"Disappointed at closure of St Francis Hospital's Bestwood Ward "

About: Nottinghamshire Healthcare NHS Foundation Trust / Mental Health Services for Older People – Inpatient

(as a relative),

Prior to my fathers admission to Bestwood Ward we had heard that there was a proposed closure to St Francis Hospital (Bestwood and Daybrook Ward) but it was unlikely to effect my dad because it would be later in the year - sometime between October/ December at the earliest. Unfortunately my father has experienced several moves during the past year which has contributed to his mental health deterioration, therefore we wanted his next move to be permanent, carefully chosen with advice from professionals to enable the family, including my father, to make an informed decision. It has been a very emotional journey for my family to accept our dad is unlikely to come home. However we now have the additional stress to find a suitable nursing home as soon as possible prior to the closure proposed in July.

It also seems the staff are not sure of their futures, which has clearly had an impact on moral.

I have witnessed dedicated nurses and carers under pressure with a reduction in staff and unfamiliar bank staff being used. New faces can be confusing to patients and can impact on their behaviour especially when personal care is needed. This is not fair to patients who generally respond well with staff they know and trust.

It is very sad that Bestwood and Daybrook Ward which has helped so many people over the years should close without first consulting staff, patients, families and the community. This service will be hard to match, but the hardest thing of all is telling my dad he is moving again.

Carers and staff have been informed (but not to my knowledge, consulted with) that this well respected and community mental health inpatient service is closing. Originally the date was to be October 2014. Now it has been brought forward to the end of July. It appears senior management and commissioners made the decision in principal prior to full carers/patients and public consultation.

The reason given was to increase community services. But my question as a relative of someone who uses the service is, what do these increases in services look like?

I am told a new service called 'IRIS' will take over but we have no further details.

For example what does 'IRIS' look like? Unfortunately full details were not available as the service service is still developing.

Who then I ask is responsible for finding appropriate community care or nursing homes within 6 weeks for some of the most vulnerable people in our community? Many of these people are unable to express their views and are not represented. Carers and families have been put under pressure and worrying what is going to happen.

In my mind this is not community care. This is nothing more than management led NHS cost cutting.

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Response from Helen Smith, AHP lead, Mental health services for older people, Nottinghamshire Healthcare NHS Trust

Thank you for taking the time to post your concerns regarding your father’s care and the proposed closure of Daybrook and Bestwood wards.

Understandably your father’s care is a large concern to you I would advise you to discuss his discharge plans with a senior member of the ward team or with Sharon Howe, Matron (0115 8542257) to ensure he receives the right care for him both in hospital and after discharge.

You are correct in that the original intention was to look at closure of these wards in October. The rationale for potentially closing Bestwood ward earlier was due to having a large number of vacant beds across the dementia wards. In order to maintain patient safety and continuity of care we were planning to amalgamate the staff and patients on to other wards. However recently there has been an increase in admissions and so Bestwood ward will remain open until we have enhanced community based services.

The intention is to enhance community services by expanding Intensive Recovery Intervention Services (IRIS, which you refer to). The Intensive Recovery Intervention Services are provided by Mental Health Services for Older People for people who live in the county area and are made up of specialist nurses, occupational therapists, physiotherapists and support workers specifically trained to work with people with dementia and older people with other mental health conditions. They provide care for people in their own homes who are at risk of being admitted seven days a week, up to 4 times a day. The service has been very successful in supporting people with dementia and other mental illnesses who need extra support in being cared for at home, maintaining a familiar environment for the person with dementia. Part of the plan for reinvestment is to look at an equivalent service for city residents and an increase in the hours covered by state registered staff in the teams. Also there will be an enhancement of the current Dementia Outreach Services who support people in care homes with dementia.

Commissioners have agreed in principle to the closure of the two wards and informal meetings have been held with patients and carers on Daybrook and Bestwood wards. However formal consultation can only commence once the proposal has been approved by the Overview and Scrutiny Committee in the city an county local authorities.

The rationale for the closure of the two wards is based on the following:

• The independent review of the usage of older people’s beds showed that there were few alternatives to admission to hospital and that once people were admitted it took a long time to discharge them, again due to the lack of alternatives

• The benchmarking data shows that we have a larger number of beds than the national average

• National guidance that recommends increasing support for people in their own home, especially for older people and to provide earlier interventions

• Some cost savings – but community resources need to be invested in as an alternative

• Since the investment in Intensive Recovery Intervention Services there has been less demand on the beds from the areas with these services

• Patients and carers tell us that they would prefer to stay at home rather than come into hospital

• There is a very real need for MHSOP to deliver services to an increasingly ageing population with less monetary resources than we have previously had

Thank you for acknowledging the impact on staff regarding the proposed changes. We are trying to support them during this time of uncertainty and are using our human resource colleagues to assist us. The Directorate has an excellent history of finding new posts either within its own services or on individual requests in other Directorates. It is anticipated that posts will be identified for all staff who require them either from existing vacancies, newly created posts arising from the service change within the community or from other Directorates. We will be offering them a package of training and support to take on these or other roles. MHSOP staff are very experienced in the specialist care of older people and we want to continue using their expertise in the planned new community services.

