“NSFT are not to fit to lead or manage mental health services in Great Yarmouth and Waveney. The testimony and reflection above demonstrates this. As such, nothing they propose can be trusted by the CCG to be able to address the endemic problems they themselves have caused.
The Waveney AMHP group calls on the CCG to wholly reject NSFT’s proposals, for the executive board of NSFT to resign and for a new board to enter into a rational and honest debate with the CCG to address both the problems of provision and cuts to funding. East Anglian Ambulance Trust has recently gone through this process. It is showing dividends in practical and strategic terms. There is no reason why the same should not be true for NSFT.”
Here is the letter in full (excepting redactions to guarantee confidentiality):
Letter from Waveney approved mental health professional (mental health act, 1983) group in response to consultation on NSFT’s proposed bed closures in great Yarmouth and Waveney.
We note with contempt the patronising attitude of the trust’s representatives at recent public consultations. This insulted the intelligence of the public the trust serves and brought mental health workers into disrepute.
Work under the mental health act has doubled in frequency of referral and length of time since 2 years ago. Effectively, AMHPs have seen a fourfold increase in their workload because of this.
The reasons for the doubling of frequency are:
- Cuts to and dilution of focus and purpose in community teams. This has been directly worsened by the uptake of voluntary redundancy by experienced and skilled workers in these teams. The residual workforce is both less experienced and knowledgeable and is now expected to deal with such a broad spectrum of mental health need that those at risk of hospital admission get a very poor service.
- Cutbacks in other areas of social provision have had a magnified effect on this group, compounded by the lack of service from NSFT.
- The chronic, chicken and egg, impact of the crisis in bed provision has caused there to be a significant increase in “revolving door” admissions.
The reasons for doubling of duration are:
- Overwhelmingly, the shortage of beds. AMHPs are waiting for hours, sometimes days, for NSFT to meet its responsibilities under the mental health act to provide suitable hospital beds to receive detained patients.
- Following this, problems in working with other agencies, notably the police and the ambulance service, to arrange conveyance of potentially dangerous and definitely vulnerable persons to hospitals that are often hundreds of miles away.
The overall effect on the AMHP service is to place it in a position of huge stress: workers are complaining they cannot do their jobs properly, they are going off sick, their private lives and own mental health are suffering.
The effect on service users and their relatives is profoundly alarming.
The effect on working relationships with frontline police, ambulance staff, NSFT staff is negative: stress is expressed in rebukes and blaming between personnel, their managers spend precious time supporting hurt colleagues and unravelling cause and effect in these individual incidents.
Below, we provide some anonymised, recent examples of how our work, ourselves, our colleagues and our clients have been adversely affected by the ongoing crisis caused by NSFTs singularly incompetent leadership and management:
The referral came late in the working day on the eve of a public holiday. A young man in his twenties in Lowestoft, having a psychotic episode, very paranoid, thought disordered, self harming and had recently attacked his father. Following assessment I received 2 medical recommendations for his urgent admission to hospital under section 2. However, I was unable to comply with my legal duty under the Mental Health Act to facilitate this admission, as there were no beds available in the NSFT area. The only bed available was a private hospital bed in [redacted but London hospital], which itself turned out to be impossible to arrange for the following reasons:-
– The private out of area hospital was very reluctant to accept the patient, not able to consider the admission until the following day. Refused to accept written risk assessment provided by the young person’s early intervention team due to “not being detailed enough”, despite my providing a comprehensive written report and verbal account to them over the telephone.
– East Anglia Ambulance Service unable to convey to beds out of area. Also private ambulance provider did not have capacity to provide the conveyance until the following day.
Despite their great efforts, the only other option the bed management team could offer was an overnight crisis leave bed at Hellesdon Hospital, Norwich, available until just 9.00 a.m prompt the next day. This raised the highly unsatisfactory prospect of further travelling and moves jeopardising the young man’s mental health further. While I was trying to make these arrangements and seemingly making no progress whatsoever, both the patient and family’s anxiety and confusion increased.
