JOINT MEETING WITH BOURNEMOUTH BOROUGH COUNCIL HEALTH SCRUTINY AND REVIEW PANEL, DORSET COUNTY COUNCIL HEALTH SCRUTINY COMMITTEE AND THE BOROUGH OF POOLE HEALTH SCRUTINY COMMITTEE
21 NOVEMBER 2005
The meeting commenced at 7.10p.m. and concluded at 9.20p.m.
Present:
Borough of Poole
CouncillorMrs Hillman (Chairman)
CouncillorsBrooke, Bulteel (substituting for Mrs Butt), Mrs Lavender and Meachin
Bournemouth Borough Council
Councillors Brandwood, Levell, Mayne and Rey
Dorset County Council
Councillors Coatsworth, Mrs Fox-Hodges and Lovell
Members of the public present: 33
1.APOLOGIES
Apologies were received from Councillors Mrs Butt (substituted by Councillor Bulteel) and Garrett.
2.DECLARATIONS OF INTEREST
Councillor Meachin declared a personal interest in all items as a non-Executive Director of Poole Primary Care Trust.
3.MINUTES
RESOLVED that the Minutes of the meeting held on 18th July 2005 were approved as a correct record, confirmed and signed by the Chairman.
4.PRESENTATION BY DORSET HEALTHCARE TRUST ON “PROPOSED DEVELOPMENT OF TREATMENT, OUTREACH AND REHABILITATOIN SERVICE AT HAHNEMANN HOUSE (TORCH) SERVICES”
The Chief Executive of Dorset Healthcare Trust presentation by outlining that he felt that the scrutiny process was an important part of the consultation the Trust was undertaking. He believed that the Healthcare Trust proposals would increase opportunities to service users and that more opportunities would not increase the burden on carers.
A Team from the Dorset Healthcare Trust gave a presentation regarding the proposed changes to the TORCH services. The main points were as follows:-
- The reasons for changing the service were more towards the best possible assessment and treatment service which were local and accessible, easily and quickly. The changes would help reduce duplication with other recent local service development and increase social inclusion. There would be an effective implementation of the recovery model and social inclusion unit report through the development of TORCH services.
- The changes were to ensure a single assessment process and a single over arching care plan. The onus was to provide treatment groups in the community, to reflect local needs wherever possible. Within this it would be important to build on existing access to specialised services across Community Mental Health Teams (CMHT’s) and to deploy Clozapine monitoring processes in local areas. The Dorset Healthcare Trust was also to provide social activities via “non-profit” sector in the community. Resources were to be deployed efficiently for evening and weekend work. The delivery care support, involvement and education were to be serviced at the local level.
- The Dorset Healthcare Trust proposed that there be three locally based community recovery services (Bournemouth, Poole and South and East Dorset). These would provide all current TORCH therapies and treatments, supporting service users accessing community based facilities. The TORCH professional staff would retain specialist roles and skills as Community Recovery Workers (CRW’s) within these services. All existing TORCH service users would be supported within this model. Workers would collaborate across locality integrated Community Mental Health Team (CMHT). TORCH clerical support staff would work alongside CRW’s as Support Time and Recovery workers (STR’s). The Community Recovery Service (CRS) would support the development of expert patient roles. Service core hours would be from 9.00a.m. to 5.30p.m. but would also be flexible to need. The CRS would be managed centrally to ensure maintenance of specialist roles.
- The Community Recovery Workers would provide an initial period of intensive support following hospital discharge to CMHT to support recovery and engagement in the community. They would specialise in promoting recovery and sharing expertise, contribute to care plans and conduct specific work in context of the Area Care Plan. They would work on case load needing intensive and frequent recovery work. They would collaborate across locality to provide therapeutic intervention based on local user needs. They would take the lead role in supporting people accessing mainstream facilities and developing skills to be able to fulfil this. There would be local employment offices to promote employment opportunities, with “not for profit” sector to develop social support facilities and support engagement with this Group.
