Agenda item

Resolved: that the changes proposed constitute a substantial variation in services; and to agree that the planned consultation takes place, with the findings reported back to the Committee.

4.1      David Norman (Service Director, Mental Health of Older Adults & Dementia Clinical Academic Group, SLaM) introduced the report; the following key points were noted:

• Demand for specialist dementia services was decreasing
• Some of SLaM’s dementia services had been moved outside of the borough
• Work had taken place to re-assess provision for service users
• The availability of discharge and support services had improved in residential accommodation.
• The decline in numbers of patients in Lewisham provision raised concerns over continuing clinical safety in residential provision.
• Discussions would take place with commissioners over alternative provision for specialist care.
• Members were asked to determine whether this constituted a substantial change in services and to comment on the proposed consultation plan in advance of its consideration at the SLaM trust board.

4.2      David Norman (Service Director, Mental Health of Older Adults & Dementia Clinical Academic Group, SLaM) and Helen Kelsall (Service Manager, Inpatient Services, SLaM) responded to questions from the Committee; the following key points were noted:

• Numbers of patients from Lewisham requiring specialist care had declined more quickly than neighbouring boroughs because of Lewisham’s early adoption of community model of care, to support people in care home settings.
• Specialist provision would always be available for those who required it.
• It was recognised that the decline in patients was in contrast to reports in the media about NHS services being overwhelmed. However, the provision of community services was now the preferred model of delivery.
• There had been changes in national policy, which had reduced numbers of patients requiring specialist care.
• National continuity of care criteria also changed in 2008 – which meant that the NHS no longer looked to provide patients with a home for life.
• There were regular clinical assessments of patients, which often indicated alternatives for patients with physical health problems that no longer required specialist mental health services.
• 9 individuals and their families would be affected by the proposed changes.
•  Officers from SLaM had initial conversations with almost all family members of the patients affected by the changes.
• Each of the service users would have a clinical assessment and would remain in specialist care if there were clinical reasons for them to do so.
• Consultation would be open and honest. SLaM would genuinely listen to concerns of stakeholders; the proposals would not be considered a foregone conclusion.
• It was not anticipated that there would be redundancies – because there should be vacancies for those who required them.
• In 10 years’ time there would be different services in the community and less reliance on acute services.
• Demographic projections and epidemiological work carried out in London, was well developed – and the projections for Lewisham were considered to be reliable.
• There were currently a lack of treatment options for the dementia – and work focused on early identification and support.
• Government had a special interest in the dementia care – early detection and primary care changes were being developed nationally to provide a coordinated response to dementia.

4.3      The Committee also discussed the proposal and noted their concerns about the impact on patients, particularly those who had already been moved from previous decommissioned provision. The Committee also highlighted its concerns about the future capacity of specialist services and requested an update on the 2007 projections provided in the report.

Resolved: that the changes proposed constitute a substantial variation in services; and to agree that the planned consultation takes place, with the findings reported back to the Committee.