Download 3. Current Position

Appendix ‘B’
Lancashire Adult Social Care and Health Overview and Scrutiny Committee - 29
August 2006
Temporary Closure of Older Persons Mental Health Ward Chorley
1.
Introduction
This paper sets out the reasons for the transfer of the Chorley and South Ribble Admission
and Assessment service, currently provided at Hazelwood Ward on the Chorley District
General Hospital site, to Ribbleton Hospital in Preston, and explains the circumstances
that have lead to these actions.
2.
Background
As with most services in Lancashire, the current in-patient areas in Preston and Chorley
are delivered from the standard capital developments of the 1970’s, which are typical
“ESMI” type design. The outdated design, and particularly the revenue provision as
determined at that time, are now completely inadequate, and are insufficient to deliver the
standards of care and treatment expected in the 21st century.
Despite a variety of alterations, the design remains an inadequate base from which to
deliver modern services, but this is particularly evident in the Chorley ward (Hazelwood).
This has led to significant recruitment difficulties.
Both Preston and Chorley areas are using bank / agency staff to meet basic safe staffing
levels, cover vacancies, sickness, training, annual leave and, more importantly, meet the
needs of more acutely ill older patients. Currently, an average of 50% of the staff available
on Hazelwood ward at any one time is made up of agency staff. At times, particularly at
night, the vast majority of staff are made up of temporary staff. This is an unacceptable
and unmanageable situation which is a cause of significant concern to the Trust, despite
the measures put in place to reduce the risks.
Two serious drug administration errors and other clinical incidents have already occurred
on Hazelwood ward in the last six months, apparently as a consequence of the high levels
of Agency staff used. These clinical risks are the most significant concern of all and have
serious potential effects for individual patients, clinicians and managers if the ward
remains open.
Therefore this paper sets out the only solution which will:
1) Consolidate substantively employed staff on a single site thereby enabling the
clinical care standards to be improved to a level which is expected in a modern
mental healthcare system and significantly reduce the clinical risks to in-patients
(and the Trust) to a manageable and acceptable level,
2) Provide services for organic and functional patients separately on two wards with
sufficient staffing levels to enable a good quality of care to be provided, within
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Appendix ‘B’
existing resources and utilising a male/female environment preserving the privacy
and dignity of service users.
3) Re-direct existing financial and staff resources to alternative community services for
older adults where recruitment will be more successful and provide a viable
alternative to hospital admission.
3.
Current Position
At Ribbleton Hospital, 2 wards operate on 16 beds, each with a physical capacity for up to
25 beds. These are split into mixed sex organic and functional areas. The Ribbleton
Hospital site is a small community hospital with a pleasant external environment with a
new patient’s garden. Internally the wards have adequate interview rooms, quiet lounges
and staff rooms, which are not available in Chorley.
In Chorley, one ward, Hazelwood Ward, operates on the District General Hospital site. It
is isolated, split into two, to provide 9 organic beds and 16 functional beds on the second
floor with limited access to the outside area, especially when staff shortages occur. The
organisational layout of the ward places additional demands on the levels of staffing
required to manage the patients care and treatment effectively.
4.
Proposed Solution
Increase bed numbers to 24 beds on each of the two Ribbleton Hospital wards, ward 1
and ward 2. These wards would continue to provide assessment and treatment for people
with either a functional or organic mental illness. This will reduce the capacity by nine
beds.
In addition we propose that approximately one third of the existing Hazelwood resource is
converted into extra community healthcare staff, which will increase the caseload capacity
of the current service by 70-100 patients, thereby offsetting the reduction of the in-patient
capacity and providing alternative strategies to hospital admission for clinicians.
The following actions are already underway:
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5.
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Facilitating the discharge of patients from Preston/Chorley of delayed discharges
with the help of LCC Social Services.
Temporarily closing admissions to the Chorley site.
Subsequently consolidate all in-patient services in Central Lancashire on the
Ribbleton Hospital site, providing 48 admission/assessment beds in two wards (one
organic and one functional ward).
Immediately close down the inpatient service currently provided on the Chorley site
in the Hazelwood Ward, moving any remaining patients from Chorley to the Preston
site.
Benefits
Reduces the reliance on temporary bank or agency staff to achieve safe staffing
levels in an isolated unit – Hazelwood Ward, thereby reducing the clinical risks to
patients as demonstrated elsewhere in the findings of the Rowan report. Releases
experienced staff into community services at an early stage.
Staff can focus on developing their expertise in dementia care and functional mental
illnesses respectively.
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Appendix ‘B’
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6.
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Consultants will be able to reorganise the allocation of their duties as follows; two
Chorley Consultants separating their work into in-patient care and community care
respectively, with the two Preston Consultants working in the same way.
All in-patient services will be consolidated on one site which will enable us to
improve professional cover, particularly in the medical, nursing, Occupational
Therapy, Psychology, Dietetics and Speech and Language areas, and improve the
quality of the service provided to a safe level, enable a speedier response from the
medical staff and reduce infrastructure costs. Adequate free car parking is
available for staff and visitors.
Preston wards have recently undergone extensive refurbishment, giving a much
improved mixed sex environment.
Current proposals to develop three in-patient services across Lancashire propose a
single site option in Central Lancashire. This would provide an interim step towards
this goal for older adult services.
Substantive staff from Chorley to transfer with patients, providing continuity.
Standards of catering and nutritional support are of a very high standard at
Ribbleton Hospital, reflected in a high PEAT score.
Risks
All patients to be transferred from Chorley will be fully assessed first, to ensure that
they are fit to travel. The Lancashire Ambulance Trust will be used to convey
patients with Nurse Escorts, ensuring their safety is maintained.
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Conclusion
Due to the significant clinical risks which exist associated with the provision of in- patient
services at Hazelwood Ward, the Trust would like to transfer these services to the
Ribbleton Hospital site.
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