Building Better Mental Health Care CNWL Consultation Update

Transcription

1 Introduction: Building Better Mental Health Care CNWL Consultation Update This report outlines the issues raised from the recent consultation Building Better Mental Health Care along with Central North West London s responses. We would like the committee to consider the following questions: 1. Does the committee support the trusts plans of bed reconfiguration in-line with the government s efficiency policy? 2. Does the committee endorse our response to the concerns raised from the consultation process? 3. Is the committee satisfied that the trust has taken all reasonable steps to deliver a sustainable safe high quality service? 4. Does the committee have any suggestions/recommendations following on from the public consultation? The changes proposed by Building Better Mental Health Care to inpatient mental health services in Kensington Chelsea and Westminster were subject to a formal public consultation between the 24th of August 2012 and 16th of November Central North West London NHS Foundation Trust carried this out. Consultation Process Prior to the public consultation we undertook 6 weeks of stakeholder engagement as part of a preconsultation programme. This consisted of presentations and meetings to discuss the trusts bed reconfiguration plans. Letters to MP s, CCG Chairs and s to alert local stakeholder representatives were sent out prior to the formal launch of the public consultation. During the pre-consultation phase Stakeholder raised the following concerns which they felt would need to be address by CNWL, responses to these issues are shown in blue: Housing issues acting as a blockage to discharge - This is being dealt with at board level and with local authorities Safety of reducing bed numbers - We are committed to providing a bed to everyone in need, if there are any concerns over safety and quality at any time, the process will be halted. Sufficient opportunities for feedback - We will ensure that there are a number of opportunities for feedback throughout the consultation process. Ability of local community services to absorb the impact of the proposed changes - Community teams will work differently to cope with the changes. Insufficient capacity to reduce acute bed numbers - Delayed discharges and length of stay are currently very high and we will tackle this as well as focussing on housing and placement issues.

2 Changes in community services to support care out of hospital - In past years there has been considerable investment in community teams across KCW and we have specifically invested in home treatment teams (HTTs) to support the Mulberry North Ward trial closure. CNWL has also recently launched the CNWL Recovery College with local borough access to courses. Accessibility concerns over moving services to the north of the borough - It is common in other boroughs to have only one inpatient site, ultimately we strive to reduce occurrence and length of hospital admissions. Ensure proper breadth of consultation - We are using our existing links with representative groups and will hold a number of stakeholder meetings as well as public meetings, to ensure engagement with hard to reach and vulnerable groups. Redundancies for staff on affected wards - Our preferred option have the lowest possible impact on staff and we have undertaken workforce planning to hold vacant posts open for redeployment of affected staff. On the 24th of August 2012 the public consultation was launched with 1000 full consultation documents and 1000 summary documents distributed to stakeholders and libraries. All documentation contained a consultation questionnaire, which could be return via or post posters were sent to a variety of stakeholders throughout Kensington Chelsea and Westminster, these included: 96 GP surgeries 112 Pharmacies K&C Link Westminster LINK Westminster Carers Service User Network Advocate for Mental Health (KCW) SMART (K&C) CNWL Services Commissioners for Homeless People 1. Janet Haddington Rough Sleeps Commissioner 2. Mick Clarke - Chief Executive of The Passage 3. Colin Glover - Chief Executive, Connection Day Centre 4. Westminster Rough Sleepers Team 5. Kensington and Chelsea Social Inclusion Team 6. Westminster Joint Homeless Team 7. Dr Hickey Surgery 8. Great Chapel Street Medical Centre (run by St Mungo s Association) 9. Cardinal Hume Centre Details of the consultation were also presented to the Central London CCG Board on 6 September 2012 and the West London CCG Board on 25 September The consultation was highlighted in an article in the Trust s members magazine Inview, which was sent to 10,000 registered members on date

3 Individuals and organisations for onward distribution requested 50 electronic copies of the report. One summary document was transcribed into Arabic on request. Newspaper Adverts regarding the consultation were taken out in the Hammersmith and Fulham Chronicle dating from the 24th of August 2012 to the 5th of October These advertisements highlighted the consultation period, the community road shows (see below) and how to respond to the consultation. 1 public meeting per borough was held along with 9 community road shows, which were arranged throughout Kensington Chelsea and Westminster.

