JOINT COMMISSIONING PARTNERSHIP BOARD

THURSDAY 15 OCTOBER 2009 AT 10 A.M.

CONSULTATION ONTIER 4 PERSONALITY DISORDER SERVICES

Authors: Sarah Damms, Service Development Manager, Hertfordshire Primary

CareTrusts

Tel: 01438 843232

  1. Purpose of report

To present to the Joint Commissioning Partnership Board the responses to the Tier 4 Personality Disorder Service consultation and to make a recommendation on the Primary Care Trusts(PCT) preferred option for the future model of care.

2.Summary

The Joint Commissioning Partnership Board members are being asked toconsider stakeholder information compiled from a recent consultation across four regions on provision of Tier 4 services for people with complex personality disorder.

A review of the consultation responses confirms that a specialist outreach team in each region to support local work would be of benefit, particularly to work with the currently commissioned Tier 2 community Personality Disorderservice. There is also recognition of the need for some provision of inpatient beds. Use of Tier 4 services has been very low, although there were four services users funded during 2008/2009 (not all inpatient). It is important to note that these people have been using the services for the last three years, and only one of them was an inpatient for longer than one month.

3.Background Information

Between 20April and 27 July 2009, South East Coast, East of England, South Central and London regions ran a consultation to consider Tier 4 Personality Disorder Services and how best to support people with complex personality disorder ina way that is clinically and financially sustainable.

At present, two key London-based facilities (one temporarily closed) have been providing these specialised services for all four regions. In considering a potential new way of providing support to people with complex personality disorder, stakeholders were asked to consider the following options:

  • Should there be a specialist outreach team in each region?
  • Is there a need for specialist inpatient provision?
  • If there is a need for inpatient provision do we need one, two or four units across the whole region?

The consultation focused only on these questions and did not consider the types of treatments that should be provided by different services. The type of treatments that would be available in the inpatient services is an important consideration when making a decision on quantities of services and this was pointed out in the consultation response.

3.1 Hertfordshire’s response to the Tier 4 Consultation

NHS Hertfordshire compiled a response to the consultation which outlined the advantages and limitations to these options; it was highlighted that the Tier 2 community personality disorder service provided by Hertfordshire Partnership NHS Foundation Trust (HPFT) meet a number of the proposed criteria of a regional Tier 4 outreach service and that we would be interested in strengthening the services that are available locally. In particular, investment in a regional specialist team should not be at the expense of local services.

It was acknowledged that people with complex personality disorder might require some specialist inpatient provision and that each of the options (one, two or four) all had advantages and limitations.

3.2Independent summary of consultation themes

Across the four regions, there was overwhelming support for each region having a Tier 4 community outreach teamalthough there were concerns raised about the potential workload and the difficulties of the geographical distances these teams would have to cover. Areas that have already invested in community personality disorder services were all keen to see that these regional teams would work alongside them, strengthening local resources.

With regard the availability of residential treatment centres, the results were less clear. 16% of respondents stated that there was no need for specialist inpatient provision; however, the service user stories throughout the document and the majority of people responding recognised that people need the option of a safe place, somewhere that will provide containment for people and therapeutic approaches that might not be possible to deliver in the community.

A quarter of responses supported one unit to be available across the four regions; the reasons for this are to ensure that there are some beds available for people, there is the potential for development of a centre of excellence, which would provide a consistent approach and good communication with local and regional community teams. Distance and the limitations on the different types of treatment were the main disadvantages to having only one unit.

The remainder of responses were split between two and four units being available across the four regions. The disadvantages for having two units were the same as for the first option – distance from people’s homes and the possibility of limited capacity. The advantages, however, were felt to be that two units could be more evenly spread across the regions, that it could potentially provide two different approaches, increasing service user and referrer choice.

The limitations with regards four units are the concerns over cost and sustainability – there are worries about the availability of a specialist workforce that would be available to staff four units, specialist outreach teams and maintain the community services that have already been commissioned.

3.3PCT’s preferred option

West Kent PCT collated the responses on behalf of the four regions and these were compiled by The Evidence Centre to give a summary of the consultation themes. The 62 PCT’s represented by the four regions have been individually asked to review the stakeholder feedback and come to a conclusion on a preferred option. PCT’s have been asked to confirm in writing their option by 29 October 2009.

Investment in a Tier 4 regional outreach service would bring benefits to people in Hertfordshire if it works alongside the already commissioned Tier 2 service.

Appendix 1 is a table provided by the Joint PCT Committee to support the decision making process.

4.Recommendations

The Board is asked to note the responses to the consultation.

The Board is asked to consider and approve the PCT recommendations on organising services for people with complex and severe personality disorder.

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