Campaigners criticise new mental health trust proposals: 'We want beds not cups of tea'
PUBLISHED: 08:38 26 April 2017 | UPDATED: 08:12 27 April 2017
No new beds for patients in psychiatric crisis will be made available by the region's mental health trust, despite concerns being raised by the health watchdog over that a shortage of beds "had impaired patient safety and treatment at times".
The £58,000 review was commissioned to look into whether Norfolk and Suffolk Foundation Trust (NSFT) had enough beds, after a Care Quality Commission (CQC) inspection last year lifted it out of special measures.
But despite conclusions that no new beds were needed to treat those in psychiatric crisis, the number of days patients spent either in private care or outside the area was at its highest level in a year.
Last week an inquest in Ipswich heard the case of Neil Jewell, a Norwich man with paranoid schizophrenia who died under NSFT’s care in 2014.
There were no beds for Mr Jewell in Norfolk, nor at West Suffolk Hospital where he was originally taken. He ended up at Ipswich Hospital.
His brother-in-law Edward Welfare said if it was the case that there were enough beds, then it was positive news.
Meanwhile, a report is suggesting the introduction of cafes to treat mental health patients - with the first one planned for Norwich later this year.
The cafes would “primarily be non-medical” and focus on de-escalation, according to a report seen by the NSFT board of directors. But they would “be supported by clinical staff”.
But campaigners hit out at the plans, saying “people in psychiatric crisis needed beds, doctors, nurses, psychologists, social and support workers rather than platitudes and cups of tea”.
In March, 1,107 bed days were spent either outside of the trust at the private Mundesley Hospital, or outside of Norfolk and Suffolk, at a cost of £737,000.
This compared to 984 bed days in February and 328 in April 2016. Mundesley Hospital was rated as inadequate by the CQC in March this year.
One of the trust’s key performance indicators is to have zero out of area bed days by October 2017.
According to NHS Digital there were 25 out-of-area placements in Norwich at the end of February, the last month data is available for. There were another 10 in North Norfolk, five in South Norfolk and five in West Norfolk. Data is rounded up to the nearest five. There were none in Suffolk.
Instead of introducing new beds, the review recommended the introduction of crisis cafes and additional step down beds.
The cafes would initially be in Norwich and would support people experiencing heightened emotional distress.
A new community personality disorder service is also in the pipeline.
And it is hoped that by addressing clinical variance across the trust, the current number of beds could be sufficient.
Julie Cave, director of finance and NSFT’s lead director for the bed review, said there were plans to increase bed numbers, but “these beds would not be described as adult acute crisis beds”.
She added: “We cannot discuss the details of these beds any further during the pre-election period as all such announcements are on hold in this period. “All of our inpatient beds would be described as being for ‘people in mental health crisis’, although not all people in mental health crisis need to be, or should be, admitted to a bed.
“As is nationally documented, beds are not the only, nor necessarily the best, solution to supporting someone in a mental health crisis.”
Asked about the target is getting out-of-area mental health placements to zero by October 2017, Ms Cave said the report had highlighted “hotspots” in certain areas, with more people being sent out-of-area.
She added: “We have set ourselves a more realistic timetable of March 2018 to reduce OOA placements to nil by which time many of the initiatives outlined in the bed review summary, along with further initiatives from our frontline teams, will be underway and we expect to be delivering greater results.
“These would include the crisis cafes, step down beds, along with our personality disorder strategy.”
Campaign to Save Mental Health - ‘NSFT is plumbing new depths’
A spokesperson for the Campaign to Save Mental Health Services in Norfolk and Suffolk said: “NSFT is plumbing new depths, transporting people in mental health crises to private hospitals across the country, some rated inadequate by the CQC, in greater numbers than ever before. The £4.5m NSFT wasted last year could have funded at least 40 high-quality, local NHS beds.
“NSFT’s claim that it has enough beds, following record expenditure of more than £700,000 in just the previous month, is worthy only of North Korea’s state media. For more than three years, NSFT has made excuses as the beds crisis has intensified and the number of unexpected deaths has doubled. Now is the time for the doublethink to end; for a new board and management at NSFT and for commissioners to deliver the investment in local mental health services that the people of Norfolk and Suffolk so urgently need.”
Improvements had been made
In the trust’s latest CQC inspection, carried out in July last year, it was found improvements had been made and their rating was upped from inadequate to requires improvement.
But the CQC found “there remained a shortage of beds across the trust and that this had impaired patient safety and treatment at times” and “a lack of available beds meant that people may have been moved, discharged early or managed within an inappropriate service”.
However, this is contrary to the objectives of the mental health workstream of the Sustainability and Transformation Plan (STP) for Norfolk and Waveney - which is designed to find ways to save the NHS money.
One of their key objectives is “reducing acute hospital use for people of all ages with reported mental health problems, including children and young people and dementia”. However, another of the objectives is “offsetting and reducing the growth in out of area bed days”.
Norfolk and Waveney Clinical Commissioning Groups (CCGs)
Norfolk and Waveney’s five CCGs jointly commissioned the beds review alongside NSFT.
A spokesman for all five said: “This review has not yet been fully circulated or published and therefore CCGs are not in a position to comment in detail. “It would not be correct at this time to conclude the answer to NHS mental health service capacity lies in providing more beds.
“As set out in NSFT’s Board paper, there are a number of conclusions which are being considered further. These include looking at what support and treatment is offered in the community with a view to reducing the number of people needing a hospital bed.”