Agenda and minutes

There were no declarations of interest.

The minutes of the meeting held on 20^th July, 2016 were signed as a true record. There were no matters arising.  

Report from Simon Gilby, Chief Executive of Coventry and Warwickshire Partnership Trust

Juliet Hancox, Coventry and Rugby Clinical Commissioning Group (CCG) has also been invited for the consideration of this item

The Board considered a report and presentation from Simon Gilby, Chief Executive of Coventry and Warwickshire Partnership Trust (CWPT) on the outcome of the recent Care Quality Commission (CQC) Inspection of CWPT and the Trust’s Action Plan in response. Councillor Abbott, Cabinet Member for Adult Services attended the meeting for the consideration of this item along with Jed Francique and Anita Morgan, CWPT and Matt Gilks, Coventry and Rugby Clinical Commissioning Group (CCG). Councillor Mal Mutton was also in attendance for this item.

The report indicated that the comprehensive inspection took place between 11^th and 15^th April, 2016. The Inspection team consisted of around 80 people including inspection staff along with doctors, nurses, allied health professionals, managers and experts by experience. The team met with patients and carers receiving services as well as staff who provided care and support services.

The CQC gave a rating across its 5 Core Inspection Domains: Safety, Effectiveness, Caring, Responsiveness and Well Led. The overall outcome for the Trust was ‘Requires Improvement’, with the domain ‘Caring’ rated overall as ‘Good’. The CQC had also rated each type of service provided by the Trust, of the 14 services inspected 6 were rated as ‘Good’ and 8 were rated as ‘Requires Improvement’. Further details were set out at an appendix attached to the report. The Board were informed that community health services for children, young people and families and end of life care were both rated as outstanding for caring. The report also detailed the issues of good practice highlighted by the Inspection Team.

The Board noted that the CQC had issues one warning notice which focussed on the Trust’s arrangements for managing eliminating mixed sex accommodation requirements which needed to be addressed. The Trust immediately put in place arrangements to ensure that patients within an area of mixed sexes had the appropriate risk assessments and care plans in place and were monitored daily. The Trust had also reviewed its policy arrangements. The Trust were also issues with three requirement notices and the actions required by the Trust to make to improve services were detailed.

The CQC had hosted a Quality Summit for partner agencies when the findings of the inspection were presented and the actions to be taken in response. The Trust’s detailed improvement plan had been submitted to the CQC on 12^th August 2016.

The presentation indicated that the inspection had been a positive experience and CWPT had welcomed the report and accepted the findings. The Trust were pleased that areas of success and good practice had been identified and recognised that there were areas which required attention. The immediate actions taken were highlighted. Further information was provided on what the Trust was proud of along the improvements to be made. 

The Board questioned the representatives present on a number of issues and responses were provided, matters raised included:

·  What was being done to address the issue of low staff morale

·  A request to have the  ...  view the full minutes text for item 15.

Briefing Note of the Executive Director of People

The following representatives have been invited to the meeting for the consideration of this item along with Councillor Ruane, Cabinet Member for Children and People and Councillor Mal Mutton, Chair of the Education and Children’s Services Scrutiny Board (2):

Simon Collings, Specialist Commissioning Team, NHS England

Simon Gilby, Coventry and Warwickshire Partnership Trust

Matt Gilks, Coventry and Rugby CCG

Andrea Green, Coventry and Rugby and Warwickshire North CCGs

Paul Green, Lyng Hall School

The Board considered a briefing note of the Executive Director of People concerning the Child and Adolescent Mental Health (CAMHS) Transformation Agenda. The note provided an overview of CAMHS system performance and any barriers to performance; an update on progress towards achieving the Transformation Plan and how the Plan would address barriers to performance and any service gaps; and an update on commissioning decisions. Councillor Ruane, Cabinet Member for Children and Young People and Councillor Mal Mutton, Chair of the Education and Children’s Services Scrutiny Board (2) attended the meeting for the consideration of this item. Matt Gilks, Andrea Green and Glynis Washington, Coventry and Rugby Clinical Commissioning Group (CCG), Simon Gilby, Asif Atta, Barry Day, Jed Francique, Anita Morgan, Jo Morris, Donna Reeves and Josie Spencer, Coventry and Warwickshire Partnership Trust (CWPT), Simon Collings, NHS England and Paul Green, Head Teacher, Lyng Hall Secondary School were also in attendance.

