Agenda item

Presentation by representatives of Northumberland Tyne and Wear NHS Foundation Trust

The Committee received a presentation by representatives from Northumberland Tyne and Wear (NTW) NHS Foundation Trust outlining progress on the implementation of ‘Deciding Together – Delivering Together”

It was highlighted that implementation had focused on the following priorities

·         Access to mental health services, and making this more streamlined and easier to navigate including the development of a safe haven hub

·         Redesign of mental health inpatient beds in accordance with decisions made through the Deciding Together consultation

·         Availability of short-term non-hospital crisis beds for Gateshead residents (this service is already available to Newcastle residents)

·         Developing services for older people and ensure physical health, mental health and social care needs are met. Include a more integrated approach when responding to crisis situations

·         Strengthen and improve the community-based services

The Committee was advised that, as a result work around Urgent and Emergency response, considering gaps identified in current services, is being developed through CCG led group. Mental Health and Learning Disability Service Directories are also being developed and work is also taking place with Our Gateshead and Information Now in Newcastle who host news, events and regular activities by groups and organisations across the area, to include information on NTW’s Mental Health and Learning Disability NHS services. Mental Health Concerns (MHC) are also working with their core partners on the provision of non - hospital crisis beds in Swalwell, Gateshead and these should be available soon.

The Committee was informed that work around urgent and emergency response for older people in crisis is being developed through a CCG led group to reflect the different commissioning arrangements in each locality. Continued work is also taking place across pathways to prevent / reduce admissions /promote effective discharge.

Gateshead Health NHS Foundation Trust has also recently completed a major refurbishment of its inpatient facilities for people with cognitive conditions.

Work has also been taking place to reduce waiting times for Adult Mental Health community assessment and treatment; develop a mental and physical wellbeing pathway for people who are on long-term medication and a step- up hub which prevents people from getting worse and needing support from the crisis team.

A buddy system for care co-ordinators is also being developed providing continuity for people if their care coordinator is on holiday or not available. Recovery clinics are also being established to support people to prevent relapse, manage their medication, manage their long - term mental health conditions and help to prepare for being discharged from the team. Improved links with primary care and the local authority are also being created and further development work is planned. The Trust is also looking to work more closely with GPs around accessibility to mental health services as part of the longer- term planning in community.

In terms of the redesign of mental health beds the Trust has been successful in gaining £54m in public funding to improve buildings and the estate within secure care services (Northgate site) and the development of a state-of-the-art adult acute care facilities on the St. Nicholas’ Hospital site. The Trust expect new centre of excellence to be open in 2023. However, as an interim move the Tranwell unit in Gateshead will move across resulting in two female and one male ward in Hadrian and a further male ward at St Nicholas Hospital. All wards will move to improved accommodation on St Nicholas site within the next 3-4 years.

The Committee was informed that NTW older people’s services in Akenside and Castleside within the CAV will remain where they are during this time, while future accommodation is being considered. There will be no change at the present time to the accommodation. However, the Committee was advised that it was likely that the Trust will look to relocate these services at some point in the future.

Details of the proposed timelines for acute ward moves were provided to the Committee. The Committee was advised that it was anticipated that the withdrawal from the Tranwell Unit would take place in October 2019. There had been a slight delay in securing the end of the service due to clinical reasons.

The Committee was informed that the refurbished facilities at the Hadrian Clinic did not provide ensuite facilities due to the nature of the building but the finalised facilities on the St Nicholas Hospital site will have ensuite provision.

The Committee noted that some members had visited the recently refurbished facilities at the Hadrian Clinic and raised concerns that they did not include ensuite provision. The Committee expressed their disappointment that the refurbished facilities at the Hadrian Clinic did not include the provision of ensuite facilities as this had been previously highlighted as one of the key reasons why the Tranwell Unit was no longer fit for purpose and the Committee had been led to believe that it was a safety issue that such facilities were not in place.

The Committee was advised that representatives of the Trust who were present during the visit had understood that the Committee had been pleased overall with the work that had been carried out as the Committee had commended them on the work carried out. It was acknowledged that concerns in relation to the lack of ensuite facilities had been raised by members of the Committee. However, representatives of the Trust had been clear at the time that unfortunately, due to the nature of the building, it was not possible to provide ensuite facilities at the Hadrian Clinic. The Committee was advised that the Trust is doing it’s best to improve mental health provision and has spent £1.5m to improve the facilities at the Hadrian Clinic. The facilities now in place are much better than previous facilities and the facilities at the Tranwell Unit are a step towards the provision that the Trust is working towards putting in place at St Nicholas Hospital.

Assurances were provided to the Committee that a lack of ensuite facilities at the Hadrian Clinic was not a safety issue. The Committee was advised that in terms of the level of facilities provided the Trust is viewed as class leading across the NHS.

The Committee was advised that there are a significant number of wards nationally which are dormitory style and the Trust does not have any of these. Once all refurbishments are complete the Trust aims to be one of the first organisations to be fully ensuite. The Committee was advised that the Trust has out in a huge amount of effort to provide facilities at the best possible standard for Gateshead residents.  The Committee was advised that the Trust provides some of the best in -patient services and its services have been rated as outstanding by CQC. The Committee was assured that the Trust is committed to providing the highest quality in patient care. The Committee was also assured that the Trust provides excellent safe services.

The Committee highlighted that as local councillors they sometimes have residents who are in mental distress attend their surgeries and indicated that going forwards it would be helpful to have contact information for support services across the borough.

It was also highlighted that during the earlier workshops relating to the vision for mental health services discussion had focused on the provision of several mental health hubs and it was queried whether it was now the case that there would be only one. The Committee was advised that the workshops were held to generate discussion on what people viewed as the ideal position. This piece of work was not being progressed by the Trust but was being led by Mental Health Concerns and now that the Long Term Plan has been published and there is information on investment they should be able to provide further information on this matter.

The Committee expressed concern that it had taken approximately three years to get to this point.

Trust representatives acknowledged that this had been a lengthy process but this had been due to the availability of capital funding. The Committee was advised that the Trust was the only organisation in the NE to receive national funding, due to the fact it had such a good case and is cause for celebration as it means that facilities can be improved to the highest standards.

Approximately fifteen years ago the Trust had one of the worst estates in the country but they have had a long term strategy and have invested to make sure the Trust has the best provision / services and they are now on the last part of that journey. It was acknowledged that there are still a lot of improvements to be made but it was considered that the Trust provides some of the best mental health services in the country.

A representative of Healthwatch Gateshead noted that Healthwatch Gateshead had been involved in the initial workshops in relation to the Deciding Together – Implementing Together process but indicated that there had been no engagement with them since then.

Representatives of the Trust apologised and stated that this would be addressed following the meeting.

A member of the public raised concerns in relation to bed capacity for acute mental health provision in Gateshead and the use of out of area provision for Gateshead residents and the movement of forensic services. As a result, the member of the public felt that there was a need to retain the Tranwell Unit.

Representatives of the Trust advised the Committee that last year across Newcastle and Gateshead there were only 136 occasional bed days where patients were placed in appropriate provision outside of the NTW area. This amounted to 0.5 percent. The Committee was advised that the Trust is one of the best performing Trusts in this particular area.

In terms of bed capacity, the Trust is managing occupancy levels and currently is slightly above the national average. However, the NewcastleGateshead CCG area still has more bed capacity than other parts of the patch. The Trust is committed to achieving no out of area placements in the next three years.

The Committee was informed that secure services are a separate matter to the services covered by the Deciding Together proposals.

The Committee sought assurances that when individuals were sent to out of area placements they were still receiving a good standard of care. Representatives of the Trust assured the Committee that they are committed to providing the best services possible for Gateshead residents and out of area placements were managed very closely in terms of how and where and were kept to a minimum.

Representatives of the Trust invited the OSC to be involved in the design phase for the new in - patient unit and to visit the new Bamborough unit at St Nicholas Hospital in due course.

The Committee thanked the Trust for the offer and accepted the Trust’s offer and reassurances on the issues raised but indicated that it had been important to highlight those issues with the Trust and seek relevant reassurances for the benefit of Gateshead residents.

Representatives of the Trust reiterated that they are fully committed to providing the best services for Gateshead residents and acknowledged that there are always areas where an organisation can improve.