Scrutiny Report Template
Scrutiny Report Template
Health Overview & Scrutiny Committee
Subject: Brighton & Hove Specialist Inpatient Dementia Services
Date of meeting: 16 September 2024
Report of: Chair of the Health Overview & Scrutiny Committee
Contact Officer: Name: Giles Rossington, Policy, Partnerships & Scrutiny Team Manager
Email: giles.rossington@brighton-hove.gov.uk
Ward(s) affected: all wards
Key Decision: No
1.1 Members are asked to consider NHS plans to make changes to the provision of specialist inpatient dementia services in the city. Details of the planned changes are outlined in part 3 of this report and there is more detailed information, provided by NHS partners, in Appendix 1.
2.1 That the Health Overview & Scrutiny Committee (‘the HOSC’) notes the planned changes to Brighton & Hove specialist inpatient dementia services referred to in this report and determines while it does not require any further formal consultation on the proposals, it nonetheless wishes to be kept informed of the development and delivery of the plans.
3.1 Sussex Partnership NHS Foundation Trust (SPFT) provides mental health services across Sussex, working in 3 localities: West Sussex, East Sussex and Brighton & Hove. The Sussex Integrated Care Board (ICB) commissions NHS health services across Sussex, and at place level (also Brighton & Hove, West Sussex, East Sussex).
3.2 SPFT, working with NHS Sussex have developed comprehensive plans to transform services for people living with dementia, their families and carers while reducing variation in community service provision across Sussex. These plans include proposed changes to inpatient dementia services in Brighton & Hove- the resulting changes propose an increase in local inpatient capacity for adults with mental health conditions. The proposals are supported by NHS Sussex.
Background
3.3 Brighton & Hove benefits from a robust network of community-based dementia services, including specialized mental health support for older adults, an Enhanced Duty Service for Dementia (ENDU) available 7 days a week with extended hours, and dedicated care home support. These comprehensive services, combined with the city's relatively younger population, result in lower demand for inpatient dementia beds compared to East and West Sussex. However, the need for acute mental health inpatient care for non-dementia conditions remains high.
3.4 The Brunswick Ward, a 10-bed mixed-gender dementia unit at Mill View Hospital in Hove, currently serves a patient population primarily from East or West Sussex, with a minority being residents of Brighton & Hove. This disparity is attributable to the significantly older demographics in both counties compared to Brighton & Hove, coupled with the higher statistical likelihood of dementia affecting older individuals. As inpatient care on Brunswick Ward is not restricted to city residents, when the ward reaches capacity, Brighton & Hove residents requiring admission may be placed in inpatient facilities in East or West Sussex.
Proposed changes
3.5 SPFT, in collaboration with the ICB, has developed plans to repurpose Brunswick Ward, which would result Brighton & Hove residents living with dementia, who require an admission for inpatient care being accommodated within SPFT's specialist dementia inpatient services in Worthing or Uckfield
Brunswick Ward will be refurbished into a 15-bed acute mental health ward, utilising recently awarded NHS England (NHSE) capital funding. In parallel, investments will be made in East Sussex community dementia services to enhance their capacity to reduce inpatient admissions. These proposals have been considered and supported by the ICB, reflecting the shared goal of reducing reliance on inpatient dementia beds and prioritizing effective community-based services across Sussex.
Considerations for the HOSC
3.6 While these changes will result in a net gain of 15 adult acute mental health beds in Brighton & Hove, they will also lead to the removal of 10 inpatient dementia beds within the City. While the city experiences relatively low demand for inpatient dementia beds, there is a pressing need for adult acute mental health beds. Therefore, this increased capacity is likely to benefit a greater number of the City's residents and reflects the population need. Additionally, these changes aim to facilitate a shift in dementia services countywide towards a best-practice model, prioritising community-based care for people living with dementia.
3.7 The proposed changes aim to address the pressing need for acute mental health beds in the city while aligning the Sussex dementia pathway with the best practice model of prioritising community-based services. This strategic shift is supported by the relatively low local demand for inpatient dementia beds, while simultaneously increasing city's capacity for specialist mental health beds.
3.8 The Trust and NHS Sussex will continue to evaluate the long-term viability of the proposed plans, considering demographic projections and the potential impact on patient care and accessibility. These considerations will encompass the needs of both individuals living with dementia (who may be admitted to an out-of-city inpatient care) and those experiencing mental health issues (who will benefit from increased local access to specialist mental health bed).
4.1 None directly to this report. Members may be interested in exploring whether NHS providers and commissioners considered alternative options before agreeing on their current plan.
5.1 None directly to this report. Members may be interested in NHS plans to engage with communities or community organisations.
6.1 None for this report
7.1 The Council’s Health Overview & Scrutiny Committee has delegated to it the statutory responsibility of reviewing and scrutinising matters relating to the planning, provision and operation of health services in Brighton & Hove.
7.2 The changes outlined in this Report are not considered to amount to a substantial development or variation in health services (a category of changes which requires a specific process of consultation to be followed). However they nonetheless constitute changes to healthcare provision which will impact on people’s lives, including those of some residents of Brighton & Hove. As a result, the changes are properly the subject of this report, which asks Committee to note them and to consider the level of engagement it wishes to have with the development and delivery of relevant plans.
Name of lawyer consulted: Victoria Simpson Date consulted 3/09/2024
8.1 None directly to this report, but members may wish to explore what steps NHS partners have taken to assess and minimise any equalities impacts of their plans.
9.1 There will be a small increase in patient journeys to out of city inpatient wards. However, this is likely to be minor given the low numbers involved. Plans to enhance East Sussex community services, and plans to increase acute mental health bed provision in the city, may lead to a net reduction in travel to inpatient units.
10. Health and Wellbeing Implications:
10.1 The planned changes will significantly increase provision of acute mental health beds in the city. There is high demand for these beds, with the impact of long waiting times currently being felt across the health and care system. A substantial increase in acute mental health bed capacity would consequently be positive, and financially feasible if achieved by the re-purposing of beds for which there is relatively low local demand.
13.1 Members are asked to consider plans to make changes to city specialist inpatient dementia beds, while also increasing capacity for adult mental health beds. The plans will significantly increase city acute mental health bed capacity and reduce local inpatient dementia bed capacity. Members will want to be assured that there are robust plans in place to mitigate any negative impacts of the loss of local dementia beds.
Supporting Documentation
1. Information provided by Sussex Partnership NHS Foundation Trust/Sussex Integrated Care Board