10-bed Assessment Unit fiasco: Can it get worse?

Several supporters have been in touch. They tell us that while Nic Rigby’s report of the rejection of the opening of the 10-bed Assessment Unit is accurate, it is quite conservative in the conclusions it draws.

We have also been sent by several sources the relevant sections of the Investment Committee (IC) report submitted by Adrian Stott to the main Board of Directors meeting of Norfolk & Suffolk NHS Foundation Trust (NSFT) on 23rd October 2014. The agenda for the Board of Directors meeting claims the IC report to be verbal and this written report was not included in the papers posted on the NSFT website.

Report to: Board of Directors

Meeting Date: 21/10/14

Title of Report: Investment Committee Chair’s Report

Action Sought: For information

Estimated time: 3 minutes

Author: Adrian Stott: Chair of the Investment Committee

Director: Adrian Stott: Non-executive Director

Executive Summary:

The Thurne Ward CF1 was not approved due to negative net financial return, lack of CCG funding and NED concerns on direction of travel.

A CF1 to open Thurne Ward as a 10-bed assessment unit was discussed (note: this is not on the meeting agenda, as it was a very late addition). The CF1 included capex cost of £0.4m and operating cost of £1.9m p.a. against savings of £2.4m in year 1 and of £1.4m in subsequent years. CCGs have indicated operating cost funding for 3 months (1-3/15), but negotiations are only at a very early stage for possible long-term funding. Capex would not be covered by CCGs. Concerns expressed included the negative return, the addition of £1.9m of unfunded ongoing operating costs to NSFT at a time of financial distress, and that the focus to reduce OOA cost should instead be on reducing the number of inpatients who are not ill enough to be inpatients. IC decided to defer the CF1, with any future approval likely to require long-term CCG funding of operating costs.

There were some Exec views that the average ongoing OOA level may now be c.30 people (if no actions to change).

What do we learn?

1. NSFT is indeed, in its own words, in ‘financial distress’
2. Despite making a public declaration in January 2014 to eliminate the use of out of area beds by the end of April 2014, the Magnificent Seven CCGs are unwilling to provide the funding to make it possible in a safe and prompt fashion.
3. Despite making a public announcement in September 2014 to open a 10-bed Assessment Unit at Hellesdon Hospital, NSFT did not have funding for the project and has been unable to receive approval from its own Board for the project finance
4. Given that ‘negotiations are only at a very early stage for possible long-term funding’, it is clear that there is no sense of urgency or public accountability from the NHS bureaucracy, since:
   • The CCGs undertook to eliminate the use of out of area beds back in January 2014
   • In April and May 2014 both Health Secretary Jeremy Hunt and his friend Norman Lamb, Secretary of State for Health directly responsible for mental health and a Norfolk MP, said the use of out of area beds was ‘totally unacceptable’
   • The number of out of area placements continues to grow, now reaching 50 (which excludes specialist and child placements)
5. The NSFT Board is divided. The non-executive directors have ‘concerns on direction of travel’ while dissenting ‘Exec views’ are that ‘the average ongoing OOA level may now be c.30 people (if no actions to change).’
6. ‘Negative net return’ – i.e. not making a profit – trumps human need and public promises
7. This isn’t merely a ‘report’. It is rather a report which records a decision by an important Board subcommittee to refuse funding for the 10-bed Assessment Unit.

There appears to be very little evidence of input from clinicians, service users, carers, the evidence-base or sunlight into this decision-making process: it seems to be driven by a toxic combination of finance, dogma, bureaucratic wrangling between various quangos and wishful thinking.

What clinical qualifications or experience do former equities analyst Adrian Stott and his non-executive director colleagues have that allow them to know better than Approved Mental Health Professionals (AMHPs), nurses and doctors, and indeed statute, that there are too many people in hospital and ‘that the focus to reduce OOA cost should instead be on reducing the number of inpatients who are not ill enough to be inpatients’? They appear to have none.

Adrian Stott and his colleagues should talk to recently-bereaved relatives, as we do. This month, we supported a campaign supporter whose son was told at a time of crisis there were no beds anywhere in the trust; that the nearest private beds were in Somerset or Manchester but those beds were only available for the psychotic; that there were no beds available for ‘the suicidal’ and that he had to take responsibility for his own life. The man’s son killed himself shortly afterwards.

Yesterday, after we posted Nic Rigby’s article on our Facebook page, a grieving mother wrote:

My son is dead because there were no local beds for him and the mental health service did not take him seriously.

For how much longer will this shameful situation be allowed to continue?

We are moving from crisis to meltdown.

What is the ‘negative net financial return’ on a stream of funerals?

This is an absolute disgrace. Shame on you, Norman ‘mental health champion’ Lamb.

Join us at our anniversary public meeting on Thursday, 27th November 2014 and help us fight for decent mental health services for the voiceless and the vulnerable.