Self Assessment Report attached
The Trust were represented by Neil Carr Chief Executive, Dr Neil Brimblecombe Director of Nursing/Chief Operating Officer, Jayne Deaville Director of Finance and Performance, Therèsa Moyes Director of Quality and Clinical Performance, Steve Grange Director of Commercial Development, Lesley Crawford Director of Mental Health Dr Abid Khan Clinical Director, Adults of Working Age, Lisa Agell Head of Mental Health Nursing Services, Patricia Wain Deputy Director of Nursing, Dr Andrea Voice Clinical Lead,Paediatrics,Carolyn Gavin Clinical Lead ,CAMHS and Dr Caron Thomas Clinical Director, Learning Disability Services.
Neil Carr made immediate reference to the recent closure of the Margaret Stanhope Hospital. He acknowledged that this was an issue of significant interest to the stakeholders Local Authorities and the community affected by the closure.
He said that he felt that this was of particular significance as it was accepted that one in four of an aging population will now suffer from dementia or other mental health issues together with drug and alcohol misuse. For this reason it was imperative that where services were delivered they were at their most effective. Therefore it was essential that the best model for delivery be identified and implemented.
He stated that the situation was not helped as the financial expenditure on mental health in Staffordshire was in the bottom 20% of the monies available. This particular shortfall made it essential that the delivery model reflected care in the community. It should be recognised and accepted that delivery of in patient services was not necessarily the best form of treatment.
Neil Brimblecombe, commented that decision to close the Margaret Stanhope Hospital three weeks ahead of plan was made after consultation with the Primary Care Trust and the Commissioning Board made the final decision subject to certain criteria being met.
He explained that there had been a pilot scheme in respect of reduction in beds. The Commissioners had requested a similar process in advance of any decision. As there were only two patients left in the hospital the decision was made by the Commissioning Group to close three weeks ahead of time, as the unit was taking no new patients, as agreed with commissioners.
Questions from Health Scrutiny Members
The Chairman then asked the members present if they had any questions in relation to the closure of Margaret Stanhope Hospital.
A member commented that there had been a speedy completion of the closure process. There was a serious lack of information prior to the closure, but plenty afterwards which was a little bit pointless. Asked how the carers were responding to the patients discharged from the hospital and how are the patients responding to being discharged.
Lisa Agell replied saying that there was care and support available with the ability to initiate interventions when needed. Overall the process was closely monitored.
Neil Carr responded offering apologies for the lack of information and that the concerns of the member would be borne in mind for the future. He gave an assurance that carers had not been inconvenienced unnecessarily, and that excessive distances of travel had not been an issue. He added that there were budgets available for carers and patients to draw on if travelling expenses were a problem.
A member commented that the closure of the Margaret Stanhope Hospital had been reported through the Burton Mail due to the lack of information from the Trust. The lack of information prevented a meaningful interaction with the public of Burton and the Scrutiny Committee.
Neil Brimblecombe asked which committee the member was referring to, the member advised East Staffordshire Scrutiny Committee . Neil Brimblecombe offered his apologies for any lack of information but explained that he had been informed that the Trust was to report to the County Health and Scrutiny Committee and they would liaise with local committees.
However, the Trust did see it as their responsibility to form relationships with these other local committees and would be taking steps to do so immediately. This would prevent a repetition of the Margaret Stanhope situation. The Trust would need to be advised as to how to maintain regular contact with local health service communities
The member commented that he had accepted the apologies from the Trust. He said that committees did not want to sit back, they needed to be involved if they were to function properly there was a need to know basis. Information must be shared if relationships were to improve and flourish. Where he asked if there were there any assurances that the Trust that these issues would be considered should similar circumstances arise.
Neil Carr responded saying that they were valid observations, if the democratic processes were to be followed then it was imperative dialogue should take place.
Also in view of the radical change anticipated and the role of local committees in the process then was a need for regular communication. He asked o be advised about future meetings, in particular the frequency and locations.
Neil Carr then gave a presentation outlining the achievements of the Trust in the last 12 months making specific comments about the importance of care in the community.
It was accepted that this was a more effective method ,subject to certain safety measures being put into place. Additionally in the long term given the finite budget available it made financial sense to wherever possible to deliver this method of care.
He commented that it was necessary to have robust crisis resolution in place and particularly for home care and in severe cases prompt assessment, within four hours.
He stated that normally mental health treatment and services sought to be age blind, the service delivered should not be determined by age but able to ensure that patinets received treatment needed in the right environment.
He added that there had recently been ward extensions with additional beds for women in the Psychiatric Intensive Care Uunit. He outlined the out of hours Child Adolescence Mental Health Service advising it had been started to provide out of hours service. There was prompt assessment available during weekends, and that overall children were not disadvantaged by the system.
Neil Carr then outlined the importance of being a good partner outlining the very close work with the CCG’s and other members of the health economy. He considered it of vital importance to support local Commissioners through the economic challenges and to work within and across membership.
Neil Carr commented on the challenges of the last year mentioning the Dementia Pathway, Commissioning Gaps, the need for new strategy for people with learning disability. It was noted that that the Local Authority had reduced budget for early intervention school based services and that substance misuse provision in Staffordshire Prisons had been lost to an independent sector provider. Comment was also made on the Section 75 Agreement with the Local Authority in respect of adult mental health which provides dementia which offered an integrated seamless care system for sufferers.
