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Developing our strategy - the local picture

People in Kent and Medway deserve safe, high quality health and social care services that are joined up and meet their needs now and into the future. This will help everyone live their best life, and get great treatment, care and support when they need it.

Kent and Medway has a population of approximately 1.8m people. This is expected to grow by 4.5 per cent and 4.2 per cent for children and adults respectively, over the next five years. While it is great news that we’re living longer, many people are developing multiple long-term conditions over time and as they age, meaning they have more support and care needs.

People with severe mental health illness are more likely to have a physical health condition and die on average 15 years earlier than people with no mental illness. This is an unacceptable health inequality which must be addressed.

Helping local people live their best life

Alongside a growing and ageing population, we know there are wider determinants of health that can have a negative impact on people’s physical and mental health. The coexistence of mental health problems, like depression or anxiety, with other problems such as obesity, smoking, alcohol misuse and poor self-care is also increasing.

In Medway 20 per cent of people live in the most deprived 20 per cent of the country. In Kent, 13 per cent of people live in the most deprived 20 per cent
The rate of homelessness in Kent and Medway is 2.2 per cent, which is similar to the South East and England average
Violent crime is higher than the average across England in Kent and Medway
According to the Kent Integrated Data Study of September 2018, 4.1 per cent of those with a serious mental illness died prematurely in Kent and Medway compared with 1.1 per cent of the rest of the 18-74 years old population. This suggests that adults in Kent and Medway with a serious mental illness are 3.6 times more likely to die prematurely, in line with the England average (of 3.7). This is an inequality that we are determined to address
The prevalence of those people with more than one long-term illness or condition in Kent and Medway is around 50 per cent higher amongst those with a serious mental illness than the rest of the population
Across Kent and Medway, 21 per cent of adults aged 18-74 with a serious mental illness were recorded in the 12 month period between October 2017 and September 2018 as multi-morbid (i.e. having more than one illness or long-term condition) by their GP, compared to 14 per cent of other adults aged 18-74 years
The rate of suicide in Kent and Medway was 10.9 per 100,000 (i.e. nearly 11 people in every 100,000 across the county took their own life) in 2015-17. This is higher than the England average rate; 9.6.

We need to do more to look after the mental health and emotional wellbeing of our population. We want to improve services for people in Kent and Medway so they:

are personalised and focused on the various health and care needs of individuals
help people to stay healthy and, where possible, avoid ill health
are easier to access, where possible locally in their community, and outside of a hospital environment when that is the most appropriate setting.

Working together to transform care

The NHS, social care and public health organisations in Kent and Medway have made progress by working together as the Kent and Medway Sustainability and Transformation Partnership (STP). To help us go further, faster, we are looking ahead to working as part of the Kent and Medway Integrated Care System (ICS). The Kent and Medway ICS has made explicit
commitments to:

Focus on mental health, expand mental health services, and better look after the physical health of people with severe mental illness
Make sure children, young people and adults with special educational needs and disabilities, learning disabilities and autism – and their families and carers – receive the care and support they need and deserve.

KMPT will play a critical role in supporting the Kent and Medway system to deliver those commitments.

Mental health in Kent and Medway – a snapshot

The most current data from the Kent Public Health Observatory Mental Health Needs Assessment (September 2019) for Kent and Medway shows that an estimated 17 per cent of the population aged 16+ has a common mental illness e.g. anxiety and depression. This is estimated at 236,545 people. This is similar to the rest of the country and, as with other areas in England, the trend is upward
In Kent and Medway, 2,734 per 100,000 people are in contact with specialist mental health services
Approximately 6,000 people in Kent live with severe psychosis
Since 2014, rates of severe depression have increased in Kent and Medway and suicide rates are higher than both the national average and regional neighbours, particularly in men
Around 13 per cent of children and young people aged 5 to 19 years are estimated to have a mental health condition and there is particular concern for looked after children
Change is already happening at pace across the Kent and Medway health and care system, with providers and commissioners working more closely together to transform care for local populations. The Kent and Medway STP is transitioning to a fully operational ICS across Kent and Medway during 2020-21
Since April 2020 a single strategic commissioner has been operating across Kent and Medway, formed through the merger of the pre-existing eight Kent and Medway Clinical Commissioning Groups (CCGs)
Four newly established Integrated Care Partnerships (ICPs) are operating across local geographies in Kent and Medway of circa 250,000 to 500,000 resident population
42 GP-led Primary Care Networks (PCNs) each with an appointed clinical director, serving a registered population of circa 30,000 to 50,000, now lead the provision and delivery of local care (care delivered outside of hospitals)
A Kent and Medway Medical School has been established which, from September 2020, has been educating aspiring doctors to train to deliver 21st century medicine
A new Mental Health Learning Disabilities and Autism Improvement Board has been established, bringing together commissioners, providers, clinical leaders and local authorities to focus on transformation projects across our area.

We know that people across Kent and Medway feel a strong sense of place and they will have different needs depending on where they live.

