We are running a consultation on our proposal about where we provide the inpatient (hospital bed) services that were previously provided at the George Bryan Centre.

Background – changes to national best practice

Our priority is to deliver quality mental healthcare for patients in their own home or community whenever possible, rather than admitting people to hospital. This model of care is the national ambition set out in the NHS Long Term Plan. It is based on the latest clinical evidence, which shows that this approach gives the best outcomes for most patients.

This is not new – we have been working with our partners and investing in our community mental health services for many years. We have enhanced our community teams and built better ways of working to help us meet the national goals – like making community services easier to access and giving people more choice and control over their treatment.

For the small number of patients who do need a hospital stay, we want to make sure that the right specialist staff are on hand to give them the best care.

Background – the George Bryan Centre

The George Bryan Centre provided mental health beds for patients living in Burton upon Trent, Lichfield, Tamworth and the areas around those towns:

• the West Wing had 19 beds for adults aged 18 to 65 with severe mental illness
• the East Wing had 12 beds for older people (aged 65 and over) with dementia and/or other mental health problems.

In February 2019, a fire destroyed the West Wing. The patients there were transferred to St George’s Hospital, Stafford, to a ‘contingency’ ward that was kept for use during peaks in demand. Since then, this ward has been refurbished and provides 18 beds.

Soon after the fire, the board of Midlands Partnership NHS Foundation Trust (MPFT) decided to temporarily close the East Wing, for safety reasons.

Since the centre’s temporary closure, we have been investing in our community mental health services and improving them. This is in line with national best practice, which is for mental healthcare to be provided in people’s own homes and communities whenever possible, rather than in hospital.

Our enhanced community mental health services mean that most patients who would have previously stayed at the George Bryan Centre can now be supported in the community, which is better for their long-term wellbeing and independence.

Since the centre’s temporary closure, most patients from the area who have needed a hospital stay have been admitted to St George’s Hospital in Stafford, with a small number going to different hospitals further away.

We are proposing to make the temporary changes permanent, which means keeping open the refurbished 18-bed ward at St George’s Hospital, Stafford, and not reinstating beds at the George Bryan site.

Our consultation document, which is available in full, summary and accessible versions, explains how and why we have reached this single proposal.

Small, standalone inpatient sites like the George Bryan Centre are no longer considered the best option for mental health patients. There is a clear national drive to treat as many patients as possible at home rather than admit them to hospital. Clinical evidence suggests that better outcomes can be achieved this way and we now have enhanced services in the community.

Where inpatient care is deemed necessary it is better to do this in larger facilities that tend to have a greater range of staff and treatments available. Providing high-quality, safe care is more challenging at a small facility like the George Bryan Centre. St George’s Hospital is a bigger hospital with a much larger workforce and better facilities.

We sincerely believe that this model will lead to overall improved outcomes for patients with mental health needs.

Clinical evidence

“If people are admitted for longer than clinically necessary, they can become institutionalised, finding it harder to resume normal life (including loss or difficulty of finding work, benefits and a place to live).”

“Recovery and rehabilitation need to occur as close as possible to where people live – for example, training people in ‘activities of daily living’ while in acute inpatient settings does not adequately equip them to use these skills in the community.”

Source: ‘Improving acute inpatient psychiatric care for adults in England’, Feb 2016, The Commission to review the provision of acute inpatient psychiatric care for adults

“Hospital admissions (especially when extended) can exacerbate the symptoms of dementia, permanently reduce independence, and increase the likelihood of discharge to residential care and readmission to hospital.”

Source: ‘The dementia care pathway: full implementation guidance’, 2018, National Collaborating Centre for Mental Health

The three main potential problems involve patient safety, staffing, and quality of care.

Safety

At small sites it can be difficult to provide an adequate response if there are emergencies.  In 2018 (the last full year of the George Bryan Centre’s operation), the rate of police call-outs there was higher than at St George’s Hospital, when taking into account that the George Bryan Centre had a smaller number of patients. (You can read more about this in our business case, section 3.5.3, on our website.)

In the past, patients at the George Bryan Centre sometimes needed urgent transfer to St George’s Hospital in emergency situations because the larger hospital was better equipped to meet their needs. Transfers like this are not ideal, as they disrupt the patient’s care. (In 2018, 142 patients were transferred between the George Bryan Centre and St George’s Hospital.)

