Salford Older Adults Consultation Doc

Community, Health and Social Care Scrutiny

20 April 2006

Agenda item: 4

BOLTON SALFORD& TRAFFORD MENTAL HEALTH NHS TRUST

Salford Mental Health and Social Care Directorate – Older Peoples Services

Consultation on Proposals for the Re-configuration of In-patient beds

Introduction

This paper outlines proposals for change within Older People’s Mental Health In-patient Services in Salford, taking consideration of the following: -

·  Outcome of the recent whole systems review

·  Key targets for Older People’s Services including NSF and Health and Community Care legislation

·  Creating more appropriate environments that will enhance and improve the quality of stay for patients in line with Safety, Privacy and Dignity requirements

·  Analysis of occupancy and activity levels

·  Current financial and contract position within Older People Service

The whole systems review recommended a wide range of service changes and improvements that span health and social care in-patient, residential and community based day services and multi-agency team working. The proposals in this consultation paper are concerned with the in-patient services and can be considered as the first stage of modernisation and improvement. These changes are of prime concern to the organisation and delivery of Bolton, Salford and Trafford Mental Health NHS Trust in-patient services. The proposed changes will create a more efficient and effective use of the beds without impacting on the community services. Further stages of modernisation in keeping with the whole systems review and the need to develop community based services are being planned in conjunction with Salford Social Services and these will be subject to a second stage of consultation later in 2006.

Context

Over the last year attention has been given to a whole system review of services for older people through the commissioning of an independent report known as the “Lake and Lacey Review”. It is now timely to consider the service configuration and delivery of clinical services to this client group in light of the review and recommendations. The proposals in this paper build on the review outcomes and offers a plan that ensures the modernisation and development of in-patient services in line with a vision that sees the emergence of centres of excellence, addresses medical employment requirements, enables a focus of expertise, ensures fit for purpose accommodation and better meets the needs of service users and commissioners.

The plans for redesign are aimed at improving the effectiveness and standards of mental health services for Older People in Salford through the delivery of a number of key targets and the continued implementation of the recommendations from the Lake and Lacey review. This work would provide the opportunity to realise a number of benefits including:

·  Providing an opportunity to further develop specialist expertise within identified centres of excellence to manage the complex needs of patient groups, within a multi-professional, integrated framework

·  Facilitating opportunities to modernise service models and approaches to care through improved privacy and dignity standards, and providing better support for staff by reducing isolation

·  Providing the framework through which the service takes responsibility for continuously improving governance arrangements

·  Providing more appropriate and ‘fit for purpose’ accommodation to meet the needs of patient groups

·  Maintaining contract activity levels within the service thereby reducing the risk of loss of income

Through these service changes the Trust intends to develop centres of excellence for the provision of in-patient services to older adults. The Woodlands site will focus on people with organic illnesses whilst the Meadowbrook site will provide for people with functional illnesses. The Trust will invest capital into these sites to improve the current accommodation and ensure that privacy and dignity, space utilisation and high quality clinical environment requirements are in place to improve the patient experience during their stay as an in-patient.

The focus on centres of excellence for organic and functional illnesses will be further enhanced by the appointment of Professor of Nursing for Older Adults in conjunction with Manchester University. This post will work towards improving practice-based research, supporting memory clinics and innovation in service delivery. A specific focus of the post will be to support and develop services for pre-senile dementia.

Current Provision

The re-configuration proposals within this document need to be considered within a clear context of current provision. Up until the end of July 2005 the beds in the service were provided from a total of five separate areas of accommodation giving 108 beds. In addition the Directorate is responsible for providing support services and accommodation for a further 10 beds in the supported network. This is shown in Table 1 below.

TABLE 1 (Bed configuration as at July 2005)

Ward / Area / No of Beds / Gender / Function
Claremont Ward at Meadowbrook / 20 / Male / Female / Acute organic assessment
Ellesmere Ward at Meadowbrook / 20 / Male / Female / Acute functional assessment
Cavendish House / 22 / Male / Female / Medium to long term rehabilitation for severe and enduring functional mental illness
Armitage Ward at Woodlands / 28 / Male / Female / Continuing organic assessment/respite
Kenyon Ward at Woodlands / 18 / Male / Female / Acute assessment and medium term management for men who present with impulsive, volatile, unpredictable behaviour, secondary to dementia.
In-patient beds / 108
Queen Alexander Close / 7 / Male / Female / Supported tenancies
Stanhope Road / 3 / Male / Female / Supported tenancies
Total beds / 118

The 10 beds in the supported network are occupied on a supported long-term tenancy basis and are 100% occupied with very little movement on to other forms of accommodation from the tenants. For the purpose of analysing activity these beds have therefore been omitted from the performance data. Table 2 below shows data from the 12 months up to July 2005 (i.e. from August 2004 to July 2005).

TABLE 2 (Aug 2004 – July 2005 bed usage)

Ward / Area / No of Beds / Average Occupancy / Average No of Beds used / Ave Monthly Occupied Bed Nights
Claremont Ward at Meadowbrook / 20 / 73% / 14 / 444
Ellesmere Ward at Meadowbrook / 20 / 93% / 18 / 565
Cavendish House / 22 / 72% / 16 / 481
Armitage Ward at Woodlands / 28 / 61% / 17 / 520
Kenyon Ward at Woodlands / 18 / 73% / 13 / 402
In-patient beds / 108 / 73% / 78 / 2412

In August 2005 the Trust took an urgent decision to relocate the service provided in Claremont Ward on a temporary basis to Armitage Ward. This move was prompted by particular difficulties in maintaining staffing levels in the short term and associated risks with maintaining high levels of quality in service provision. Therefore since August 2005 the configuration of inpatient beds has been as shown in Table 3 with a total of 88 available beds along with the 10 beds in the network.