The note indicated that the CAMHS Transformation Plan related to system-wide change across tiers 1-3.  The initial six months of the five-year plan had focused on addressing some of the fundamental legacy challenges relating to capacity and demand, faced by similar services across the country.  Performance in relation to initial referral to treatment was within the expected range across all services, and while specialist CAMHS (tier 3) follow-up waiting times had been a specific challenge, this had improved.

The Board were informed that there was high demand for autistic spectrum disorder assessments (ASD) compared to other localities and this remained a challenge, even though additional funding had been released. The complexities of need young people were presenting with to targeted tier 2 services such as Reach was also a significant challenge. Recognising that these challenges were not within the gift of a single agency to resolve, the Transformation Board had been strengthened. A Coventry commissioner’s sub-group of the CAMHS Transformation Board had been convened and was meeting on a monthly basis to provide further scrutiny of the progress towards transforming CAMHS across Coventry and to oversee the work programme developed to drive significant transformation change in the next two quarters. A key focus would be on early intervention in schools, revising the ASD pathway and associated partnership arrangements to deliver reduced waiting times and implementing improved support for vulnerable young people including Looked After Children (LAC).

The Board noted that Coventry and Warwickshire Partnership NHS Trust (CWPT) recently received an overall rating of ‘good’ for specialist community mental health services for young people. In July 2016, Coventry and Rugby CCG (CRCCG) Governing Body made a decision for Coventry, to continue to support the delivery of the CAMHS Transformation Plan with a further review in six months’ time. 

Paul Green, Lyng Hall School provided an update of the transformation agenda from a school’s perspective, indicating the main issue had been the significant waiting times but this situation was improving. He expressed strong support for the new focus  ...  view the full minutes text for item 16.

Report of Simon Gilby, Coventry and Warwickshire Partnership Trust

Juliet Hancox, Coventry and Rugby CCG has also been invited to the meeting for the consideration of this item

The Board considered a report of Simon Gilby, Coventry and Warwickshire Partnership Trust (CWPT) which provided an update on key activity challenges in respect of Adult Mental Health Services in Coventry. Current actions that the mental health leadership team had planned or put in place to provide greater assurances on the clinical pathway from referral to intervention were detailed. Councillor Abbott, Cabinet Member for Adult Serices attended the meeting for the consideration of this item along with Josie Spencer, Barry Day and Asif Atta, CWPT and Matt Gilks, Coventry and Rugby CCG.

The report highlighted that as with other mental health services, Coventry Adult Mental Health Services remained under pressure with the community teams delivering over 2,500 patient contacts each week, having an average active caseload of 3,000 a week and discharging 150 clients back into primary care or the community. The Board were informed that there had been an approximate 15% increase of referrals compared to the previous year.

Overall there were increased waiting times for patients for assessment. A plan had been formulated to address the significant wait in clinical triage.

Specific areas of challenge were IPU 3-8 (non-psychosis) team who dealt with high levels of referrals for anyone with an appearance or diagnosis of mental health unwellness; early intervention, the new national target of referral to NICE intervention within 2 weeks; IPU 10-17 (recovery) team in terms of staff turnover; Section 175 arrangements, with the increase in MHA assessments; and IPU 18-21 (dementia) where the service was really busy and an action plan had been developed to support improvements.

Additional information was provided on the urgent care services in mental health including the Crisis Response and Home Treatment which was the busiest service; the Street Triage service; and the AMHAT (psychiatric liaison) which provided liaison services to A and E and the hospital wards. These areas were performing well.

The Board were informed of the actions being developed to improve the clinical triage process and assessments within the mental health services which related to patient flows, clinical triage/ assessments, DNAs, addressing long waits and managing capacity and demand. 

The Board questioned the representatives present on a number of issues and responses were provided, matters raised included:

·  Further information about the Street Triage Service including the follow up arrangements for patients who miss appointments

·  Whether the Street Triage Service dealt with homeless people

·  The partnership work with the Triage Street Service

·  The issue of the service being able to cope with the increasing numbers of elderly residents and increased numbers of patients with dementia

·  The support available for carers.

RESOLVED that:

(1) The contents of the report and the actions detailed be noted.

(2) Members to consider whether they want the opportunity to visit the Street Triage Service.

There are no outstanding issues for consideration

The Board noted that there were no outstanding issues for consideration.

Report of the Scrutiny Co-ordinator

The Board noted their Work Programme for the current municipal year.

Any other items of public business which the Chair decides to take as matters of urgency because of the special circumstances involved

Further to Minute 17 above, Councillor Ruane, Cabinet Member for Children and Young People raised concerns about the homeless people in the city and asked about the support that was available.

RESOLVED that a briefing note on the work to support the homeless be circulated to members of the Board and Councillor Ruane.