Modernising Mental Health
Services in Bath and North
Mental Health Services Improvement
Stakeholder Engagement questionnaire
Thank you for completing this engagement questionnaire that is getting feedback about the long
term in-patient facilities in Bath and North East Somerset. The Primary Care Trust mental health
commissioners are asking for your views at the very early stages of thinking about the best way to
provide in-patient mental health services into the future.
Your views, alongside the views of staff, clinicians and managers, will be an important test of
opinion on which to build and shape our ideas and eventual proposals. Even though any change
will not take place for at least 2 years we know from previous feedback from the B&NES
community that in order to make sure services succeed in meeting our future needs, it is important
that we all work together right from the beginning and before ideas and solutions are generated. If
we do this then any eventual change or improvement is recognised by local people because they
have helped to shape it. Your views really do count!
Please send your feedback/questionnaires to:
Andrea Morland, Mental Health Change Programme Manager, Trust HQ, St Martin’s Hospital,
Clara Cross Road, BA2 5RP or by e-mail to firstname.lastname@example.org.
Please could you send your comments back by the end of June.
If you would like further information or would like someone to come and talk to your
group/members do not hesitate to contact me on the above or telephone 01225 831513.
Please call 01225 831755 if you need this document in a different format, would like assistance or
have special requirements.
All the documents we talk about here are available on The Care Forum website
www.thecareforum.org or by ringing the number above.
Detailed information on the background to the whole review of mental health services is contained
in the document Modernising Mental Health Services in Bath and North East Somerset
Mental Health Services Improvement Review and Engagement document (February2008). This
has been reviewed and agreed by the Joint Commissioning Board and the Overview and Scrutiny
Committee. The document describes the improvements in mental health services in B&NES. It
also describes the plans for improvements to older people’s mental health services to take place
over the next year that includes expanding our small community teams and reducing our beds,
which are underused, in order to care for people closer to home. The document also discusses the
future of mental health in-patient facilities which is what we will consider here.
Future challenges for in-patient services
The service improvement plans for older people’s services described briefly above are being
developed within existing finances and over the next year. However, they do not address the fact
that currently older people’s mental health in-patient services are provided in facilities designed for
general rehabilitation care. The environment, whilst an improvement on previous facilities used on
the St Martin’s site (wards 5 and 6), does not meet the best practice standards that we aspire to
for future services.
So while our short term plans can deliver significant improvements there will be future challenges
in relation to in-patient facilities, and investment needed to meet these challenges.
It is important that we think about this now because the in-patient service needs to be working in
best practice facilities in order to support the work of the community services. The community
services, in turn, will need to maintain their progress so that they work seamlessly as part of the
mainstream joint community teams being developed in B&NES. This will include developing
processes that enable, for example, single points of access into services, joint assessments and
Adults of working age
The Modernising Mental Health services in B&NES document details the significant
improvements to adult health and social care services over the past year. It is possible– as we
have found in older people’s services – that, as a result of further success with our community
based model, we may need fewer adult beds in the future as people are cared for more
successfully in the community as well as needing less specialist care.
This raises the issue in B&NES, where we already have relatively fewer people than other areas,
that in the future the numbers of people using our adult in-patient services will be too low to make
the inpatient service cost effective. This means the buildings you use, and the staff you employ in
them, cost you a lot of money if you have few people using them.
Also, on small units with low patient numbers, staff can miss out on the levels of
experience, supervision and development they need to keep delivering high quality, up-to-date
acute services. This means keeping staff can become difficult.
Considering all of these issues together for adults and older people’s specialist services there are
several ideas we would like you to think about to help us shape our thinking about future in-patient
facilities. The ideas are:
1. Make no changes to current arrangements and monitor our level of risk in terms of patient
experience, clinical care, costs and staffing.
2. Create a single specialist mental health centre that works with older adults and adults of
Working age to protect against increased cost by maintaining patient numbers and staff
development, expertise and retention.
3. Consider linking with other neighbouring NHS partners to get our in-patient services for adults
of working age delivered - either in or outside of B&NES - for the reasons stated in point 2,
whilst retaining existing older people’s in-patient facilities and integrating the community
services with mainstream joint community teams.
The questionnaire at the end of this information gives you the structure to give us your views. You
can put as much information in each section as you like. Or send your comments back using these
Our very early thinking suggests that some possible solutions could be:
Refurbish or rebuild either one of our existing sites at St Martin’s Hospital or Hillview Lodge
for joint use.
Refurbish or rebuild existing older people’s facilities and link with NHS partners for adult
service at Hillview Lodge or another local/neighbouring facility.
Building a joint facility on a new site
Costs of Changes
Any investment in improving local facilities will cost money. We currently appear to be spending an
above average amount of money on mental health services. Also we are already committed to
increasing investment in community based services e.g. primary care services. So at this stage in
our thinking, we would expect other improvements to be delivered within the existing finances.
This might therefore involve further rebalancing of services.
To rebuild or refurbish buildings would require capital to build the facility, enough money to cover
the costs of that capital (called revenue charges) and ongoing money to meet the running costs of
the building. Current estimates of rebuilding costs are in the region of £12-15million with revenue
charges of approximately £0.5 million. Recent experience suggests that refurbishment costs are
not significantly different.
Clearly, we will need to be sure that all costs can be met to progress any ideas but at this stage
we want to find out what local stakeholders believe are the pros and cons of our early thinking and
to suggest any other options that we should consider.
FUTURE CHALLENGES – YOUR VIEWS
Ideas for future in-patient services
We would very much welcome your views about the following ideas and potential
solutions to help shape our thinking about the future development of in-patient
1. Make no changes to current arrangements and monitor our level of risk in terms of costs and
2. Create a single mental Health centre that works with older adults and adults working age to
protect increased costs by maintaining patient numbers and staff development, expertise and
3a. Consider linking with other neighbouring NHS partners in relation to in- patient services for
Adults of working age – delivered either in or outside B&NES.
3b Retain older people’s in-patient facilities in B&NES and integrate community services with
mainstream joint community teams.
1. Refurbish/rebuild St Martin’s mental health facilities for joint use
2. Refurbish/rebuild Hillview site at the RUH for joint use
3. Build a joint facility on a new site
4. Refurbish/rebuild mental health facilities for Older People and share Adult in-patient facilities
with NHS Partner