Agenda item

RESOLVED:

·         that the Committee write to Norman Lamb (SLaM) and Andrew Bland (South-East London ICS) to express disappointment in the lack of capital funding for the replacement of the Ladywell Unit;

·         that the Committee recognised that the lack of capital funding meant there was a need to review the existing assets of SLaM, Lewisham Council and other partners, to see what could be done for improving Lewisham’s mental health estate;

·         that the report be noted.

Bobby Pratap (Programme Director, Community Transformation, SLaM), Kate Lillywhite (Director of Strategy and Transformation, SLaM), Mark Pattison (Lewisham’s Service Director for SLaM), Neil Jackson (Director of Estates and Facilities, SLaM), and Ade Odunlade (Chief Operating Officer, NHS Foundation Trust) were in attendance to present the report. The following key points were noted:

4.1. In February 2023, officers from SLaM updated the Committee on the development of a business case to bring significant capital investment to improve the mental health physical infrastructure in Lewisham. It was discussed that sadly the national new hospitals programme did not accept SLaM’s business case. No business case from a mental health organisation had been accepted by the programme.

4.2. The government had announced that no national funding would be made available for big capital projects until 2030. This meant SLaM had to take a different approach to the improvement of the Ladywell Unit.

4.3. Along with other partners, SLaM would continue to lobby that improving the infrastructure of the Ladywell Unit was their most important capital priority and a major clinical and safety risk. South-East London ICB had also made this their top priority, but significant funding issues still existed.

4.4. During 2022-23, the SLaM’s estates team completed a programme to address the highest risk safety issues in the Ladywell Unit. An investment of £2.8m had been made to significantly improve the safety and environmental condition within the building. A further assessment would be undertaken in the last quarter of 2023-24, which would inform the annual long term maintenance programme of the current unit.

4.5. Officers reported that the current priority was to ensure alignment with Lewisham and Greenwich NHS Trust’s general estates planning for their University Hospital Lewisham site on which the current Ladywell Unit was situated. But along with that, SLaM wanted to ensure that they were reducing the use of the Ladywell Unit which meant improving and optimising access, outcomes and experiences of their community services.

4.6. Since 2019, SLaM NHS Trust had been working to transform its community services and had made significant investment to deliver the necessary changes. Now, SLaM was carrying out a review of its community transformation programme and associated investment. The investment in the community services had shown some improvements such as improved access and shorter waiting times but teams were still struggling to keep up with the demand for services.

4.7. The findings from SLaM’s review of its community transformation programme till date, would inform the development of a detailed specification for a new neighbourhood community model of care in Lewisham.

4.8. It was recognised that the care currently being delivered was much poorer for individuals of black ethnicity. SLaM was a pilot site for the ‘Patient and Carer Race Equality Framework’ (PCREF) for the last couple of years and this framework was due to be statutory from the next financial year. As a result of the work based on this framework, a Lewisham team made up of a- service user or carer, member of staff and member of the community team would be advising the Trust around how the organisation could be better at dealing with racial inequality.

4.9. It was discussed that Lewisham had an amazing and hardworking voluntary sector. Officers stated that the priority for the next 12 months was to strengthen the relationships with the voluntary sector.

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

4.10. The Committee expressed its disappointment on the capital funding situation but was happy to hear that the replacement of the Ladywell Unit remained a high priority for SLaM and South-East London ICB.

4.11. Community wait times had improved with 13 individuals waiting for secondary care contact as of last week. Officers reported that the biggest concern was individuals not being able to access primary mental health care and ending up in A&E. Last month, 300 individuals accessed mental health services through A&E. There was a need to increase clinical capacity at primary care level so that more people could be supported closer to home at their PCN (Primary Care Network).

4.12. The high-risk issues at the Ladywell Unit had been fixed. This included the replacement of all windows, improved airlocks for security and improved layout and visibility in the wards.

4.13. Replacement of the Ladywell Unit was a high priority for Lewisham. It was also important that the unit was rebuilt at the hospital site to ensure the integration between mental health and physical health. Lewisham’s Executive Director for Community Services and SLaM were both part of the ‘Lewisham Reconfiguration Programme Board’ which was working on the proposals for rebuilding the Ladywell Unit.

4.14. It was discussed that austerity in local government had highlighted the impact of the wider social determinants on increasing mental health issues. 

4.15. Given the current challenges in mental health services, it was important to innovate inpatient services for those individuals who did not have the option of community care. For the last 2 years, SLaM had gone through a process of quality improvement approaches across the Trust. Now each team had regular improvement huddles where they looked at key metrics and how they could be improved. This encouraged innovation of new practices inspired by patient experience at the ground level.

4.16. SLaM’s Lewisham Board had a monthly meeting where the Head of Nursing, Associate Medical Director and other lead clinicians were in attendance. They reported assurances to the Board around quality of services. This information was triangulated through feedback from patients, carers and staff. Tenable audits were also undertaken that captured quality metrics from each ward.

4.17. The team aimed to keep the length of stay at the Ladywell Unit to an absolute minimum. The current average length of stay was 42 days, but the benchmark was 30 days, and the team was striving to achieve that.

4.18. The dependence on out-of-area beds had been reduced significantly over the last 6 months. A new 15-bed ward (Evans ward) was being opened at the Ladywell Unit to increase capacity. Officers were confident that the opening of Evans ward would significantly reduce and eventually stop all of Lewisham patients from being sent out-of-area.

4.19. A Committee member gave an example of the ‘Repeat Attenders Service’ that ran in Lewisham in partnership with One Health Lewisham but had now ceased. This service had 240 patients on the list and excelled at social prescribing. Patients met regularly at the Green Man and were supported in the community via various activities. SLaM officers expressed that they would be interested in learning more about this service.

4.20. SLaM had recently opened a recovery house which was a Trust-wide resource. This recovery house had 6 beds and was used to support people who approached A&E with mental health issues and were in need of short-term support. This was a relatively new service and clinicians had seen some people returning to the service. However, clinicians were trying to learn why people were returning and that information was helping tailor the development of the community service model of care.

4.21. As a result of the national community transformation programme- Lambeth, Southwark and Lewisham had received £38 million worth of investment over the last 3 years. Officers now needed to review whether the investment had been used in the right way. A conversation was also being had with the Maudsley Charity. The Charity was interested in investing in the community model of care and was willing to test the Lewisham community work with fundraisers. Officers were also hoping that NHS England’s support for the programme would translate into funding.

4.22. South-East London ICB’s Medium Term Financial Strategy included the ICB’s commitment to increase the proportion of their budget going into mental health services. The strategy also recognised that Lambeth, Lewisham and Southwark had been underfunded for their mental health services. This meant that Bromley, Bexley and Greenwich had been overfunded. Therefore, ICB had made the commitment to increase funding for mental health services faster in Lambeth, Lewisham and Southwark. This increase in funding would be for both children and adult mental health services.

RESOLVED:

·         that the Committee write to Norman Lamb (SLaM) and Andrew Bland (South-East London ICS) to express disappointment in the lack of capital funding for the replacement of the Ladywell Unit;

·         that the Committee recognised that the lack of capital funding meant there was a need to review the existing assets of SLaM, Lewisham Council and other partners, to see what could be done for improving Lewisham’s mental health estate;

·         that the report be noted.