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Gateshead Adult Mental Health Urgent Care Services Proposed Modernisation Gateshead Inpatient Facilities Tranwell Uni

Gateshead Adult Mental Health Urgent Care Services Proposed Modernisation Gateshead Inpatient Facilities Tranwell Unit February 2009 Mark Knowles – Divisional Manager Urgent Care. Overview of Current Inpatient Services. 60 Acute Inpatient beds Additional 5 PICU beds

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Gateshead Adult Mental Health Urgent Care Services Proposed Modernisation Gateshead Inpatient Facilities Tranwell Uni

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  1. Gateshead Adult Mental Health Urgent Care Services Proposed Modernisation Gateshead Inpatient Facilities Tranwell Unit February 2009 Mark Knowles – Divisional Manager Urgent Care

  2. Overview of Current Inpatient Services • 60 Acute Inpatient beds • Additional 5 PICU beds • 60 Acute beds at Tranwell Unit, Gateshead – 2 Single sex wards and one mixed gender. • All beds are ‘gatekept’ by the Crisis Referral Home Treatment Team

  3. What was the Initial Proposal? Proposal is in 2 parts 1. Staged closure of Lyndhurst Ward (mixed gender) 2. Reprovision of services to provide an MDT Urgent Care Day Service Staged development over 12 month period 08 / 09 Including service user and carer questionnaire Managed by project team approach

  4. Drivers for Change • NSF (1999), NHS Plan (2000), OHOCOS shifted emphasis to community provision with the aim to help people in the least restrictive environment • Expectation that admissions to hospital should reduce by as much as 30% with reduced reliance upon inpatient beds generally • Significant local investment in developing new community, AOT, EIP and CRHT provision • Foundation Trust strategic aim to reduce reliance on acute inpatient beds developing alternatives to hospital admission • Imposed cost efficiency targets for the organisation

  5. Drivers for Change RCP AIMS accreditation & HCC Standards • RCP & HCC identified a number of evidence based standards acute wards should aspire to and meet in order to demonstrate good practice • NTW plans to have all of it’s acute wards AIMS accredited & plans to meet HCC recommendations • Extremely difficult for mixed gender facilities to achieve accreditation or meet HCC standards • Would require significant capital investment and major structural changes in Tranwell to make it possible • No reduction in Gateshead bed numbers following significant community investment

  6. Capacity Impact of Change National Recommendations for Adult General Psychiatry Beds • Comparison of acute beds provided by Gateshead with the recommended requirements evidenced by the RCP • Comparison completed on the number of beds required per 100,000 ‘weighted’ population • RCP recommend we have 25 – 33 beds per 100,000 population • Currently have 55.9beds per 100,000 in Gateshead • Following bed reduction we will have 38.7 beds per 100,000 population which is still well within recommended range • Figures obtained from the Centre for Public Mental Health at Durham University using MINI2000 from the service profile they completed for Gateshead PCT in 2002

  7. Snapshot of Bed Usage 07 • On 2 August 2007 there were 59 service users registered as inpatients in Tranwell • 12 out on home leave (8 of which for a period > 1 week) with 47 people actually in the Unit • Percentage occupancy rate of 78.3% • 5 service users within PICU • Delayed discharges totaled 17 • Figures indicated that of the 59 inpatients at least 25 could have been treated and supported in other, less restrictive, ways

  8. Outline Business Case • New Urgent Care Day Service (Alternative to admission) • Adaptation of Lyndhurst Ward. Capital cost of adaptation approx. 150K but is a spend to save initiative (More efficient services) • Patient group would be those requiring intensive treatment and inpatients nearing discharge from hospital (Less restrictive) • Increase capacity for the prevention of unnecessary admissions and promotion of timely discharge (Increased patient flow) • Service to be managed by CRHT Team with partial transfer of revenue / staffing establishment (Increased capacity where needed) • Inbuilt safety net via evaluation mechanisms with the opportunity to review effectiveness (Service flexibility) • Services that meet national standards (More effective services) • Better use of public money (Cost improvement targets)

  9. Considerations • Occupancy rates from Aug ’06 to June ’07 = 99.8% • Snapshot and subsequent data suggests actual occupancy rates and demand for beds is steadily decreasing 70 – 75% • New telephone triage systems and additional staffing resource should enable CRHT to focus more on treatment with further capacity for enhanced service • New Urgent Care Day Service provision will enable the CRHT to offer an alternative service to those who would previously have been admitted to acute wards and support early discharge, which has historically been delayed for many people

  10. Summary • Lyndhurst Ward closure reduces beds to 40 + 5 PICU • Leaving 38.7 beds per 100,000 population which is above RCP recommendations • Reconfiguration provides alternatives to admission and a more efficient, modern, treatment focused urgent care service for people with substantial/critical levels of mental health need • In conjunction with bed reduction the remaining services must be fully functional i.e. • Additional capacity crisis resolution/home treatment is essential • Additional capacity remaining wards to manage increased acuity • Priority for discharged patients given from community services • Local Authority & Voluntary Sector support is paramount to expediate delayed discharges and maintain community support

  11. Summary • NTW is required to provide a range of community & inpatient services and must do this in a balanced & efficient way that: • Continues to meet the needs & aspirations of service users & carers • Makes efficient use of public money through increased activity with improved outcomes • Moves mental health service provision forward in the agreed strategic direction towards greater community provision with less reliance on bed based services • There is real change in the way people can access services following extensive investment in community teams in recent years • The changes proposed should ensure that service users are wherever possible treated at home or within the least restrictive environment

  12. What Now ? • Evidence and work of the project team and user questionnaire is sufficient to support Full Business Case & Formal Consultation (Feb 09) • Proposals presented to Gateshead Mental Health Partnership seeking support (Feb 09) • Proposals presented to Gateshead Overview & Scrutiny Committee prior to formal consultation process (Feb 09) • Return to Gateshead Overview & Scrutiny Committee during formal consultation seeking views on proposed changes (March 09)

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