1. What is 'Transforming Mental Health Services' about?
Transforming Mental Health Services’ is a public consultation led by the local NHS which aims to improve adult and older peoples’ mental health services across Hambleton and Richmondshire.
Local health commissioners, NHS Hambleton Richmondshire and Whitby Clinical Commissioning Group (the CCG) is working in partnership with the local provider of mental health services, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) to transform these services.
We’re building on learning from previous clinical and public engagement under ‘DISCOVER!’ and the ‘Fit 4 the Future, Transforming Our Communities’ consultation, where a majority of people said they wanted services at home or as close to home as possible.
It’s our ambition to support people to live fulfilling and meaningful lives in their own communities, no matter what their symptoms or diagnosis of mental illness is (known as a recovery-focussed approach).
We aim to do this by:
- Providing more recovery-focussed services in the community, closer to patients’ homes.
- Making sure patients and their carers get the treatment and support they need, when they need it (any time, day or night).
- Supporting access to specialist assessments and treatments, such as inpatient care, when required.
- Providing evidence-based treatment in the most appropriate care setting.
- Ensuring mental health services continue to work closely with GPs to provide local services for local people.
- Delivering inpatient and community services in high quality, fit-for-purpose buildings.
2. Why do the current services need to change?
There were two main drivers which forced us, in collaboration with Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), who are our providers of mental health services, to reassess how we support people with mental health problems:
1. The inpatient wards at The Friarage Hospital in Northallerton) are no longer fit for purpose. They are on the first floor, with mixed sex accommodation and privacy issues. The Care Quality Commission (CQC) has expressed concerns about the in-patient accommodation during their last two inspection visits.
2. Support for patients in the community needs improving. More patients are admitted to hospital than the national average and for other areas where TEWV is the mental health provider. These patients also tend to stay longer in hospital than in other TEWV hospitals.
3. Why is Whitby not included?
As the population of Whitby and the surrounding area is served mainly by the Teesside and Scarborough mental health teams, this area is not included in this consultation. However, developments that arise from this system transformation will be considered for the whole CCG population.
4. Why is children’s mental health not included?
There are separate transformation plans for children linked to the publication of the Future in Mind guidance which are already underway.
5. Who have you engaged with so far?
We have engaged with service users, clinicians, carers, staff, partner organisations, the voluntary sector and the wider local community. We’ve also included engagement activities that took place during 2016 such as “Fit 4 the Future, Transforming Our Communities” and an event held at Richmondshire Cricket Club attended by over 100 delegates.
Pre-consultation engagement officially began in January 2017. This resulted in 537 comments captured from a number of events attended by 481 people. In addition, 258 comments were collected via email or completed forms.
In May 2017, two larger events were held: one in Northallerton and another in Richmond. These were attended by 64 local service users, clinicians, voluntary sector organisations and residents.
6. How did you come to these options?
We used the feedback gathered during the engagement with service users, clinicians, carers, staff, partner organisations, the voluntary sector and the wider local community. The options were also informed by clinical evidence and best practice.
7. How will you show that you’ve listened to service users and the general public in deciding on the options?
As part of the NHS England assurance process we have to be able to evidence that we have engaged and involved service users and carers. Throughout the pre-consultation engagement, we spoke with service user groups, sent out packs of information and held events. We collated all this information and the programme leads analysed this as part of the options development. We are taking the same approach during the formal consultation and will ensure any decisions made will be informed by what we have heard from service users, carers, clinicians and the wider public.
8. Are you going to close the mental health wards at the Friarage Hospital?
No decision about the future of the mental health wards at The Friarage Hospital will be made until after the consultation. We believe that a formal decision on the consultation will be made in autumn 2017 informed by results of the public consultation.
Two of the options focus on strengthening community mental health services so that more people can be supported at home rather than having to go into hospital. Both these options propose that specialist inpatient care is provided in one of the Trust’s purpose designed mental health hospitals in Middlesbrough, Darlington or Bishop Auckland. Specialist dementia care services are already provided in Bishop Auckland.
As we are given no extra money, both of these options would result in the removal of the beds in the two mental health wards on site at the Friarage Hospital enabling the funding to be used in the community closer to a majority of patients across Hambleton and Richmondshire. However, the facilities will be handed back to South Tees Hospitals NHS Foundation Trust to utilise.
We are also putting forward a ‘do nothing’ option which would mean inpatient services would remain at The Friarage Hospital in Northallerton with all the current challenges and no additional investment in community services.
The views of local people are extremely important in helping us decide which option to implement.
9. Why can’t you just improve the facilities at the Friarage Hospital?
There is limited scope or funds to redesign the unit.
All commissioners get their money via a national funding formula. Our assessed need for mental health services is 8% of our total budget. We feel that mental health is important and so spend 10% of our budget on mental health services. These are financially challenging times for the whole NHS. We have no more money and so we need to spend what we have as efficiently as possible.
