Central and North West London NHS Foundation Trust. Change to CNWL Max Glatt Unit: Consultation document.

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1 Change to CNWL Max Glatt Unit: Consultation document

2 Change to CNWL Max Glatt Unit: Consultation document Introduction This document summarises the consultation process on proposed changes to Central and North West London (CNWL) inpatient specialist substance misuse unit, the Max Glatt Unit. This is a joint consultation between CNWL and the lead commissioner of the Framework contract covering six London boroughs. The Max Glatt Unit is a 15 bedded inpatient ward located within the South Kensington and Chelsea Centre for Mental Health, Nightingale Place, London SW10 9NG. It provides specialist `medically managed drug and alcohol inpatient treatment for those with complex needs which may include physical and mental health problems. Why consult? Despite the Max Glatt Unit providing proven, high quality inpatient treatment, the unit costs around 1.9 million to run per year and it made a financial loss of around 600,000 in 2013/14. CNWL cannot sustain this loss and cannot make up this shortfall from other funding arrangements. These losses have occurred for two main reasons: The unit is not always fully occupied and so income has fallen. The current funding arrangements do not cover the costs of running the unit. CNWL undertook a commercial review of the unit which concluded that the unit is no longer financially viable in the current market. This is due to: The Max Glatt Unit funding arrangements having changed. Previously most funding arrangements were guaranteed income block funding arrangements. Although we have some of these funding arrangements, most are `preferred provider funding arrangements, or only guarantee a limited amount of funding; Overnight bed night payments contracted at a rate which is below the cost of an NHS bed; and Reductions in local substance misuse resources appear to be impacting on the numbers some areas are sending to inpatient treatment. This situation means the current provider, CNWL, cannot continue to run this service within the current resources provided. We therefore need to consult on future options. This consultation has been jointly organised by CNWL and the lead commissioner of the Framework contract covering six London boroughs, as it is an opportunity for commissioners to review the best way to provide inpatient medically managed addiction treatment for patients with complex problems. What does the Max Glatt Unit provide? The Max Glatt Unit provides inpatient treatment for those with drug and alcohol dependence for over 50 years and is recognised as a high quality service by the Care Quality Commission and commissioners. The Max Glatt Unit provides medically managed inpatient drug and alcohol treatment for those with complex needs. This may include people dependent on multiple substances who also have physical or mental health issues: Medically managed treatment for those with drug or alcohol dependence who require a relatively straightforward inpatient detoxification, but who do not have other problems, and Medically managed detoxification and stabilisation treatment for those with complex addiction problems plus physical or mental health problems. Max Glatt Unit eligibility criteria is:

3 18 years old or over. Dependent on drugs and or alcohol including: heroin or other opioids; stimulants such as crack cocaine; cocaine; methamphetamine; amphetamine; `club drugs including GLB/ GHB; benzodiazepines and other prescribed medications. Unable to detoxify or stabilise in the community. Complex physical or mental health needs. including: pregnant women; those with physical healthcare problems e.g. severe liver disease, mobility restrictions; mental or cognitive health problems eg alcohol related brain damage, mental health problems etc. The unit provides 1-28 day planned admissions for inpatient treatment for addiction as part of a patients care-planned treatment journey. We work closely with community substance misuse treatment providers and commissioners to ensure patients are prepared for their planned entry into Max Glatt and have a comprehensive aftercare package after discharge which may include community based treatment and recovery interventions or residential rehabilitation. Each patient at Max Glatt receives comprehensive medical and nursing assessments. Each patient receives individually tailored care-planned treatment comprising: medication to detoxify them from drugs and/or alcohol or to stabilise them plus a full programme of group and individual psycho-social support (eg counselling); activities, and recovery support from `experts by experience who have recovered from drug and alcohol dependence. Who did the Max Glatt Unit treat in 2013/14? In 2013/14 The Max Glatt Unit provided treatment for 295 patients. Of these 73 had drug or poly substance dependence and 222 had alcohol dependence. Similar to community substance misuse services, around two thirds of admissions to Max Glatt were men. The majority of patients admitted to the Max Admisisons by Gender ( ) Female Male 202, 67% 99, 33% Glatt Unit were white (80%). Admisisons by Ethnicity ( ) White Non-white Other/Not Stated 10, 3% 52, 17% 239, 80% Patients came from a wide number of local areas including: the City of Westminster 21% (63) patients; the Royal Borough of Kensington and Chelsea 15% (44); the London Boroughs of Hammersmith and Fulham 16% (48); Hounslow 5% (14); Islington 3% (10); Harrow 2%(6); Ealing 13% (38); Brent 12% (35); Hillingdon 11% (32); Barking and Dagenham 0.5% (1); Camden 1% (2); Newham 0.5% (1); Tower Hamlets 0.5 %(1); Wandsworth 0.5% (1); Richmond-upon-Thames 0%(1); plus Oxford County Council 0.5% (1); and Berkshire County Council 1% (2).