Ultimately I felt forced into a making a very risky judgement to leave the young man with his father overnight, passing the completion of the assessment onto the Emergency Duty Service (EDS) AMHP the following day. This was a decision purely dictated by the lack of a locally accessible bed resource, and also the absence of any available alternative. I remained highly anxious overnight for the safety and welfare of the patient and his father, as well as my own professional accountability in that situation. The next day I spent considerable time liaising with the EDS AMHP who then faced having to arrange a potentially traumatic hospital admission for this young man hundreds of miles away from his Lowestoft home. Thankfully in the event an unexpected discharge from Carlton Court enabled a local admission for him in the late afternoon of New Years Day, approaching 24 hours after the referral was first received.
This scenario highlights the already acute shortage of local beds, and the difficulties of co-ordinating out of area alternatives, particularly as it was difficult to secure an admission to the private hospital. The refusal of the East of England Ambulance Service to convey out of area compounded this problem, with the private ambulance provider also not able to offer a timely response. The net result of all this was an acutely unwell young person and his family being left at risk overnight, and it was only as a result of luck that nobody came to serious harm.
March 2014 MHA [Mental Health Act] ASSESMENT in the PIC [Psychiatric Intensive Care] – no beds available locally – 4 hr delay in locating Bed at The Priory, Essex. EAA [ambulance] delay 2½ hrs. Initially refused to convey – based on Risk. Police Officers x 3 accompanied. Daytime AMHP arrived home 12:45 a.m. Datex completed. AMHP worked 15½ hr. day. SECTION 2 admission.
March 2014 – MHA ASSESSMENT in service user’s parents home. [Service user] attempting to leave. No beds locally – Chaos experienced during ‘process’ of identifying a bed – 5hr delay – 12.00pm – AMHP handed over to Out of Hours worker to complete. AMHP home 12.30. AMHP worked 15 hr day. SECTION 2 admission.
MHA assessment took place [close to Christmas] which resulted in a [redacted but a woman in her nineties] year old female with dementia being admitted to the Julian Hospital in Norwich. It was evident from my discussions as the AMHP with the Consultant Psychiatrist who had knowledge of the person that the least restrictive option would have been for her to be placed in an alternative to admission bed locally. Relevant issues highlighted by this assessment from my perspective as an AMHP included –
- NSFT had commissioned a number of beds at this residential/nursing home as an alternative to admission; however it was not possible to place her there despite my understanding being that funding would have been available to fund an extra member of staff to manage the presenting risk. Whilst acknowledging the date and time of the potential placement (i.e. [close to Christmas]) a more flexible response would have been beneficial in meeting the needs of a very frail, vulnerable and elderly person.
- Due to the lack of availability of the above placement it was necessary to admit her to a hospital in Norwich; a more local bed being available at Carlton Court would have, at least, made it possible for the person to be admitted in a more timely and appropriate way.
- The person had recently experienced considerable distress through being rehoused twice as a result of the recent floods in Lowestoft; the outcome of the MHA assessment compounded her levels of distress even more so.
- The conveyance of the person to Norwich was delayed by about 2 ½ hours due to how long it took for the ambulance to arrive. This led to the arrival and subsequent admission to hospital in Norwich taking place about 9.00 p.m. which clearly was very disruptive to the normal evening routine of this very vulnerable person.
Summary and Conclusion
NSFT are not to fit to lead or manage mental health services in Great Yarmouth and Waveney. The testimony and reflection above demonstrates this. As such, nothing they propose can be trusted by the CCG to be able to address the endemic problems they themselves have caused.
The Waveney AMHP group calls on the CCG to wholly reject NSFT’s proposals, for the executive board of NSFT to resign and for a new board to enter into a rational and honest debate with the CCG to address both the problems of provision and cuts to funding. East Anglian Ambulance Trust has recently gone through this process. It is showing dividends in practical and strategic terms. There is no reason why the same should not be true for NSFT.
[Letter signed by all eleven members of the Waveney Approved Mental Health Professionals (AMHP) group]