In addition to financial constraints there are space considerations at The Friarage Hospital. The Royal College of Psychiatrists guidelines state that working age adults and older people should have separate in-patient facilities to meet their very different and specific mental health needs. Older people with organic mental health issues (due to medical or physical causes, such as dementia) have different care needs from patients with functional mental health problems such as depression, anxiety and psychosis.
The changes required to make the mental health unit fit for purpose are not just minor works. There is an expectation that patients are cared for in a single sex environment – we don’t have the space to do this, although we have made provision to accommodate same sex areas. We also need to provide inpatient care for older people who have dementia separately from those patients who have a functional illness (e.g. psychosis, schizophrenia). Single room provision would also need to be provided to achieve TEWV standards as opposed to the current dormitory style accommodation currently.
In addition to the mixed sex accommodation, people are cared for on the first floor, which limits access to outside space and creates a risk to patients who have suicidal thoughts.
There are a number of ligature risk to patients as well as opportunities for patients to abscond which has happened in the past. Access to patient bedrooms with an en-suite is the expected standard for patients and the adult unit still offers dormitory sleeping arrangements. Whilst privacy screens are in place, issues still arise for patients.
In order to address patient safety environmental safety concerns we would require a dedicated purpose built unit that requires significant financial investment. Neither the Trust nor the CCG have enough funding currently to do this and it would also limit the resources available to invest in the community.
10. They’re building a new hospital in York – why can’t you do this in our area?
York has greater numbers of patients which could sustain the need for a full purpose built mental health hospital. We simply don’t have the same level of demand in Hambleton and Richmondshire to warrant a full new build mental health hospital and it wouldn’t be safe to re-provide a smaller inpatient unit that accommodates working age adults and older people in the same unit.
11. Have you thought about increased travel time for patients, carers and families if you do remove the wards at The Friarage Hospital?
We are very aware of the challenges in relation to travel due to our rurality. If options 2 or 3 are taken forward, it is likely that patients in Northallerton and the immediately surrounding areas will need to travel further if in-hospital care is required. We believe this will be offset by more specialist care in hospital and reduced in patient stays. All follow-up care will be in the community and increased community services will hopefully mean less people needing to be admitted to hospital in the first place.
We recognise that some patients and their families may need to travel further to receive a level of inpatient care that meets their specific needs and is delivered in a fit for purpose building. We will work in partnership with patients and their families to minimise the impact of additional travel times. We want to deliver community services that reduce the need for inpatient admission. When admission is required, we aim to ensure that hospital stays are as short as possible and people are discharged to their homes or as close to their homes as possible with the support of local services.
12. Is this not another way to remove services from The Friarage Hospital?
This is not a way to remove services from The Friargae Hospital. Other physical services will go into wards 14 and 15 should options 2 or 3 be taken forward. In addition, there will also be a new build community mental health hub on the site (part of a separate TEWV project).
We want to support people to live fulfilling and meaningful lives in their own communities, irrespective of their symptoms or diagnosis of mental illness. We have engaged with people to develop these options and we are now asking people to let us know what they think of these options. Our priority is to deliver services to people when they need them, in the best way possible, in their own homes wherever possible and reduce the need for inpatient admission.
13. Is this all about money?
This is not all about money as there will be no change to funding. We will continue to meet the national mental health investment standard. We also need to make sure that we are making best use of tax payers’ money. It’s to be celebrated that patients are living longer, but this does increase the financial pressures on the NHS. We need to use our money as efficiently as possible. If our proposals are approved, savings will be reinvested in community mental health services. This will mean an enhanced specialist community mental health service, providing access to adult and older person community mental health teams and crisis response for over 16 year olds up to seven days a week.
14. Is this part of the Better Health Programme or the Sustainability and Transformation Plan?
No – this is a joint transformation programme between the CCG and TEWV. We are mindful of the larger context in which we operate and are keeping our STP and BHP colleagues briefed regarding our work. As part of the statutory assurance process we have also sought and gained support for our strategic direction of travel from the STP, clinical senate and NHS England.
15. How can you ensure there are enough staff in the community if the wards are not there?
We will use the money released to invest in the community if options 2 and 3 are taken forward. It is important that any money released supports and increases our workforce in the community. It would also be important that staff who currently work in our inpatient units would be offered the choice to be part of the community services in the future and this would be considered wherever possible.
16. How can you support the voluntary sector as their funding has been cut?
Should the public ask us to enhance community services we are fully committed to the voluntary sector having a significant part to play in this model and will commission a system which utilises the best of all services in the market in order to create mental health services which are fit for the future.
17. Will reduced social care funding and problems with nursing homes in the area affect this?
We are working in partnership with our local authority colleagues across the housing, care home, benefits and third sector specialists to ensure that we have captured the impacts of the proposed transformation on the wider health and care economy and the impacts of changes in other parts of the system.
18. How would you provide step-up/down-type care for mental health patients?
The design of the community model will be determined by what the public tell us they want us to do to transform mental health services. We are exploring how we can work with our local authority and third sector partners to match step-up care in community housing.
