As per the resolution agreed by Overview and Scrutiny on 2nd September 2024, the Chairman of Worcestershire Health Overview and Scrutiny Committee (HOSC) and the representative from Herefordshire and Worcestershire Health and Care NHS Trust (H&W NHS Trust) have been invited to attend to discuss the subject of the reconfiguration of Adult Mental Health Inpatient and Rehabilitation Services, Redditch, and the closure of Hill Crest Ward.
Minutes:
The Chairman of Worcestershire Health Overview and Scrutiny Committee (HOSC) alongside representatives from the Herefordshire and Worcestershire Health and Care NHS Trust (the Trust) and NHS Herefordshire and Worcestershire Integrated Care Board (ICB) were introduced.
The HOSC Chairman explained that the Worcestershire County Council’s Health Overview and Scrutiny (HOSC) was the only committee in the county to which the different NHS organisations were required by law to consult when any changes to health services were planned. HOSC could ask the relevant health professionals to attend its meetings to explain the change of service. It was reported that officers appeared before HOSC on a number of occasions to update on the situation concerning the Hill Crest mental health unit.
It was explained that the Hill Crest Mental Health ward was for acute care designed to admit people experiencing mental health difficulties, including patients detained under the Mental Health Act, for a period not exceeding one month.
The Trust’s Director of Nursing provided background information into the situation at Hill Crest ward. It was explained that patient safety and quality of care concerns at the Hill Crest ward were highlighted in July 2022, following which discussions took place with the Care Quality Commission (CQC) that triggered the first intelligence-led CQC inspection of Hill Crest ward.
During the CQC inspection in February 2023, concerns were identified which included poor patient experience in relation to insufficient staff to allow escorted leave from ward or supervised use of garden areas, lack of therapeutic activity for patients, and high use of temporary staffing. It was stated that many of the issues with Hill Crest ward had been identified prior to the 2023 inspection, and an Improvement Plan to restore safe operations within Hill Crest had been in place from September 2023. To lead the development and implementation of the Improvement Plan, the Trust and the ICB took the decision to appoint an Improvement Director to lead the development and implementation of that Plan.
It was reported that improvement in operations had subsequently been noted. Currently, there was a provision of 14 beds at the unit, which was deemed the safest level of provision. However, there were inherent environmental constraints with the Hill Crest building as it is a large, ‘sprawling’ ward, with a number of blind spots, which presents challenges for staff to provide good levels of observation to supervise the patients. Members were informed that in an acute mental health ward, there were safety risks related to patients detained at the ward becoming suddenly unwell, for example engaging in attempted self-harm or suicide. Therefore, observation by staff was required but the layout of the Hill Crest ward presented significant challenges in this.
There were also safety concerns arising from the ward’s isolation from other mental health wards. Although the Hill Crest ward was on site of Alexandra Hospital in Redditch, the mental health ward was run by Herefordshire and Worcestershire Health and Care NHS Trust (the Trust), whereas the rest of the hospital was managed by the Worcestershire Acute Hospitals NHS Trust. As such there was little resilience and emergency staffing capacity in case of a serious incident occurring on site. Moreover, due to design and age of the building, improvements such as adding on suite bedrooms could not be made at Hill Crest.
The Trust’s Director Strategy and Partnerships explained that in light of inherent building and staffing layout challenges at Hill Crest, it was proposed to relocate the acute mental health unit to a vacant Athlon Ward located on Elgar Unit on
the Worcestershire Royal Hospital site. This was deemed the most effective and safest option as the Athlon ward was well designed and able to be adapted to most modern standards. The remaining acute mental health beds in Worcestershire were also located at the Worcestershire Royal Hospital site, and the Athlon ward was located next to a psychiatric intensive care unit, which provided additional back-up staff support when required.
