Issue - items at meetings - Mental Health: Acute Beds

Update on plans to reduce acute bed capacity at Mill View hospital (verbal)

91.1    This item was introduced by Ms Anne Foster, CCG Lead Commissioner for Mental Health.

91.2    Ms Foster told members that performance at Mill View had continued to fail to meet the targets set by the Clinical Taskforce (e.g. in regard to out of area placements). It was evident that the targets would not be achieved across the long term without significant improvements in services for people with personality disorder and in supported accommodation.

91.3    In response to a question from Mr Brown about the impact of closing St Patrick’s Night Shelter, members were told that there had been an impact in terms of delayed transfers of care, although an agreement was now in place with the West Pier Project.

91.4    Ms Foster agreed to circulate the Taskforce’s meeting minutes and the metrics being used to monitor the impact of the temporary bed reductions.

91.5    The Chair thanked Ms Foster for her contribution and requested a written progress report for the next committee meeting (i.e. the first meeting of the Health & Wellbeing Overview & Scrutiny Committee).

Update on plans to reduce acute bed capacity at Mill View hospital (for main meeting)

78.1    This item was introduced by Geraldine Hoban, Chief Operating Officer, Brighton & Hove Transitional Clinical Commissioning Group (CCG); Sam Allen, Service Director, Sussex Partnership NHS Foundation Trust (SPFT); and Anne Foster, CCG Lead Commissioner, Mental Health.

78.2    The committee was told that the Clinical Taskforce examining the planned Mill View bed reductions had met twice to agree the set of metrics they would use to determine whether beds should be permanently reduced and to begin to apply these metrics to the data on activity at Mill View. The Clinical Taskforce was being Chaired by Dr Becky Jarvis, CCG Clinical Lead on Mental Health.

78.3    The key metric was the percentage of Brighton & Hove patients seeking admission at Mill View being placed in the hospital, with a target of 95%. SPFT was not currently meeting this target, although it was performing at 92-93%. The Taskforce identified the lack of a local specialist service for Personality Disorder and a paucity of suitable supported housing to accommodate people being discharged from hospital as the key areas that required improvement if the target was to be reached.

78.4    In response to a question from the Chair as to how the 95% target was agreed, members were told that it was not feasible (or desirable) to set a target of 100%; 95% represents a challenging but achievable goal and will ensure that almost all local people receive treatment locally. SPFT would have to show it could attain the target level of services for three consecutive months before the Taskforce would agree to permanent closure of beds. In addition, there were other metrics being considered, looking at bed occupancy rates, user complaints, re-admission rates and seasonal variation.

78.5    In answer to a query from Mr Hazelgrove on the problems associated with supported housing in the city, members were told that there was historically a lack of housing at all levels of support need. There were also wide variations in quality and cost of supported housing across the city and a general lack of ‘move-on’ in the system – e.g. people no longer requiring high levels of support being moved on to lower support housing. A good deal of work has been undertaken in this area, and local providers are confident they can increase capacity.

78.6    The Chair thanked Ms Hoban, Ms Allen and Ms Foster for their contributions, noting that the committee was very happy with the way the process had been handled to date, and would welcome more updates at future meetings.

Verbal update on progress in implementing planned changes to city acute mental health beds.

65.1    This item was introduced by Geraldine Hoban, Chief Operating Officer, Brighton & Hove Transitional Clinical Commissioning Group (CCG); Dr Richard Ford, Executive Director of Strategic Development, Sussex Partnership NHS Foundation Trust (SPFT); and Samantha Allen, Service Director, SPFT.

65.2    Ms Hoban told members that a phased reduction of beds at Mill View would commence in April 2012. This would be overseen by a Clinical Taskforce to be chaired by Dr Becky Jarvis (the CCG mental health lead clinician), which would be established in February.

65.3    Dr Ford told the committee that there had been a spike in demand in January 2012 which had stretched services and required some out of area placements – these patients had now been repatriated.