Should this include a step-up/step-down model (which now exists across Hambleton and Richmondshire for physical health needs) this would enable service users to be in a safe supported space whilst they are in crisis but who do not need to be in hospital so they can make a safe supported transition back to living in their own community as soon as possible.
19. Are you going to get more money to spend on mental health services in our area?
No, we will get no more than the existing finances available for this element of mental health will remain at £15 million but will be ring-fenced.
20. How will strengthening community services reduce hospital admissions?
The ability to support patients in the community with more community resources, both from a routine and crisis perspective has been shown through Trust benchmarking exercises. Admission rates can be reduced and that their length of stay can also be shortened by improved community provision. While adults services already offers a degree of home based treatment and intensive home support for people in crisis – this service will be enhanced to allow support to be offered for the older aged population and those with presentations such as dementia.
21. Can you assure the public that if someone needs a bed they will get one in one of these hospitals?
TEWV actively manage all of their ‘Assessment and Treatment beds’ to ensure that all patients who need to be admitted go to the nearest available TEWV hospital. Historically TEWV have always been able to admit patients to one of their hospitals (unless there was a clinical need to do otherwise). They would always try to admit people to their preferred hospital although this may not always be possible (due to increased demand).
Should options 1 or 2 be taken forward, TEWV have assured the CCG that all patients who need an inpatient bed will be admitted in order to meet their care needs.
22. How will you make sure that people in Hambleton and Richmondshire have equal access to beds and that people from the locality (e.g. Teesside or Durham and Darlington) won’t be given priority?
Patients who need admission will follow existing admission processes, involving the crisis “gatekeeping process” and appropriate mental health professionals. TEWV has provided assurance that there is adequate bed capacity, so patients can be admitted to the inpatient environment that meets their clinical need. TEWV will work closely with our neighbouring units to ensure that there are no delays to admission.
23. How did you work out how many beds you’re likely to need once enhanced community services are in place?
The number of beds required has been estimated based on the potential for reducing the number of hospital admissions and the average length of stay (days in hospital) to the average across all of TEWV. It is expected that the enhanced community service will enable those reductions to be made across Hambleton and Richmondshire as we have seen in other parts of TEWV.
24. What does seven day community service mean (what hours will they work)?
From discussion with patients and our general practitioner clinicians; in adults services we aim to extend the working week by offering routine care on an evening and on a Saturday. Those people who need a crisis response and intensive home treatment will have access to care seven days a week.
Older Peoples’ services will provide a seven day service and introduce an intensive approach to working with people at risk of inpatient admission, and those recently discharged from hospital, to support people to remain at home or as close to home as possible, for as long as possible. The ambition we have is to extend our hours of working to 12 hrs per day seven days per week providing core services currently provided by the Community Mental Health Teams (CMHT) and extended intensive services. This will enable us to work with more people at the times they need it most and times that fit with their life circumstances.
25. Why can’t people with dementia be admitted to Roseberry Park or West Park Hospital?
Auckland Park Hospital, Bishop Auckland has specialist dementia care wards that are designed to meet the needs of the very severest dementia patients and they have the capacity to support patients from the Hambleton and Richmondshire area. This will provide access to the highest quality inpatient services for this patient group and some of our patients are already admitted there.
26. How can I have a say?
There are a number of ways to get involved in this consultation:
The consultation ends at 5pm on 15 September 2017.
27. If I’m not happy about these options – how can I complain?
If you have any concerns or queries around the current services please contact the CCG’s Patient Relations team via firstname.lastname@example.org
or HRW CCG Patient Relations, Civic Centre, Stone Cross, Northallerton DL6 2UU
28. When will a decision be made?
The outcomes report will be discussed with the CCG Council of Members (which is made up of representatives from each of the member GP Practices). Final proposals will be shared with North Yorkshire County Council Scrutiny of Health Committee for approval. The final decision will be made by the CCG Governing Body due in autumn 2017.
29. If changes are to take place, when we will we see the effect?
Once a decision is made following the consultation process, any change process has to ensure we continue to meet the needs of patients and that staff are available to deliver the care required. Whilst there is an ambition to commence changes from June 2018, we will have a phased approach that supports patients in their current inpatient wards and while new patients will be managed will be considered in a way that best meets their needs.
30. How can increased travel for some dementia patients needing a bed be in their best interest?
Our aim is to reduce the number of people who need to spend time in hospital. However, we recognise that some patients and their families would need to travel further and we will do everything we can to support them to stay in touch and visit their loved ones.
It’s important that whenever possible people are able to remain in familiar surroundings which are less disorientating. We want to develop our community services so that most people with dementia can be supported in their own home, nursing or residential home. For those who need to be admitted to hospital we want to provide the best possible inpatient environment. Auckland Park Hospital in Bishop Auckland has specialist dementia care wards that are designed to meet the needs of the very severest dementia patients and they have the capacity to support patients from the Hambleton and Richmondshire area.