Agenda item

Context

To present a draft Monmouthshire County Council response to the Aneurin Bevan University Health Board (ABUHB) consultation Redesigning Mental Health Services for Older People for scrutiny, requesting that Members provide comments to inform the final response to be presented to Council on the 18th January 2018.

Recommendations

That Select Committee scrutinise the attached draft consultation response (Appendix A) and makes recommendations as appropriate.

Key Issues

1. ABUHB approved recommendations at its Board meeting on 27th September 2017 to enter into formal public consultation a preferred option for the redesign of older adult mental health services.

2. The public consultation process was agreed between ABUHB and the Community Health Council to run between November 2017 and January 2018.

3. The ABUHB consultation document is included as Appendix B to this paper. The consultation sets out a vision for older adult mental health services and describes the challenges faced by the Health Board in recruiting a registered mental health nursing workforce to safely provide quality inpatient services. The consultation advises of urgent changes to services that were made in January 2016 to ensure that safe services could be provided. The consultation then sets out and appraises a number of options for future service provision. There is a preferred option described in the paper, to consolidate the number of older adult mental health wards, to 3 dementia wards and 1 functional mental health ward. This option would mean that dementia inpatient services would no longer be provided from St Pierre Services at Chepstow Community Hospital. This would mean that people from Monmouthshire requiring this service would access either St Woolos Hospital or Ysbyty Tri Chwm Hospital in Ebbw Vale.

4. Monmouthshire County Council Members have actively engaged in the ABUHB consultation process. In addition to an all Member seminar, there have a number of public engagement meetings well attended by Councillors. At the all Member seminar, and in public meetings, a number of concerns have been raised regarding the consultation proposals, the lack of consideration in the options appraisal to Monmouthshire’s demographics – current and projected- and prevalence of mental ill health. Concerns have also been consistently raised regarding transport and access issues, the impact on carers, lack of detail around investment in enhanced community services and the impact of service withdrawal on the viability of Chepstow Community Hospital. These concerns mean the consultation response is not supportive of the preferred option. It is proposed that Council expresses a view that a more robust option appraisal is undertaken considers fully all relevant information, and puts in place a plan for quality older adult mental health services – community and inpatient which meet the needs of current and future generations.

5. Notwithstanding the consultation response, it is important to emphasise the absolute commitment of Monmouthshire County Council to work in partnership to deliver integrated health and social care services. The commitment of the Health Board to a positive future for Chepstow Community Hospital, and the work being taken forward to plan for service provision in South Monmouthshire through the group co-chaired by the Chief Operating Officer, ABUHB and the Chief Officer, Social Care and Health, Monmouthshire County Council is welcome. To instil confidence, it needs to deliver detail of how primary and community health, social care and wellbeing services will be enhanced, making best use of the hospital and other physical assets.

Member Scrutiny:

The draft response was introduced by the Chief Officer, Social Care, Health and Safeguarding explaining that the draft consultation response reflected members’ views expressed at a seminar.  The Cabinet Member acknowledged that this was a significant recommendation, and the decision to present the draft response has not taken lightly.  The response identifies the severity of feeling about the proposals and everybody’s views and ideas are welcomed.  Questions and comments were invited.

A Member thanked the officers Elected Members and the public, for their involvement and also and commented that it was an excellent report that reflected what the public are saying.  It was added that the future of Chepstow Hospital for the south of the county (and for Monnow Vale for the north in terms of travelling to services) is a significant issue.  The County Council were urged to support the draft response.

A Member had personally sent a detailed response to the ABUHB and was pleased the Council was arguing against the preferred option and urged support of Option 1. This option avoids the issue of no provision in Monmouthshire where there is a higher than average percentage older population, would reduce the stress on patients, families and carers in terms of travelling, prevents under-utilisation of Chepstow Hospital and has the benefit of staff already being in place.  The view was added that Option 3 is not practical in terms of limited public transport and car parking.  If the ward was closed, concern was expressed that 7 dementia beds in the region would be lost overall, there will be insufficient inpatient care for dementia patients.  Chepstow patients may have to travel to Ebbw Vale or Ystrad Mynach.   The Health Board were urged to take account of the stress on carers adding that the resultant strain will absorb the projected savings. 

The Chief Officer welcomed the view of Select Committee Members regarding positive identification of Option 1.

Mr. P. Farley valued the remarks made.  He expressed his displeasure with the quality of Health Board engagement and provided examples of shortcomings. Accordingly, he asked that the following points were considered for the Council’s response:

1. An offer to work together on future consultations, and at an earlier stage, adding that, at a recent event there had been no opportunity hear information e.g.  the good work undertaken by Adults Services.

2. An offer to help with staff recruitment and retention by e.g. offering favourable access to leisure services or use of underused housing to meet staff accommodation requirements.

3. In terms of transport, it was questioned if the Council, as a transport provider, could influence services and support the amendment of routes, in collaboration with other councils, as necessary, to improve public transport to hospitals. 

4. How the south of the county becomes engaged in such issues in future. There is no accessibility for particular age and other groups to consultation as there is no forum for older people in the south of the county (unlike Monmouth and Abergavenny).  The support of Chepstow Senior Citizens Welfare Trust was offered in this respect.

A Member felt the report was good, noting the initial focus was clinical safety and challenges of future workforce planning but there is no focus on improving services.  It was agreed that transport is a massive challenge and that workforce is a national issue.  It was suggested that the Health Board has responsibility as a commissioner of educational posts and staff training.  The Health Board, in preferring Option 3, refers to savings to reinvest in local services but it was the Member’s view that whilst this would not necessarily disappear into the new SCCC, there was reticence to confirm that it would be allocated to the south of county.  It may, therefore, be used to address pressures elsewhere in the region.  The Member recommended that, as the Council wasn’t involved in the initial option appraisal, it’s not in a position to endorse any option.  It was suggested that there should be a start from scratch on an integrated approach with involvement in the developmental process.

The Member suggested that Option 1 should be included in the response to work towards but that there should be better consultation on option appraisal. It was observed that there is a need to define the local offer before any service is added or removed.

A Member agreed that it is necessary to return to foundations with the Health Board and Council working in harmony from the start.

The Cabinet Member questioned why Chepstow has been chosen instead of other areas.

A Member commented that the Health Board had reported, at a ward residents’ meeting, that the Council is formulating a plan for transporting patients.  The Member supported Chepstow Hospital as a Centre of Excellence instead of St. Woolos Hospital.  The Chief Officer responded that the Council is involved in forming transport plans and had hoped to attract integrated care funding with resource from the Health Board that would be added to the integrated transport structure.  The Health Board accepts that, with all changes re SCCC, it needs to have a transport plan but it is not just for the Gwent region Councils to resolve in isolation.

A Member raised the issue of loneliness and isolation, especially in rural areas and linked it to the stress encountered by carers who may not have the support of family of friends.  The availability of local services and the ability to visit relatives locally can provide relief so it is important not to underestimate demand for local health services where there is need and advocated Option 1 adding that Option 3 has not been adequately considered.

A Member observed that the Health Board approach has been wrong from the start and did not support an unsustainable proposal that will negatively impact of quality of life. 

A Member questioned what happened between the Clinical Futures meeting on the 8^th September 2017, the Lower Wye Area Committee Meeting on the 20^th September 2017 and the proposals to make changes on the 27^th September 2017.  The Member supported Option 1 to retain the status quo temporarily to allow broader consideration of dementia care linked to the proposed Crick Road provision.  

The Chair recalled that previous scrutiny called for a long-term, county wide strategy on dementia care and suggested this could be included in the draft response to Council.