By working closely with our four ICPs and the 42 PCNs across Kent and Medway we can focus on better meeting those needs. The role of our local authority colleagues, especially at district and borough council level, will be integral in helping us respond appropriately to place-based needs and issues. Kent and Medway’s primary care services are the ‘front
door’ to NHS services for many people and GPs and their teams can offer a unique perspective on the health and care needs of their local populations.

The four ICPs bring together the providers of health and care services, along with other key local partners to work together to plan and deliver care. Profiles of populations in each of the four ICP areas (as shown in the map) have been developed to help focus service planning and population health management in a way that brings the greatest benefits to
local people. Depression and suicide are the key adult mental health indicators in the ICP level population profiles (source: Kent Public Health Observatory1).

Mental health profile by area and population
ICP area	The population	Mental health profile
Dartford, Gravesham and Swanley	Around 260,000 people live in the area covered by Dartford, Gravesham, and Swanley ICP which focuses on providing joined-up health and care for people living within the boundaries of the current Dartford, Gravesham and Swanley CCG. Life expectancy varies across Dartford, Gravesham, and Swanley. In Bean and Darenth ward in Gravesend, the life expectancy of the average male is 75.9 years. In Riverhead ward in Sevenoaks area, it is 89.9 years.	There is a lower rate of depression in Dartford, Gravesham, and Swanley than the national average, but the prevalence of male suicide, particularly, is in line with the national average.
West Kent	West Kent ICP covers a population of about 464,000 people. It has some of the most and least (top and bottom 10 per cent) socially deprived areas in England. On average, men and women live slightly longer in west Kent than the average for England: the average life expectancy in west Kent is 84 years and five months, the national average is 81 years and two months.	Depression and suicide rates in west Kent are in line with the national average.
Medway and Swale	Medway and Swale ICP covers a population of about 427,000 people. It has some of the highest levels of deprivation in the UK with some wards being in the ten per cent most deprived areas in the country. The percentage of adults classified as overweight or obese, and the number of people aged over 18 who smoke, is four per cent higher than the national average.	There is a higher rate of suicide, particularly in men, than nationally and there is a two per cent higher prevalence of depression.
East Kent	East Kent as an ICP area covers Ashford Canterbury, coastal south Kent coast and Thanet and covers a population of about 500,000. Life expectancy is only slightly lower than the rest of Kent and national average, whilst smoking and obesity are worse than in other parts of England.	Depression and suicide are higher than the Kent and the national average. In this area, the number of people with a serious mental illness is expected to rise by 13.9 per cent over the next 10 years.

We have a strong foundation of data and information about our local population on which to build our strategy, but it’s been important too to talk and listen to the people who use our services and need our support. Alongside our NHS partners we have been having conversations with local people about mental health services. People have told us that we need to:

Find ways to drive up the quality of mental health care and improve the way care is organised, including the communications between different services and with patients
Make it as easy as possible to access mental health care, including training all NHS staff to recognise mental health problems and having more mental health staff in A&E and urgent care centres and primary care
Work with organisations such as schools, employers and councils and with communities to raise awareness and understanding of mental health problems and ways to improve mental health and wellbeing.

Responding to COVID-19

While COVID-19 has presented society and the NHS with an immense challenge, it has accelerated change and fostered significant innovation in the way that services and support are provided in unprecedented circumstances. At KMPT, we have established a ‘recover and transform’ programme to enable new ways of working to be sustained and embedded across the organisation. Examples of long-term changes and improvements that have been made as a result of the pandemic include:

greater use of digital technologies, including telephone and video technology, for virtual assessments and therapeutic delivery
use of Mental Health Investment Standard (MHIS) monies to fast track the delivery of our 24/7 open access crisis telephone lines, extending our existing ‘single point of access’ (SPOA) capability, with well-developed plans for a new telephony system (including moving to a freephone 0800 number)
providing tangible leadership and specialist support to organisations and colleagues across the Kent and Medway system to support staff and local people in the face of increased pressure as a result of the pandemic. This support includes self-help support leaflets and videos, help lines (advice and signposting), reflective practice, operational review, tailored virtual events for professionals, and a stepped model of psychological support defined for NHS/healthcare staff with a supporting business case that is being used by partners across the system.

COVID-19 – assessing the impact, learning the lessons

COVID-19 has provoked an extraordinary response from everyone involved in the delivery of health and social care and other essential frontline services. Health and care staff are demonstrating resilience in the face of unprecedented pressures. They are working with extreme compassion, care, dedication and loyalty to their teams, colleagues, and patients.

And they are transforming services and adapting quickly to work in different ways to keep people safe. Lockdowns, social-distancing measures, and ongoing restrictions continue to impact on the emotional and mental health and wellbeing of our local population. A wealth of evidence, data, and feedback on the impact of the pandemic is emerging at national and local level. Sir Michael Marmot’s Build Back Fairer report for The Health Foundation on the impact of COVID-19 on health inequalities, outlined how different groups of people in the UK are experiencing the pandemic and its impact very differently.