4 Max Glatt Unit funding arrangements in 2013/14 The Max Glatt Unit has the following funding arrangements A framework contract with six London boroughs with the City of Westminster as lead contractor. The other boroughs are: the Royal Borough of Kensington and Chelsea; and the London Boroughs of Hammersmith and Fulham; Hounslow; Islington; and Harrow. This contract provides a guaranteed minimum number of `bed nights and an option to purchase more at a fixed tariff of 349 per bed night. Three block funding arrangements with the London boroughs of Brent; Ealing and Hillingdon. The unit is spot purchased by a range of other local areas including: Buckinghamshire County Council; Milton Keynes; and London boroughs of Barking and Dagenham; Camden; Newham; Richmond upon Thames; Tower Hamlets; Wandsworth and Barnet. What is the need for specialist inpatient drug and alcohol treatment? According to national guidance, each local area should commission access to a range of types of drug and alcohol treatment and recovery services. The majority of these services are provided in the community whilst people live in their own homes, but a minority of people with complex needs require access to inpatient detoxification or stabilisation treatment and/or residential rehabilitation. According to national statistics, the need for treatment for alcohol problems and alcohol dependence is increasing. National statistics also indicate that the number of people with heroin and crack dependence has fallen slightly in the past two years, but there are changing drug trends bringing new problems. This includes the use of new psychoactive drugs and stimulant drugs including methamphetamine, and GLB/GHB. CNWL addiction services are increasingly treating patients with problems with these drugs. Does drug and alcohol treatment deliver good outcomes for patients and offer value for money? More than three quarters of patients successfully completed their treatment at Max Glatt and became drug or alcohol free which is an excellent success rate for this complex group of patients. The success of Max Glatt Unit patients contributes significantly to local authority key performance indicators relating to helping people completed drug treatment. Public Health England information states that evidence-based drug and alcohol treatment is costeffective with every 1 spent saving at least 2.50 of local community resources. The consultation Despite the Max Glatt Unit providing high quality treatment to a population with complex needs, the situation remains that the Unit is making a significant loss and is not financially viable. We would therefore like to consult you on a number of options. The options are not mutually exclusive and we welcome your views on whether they are desirable and how they may be achieved. Option 1 Closure of the Max Glatt Unit with no additional provision for medically managed inpatient treatment for substance misusers. Option 2 Keep the Max Glatt Unit open with a sustainable funding strategy supported by commissioning bodies and others. Option 3 Closure of the Max Glatt Unit but explore with a voluntary sector independent sector agency, merging a medically managed service (using Max Glatt doctors and nurses) with an existing medically monitored unit for drug and alcohol problems with less complex needs.

5 How to engage in the consultation The consultation period will run from September 8 to the 31 October We welcome your responses to this consultation and you can engage with us in the following ways Contact us via on Contact us via CNWL website Attend one of our two public events. These are: º Thursday 25 September, 5-8pm, Small Hall, Kensington Town Hall, Horton Street, London W8 7NX º Wednesday 15 October, pm, First Floor meeting room, Soho Centre for Health, 1 Frith Street, London W1D 3H2 We will also convene meetings with local service providers in conjunction with commissioners as requested We will consult with service users and hold a service user meeting on Monday 13 October, 5-7pm, First Floor meeting room, Soho Centre for Health, 1 Frith Street, London W1D 3H2 We will also arrange ad hoc meetings on request. What next? We will analyse all consultation responses and write a report by mid November We will consider the results of the consultation and discuss them with the Max Glatt Unit commissioners at the end of November. We will write a report with a summary of the consultation and our conclusions by the end of December 2014 which will be made available on CNWL Trust website. This consultation will be discussed with the Health Overview and Scrutiny Committee s in the triborough area, where most patients seen at the Max Glatt Unit come from. If you have any queries about the consultation process please contact Annette Dale-Perera on or by on About us Central and North West London NHS Foundation Trust specialises in providing health and social care interventions for people across a range of location including in London, Kent and Medway, and Milton Keynes. Our interventions span community health services, mental health services, sexual health and addiction services, learning disabilities and a wide range of offender health services in communities and Prisons.

6 This document is also available in other languages, large print, Braille, and audio format upon request. Please Arabic Farsi Bengali Dokumentigaan waxaa xitaa lagu heli karaa luqado kale, daabacad far waa-wayn, farta indhoolaha (Braille) iyo hab dhegaysi ah markii la soo codsado. Somali Mediante solicitação, este documento encontra-se também disponível noutras línguas, num formato de impressão maior, em Braille e em áudio. Portuguese Tamil Este documento también está disponible y puede solicitarse en otros idiomas, letra grande, braille y formato de audio. Spanish Dokument ten jest na życzenie udostępniany także w innych wersjach językowych, w dużym druku, w alfabecie Braille a lub w formacie audio. Polish Gujurati Be belge istenirse, başka dillerde, iri harflerle, Braille ile (görme engelliler için) ve ses kasetinde de temin edilebilir. Turkish Central and North West London Stephenson House, 75 Hampstead Road, London NW1 2PL.

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