Issue - meetings

To receive an update from Barnet, Enfield and Haringey Mental Health Trust (MHT) on their current consultation on the reconfiguration of adult acute mental health services within the Borough including:

§         Additional information requested by the Panel (attached)

§         Current occupancy, “sleeping out”  and delayed discharge statistical information

§         Interim responses from the consultation.

To receive an update from Barnet, Enfield and Haringey Mental Health Trust (MHT) on their current consultation on the reconfiguration of adult acute mental health services within the Borough including:

·        The proposals and their implications for service users and carers;

·        Relevant supporting statistical information;

·        The consultation process;

Copies of the full consultation document, the short easy read document and the consultation plan are attached.

Andrew Wright, from Barnet, Enfield and Haringey Mental Health Trust (MHT), provided an update on the consultation that was being undertaken on the reconfiguration of adult acute services within the Borough.  The proposal had been reviewed by the National Clinical Advisory Team (NCAT).  It had been subject to this process as part of a pre-consultation review undertaken by NHS London.  This was necessary in all cases where an overview and scrutiny committee had designated a proposal to be a “substantial variation” to local services.  NHS London had now given its approval for the consultation to proceed. 

The consultation document had been circulated and a series of public meetings arranged and publicised. This would include meetings with carers and service users.  The feedback was being submitted to an independent external organisation who would report back on the outcome.

The proposed changes were about improving services and increasing investment for providing services in community settings.  The MHT was of the view that home treatment was a better option for many people.  This was recognised national policy.  The policy was not new and many parts of the country operated with a similar model of care.  All of the staff affected directly by the proposals would be re-allocated to either the home treatment teams or other wards. 

Services provided by the MHT had improved and the average length of stay had gone down from 76 to 32 days.  This was due to a large extent to improvements in processes.  There was now less demand for beds and one male ward at St Ann’s Hospital had been temporarily closed. There was currently no difficulty in accommodating male patients who needed beds.  It was recognised that there were significant concerns about the proposed changes but these were not concerned with the policy but its implementation.  In response to these, he stated that:

·        Improvements were being made to support carers.  This included the provision of a carer’s assessment for everyone.

·        Home treatment would be undertaken in partnership with carers.  If the carer was not able to cope, the patient would be admitted to hospital.

It was noted that there had been concerns expressed by other agencies. It was emphasised that the changes only affected acute patients.  They would receive the same care from the same staff but in a different setting.  Patients would be visited several times a day and would still be treated as a priority.  The MHT did not believe that the proposals had significant implications for other agencies.  

Lisa Redfern, Assistant Director of Adult Services, reported that the overall direction of travel was welcome.  However, there had not yet been many opportunities to discuss the potential impact (financial/performance/practice perspective) of the proposals.  She did not concur with the view that the proposals would have no impact on partners.  The infrastructure necessary to support the changes needed to be put in place and this took a lot of prior planning. The proposals were likely to impact on the Adult Services budget and there was a  ...  view the full minutes text for item 19

(i)                 To consider progress with proposals by Barnet, Enfield and Haringey Mental Health Trust (MHT) to reconfigure adult acute services in the Borough in the light of the recent report by the National Clinical Advisory Team (NCAT) on the clinical implications (attached).

(ii)               To consider further the consultation arrangements for the proposed changes and any changes to the terms of reference for the scrutiny review that may be necessary in response to the NCAT review. A copy of the scope and terms of reference for the review, as approved by the Overview and Scrutiny Committee on 6 October, is attached.

Lee Bojtor, the Mental Health Trust’s Service Director for Haringey, outlined progress that had been made since the last meeting of the Panel.  Following the meeting, the MHT’s proposals had been subject to a pre-consultation review by NHS London.  This was now required in all cases where an overview and scrutiny committee designated a proposal to be a “substantial variation” to local services.  In addition, it had become necessary to close a ward at St Ann’s due to flooding.  Although the problem had been resolved, the ward had remained closed.  Beds were nevertheless available if required.  However, demand had reduced due to the measures that the Trust had been taking to discharge people more quickly.

Part of the pre-consultation review had included an independent assessment of the clinical implications by the National Clinical Advisory Team (NCAT).  This had been undertaken by Dr Ian Davidson.  His report had been broadly favourable to the proposals but had suggested that the scope of the consultation be widened to include further possible changes to acute services.  In addition, some service users had suggested that, in view of the fact that the issues had been in the public domain for some time already, the consultation period be reduced from 12 to 8 weeks.

The consultation still required final sign off by NHS London before it could proceed.  However, it was envisaged that it would begin in mid to late January.  It would be a joint consultation with Haringey TPCT, although it would be managed by the Mental Health Trust.  The scrutiny process would run in parallel to it.

In the meantime, further steps had been taken to increase safety and prompt discharge.  This included:

·        Dividing support and recovery teams into two for the east of the Borough and two for the west.  Each team had one dedicated consultant psychiatrist

·        Locating Home Treatment Teams at St Ann’s Hospital near in-patient wards

·        Notifying all service users individually of the new arrangements

Both the MHT and Haringey TPCT, together with LB of Haringey, were committed to working together to develop mental health services in Haringey. Current work was focusing on planning what services were needed in the future and how these should be provided to deliver the best possible care.  A new Mental Health Strategy for Barnet, Enfield and Haringey would be produced in the spring and would be consulted widely on.

The changes in acute services that the MHT were currently proposing were fully aligned with national policy and therefore with the main themes of the new Mental Health Strategy. The MHT would also be seeking views in the spring on the wider development of mental health services in Haringey in order to support the business case for services at St Ann’s Hospital.  In addition, the PCT would also be consulting on the future of its services currently at St Ann’s as part of its Primary Care Strategy. The process and timetable for effectively managing these pieces of work were still being worked  ...  view the full minutes text for item 13