Inpatient mental health services south east Staffordshire

Inpatient mental health services south east Staffordshire

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19 December 2022


The Staffordshire and Stoke-on-Trent Integrated Care System (ICS) has been working with the Midlands Partnership University NHS Foundation Trust (MPFT) to identify a long-term solution to the inpatient mental health services previously provided from the George Bryan Centre. Following on from extensive stakeholder involvement activity and reviews of clinical data, clinical models, travel and equality analysis, a business case, including a recommendation of a single viable proposal to centralise inpatient beds at St George’s Hospital in Stafford, has been developed.

The proposal was the subject of a public consultation earlier this year. You can read the main report of findings or the summary report of findings.

The next steps are the development of the decision-making business case and the completion of the governance process ahead of any decision being made by the Integrated Care Board (ICB). We will continue to update the ICB website about this programme.

Background

Two proposals considered

As part of this work, two proposals have been considered:

Proposal: Centralise inpatient beds at St George’s Hospital

  • Patients who need inpatient treatment are admitted to St George’s Hospital in Stafford. This is for adults of any age experiencing a severe mental illness or dementia, who need intensive medical supervision and treatment in hospital
  • Wherever possible, patients are treated at home, supported by the enhanced community mental health services
  • Distinct enhanced services for adults of any age with a severe mental illness and for the population with dementia.

This proposal as found to be viable on clinical and safety grounds.

Proposal: Provide beds at George Bryan Centre site

  • Provide a ward with 18 beds at the George Bryan Centre site. This is for adults of any age experiencing a severe mental illness or dementia, who need intensive medical supervision and treatment in hospital
  • Wherever possible, patients are treated at home, supported by the enhanced community mental health services
  • Distinct enhanced services for adults of any age with a severe mental illness and for the population with dementia.

This proposal was found to be unviable on clinical and safety grounds and is based on a model which will help to deliver national best practice, based on clinical evidence, to people living in south east Staffordshire.

The business case has to pass through a number of required steps as part of the governance and assurance process. The most recent stage of that process was for the business case to be considered by the ICB. This took place on 18 August 2022, when the ICB was asked two things:

  • If they are assured by the process undertaken by MPFT in developing the business case and proposals to date
  • If they approve for the business case to be passed to the NHS England assurance process

The ICB confirmed they are assured by the process undertaken and approved for the business case to proceed to the next stage. This does not represent a final decision about the long-term solution for the provision of inpatient mental health services in south east Staffordshire, and there are several more stages which need to be completed before a decision is made.

The next stage in the process was for the business case to be considered by NHS England. This took place on 30 November and we await the outcome of that review.

On Thursday 19 January 2023 the Staffordshire and Stoke-on-Trent Integrated Care Board approved the recommendations put forward for inpatient mental health services in south east Staffordshire. The consultation ran between 9 February and 23 March 2023, and you can review the information from that consultation on this page on the ICB website.

You can also read the latest update on the news and events page of this website.

2023 Public Consultation

You can access more information by clicking on the title of the document, below:

Travel impacts and how we analysed them

  • What is this about?

    We are running a consultation about inpatient (hospital bed) mental health services in south east Staffordshire. It is about where we provide the inpatient services that were previously provided at the George Bryan Centre. The centre closed temporarily in 2019.

    We are recommending a proposal to keep 18 inpatient mental health beds at St George’s Hospital in Stafford.

    If the proposal goes ahead, there will not be any mental health beds at the former George Bryan Centre site.

    This would mean that some family, friends and carers would have a longer journey to visit patients who were admitted to St George’s Hospital in Stafford.

  • Why have you been looking at the effects on travel?

    We know that visits and support from family, friends and carers are very important and helpful to patients in hospital.

    We have heard from some patients and family members that they are worried about being able to visit and stay in touch if we keep the mental health beds at St George’s Hospital. For some people, travelling could take longer, be more difficult to manage, and cost more.

  • What group of people were covered by the activity and travel analysis?

