Morecambe Bay Primary Care Trust

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1 Morecambe Bay Primary Care Trust.NHS. PUBLIC CONSULTATION ON PROPOSED SERVICE CHANGES IN MENTAL HEALTH ALCOHOL SERVICES 13 TH DECEMBER 2005, COUNCIL CHAMBER, MORECAMBE TOWN HALL CHAIR: ANN GEGG, NON EXECUTIVE DIRCTOR No QUESTION/STATEMENT RESPONSE AT CONSULTATION CURRENT PCT RESPONSE How can you treat more people if you are closing something down? People that currently access Castle Unit can still access some Inpatient Provision. Will see more people in the Community. People that currently access Castle Unit can still access some Inpatient Provision. Confirm response at consultation There are 3 beds in Harvey House purely for Morecambe Bay and you will loose 2 beds Only 1 bed in the Castle Unit is for drug detox. National good practice indicates that 3 beds within Morecambe Bay will provide the necessary element of the treatment system for alcohol detox, as longs as this is incorporated into treatment system with an enhanced capacity for community based treatment. This approach forms the basis of the Proposed Model for Alcohol Services in the Board Paper. How will you prioritise access to drug beds Wont be providing in Harvey House Expect to use beds through Drugs North West. Looking to do home detox if appropriate or looking to build in provision into Alternative provision of drug detox is being considered, and there options from reprovision are outlined in the Board Paper on Proposed

2 What is the current waiting time? What would I do if a felt vulnerable what about aftercare I had Hepatitis C, GP phoned the Castle Unit and I got in straight away, tried detox at home at it does not work I would have died if I had to wait to access the Castle Unit Barrow had the highest death rate apart from Lambeth If the Service isn t there, people don t ask for it. When there is a detox service, lots of people come forward. Because there won t be a local service, people won t come forward. My clients don t want to be treated out of the area. I had 3 home detox programmes but the Castle Unit was the only thing that broke the cycle. The letter I detox if appropriate or looking to build in provision into the new model Up to 7 months and we know this is unacceptable. There has always been a backup service We only had 1 death last year please sent in the statistics if you have information that proves different are outlined in the Board Paper on Proposed The proposed service model, with its enhanced community service should eventually result in reduced waiting times. This may be difficult to achieve during the Phase 1 transition/development period, where there is a risk that waiting times may increase. Community services will include aftercare and relapse prevention support There needs to be acknowledgement that for some people drug (and alcohol) detox is most safely effectively achieved in an inpatient setting. This needs to be addressed when determining options for re-provision of the drug detox component currently delivered by the Castle Unit No further information has been received There will be expand capacity for alcohol detox by investing in home based detox, maintaining an appropriate level of provision for those requiring inpatient treatment. This should bring treatment closer to home for clients Confirm point noted above-we acknowledge that some inpatient detox is indicated for some patients

3 broke the cycle. The letter I have sent in details my personal experience and how vital the Castle Unit is. I can pick up the phone now and speak to someone at the Castle Unit, any time of the day, what will happen now? I have my drug administered at the Unit I have taken a commitment to go into the Unit and have my drug administered this is part of my treatment. There is always someone at the Castle We envisage this will still be available and Anitibuse will still currently prescribed within the Community Team We anticipate the service to be provided will be done by the people currently within the service. There would be increased capacity within the Community. Response confirmed. Board Paper on Proposed 2006 identify the need to provide this from the enhanced community based service. Response confirmed. Board Paper on Proposed 2006 identify the need to provide this from the community based service Unit the back up is superb If Unit closes, where will I go? The service will be developed in the community Response confirmed. Board Paper on Proposed 2006 identify the need to provide this from the community based service Are you committing yourself to a 24/7 outreach service? Am I allowed to react to what is decided through the consultation? Can users input into the plan? 24/7 service will need to be looked at for Drug users, 24/7 service still available at Harvey House. The consultation is on a broad model of service. There will be a summary of responses and the issues raised and recommendations will be made to the Board. The Board will make a decision on the model but there is an expectation they will reflect on the issues/themes raised. Once decision has been made, the detailed implementation plan will then be developed. There will be a mechanism which we will need to explore. The implementation Plan will be informed by The practicalities of providing 24 hour access to telephone support will be further developed in the implementation plans. It is being proposed in the Board paper that input from stakeholders, including patients will be sought on developing the implementation plans. It is being proposed in the Board paper that input from stakeholders, including patients will be

4 It is alright talking about the model, whether the model works is dependent on mechanisms. The PPI has concluded that there is not enough info if mode will work On Page 23, , talk about collaboration has anyone approached Social Services who have a remit to support people In agreeing to model, the Board pre-empts actions that cannot be rescinded. Would ve lost something that is working well. Our fear is that there won t be a saving, as to pass on responsibility to other agencies which are not yet in a position to take on responsibility. Will be passing on responsibility to families who won t be helped by changes. staff and users. We will also look at how the service is reviewed and monitored. The consultation is about a change in model, explicit that the document sets out reasons and nature of model. We are consulting on service but the detail will have to be developed. If the concern is that there isn t enough detail, we haven t yet worked through all the parts of implementing the model. Part of what the Board will have to do is decide how to communicate their decision back to the people commenting on the consultation. Model sets out model of service that is about meeting needs. There are some needs that are not currently being met sought on developing the implementation plans. Comment noted, and addressed in above point. Social Services were included in the consultation and both Cumbria and Lancashire sent in written responses. Board Paper on Proposed Developments for Alcohol Services,, highlights issues which need further negotiation with Social Services, and seeks approval of the Board to progress with this. The implementation of the proposals would require careful monitoring.