In a larger hospital like St George’s, which has many wards, staff can be moved between wards to provide extra support to deal with emergencies, as well as providing cover when colleagues are absent. St George’s Hospital has a psychiatric intensive care unit (for male patients) where very unwell patients can get intensive specialist care.

Staffing

Staff generally prefer to work at larger sites where they have more support available and colleagues with a greater mix of skills. This kind of environment supports staff to develop their own skills and become more proficient at providing care. Nationally there is a shortage of qualified mental health staff, and we are competing for staff with neighbouring areas. We need to provide settings where people want to work or they will go elsewhere.

Care

When it comes to high-quality care, outcomes for patients are better when they have access to a wider range of treatments, therapies and activities, provided by staff with the right specialisms. St George’s Hospital has that larger, more multi-skilled workforce, meaning that patients benefit from more specialist medical care, and therapies such as art and music therapy provided by on-site specialists.

As already mentioned, there is a shortage of qualified mental health staff, so staff have been redeployed, either providing services within the community or at St George’s.

Midlands Partnership NHS Foundation Trust (MPFT) received £1m from NHS Resolution, which insures all NHS buildings, including the George Bryan Centre. In line with NHS financial rules, this money is received as revenue and not capital. It will be released into this year's accounts (2022–23) and will be spent on community services. Revenue cannot be spent on buildings. 

NHS insurance cover is capped at £1m. Investment in buildings (capital) is managed by NHS England, through an established bidding process involving the writing of three separate business cases. In the case of the George Bryan Centre, the rebuild cost is estimated to be £11.37m. The bidding process allows NHS organisations to request the full cost of any new builds or rebuilds.

We need to make a decision about the services first, before any decision is made about the George Bryan Centre building. Once the future of the services is clear, we will be able to look at what happens to the building.

The enhanced community services are real and tangible. The following are some examples.

We have introduced integrated neighbourhood teams that provide care for anyone with a mental health condition who does not need inpatient care. There are four teams in the area covered by the consultation – East Staffordshire; Burntwood, Lichfield and Mercian; Stafford and Seisdon; Cannock, Rugely and Great Haywood.

Integrated neighbourhood teams work with staff in local authorities and the local voluntary sector organisations to give more support to people using our services. The teams bring together medical professionals (nurses, medics, healthcare support workers, occupational therapists and pharmacists) with staff such as social workers and housing officers. They also bring in voluntary organisations like the Citizens’ Advice Bureau, Mind and the Alzheimer’s Society.

This means we can provide coordinated, wrap-around care – addressing the range of problems that may affect a person’s mental health, such as physical health problems, substance abuse and addictions, and social/financial problems such as debt or housing difficulties.

There are services to provide support for people experiencing a mental health crisis. Our Crisis Resolution and Home Treatment (CRHT) team works 24/7 and responds within four hours if someone needs urgent help. There is a Hospital Avoidance team (enhanced since 2019) doing the same work with older adults.

We have opened the Safe Haven Crisis Café at the Sacred Heart Church, Tamworth. This is a safe, supportive environment, offering emotional support, information on other help and services that are available, and guidance on skills for coping with a crisis. It will be open 365 days a year, outside normal working hours:

• Weekdays: 5pm to 11pm
• Saturday and Sunday: 9am to 5pm
• Bank holidays: 10am to 2pm

There is specific support in place for older adults with dementia and/or other mental health needs, starting with an older adult specialist being involved when a patient or their carer first gets in touch to ask for help. They help get the right teams in place for each patient and to speed up the process. Voluntary sector organisations are also involved – for example Alzheimer’s Society dementia advisers supporting people at home, and Burton Mind, who will be providing a newly launched home sitting service to give carers some respite.

The home sitting service will have two 2-person teams who will be able to spend time with an older person at home, allowing their carer some much-needed time to themselves. This service covers East Staffordshire, Lichfield and Tamworth, Stafford Borough and Cannock Chase and is available:

• weekdays: 4pm – midnight
• weekends: 12 noon – midnight.

The service is linked to the Crisis Resolution and Home Treatment team, who will refer patients to the service.

We’ve always acknowledged that travel is an issue for some people.

MPFT is developing a standard operating procedure (SOP) to help those affected by the temporary closure of the George Bryan Centre. The purpose is to help this group of family, friends and carers to visit and stay in touch with loved ones who have been admitted to St George’s Hospital

If the proposal to keep the beds at St George’s Hospital as the long-term solution goes ahead, the SOP would stay in place to support the change for a period of time (not yet decided).

Apart from help with costs, MPFT has promised to help in other ways.

