rather we would like to see more flow and less care in acute settings. This is not an easy problem to solve. There will be a pilot project looking at 24 hour access to home treatment; this is about preventing crisis. The council are working with police and ambulance services. She would like to come back to committee to report on this. If it works we would like to make that the norm.

The committee asked about meeting the needs of patients who are presenting in mental health patients crisis. The consultant said many of the crisis’s happen out of emergency department. We have a bleeping arrangement, and crisis arise in many situations. The rate of need is huge: many people now have long term health conditions which raises the risk of mental health needs: about 30% of people will experience depression, anxiety etc. A member commented that she knew a person who had an acute health need and then developed anxiety. It's was very challenging. The consultant said that this is a typical problem where someone needs both types of care and there needs to be an assessment of priority and care need.

A member asked how the 6 million been spent? The Deputy Director of Operations said he would ask the chief officer to provide a briefing on this.

RESOLVED

KCH chief financial officer will provide a breakdown on the 6 million spend and provide a briefing and presentation at a following committee meeting.