    We looked at a group of adult patients from Stafford, Cannock Chase, east Staffordshire, Lichfield, south Staffordshire and Tamworth. These patients were admitted to wards at St George’s Hospital in Stafford, Harplands Hospital in Stoke-on-Trent and the Redwoods Centre in Shrewsbury.

    We didn’t look at patients who went into some specialist wards like those for eating disorders. This is because patients who need care for those particular conditions would not have been admitted to the George Bryan Centre, as it was not suitable for their needs.

  • What time period did you look at?

    We looked at the two years after the George Bryan Centre’s temporary closure (March 2019 – March 2021).

  • What were you looking at?
    • How long it took to travel from the patient’s home address to the George Bryan Centre
    • How long it took to travel from the patient’s home address to the nearest mental health hospital, not counting the George Bryan Centre.
  • How did you do it?
    • We used tools like TRACC software and OS Highways integrated road networks alongside TrafficMaster [2] road speeds data
    • We calculated public transport journeys using the most recent schedules from the National Public Transport Data Repository
    • We included time for walking to, from, and in between public transport stops
    • We looked at what it was like to travel at different times of day, on weekdays and at weekends.
  • What did you find out?

    If there are no mental health beds at the George Bryan Centre site:

    Travelling by car

    • Those living in Tamworth and Lichfield will be most affected in terms of travelling if there are no mental health beds at the George Bryan Centre site
    • Some visitors from the Stafford area may have a shorter journey if the beds are kept at St George’s Hospital

    Travelling by public transport

    • Visitors from Stafford, Cannock Chase and south Staffordshire whose family member/friend would have been admitted to the George Bryan Centre benefit most if we keep the beds at St George’s Hospital
    • Visitors from Tamworth and Lichfield may spend an extra 30–45 minutes on buses or trains if there are no mental health beds at the George Bryan Centre site
    • Given current public transport routes and schedules, only people living in a small geographical area would have better public transport access for visiting if beds were available at the George Bryan Centre site. These are people living in and around Lichfield and Tamworth.

    Through carrying out this activity and travel analysis, we also found out that, when the George Bryan Centre was open:

    • only one in four of the patients from the six areas around the centre were being admitted there when they needed a mental health hospital stay
    • three in four of the patients were already being admitted to other hospitals further away – most to St George’s Hospital in Stafford.
  • What will you do to help people who might have to travel further if this proposal goes ahead?

    Midlands Partnership University NHS Foundation Trust (MPFT) is the organisation that operates St George’s Hospital and operated the George Bryan Centre.

    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 with the travel costs of visiting patients at St George’s Hospital. (The SOP is available to read on our consultation website.)

    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 for a period of time.

    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 to St George’s Hospital. MPFT will look at all the ideas and suggestions and use them to help finalise the travel SOP.

     

     

     

Case Studies

Inpatient Mental Health Services

The George Bryan Centre (just outside Tamworth in the Lichfield District Council area) served the population of south east Staffordshire (Burton upon Trent, Lichfield, Tamworth and surrounding areas).

The West Wing had 19 beds for people aged 18 to 65. The East Wing had 12 beds for people aged over 65. The two wards provided assessment and treatment services for people with severe mental illness and dementia, including mood disorders, psychosis, anxiety, and depression.

This centre did not admit very seriously ill patients. Before the fire, 25 per cent of the total admissions to a mental health inpatient bed from the six district areas surrounding the George Bryan Centre were admitted to George Bryan Centre. The remaining 75 per cent were admitted to somewhere that better met their needs, including St George’s Hospital, Stafford.

In February 2019, a fire destroyed the west wing of the building. The remaining east wing was temporarily closed shortly afterwards on safety grounds.

As a temporary measure, people who need an inpatient bed are admitted to St George’s Hospital in Stafford. An enhanced community service is supporting people to remain in their own homes for longer. These arrangements are referred to as the “established operational position” in the business case.