5 My colleagues in Barrow/Kendal said desperate to access the Castle Unit beds. People don t want to detox on a psychiatric ward Do you know how many staff would be increased How many people would provide the service on the Castle Unit Who are the other providers who will be working with> Have Social Services been approached? 2.2 whole time equivalent it will be upto the service how they use the resource. Talked about two separate teams with a specialist nurse role, as recommended by the National Treatment Agency. Service would draw up their own plans. Need to put detail into the model first year would be developing relationships and year 2 there would be three Bay-wide access will be available to the 3 detox beds, if this is indicated as the safest and most effective option for a client Increases in staff are set out in the Board Paper on Proposed Developments for Alcohol Services,. The exact skill mix needs to be worked out in the implementation plan. As above whole time equivalents. GPs, Staff in A&E, CDAS, Ambulance Service Other services are identified in the Tier 1 and 2 levels in the proposed service model eg antenatal clinics, prison and probation units Yes Social Services were included in the consultation and both Cumbria and Lancashire sent in written responses. There is a potential hole in the timing of model; surely you need to put services in place before others are taken away? Given that you are burning bridges you have to be 100% sure this will work. What would happen if the service became part of There will be a detailed implementation plan which will need to address timings. How transition occurs is an important issue to raise during the consultation period. Can t be a 100% certain, envitable when talking about new patterns of service. Would be very worried if anyone says it was 100% guaranteed. Don t know what will happen, but will continue to have an organisation that s responsible for commissioning There are significant risks that without a robust change management approach, waiting lists and times may increase in the initial phase of the development. This issue is set out in the Board Paper on Proposed Developments for Alcohol Services,. Monitoring of impact of service changes needs to be included in planning the developments We anticipate the move towards a more consistent approach to commissioning services

6 Lancashire Care Trust? Generally people are uneasy about the future. Lot of anxiety has there is no going back on the changes proposed IS this just about money? Money is the driver How will Harvey House be affected? How confident are you that the changes will leave a viable Harvey House? There will be nothing for drug addicts? Always thought drug and alcohol were the same decisions and an organisation that s responsible for providing services. The context will be the same. Anticipate in the short to medium term will be a change in management rather than a change in service. Yes there is a lot of anxiety that is one of the themes the Board needs to take account of. The PCT has been open and honest and said that if there is money to be saved then this will go into the pot. Changing the nature of Harvey House will have to work on a different basis the changes Morecambe Bay are making will be the same other commissioners will have to make in the future. Part of the implementation will be a challenge in the way Harvey House will be managed. This will be dependent on the majority of other NHS Commissioners. The logic that has influenced Morecambe Bay will influence other Commissioners. The service will have to respond to what Commissioners require. There will be the Community Drugs Team and looking at Drugs North West in Manchester Would have concerns in mixing client groups across Cumbria and Lancashire, especially at the Tier 4 level. Issues of concern are set out in the Board Paper on Proposed Developments for Alcohol Services,. Confirm response. The need to continue negotiations with other PCTs which commission services from Harvey House re set out in the Board Paper on Proposed As above. Other commissioners are indicating their interest in continuing to purchase programmes from Harvey House. The forthcoming MOCAM commissioning framework potentially offers significant opportunities to remodel the suite of programmes provided in the future. Confirm response. Determining options for the reprovision of the drug detox component currently delivered by the Castle Unit will be part of taking the Proposals forward The community based approach of the Community Alcohol and Drug teams presents an opportunity to work flexibly with a range of client needs

7 With regard to Antibuse, what does prescribing in the community mean How can you explain this, when enhanced service payments are currently frozen? Out clients saw Antibuse assistance as a way of maintaining sobriety Yes I find GPs reluctant to prescribe Antibuse We know what we are loosing but we do not know what we are getting has it been costed? Have costings been done for other players, voluntary, private and statutory bodies who will have to take on board their own costings on implementation? There are two lots of Social Services and at present have heard you say that voluntary sector isn t equipped to respond to change of this magnitude. If appropriate, it will be a GP, Nurse the expectation is that it will be within primary care There is a current decision not to expand level of enhanced services this year, not expanding at the rate that was expected. Every year there is a bottom line figure that must be spent on enhanced services If we had a doctor in the Community Team prescribing, would that be acceptable? We then need to take this into consideration With additional training, we expect GPs to be linked in more to prescribing. The detail of the implementation plan had deliberately not been finalised but outlining costings have and it is appropriate to continue down this route. We have gone to Statutory and Voluntary agencies about indicative costs; it is not our responsibility to fund social care. Joint working is part of the implementation plan. needs There are a number of options for providing this within the proposed service model and these are set out in the Board Paper on Proposed Primary care is not the only option As above- there are other options that can be used. As above As above The need to continue to work on implementation and refine financial detail is noted in Paper on Proposed Development of Alcohol Services to Board The model treatment system set out in the Paper on Proposed Development of Alcohol Services to Board, identify the need to clarify the potential role of the voluntary sector, and potential costs.

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