What’s happening at Carlton Court? How different is it to what NSFT proposed and the public opposed?

Great Yarmouth & Waveney CCG (HealthEast) has set out recommendations this week for the future of mental health services after its public consultation. We are grateful to HealthEast for being the only one of Norfolk’s five clinical commissioning groups (CCGs) to hold a public consultation.

Let’s look at the facts:

1. Acute adult services at Carlton Court is being closed, exactly as proposed in the original consultation, with the loss of fourteen beds, leaving no acute adult beds in Waveney although six additional beds will be built in Great Yarmouth. This was opposed by 80% respondents in the consultation;
2. Larkspur ward at Carlton Court is being closed, exactly as proposed in the original consultation, with the loss of twelve beds, leaving no dementia assessment beds in Waveney or Great Yarmouth, with patients and families forced to travel to much more limited capacity in Norwich (four beds). This was opposed by 78.4% respondents in the consultation. This closure is apparently supported, in spite of massive public opposition, by Norfolk & Suffolk Dementia Alliance (NSDA). NSDA is quite unbelievably chaired by Maggie Wheeler, the Chair until Spring 2013 of Norfolk & Suffolk NHS Foundation Trust (NSFT), who led the Board which approved of the disastrous ‘radical redesign’ and massive cuts to mental health services across Norfolk and Suffolk. Wheeler fortuitously left NSFT before the full impact of her ‘improvements’ and ‘enhancements’ was felt;
3. Laurel ward at Carlton Court will eventually be closed, exactly as proposed in the original consultation, with the loss of twelve beds. The ward is being reopened on a temporary basis with ten beds ‘until services to support these patients in the community have been fully developed.’ Closing Laurel ward was opposed by by 78.4% respondents in the consultation. HealthEast, which puts the other CCGs to great shame in terms of transparency and genuine engagement, assures us that the beds will remain open ‘for as long as necessary’ but what does this mean? HealthEast tells us ‘The funding for Laurel Ward will be available for as long as complex patients in later life in Great Yarmouth and Waveney need an inpatient service’ but what happens if the beds are needed by patients from beyond the Great Yarmouth and Waveney area, for instance? Are we starting to see the emergence of a postcode lottery or what Jonathon Fagge would call ‘geographical innovation?’
4. Waveney will no longer have a place of safety for those in crisis with the closure of the Section 136 suite at Carlton Court. Some in the police supposedly support the change if it means that they now longer have to staff the suites but is this a change of benefit to people in crisis. Many remain dubious about police taking patients across county boundaries on a section 136. It is best practice for a doctor undertaking mental health assessments to know the patient: are doctors from Southwold or Lowestoft going to make the journey to Great Yarmouth? Without the adult acute ward at Carlton Court, it is almost impossible to have a Section 136 suite.
5. Waveney will no longer have a crisis team of its own. Healtheast claims it is irrelevant where the team is based. From our experience we’re not so sure as remote locations often become less well-served. We need to see how the team will be resourced, having seen what happens when NSFT ‘enhances’ crisis teams before.

At least now it appears that implementation will be phased, so that services and beds are not closed before new community services are in place and construction work completed and the new DIST team will be commissioned to work 24/7. These are improvements, given that previously NSFT closed Laurel and Larkspur wards and made their staff redundant at a cost of hundreds of thousands of pounds before the consultation had even begun.

But the bottom line is that Waveney will lose 26 beds (even if Laurel remains ‘necessary’ indefinitely), its section 136 suite and its dedicated crisis team.

Should any beds be closing when last week there were no suitable beds in Norfolk or Suffolk and the closest available bed was Manchester?

In looking at what is happening at Carlton Court, we’ve ignored the simultaneous and welcome announcement of the reopening of ten adult acute beds in Norwich, as these will be funded by the three central Norfolk CCGs and are intended for their residents – although these ten beds could reduce demand for HealthEast beds from central Norfolk, this is most unlikely as there are usually more than ten out of area placements beyond Norfolk and Suffolk whose repatriation from £625 per day private beds is a higher priority. Similarly, although the idea of moving Tier 4 CAMHS a few miles down the road (from Lothingland) will help fill the Carlton Court building, it is neutral in impact because it is moving ‘a centre of excellence’ and its staff into another. HealthEast claims that Lothingland was always temporary and the move ‘supports the future of Carlton Court generally’ but we’re more bothered about services and people than buildings.

We will get yet another unfunded cuts café/information centre though. The spin is much cleverer but how much has genuinely changed?

You can read the recommendations and decide for yourself here.

We’re planning a sleeping bag and cardboard city protest at the Great Yarmouth and Waveney CCG Board meeting at 1300 in Beccles, Suffolk on Thursday 25th September. We’ll put up more details shortly but do please join us.