4 3 Stakeholders requested meetings to discuss the consultation and 2 stakeholders requested additional information sessions. Consultation Reponses An independent organisation, Verve Communications, was appointed to evaluate the consultation responses. A questionnaire was designed to capture this information and included sections where respondents could add comments on the proposals, as well as any further general views. The questionnaire was included in 1,000 copies of the full consultation document circulated to interested parties, stakeholders, local organisations and the public at large. It was also made available at Trust s offices, promoted on its website and made available at all public meetings and events. A FREEPOST address was created to enable people to return the questionnaire at no cost. The public could also access and download a copy of the questionnaire, with supporting material available, from the CNWL NHS Trust s website, and it to the Trust. A Braille version of the form, audio version, large font version or help in understanding this document in a language other than English were also available. There was also an offer of assistance from the User Involvement Project at Advocate for Mental Health A Total of 60 documents ( s correspondence, formal contributions, notes of meetings and conversations and questionnaires) containing comments from stakeholder groups, local people and the Westminster City Council Adult Services & Health Policy and Scrutiny Committee were received. Other relevant content such as information on staff engagement, impact assessments, schedule of consultation activities and a summary of media coverage, blogs and petitions were also collated. From the 60 documents received the 21 related to correspondence, formal contributions and notes of meetings and conversations. A summary of some of these responses is shown below: Public meeting held at 10 Sept 2012 CNWL Consultation St Mary s Hospital Comment from participant In the overall context, we appreciate that obviously having less beds is a sensible way of saving money if you're looking at things as a whole and indeed people don't want to be on the ward, particularly the poor service users of one of the preliminary consultations of Belgrave, they were actually quite pleased that the ward was going to be closed. Public meeting held at 12 Sept 2012 CNWL Consultation Kensington Town Hall Quote from MIND written response: Very positive feedback from members who have attended courses at the Recovery College. Comment from participant I agree in principle with what you are proposing and I recognise the financial constraints that you have no choice but to deal with. My biggest concern though as a patient who has had extensive use of all your services really over the last eight years, is how that is

5 going to be implemented and how that is going to affect us, your clients, your service users and I think that is probably most people s key concern. Direct quotes from St Mary Abbots Rehabilitation and Training (SMART) RESPONSE: Members were in agreement that recovery can be better aided in the more therapeutic environment of a patient's home. They support the proposal that more work will be undertaken by Home Treatment Teams. Your underlining principle of improving the quality of inpatient care and experience, ensuring timely discharge from hospital using the recovery model and individual care planning and involving service users and carers from the outset is enthusiastically supported by both our members and the staff team. We have been using the Recovery Star as a tool to support recovery for many years and our members appreciate the holistic approach to supporting their recovery and respond extremely well to it. Patient Flows. Members were in agreement that recovery can be better aided in the more therapeutic environment of a patient s home. They support the proposal that more work will be undertaken by Home Treatment Teams to prevent hospital admissions and to facilitate the timely release of patients from hospital. Housing. While we support the intention to start discharge planning at the point of admission, it has been suggested that a better partnership/working relationship between the local authority and CNWL could facilitate this. Verbatim comments from meeting with SMART We understand the need for efficiencies and the targets and this can be an opportunity to do something creative, involving us as equals. This offers a good opportunity for acute services to develop alternatives for admission maybe staff can offer support at SMART or use SMART as a step-down service. We recognize that SMART has its own concerns we need to work together and collaborate to minimise impact on patients. This could be exciting for user groups to work with commissioners take ideas from Canada and other countries. Golborne Forum In general, the Golborne Forum supports the preferred option outlined in the consultation document of a reduction in inpatient care following sustained, long-term investment in community-based services From St Mungo s response: We welcome the idea of closing wards as we do not think that hospitals are the best place to initiate recovery for most of our clients, or at least only for a short period while medication stabilises them: we would like to see CNWL develop more progressive models such as the psychologically informed environments we have piloted (with CNWL patients) which have high positive recovery outcomes. We would like to participate with CNWL and other partners in developing truly recovery-oriented alternatives to the hospital ward, which would enable closure programmes to go forward not just

