"North Staffs Users Group response to The Future Now Consultation"

This is North Staffs Users Group response to North Staffordshire Combined Healthcare Trust Model of Care Consultation The Future Now Phase 1.

We broadly agree with the closure of Bucknall Hospital and the reasons for the closure.

However we have real concerns on the impact moving the services that are currently provided at Bucknall will have on Adult Mental Health services delivered elsewhere within Combined Healthcare Trust.

We agree with the proposal to move Rehabilitation services from Ward 6 at Harplands to a community setting. This service should not be within an Acute Hospital and it has not, and cannot, function properly as a Rehabilitation service if it remains at Harplands. However we disagree with the proposal to move the service to the 8 bedded unit at Sutherland Resource Centre in Dresden. The people who access services at the Sutherland Centre are very angry about the possibility of losing the beds. There are not many services within the Longton area that people can access who need support with their mental health. The Sutherland centre bedded unit has now been closed since the beginning of this year because it does not meet the single sex accommodation requirements, reducing the number of resource centre beds available from 32 down to 24. This has meant that the people who would normally access these beds have had to go to the other Resource centres at Shelton, Bradwell or Leek so creating a greater demand for the few beds left, or have had to be admitted on a ward at Harplands.

It has been said that the closure of the unit has not had a big impact on services for people in the Longton area because they have managed to access services elsewhere but in reality for some service users this has been extremely difficult. It has been a big issue for the relatives who have to use public transport to visit people at the other centres as this means catching at least 2 buses and in some instances 3 buses to get there and for some relatives it has not been possible for them to visit at all. This has had an impact on the recovery of some services users and in some instances they have had to stay in a bed longer than if they had been able to access a bed at the Sutherland Centre. The other knock on effect the closure of the bedded unit has had for people who use the centre has been the loss of some of the day services in the resource centre itself, this is because the staff in the bedded unit used to support some of the groups that used to be provided during the day. Other groups like the Carers group that used to use the centre in the evenings have had to find other venues.

The recent report into alternatives to admission (Lloyd-Evans et al 2009) clearly evidenced higher service user satisfaction levels. Whilst we accept that the impact in terms of clinical outcome was less clear, service use one year after discharge was shown not to differ between traditional inpatient wards and alternatives, suggesting the long-term financial impact of alternative provision might be cost reducing. It is well documented that being a psychiatric in-patient is an unpleasant experience for many (Rose 2001; Quirk and Lelliot, 2001; Muijen; 1999; Department of Health, 2002): the study concluded by indicating that alternatives such as those provided by Resource Centres can provide separate services for acutely admitted patients who are not overly disturbed or aggressive may improve the experience of admission therefore encourage prompt help seeking and improve patient’s pathways to care. In our experience and what our members tell us, this is certainly their experience of the beds at the Resource Centres and is consequently why they are so passionate about their preservation.

We are concerned about the Parent and Baby unit which at present is at Bucknall hospital, although the service is not proposed to change only the venue, it seems that no firm decision has yet been made by the Trust as to where this service will be moving to, causing some concern and distress for the people who are using this service. The location of the service and its accessibility are of primary concern to the parents who need to access the service.

In regards to the loss of 20 beds for functional mental illness of older people we are concerned that the community service will not be ready when these beds are lost and that there seems to be no clear definition of what will be provided beyond more accurate assessment. Whilst more accurate assessment is to be encouraged there still needs to be adequate services to then support people who are diagnosed with functional mental illnesses and these need to be age appropriate. We are also very concerned about the proposal to reduce these beds in what is known to be an under resourced area and with an ageing population is a growth area; Age Concern produced a report in 2007 which showed that eight out of ten older people with depression do not get any treatment and as early as 2002 WHO identified that later life depression is a commonly under diagnosed condition that is seldom adequately treated and vastly diminishes quality of life.

We have only recently heard about the Newcastle Pilot project that this proposal has been based on. We don’t feel that there is enough information available for us to determine what it does and whether this has been successful in keeping people out of hospital whilst at the same time offering an alternative, high quality community service; notably in the evidence provided there has been no evaluation of service user satisfaction of the service or indeed the qualitative outcomes of the pilot. At a time when evidence is being brought into question nationally about the claimed bed reductions in Trusts where there are Crisis and Home Treatment Teams we feel this strategy is very high risk and has the potential to leave very vulnerable older people and their carer’s at risk in the community and not able to access appropriate help and support. We believe that beds currently assigned to older people with functional mental illness are already being used for people with Dementia or Alzheimer’s on a regular basis and we are concerned that people who have a functional illness and may need an impatient bed will not be able to access a bed. The result of this is that we could potentially have elderly vulnerable people admitted to the acute wards at Harplands or worse still falling through the net and being left at home with no support, particularly if they live alone and have no family.

We feel that costs savings can be made by improving transitions through services and more timely discharge to step down services from acute and further integration of health and social care.