· CARE QUALITY COMMISSION INSPECTION REPORT UPDATE
· TENDER FOR MANCHESTER MENTAL HEALTH UPDATE
· LOCALITY PLAN UPDATE
· FINANCIAL UPDATE
Minutes:
The Joint Committee resolved that agenda items 6 and 7 would be considered together.
Members of the Joint Health Overview and Scrutiny Committee considered a verbal presentation from Keith Walker Executive Director, Pennine Care NHS Foundation Trust and Emma Tilston, Deputy Director of Finance, Pennine Care NHS Foundation Trust. The presentation contained information on the following areas:
• Care Quality Commission (CQC)
• Manchester Mental Health & Social Care Trust
• Finances
• CAMHS
The Executive Director, Pennine Care, reported that the CQC visit had now taken place and an initial draft of the report had been received by the organisation. The Trust had highlighted some areas of concerns in respect of the inspection process. The Trust also has the opportunity to comment on issues of factual accuracy contained within the report. As part of the inspection process the CQC will hold a Quality summit in November to feedback to stakeholders, members of the Joint Committee will be invited to attend.
With regards to the Trust’s bid to provide service once provided by Manchester Mental Health and Social Care Trust, the Executive Director reported that Pennine Care’s bid was unsuccessful. The Executive Director reported that the Trust had put together a strong bid, which included innovative work with General Practice. The contract had been awarded to the Greater Manchester West Trust.
The Executive Director reported that the work undertaken by the Trust in preparation for the contract had not been time wasted. The Executive Director reported that there is a definite move towards less providers in the system which will ultimately result in a more standardised approach to mental health provision across Greater Manchester.
Emma Tilston, Deputy Director of Finance, Pennine Care NHS Foundation Trust, provided members with a financial update. The Deputy Director of Finance reported that in the financial year 2012/13 NHS providers reported a financial surplus of £500 million. In the financial year 2015/16 the same providers reported a deficit of £2.44 billion. PCFT results in comparison show strong financial resilience, the normalised surplus, in 2012/13 was £3.1 million, 2013/14 £5.7 million, 2014/15 £3.4 million and in 2015/16 £0.19 million.
The Deputy Director of finance reported that the Trust is expected to spend £12 million pounds on agency staff in the financial year 2016/17. The Trust will not be spending on capital programmes as initially planned. An ICT strategy is being developed and the consultants Price Waterhouse Cooper have been asked to conduct a Trust wide sustainability review.
The Pennine Care NHS Foundation Trust is also being asked to contribute additional savings to a fund to assist Trusts across Greater Manchester with large financial deficits.
The Executive Director reported that how services are developed will have to change, services will need to be co-designed and co-developed, one of the biggest drivers for this will be the Locality Plan. Pennine Care will want to be involved in the development of each Boroughs Locality plan.
Members expressed concern that there is no incentive for the Trust to achieve a surplus if the money is then going to be used to support other Trusts in Greater Manchester. The Executive Director reported that following GM Devolution if a Trust is struggling within Greater Manchester all Trust will feel the consequences of an underperforming Trust.
Members discussed the problems with the large amounts of spend on agency staff. The Executive Director reported that this is a national problem, a national framework agreement commenced on 14th May 2014. The Framework was established in collaboration with three other NHS procurement hubs to meet the need for ensuring the provision of quality temporary and permanent staff from the UK and overseas.
In response to a Member’s question, the Executive Director reported that all the staff supporting the bid for Manchester mental health services, bar one already worked within the Trust and the work was undertaken as part of their ongoing workload. The work undertaken as part of the bid process will inform future develop work and long term planning within the Pennine Care Trust and will therefore not be wasted.
The Deputy Director of Finance reported that the consultants PCW will provide the Trust with a review report on all the services provided by the Trust and all the costs associated with providing each service. The report will also include information in relation to the sustainability of each service.
· Child and Adolescent Mental Health Services
Sarah Barnes, CAMHS, Pennine Care NHS Foundation Trust attended the meeting to provide members of the Committee with an update in respect of Child and Adolescent Mental Health Services provided by the Trust. The verbal update contained the following information:
Pennine Care provides two inpatient CAMHS facilities at the Hope and Horizon units. When a child presents out of hours requiring an inpatient bed and there is none available within the Trust, staff would try to find a bed within the northwest, failing that and if appropriate they would then look to place the child on an adult ward. There are no inpatient beds in the Yorkshire and Humber regions, a problem that has been recognised by NHS England.
The following young people aged 16-18 years were admitted to adult wards:
2013/14 - 16 young people
2014/15 – 16 young people
2015/16 – 6 young people
2016/17 -1 young person
Over the last four years Pennine Care CAMHS teams have undergone significant transformation.
Community promotion & prevention:
· Early identification & intervention via community, education & peer-led interventions.
Primary care, community services, voluntary sector and education
Assessment and signposting
· Self-help, E-interventions, Brief & group Interventions
Primary care, community services, voluntary sector and education in partnership with CAMHS
· Time limited, goal focused evidence based interventions, CAMHS in your community led interventions, Complex assessment, formulation and intervention.
CAMHS hospital and hospital at home services
· For serious illness/crisis/risk
In response to a member’s question, the CAMHS Service Manager reported that a NHS England national procurement exercise is currently underway in respect of CAMHS inpatient beds, this will attempt to address the identified need in Yorkshire and Humber which inadvertently buts pressure on Pennine Care beds.
The CAMHS Service Manager reported that a Greater Manchester whole system review of the CAMHS crisis pathway is underway.
The Trust will provide support with early intervention for psychosis from 14 years and an eating disorder pathway up to the age of 19. The CAMHS service manager reported that a challenge for the Trust is the transition from CAMHS provision into adult service. Up to 6000 children access Trust CAMHS provision every year.
In response to a Member’s question, the CAMHS Manager reported that if a child is place on an adult ward that it would be unusual for that child to remain there for more than two days, if the stay lasts longer than five days then a meeting must be arranged with stakeholders from a number of different agencies.
In response to a Member’s question, the CAMHS Manager reported that there were no plans to build a CAMHS inpatient facility in the south of the Borough.
With regards to safeguarding concerns highlighted by elected members, the CAMHS Manger reported that the children would always be properly safeguarded and an adult would be with them at all times. If it is necessary to place a child on an adult this would be reported as a serious incident within the Trust and it would be because this would be the safest place for the child and the trust would ensure that the ward was age appropriate for that child/young person.
The Service Director reported that the Trust’s Service manager lead the work being undertaken on behalf of Greater Manchester, it is hoped that this piece of review work will ensure that CAMHS provision across the Borough is fair and equitable.
It was agreed:
The Trust would provide further information at a future meeting in respect of the NHS England procurement exercise in respect of CAMHS inpatient beds and the Greater Manchester wide review.