• Making visiting times at St George’s Hospital more flexible, to make visiting easier for visitors who use public transport
• Supporting ‘virtual visiting’ – staying in touch through video calls. This includes making sure that patients and visitors have access to devices like tablets. MPFT’s website has a page with support and guidance about digital skills: mpft.nhs.uk/about-us/digital/training

As part of the consultation, we are asking for people’s ideas and suggestions about how we can support visitors if we decide to keep the beds at St George’s Hospital. MPFT will look at all the ideas and suggestions and use them to help finalise the travel standard operating procedure.

It has to be remembered that our improved community offer means that overall the number of people needing to travel has significantly reduced. Lengths of time that patients spend in hospital are also coming down – this is in line with national best practice, which is for mental health hospital stays to be as short as possible, until people can safely go home, with continuing support coming from community teams.

Even when the George Bryan Centre was open, it was not a certainty someone would be admitted there even if it was their nearest mental health unit. One reason would be the severity of their illness – patients who needed specialist treatment because they were very unwell were more likely to be admitted to St George’s Hospital or other specialist settings. In fact, analysis that we carried out around activity and travel showed that, while GBC was still open, 75% of patients from the local areas were admitted to other hospitals – most to St George’s Hospital.

Long-term service changes are never rushed, although the fire meant inpatient care had to be transferred to St George’s Hospital as an emergency measure initially.

MPFT took time to consider the options. This involved talking to service users and other people locally.

A business case was then developed which was considered by both MPFT’s Board and the Staffordshire and Stoke-on-Trent ICB. Then there also had to be external scrutiny as otherwise we would be marking our own homework. This included expert input from the West Midlands Clinical Senate and the NHS England assurance panel.

Of course, as with many other things, the COVID-19 pandemic caused considerable unforeseen delay.

There are strict laws about service changes of this kind. We do have a preferred option, and the law means we must set out why. We also need to give people adequate opportunity to respond, we must show we have listened to those responses and adjusted our plans accordingly if there are important issues raised that we have missed.

All responses, however they are received, will be analysed and a report of the findings will be published.

Failure to do this can be expensive and time consuming and lead to the whole process being brought before a judge who could tell us to repeat it.

So yes, this is a genuine consultation, and although we think we have identified the best option, we could make changes.

Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) is the body legally responsible for making a decision. (Integrated care boards are the organisations that commission NHS services in their local area, from the NHS trusts and other bodies that provide them.) Before any decision is made, we are asking the public:

• if there are any other ideas we have not considered
• if there is any positive or negative impact we need to plan for, if we decide to go ahead with this proposal
• how we can support people if these changes are agreed, including how we can support people with travel.

The ICB will look at the views and comments that people give us during the consultation, and consider these alongside issues like patient safety, how we can provide the best care, and how we can safely staff our inpatient and community services.

The report of findings from the consultation will be carefully considered by the Staffordshire County Council Health and Care Overview and Scrutiny Committee, as well as by the ICB. And the ICB will continue to work with NHS England and the Consultation Institute, who will monitor our decision-making process.

It is anticipated that the ICB will make a decision late summer/early autumn subject to the findings of the consultation.

Join an online event – you need to register for these on our website at https://staffsstoke.icb.nhs.uk/get-involved/consultation-and-engagement/consultation-inpatient-mental-health-services-south-east-staffordshire/.

• Friday 3 March 2023, 1pm – 4pm
• Thursday 9 March 2023, 10am – 1pm

Drop in to an event

• Lichfield Library Thursday 23 February, 10.30am – 2.30pm
• Asda, Ventura Road, Tamworth Monday 6 March, 10.30am – 2.30pm
• Burton Library Friday 10 March, 10am – 2pm
• Asda, Octagon Centre, Burton Friday 17 March, 10.30am – 2.30pm 

Fill in our survey

• You can fill in our survey online at staffsstoke.icb.nhs.uk/mentalhealthconsultation, or you can complete the survey on paper in the printed consultation document.

We have promoted the consultation:

• to the public via our website, through social media, and a printed leaflet and poster
• to staff using channels such as newsletters and intranet sites
• to stakeholders with updates (emails and letters)
• through the media, via press releases and advertising.

So that we can reach as many people as possible, we have prepared accessible versions of our consultation document and survey, a summary version of the consultation document, and two animations (one explaining the journey to reaching our proposal, and one walking people through how to access mental health services).

We will organise for the consultation documents to be translated on request.