ITEM 5 (ii)
HCC Health Scrutiny Committee
Preliminary Topic Group on Mental Health Acute Inpatient Services – 20th January 2011
Official Submission of the Hertfordshire Link
Objective of the Topic Group:To review the public engagement that there has been about HPFT’s proposal for future Mental Health Acute Inpatient Services, and to consider if any further engagement or consultation is required
Outcome desired at this session:
Advice on whether sufficient engagement has taken place for HPFT and Commissioners to reach a satisfactory decision about the proposal
What are the relative benefits and disadvantages of the proposals?
· Much earlier provision of high-quality AI accommodation which can support improvements in patient care
· The scheme is less costly than the previous one, but provides almost the same number of beds, and some further flexibility of bed provision to accommodate fluctuating patient population needs.
· All inpatients would be housed in single, ensuite rooms, and all environments brought up to the best possible standards, with consequent improvements in dignity and privacy for service users.
· There would be a broader spread of units across the county and the scheme offers the possibility of linked smaller day hospital units being placed in buildings in the community later rather than on large hospital sites
· There would almost certainly be some loss of provision due to decanting during refurbishment work.
With whom has the proposal been discussed?
· The main constituencies with a material interest in these proposals are: working age current and past users of acute inpatient services; their families and carers; also older people who may be in need of acute inpatient care at times, and their carers; users of day hospital services where similar treatments are available; young people who may need the services at some time in the future. HPFT staff. Also GP and other community service provision networks in the districts affected.
· The Hertfordshire LINk was very actively involved with trying to draw some of these constituencies into the consultation process. HPFT approached the LINk, prior to the beginning of this renewed consultation on the revised proposals for the development of Acute Inpatient Re-provisioning (AIR), with a request to help as much as possible with bringing this consultation process to the notice of relevant LINk members and member organisations. This we did. We made strenuous efforts to reach as many of our members as possible, to send them the new proposals, invite them to attend one of the consultation meetings planned, and/or to let us know what their views on the proposals were, so that we could put them to HPFT on their behalf.
· HPFT ran a series of 4 or 5 main consultation meetings across the county. We then ensured that a member of our Mental Health Theme Group represented us at each meeting - in St. Albans, Welwyn Garden City, Hertford, Stevenage and Watford, so that we could both contribute to the discussion, but also hear the views of other participants from each area/district and take them back.
· Subsequently, we invited the planners from NHS and HPFT to our Mental Health Theme Group meeting on 17th November to talk to a representative audience of LINk members, who had, by that time become familiar with the issues, talked and listened to others they represented and came with a view to summarising for HPFT the views of people in their districts about the plans.
· HPFT also organised and/or attended a number of consultation meetings with other groups, including relevant voluntary organisations for service users and carers. Many HPFT staff and clinical and other colleagues from relevant NHS organisations participated in these meetings too. Quite a high proportion were able to attend more than one meeting and were, therefore, able to consult with others between events and also form much more informed views on the merits and demerits of the proposals.
What are people’s views about the proposal?
Hertfordshire LINk has just completed a series of monitoring visits to all nine acute inpatient units run by HPFT, including the CAMHS provision on the Harperbury site. We now have up-to-date impressions and data on the whole service, and this provides us with a very useful background for responding to the latest proposals for re-provisioning. We have a clear picture of the quality of new-build and refurbished accommodation for the services which HPFT envisage for the whole service, as well as the shortcomings in terms of patient care and recovery, of some of the current accommodation which needs replacing.
In general, following discussion, explanation and creditable NHS/HPFT responsiveness to issues raised during the consultation, most people eventually felt positive about the proposals, particularly since implementation would mean substantial upgrading of the quality of the AI accommodation for service users, and would spread provision over five sites in the county rather than the previously proposed three, so increasing accessibility.
The issue of transport between sites for carers and visitors, and for service users on home leave had been worrying a substantial number of people, particularly in the south-east of the county, where little provision is planned. However, as the consultation progressed, this concern was met with a proposal from the planners for a free inter-site transport system, as there can be no guarantee that all service users can be placed in the unit nearest their home, whatever system or configuration is introduced.
Nevertheless, the following are still issues of some concern:
· The withdrawal of the AI service from the QE2site without any assurance on the provision of at least day hospital or clinic services in that district is a worry for some. Similar concerns were originally expressed over the disappearance of MH AI services from Watford when the Shrodells building is closed, as that building, with two inpatient wards, also houses the experimental day hospital service for service users who can manage to remain at home, but need treatment or services daily, or very regularly. Though there is, of course, no opposition to the replacement of Shrodells itself, as there is a general acceptance that the building itself makes it difficult to provide the best quality AI care that is universally desired.
· There is similar concern in Welwyn at the loss of the facility on the QE2 site. Day hospital provision would be welcomed there too. .
· There is considerable confusion still emerging as to the effects of these changes on the existing provision - acute inpatient, day hospital and longer term inpatient provision - for older people with mental health problems. This does need a clear exposition.
· It is our understanding that this project concerns provision for working age service users, but issues of how the decanting process during implementation would work, and whether that would affect provision for older people do need to be clarified.
· One suggestion from us would be for the Joint Commissioning Team to include one or two voluntary sector representatives of Older People in the new Mental Health Strategic Commissioning Group, to watch-dog inpatient provision for Older People whilst these changes are taking place, as the progress would be reported on regularly in that group.
· There was some concern about service users’ access to physical health services and clinicians when the units are no longer on main hospital sites. How this quality of this service area can be maintained over the five non-general hospital sites needs to be carefully considered and explained, though there is no inherent reason why the service could not be fully maintained.
· The proposed provision of free transport has reassured many, but we believe a more detailed exposition of the plans for this service would be welcomed.
· The issue of day hospital provision has been raised and promoted very strongly by us in the consultations described above, but this popular mode of provision does need to be applied to older people’s services as well when the opportunity arises. It should not be confused with ‘care in the community’
Generally, although the scheme is not perfect – and cannot be where capital funds for upgrading are limited and reducing, the feeling is that much improved accommodation and care can be provided through this scheme more locally and much more quickly than under the previously planned arrangements, and these plans do allow for the development of day hospital provision in the future and, therefore, expanded provision.
Is enough information available now for a decision to be made (so that development can proceed swiftly?)
· Hertfordshire Link is satisfied that every possible effort has been made to contact the working age mental health constituencies who are directly affected by these proposals for future AI provision, and to engage with their interests and issues regarding the proposed changes. All avenues have been explored and there is a general consensus of satisfaction with the proposals, subject to the peripheral issues outlined above being included in the planning and implementation.
· There does, however, seem to be some concern that these proposals might well affect the Older People’s mental health services in some ways, and that this constituency, and its advocates, might need some further contact, discussion, clarification and reassurance, prior to final decisions being taken.
Jean Brown
LINk Board Member,
Chair, Mental Health and Learning Disabilities Theme Group
11th January.2011
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