Does NSFT have enough beds? Can NSFT cut any more?

[admin]

What are your experiences?

[Susan]

No. NSFT does not have enough beds now, as people are not being admitted to hospital when both the service user and the professionals involved have decided that this is what is required.

This is occurring regularly in crisis situations, when admission is delayed because of no beds being available, or declined only because the bed offered is a very long way from home.

It is also making it almost impossible for service users to be commenced, or recommenced, on Clozapine, the only recognised drug available for treatment resistant schizophrenia, as this requires admission to hospital, or very frequent physical monitoring in the community, which the understaffed community teams are completely unable to provide.

Is a mental health service that is unable to provide timely appropriate treatment for those with the most severe mental illness fit for purpose?

[Know1]

Not only is nstf cutting beds, but it seems that certain consultants who work in the trust are opening more beds in their private unit. is that interesting or what?

[Terry Skyrme]

We have been contacted by Social Services EDT Approved Mental Health Professionals regarding incidents last weekend when two patients had to be admitted after long delays, one to a hospital in the West Country and one to a hospital in Yorkshire; We  were told last week that there were 19 patients in out of area beds, 8 of them in private hospitals. Of course there are not enough beds, but the Trust ploughs on regardless; the situation changes from week to week, and the Trust can cite some weeks when out of area placements are low, but the overall trend is clear and the situation is only going to get worse. You cannot close beds AND reduce community care at the same time, The Trust say they are going to set up locally based units as an alternative to hospital admission ( see report on Acute Service Strategy by Kathy Chapman to the Trust’s Board of Directors on 19/12/13.) What exactly will these units be if not admission to hospital? When will they come into operation? Who will staff them? When will the Working Party on alternatives to hospital admission actually deliver something?

[Terry Skyrme]

Almost every time we ask the Trust’s Bed Management Team whether there are any beds available for admissions to hospital under the Mental Health Act the answer is NO. On a REGULAR basis there are long delays in admitting patients in urgent need. This means that the Clinical Commissioning Group is in breach of its legal DUTY under the 1983 Mental Health Act. This is not just a crisis for patients and their relatives it is also a major problem for other agencies such as the police. We are in danger of losing the good will of the police who often have a major role in keeping patients safe. I would recommend that people look at the mentalhealthcop website and read his post on Section 140 Mental Health Act.

[Terry Skyrme]

Section 140 Mental Health Act reads as follows:
“It shall be the duty of every Clinical Commissioning Group to give notice to every local social services authority…within the area of the CCG, SPECIFYING the hospitals available….
a) for the reception of patients IN CASES OF SPECIAL URGENCY;
b) for the provision of accommodation or facilities designed so as to be specially suitable for patients who have not attained the age of 18 years.”

[Terry Skyrme]

The bed crisis remains as desperate as ever; as of yesterday there were 17 patients in out of area hospitals. There were no beds available in Norfolk and Suffolk, and five potential admissions. Two Section 136 suites in Norfolk were occupied ( one overnight ) by patients who had been assessed as needing to be detained under the ACT but could not be detained and admitted for urgent treatment because no beds were availble. The only potential bed available was in Hastings ( Yes on the South Coast! ) but by midnight this hospital had still not agreed to accept one of our patients; they responded the next day and refused to accept our patient who they considered too risky. This highlights how well market forces work; with a national shortage of acute psychiatric beds private hospitals such as The Priory Group can cherry-pick patients and charge the NHS a fortune, which is exactly what David Cameron and his cronies want – public money going into private hands. If NSFT will not open wards for the sake of patient care, why dont they open wards for the sake of profit; then with spare capacity they can charge other NHS Trusts for accommodating their patients in Norfolk hospitals. AMHPs employed by the Trust and by Norfolk CC have written to the CCGs and CQC.

[Terry Skyrme]

I’m writing this just before going to bed. How must it feel to be a patient on a psychiatric ward, half-way through treatment, settled and adjusted to the ward, and just getting ready to go to bed, and then to be told that they are being moved to another hospital that night so that the bed can be used for an urgent admission – ” Patient choice ” supposed to be one of our core values; the lack of beds means no choice and patients shuffled around as if they were objects and not human beings.

[Terry Skyrme]

I’ve just arrived home from doing duty as an Approved Mental Health Professional (AMHP); we had seven requests for Mental Health Act assessments today, eight yesterday. The demand for beds is greater than ever and the Trust still refuses to reopen an acute psychiatric ward in Central Norfolk. They appear to be continuing with their disastrous plan to close the acute ward at Carlton Court. When services were normal we never had so many referrals for Mental Health Act assessments – one or two a day on average. Now it is always five a day, and sometimes even more, today reaching seven or eight. The AMHP service acts as a gauge to how the service is in general. Today we are seeing a service in crisis in almost every area. If we analyse this week’s referrals they consist of people with severe mental illness such as schizophrenia or Bipolar Mood Disorder who have been discharged only recently from hospital or from the service altogether and are now in crisis; the other major group are patients with severe dementia whose families can no longer cope; these patients are having to be admitted out of area because there are no beds at all in Norfolk, and one patient today could not be admitted at all for lack of a bed anywhere. Her family are caring for her overnight and we are praying a bed will come available somewhere tomorrow. When I left work two patients were still in Section 136 Place of Safety suites, each attended by two policemen, where they had been all day waiting for a bed to be found; when an ambulance finally arrives (which is coming from Bristol) these patients will be admitted to Priory Hospitals in distant parts of the country; they will arrive there escorted by strangers late at night and will wake up tomorrow in a strange hospital, hundreds of miles away from their families; another very ill patient has been left alone at home with her psychosis because no bed was available when she was assessed. Many AMHPs are falling sick with the strain of working in a system without resources, and many others are thinking of giving up their warrants to act under the Mental Health Act; many of us no longer want to collude with an oppressive system. There are no short-term easy quick-fix solutions to this crisis such as “decant beds”, unstaffed Hostels, step-down residential care beds; we need sufficient HOSPITAL beds where people can be treated long enough until they are really well and their social situation is stable enough for them to maintain their recovery; without this we are seeing the return of the Revolving Door patient, except the revolving door now often leads to a different hospital.

[Terry Skyrme]

If you admit a patient to a hospital hundreds of miles away from her young children, are you not breaching her Article 8 Human Rights of respect for family life? All the more so if this situation is brought about by a DELIBERATE policy of reducing the numbers of acute psychiatric beds? I wonder what the Trust’s legal advisors make of this issue? Are they even interested?

[Terry Skyrme]

I was told last week that the Trust’s latest attempt to resolve the bed crisis is to commission beds, possibly up to nine in total, in private hospitals in Royston and Chelmsford. How this will solve the Out of Area bed crisis is beyond me. How it will solve the Trust’s financial crisis is hard to imagine. Are the Trust really still going ahead with its plan to close the acute ward at Carlton Court? Do they still not accept that we need to re-open an acute ward in Central Norfolk? Over the last month there has been a high demand for dementia beds in Norfolk, a demand which could not be met and led to delays in admission, and then admissions of elderly patients many miles away from their relatives. Last week there were a number of patients who, for lack of available beds, could not be detained under the Mental Health Act,. Some were left overnight in police cells in clear breach of their human rights, others had to be left waiting at home in the care of exhausted relatives. THIS UNACCEPTABLE SITUATION HAS BEEN GOING ON FOR OVER TWO YEARS NOW. We dont need any more sticking plaster solutions. The Trust needs to demand the funding from CCGs and Central Government to reopen wards and stop this inhuman treatment of patients.

[Gillrow1]

Hello Terry, you used to help support me in the community, years ago when the service was so good.  It is appalling – the situation both “service users” and “frontline” staff find themselves in today. There is currently for the majority, no “Care in the Community” only “fend for yourself” and “survival of the fittest”!  At the NSFT meeting at Hellesdon on 29th Oct. 2014 it was set before “service users”, carers and staff,  the positives changes in place, with better to come, it is hoped,  to support and help those with mental heath diagnoses.

Much was made of activities available for those well enough to attend them BUT as to the availibility of beds and help for those in crisis, no mention was made.  The only community psychiatrist at Hellesdon said just this week that nothing has changed in this regard.  It is the same as a year ago.  People in crisis being sent hundreds of miles for a bed. Once the whole bed management team were in a meeting when approached, thus not offering a service to a suicidal person who subsequently made an attempt on his life. In this case there might have been a bed. Why was not one person left to man the phone?

After so many Ward closures at Hellesdon it seems that one is to open again with 10 beds! But it is a drop in the ocean – and who will staff it?!  With plans to cut the financial deficit further, the whole service looks set to go into meltdown. NSFT must not cut beds any more, they must use available funding to return to supporting people better in the community. The rising major relapse rate might then fall. Maybe a balance could be regained.  Excellent staff who once offered this service have been made redundant or left, rather than work under impossible pressures with a risk to their own health. Changes for the better will be a long time coming.