Agenda item

Report of Director of Operations, Tees, Esk and Wear Valley NHS Foundation Trust

The Director of Operations, Tees, Esk and Wear Valley (TEWV) NHS Foundation Trust submitted a report (previously circulated) updating Members on the proposal to reconfigure and streamline adult crisis services across Durham and Darlington and to close the Crisis and Recovery House, in order to improve patient experience and allow more efficient use of flexible resource.

The submitted report outlined the current crisis service provision, which consisted of two separate teams covering North Durham and South Durham and Darlington, working on a 24/7 basis; a Street Triage Team, working in partnership with Durham Constabulary with core working hours of 14.00 to midnight, seven days a week; and a nine bedded Crisis and Recovery House in Shildon.

It was confirmed that the utilisation of the Crisis and Recovery House was consistently lower than 50 per cent due to limitations of use; there were only 88 admissions in 2017; there were no admissions between December 2017 and May 2018; since May 2018, the average occupancy had been 8.45 per cent; and due to low demand was temporarily closed.

Members were advised of the engagement and consultation undertaken in respect of future options for the crisis service, including pre-engagement work in the summer of 2018 with service users, their families, the public and stakeholders. The pre-engagement work identified the need for patient choice with a range of options; the need for consistent access to support out of normal working hours; support for carers and peer support; the need for ease of access, a quick response and early support; and the need for a safe haven providing support and signposting.

A three-day Improvement Event in September 2018 with staff, patients and stakeholders proposed that the crisis service be reconfigured to create a single team; this proposal was supported by the local Crisis Concordat, Mental Health and Learning Disability Partnership, Commissioners and TEWV Trust; and a hub and spoke model would be implemented before the end of 2019.

It was stated that decommissioning the Crisis and Recovery House was felt to be the only viable option; this would create an annual saving of £265,000 which would be reinvested into the integrated crisis service, with an additional seven members of staff and new phone triage system; and would enhance the offer of Intensive Home Treatment.

Members were advised that funding had also been secured to develop local safe havens.

Discussion ensued in respect of the safeguards in place for the Healthcare Assistants responsible for triaging calls from patients; and were reassured that there would be support from Band 5 and Band 6 (registered nurses), along with Band 7 (Advanced Practitioner) staff members.

Concern was raised in respect of the response to incidents involving members of the public having a mental health crisis; and the lack of empathy and compassion displayed by staff members from the crisis services. Members were assured that the street triage team work closely with the crisis team and police when responding to any mental health crises. It was confirmed that the review had been initiated following recognition of feedback received, which included concerns in respect of empathy and compassion; that these concerns were being addressed; and Harm Minimisation, a recovery-orientated approach to clinical risk assessment and management, had been introduced with training for staff ongoing.

Members highlighted that the proposal to close the Crisis and Recovery House would mean the loss of a service, utilised by a small number of individuals; it was confirmed that the house had not been used in this financial year; those patients that used the service in the past were being case managed; and that service users recognised the benefits of the safe havens.

Members felt that given the ongoing work on the Crisis Service that this should be considered as an item for the work programme; and felt that Members would benefit from Mental Health awareness training.

RESOLVED (a) That the outcome of the work undertaken and the proposed integration of crisis services across Durham and Darlington be noted.

(b) That the single service approach and the implementation of the revised model be supported by Members.

(c) That the decommissioning of the Crisis and Recovery House, to enable resource to be more effectively reinvested in an enhanced crisis and home treatment service, be supported.

(d) That the planned development of a safe haven approach to supplement the specialist crisis service provision be noted.

(e) That Crisis Services be considered as an item for this Scrutiny Committee’s work programme.

(f) That Members be provided with Mental Health Awareness training with support from Public Health and Healthwatch Darlington.