Discussion document - North Essex Partnership NHS Foundation Trust

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					Discussion document
Improving the mental health and well-being of
people in our communities




Lucas ward, Kingswood Centre, Colchester
Potential options for future service development




What’s your view?


Deadline for feedback - 8th October 2010


This discussion document has been published by NHS Mid Essex on behalf of
NHS North East Essex, NHS West Essex and NHS Mid Essex


                                   1
Distribution list
Please cascade as appropriate to those with an interest in this area
including:

      groups or families
      clinicians and other members of staff
      local organisations in your area

Initial Distribution

All district and borough councils across north Essex*
Colchester Hospitals University Foundation NHS Trust
Essex County Council, including Social Services
GP Practices across north Essex
Independent and Private Sector Providers
Local Involvement Knowledge Networks (LINkS)
Local Representative Committees
Mid Essex Hospital Services NHS Trust
NHS Mid Essex
NHS North East Essex
NHS West Essex
North Essex Partnership NHS Foundation Trust
MPs in north Essex
Practice-based commissioning groups in north Essex
Staffside and Union Representatives
The Princess Alexandra Hospital NHS Trust
Voluntary sector services including:

      Alzheimers Society
      Age Concern.
      Mind


*North Essex refers to the area covered by NHS West Essex, NHS Mid Essex
and NHS North East Essex.

For more copies of this discussion document or
for copies in large print or any other format then
please contact:
NHS Mid Essex
Communications

Tel: 01245 459473
Email: communications@midessexpct.nhs.uk




                                      2
This document is also available from www.midessex.nhs.uk/consultations


Contents
                                                                  Page No

  1. Why we need your views                                              4

  2. What happens now - care on Lucas ward                               4

  3. The context of these discussions                                    5

  4. Summary of some of the potential options for the future             5

   5. The options for improving services                        6, 7, 8 & 9

            Option A
            Redesign the way Lucas ward functions to provide care for
            patients, normally over the age of 65, with long term needs and
            complex and significant mental health conditions. This may
            include people who have dementia.

            Option B
            Decommission the current Lucas ward service and use the
            savings to reinvest in other areas of mental health services/need


            Option C
            Decommission the current Lucas ward service and use the
            savings to reinvest in dementia care services (regardless of age).



    6. How to give your views                                            10

    7. Next steps                                                        10

    8. Feedback form                                                     11




                                     3
1. Why we need your views

One of our key commitments is to improve the mental health and well-being of
people across north Essex.

We are looking at some potential options for improving services, using the
resource which will be freed up by clients moving from Lucas ward, in
Colchester, to new homes in the community.

There are a number of ways in which you can give your views (see page 10).
We would welcome views from clinicians as well those of stakeholders, groups
and individuals with an interest in this area.

This discussion period will be from 20th August 2010 to 8th October 2010.

Details on how your views will be used to inform the decision-making process
are on page 10.

2. What happens now - care on Lucas ward
Lucas ward is an 18 bed ward at the Kingswood Centre in Colchester and cares
for people with continuing mental health needs.

The needs of most of the clients currently on Lucas ward have been carefully
assessed and the majority of these people can now be cared for in nursing and
residential homes. This will enable them to live in the community and have
opportunities for a better quality of life.

There are ongoing discussions with the clients, their families and staff about the
move from Lucas ward to new homes. These discussions are not part of this
paper.

Finding the best and most appropriate homes that meet the needs of the clients,
their friends and families may take some time. The timescale will be dependent
on this but the broad aim is to complete the changes by the beginning of April
2011.

When the clients have moved to their new homes the resource from Lucas ward
can be used to meet the needs of others who have specific mental health
needs.

Although we are still continuing to admit clients to Lucas ward, the admissions
are not on a long-term basis. We are changing the model of care as ‘no
change’ is not an option. National Health Service responsibilities are to ensure
that people with continuing health care needs are helped to find a home rather
than living in a hospital ward environment on a permanent basis




                                       4
3. The context of these discussions
In north Essex we are exploring ways of providing services for the future in the
context of an older population and increasing needs for dementia services. This
is an opportunity to consider how best to meet these complex needs.

The national direction for mental health services is to move towards more
community based recovery services so that people receive the right care in the
right place. They should only be admitted to hospital when it is absolutely
necessary for their care.

A key priority is the ‘Living well with dementia: A National Dementia Strategy’
which was published in February 2009. The aim of the strategy is to ensure
that significant improvements are made to dementia services across three key
areas: improved awareness, earlier diagnosis and intervention, and a higher
quality of care. The strategy identifies 17 key objectives which, when
implemented, largely at a local level, should result in significant improvements.
More information is available from www.dh.gov.uk/dementia.

4. Summary of some of the potential options for
the future
Currently NHS Mid Essex commissions the services of Lucas ward from North
Essex Partnership NHS Foundation Trust. This discussion focuses on some of
the potential options for improving mental health services and well-being, by
using the resource which will be freed up by clients moving from Lucas ward to
new homes.

