The Staffordshire and Stoke-on-Trent Integrated Care System (ICS), previously known as Together We’re Better (TWB), is supporting the Midlands Partnership NHS Foundation Trust (MPFT) as it works 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.

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 is currently going through the 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 will launch on or before 9 February and will be hosted from this page on the ICB website.

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

Background

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

• Listening exercise paper
• Summary listening exercise paper
• Communications and involvement strategy
• Report of findings
• Summary report of findings
• Public responses on general practice which should be read with the main report of findings. 
  
  

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

• Issues Paper
• Summary of Issues Paper
• Presentation (used for two online events)
• Report of Findings
• Summary Report of Findings
• Reference Group Report of Findings

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:

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 there may be further opportunities for people to share their views on the programme.