Neil Carr stated that the Trust had undergone a number of unannounced inspections by Monitor intended to determine whether the Trust was operating ethically legally and deploying effective service delivery.
The inspection found that the Baswich and Bromley wards at Stafford were functioning to an excellent standard. The 2012 CQC assessment out of the 8 generic questions 5 had been improved upon. The Trust was one of the best in the country.
He advised of modifications in working conditions for staff, shifts etc had not affected the quality of care delivered, in some areas it had actually improved. Overall the inspections had very positive outcomes and the Trust was heading in the right direction.
He went on to say that that the crisis team were gatekeeping 95% of the patients admitted the 7 day follow up after discharge teams were performing at 95% of the patients that benefited from specialist intervention.
A member asked if the same services were made available to those persons or personnel who had been in the forces,
and was assured by Neil Carr that it was.
The member complimented Neil Carr on the content of the presentation before making reference to the thematic review for Safeguarding and asked if he could he provide details of incidents, a break down of lessons learnt and practices introduced as a result.
Therèsa Moyes said that incident figures are publicly available through Trust Board reports and that their thematic reviews provide a deeper way of exploring areas for improvement through lessons learned. In addition, all serious incidents are collated into a quarterly report and discussed in detail with commissioners, as well as being made available to the public via Board papers.
A member commented on the increase of dementia resulting from of an aging population, and asked if the Trust looking forward to ensure that they could accommodate the increase.
Additionally she was disappointed that the funding had been taken away from school in respect of early intervention and the prison contract for out reach work had also been lost.
Neil Carr commented that CCGs and the PCT were looking at these issues with a third party to determine a strategy. It was accepted that this may take some time. There was a delivery model with the GP’s and that there was a stronger emphasis on elderly dementia services year on year.
He made reference to local member of parliament Jeremy Lefroy who had advised that he would support the £50m had been put into the Dementia Care budget. It was a challenge to ensure that they got what was perceived to be their share.
In respect of the removal of school fund for early intervention he felt that work with parent schools had become imperative if this shortfall was to be overcome.
A member asked for an explanation and further information in respect of the 7 day visit after discharge. She was disappointed that the period was not extended further.
Neil Carr advised that it was a national target a 7 day indicator and would not preclude further treatment and care following the period if it was identified to be necessary.
A member asked for information about the link between GP’s and the specialist treatment required as he felt there was a gap in the understanding. He asked if there was scope for a specialist in the mental health to be identified and form part of each GP’s surgery.
Neil Carr replied, generally GP’s know and can identify people at risk at an early stage through their normal and positive GP patient relationships.
Lisa Agell advised that there was more work to be done with GP’s by local teams, consultant and medical staff, particularly focussed on increasing knowledge and ensuring local services are responsive. .
Dr Abid Khan added the majority of patients are seen by the community team who work with the GP’s. However there is a definite need to know and signpost to the crisis system to ensure that people do not fall through the net. Clinicians and GP’s are helping with this pathway.
The member asked that in addition to Jeremy Lefroy would the Trust be speaking to other MP’s in relation to the £50m being made available for dementia care.
Neil Carr replied that the original approach had come from Jeremy Lefroy but it would not be unreasonable to brief other MP’s.
A member asked since this investment in CAMHS in the area of adolescence service, how the service was rated and were they still able to deliver a service.
Carolyn Gavin responded saying that there is an average 30% increase in overall demand for the services, which maybe the result of a decline in early support. The local authority have disinvested from the Trust’s early intervention services as they felt that there was not an equitable service across the county and will be retendering the provision to address this.
There was a need to explore options for the 18 to 25 age group a short term fixed more robust system was required, with an overarching need to liaise with other services to deliver the patient care.
The same Councillor asked if they were meeting the needs and, Carolyn Gavin responded saying it was very tight.
Neil Carr said that they were suffering from severe underfunding and that there were issues around the availability of inpatient beds for young people regionally..
He explained that 16 to 17 year olds were often lost to the service as they did not make the step to 18 to 25. To address this he felt that effective partnerships school and parents was of the upmost importance.
A member asked that with the changes were they confident that the information available between the care providers was both accurate and adequate.
Jane Deaville commented saying that they were looking to implement a new system of electronic care plans to link up with primary care in the longer term.
Dr Abid Khan commented that there was a pilot scheme and disregarding the geography it was critical to access investigations electronically from whatever location you found yourself in.
Neil Carr responded saying that it revolved around the general practitioners but it was important that they found a way of locking their system into the GP’s system thereby having a seamless transfer and availability of information.
The Chairman interjected saying that this work was included in the work programme and would be monitored accordingly.
A member commented on the loss to the service of the 16 to 17 year olds not making the move to the 18 to 25 group asking did they return at a later date.
Carolyn Gavin responded saying that at 18 there are a lot of changes in a young person’s life such as starting work, leaving school going to college and attending appointments may not be viewed by the young person as a priority resulting in them being lost to the service at this time. It was important that should they return that a flexible approach should be maintained in order that they could be seen again.
A member asked if there was any relationship with local business in respect of placing people suffering with mental illness in employment.
Neil Carr responded saying that under Care Plus people experiencing mental illness going into employment.
Steve Grange added saying that there was vocational fixed appointments to facilitate employment through the in the Chamber of Commerce across Staffordshire and Shropshire, they were also trying to work with their local businesses and other organisations.
Questions from the public
There were no questions from members of the public.