An open letter to NSFT, its Board of Governors and the CCGs
Why the Ashcroft contract should be ongoing
The Bed Crisis
Over the last two years, there has been a serious shortage of acute inpatient provision. The number of patients placed out of area, in expensive private hospitals, has fluctuated constantly from a low of seven to a peak of more than fifty patients, around an average of twenty patients at any one time. This shortage of provision has contributed significantly to the Trust’s current economic problems. NSFT has consistently underestimated the number of beds needed and there has an upward trend with £600,000 being the latest monthly expenditure on out of area beds.
No Economic Sense
The cost of an out-of-area bed at The Priory: £3,850 per week
The cost of a bed at Ashcroft: £651 per week
The ‘Decant Beds’
In order to alleviate the crisis, seven ‘decant’ beds were commissioned: three at the Old Vicarage for male patients and four at Ashcroft for female patients. Our campaign argued at the time that this measure would not in itself be sufficient to alleviate the bed crisis: this has proved to be the case.
Alternatives to Admission
In 2012 Approved Mental Health Professionals (AMHPs) wrote to the Chief Executive of the Trust, expressing serious concerns about the Trust’s strategy of reducing inpatient provision, while at the same time cutting back on community care. Several meetings were held with Aidan Thomas, the then Chief Executive and Kathy Chapman, Operations Director. AMHPs were promised that alternatives to admission would be provided and that the Crisis Resolution and Home Treatment Teams (CRHTs) would be “enhanced”. However, the ‘alternative to admission’ working party – set up in June 2012 – produced very little of substance. AMHPs were given authority to commission 7 days emergency social care and – more recently – up to 80 hours of community support worker care (Julian Support) at any one time were made available to community teams. Neither of these measures has proved effective in reducing admissions.
In a crisis, CRHTs and AMHPs need to be able to access an alternative care placement, with the minimum of bureaucracy and without financial cost to the patient. Not renewing the contract for Ashcroft flies in the face of the Trust’s own service strategy and the recommendations of its own working party on admission prevention.
An Historic Opportunity
Before the cost-cutting of recent years, NSFT had developed services of outstanding quality. The Central Cluster CRHT and the Assertive Outreach teams were nationally recognised as leading examples of the ideal model. The Trust now has an opportunity to create a model of best practice by commissioning the beds at Ashcroft and the Old Vicarage as alternatives to hospital admission, in conjunction with support and treatment from the CRHT.
The latest National Confidential Inquiry into Suicides among mentally ill people noted that the number of suicides of patients under the care of crisis teams had increased. They recommended that caution should be exercised in offering home treatment to high-risk patients who live alone. To be able to offer support and home treatment to patients in a supportive setting such as Ashcroft would surely provide CRHTs with an additional weapon in their armoury.
Ashcroft is a Unique Service
Research tells us that many women who present to psychiatric services have experienced abuse in childhood and/or domestic violence. Many do not do well if admitted to mixed acute psychiatric wards. Ashcroft is a female-only care facility, with staff who are experienced in caring for women who have suffered abuse. It is significant that – when threatened with closure – service users themselves have come forward to defend Ashcroft. It is hard to imagine any other care home where this would happen.
We call on the Board of Governors, NSFT and the CCGs to commit to renewing the current Ashcroft contract that is due to expire in February 2015. We note that Norfolk County Council has guaranteed to fund social care beds at Ashcroft for the next three years. A similar commitment from the CCGs to fund four beds as an alternative to admission/step-down beds would ensure stability of staffing and service provision, both of which are currently under threat. Since this service can be used by any female patient in Norfolk and Suffolk, it should be funded by contributions from all Clinical Commissioning Groups.