Kernow Clinical Commissioning Group
NHS / Health Body
Action Planned
The CCG acknowledges the concerns about ADHD diagnosis and treatment and states that it has committed to developing a new adult ADHD pathway for Cornwall, due to be established in 2019, to address the identified gaps in service provision. (AI summary)
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Dear Mr Davies,
Prevention of future death report following inquest into the death of David Morley Sargeant
Thank you for your Regulation 28 Report to Prevent Future Deaths pertaining to Mr David (Davy) Morley Sargeant. In your report you identify a number of concerns and considerations to be taken by NHS Kernow as joint commissioners of mental health and learning disabilities in Cornwall, alongside Cornwall Council.
The matters of concern you have raised to be addressed include the review of the arrangements for the diagnosis and treatment of ADHD by specialist services either in Cornwall or out of county. I have noted these concerns and our responses to each below.
1) CFT is not commissioned to assess, diagnose or treat ADHD: NHS Kernow Clinical Commissioning Group (CCG) has not historically commissioned a specialist adult ADHD service. However, in April 2018 it was acknowledged that this constituted a gap in service provision, and therefore an intention was set to develop and operate a pathway for adults (18 years and older) with ADHD. NHS Kernow identified and committed to a recurrent investment for CFT to co-design, develop and deliver the required level of intervention in line with the National Institute for Health and Care Excellence (NICE) guidance. The new service, due to be established in early 2019, will deliver an adult ADHD assessment, diagnosis and treatment pathway.
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A Shared Care Agreement and Guideline for the treatment of ADHD in adults will be developed by the NHS Kernow prescribing team to support the new commissioning model. This will support the prescribing of the evidence based pharmacological treatment, and is supported by an already identified budget within the prescribing team.
2) Addaction Cornwall does not have access to a specialist psychiatrist with skills to diagnose or treat ADHD: Cornwall Council’s Drug and Alcohol Action Team (DAAT) are responsible for the commissioning of Addaction services which provide treatment for adults with substance misuse where ADHD is a co-occurring diagnosis. We would ask that you seek clarification regarding this point from Cornwall Council as the lead commissioner of Addaction.
3) Although GPs have the option to refer under Patient Choice for treatment out of county, experience indicates that this is impracticable because it would not be possible to successfully deliver the ongoing oversight and review of medication: GPs are currently able to prescribe in the absence of a specialised pathway but do require specialist knowledge which can impact on whether they feel competent and confident to do so. Once initiated the new adult ADHD pathway will ensure that people in Cornwall will have dedicated assessment, diagnosis and treatment by a specialist service in Cornwall.
Our response outlines the arrangements that are being developed for the diagnosis and treatment of adult ADHD by NHS Kernow CCG in Cornwall and the Isles of Scilly. We are committed to monitoring the implementation of these arrangements within the timescales noted.
I hope that this response provides you with satisfactory information that we are committed to and are already working closely with partner agencies to take measures to prevent future deaths as set out in the Regulation 28 Report.
We are aware that this response may be shared with Mr Sargeant’s family. I do hope that this information will provide them with assurance that actions are being taken in relation to the concerns’ identified in relation to Mr Sargeant’s death. We would like to extend our sincere condolences to the family.
Please do not hesitate to contact me if you require anything further in relation to this case.
Prevention of future death report following inquest into the death of David Morley Sargeant
Thank you for your Regulation 28 Report to Prevent Future Deaths pertaining to Mr David (Davy) Morley Sargeant. In your report you identify a number of concerns and considerations to be taken by NHS Kernow as joint commissioners of mental health and learning disabilities in Cornwall, alongside Cornwall Council.
The matters of concern you have raised to be addressed include the review of the arrangements for the diagnosis and treatment of ADHD by specialist services either in Cornwall or out of county. I have noted these concerns and our responses to each below.
1) CFT is not commissioned to assess, diagnose or treat ADHD: NHS Kernow Clinical Commissioning Group (CCG) has not historically commissioned a specialist adult ADHD service. However, in April 2018 it was acknowledged that this constituted a gap in service provision, and therefore an intention was set to develop and operate a pathway for adults (18 years and older) with ADHD. NHS Kernow identified and committed to a recurrent investment for CFT to co-design, develop and deliver the required level of intervention in line with the National Institute for Health and Care Excellence (NICE) guidance. The new service, due to be established in early 2019, will deliver an adult ADHD assessment, diagnosis and treatment pathway.
Page 2
A Shared Care Agreement and Guideline for the treatment of ADHD in adults will be developed by the NHS Kernow prescribing team to support the new commissioning model. This will support the prescribing of the evidence based pharmacological treatment, and is supported by an already identified budget within the prescribing team.
2) Addaction Cornwall does not have access to a specialist psychiatrist with skills to diagnose or treat ADHD: Cornwall Council’s Drug and Alcohol Action Team (DAAT) are responsible for the commissioning of Addaction services which provide treatment for adults with substance misuse where ADHD is a co-occurring diagnosis. We would ask that you seek clarification regarding this point from Cornwall Council as the lead commissioner of Addaction.
3) Although GPs have the option to refer under Patient Choice for treatment out of county, experience indicates that this is impracticable because it would not be possible to successfully deliver the ongoing oversight and review of medication: GPs are currently able to prescribe in the absence of a specialised pathway but do require specialist knowledge which can impact on whether they feel competent and confident to do so. Once initiated the new adult ADHD pathway will ensure that people in Cornwall will have dedicated assessment, diagnosis and treatment by a specialist service in Cornwall.
Our response outlines the arrangements that are being developed for the diagnosis and treatment of adult ADHD by NHS Kernow CCG in Cornwall and the Isles of Scilly. We are committed to monitoring the implementation of these arrangements within the timescales noted.
I hope that this response provides you with satisfactory information that we are committed to and are already working closely with partner agencies to take measures to prevent future deaths as set out in the Regulation 28 Report.
We are aware that this response may be shared with Mr Sargeant’s family. I do hope that this information will provide them with assurance that actions are being taken in relation to the concerns’ identified in relation to Mr Sargeant’s death. We would like to extend our sincere condolences to the family.
Please do not hesitate to contact me if you require anything further in relation to this case.