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Update posted by Lotty (a relative)

Thank you for further details regarding ‘IRIS’. However your information regarding the closure of Bestwood Ward appears out of date. My family has been informed only yesterday that closure is imminent. Clearly it appears the decision has already been made without Service Users and their families/Carers involvement. No words can express my concern for my father’s future and other patients on Bestwood Ward.

Response from Veronica Smith, Operational Manager (Clinical), Mental Health Services for Older People Highbury Hospital, Nottinghamshire Healthcare NHS Foundation Trust

Thank you for your response.

It is still planned for Bestwood ward to close in October.

If the patient numbers continue to reduce, for patient and staff wellbeing,safety and resource issues the ward may need to close earlier than planned.

Please be assured that patients will only be discharged if clinically appropriate.

Please feel free to contact myself or Sharon Howe Matron.

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Update posted by Lotty (a relative)

It seems to me there is a breakdown in communication between senior management, middle management and ward staff. My family is currently being supported by professionals who are assisting patients to find suitable placements. This is creating pressure not only for the families concerned, but anxiety to the remaining patients who are now aware something is happening.

My family is finding it very hard to find a suitable nursing home that has vacancies, therefore we have been informed by hospital staff (not consulted) that my father will be transferred to another hospital possibly as soon as next weekend along with other patients.

Quite frankly we know longer have confidence in what we are being told anymore. Patients are not cattle that can be moved around various fields. They are vulnerable older people who have paid their national health insurance for many years and deserve more respect than they are receiving at the moment. Most of all they want the truth.

I think it is time Senior Management makes a public statement, so everyone is 100% clear what is happening.

Update posted by Lotty (a relative)

It has been 10 days since my response was published and still no reply. The ward is down to 5 five patients when I last visited and understand new admissions have been refused for some time now unless they are emergencies who only stay a few days. It appears to me this local inpatient service is still needed, but patients are now sent to other hospitals outside of their local community, which involves more travelling time and money for relatives and carers. Dementia patients will also have to adapt to a new strange environment.

Considering all the current media coverage relating to Alzheimer’s/Dementia and government promises of improved local community care and services I have not seen any public statement about Bestwood and Daybrook Ward closing and the new proposed services which will fully meet patients needs.

It is still proving very difficult to find a suitable local nursing home with vacancies, which accepts dementia patients and meets all the standards of the Quality Care Commission. In my opinion there is a frightening lack of quality services to replace Bestwood and Daybrook Ward.

Response from Veronica Smith, Operational Manager (Clinical), Mental Health Services for Older People Highbury Hospital, Nottinghamshire Healthcare NHS Foundation Trust

Thank you for your further posting.

I am sorry to hear you are having difficulties finding a suitable nursing home for your father. Please can we arrange to meet with you regarding your own personal situation with your father and his care? I am willing to meet with you, if you would like to give me a ring to make arrangements for this.

In terms of the ward closure proposals, they were discussed at the Local Authority Overview and Scrutiny Committee yesterday. From this six week patient engagement meetings will take place. We will send on the details of this once we receive them. This will be where more formal announcements will be made regarding the proposal and alternative community provision.

We acknowledge that proposed changes can make things very difficult and add a level of uncertainty. We appreciate the time you have taken in posting your comments and look forward to meeting with you to discuss them more fully.

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Update posted by Lotty (a relative)

I apologise for the long delay, but our lives have been shattered and hearts broken. Our voices were heard, however no changes were made. The plans to close the ward early remained unchanged. My father is now in a Nursing Home. All my family received was sympathy and tokenism. Whatever happened to the promised Community Care called ‘IRIS’? It certainly was not rolled out and in place to have an impact on my father’s quality of care. I hope it is in place for the next generation.

It appears to me the introduction of the Community Act 1990 has never been fully developed. In reality the most vulnerable of our elderly population are still institutionalized and the caring front line professionals supporting them are restrained by policy and funding.

There is no future for my dad just a slow decline before our eyes. We are without doubt powerless – there is no closure just grief.

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