- The TORCH centres would include a full range of services to promote social inclusion, recovery and person centre planning in line with the Government vision “journey to recovery”. There would be partnership with CMHT’s to promote ease of access, reduce multiple assessment, improve communication and provide continuity of care and clinical accountability. DHCT would work in partnership with “not for profit” sector, maximising local community opportunities which will increase efficiency, effectiveness and value for money.
- CRW’s would continue provision of existing therapies. The mediation therapy service at Hahnemann House would be unchanged, along with psychology services which would continue to be located at Hahnemann House and in other local areas.
- CRW’s would provide community based treatment in localities and will run these with CMHT staff or will collaborate across localities with other CRW’s. Hahnemann House would be a convenient central location for the Bournemouth locality. Users choice in the boundary areas of Bournemouth and Poole would be in a position convenient to them.
- CMHT and CRW staff would be trained to deliver the clozapine monitoring. The clozapine monitoring for Bournemouth were to be provided at Hahnemann House along with Boscombe and Turbary Park. Other venues for this service were to be identified in Poole, Purbeck, Wimborne and Christchurch. There would be an additional choice of venue for those living on the Poole/Bournemouth boundaries.
- All data core centres would continue on their current network. The “Lunch Box Initiative” would continue to seek expansion opportunities.
- Social activities would be maintained for a range of users, but would move to a more local provision. CRW’s and STR workers would organise this initially. Over time the Trust would look to commission from the “not for profit” sector, with training for staff to support and back up the Trust’s work in Joint commissioning, which would be developed with Council Social Services Departments.
- Service Level Agreements with the “not for profits” Sector would be agreed for social activities. There would be flexibility on types of activity and the Trust would be responsive to individual interests from users. The Trust would encourage and support access to mainstream facilities or community groups following social inclusion principles.
- The Trust recognised that the “drop-ins” were valued by service users, and would continue to try and modify them. The final structure of the “drop-ins” would be discussed under the implementation process.
- There would be growth in local care offices, care support workers and carer groups. Access would be provided to support these local networks.
- Hahnemann House would continue to be a base for the Bournemouth West CMHT, the Assertive Outreach Team, Crises Resolution and Home Treatment Team, as well as being the base for the Bournemouth CRS.
- The budget would see no change to Data Port Centres, Lunch Box, or to Hahnemann premises’ budgets. Service delivery charges outlined above would produce £50,000 worth of savings. The remaining TORCH budgets of £620,514 would be split across Bournemouth, Poole and Dorset localities. TORCH staff would be redeployed in line with locality budgets.
- The Trust recognises that implementing the proposals would have an impact on individuals. The Trust would endeavour to ensure that a smooth transition for all service users along with clozapine monitoring, social activities, drop in, carers, maintenance of specialist roles, provision and development of staff team would all be included.
- The impact on individuals would be the development of a modern, improved, inclusive and enabling community recovery service which would have a positive impact on individuals. Change could present challenges for individuals and carers, therefore the Trust would ensure that change was handled sensitively and carefully. The Trust would work with individuals and carers in developing individually tailored care plans.
- To ensure a smooth transition the TORCH staff would work within locality community recovery teams and ensure individuals and carers were familiar with the staff working in their areas. CRW’s had existing therapeutic and supportive relationships with individuals and carers promoting continuity of care. There would be community based treatment interventions introduced over time.
- Clozapine monitoring would be carried out by CMHT staff who would have additional training in being able to take blood. This expertise would be added to the TORCH staff already trained. Phase I would be new starters on clozapine monitored via CMHT, Phase II would be care co-ordinators to agree the most convenient location with those using TORCH solely for clozapine monitoring and support change and Phase III would be for people monitored at TORCH and using the occasional drop in facility. The drop in facility would work with people’s needs and preferences, support changes in monitoring location with clear access to local support services and possible continued attendance of Hahnemann weekend drop ins. All current TORCH out of treatment attendees were monitored by TORCH staff for being included in their new role of CRW’s.
- TORCH clerical staff in their new role as Support Time and Recovery (STR) workers would continue to perform social activities. Activities would be gradually shifted to localities accessing local facilities in existing community resources. The Trust would commission the “not for profit” sector to provide these activities as opportunities arose. The Trust would aim to achieve this in partnership with Councils and Social Services Departments.
- There would be revised times for Hahnemann drop ins at the weekend with the new times being 10.00a.m. to 2.00p.m. and would be introduced in a planned way. There would be a review of care plans for individuals to ensure that information is given to them about other additional sources for support. The Trust would also explore weekend facilities becoming user led, supported by experienced agency in the “not for profit” sector, once identified. There would also be trained staff to back up any essential features whenever required.
- All carers would be given information on the local care officer, care support worker and local carer groups with information on how to access these services. Attendees of the TORCH monthly carers group would be offered a meeting with a local carers officer to discuss needs, complete any carer’s needs assessments and arrange support packages. All users and carers would receive the most support as they do at present. The Trust would endeavour to ensure that no user or carer is disadvantaged by these proposals, no greater responsibility would fall on carers.
- The Trust was committed to the maintenance of the specialist role of CRS. Hahnemann House would initially be the primary base for the whole of the CRS Team but would also have access to CMHT bases and facilities. Over time Poole and South and East Dorset localities would receive CRS based staff with CMHT’s for those areas. The Bournemouth locality would continue to have Hahnemann House as the base for all CRS issues.
- The benefit to the change in service would include accessibility to services at a local level for all. The specialist recovery role would be developed, sharing of expertise and knowledge with CMHT’s. A more responsive service to individuals and local needs, the development of the “not for profit” sector. An opportunity for service user led facilities. The monitoring of medication and the responsibilities of the CMHT team at local level. There will be an introduction of a single assessment process and single overall care plan. The new structure would encourage a better communication and clear lines of accountability. From a financial prospective it would provide a better use and targeting of public monies.
A Member asked what the service would be for patients in Christchurch. Roger Browning answered that patients would still be able to use Hahnemann House but that there would be a restructuring to allocate different facilities to different needs.
A Member asked which non profit organisations would be involved in the partnership with Dorset Healthcare Trust?
A representative from Dorset Healthcare Trust answered that there would be many non profit organisations working with DHCT, these would include MIND, the Richmond Fellowship, service users themselves, RETHINK, sheltered work opportunity schemes, contracts with Councils and other non profit organisations. Non profit organisations would become involved with DHCT by a tendering process which, in turn, would aid an increase in capacity for the service.
A Member asked what the new opening times would be at Hahnemann House under the new structure?
A representative from DHCT responded stating that the opening times would be normal Monday to Friday and on Saturday from 10.00a.m. to 2.00p.m. At present they are open 9.00a.m. to 5.00p.m. on a Saturday, but if the Centre had no users it would close. They would endeavour to have opening times which were led by the users themselves.
A Member raised the question of how DHCT were going to make the £50,000 savings when much of the restructuring of the service was still undecided? A representative of DHCT responded stating that the change in opening times would be one area where savings could be made, as most users attended the Centre between 10.00a.m. and 2.00p.m. and that the user has a starting point to go on to other activities during the day. Experience showed that between the times of 9.00a.m. and 6.00p.m. only two people attended the whole day. There would be other ways in which the savings could be achieved but this would not happen immediately and that there was no timescale for the savings.
A Member made the comment that in a recent report, Poole PCT had been criticised for having no strategy for making savings, its users felt disenfranchised and the same was happening here with the issue of Hahnemann House. How will you prioritise key elements of the services and show that the savings will work?
A representative of DHCT answered that changes would be done smoothly, carefully and they would be robust savings. The changes at Hahnemann House would offset the Supporting People Project. From the consultation the elements which required the need to change and how best to do this would be highlighted.
A Member asked what choice will people have and how will the new system work?
A representative from DHCT answered that the service was about recovery, advantages, disadvantages and making chances that best suit the individual.
RESOLVED that the Presentation by Dorset Healthcare Trust be noted.
5.PRESENTATIONS AS AGREED BY THE CHAIRMAN FROM THE PROSPECTIVE OF SERVICE USERS AND CARERS
A number of service users and carers spoke regarding the issue of the proposed developments of TORCH services, of which the key points are as follows:-
- The patient and public involvement forum welcomed the recommendations from the Special Joint Health Scrutiny and Review Meeting on the 18th July 2005. The Forum was pleased that the Trust had begun its public consultation for TORCH. The Forum was concerned though that the Trust had not shown that it was actively inviting comments and engaging with all potential interested parties. A further concern was that the consultation document posted on the Trust web site did not enable people to easily respond. The design and content of the questionnaire at the end of the document contained technical, closed questions incorporating too much jargon which led the Forum to question whether any feedback was generally welcomed. The Forum hoped that the consultation process would go some way towards alleviating the anxieties that many people expressed earlier in the year. While some service user groups and Forums had been formed over the proposal, others had not and therefore the opportunity for all parties to engage in a consultation dialogue had been missed. The Forum was keen to know what training in mental health would be provided by the Trust in support of organisations who were providing the new service.
- The consultation paper questionnaire was a confusing document with only yes and no answers, which could lead to ambiguous outcomes as a result. The way the questionnaire was written could lead people to view the Trust as not engaging fully with those groups that it most needed to within the consultation process.
- A private provider under contract highlighted that schizophrenia was a complex and misunderstood condition and good after care needed to be provided to these patients. To close and to economise on services like TORCH was detrimental to this, and should thought be given to expanding these services. The closure of large mental institutions had led to the care in the community services but these were still developing. Schizophrenia was an enormously disabling condition, generally striking in the late teens, men more than women and its negative and positive systems could be extremely bizarre. It was complex in nature but put in simple terms it robbed young people of their lives. Individuals who have led normal lives who were struck down with the condition which can lead to hospitalisation and a need to go “through the system”. Individuals could be left with an inability to manage money, so this will lead to being unable to sustain any type of tenancy. This was an illness that stole lives, if left without the help of TORCH services. Revolving door cycle of hospital treatment, followed by failure in the community, a return to hospital needed to be avoided at all costs and is the worst scenario from all points of view. There needed to be understanding of the intensity that families and carers had lived through. It was from their experiences that it can be seen why after care services were so important.
- The proposals by Dorset Healthcare Trust lacked detail and clarity in the proposals they were making.
- There was evidence to suggest that the existing excellent service, facilities and dedicated experienced team of staff provided by TORCH at Hannaham House would be broken up and integrated into local Community Mental Health Teams (CMHTs). The staffing budget would be split in the same ratio as current activities. This would lead to the following, out of 29 staff at present: with Bournemouth usage at 80% they would have 23 of the staff, with Poole usage at 10%. They would have 3 staff, with South and East Dorset usage of 10% they would have 3 staff (with possible allocation of one member of staff to Purbeck, Christchurch and Wareham). Within the planned changes there was no allocated timescale for when these changes would be implemented nor venues in which new service provision would be provided. No provision had been made to ensure that ex-TORCH staff maintain an independent role focusing on recovery services.
- A centralised service in one location with one team had many benefits. One example would that be the case of staff absences, that there would be a large enough team to be able to cover.
- The Service, treatment of therapeutic groups which were currently provided by TORCH staff in an integrated way would, in future be provided in partnership with CMHT’s. This raised the question of whether CMHT’s had the spare capacity to be able to do this and what funding would be allocated to them? Another question would be whether the Community Recovery Services (CRS’s) would have the lead, control and responsibilities of the resources for these services?
- TORCH services, excluding the cost of premises, were costing DHCT £670,514. Of that amount TORCH staff costs were £634,376.000 and the Trust had given assurances that staffing would not be reduced. Leaving a saving of £36,138.000 as none staff costs. This raised the issue of what extra savings could be made. The proposals did show savings of £50,000 and this would be achieved by cutting back on the service provided by limiting operating hours? If this was the case then the saving could be made now without any more changes to the service.
Full transcripts of the presentations received are attached at Appendix A to these Minutes.