Agenda item

The Board received a presentation on the proposals from the 5 Boroughs Partnership NHS Trust for the redesign and reprovision of its services for Adults of Working Age, and for some Older People (“Change for the Better”) from Mr. J. Kelly, Director of Adult Services. His presentation detailed:

• the five national and five local drivers for the modernisation of mental health services;
• Local Service and Financial Drivers;
• the four Tiered Models of Service;
• Access and Advice Centre;
• the reasons for proposed changes;
• Resource and Recovery Centres (RRC);
• the eligibility and benefits of RRC’s;
• the proposals for Halton; and
• the benefits of modernising mental health services.

The Chief Executive of Halton Citizen’s Advice Bureau (CAB) had submitted the following question/statement:

“We are very concerned about the number of bed losses that is being proposed for the Halton area and the impact it will have on other “non-5Boroughs Partnership” funded services.  The 5 Boroughs Partnership have stated that such a reduction is possible because their efficiencies to be gained from “treating” people in the community and having better engagement with the voluntary and community sector to support such people.  However I do not believe any meaningful impact assessment has been done on other services if the proposed bed closures go ahead.

Halton CAB’s services are already heavily over subscribed and it is only thanks to the generous funding we get from Halton BC that we can play the role we do, i.e. to help mental illness sufferers claim the right benefits, helping with their housing rights, etc.  Currently we visit patients in the Brooker Centre where we can see a number of them in one visit.  If there are bed closures we would have to do individual home visits which are much more resource intensive and 5Boroughs have not mentioned how they would support such activities.

I appreciate we are only one agency but I hope this point illustrates how this strategy can have serious ramifications for other services Halton BC fund”.

In response it was noted that the proposed model had been piloted in Knowsley, where a recent study, by the University of Manchester, had not found any evidence of this model impacting on Voluntary Sector organisations.

Arising from the discussion the Board made reference to a number of issues in relation to:

§         the level of funding reduction expected within Halton;

§         how the number of beds required was determined, whether it was based on need or population; It was noted that bed numbers were based on Royal College figures, the need index and population size;

§         recent media reports depicting serious sexual attacks taking place in mixed sex wards, whether there was a need for separate wards as well as separate communal areas and how staffing levels impacted upon such attacks;

§         no physical plans being available for Members consideration;

§         the on-going issue of funding with West Cheshire Hospital and the 5 Borough’s Partnerships’ sizable debt of approximately £5M;

§         how the referrals process would work and what support would be available for patients who did not need hospitalisation;

§         where the funding for the Alcohol Bed had come from;

§         concerns that the timescale of the project was 3 months compared to 18 months at Knowsley. It was noted that all the key teams were in place, or would be in the near future within Halton, whereas this had not been the case at Knowsley. In addition it was anticipated that there may be some slippage in the timetable;

§         financial stability and spending, in particular the amount of money spent per patient both regionally and nationally compared to Halton;

§         the reduction in beds seemingly larger than the other Boroughs, however, it was noted the other Boroughs had previously reduced the number of beds considerably and that this had not been feasible in Halton until now;

§         if there would be an increase in staff to accommodate the proposed changes; it was noted that investment in new teams had taken place in the last few years;

§         whether any assessment of family needs had taken place or would take place;

§         whether any voluntary sector organisations could be involved, especially in light of the recent funding difficulties in the sector; it was noted that while negotiations would need to take place with individual organisations it was expected that accommodation and telephones would be made available;

§         whether independent family support workers would be included within the model;

§         the ratio of staff to clients on each of the different teams i.e. assertive outreach team which would have one member of staff to 10 patients;

The Board felt that under Regulation 4 of the Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002 SI No. 3048 regulations this proposal was a substantial variation in the provision of mental health services and as such would be subject to joint scrutiny.

RESOLVED: That

(1)   the presentation of the proposed changes be received;

(2)   the report be noted;

(3) under Regulation 4 of the Local Authority (Overview and Scrutiny Committees Health Scrutiny Functions) Regulations 2002 SI No. 3048 regulations, the proposal be noted as a substantial variation in the provision of mental health services and as such be subject to joint scrutiny by Halton Borough Council (BC), Warrington BC and St. Helens BC.