6 safely but in a way that would enhance the recovery potential for those in acute mental distress or illness. We believe that a more strategic involvement of the third sector and patients in developing new services would benefit both patients and CNWL strategy, and would also come up with solutions that would reduce the cost for the commissioners. From Westminster s Adult Services and Health Policy & Scrutiny Committee response: Westminster s Adult Services and Health Policy & Scrutiny Committee at Westminster City Council would like to put on record our tentative support for Central and North West London Foundation Trust s plans outlined in their consultation document Building Better Mental Health Care. We do retain residual concerns over the continuing success of providing more care in the community for patients with mental health conditions. On the 5th July 2012, the Committee noted that when developing proposals for community settings, the local community and population need to be engaged throughout and taken into account, in addition to service users. We acknowledged the importance of effective communication, and for consideration to be given to patient and community safety, ethnic communities and homeless people. We also would like to be assured that patient experience should not suffer as a result of the changes, given that satisfaction with care did seem to be lower post-changes in Kensington and Chelsea. Of the responses received 38 related to questionnaire, 16 of which came from one inpatient ward. The results are shown in the table below: Question 1 Do you support our proposed model for providing more acute care outside of hospital and reducing dependence on inpatient services? Proposals for providing more acute care outside of hospital were supported by 37% of respondents, with a further 18% answering don t know or not stating a preference. 45% did not support the proposed model. Question 2 Do you support our proposals for change in Kensington and Chelsea? Proposals for change in Kensington and Chelsea were supported by 34% of respondents, with a further 24% answering don t know or not stating a preference. 42% did not support the proposals. Question 3 Do you support our proposals for change in Westminster? Proposals for change in Westminster were supported by 37% of respondents, with a further 16% answering don t know or not stating a preference. 47% did not support the proposals. Question 4 Are there any issues you think we should particularly take into account? See analysis of comments Question 5 Do you have any other comments you See analysis of comments

7 would like to make? Alongside mixed levels of support for some of the proposals, the consultation revealed a significant degree of uncertainty and concern among local people and stakeholders about some issues arising from the proposals. In principle there is support for more care being provided outside of hospital but sufficient resources must be available The main comments from both questionnaire responses and stakeholders events related to the following topics: Community healthcare services and social support Social Housing Capacity in Hospital Care NHS reforms and financial challenges Public Information and engagement Accessibility of services, travel and transport In addition responses included a range of suggestions for additional activity or actionable ideas to be considered. A full independent report regarding the responses received from the consultation is being prepared. Following on from this report a consultation feedback event is to be arranged, this will give stakeholders an opportunity to see the outcomes of the consultation. Central North West London Response to Consultation As part of running a public consultation process Central North West London has engaged with stakeholders at every opportunity. It is aware of the concerns raised by interested parties and has in the most part mitigating action plans to address these issues: Community healthcare services and social support - You need to be much more specific about what the improvements to community based services will be, how they will be funded and how they will be up and running well ahead of any reduction in bed spaces. We have held extensive talks with the Clinical Commissioning groups to negotiate sharing the savings from these plans. A case was put forward to re-invest some of the savings into Community Recovery and Home Treatment Teams and Acute Day Care to expand their capacity and ability to provide an alternative to inpatient care. A way forward has been agreed. The service has piloted a 7 day a week acute day care program post test ward closure at South Kensington and Chelsea. We have also increased the consultant medical provision within the Home Treatment Team. A new initiative called the recovery college has been set up by the trust, its aim is to implement the recovery model at every stage within the service users life and as such looks to train current CNWL staff and supporters of people using CNWL services such as family, friends and carers. The training is co-delivered by peer recovery trainers, (these are people with lived experience of mental health issues) and mental health practitioners. This additional service looks to improve and support the service users community environment.

