Issue - items at meetings - Mental Health Beds Update - Final Report

Additional information was provided by the CCG after the meeting; this has been attached to the document pack.

100.1    This item was presented by Anne Foster, CCG, Samantha Allen, SPFT, Dr Becky Jarvis, CCG Clinical Lead for Mental Health, and Dr Mandy Assin, Consultant Psychiatrist, SPFT Divisional Clinical Lead.

100.2    Ms Foster began by giving a brief update on the history behind the decision to permanently close the mental health beds in question, reducing the total in city from 95 to 76. In November 2011, it was agreed to temporarily close a ward of 19 beds, closely monitoring the situation from a clinical basis. Since the ward has been temporarily closed, it has allowed some of the variable costs to be reinvested into community services including additional care co-ordinator posts and nursing posts in the crisis resolution home treatment team. In addition the CCG and SPFT had undertaken some additional redesign of community mental health services including the development a new personality disorder clinic, which had not been available in the city before.

100.3    Dr Jarvis, Chair of the Clinical Review Group (CRG), summarised the role of the CRG. They have met regularly over the two years, monitoring key metrics relating to the temporary closure of the beds. 

Amongst the metrics being monitored, the CRG found that there was on average, two people per day needing admission to hospital, and that although there may be a shortage of beds, there was no one type of bed that was in shortfall, eg it was not always male beds or female beds in shortfall.

They also found that the re-admission rate stayed fairly stable over the period that the ward was closed. The CRG also took complaints and other soft data into account.

100.4    Since January 2012, 9 out of every 10 residents needing admission have been able to access beds locally. Although there has been a higher demand than this at times, there has never been the demand for a further nineteen beds at any one time.

100.5    The CRG carried out an options appraisal, considering three options – keeping the status quo, reopening the entire ward, or permanently closing the ward but allowing for flexible capacity from the Priory. This third option was found to be the preferred option, as this allows for a much more cost effective way of meeting the actual demand in the city. The funds released from the closure of the ward will be ring fenced for further investment in mental health services, with the cost of the Priory beds receiving priority.

100.6    The CRG will now review its membership, to include representatives from Adult Care & Health and from Healthwatch.

100.7    Denise D’Souza, Executive Director, Adult Services, was asked to comment on the preferred third option. She said that she had held separate conversations with the CCG and she was satisfied with the third proposal from a social care perspective. The increase in local beds will help to ease the pressure on services and on social care staff, including Approved Social Workers.

100.8    Members then asked questions.

100.9    Members asked for more detail about the proposed service delivery from the Priory.

• They heard that the Priory offered single ensuite rooms, and could accommodate a mixture of male and female customers. There were 16 beds in total, provided over two different floors with ensuite bedrooms for men and women, which is something that could not be offered within the current arrangements at Mill View Hospital. It was envisaged that SPFT would spot-buy five or six of the beds at any one time.

• SPFT would only pay for the bed days that they needed, rather than all of the associated fixed costs of running a ward. Local provision at the Priory also means that there will be reduced costs in terms of patient transport etc.

• If the Priory happens to be full, the client would be taken to other SPFT hospitals in Sussex, or if that were unavailable, to other NHS or independent sector provision further afield. Brighton and Hove residents will have priority for Priory bed availability.

• The empty ward at the Nevill hospital will be used, first as a temporary home for the Brunswick ward residents whilst that is being refurbished, and then to use as a nursing home for people with dementia.

• There was no other similar provision available in Brighton and Hove.

100.10                        Members asked for clarification of the ‘care coordinator’ role. They heard that this role used to be known as a Community Psychiatric Nurse, and their role is to help the client and coordinate care for a particular customer. .Care Co-ordinators can also be other health professionals such as Occupational Therapists and Social Workers and  they are all trained mental health professionals.

100.11                        Members asked how the released money would be spent. They heard that approximately half of the £1.8 million had already been used for the additional Care Co-ordinator and Crisis Resolution Home Treatment posts, and the other half held by SPFT due to the fixed costs associated with the empty ward.

100.12                        Members asked how the quality of patient care would be monitored in the contract. They heard that there will be a Mill View clinician liaising with the Priory, carrying out regular clinical reviews.

100.13                        Several members queried the £800,000 fixed costs that had been quoted for keeping the ward empty and how this had been calculated. They heard that this was the share of the fixed costs associated with the space, including the opportunity cost of not using that space for another reason. Members asked for a more detailed breakdown to be circulated following the meeting. They would also like this to include the ongoing costs of a Discharge Coordinator attending the Priory, and the costs of different types of beds, eg in NHS or private provision. This was all agreed. [NB This has now been provided and attached to the agenda document pack.]

100.14                        Members asked whether there was any financial saving to SPFT if option 3 were taken up. They heard that if the released funds were totally invested in mental health as proposed, there would be no financial saving but it would mean a much stronger community mental health service.

100.15                        Had the clinical impact on the patients been assessed? Dr Assin said that this had been carefully considered. The Priory would not be used for anyone in acute need, but would be more likely to be used for people coming to the end of their treatment. It was hoped that this meant that people would not be moved from the Priory back to inpatient treatment at Mill View.

100.16                        Some members said that they were very supportive of the proposals, feeling that this was the way forward for service provision across a number of areas. They considered that the £800,000 fixed costs which had been lost so far were in effect an expensive insurance policy. Were there any lessons that could be learnt from this so that costs would be minimised in future? There were many lessons for the future which the CCG and SPFT were reviewing and the learning could be shared with HWOSC members.

100.17                        Members asked whether the two year monitoring period was at least in part caused by the fact that politicians were overseeing the process. Geraldine Hoban, Chief Operating Officer of the CCG said that it was true that this might have had an impact although this was not necessarily a negative thing. If the beds had been closed too prematurely, this might have introduced risk into the system. Although the process had taken a long time this has allowed community services to be developed as real alternatives to inpatient care.  The Chair of HWOSC commented that HWOSC’s approach had been to take a cautious view of the proposals and monitor it closely and therefore there was a shared responsibility for the time it had taken so far.

100.18                        The Chair concluded that there still was still a sense of anxiety about the financial and some of the clinical aspects of patient care, but he had not picked up a huge sense of concern about the general direction of the approach. He hoped that the SPFT and the CCG had noted the committee’s concerns – they would be sent more formally too. The Chair also hoped that there would be learning to go forward to other schemes.  The Committee notes the proposal and the CRG decision to proceed with Option 3.

100.19                        HWOSC noted the report, with a formal follow up to share concerns, and with an update report in approximately six months’ time.