Minutes:
The Board considered a report of
the Strategic Director, Communities which gave information of the 5 Boroughs
Partnership NHS Foundation Trust proposals to re-design the Adult Acute Care
Pathway and the Later Life and Memory services for older people.
The Board was advised that during 2010/2011, 5
Boroughs Partnership NHS Foundation Trust, with the support of Commissioners,
had examined the Acute Care Pathway.
This process had been led in its initial stages by an expert group of 5
Boroughs clinicians and senior managers, mental health commissioners, social
care leads and the GP Clinical Lead for Mental Health. This group reviewed current service
configuration, utilisation, care pathways, service pressures and other demands
to inform potential adjustments to care pathways across adult and older people
services. The intention was to enable improvements in access, quality of care,
recovery rates and increased avoidance of acute care bed use and out of area
treatments.
The Board was further advised that the Acute
Care Pathway re-design related to adult mental health services only. It would include services for older people
with a functional illness who access adult services, but did not include
services for older people and frail elderly people with mental illness.
It was reported that by re-designing acute care for adults and older
people, there was a potential for a reduction in the need for beds across the 5
Boroughs Partnership localities. This may result in a need for estate
rationalisation. The proposals, if
agreed would lead to a joint
It was also reported that the Later Life
and Memory Service re-design related to older adults mental health services.
The model included a proposal to develop a single point of access, which would
provide cognitive and functional screening for patients. It was envisaged that
this function would considerably reduce the waiting time from referral to
service delivery and greatly improve patient experience.
The proposals were discussed by 5 Boroughs
Partnership NHS Foundation Trust, with the support of Commissioners. This
process had been led in its initial stages by an expert group of 5 Boroughs clinicians
and senior managers, mental health commissioners, social care leads and the GP
Clinical Lead for Mental Health.
In this respect, the
Board received a presentation from Trust Assistant Directors, Pauline McGrath
and Sam Oliver which:-
§
Explained the reasons for changer the Later Life and
Memory Services (LLAMS);
§
Outlined the LLAMS current services;
§
Set out LLAMS proposed services in Halton in the
future;
§
Highlighted why the changes to LLAMS would benefit
the residents of Halton;
§
Set out the LLAMS current and proposed structure;
§
Detailed the conclusions to the proposals – that it would
be clinically led, local project groups would involve all local key players, there
would be user and carer involvement throughout and GP and Commissioners were now
fully signed up; and
§
Detailed the business activities to support the change,
In conclusion, it was reported that it had
been agreed that there were still some additional evidence required to support
the model’s assertion that Community services would be of sufficient quality to
deliver the required levels at the same time as reducing the bed levels.
Therefore the 5Boroughs Partnership would be carrying out a pilot of the
changes in
The following comments arose from the discussion:-
§
Concern was raised that patients would have to travel to Wigan
and
§
It was suggested that there was still a stigma related to mental
health and people could become isolated in the community because of this. In addition, there were young carers in the Borough
who would require a break from their caring duties;
§
Concern was raised that a lot of older people had no family in
the Borough. In response, it was reported
that older people would be part of an assessment whereby relevant questions would
be asked. It was reported that a lot of
work was being undertaken with carers and there were some very complex people coming
into the service currently both of whom were stressed and which required suitable
interventions to alleviate their stress.
In addition, it was reported that the Community Mental Health Team were
very proactive with service users who required transport. These users were transported to their venues. It was also
reported that a lot of people over 65 years of age functioned very well but had
anxiety and depression problems and needed to be signposting to the correct service;
§
Clarity was sought on the reduction of medication in patients
with mental health problems. In response,
it was reported that because of the restraints medication could put on people
and the side effects of such medication the Government had developed Mental Health
policies reducing medication. However, it
was reported that over the last few years with early intervention, patients
with dementia were medicated when appropriate
§
The importance of a good initial assessment, treatment and diagnosis
for mental health problems was noted. It
was also noted that there would be a 24 hour assessment service;
§
It was noted that home treatment was a low qualified clinician
who visited a patient 2/3/4 times a day
and supported that individual in the home. It was also noted that there was no proposals
to close The Brooker Centre or
§
It was noted that GPs were not trained to recognise dementia
and this could lead to it being undiagnosed;
§
It was noted that there was a significant number of people
with dementia and it was anticipated that 1 in 10/15 people over the age of 65 would
have dementia as the population ages. Research was being undertaken and discussions
taking place to ensure that the service would meet the need of Halton residents
in 2/3 years time. In addition, it was
reported that 2/3rds of older people drank alcohol in excess and there was a conference
taking place on 27 January 2012, to discuss how the service would deal with this
increase;
§
It was reported that as a result of the Mersey Gateway, there
was a predicted increase in employment and housing developments in the area over
the next two years and clarity was sought on whether this had been taken into account.
In response, it was reported that the service
would need to be flexible enough to deal with the demand and be a ‘needs led service’;
§
Clarity was sought on patient choice and the number of people
accessing services in Halton from outside the Borough and the impact it would
have on the residents of Halton. In response,
it was reported that there was flexibility and sensitivities relating to patient
choice. It was also reported that there would
be incentives to place local people in local services and protocols drawn up. However, there are some people who prefer to access
services outside of their Borough.
RESOLVED: That
(1)
the report and comments made be noted;
(2)
the presentation be received; and
(3)
Pauline McGrath, Sam Oliver, John Chiocchi, Eileen O’Meara, Theresa Patten, Ashley Baldwin
and Dr Anne Tennant be thanked for their attendance and informative presentation.
Supporting documents: