Agenda item

Changes to Mental Health Rehabilitation Services in Cumbria

To consider a joint report by NHS North Cumbria Clinical Commissioning Group, Chief Officer, Morecambe Bay Clinical Commissioning Group and Chief Operating Officer, Northumberland, Tyne and Wear NHS Foundation Trust (copy to follow).



The Committee received a joint report which provided information on the planned changes to the provision of mental health rehabilitation inpatient services, currently delivered by Cumbria Partnership NHS Foundation Trust (CPFT) through the Acorn Unit at the Carleton Clinic in Carlisle.


Members were informed that due to the membership of the Cumbria Health Scrutiny Variation Sub?Committee not being agreed at the time of the proposal the full Cumbria Health Scrutiny Committee was asked to consider the first phase of the Variation Protocol; whether the proposal constituted a substantial service change.


The Committee held a detailed discussion regarding the review of the pilot 16 bed Acorn Unit at Carleton Clinic, Carlisle which was initially established to facilitate rehabilitation for men with complex mental health needs.  Members were informed that future provision would be to meet the needs of both males and females.


It was explained this was established under agreement that CPFT held responsibility for costs other than those agreed at the time the pilot was commissioned.  It was noted the Clinical Commissioning Group (CCG) had agreed to support the pilot service on a ‘cost per case’ basis, up to a maximum of 10 beds.


Members were informed that over the five years of the Acorn Unit being available it had never gone beyond its pilot status, therefore, it had not been formally commissioned by either CCG.  It was explained it had not reached optimum level of inpatients, usually with no more than 60% of its beds filled at any one time, with use across the two CCGs varying each year. 


The Committee was informed that the male patient group had been very mixed and there was some confusion around the aims and purpose of admission, expected length of stay and clinical outcomes.  It was highlighted they had varied from the pilot stage to present service delivery and little change had occurred to the model whilst demand and need for rehabilitation services had changed around the Acorn Unit. 


Members were given an update on the background to the Unit which admitted men from acute mental health treatment and rehabilitation wards that had a longer length of stay as well as providing active rehabilitation for a number of them.  It was noted that it also acted as a ‘step-down’ for male patients returning to Cumbria from Low or Medium Secure Forensic Hospitals elsewhere in the country.  The Committee was informed that the typical discharge destination from the Acorn Unit was supported living, including individual tenancies, which was a pathway supported by the system and provided a positive outcome to service users.  A concern was raised that the mental health pathway for patients currently in the Acorn Unit had not been completed.  Members were informed that due diligence reviews had been undertaken with all patients. 


The Committee was informed it had been agreed to review the current mental health services, including the Acorn Unit as part of a wider review of Rehabilitation Pathways in Mental Health services.  It was explained that as both CCGs were now placed within different larger Integrated Care Systems (ICSs) the design and commissioning of future service provision would sit in those footprints.  It was noted that the ICS commissioning groups were identifying a longer term bed model and rehabilitation model for each clinical system.  It was anticipated the Acorn Unit review would help inform those processes and also ensure that learning from the Acorn pilot, and the needs of Cumbria residents, was embedded into those new services.


Members were informed that as a result of the review it was also acknowledged that Cumbria did not provide an accessible, evidence-based, best practice rehabilitation pathway consistently across the two emerging systems of North East and North Cumbria, and Lancashire with South Cumbria.   It was explained that such a pathway would include community rehabilitation services which facilitated care as close to home as possible and delivered continuity of care and early discharge when within an in-patient setting, high dependency unit or longer term rehabilitation services.  The introduction of patients being looked after at home and managed by a community service was also being considered for the future.


The Committee was updated on the CCG commissioning intentions noting the North Cumbria System Executive Team had acknowledged that the current stand-alone service had not been commissioned in the traditional sense and currently did not meet the identified population need for mental health rehabilitation.  Therefore, it had approved the temporary closure to admissions and the re-provision of high dependency and in-patient open rehabilitation services for up to approximately eight individuals per year within the well-defined Northumberland, Tyne and Wear NHS Foundation Trust (NTW) rehabilitation pathway. 


A discussion took place regarding the future of the Acorn Unit and whether this was a potential temporary closure.  Officers explained the closure was to allow a review of the pathway as the Service was not fit for purpose.  Members were informed that in the next 6-12 months the review of urgent and rehabilitation pathways would be concluded and a model going forward, to strengthen a community based service, would be investigated.  It was explained that the new service may not be ready in 12 months’ time emphasising the need to get the model right.


It was explained that the NHS Morecambe Bay CCG had also identified the need to redesign mental health rehabilitation services to meet the needs of residents from south Cumbria and include a whole Bay service offer to include residents of north Lancashire.  Members noted that Lancashire Care NHS Foundation Trust (LCFT) was currently developing a service profile for rehabilitation beds in line with the well-established NTW offer to ensure consistent outcomes for all residents.


Members raised their concerns regarding the impact the closure of the Unit could have on South Cumbria and were informed that this should be minimal.


A discussion took place regarding services in the south of the county and concerns were raised regarding the availability of adequately trained resources.  It was acknowledged that historically there had been challenges regarding recruitment but emphasised to members that safety was paramount.  Members were informed that the priority for this year was to expand the urgent care services and whilst the availability of staff was a cause for concern it was explained there had been some recent recruitment success.


A discussion took place regarding the availability of a Psychiatric Intensive Care Unit (PICU) in South Cumbria and members were informed that service users would have to travel to the Carleton Clinic in Carlisle as this was where the service was provided for the whole of Cumbria. 


Members were informed that LCFT had agreed to a partnership with NTW to work on an improvement partnership.  It was explained that representatives from NTW would engage with colleagues in the south throughout the continuous improvement journey to ensure a smooth transition. 


It was agreed that a report on the development of Innovative Staff Models from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust would be considered at a future meeting of the Committee.


A discussion took place regarding engagement and it was explained that a view of the needs of all patients currently receiving services within the Acorn Unit was completed and an analysis of projected future need undertaken; based on current usage and numbers requiring step-down from secure care.  It was highlighted that senior clinicians from CPFT had met current service users and their families and they would be involved in the ongoing care plan of the individuals.


Members were informed this had identified that some of the current in-patients were ready for discharge and would require support into the community which could be actioned within a number of weeks.  It was explained that the needs of the remaining individuals could be met via transfer to both NTW open rehabilitation and high dependency unit (HDU) rehabilitation services to be facilitated at the earliest opportunity. 


The Committee raised their concerns at the length of time the current service at the Acorn Unit had been tolerated and why the situation had not been allowed to evolve into a fast track recovery service.  Officers explained that at the time the provider and commissioner had tried to do what they could but this had evolved into an incorrect model which did not meet the needs of patients.  It was explained that work undertaken by NTW had identified that a fast track recovery service was needed for some patients who required intensive support and rehabilitation but that each case had to be considered on an individual basis.  Members were informed that currently there was no flexibility in the pathway and that different skills were required from staff.


The Committee was informed that staff had been briefed and were being supported by contact on site with senior managers alongside HR and union representatives.  It was noted that staff would continue to work in partnership with current patients, their carers and families to support existing care pathways.  It was emphasised to members that all of the staff aligned to the Acorn Unit were part of the transfer of services to NTW and as such there was no impact to staff in the south of the county and NHS Morecambe Bay CCG had no ongoing concerns about staff within the south profile.


The Committee was informed that Stakeholders were provided with a written briefing ahead of the executive decision and had the opportunity to ask questions ahead of the information being shared more widely.  Concerns were raised regarding the temporary closure to admissions at the Unit without any communication with the Cumbria Health Scrutiny Committee.  Officers acknowledged members concerns and apologised for the lack of communication.


The Committee questioned how confident the Trust was that the wider community of people providing mental health care were briefed on the changes.  Officers explained that a comprehensive communication exercise had been undertaken to identify and engage with as many people as possible including service users, carers and governors of CPFT.


Members were informed that where in-patient services were required, support arrangements would be established to ensure carers and families were able to maintain contact should they be transferred to NTW Services.  It was explained that technology including the use of skype and other social media applications would be used to ensure communication continued.  Officers highlighted there was also a commitment to support issues around travel.  The importance of ensuring relationships continued with family and friends was acknowledged.


Members were informed that information had been shared through the media, social media and other networks.  A concern was raised regarding the reference to a ‘potential temporary closure’ and highlighted the need for effective communication to prevent anxiety to the public.


In conclusion the Committee was informed that the recommissioning of mental health services for the population of Cumbria had already seen significant improvements to services and had supported the reduction in unplanned acute out of county placements.  It was emphasised to members the priority was to ensure that services provided were consistent within well?defined rehabilitation pathways for the residents of Cumbria.


The Strategic Policy and Scrutiny Adviser outlined the substantial variation protocol.  Member raised several concerns including the lack of a clinical consensus as the review had not been concluded, inadequate community engagement and the reference to a ‘temporary’ closure.  Officers confirmed that the future of the Unit had not been decided but confirmed it would not re?open as it was at present as it was deemed to be clinically inappropriate and not beneficial to patients.  It was also explained that current patients were part of the consultation and engagement had been undertaken with them and their families.


On being put to the vote with four members abstaining and seven members agreeing that the proposal did not constitute a substantial service change, it was


RESOLVED,   that


                          (1)          the proposal did not constitute a substantial service change;


                          (2)          a report on the development of Innovative Staff Models from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust be considered at a future meeting;


                          (3)          the Committee receive early notice and comprehensive reports on any potential substantial variations as a result of the reviews of the Urgent Care and Rehabilitation pathways which are underway and will take approximately 6-12 months.


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