The current options for discussion are outlined below but if you think
there are other options that should be considered then please let us know.


Option A     Redesign the way Lucas ward functions to provide care for
             patients, normally over the age of 65, with long term needs and
             complex and significant mental health conditions. This may
             include people who have dementia.

Option B     Decommission the current Lucas ward service and use the
             savings to reinvest in other areas of mental health services/need.

Option C     Decommission the current Lucas ward service and use the
             savings to reinvest in only dementia care services (regardless of
             age).




                                      5
5. The options for improving services

Option A      Redesign the way Lucas ward functions to provide care
              for patients, normally over the age of 65, with long term
              needs and complex and significant mental health
              conditions. This may include people who have dementia.

Currently Primary Care Trusts in north Essex purchase high-cost care for this
client group from the independent/private sector, mainly a registered hospital in
Tendring.

The independent/private sector provides care for a wide range of people,
including adults of both working age and older. Many clients have complex
needs and often challenging behaviour. A significant number of the clients are
treated in a hospital environment because they require detention and treatment
under the Mental Health Act. Many of the clients are relatively young (under 70)
so it is a long-term commitment.

There is very little choice for this client group in north Essex.

Currently the cost of providing services for people with long term needs and
complex and significant mental health conditions is around £2million per year,
across north Essex. There is no established condition-led pathway for these
people.

Benefits of this option

Redesigning Lucas ward to meet the needs of this client group offers us an
opportunity to improve care as well as making savings which can be reinvested
in other areas of mental health care. The benefits include:

      More choice of service providers for this client group

      Potential for improved care pathways

      Potential for developing a condition specific service

      Savings that can be used to develop related community services for this
       client group. This may then reduce the number of people who need to
       be treated as inpatients and reduce length of stays for those who need
       hospital care.

      Robust patient safety and risk structures exist in North Essex Partnership
       Foundation NHS Trust (the provider of services for Lucas ward)




                                         6
Considerations

There are a number of issues to consider when exploring this option. These
include:

      Lucas ward would potentially require more staff in order to effectively
       care for this client group and staff would need additional training. This
       would require time to allow this staff development.

      The physical environment of Lucas ward may over time to be upgraded
       to meet the needs of higher dependency clients.

      Policies would need to be in place that promote recovery and ensure that
       clients are moved on to community settings once their needs allow. This
       is particularly important as the older population is expanding.

      Links with the independent sector and any emerging providers would
       need to be made and maintained.

      A number of clients are settled in the independent sector facilities. There
       would need to be consultation with the clients and their families and
       sensitivity regarding moving any clients.

      An ageing population and increased numbers of clients requiring
       relatively complex care means that there is a risk that a redesigned
       Lucas ward will not cope with demand.


We think that this option will result in better care and savings. The savings
could then be used to improve community services related to this client group
and also deliver some of the improvements in options B and C.


Option B      Decommission the current Lucas ward Service and use
              the savings to reinvest in other areas of mental health
              services

Benefits of this option

If the entire Lucas ward service was decommissioned the savings could be
used to fund service improvements in a number of areas. Potential areas
where the savings could be used for service improvements include:

      Diagnostic and community support for people with Autistic Spectrum
       Disorders (ASD)/Aspergers




                                        7
      Diagnostic and community support for people with Attention Deficit
       Hyperactivity Disorder (ADHD)

      Community services for people with Eating Disorders

      The Personality Disorder Pathway

      Perinatal mental health services

      Criminal Justice Services


Some of the savings could also be used to fund additional capacity within
mental health commissioning to enable condition-led pathways to be developed
for the services above.


Considerations

These include:

      Continued reliance on high-cost services for people with complex needs

      Support for this option may not be forthcoming from those who use older
       people mental health services and dementia services.


Option C     Decommission the current Lucas Ward service and use
             the savings to reinvest in dementia services (regardless
             of age).

Currently in north Essex, there are always some people of working age with
young onset dementia (such as Korsakoff’s or Picks dementia) who are being
cared for on adult acute inpatient wards.

Normally people with young onset dementia are in their 50s and physically fit.
This can lead to a number of problems relating to the environment, patient
profile mix and staff skills if they are on a ward with older patients.

It may cause delays in diagnosis and referral to community settings or
independent sector care.

For people over the age of 65 there are memory assessment services,
community mental health team services, outpatient services, day services and
inpatient assessment services. These work with social care services also
designed to support people with dementia. Changing the way in which services
are provided could improve the results for people across the age range




                                      8
Benefits of this option

      Potential for developing a coherent care pathway for assessment
       and/or treatment for patients who either have a suspected or
       confirmed diagnosis of a dementia, including young onset dementias.

      Reduction in delays in discharge associated with admission to acute
       adult inpatient wards.