It was highlighted that acute mental health provision at Hill Crest was a county-wide service and there were people from across the county accessing Hill Crest the unit. From October 2023 to the end of September 2024, 144 individuals had been admitted to the Hill Crest ward, of which 39 were Worcester residents at the time of admission, 24 from Redditch Borough, and 14 from Herefordshire. It was reiterated that the advantages of putting all beds into one campus area were that of safety and the ability to respond to emergency situations. It was highlighted that local mental health provision remained unaffected as a result of this change. Community, children and adolescent mental health provision would remain in Redditch, with mental health crisis team operating from the Town Hall.
Questions were invited and the following main points were made:
· Impact on staff resulting from relocation to Athlon ward, Worcester – A Member asked if all staff would be transferred to the new Worcester unit. It was explained that following engagement with staff, some staff had chosen not to relocate to Worcester as they lived locally to Hill Crest. However, all staff members had been retained and no redundancies were made as a result of the planned relocation. It was also explained that pay and conditions for all staff would remain unchanged following the move to Athlon ward as the Trust adhered to strict pay and conditions criteria set by the NHS.
· It was explained that the Hill Crest ward was staffed predominantly by a mixture of mental health nurses and healthcare support workers. Most mental health nurses at the ward were employed through a long-term booking with an agency. It was explained that there was a national shortage of mental health nurses.
· Use of Hill Crest unit following relocation of the mental health ward – It was explained that the Hill Crest building would remain in the NHS with outpatient mental health clinics and wider neighbourhood mental health services would continue operating from the Hill Crest site. It was only the acute mental health beds provision that would be relocated to the Athlon ward. It was further clarified that the risks highlighted relating to the layout of Hill Crest site concerned bedded care rather than provision of neighbourhood mental health services.
· Impact of relocation on arrangements for family visits – Concerns were raised about the impact of the relocation on creating additional transport burden placed on the family members from Redditch visiting patients. It was noted that the main messages from public engagement about relocation plans related to parking on the Worcestershire Royal Hospital site and transport costs for family members in Redditch visiting patients in Worcester. Members were reassured in this regard that the staff at the Hill Crest ward were providing bespoke arrangements to maintain visits for families of patients who had children, mobility and transport difficulties etc. Support included sourcing of local taxis, helping with the local bus routes. This arrangement would continue after the move to Athlon ward to accommodate visits from families of Redditch patients.
· It was reiterated that the acute mental health service provided from Hill Crest was for people from across Worcestershire and Herefordshire, and only a minority of patients currently admitted to Hill Crest were Redditch residents.
· Patients being placed in out of county placements – It was noted that the acute mental health service was subject to non-predictable fluctuations in demand and there were often patients who would have to be treated outside of Worcestershire, especially in specialist cases. It was explained that due to its nature there could be no waiting list for acute mental health services, and to cope with demand some patients would need to be treated out of county. It was noted that currently there were 10 people in out of county placements. Members requested that they be provided with data on how many people were placed in an out of county mental health placement in the last year and the number of people who were placed out of county because they could not be treated in Worcestershire.
· Members requested that an update be provided to the Committee on the repurposing of the space vacated at Hill Crest, including a plan on how this space was proposed to be accommodated.
· A query was raised about why NHS England (NHSE) commissioned a Child and Adolescent Mental Health Service (CAMHS) Tier 4 unit – for children and teenagers with the worst mental health problems – in an isolated location in a housing estate in Webheath. It was responded that whilst this was NHSE commissioning decision, outside of the control of the Trust or the ICB, the NHSE had plans to ultimately eliminate Tier 4 out of area (independent sector) beds in the country. It was noted that this target would take time to be realised and at a local level the Herefordshire and Worcestershire In-Patient Strategy details how the number of people in independent placements could be reduced locally. It was stated that locally only units rated at least ‘good’ by CQC were used. Members requested that they be provided with copies of the Herefordshire and Worcestershire In-Patient Strategy.
Members took the opportunity to thank the Chair of Worcestershire HOSC and Officers from the Trust and the ICB for attending the meeting.
RESOLVED that
the information provided regarding reconfiguration of Adult Mental Health Inpatient and Rehabilitation Services and the proposed closure of Hillcrest Mental Health ward be noted.