Agenda item

This paper informs Members of the Government’s scheme to eradicate out-of-date mental health dormitory wards and the development of modern, purpose-built accommodation for older adults with mental health issues, including dementia. The paper also updates Members on new capital investment, the process by which this was secured, and timescale requirements for accessing this capital funding, as well as outlining early progress in reviewing locations for a new, updated facility for Kent and Medway residents and how this fits with an ambition to provide high-quality and safe accommodation for patients within the context of a programme of wider mental health transformation.

Discussion:

Members considered a paper regarding the Government’s scheme to eradicate out-of-date mental health dormitory wards and the development of modern, purpose-built accommodation for older adults with mental health issues, including dementia. The paper updated Members on Kent and Medway Health and Social Care Partnership Trust’s (KMPT) successful bid for £12.65m of government funding as part of this national policy, to build a new facility including single ensuite bedrooms for 16 patients (rising from 14). The paper  described the process by which this investment was secured, and the timescale requirements for accessing this capital funding, as well as outlining progress in reviewing locations for this new, updated facility for Kent and Medway residents and how this fitted with an ambition to provide high-quality and safe accommodation for patients within the context of a programme of wider mental health transformation. The CCG explained that a new purpose-built facility would offer greater privacy, access to outside space and improved infection control measures – an increasingly important concern in light of the COVID-19 pandemic. Following an extensive review of potential locations for this new facility it was proposed that a new unit for Older Adults was built at KMPT’s site in Maidstone.

Members raised the following issues and concerns:

·       Identifying a site in Medway – noting the high demand for services in Medway, several Members expressed concern at the fact that the CCG had been unable to identify a suitable site in Medway for the new purpose-built building for inpatient mental health services in place of Ruby ward at Medway Maritime Hospital. Whether the option of locating this on the hospital site had been fully explored was questioned. KMPT assured Members that extensive efforts had been made with partners to find a site in Medway, including working with the CCG to see if any care home providers met the criteria. Some potential options had been identified and the report gave reasons for why these had been discounted. KMPT had worked with the Medway Foundation Trust (MFT) to look at suitable options at the hospital site but MFT had confirmed there was no suitable alternative space that could be used to provide single room, ensuite facilities.

KMPT clarified that £12.56m funding was available for this project but this did not include funds to acquire new assets, including the development of a new ward on the hospital site. The suggested Maidstone site for the new facility would mean it would be co-located with other services which would result in good quality care.

Members suggested Canada House, Harmony House and the Medway ambulance site that was being sold as potential sites that should be explored. Noting that Harmony House had been developed as a dementia unit but was currently being used a Covid recovery centre, it was questioned whether Medway Community Healthcare (MCH) may have changed their plans for Harmony House meaning it could then be an option. KMPT undertook to respond on this specific query but confirmed they had worked with MCH to look at possible sites and at the point this work was carried out had been told there were no suitable sites MCH could release. KMPT confirmed that Canada House was not a suitable location and that none of the sites they had identified in Medway had met the criteria. Nevertheless, several Members asked for a further assurance that all efforts to find a suitable site in Medway had been exhausted.

The CCG commented that they were working to a tight timescale set by the Government and risked losing the capital investment from the Government if they did not act quickly and start work on a new site by October 2021.

·       Services in Medway - concern was expressed that this represented another example of a service being moved out of Medway. In response to a comment that 23 of the 52 patients admitted to Ruby ward in 2019/20 were from Medway and Swale, the CCG advised that this was a Kent and Medway wide service. Whilst Members’ concerns about losing dementia services in Medway were understandable, KMPT commented that moving this in-patient facility from Medway did not represent a reduced service and that two additional beds would be created as a result and other dementia services would remain in Medway. It was also explained how the Care Quality Commission (CQC) had ongoing concerns about the poor-quality of Ruby Ward and the limited ability to improve the standard of the environment despite significant investment over a number of years.

Acknowledging Members views that mental health problems in Medway were significant, the CCG commented that there were major plans to improve mental health services in Medway which included prioritising the rollout of community-based dementia services.

In terms of what services would be brought back to the hospital if Ruby ward closed permanently, Members were advised that this would enable  some general surgery currently being provided by the independent sector to be provided at the hospital.

·       Travel time to Maidstone – the point was made that the journey from Medway to Maidstone was not straightforward in spite of the 12-mile distance. Some patients could remain in the ward for up to 70 days which could make it difficult for friends and family to visit regularly, particularly in the case of elderly people. The CCG acknowledged these points and said they would listen to what the public had to say when carrying out engagement work on the proposals.

·       Engagement and consultation – The CCG commented that their preferred way forward was for a period of public engagement to discuss the proposals with patients and carers and that this work could start fairly soon. The CCG felt that a 12-week consultation period would make it extremely difficult to meet the deadlines they were operating under and if work did not begin on site in October then the capital funding would be withdrawn. Concern was expressed about how meaningful a short consultation period would be during a period of lockdown. The CCG responded that they had experience of running virtual engagement activity during the pandemic with good levels of engagement and while face to face events may, at times, be preferred this might not be possible. Healthwatch Medway confirmed that they could help with targeting the appropriate groups and exploring issues around transport and services.

·       Practical considerations – if the new facility was to be in Maidstone then the practicalities of this would need to be worked through with the Council as council staff were involved with mental health assessments and discharge arrangements. The proposal needed to be seen in the broader context of improving services for people with dementia.

Decision:

The Committee agreed to:

a)      note recommendations a) to e) in the report.

b)      agree that the reprovision of services from Ruby ward at Medway Maritime Hospital to the Maidstone Hospital site is a substantial variation to services.

c)      recommend that a 6-week period of public consultation takes place with this Committee and local people including patients, families and carers who have used the Ruby ward service, to identify alternative sites or solutions to urgently eradicate the Trust’s remaining dormitory ward by 2022.

d)      request that the CCG and KMPT investigate further Harmony House, Canada House, the Medway ambulance site and Elizabeth House as possible alternative sites for the new facility and also explore further with the Medway Foundation Site whether a suitable site can be found at Medway Maritime Hospital.

e)      agree that the outcomes of these investigations and discussions be discussed with a small Member Working Group.

(In accordance with Council Rule 12.6, Councillors McDonald, Murray and Price asked that their votes in favour be recorded.)