Mental health is a major concern, with some groups, particularly children and young people, profoundly affected by the pandemic, including the impact of lockdown and social restrictions.

Build Back Fairer cites evidence to suggest that more than two-thirds of adults in the UK (69 per cent) report feeling somewhat or very worried about the effect COVID-19 is having on their life. The most common issues affecting wellbeing are worry about the future (63 per cent), feeling stressed or anxious (56 per cent), and feeling bored (49 per cent).

While some degree of worry is understandably widespread, more severe mental ill health is being experienced by some groups and this emerging evidence reveals a widening of pre-existing inequalities in mental health.

Commentary from The King’s Fund and National Voices refocuses our attention on the importance of listening and responding to the views and experiences of patients and the public, whatever the circumstances: ‘Too often efforts to understand what goes on for people and to respond to their needs and aspirations can feel like a nice to have rather than a key part of how to deliver health and care services effectively.

It is tempting for services to extend this view into crisis periods by saying ‘We don’t have time to do it’, but now, more than ever, health and care services need to base their decisions on the reality people experience.’

Voluntary and charity sector groups are key partners in our work helping information exchange and fostering discussions with service users, their loved ones, and carers. These are groups and networks which have been adversely affected by COVID-19 with negative impacts on their ability to fundraise, deliver services and support, and to recruit volunteers and helpers. In an article ‘Time to unmute the patient voice’ published on 16 July 2020,
Health Service Journal correspondent Sharon Brennan concluded that ‘patients may be more distrustful, charities have less time to campaign or engage and services already have rapidly changed, but if the NHS is to reduce health inequalities in its COVID-19 reset, patients must be both heard and listened to.’3 Reviewing our relationships and
partnerships with the voluntary, community and charity sector will be an important next step in developing our plans.

COVID-19 – our local response

Since April 2020 KMPT has experienced increased demand for our services. Phone contacts via our open access crisis line have increased by 65.1 per cent, community mental health team contacts have increased by 13.6 per cent and Community mental health service for older people (CMHSOP) contacts have increased by 10.7 per cent.

Furthermore, the levels of people admitted to hospital under a Section of the Mental Health Act have increased
overall, highlighting an increase in acuity. There has been a surge of people needing crisis care who are autistic alongside an increase in people who have had, up until COVID-19, a well-managed psychosis illness. We have seen an increase in admissions to hospital for people with complex emotional disorders.

In response to COVID-19, KMPT has established a ‘recover and transform’ programme to enable new ways of working because of the pandemic to be sustained and embedded across the organisation alongside NHS Long Term Plan transformation objectives. There is an opportunity to capitalise on the benefits we have seen including an accelerated adoption of digital innovations, increased flexibility in working patterns for many staff, and reduction in travel resulting in a reduced carbon footprint.

The programme spearheads our ‘adopt and adapt’ approach to the pandemic, ensuring that we continue to provide high quality services and support in existing, new, and innovative ways. It includes engaging with service users, carers and staff and learning from emerging evidence and data to help us ‘adopt and adapt’ because of COVID-19.

The programme also takes a longer-term view of the need to maintain productivity and financial sustainability as we navigate our way through continued periods of emergency response and the post-pandemic period when we get there.

As a result of this work, some of the areas where we have made significant progress include:

Increased use of digital technology within community mental health teams with video and telephone contacts increased by 70 per cent during the first national lockdown returning to around 50 per cent from June 2020 onwards. The use of virtual platforms such as ‘Attend Anywhere’, video and telephone for virtual assessments, therapeutic delivery and implementation of care is now part of everyday working and performance reporting
Ensuring that services did not become ‘digital by default’ recognising that some groups and individuals do not and cannot use digital or online methods; maintaining telephone and face-to-face services for those who need them
Extended hours with community mental health teams operating seven days a week during lockdown, focusing on urgent crisis responses. From June 2020 onwards some weekend and extended evening working across localities has been in operation. This was supported as part of the Mental Health Investment Standard system planning and is built into our future modelling to maintain
Changing working practices to ensure that crisis care provision was maintained during national lockdowns for those with complex emotional difficulties, successfully moving from face-to-face sessions to video conferencing to maintain help and support for those in need.

COVID-19 has had a significant impact on the working lives of our staff. On the front line, staff across all care settings are experiencing unprecedented levels of stress as they deal with the COVID-19 crisis. Many people working in support and back office functions have adopted a remote working set-up to keep safe and comply with government guidelines.

KMPT has taken a system leader role during the pandemic, helping partner organisations to support staff during this uniquely challenging time. Some of the ways we have done this include:

Providing self-help support leaflets and videos, a managers’ help line (advice and signposting), reflective practice, operational review, operational debriefing sessions, supervision for psychological first aiders, and guidance and support to those already providing support in the hospitals
Providing low level Cognitive Behavioural Therapy and mindfulness training to Kent and Medway GPs including contributing to the regional ‘Coping with Covid – Empowering Primary Care’ event in November 2020
Development of a bid to implement a ‘resilience hub’ within Kent and Medway in 2021 to provide signposting and psycho-educational support.

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