NSFT seeks to reduce out of area placements by refusing emergency admissions rather than by providing necessary beds

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A member of the Norfolk & Suffolk NHS Foundation Trust (NSFT) crisis team writes:

“NSFT seems determined to reduce the number of out of area placements but not by providing an adequate number of local beds. A senior NSFT manager is going around the country trying to discharge out of area patients. How can this be a substitute for proper Discharge and After-care planning under CPA or Section 117 of the Mental Health Act?

This week we in the Crisis Team were caring for two desperately ill patients who needed urgent admission. Two beds became available at Hellesdon Hospital and were identified by the Bed Management Team as needed for our severely ill patients. This decision was overruled by a Deputy Service Manager without any reference to clinical need, and a shuffling exercise of patients took place so that an out of area patient could be transferred back to Norwich.

What happened to our patients? They were left at home in a distressed state with their families struggling to cope. One was subsequently admitted to a hospital over 150 miles from Norfolk and the other at the time of writing is still waiting for admission. In the first case the failure to provide a bed at the right time nearly led to a unnecessary detention under the Mental Health Act.

We have now been told by the Bed Management Team that they cannot even look for an out of area bed until they have made absolutely sure that no bed can be made available in Norfolk and Suffolk. This will mean even further delays in urgent admissions as patients are often not reviewed for discharge until late in the day. For example, yesterday an out of area bed could not be authorised until 3 p.m. although the need for the bed had been identified the day before; it then took two members of CRHT staff until 11.30 p.m. to convey the patient and return to base.

The lack of beds is causing untold distress to patients, unsafe and unethical practice, and sometimes illegal practice. Many staff are off sick with stress and many others cannot wait to leave what was once a great Crisis Resolution Team.”

10 thoughts on “NSFT seeks to reduce out of area placements by refusing emergency admissions rather than by providing necessary beds”

  1. As a supporter of this website it saddens me to see it becoming a medium for constant negativity towards the efforts made by the trust. Yes I feel we do need more beds but moaning about every attempt the trust makes to reduce patients out of area bed just makes the hard work that has gone into this site seem at times immature and spiteful and will ultimately discredit the sites reputation.

    I take umbrage to the opening statement, the “senior manager” that has been driving round the country, is actually a very competent clinician, and as for patients just being discharged without appropriate follow up is simply wrong. These patients are being assessed and those who need it are being taken on by the CRHT or other local mental health teams, this has only been undertaken after lengthy discussion with the out of area hospital, and local care providers such as the CRHT. If the patient’s risk(s) or level of care is too high then they will stay at that hospital until a local bed is available.

    It just seems to me that whatever effort is made by the trust is shot down by this site, and although im a keen follower and agree with lots of the content, one has to at least give the trust a nod of acknowledgement when they are trying.

  2. But the trust aren’t trying, that’s the point!  They’ll happily take their inflated salaries and deliver nothing but distress to patients. The trust is desperately short of cash but Page & Co are terrified to stand up to the CCG and DoH.

    A case in point: I took a very distressed man to A&E in Suffolk today. They couldn’t have been less interested. There was no way to access a Crisis Team and he was too unwell to fill out a self-referral form (which didn’t work anyway) for this joke of a Wellbeing Service!

    He’s currently on suicide watch at home, and his family don’t know how to deal with him. If he were to die tonight, the trust you think shouldn’t be criticised wouldn’t care because he’s not had the opportunit to engage with their broken system!

  3. I probably agree with Mr. Fair that the ‘senior manager and competent clinician’ is putting in some hard work to reduce the number of out of area placements. And I am delighted to hear that ‘these patients’ are actually assessed and if  the risk is too high even allowed to stay in hospital, that’s ever so kind.

    I do have a couple of questions though. Why is the trust paying a lot of money for out of area placements if the clinicians responsible for delivering the care in these placements are unable to decide if a patient needs to remain in hospital or should be transferred into the community? And, what happened to the two local unwell patient who had also been assessed ( just not by a very senior manager I suppose) and assessment had shown that their risk(s) were too high and they needed to be in hospital…./

    I am afraid, this is not a service model and any hard work that goes into it seems somewhat wasted……

  4. It would make no difference if our senior manager was superman; patients are legally entitled to a needs assessment under the Care Programme Approach, Community Care Act and Section117 1983 Mental Health Act. This assessment should be holistic and out of it should emerge a care plan monitored and reviewed by a care coordinator with full access to a care budget. It should be designed to keep the patient well and prevent relapse and readmission to hospital. None of this is possible when a patient is over a hundred miles away from Norfolk. It is not good enough just to refer people to an already stretched to the limit Crisis Team.Mr Fair accuses the Campaign of ‘ constant negativity ‘ and of being ” immature and spiteful ” towards the Trust. If only we could be more positive! The Trust continues to deny the extent of the crisis and still does not accept that there are not enough beds for urgent acute admissions. They still claim that they have boosted community support for the severely mentally ill whereas the opposite is true. The Department of Health has written to the Campaign quoting the Trust’s vindication of its strategy. No, it is not negative and spiteful to expose poor, unsafe practice. Nor is it spiteful and immature to highlight ill thought out, knee-jerk actions by the Trust which will not solve the problem but make things worse. Furthermore the Trust has not learned anything by this experience and is now proposing further cuts in its new 5 year strategic plan.

  5. The people bearing the brunt of all these mistakes (that no one has been held accountable for incidentally) are people who need services and frontline staff. The mess is so big that these tinkering around the edges, deckchair shuffling approaches, will serve no more than to further obstruct staff and have patients treated like cargo shifted from one place to another. Our services have been wilfully run in to the ground. NSFT has a monopoly, grass roots staff can’t jump ship & take up handsomely paid jobs elsewhere (a la former chief exec) or retire early on a handsome pension (nursing / medical director). We will be stuck, with failing services carved up and handed over to the private sector, and pay and conditions will further reduce in real terms. Those responsible at the top will find their way in to handsomely paid other top jobs or consultancy etc. etc. I for one will give no credit to NSFT board for trying to repair damage they caused. It’s the least they can bloody well do.


    ” Discharge planning will maximise the safety of the service-user, minimise thr risk of difficulties that may increase their anxiety/stres at this time and as far as possible meet the individuals needs.

    ” Discharge planning should commence at the point of admission. ”

    ” If factors relating to discharge are not identified early on, this has implications for the safety and timeliness of the discharge. ”

    ” The Multidisciplinary Team, with the service-user and their family should consider discharge planning…at the earliest opportunity. ”

    ” The period around discharge is recognized as a time of particularly high risk for suicide (Avoidable Deaths2006,National Confidential Inquiry 2006)

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