Geraldine Scott of the Eastern Daily Press reports:
The region’s mental health trust has pledged to eradicate the use of out of area beds by 2021.
Oh dear. That’s three years away, a national target and seven years after commissioners’ original promise to end the use of out of area beds before the end of April 2014.
The ambitious claim follows broken promises over the last few years but the organisation said it is confident the goal will be achieved this time around as more detailed and comprehensive plans were in place.
The problem isn’t about ‘plans’. The problem is lack of resources in both inpatient and community services. Lack of money, lack of staff, lack of beds.
Norfolk and Suffolk NHS Foundation Trust (NSFT) has been hamstrung by a lack of beds for many years, meaning when a patient needs to be admitted to hospital they can be sent hundreds of miles away or to a private hospital.
Let’s remember that the crisis has become worse not better.
In some cases patients were kept in police cells for longer than they would have been due to a lack of beds.
Police cells are not an appropriate place for people who need mental health treatment.
Or in the case of 42-year-old Neil Jewell, from Norwich, when a bed was not available in 2014 he was instead placed in a care home, where his condition deteriorated.
He later died in hospital.
During 2013/14, 113 patients were sent to out of area (OOA) inpatient beds, outside of Norfolk and Suffolk, at a cost of £1.5m.
By the following year this had risen to 279 – a 272pc increase from the 79 patients sent away in 2010/11.
The most recent figures showed patients spent 8,585 bed days outside of the trust in 2017/18 at a cost of £5.4m.
So, the amount spent on out of area beds has increased by more than three times since commissioners promised to eliminate them.
Does that make us feel confident about the 2021 promise?
But commissioners agreed to cover any costs above NSFT’s £996,000 budget – an arrangement in place for this year too.
Rest assured that the commissioners will find a way to claw the money back.
And pressure is only set to increase as the trust has closed 36 beds – 28 temporarily – since autumn last year.
It will be fascinating to see how long ‘temporarily’ really is.
An NSFT spokesman said two new OOA placement managers had been recruited to help bring numbers down.
Because the bureaucrats solution is always more bureaucrats.
He said: “They monitor bed requests to keep patients within area, wherever possible, and where patients have to go OOA due to the lack of beds locally we look to bring them closer to home as soon as possible.”
The alternative could, of course, be to have more staff in the community working with service users and carers to keep people out of hospital and to have enough beds for those who need them. But that wouldn’t create more bureaucratic jobs, would it?
But commitments to stop OOA placements have been made before.
This was not achieved and more recently the trust set itself the goal of to October 2017, before being adjusted to the “more realistic” date of March this year.
This was again missed but now national targets have demanded all mental health services stop sending patients OOA by 2021.
Why should we believe a word of this?
This time around the trust said a more detailed plan meant they were confident they could succeed.
The trust said a number of steps were being taken to ensure the 2020/21 target was reached.
Oh, this sounds promising.
More community staff, restored crisis teams, assertive outreach, early intervention?
The first involved introducing a bed management system on NSFT’s computer system, Lorenzo, and managers had also been recruited to oversee OOA placements.
Because Lorenzo has been such as success.
More managers is just what is needed.
A review was planned for the management structure of the central Norfolk acute team.
Rearranging the bureaucratic deckchairs will help, won’t it?
Partial hospitalisation was also going to be introduced across all NSFT wards – this is where treatment is more concentrated than outpatient care but patients don’t stay overnight at hospital, and therefore do not need a bed.
If NSFT doesn’t have enough staff for its existing inpatient beds, how is it going to deliver this? Where will the money come from? Where’s the space?
Like much of the NHS many beds at NSFT are taken up when patients cannot leave due to social care not being arranged. These cases are known as delayed transfers of care and are being reviewed by NSFT, including bringing in executive trust members to tackle the issue.
Because the ‘executive trust members’ have been such a success and know so much about front line mental health services.
NSFT has been using ‘bed-blocking’ as an excuse for years but little has changed. In fact, lack of mental health beds is blocking beds at the acute trusts in Norfolk and Suffolk.
Any delays in the discharge process are being looked at and already seven beds have been commissioned as step-down beds to help people get home.
That’s nothing like the number of hospital and hostel beds closed during the radical redesign.
Also set to be introduced are a dedicated personality disorder provision, community wellbeing hubs, and a new project on patient flow.
That’s mental health sorted then. Especially with the chief commissioner who has failed to resolve the beds crisis, Antek Lejk, being imposed as the new Chief Executive of NSFT on 1st May, even after service users and carers found him unappointable. The CQC has twice found that NSFT does not have enough beds.
And we thought the problems were down to lack of money, front line clinical staff and beds. But no, it is all about ‘flow’, ‘projects’ and ‘hubs’. ‘Hubs’ presumably being the new name for the cuts café.
Click on the image below to read the article in full on the EDP website: