Agenda item

Re-design of the Adult Acute Care Pathway and the Later Life and Memory Services


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 Warrington and Halton Assessment Team and Home Treatment, alongside six Recovery Services, which were set out in the report.


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 Wigan commencing in January 2012.


The following comments arose from the discussion:-


§         Concern was raised that patients would have to travel to Wigan and Warrington to access these services.  Concern was also reaised re the proposal to reduce the number of beds.  In response, it was reported that currently 70% of services were provided in the community. The average time an individual  spent as an ‘in patient’ was 24 days.  It was reported that families wanted treatment and to go home as soon as possilbe.  The proposals would provide daily contact in the home and intervention would be at a much earlier stage, which would result in few hospital placments and therefore fewer beds would be required in the future.  The scheme was being pilotted in Wigan and would be closely monitored and scrutinised.  In addition, it was highlighted that a further report on the outcome of the pilot would be presented to a future meeting of the Board with proposals for a way forward;


§         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 St Johns and they would continue to be used for community services.  It was also anticipated that these services would be improved and these services would remain in order to provide local services to local residents in Halton to keep patients out of the hospital;


§         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.




(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.




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