Since 2019 MPFT, working with the Integrated Care System partners, has been exploring proposals for long-term service provision for the services previously provided by the George Bryan Centre. Following the feedback from clinicians, staff and through a series of listening exercises with the public and patients, they have developed a business case which outlines their recommendation to make the temporary arrangements permanent. This includes the continuation of the enhanced community offer for both groups of patients and the provision of the 18 beds for adults with acute mental illness, previously provided in the West Wing of the George Bryan Centre, being provided at St George’s Hospital, usually in the Milford Ward. These recommendations will now be considered by the Integrated Care Board, who are the statutory decision makers.

You can read about the previous involvement activity undertaken by clicking on the relevant link, below:

2019 Listening Exercise by Together We’re Better

2019 Involvement events by MPFT

A series of engagement events took place in 2019 to establish what was good about the services and what needed improving, to help shape the long-term solutions. Feedback could also be submitted by email or by post.

The Board of MPFT received a report detailing the outcomes of the engagement exercise [R(1] on 30th January 2020.

2021 Listening Exercise Refresh

At this point no decision has been made, and the business case will still need to undergo a robust assurance process and potential further involvement activity. As this involves the permanent reprovision of inpatient beds at an alternative site and a reduction in the number of beds for older people, due to an enhanced community offer, this is considered service change.

The NHS must meet certain statutory and regulatory requirements when considering service change. The table below shows the timeline of activity carried out to meet these statutory and regulatory requirements:

MilestoneDate
Listening exercise3 June – 25 August 2019
MPFT engagement activity25 September- 24 October 2019
Option appraisal process startsAutumn 2019
COVID-19 pandemic programme pausedMarch 2020 – August 2021
Sense check involvement with service users/staffOctober 2021
Technical group of clinicians and staff meets to review feedback10 December 2021
Public/patient reference group meets to review process to date and emerging viable proposal15 March 2022
Draft business case developedApril – June 2022
West Midlands Clinical Senate review10 June 2022
MPFT internal governance process28 June 2022
MPFT Board reviews business case30 June 2022
Update to Overview and Scrutiny Committee on process to date1 August 2022
ICB to review business case and decide whether to proceed to NHS England assuranceAugust 2022 – ICB members agreed to proceed to next stage
NHS England assurance processNovember 2022
ICB to decide whether to proceed with involvementWinter 2022/23
Working closely with Overview and Scrutiny Committee on potential plans for involvementAutumn to Winter 2022/23
Potential involvement activityWinter 2022/23
Analysis of involvement activitySpring 2023
Development of decision-making business caseSummer/Autumn 2023

This programme is being led by MPFT, and you can read more about it and the report of findings following the involvement work on the MPFT website.

NHSE Assurance Process and NHS Clinical Senate

NHS England and the Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) agreed to pause the Assurance Panel planned for September to allow the ICB to reflect further on the feedback received from our stakeholders. The Assurance Panel was rescheduled and took place on 30 November. We await the outcome of that panel review and will provide an update as soon as we can.

The NHSE Assurance Panel follows the ICB’s decision on 18 August 2022 to move to the next stage in the process which is gaining assurance from NHS England.

Following best practice and as part of our robust process for this programme, we commissioned the West Midlands Clinical Senate to independently review our work. The Clinical Senate is an established source of independent and objective clinical advice and guidance to assist health systems in making the best decisions about healthcare for their populations.

Under the terms of reference, the Clinical Review Panel were asked to:

  • Provide an opinion on the clinical model and recommended proposal
  • Explore the proposed clinical model and its alignment with the national strategy for mental health services to move from a bed-based model to one where patients are supported in the community where possible, with inpatient stays only where there is no alternative
  • Explore the proposal to centralise beds at the St George’s Hospital site in Stafford and to provide an opinion on the impact on patients.

The review panel has now published its report which includes five recommendations to support the transformation programme to move forward through the NHS England assurance process for major service changes. You can read the full report on the West Midlands Clinical Senate website.

No decisions have yet been made and we will continue to update this page about the programme.