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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 The outdated design, and particularly the revenue provision as determined at that time, are now completely inadequate, and are insufficient to deliver the standards of care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 1 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: 5. 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. 2 Appendix ‘B’ 6. 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. 7 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. 3