Agenda item

To receive an update on the redevelopment of St Ann’s Hospital, including on plans to address the increasing demand for access to beds.

Andrew Wright, Director of Strategic Development at Barnet, Enfield and Haringey Mental Health NHS Trust and David Kovar, Managing Director – Haringey at Barnet, Enfield and Haringey Mental Health NHS Trust, gave a presentation to the Panel on the redevelopment of St Ann’s Hospital and mental health beds.

The presentation included the following points:

• Construction on a new mental health inpatient building commenced in January and is on time and budget with the new building due to open in summer 2020. It will re-provide the three acute adult wards and the specialist eating disorders unit.
• The second phase involves improvements to the rest of the site which will start in autumn 2020 and be completed by late 2021.
• Images displayed from the slides showed the new pedestrian entranceway from St Ann’s Road. One of the objectives of the new layout is to make the hospital clearer and easier for people to find their way around.
• Images were displayed of the interior of the building including a typical patient’s bedroom which has en-suite facilities.
• The Trust is currently facing very significant demand pressures. There are currently 28 patients across Barnet, Enfield & Haringey who are in beds outside of these boroughs, though the average is typically about 20. The national target is to eliminate all out of area placements by 2021.
• Additional investment in Crisis Teams and Community Mental Health Teams to support people in their own homes is welcome but would not be enough on its own. The Trust is creating additional 10 beds at Edgware Hospital, which will replace 5 beds currently being used in East London, resulting in a net increase of 5 beds.
• The Trust believes that there is a need for an additional mental health ward in the area, with around 18 beds, in order to meet increasing demand.
• Figures for the Trust’s current acute adult bed provision was given as follows:

o   Barnet – 41

o   Enfield – 51

o   Haringey – 50

o   Recovery House beds (one per Borough) – 30

o   Male psychiatric intensive care beds (across the whole Trust) - 14

• The solution to these challenges include partnership working across the whole system with primary care, acute hospitals and social care.

In response to questions from the Panel, Andrew Wright and David Kovar said:

• The Trust considers that the overall additional demand can be met through a combination of the net increase of 5 beds through the changes at Edgware Hospital, a new ward with 18 beds additional and further work to upstream interventions to reduce the need for beds. Dealing with delayed transfers of care could also help with this. These are cases where the patient is clinically well but where another factor, such as housing issues, prevents them from being discharged. These changes taken together would put the overall occupancy rate of the organisation as a whole at around 95%. The next stage of long-term planning would be to aim to reduce that to around 85%.
• The most important aspect of the design is having a modern environment designed specifically for mental health services users. This includes having single en-suite bedrooms, more open common space to enable socialising and a therapeutic environment, IT facilities. The building also meets the latest environmental standards. There is also a comprehensive programme of work planned to improve the model of care within the building.
• The reason that there are male psychiatric intensive care beds within the Trust are and not female ones is due to lack of demand. Camden and Islington NHS Foundation Trust has a female psychiatric ward on the St Pancras site which provides these services for the whole of the North Central London area. This would not be classified as an out of area placement.
• The mental health compact is an agreement between health and care providers in London to get organisations, including the police, to work together more effectively to support patients. The rationale is to try to prevent patients being held for too long in inappropriate locations such as in A&E or occasionally in a police cell and to ensure that they are admitted to a mental health ward as soon as possible where appropriate. However, this can further increase the pressure on mental health beds so the Trust has been actively increasing the staffing complement in the North Middlesex Hospital and improving the way that the mental health team works together with the A&E staff. However, the compact has not increased the number of patients, it just aims to get patients to the right place more quickly.
• On the funding that would be required for a new 18-bed ward, the NCL mental health board is preparing a business case for this. The capital cost is easier as it is a one-off cost but the ongoing revenue cost would be around £2.5m per year.
• A briefing would shortly be provided for the Joint Health Overview & Scrutiny Committee in response to the issues that had previously been raised there and the NCL response to the Long Term Plan will include a chapter which sets out much of this information in more detail.