Agenda item

(To receive a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which provides the Committee with an update on the LPFT services.  Jane Marshall, Director of Strategy LPFT and Chris Higgins, Director of Operations LPFT, will be in attendance for this item)

The Chairman welcomed to the meeting the following representatives from Lincolnshire Partnership NHS Foundation Trust (LPFT) Services:-

·         Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust (LPFT); and

·         Chris Higgins, Director of Operations LPFT.

The Committee was advised that LPFT were committed to their vision of providing care as close as possible to people's homes; and to exploring new ways of working to build up resilience within the community.  The Committee was advised further that LPFT were also keen to improve the quality of the physical environment for the wards LPFT operated, in order to protect patient dignity and privacy.

It was reported that whilst upgrading the Brant Ward, Lincoln, LPFT had decided to try out a pilot called 'Home Treatment Team' (HTT), the results of which were detailed on pages 26 to 28 of the report presented.  The Committee was advised that the older adult functional Mental Health Home Treatment Team was proving to be very successful as an alternative to inpatient beds.  The Committee noted that LPFT would be engaging with patients and the public on the potential for retaining the HTT when the Brant Ward re-opened later in the year following its refurbishment.

It was highlighted that since the commencement of the older adult HTT and the temporary closure of Brant Ward, there had been improvements in length of stay.  The Committee was advised that the average length of stay for patients under the care of the HTT was 23 days.  This was significantly lower than the length of stay of Brant Ward (pre-HTT) at 59 days. 

The Committee was advised further that the average length of stay had also reduced on the Rochford Ward, Pilgrim Hospital, Boston (the remaining older adult functional mental health ward) from 76.2 days to 45.2 days with HTT being in place.  It was highlighted that no patient had been re-admitted to an inpatient bed within 30 days of discharge (30 days being an indicator of appropriate discharge) from Rochford Ward, since the HTT had been in place. 

It was reported that there had been 100% patient satisfaction with the HTT, 73.91% of people reported that they were 'extremely likely' to recommend the service and 26.9% were 'likely' to recommend.  Some feedback comments were detailed on page 27 of the report for the Committee to consider.

The Committee noted that the Clinician Related Outcome Measures had also shown high levels of clinical staff satisfaction with patient condition on discharge from the service as well as 'very good' referrer satisfaction. The Committee noted further that when using the 'Warwickshire Edinburgh Wellbeing Scale' validation tool, the HTT was able to demonstrate a statistically significant improvement in the self-reported wellbeing of patients following HTT intervention.  A chart on page 28 of the report provided details of the proportion of clients in each group before and after intervention.

It was highlighted that for the five months October 2018 to February 2019, there had been five clinical incidents associated with HTT, in comparison to 123 clinical incidents associated with the Brant Ward in the five months May 2018 to September 2018. It was highlighted further that the HTT had reported zero serious incidents since it had become operational in October 2018.

In conclusion, the Committee was advised that the Lincolnshire Partnership NHS Foundation Trust was committed to a vision of providing care as close as possible to people's homes; and the Trust was keen to explore new ways of working to build resilience in communities.  The Committee was also advised that there was a need to improve the quality of the physical environment for the wards that the LPFT operated to ensure that patient privacy and dignity was protected as they received inpatient care and treatment.  

During discussion, the Committee raised the following comments:-

·         The need for completion of a cost benefit analysis, in order to create a business case to present to commissioners for retention of the HTT;

·         The importance of socialisation and collaboration to aid recovery. The Committee was advised that the HTT was able to access services that were already available within the community;

·         The Committee welcomed the report, and the fact that the HTT was able to find more time for the patient;

·         The need to ensure that medication was reviewed regularly;

·         The effect of the potential reduction in in-patient beds for those patients detained under the Mental Health Act.  The Committee was advised that such patients would be detained in one ward.  Reassurance was given that there would be extended provision but not 24/7.  It was noted that there was an Adult Crisis Team available from 8pm to 8am, should a patient require help or assistance;

·         A question was asked as to what happened prior to the HTT.  The Committee was advised that the service had been provided in the in-patient wards 9am to 5pm, with an inadequate range of services outside of 9am to 5pm; and that patients would end up at A & E.  HTT had solved the problem by bridging the gap and by stopping people going to hospital.  Reassurance was given that the Trust was committed to keeping in-patient beds when they were needed and were committed to investing in community teams.  It was noted that the newly refurbished Brant Ward would be a great patient environment; and that work was still to be done to reconfigure the Rochford Ward;

·         One member from personal experience welcomed the positive approach to delivering the service in a different way; and to the fact that HTT bridged a gap that had previously existed, when people required that extra level of support. Reassurance was given that arrangements were in place to provide assistance out of hours and that the Trust was aware that there was more work to be done.  The Committee was advised that the Trust was looking at setting up its own internal helpline later in the year, which would provide 24/7 support to patients.  The Committee was advised further that a lot of work was also being done with the third sector, and charities to provide help and advice;

·         How staff had adjusted to the new way of working.  The Committee was advised that staff that had previously worked on the Brant Ward had received a full two week induction into the community team and had shadowed staff, until they had felt comfortable, as providing care in the home provided an extra level of risk.  The Committee noted that it was hoped to roll out the 'pilot' to the Rochford Ward; and that the Trust was also weighing up the cost benefits of providing the HTT service.  Some Committee members welcomed the change and felt that patients would benefit from the service.  The Trust acknowledged that the environmental issues at the Rochford Ward had always caused some problems; and that there was some pressure for the Trust to come up with a solution.  It was noted that the service was operating successfully for 'functional' mental health patients; it was hoped the same service would be applied to 'organic' mental health (dementia) patients.  One member expressed concern regarding the future of the Rochford Ward.  The Committee was advised that the pilot had proved that the community model worked; and that the Rochford Ward was not fit for purpose; and that there would be further conversations as to where in-bed facilities would be based; as it was very important to improve the in-patient experience; and

·         The Committee extended their thanks to the representatives from the Trust for their report, and expressed their support for the older adult mental Health Home Treatment Team.  The Committee also requested a further update on the service once the pilot had been evaluated.

RESOLVED

That the update on Lincolnshire Partnership Foundation Trust Services (including the Older Adults Mental Health Home Treatment Team) be noted, and that a further update concerning the Older Adult Mental Health Home Treatment Team pilot be received by the Committee once the evaluation process has been completed.