Introduction
NHS Lanarkshire is committed to enhancing the patient experience for people with mental health issues and ensuring quality of service continues to improve. To achieve this, NHS Lanarkshire has developed proposals to further invest in community services, which will continue to reduce the need for inpatient beds. This follows the national policy of rebalancing care to provide services closer to people’s own homes.
Background
A great deal of progress has been made in the last decade to deliver better care to patients by modernising mental health services in Lanarkshire. New units have included Glencairn at Coathill Hospital and Beckford Lodge in Hamilton as well as new dedicated mental health facilities at Carluke Community Health Centre, Douglas Street Community Health Clinic, Bellshill Community Health Clinic and the Buchanan Centre in Coatbridge. These developments have enabled the closure of outdated facilities at Hartwoodhill Hospital this year.
There has been considerable investment in community-based services including out of hours services in line with National Crisis Standards. These developments have reduced the need and demand for in-patient treatment, leading to a reduction in bed occupancy levels. It continues a trend that has seen inpatient beds in Lanarkshire go from around 2,500 beds in the 1950s to a few hundred currently. NHS Lanarkshire has developed proposals to continue this process of modernisation including a small further reduction in bed numbers. A timeline showing the background to the development is available under related documents on the right-hand-side of this page.
Current Service – Acute Adult and Old Age Beds
Mental health acute adult inpatient services are currently provided at Wishaw General, Hairmyres and Monklands hospitals. Acute old age psychiatry beds are provided at Wishaw General Hospital, Hairmyres Hospital, Coathill Hospital, Colville Ward at Airbles Road Centre in Motherwell and Udston Hospital, Hamilton. NHS Lanarkshire is one of only two NHS Boards that does not have formal arrangements for Intensive Psychiatric Care Unit (IPCU) provision.
Proposals
NHS Lanarkshire Board approved an initial agreement for a new acute unit in North Lanarkshire in 2009. It is clear that within current economic challenges this is no longer affordable for the foreseeable future. Alternative options to enable ongoing modernisation and further shift the balance of care closer to home were presented to the Board in February 2011.
NHS Lanarkshire proposes enhancing services to patients in the community by extending the mental health out of hours service and providing intensive home treatment. This will reduce admissions and the length of any necessary hospital stays.
A new clinical model will be developed to ensure patients needing hospital care receive rapid assessment and initial management allowing them to return to receiving care in their local area as soon as appropriate. Lanarkshire’s new Integrated Care Pathways will ensure the proposals deliver seamless patient care between hospital and community with safe and effective communication between clinical teams, patients and carers.
Four options are being assessed for the future of adult acute mental health care in North Lanarkshire. The above improvements can be delivered by options C and D:
A. Do nothing - Retain services on three sites. Included for comparative purposes
B. New build - Purpose-built unit on an acute hospital site in North Lanarkshire
C. Refurbishment at Monklands Hospital - Refurbishment of existing accommodation and transfer of services from Wishaw General Hospital
D. Refurbishment at Wishaw General Hospital - Refurbishment of existing accommodation and transfer of services from Monklands.
Four options for the provision of an ICPU are also being assessed:
A. Do nothing - Continued gap in service provision
B. Service level agreement - Formal service level agreement with a neighbouring health board to provide beds within their IPCU
C. New build – New build stand-alone facility on an NHS site
D. Conversion of existing accommodation – Conversion of accommodation within a Lanarkshire acute hospital to a small IPCU facility.
It is also proposed that acute care for older people is enhanced by moving the acute admissions wards at Airbles Road, Coathill and Udston onto acute hospital sites, should accommodation become available. This may require a further review of bed requirements. An Acute Mental Health Project Board with stakeholder representation has been set up to further develop all of the proposals.
Next steps
An options appraisal event with stakeholder involvement took place on 28 June 2011. The event included consideration of the location of the unit and travel and transport issues. The project board has taken account of all feedback submitted at the event and in writing and is carrying out further work to develop the proposals before these are taken to the NHS Lanarkshire Board for consideration.