8 We are currently looking at ways in which acute community services are provided in particular the interface between health and social care. Implementing discharge coordinators may be one way of improving the patient flow between the two systems, we are also in constant discussion with the head of social care around the need for additional support within acute and community mental health teams. Housing - We... seek CNWL's commitment that meeting people's housing needs and influencing policy and practice will be priorities for CNWL's partnership working with Social Service. We are concerned regarding the shortage of housing within Westminster. We remain committed to working with Westminster City Council regarding this issue. However we do feel that all internal changes undertaken to assist have improved the situation, but further external collaboration with the Local Authority is required. Capacity in Hospital Care - When these cuts to health, welfare and social care services really start to take effect there will be an increase in mental ill health and more demand on services and there will not be enough beds. Allocation of bed numbers has evolved over time, irrespective of changing levels of need. Following the Mulberry North ward test closure CNWL services have continued to manage with the reduced bed numbers and it is reasonable to predict that further improvements in efficiency of bed usage can be achieved with a focused effort in Westminster. As part of the bed reconfiguration the trust implemented two triage wards within Kensington Chelsea and Westminster, these wards have facilitated in the reduction of length of stay and have increased the number of people being discharged straight into the community setting. An evaluation of these triage wards is currently being undertaken, the initial findings has shown that patients like the decisive nature of the ward. We have also worked on designing a new patient flow system. This has taken the trust bed management system from a reactive to a proactive function, with discharge planning happening from the point of admission, allowing acute services to manage its inpatient bed resource more effectively. However it should be noted that beds would be found for anyone with the clinical need for an inpatient stay. NHS reforms and financial challenges - The consultation is presented in isolation. The wider political and economic contexts need to be considered as these will likely impact on people's mental health. A more comprehensive presentation of CNWL's wider efficiency saving strategy should have been published so that an overall view of the economic situation and proposed strategic direction would be apparent. CNWL business plan, which includes Cost Improvement Plans relating to services across the trust, is available via public board meetings. The board papers are also available monthly via Central North West London s website. Finance reports are also presented to our council of governors at their regular quarterly meetings. We publish an annual report on our trust strategy, which is available to the public. Our financial risk rating and performance is also presented to our regulator Monitor and published on their website.

9 Public Information and engagement - CNWL needs to commit to communicating directly with the communities it serves / It is recommended that the Trust write at least annually to people to keep them informed. We undertook a public consultation, which looked to engage stakeholders at every opportunity. All community road show events were held in public buildings within the north and the south of the borough. We also hold regular service user events and meetings with a variety of carers and user groups at which feedback around the current service and proposed changes to the service is encourage. We will continue to gauge feedback on all of its service improvement schemes and is looking at new ways for service users to respond and engage with the trust. Accessibility of services, travel and transport - As St Charles is in the far north of the borough, the increased distance people will need to travel is a concern. The journey to St Charles is seen as time consuming and difficult. We appreciate that this is a concern, however currently all South Kensington and Chelsea patients are being admitted to the triage ward at St Charles. We can ensure that all follow up and post discharge services are conducted either at the patient s home or close to it. Psychiatric Rehabilitation Service Re-design Sycamore Lodge During 2012, NHS Inner North West London worked together with CNWL to identify ways to improve throughput in adult mental health in-patient open rehabilitation services, as part of the Shifting Settings of Care initiative. The aim was to better support the successful long term rehabilitation of individual patients from Kensington and Chelsea and Westminster. A report detailing the service changes is attached in Appendix A Conclusion Central North West London is committed to delivering high quality care across all the inpatient wards and for those patients under the care of Home Treatment Teams. A comprehensive programme has been developed to support this and is outlined in the attached document. Acute Service Quality Programme Appendix B We understand the concerns that have been raised throughout this consultation period and have put in place stringent action plans to address and mitigate these. We will continue to work with key stakeholders to ensure that services are delivered in the most effective and suitable manor for our users.