An independent report exploring initiatives aimed at relieving the pressure on local mental health beds has been published in full.
The independent review was jointly commissioned by Norfolk and Suffolk NHS FT (NSFT) and the NHS clinical commissioning groups in Norfolk and Waveney in response to increasing demands on mental health services. This has resulted in some patients needing to be sent for inpatient care out of the local area at times of high pressure.
NSFT has made it a priority to reduce the number of out of area placements of its patients but as demand for all Trust services has increased - in 2015-16, NSFT saw 22,000 more patients than in 2012-13 - OOAs have also increased.
In addition to opening more crisis assessment beds in 2015 and last year, NSFT and the CCGs recently appointed independent experts Mental Health Strategies (MHS) to look in detail at NSFT’s adult acute care pathway, including everything from crisis services, crisis assessment, inpatient beds, length of hospital stay, as well as community services.
The review was drawn up in consultation with frontline mental health staff, GPs, commissioners and stakeholders, and incorporates a wide variety of data, and it focused on:
- Determining how many and where beds are needed to deliver day-to-day services in Norfolk and Suffolk while continuing to meet increasing demand
- Where there may be hot spots or issues causing additional pressures in the system and on beds
- To offer best practice advice on what has worked in other parts of the country in helping to manage the increasing demand on NHS mental health beds and services
The report concludes that if differences are addressed in the way referrals to inpatient beds are made in various parts of the Trust, and additional alternatives to hospital admission are introduced, the current number of NSFT beds could be sufficient to continue meeting demand.
A number of key alternatives have been suggested and will be developed under the remit of the Mental Health Sustainability and Transformation Plan (STP).
Michael Scott, Chief Executive, of NSFT said: “This month we have seen a number of days where we have achieved zero OOAs, and the last thing we want is for local people to have to travel elsewhere for their care and we fully understand the distress this can cause to some patients. We are determined to do whatever we can to bring down the number of OOA placements consistently.
“But it is important to stress that it is not just about the number of beds. Not all people in mental health crisis need to be, or should be, admitted to a bed, and the best outcomes are often achieved when they can remain in their own home, close to the people who care for or support them, with good community-based, mental health support in place.
“That is why our Trust and our commissioners have continued to extensively invest into community services and preventative services to keep people as well as possible for as long as possible.
“We all know there are finite resources in the NHS and so the emphasis of this has to be about identifying if we have the right type of beds in the right places to meet local needs, and how can we better manage all of our services to ensure that our beds are free to support the people who really need an inpatient stay.
“The independent reviewers are suggesting, for example, that crisis assessments beds may not provide any advantage over using normal, working age, crisis beds in reducing of OOAs.
“And the report has been extremely useful in outlining some differences in clinical practices in various parts of our Trust in regards to how we make use of our existing beds from service to service, and in different geographical areas.
“It is important for us to address these differences, as they can affect the length of time a person stays in one of our beds, whether people are admitted at all, or how they are supported in a community setting.”
Michael explained that an acute and community pathway of mental health services has many stops and checks where health professionals can ensure people are kept as well as possible and avoid the need to go into hospital.
“If we are not using our existing beds and services efficiently for the best purpose and with the best outcomes then adding more beds can potentially add to the problem. You can get a revolving door scenario, where people are in and out of hospital rather than receiving more appropriate community support which better helps people to live their lives independently and well.
“For people with a personality disorder for example, unless they are severely unwell and need a prolonged specialist placement, being in a mental health unit can exacerbate their problems. And they can often be the patients who we see regularly coming in and out of beds and yet they may not be making much progress in their recovery as a result.”
The £58,000 cost of the review was shared between NSFT and Norfolk and Waveney CCGs, who jointly commissioned the project.
Antek Lejk, Chief Officer of NHS North Norfolk and NHS South Norfolk CCGs, said: “There are some really interesting initiatives which have proven to work very well in other parts of the country in keeping people well and out of hospital.
“We are working through the findings of the independent report with NSFT and frontline staff and after these discussions we will have a clearer picture on how we might develop local services and initiatives, which will be drawn up under the remit of the Mental Health Sustainability and Transformation Plan work.”
MHS’s findings include:
• Crisis cafes and step down beds would provide alternatives to admitting patients to acute inpatient units
NSFT is planning to open a crisis café in Norwich in 2017-18 to offer a safe, specialised, community setting where people with an escalating mental health condition can go for immediate professional support.
Work is also taking place to explore in greater detail the potential impact which step down beds, which are used when a person is no longer in a mental health crisis but is not yet ready to return home, could have on reducing admissions to acute units.
• The development of a community personality disorder service would provide a useful addition to existing services
NSFT already provide services to people with personality disorders, and is currently working on a Personality Disorder Strategy. The review further highlighted the need for a specific service PD service. An NSFT consultant is leading a project to create a community personality disorder service (from existing resources) which will offer high quality assessment and supervision, as well as a range of interventions such as active listening, psychotherapy and crisis response. Work is due for completion at the end of 2017-18.
• Learning and best practice should be shared across the Trust to address differences in referral and admission rates between community teams
The Trust is working with clinicians to develop a consistent approach to admitting and discharging, as well as criteria for admissions. Recommendations to standardise practice where appropriate are also being drawn up.
To read the full report log onto the Trust’s website at www.nsft.nhs.uk/our-priorities