TABLE 3 (Current bed configuration as from August 2005)

Ward / Area / No of Beds / Gender / Function
Ellesmere Ward at Meadowbrook / 20 / Male / Female / Acute functional assessment
Cavendish House / 22 / Male / Female / Medium to long term rehabilitation for severe and enduring functional mental illness
Armitage Ward at Woodlands / 28 / Male / Female / Acute and Continuing organic assessment/respite
Kenyon Ward at Woodlands / 18 / Male / Female / Acute assessment and medium term management for men who present with impulsive, volatile, unpredictable behaviour, secondary to dementia.
In-patient beds / 88
Queen Alexander Close / 7 / Male / Female / Supported tenancies
Stanhope Road / 3 / Male / Female / Supported tenancies
Total beds / 98

In the first 6 months of operation of the temporary arrangements the performance data (Table 4 below) shows that the directorate has continued on average to use the same number of in-patient beds across the service and that the total occupied bed nights remains comparable with the previous twelve months. The average occupancy has shown a 16-percentage point increase that is in keeping with 20 fewer beds available for use whilst retaining the level of contract activity.

These figures indicate a more efficient use of the in-patient beds without compromising on bed availability and over the time period demonstrating that there is still capacity to manage fluctuations in admissions on a daily basis.

Ward / Area / No of Beds / Average Occupancy / Average No of Beds used / Ave Monthly Occupied Bed Nights
Ellesmere Ward at Meadowbrook / 20 / 98% / 19 / 598
Cavendish House / 22 / 80% / 18 / 545
Armitage Ward at Woodlands / 28 / 83% / 23 / 709
Kenyon Ward at Woodlands / 18 / 90% / 16 / 497
In-patient beds / 88 / 89% / 76 / 2349

TABLE 4 (Aug 2005 – Dec 2005 bed usage)

Consultation Proposals

Older Peoples services will provide high quality, evidence based mental health services for adults over the age of 65 with functional mental illness and to adults suffering from organic illness. This will be delivered through a range of multi-disciplinary services depending upon severity of mental health need and complexity of other co - existing pathologies.

The purpose of all inpatient services is to provide care and treatment to individuals who present with a severe mental health need as a predominant feature and where, to leave the individual in their current environment would present as a high level of unacceptable risk.

An outline of the proposed future service provision is detailed below: -

Ellesmere Ward – Meadowbrook site

The location of this service provision will remain on the Meadowbrook site and its function will continue as a 20-bedded acute assessment unit for males and females with functional illnesses. The location of the beds will move to Claremont ward.

Core Business

It is envisaged that the core business of this area will be men and women, predominantly over the age of 65 with acute functional illness. This could be a first onset or a relapse of a previously diagnosed condition. Functional illnesses assessed within this area will include depression, anxiety, bipolar disorder and psychosis. These individuals are acutely unwell and require multi-professional assessment, treatment and active risk management.

Older people often present with multiple pathologies, however where the physical health care needs is the predominant feature and there is medical instability admission will not be considered until the physical condition has stabilised.

Model of Care

The multidisciplinary approach to care will continue to be developed and enhanced promoting the Recovery Model including Psychosocial Interventions and Cognitive Behavioural Techniques and will follow the NICE guidelines for these known conditions.

A multi professional team consisting of medics, nurses, occupational therapists and psychology will deliver this model of care. New roles to be developed to incorporate STR Workers and areas of skill, expertise and leadership will be developed in PSI & CBT.

Transfer of Claremont to Armitage – Woodlands site

In August 2005 Claremont Ward transferred to Armitage Ward on a temporary basis. It is proposed that the amalgamation of the two services becomes a permanent arrangement. Armitage will therefore continue to function as an acute organic assessment ward.

Rationale:

·  Patient group is broadly similar in diagnoses and support requirements.

·  Consistent under-performance on contract activity in both Claremont Ward and Armitage Ward

·  Claremont is an inappropriate environment for Older People with organic mental health needs

·  Provides an opportunity to review and develop expert medical input to the Woodlands site

·  Provides an opportunity to review skill mix and develop specialist expertise to manage the complex needs of this patient group on one site

Core Business

The core business of this area will be men and women over the age of 65 who are acutely organically unwell. Additionally the ward will also accept people under the age of 65 with an early onset dementia whose condition is presenting as acute. Respite care is also available for individuals whose needs cannot be met by other services.

The presentation of individuals requiring admission will be of such a degree of severity that the individuals’ care cannot be provided by any other provision and to leave them in their current environment would present as a high level of risk. Examples of this may include disorientation, agitation and restlessness, being unreceptive to reassurance and or distraction, high levels of distress and deterioration in activities of daily living.

Older people often present with multiple pathologies, however where the physical health care needs is the predominant feature and there is medical instability admission will not be considered until the physical condition has stabilized. However, palliative care may be provided for those individuals where this is deemed to be the most appropriate environment and their care needs can be met by the multi professional team.

Model of Care

The model of care will continue to develop to one of promoting and delivering excellence in dementia care and assessment whilst promoting a person centered approach.

A multi professional team consisting of medics, nurses, occupational therapy, physio and psychology will work closely with the individual and their carers to undertake an in-depth person centered assessment and develop appropriate evidence based plans of care as a result of this. The focus of the assessment will be one of promotion of stability and enablement thereby maximizing an individual’s independence and remaining skills.