      Currently there are patients being cared for in the independent
       hospital sector who could potentially be transferred to such a setting
       on Lucas Ward. This could create savings.

Considerations

These include:

      An approach to dementia that provides clarity about the access to
       services and the range of services available (including any
       appropriate inpatient care) is positive. Further work, if this option is
       agreed upon, needs to be undertaken to ensure mutual agreement on
       the patient journey

      The staffing profile on Lucas ward (if an inpatient service is part of the
       pathway) as it currently stands may not support a ward population
       with potentially significantly higher behavioural and mental health
       problems. If this option were to be considered, a ‘spend to save’
       scenario would be required both in terms of up-skilling the staff and
       increasing staff numbers to respond to the need of people with
       dementia.

      The physical environment of Lucas Ward may not support a patient
       profile which is designed to respond to the need of people with
       dementia (regardless of age).

      There are opportunities with this option to develop different
       community approaches to responding to people with dementia, if
       funds were freed up to do this.




                                        9
6. How to give your views
We welcome your views, please use any of the ways below to give us your
comments and ideas.



   1. Use the feedback form on page 11 or complete our online form at
      www.midessex.nhs.uk/feedback

   2. Alternatively you can write to

      Nicola Colston
      Assistant Director of Commissioning for Mental Health in North Essex
      NHS Mid Essex, 8 Collingwood Road, Witham, Essex, CM8 2TT

      Or

      Email: Nicola.Colston@midessexpct.nhs.uk

   3. Come to our discussion session – please let us know that you are
      coming by completing the booking form to be found at
      www.midessex.nhs.uk/lucas or call 01376 302157

      Monday 27 September at 9.30am to 12.00 midday

      Lion Walk United reform Church
      Lion Walk Precinct
      Colchester CO1 1LX

      Directions: www.lionwalkchurch.org/directions.htm


For further information

Please telephone: 01376 302157 or email
communications@midessexpct.nhs.uk


7. Next steps
The Directors of Mental Health commissioning in north Essex alongside mental
health commissioners from Essex County Council will receive the views of all
interested parties and take a considered decision in the light of those views.
The Mental Health Commissioning Executive meets in October 2010 when it is
expected that decisions will be made.




                                       10
8. Feedback Form
Please let us know your views by doing one of the following:

      Complete our online form at www.midessex.nhs.uk/feedback

      Complete this form and return by
            Email:         Jo.Gansbuehler@midessexpct.nhs.uk
            Fax:           01376 302139
            Post:          NHS Mid Essex, Mental Health Commissioning
                           8 Collingwood Road, Witham CM8 2TT

The deadline for your response is 8 October 2010

Privacy and Confidentiality

Your personal details will be held by the PCT for the purpose of acknowledging
your response to this discussion and sending you any additional information
about this. They will not be used for any other purpose.

You do not need to give your personal details if you do not wish to

Name
Job title
- if relevant
Organisation
 – if relevant
Contact tel and
email
Address


If you are responding as an individual, please provide first part of your
postcode e.g. CO2


If you are responding on behalf of a group or organisation please give
details below




                                     11
In giving your views which one of the following best describes you? Please put
an ‘x’ beside the closest match

Client or representative               Clinician, mental health
Carer or family                        Clinician, other
Voluntary sector worker                PCT or PBC commissioner
Local authority staff                  Professional rep/union


Your views on the options for the future
The current options for discussion are outlined on this feedback form. We
would welcome your views and ideas on these.


If you think there are other options or ideas that should be considered then
please let us know. We are very keen to have a wide-ranging discussion.
Please let us know of any other options or ideas that you think are viable
and will improve care.




                                     12
Option A    Redesign the way Lucas ward functions to provide care for
            patients, normally over the age of 65, with long term needs and
            complex and significant mental health conditions. This may
            include people who have dementia.


What are your views on this option?




                                  13
Option B    Decommission the current Lucas ward service and use the
            savings to reinvest in other areas of mental health services/need.


What are your views on this option?




                                    14
Option C    Decommission the current Lucas ward service and use the
            savings to reinvest in dementia care services (regardless of age).


What are your views on this option?




                                    15
Thank you for taking the time to give us your views

Equality monitoring

Your information in this section will be treated in confidence. This information
will help us with our continual monitoring of whether people have an equal
opportunity to give their views.

Please put an ‘x’ in the relevant boxes below

Male                       Female

Age range

16 to 24                   25 to 34                    35 to 59
60 to 74                   Over 75

Ethnic group

White: British             White: Irish                White: other
Asian/Asian                Asian/Asian British:        Asian/Asian British:
British: Indian            Pakistani                   Bangladeshi

Asian/Asian                Mixed: White and            Mixed: White and
British: other             black Caribbean             Black African
Mixed: White and           Mixed: other Mixed          Black/Black British:
Asian                      background                  Caribbean
Black/Black British:       Black/Black British:        Chinese
African                    Other
Other


Do you consider yourself to have a disability?       Yes           No




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