Agenda item

This report is intended to give an update on the major improvements within the adult in-patient mental health service since the full CQC inspection of the Trust which took place in November 2016.

The Chair welcomed Sarah Rushton, Operational Director for WLMHT. It was explained that the there was an on-going CQC inspection of the trust and that it would be helpful to report on the outcomes of the reviews at a future meeting. In terms of beds, WLMHT was always running to full capacity.  There was a lack of seclusion facilities in the psychiatric care unit, with one for older people, with 20 beds per ward which therefore exceeded guidance for ward mental health patients. Since an earlier CQC inspection, sustained improvement had been noted and the Trust was currently running at 85% capacity (as noted in paged 55 of the Agenda pack).  The Trust planned improvements included the relocation of a number of wards to the ground floor, and alterations that offered better physical and mental health care facilities.  In terms of suspended beds, there were plans to permanently move to 20 bedded wards, and have suitable facilities to support disabled patients.

Parminder Sahota reported that the Safeguarding Adults Executive Board (SAEB) would shortly be meeting for the first time but during the interim, the LBHF continued to be members of the triborough SAEB. Many changes were planned and the Trust would work with the local authority to ensure communication was fluid.

Councillor Richardson asked about younger patients and isolation. It was explained that the trust provided support across the three boroughs, but the trust did not have individual care plans for each patient that came through the Trust and would not mix people in a way that would cause an issue. However, the trust did not have the facility to accommodate younger people.

Jim Grealy asked how many beds the Trust believed it needed and what was the time delay between referral and getting a bed, and, what was the level of returns following a discharge. Sarah Rushton responded that they were developing a model of the total patient flow. The Trust was also considering an initiative involving community treatment at home, to use less beds, which was about to commence. It was confirmed that readmission rates had been within targets and there was not currently no time gap between referral and admittance. Work around improving patient flow had ensured that beds were now available according to need.  The Trust could also accommodate sectioned patients and Helen Mangan confirmed that patients could be detained under the statutory mental health regulations, which could be done immediately, comparted to previously years.

Councillor Kwon enquired about the recent publicity indicating that the police lacked capacity for out of hours provision. Ms Rushton took the view that there was a professional duty of care towards people with mental health and was disturbed by news the police would be reluctant to assist. Part of the role of the police was to undertake safeguarding work collaboratively with colleagues across social care and health services.  There was increased joined up working and the police were in regular contact with mental health professionals.

Councillor Lloyd-Harris referred to page 53 of the Agenda and the “requires improvement” rating.  Change was required and Councillor Lloyd-Harris asked what could be done.  Citing the example of female genital mutilation (FGM) Councillor Lloyd-Harris also asked what the Borough doing to address the issue and what support schools were given in dealing with the issue. Ms Rushton explained that the Trust had an adult rating and the poor rating related to bed flow, which the CQC would be returning specifically to review. Progress since the initial CQC had been remarkable and the Trust had worked very hard to deliver quality services.

Ms Sahota that with regards to FGM, NHS colleagues were trying to embed knowledge and use smart technology to capture data and it was anticipated that this would be rolled out next month, and included raising awareness of the issue with staff. They were also working with the Violence Against Women and Girls network to progress the issue and influence change. Councillor Richardson encouraged

Councillor Caleb-Landy echoed concerns raised regarding the Trusts ratings. Considering the baseline, he observed that there might be families with patients being housed outside the Borough and this was a concern.  Additionally, he asked about the reasons given for a discharge.

Following the CQC inspection, Ms Rushton explained that the Trust had reviewed patient flow and discharge data, and had worked to develop a whole system approach.   A more detailed response was assured in the next report to the Committee. There was patient flow, but this not as well-developed in LBHF compared to the other boroughs.  Ms Rushton confirmed that the Trust did not currently have any LBHF patients in out of area private bed facilities.

Councillor Richardson asked the Trust how they monitored patient satisfaction.  Ms Rushton explained that the Trust Board received regular patient satisfaction reports and worked closely with patient advocate services and a report on this could be provided to the Committee.

In response to a question regarding young people’s access to care, particularly the 18-25 age group.  Ms Ruston explained that units for older people were relocated on the ground floor was more appropriate (page 57 of the Agenda), with a more secure psychiatric unit located on the 2^nd floor. It was noted that there was adolescent mental health provision with a facility in Chelsea. There was a lack of provision for adolescents under 18.  The whole of North London had never had beds commissioned for them.  CNWL were developing a general facility for adolescent beds and for patients with eating disorders.  Children with other issues would not currently have a facility.  Direct funding from NHS England rather than from commissioners was being considered which was positive progress.

Councillor Richardson welcomed assurance that the Trust would return to the Committee to report on progress following the next CQC inspection.  She expressed particular interest in the community based provision which was briefly covered in the report and what the aftercare provision was like, and what was available.  Ms Rushton confirmed that she would be happy to report back and discuss community services, in addition to safeguarding, FGM bed capacity and the impact on community responses.  

In terms of bed flow, Ms Rushton reported that there was no impact on community responses because patient flow was much better, utilising one bed more times in a year therefore using it more but more modelling work was needed. It was noted that the Trust involved service users at every point in developing the service.  What was required was a 24hr crises team, and not be fixated on beds for patients as the answer. The key question to ask was what was the best care possible.

In response to a question about about red / green bed days, Helen Mangan explained that this system was in development so that it would be possible to identify at a glance, a value-added day.  Noting a comment that the report lacked patient insight or indicated engagement,

Ms Rushton explained that ‘red days’ meant that the person was marking time, and that the patients stay was longer than necessary.  Councillor Richardson responded that a red day equated to no clinical intervention but that this did not mean no interaction.  Ms Rushton explained that this was not the measure used in understanding patient satisfaction.  The Trust had also received sponsorship from The Kings Fund for a piece of work on co-production, which would also be reported back to the committee.