"Discussion document - North Essex Partnership NHS Foundation Trust "
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: firstname.lastname@example.org 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 email@example.com 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 16