Work is continuing to review a number of health services across Clyde, including mental health services. The aim is to develop and improve existing services and increase the range of mental health services available locally.
This work started after the Board took on responsibility for delivering health services across Clyde in April 2006. Since then local planning groups, involving service user representatives, have been working with frontline staff to review the way existing services are organised and assess the accommodation available for delivering local mental health care. A number of community engagement meetings were held across Clyde in March 2007 to give local service user and carer groups the opportunity to tell us what they thought of existing mental health services and what type of services they would like to see developed in the future.
Staff, service user representatives and community groups will be updated on further progress this week. This will help inform final proposals and recommendations which will then be considered by the NHS Greater Glasgow and Clyde Board at a meeting on 26th June 2007. If approved, the proposals would then be subject to formal public consultation from the summer.
It is clear from the work carried out to-date that there is a real need to develop and expand community based services across Clyde to improve patient care and provide more alternatives to hospital admission. This is particularly important as the vast majority of patients with mental illness can appropriately be treated in the community and only a small number need to be admitted for inpatient care. The lack of a comprehensive network of community based mental health services across Clyde has led to a higher dependency and usage of inpatient services compared with other parts of the country, including Greater Glasgow. As a result, some patients in Clyde are currently admitted to hospital because of a lack of suitable alternative community-based mental health services and support.
Anne Hawkins, Director of the Mental Health Partnership, NHS Greater Glasgow and Clyde, said: “There is a real need to shift the balance of care and resources from inpatient services to community based services, in line with arrangements in other parts of the country, including Greater Glasgow. By rebalancing services we are seeking to both free up funding for reinvestment in much needed local services, and contribute to the overall financial recovery plan for Clyde. This approach also gives us the opportunity to redesign and develop local services across Clyde to meet the needs of local service users and their families.”
The need to expand existing community based services is echoed by local service user representatives and carers who are keen to see more services delivered locally. They also want local service users in Clyde to have access to the same type and range of community based mental health services available in Greater Glasgow.
This could be achieved by:
Introducing new Community Crisis Services across Clyde – to provide additional intensive support for people with a serious mental illness during evenings and weekends and enhance the service provided by existing community based mental health teams which currently operate Monday – Friday from 9am – 5pm.
Developing and expanding Primary Care Mental Health Services across Clyde - to improve the care and treatment of people with mild to moderate mental illness including stress, anxiety and mild depression. These services offer a wide range of support and treatments including behavioural or ‘talking therapies’ such as Cognitive Behaviour Therapy (CBT). Although Primary Care Mental Health Services are currently available in some parts of Clyde they are not consistently available across the whole area. This means many GP practices may experience difficulties in accessing mental health counselling, therapy and treatment for patients. This service gap in turn places an increased burden on community mental health teams, reducing their capacity to provide care to patients with more serious mental illness.
Enhancing community based mental health teams – to increase the skill mix and capacity of existing teams across Clyde. This will enable them to provide care and treatment to a larger number of patients and, in conjunction with primary care mental health services, help reduce waiting times.
Investing in supported accommodation, residential care and home care services – to provide additional alternatives to hospital care and enable people who do require inpatient treatment to be discharged from hospital at the earliest opportunity into these care settings.
Developing and improving existing community based services and investing in a range of new services will help reduce the need for hospital admission and reduce the average length of stay for those people who do require inpatient care. This, in turn, will make it possible to reduce the number of inpatient mental health beds across Clyde while still meeting local demand. It will also free up resources required to strengthen the primary, community and residential services described above.
A number of options to redesign the way existing inpatient mental health services are organised across Clyde are also being examined. These options are still at an exploratory stage and will be subject to further work to examine the logistics and feasibility in more detail. They will also be informed by feedback from local staff and service user representatives.
These include options to
Explore how existing continuing care mental health beds for older people currently provided on the Ravenscraig, Dykebar and Dumbarton Joint Hospital sites could be re-provided locally by commissioning new NHS continuing care beds in partnership with the independent sector or transferring beds to an alternative hospital site. These beds could significantly improve the quality of the patient environment by providing single room en-suite accommodation. Similar partnership arrangements operate successfully elsewhere in Scotland. This will also enable us to progress the closure of Ravenscraig Hospital as previously agreed
Consolidate adult acute admission services for Renfrewshire on a single site alongside general acute hospital services. This could be achieved by transferring adult acute admission services from Dykebar to the Royal Alexandra Hospital in Paisley. Adult acute admissions services would remain at Inverclyde Royal Hospital. As a result of proposed improvements in community services, it is likely fewer beds would be needed at both locations in future.
Concerns have emerged about the sustainability of mental health medical cover for adult and older peoples’ acute mental health admission services provided at the Christie and Fruin wards in Vale of Leven Hospital. In addition, we will need to explore how the recommendation to transfer unplanned general medical admission services from the Vale of Leven to the Royal Alexandra Hospital in Paisley may affect existing mental health services. An option to transfer adult and older peoples’ acute mental health admission beds from the Vale of Leven to Gartnavel Royal Hospital in Glasgow is therefore being explored in the event that concerns around mental health medical cover cannot be resolved.
Maintain mental health acute admission beds for older people in Renfrewshire and Inverclyde locally on the existing Royal Alexandra and Inverclyde Royal Hospital sites. Further work will be undertaken to explore whether there would be benefits in consolidating acute admission beds for older people in East Renfrewshire on a single site as they are currently provided in Levendale and the Royal Alexandra Hospital.
Transfer the existing South Clyde 8 bed Intensive Psychiatric Care Unit (IPCU) which is currently based at Dykebar in Paisley to Inverclyde Royal Hospital. This would improve access to general acute hospital services and maintain close links with adult mental health admission beds.
Transfer the small number of IPCU beds which are currently accessed by service users in the Clyde part of West Dunbartonshire from the Argyll and Bute Hospital in Lochgilphead to Gartnavel Royal Hospital in Glasgow. This will significantly improve access and avoid the need for local people to travel long distances.
Transfer low secure learning disability forensic beds from Dykebar to Leverndale Hospital, which currently accommodates low secure provision for Glasgow patients. An option to provide low secure adult forensic mental health beds at Levendale Hospital for Greater Glasgow and Clyde is also being explored to bridge the service gap which currently exists in Clyde. The consolidation of low secure forensic services on a single hospital site will ensure there is a better critical mass of provision and more opportunities to share clinical expertise. It was agreed last year that medium secure forensic services for the West of Scotland would be provided at the new Rowanbank Clinic in Glasgow on an interim basis. Further work is underway with West of Scotland NHS Boards to explore whether this should become a permanent arrangement. Initial indications are that this would make sound clinical and financial sense.
Re-provide existing Clyde inpatient addiction beds from the Gryffe Unit on the Ravenscraig site. One option currently being considered is whether these beds could form part of a South Glasgow and Clyde addictions service.
Transferring adult acute admission services from Dykebar would also free up modern, high quality single room accommodation within the existing Adult Acute Admission Unit on the Dykebar site. This Unit could then be used for other services such as adult continuing care, which are currently provided from older accommodation on the Dykebar and Ravenscraig sites. We are also exploring the development of new Clyde-wide adult intensive rehabilitation beds which could also be located at Dykebar within this modern unit.
For further information contact 0141 201 4429.