Agenda item

RESOLVED: That the Committee

·         welcomed the report and fully supported the development of a new model of care and modernisation of our mental health estates.

·         would be happy to assist with the resident engagement exercises required for the development of this business case.

·         be kept informed of the progress on this business case.

Bobby Pratap (Director of Implementation, SLaM) and James Lowell (Chief Operating Officer, SLaM) introduced the report. The following key points were noted:

3.1. The Ladywell Unit in its current state presented an unfit physical environment for the patients and staff. £3 million had been spent on the building to allow basic renovations, but the building still remained unfit for purpose.

3.2. Even though the modern-day minimum requirement for mental health units was to have ensuite toilets for all rooms, the Ladywell Unit only had 2-3 toilets per 18 people.

3.3. Instead of just replacing the Ladywell Unit with a modern fit for purpose building, it was agreed that this situation presented an opportunity to pause, review and modernise the model of care being delivered.

3.4. It was discussed that there was mistrust in the community when it came to statutory mental health facilities in the borough, especially amongst residents from Black ethnic groups. Levels of coercion, medication and police interaction were cited as being the key reasons for this mistrust.

3.5. Black residents in Lewisham were over-represented in the mental health wards, constituting 50% of inpatient bed days in Lewisham acute and psychiatric intensive care units (PICU).

3.6. There were national concerns around the fundamental model of acute mental health care and recent high-profile incidents had raised concerns around breach of human rights in these mental health facilities.

3.7. The business case for the mental health care model modernisation would require significant investment in the long-term future infrastructure of Lewisham’s mental health services. With a robust and compelling case, there may be opportunities for some charitable fundraising.

3.8. Most of the Trust’s investment and activity was focused on inpatient and acute care which left relatively little for community and social based care. Currently, ~58% of the adult NHS mental health budget was being spent on supporting ~4% of the people which meant the remaining 96% people had to be serviced with 42% of the budget.

3.9. However, there were some positive reflections in relation to Lewisham’s mental health service such as Lewisham implementing SafeWards and the local authority’s commitment to supported housing pathway.

The Committee members were invited to ask questions. The following key points were noted:

3.10. At the Ladywell Unit, there were around 600 admissions last year out of which 70% were detained under the Mental Health Act. 50% of those admitted belonged to the Black ethnic group. Officers from SLaM stated that they would confirm these figures and data for the Committee and would circulate the data on what proportion of admissions were because of treatment orders.

3.11. SLaM had a medium secure, forensic acute admissions ward that was based in River House at Bethlem Royal Hospital.

3.12. A significant number of clinicians within SLaM were researchers who had contracts with the Institute of Psychiatry, Psychology and Neuroscience (IOPPN) which helped SLaM form strong links with the clinical academic groups.

3.13. Developing a new model of care was not driven by NHS budget reductions. On the contrary, as part of the Mental Health investment standards, more money had started to be invested in the mental health service over the last few years and more investment was due in the coming years as well. However, a lot of this money was being spent on inpatient services. The new model of care would focus on reducing the need for inpatient and crisis care by investing more in our community offer.

3.14. SLaM recognised that it could have invested more money in the Ladywell Unit early on to modernise the building but since the initial idea was to rebuild the building, investing in the current building was not a priority back then.

3.15. It was discussed that culturally appropriate mental health services were required. As part of developing the business case, SLaM was re-examining its research and evidence base to understand whether it correctly reflected the needs of the local population.

3.16. Transition services and family hubs were discussed in one of the community engagement workshops that SLaM undertook as part of its process for developing the business case and officers from SLaM stated that they would look into how they can join-up work around the family hubs.

3.17. The business case development being discussed was specifically focused on the Ladywell Unit and adults of working age, but SLaM also provided other services that were part of their wider strategy such as CAMHS (Child & Adolescent Mental health services) and specialist services for older adults and people with learning disabilities. This wider strategy and the work within the Lewisham Mental Health Alliance looked at all transitions and SLaM would cover this in their strategic outline case to emphasise the work they were doing with partners in Lewisham in specialist service provision and transition.

3.18 SLaM was aware of the limits around capital funding and was in touch with the team in the Department of Health.

3.19 The Committee noted that the re-provision of the Ladywell Unit was a priority agreed by the Health & Wellbeing Board.

RESOLVED: That the Committee

·         welcomed the report and fully supported the development of a new model of care and modernisation of our mental health estates.

·         would be happy to assist with the resident engagement exercises required for the development of this business case.

·         be kept informed of the progress on this business case.