Agenda item

42.1.      The Committee considered a report on the redesign of Inpatient Mental Health Services in East Sussex, with a focus on the services provided at the Department of Psychiatry being moved on to a new site within the next three years.

42.2.      The Committee asked what the advantages were of having services on a single site compared to the current spread of services over three sites.

42.3.      Paula Kirkland, Programme Director, said that the CCG and Sussex Partnership NHS Foundation Trust (SPFT), together with other stakeholders, had identified that as a longer term vision there could be several advantages of co-locating all services on a single site operating as a centre of excellence. These were principally around better staff recruitment and retention, patient experience, safety and capacity and clinical excellence.  This would be because:

• the site would appeal to staff as a place where they could get the best possible clinical experience from a variety of specialities and benefit from higher quality teaching;
• staff could be moved between wards to cover gaps in staffing rather than move around the county between the existing three sites;
• wards could be adapted over time to match changing demographics, such as turning working age into older peoples wards; and
• the service would meet the minimum recommended guidance for co-locating at least three-wards. Uckfield dementia ward is currently a single, isolated ward.

42.4.      The Committee asked for clarity as to whether there are plans to move all inpatient mental health services onto a single site

42.5.      Jessica Britton, Executive Director, East Sussex CCG, clarified that a potential longer term vision for a campus approach has emerged from engagement with stakeholders. This does not form part of the more  immediate and concrete plans being developed for the future of the Department of Psychiatry (DoP) currently at the Eastbourne District General Hospital (EDGH) site. The current priority is to eradicate the dormitory wards at the DoP – both to meet the national requirement and to deliver significant improvements to local people – however, any replacement service for the DoP will be designed in such a way as to be able to accommodate any future plans that might include the services that are currently located at Beechwood unit at Uckfield and Woodlands Centre at Conquest Hospital.

42.6.      The Committee asked for confirmation that any plans to replace the DoP or create a single mental health inpatient site would take into account the impact on travel times and on residents in more deprived areas such as Hastings.

42.7.      Simone Button, Chief Operating Officer, SPFT confirmed any benefits of a future single campus site would need to be weighed against travel arrangements for staff, patients, and their carers and families. Jessica Britton said further work will be done on understanding where people travel in the county to receive inpatient mental health care. Furthermore, any future plans for a single campus would look at the impact on patients and their families, including those from deprived areas.

42.8.      The Committee asked for confirmation that there were no dormitory wards at the other two inpatient units.

42.9.      Simone Button explained that the Woodlands Centre has had a fair amount of work done to it recently. This includes separating male and female wards; providing all patients with en suite rooms, rather than dormitories; and enlarging and renovating the place of safety for patients detained under Section 136 of the Mental Health Act. The Urgent care lounge in the Conquest’s Emergency Department (ED), where people who present in the ED in crisis are diverted to for a comprehensive assessment, is also being improved.

42.10.   The Committee asked what the plan was for child and young people inpatient services

42.11.   Paula Kirkland said that the current work related to adults only and there are no plans to move children and young people’s inpatient services to the site.

42.12.   The Committee asked whether the national funding to eradicate dormitories will be sufficient for the planned capital works.

42.13.   Jessica Britton said the CCG will continue to further refine its options as part of the development of a Pre-Consultation Business Case (PCBC), but it is expected that it will be eligible to receive national funding.  Any longer term plans to create a single campus would require separate, further capital investment.

42.14.   The Committee asked for confirmation that the Trust will not be reducing the total number of beds when the DoP moves to the new site.

42.15.   Jessica Britton confirmed that the proposed reconfiguration enables the Trust to provide the same number of beds but in a better configuration and environment. Demand is increasing for mental health and this factors into long term planning for the CCG and SPFT, however, some of this demand will be offset by the increase in community-based services such as 24/7 crisis resolution and home treatment teams.  Depending on the site chosen, there may also be an opportunity to increase the number of inpatient beds if demand increases.

42.16.   Simone Button said the Trust is looking for a site that can accommodate at least three wards with scope to increase if it is decide to develop a single campus in future. Paula Kirkland added that this will amount to 54 beds, the same as at the DoP, but a single campus could accommodate between 130-140 beds. The Trust will need a new build, as renovating an existing building to the standards required for a mental health ward would be prohibitively expensive. Any single campus will also be designed in a way sympathetic to the needs of the patients and will not in any way resemble older mental health institutions.

42.17.   The Committee asked whether the Eastbourne District General Hospital (EDGH) could continue to be used as a site for the DoP

42.18.   Joe Chadwick Bell, Chief Executive, East Sussex Healthcare NHS Trust (ESHT), said that the Building For Our Future capital funding is only for acute services, so there are no plans to build mental health beds on the new site as part of this funded capital programme.

42.19.   The Committee asked what benefits en suite beds have over dormitories and whether en suite facilities require more staff.

42.20.   Simone Button explained that there are enormous benefits from en suite beds including greater privacy, respect and dignity for patients. They are also safer as there are strict design guidelines, for example, around them being ligature proof. They are also preferred by patients because they offer private areas as well as communal lounges and canteens to socialise. The Chief Operating Officer explained this meant staffing levels are about the same, as en suite wards are often a calmer environment because people can retreat to their own space if they are agitated.

42.21.   The Committee asked about how patients are currently admitted, for example, at the Woodlands Centre in Hastings.

42.22.   Simone Button explained that both Woodlands Centre and DoP offer inpatient and outpatient appoints. Pressure on bed stock, however, means beds across Sussex are in high demand. Therefore, whilst it is the ambition of SPFT to admit a patient as close as possible to their home, often if a Consultant sees person at the Woodlands Centre and thinks they need an admission to a bed, there may be none available on site and they will instead go to the closest alternative inpatient bed. This may be the DoP in Eastbourne, another bed managed by SPFT in Sussex, or further afield. East Sussex beds are managed well by SPFT and are probably the right amount for the population, which means relatively few patients are admitted outside the county, albeit not always to the nearest site within the county. The Chief Operating Officer explained that this is why it is so important to have comprehensive community services, including intensive care services for when a patient is in crisis, to avoid the need for an admission.

42.23.   The Committee RESOLVED to:

1) note the proposals for redesigning inpatient mental health services in East Sussex; and

2) agree to consider a report at the 10th June meeting to determine whether the confirmed proposals constitute a ‘substantial development or variation’ to services requiring consultation with the committee under health scrutiny legislation.