65.4    Ms Allen told members that the January spike was predicted, as there was typically increased demand at this time of year. However, this did not mean that it was an easy thing to find sufficient capacity to cope, and it was sometimes inevitable that out of area placements were used. It was nonetheless important to note that there had been no out of county placements, in line with the Trust’s commitment to offer people a Sussex bed, even in peak periods. Dr Ford added to this, telling members that, if necessary, the trust would ‘spot purchase’ a Sussex private bed from a reputable, CQC-registered provider rather than place a patient outside Sussex. However, this was rarely required as there was capacity within SPFT to deal with most spikes in demand without recourse to private sector beds.

65.5    In response to a question from Mr Brown on the number of out of area placements recently, Ms Allen told the committee that there had been four in January, the first time in recent months that placements out of area had been needed. SPFT had responded to this spike in activity by postponing the scheduled transfer into Mill View of older people with functional mental health problems (from the Nevill hospital) until demand had reduced.

65.6    In answer to a query on pressures caused by a lack of suitable accommodation for homeless people with mental health problems (particularly in light of the imminent closure of St Patrick’s Night Shelter), Ms Allen told members that the trust did have in-patients from the local homeless population, and that a lack of accommodation could potentially present a problem here, but that this was currently being dealt with via the revamp of the mental health accommodation strategy.

65.7    The Chair thanked Ms Hoban, Dr Ford and Ms Allen for their contributions.

65.8    RESOLVED – That there should be a further update on this issue at the next committee meeting to include any work done by the Clinical Taskforce.

Report to follow – this will be a late report as it will be a product of the HOSC MH workshop event taking place on Nov 10

48.1    Dr Richard Ford, Executive Director of Strategic Development, and Ms Samantha Allen, Service Director, Sussex Partnership NHS Foundation Trust (SPFT); and Ms Geraldine Hoban, Chief Operating Officer, Brighton & Hove Clinical Commissioning Group (CCG), were present to answer members’ questions.

48.2    Members of the HOSC who had attended the 10 November scrutiny workshop on city mental health beds explained their views to the Committee. In addition, a letter setting out the LINK position was circulated. Generally, the views expressed were supportive of the initiative proposed by SPFT, although all members had concerns about elements of the plans, particularly in terms of the availability of supported housing, investment in community mental health services, dementia care, and out of area placement.

48.3    Dr Ford addressed these concerns, stressing that the initiative was the result of much planning and that its implementation would be closely monitored. Dr Ford acknowledged that housing was a crucial issue, but noted that a good deal had already been done to improve the availability of appropriate housing in the city. However, there was a good deal more to be done.

48.4    In terms of resourcing, Dr Ford told members that SPFT’s key community mental health teams (e.g. the Assertive Outreach and Crisis Resolution and Home Treatment teams) were well-resourced.

48.5    In terms of out of area placements, Dr Ford averred that it was in SPFT’s interests to keep these to a minimum, as a good deal of staff time and resources would otherwise be wasted travelling to treat and assess patients placed in out of city beds.

48.6    In terms of dementia care, Dr Ford stated that the trust intended to continue treating 100% of dementia patients within the city, and investing in improved early diagnosis and support.

48.7    Ms Allen told members that the planned bed reduction would be phased, and there would be contingency plans in place to pause or adapt the programme should performance be affected. A clinical taskforce will be set up to monitor the initiative, ensuring clinician involvement at every step.

48.8    Ms Hoban told members that the CCG had concerns about accommodation issues and was also keen to see the further development of SPFT community services. Dementia was also a key priority, particularly in terms of ensuring that the dementia care pathway runs as smoothly as possible. The CCG welcomed the phased reduction of beds, and would also welcome further scrutiny involvement in terms of monitoring the initiative.

48.9    Cllr Follett proposed an amendment to the report recommendation, replacing the second recommendation with a resolution to have a progress report brought to the HOSC at every committee meeting until the bed            reduction initiative has been completed. This amendment was seconded by the Chair and unanimously agreed by members.

48.10  RESOLVED – That members:

(1)       Support Sussex Partnership NHS Foundation Trust plans to reduce acute bed capacity at Mill View Hospital, with the understanding that bed capacity will be urgently reviewed should the new arrangements impact significantly upon performance;

(2)       Will require a report on implementation of the initiative to be tabled at each HOSC meeting until the bed reduction has been completed. This report should include relevant feedback from the Clinical Taskforce established to oversee the initiative.