Agenda item

Transforming Mental Health Services in Kent and Medway - Eradicating Dormitory Wards

This report outlines the initial headline results from the formal public consultation on the proposal to relocate Ruby Ward from Medway Maritime Hospital to a new purpose-built facility in Maidstone.




Members considered a report from the Kent and Medway Clinical Commissioning Group (CCG) which outlined the initial headline results from the formal public consultation on the proposal to relocate Ruby Ward from Medway Maritime Hospital to a new purpose-built facility in Maidstone. Set out in a supplementary agenda were full, detailed reports and analysis of the responses to the consultation and the activity undertaken to deliver the consultation.


The CCG advised that a range of methodologies had been used in the consultation process and there had been a particular focus on deprived areas to elicit views and feedback, particularly on travel and transport issues, as requested by the Committee.


In summary, a majority of respondents agreed the proposed move would improve care and address needs, but some challenges and concerns had been identified with regard to travelling and visiting. The CCG would carry out further work to look at what mitigations could be put in place to support patients and families. Some other potential sites had been suggested from respondents to the consultation and these would be evaluated to see if they met the criteria, the outcome of which would be included in the CCG’s decision-making business case and also reported to Members for information.


The CCG thanked the Committee for their engagement with the process. 


The following issues were then discussed:


·       Mitigations – it was emphasised that any mitigations put forward needed to be implemented and Members kept informed, noting similar circumstances in the past where promised mitigation did not take place, albeit  under the responsibility of a different leadership team.


·       Consultation process – noting that the Independent Report on the consultation stated that, of all the respondents from across the catchment population, Medway and Swale residents disagreed most with the proposals and the potential loss of this service in their locality, how people were selected for phone interviews and why no libraries in Medway were used was queried. In addition, disappointment was expressed that only two online survey responses had been received from Medway and Swale residents. The reference in the Independent report to two respondents from Medway and Swale was in relation to a comment that the proposal would not represent an improvement in the service. In response to the point about there being only two online survey responses from Medway and Swale, Members were advised that the online survey was only one of the methodologies used to seek feedback in the consultation, and other methodologies such as focus groups, attendance at patient and community group meetings, and telephone interviews were used to gather responses from across the catchment population including those from Medway and Swale. An additional 100 telephone interviews had been commissioned mid-way through the consultation specifically to boost the number of responses from those in more deprived areas, including in Medway and Swale. It was explained that the people chosen for phone interviews had been selected randomly. There had been a focus on more deprived areas, as requested by the Committee, with 200 interviews taking place in that category. Due to concerns about infection control, it had been difficult to get agreement for hard copies of the consultation survey to be left in some locations that would have been used pre-pandemic to distribute information – for example, GP surgeries and hospital waiting rooms.  


A point was made that for the drop in events, the Pentagon Centre in Chatham should have been used. The CCG advised that the Sunlight Centre had been chosen based on feedback from Members. The CCG undertook to look at whether any Medway libraries had been used to distribute consultation material.


Concern was expressed that there had been insufficient consultation with the voluntary and community sector (VCS) in Medway who could have helped target difficult to reach groups. The CCG was asked to bear this in mind in future consultations. Member were advised that the CCG had worked with existing networks to reach VCS organisations. In addition, contact had been made directly with groups representing carers, the LGBT community etc. There had been a target of 118,200 people having an opportunity to see or hear about the consultation and the assessment was that the actual figure reached 320,000.


·       Loss of services in Medway – several Members expressed concern that the proposal amounted to another service being lost in Medway and, in particular, that it meant the loss of the last in-patient mental health ward in Medway, an area with a large population and many deprived areas. In response, Members were advised that there was significant investment planned for community mental health services in Medway as part of a major mental health transformation programme which was starting in Medway and Swale and which the CCG and KMPT remained committed to. Also, the majority of people needing mental health services received care in their community. In response, a point was made that this investment in Medway would have happened in any event and that it must be rare for an area with a population of 300,000 people not to have an acute ward.


·       Staffing issues – reference was made to a concern raised by staff that they were used to dealing with 10 patients in Ruby ward, while the new unit would have the capacity to treat and care for up to 16 patients at a time. How many staff would be working in the new unit, how many were transferring from Medway, whether any needed support to work in a mixed sex unit and whether staff concerns about therapeutic activities at the new unit would be addressed were questioned. In response, KMPT noted that no decision on the new unit had yet been taken but if the proposal was approved then the affected staff would be individually consulted through a Human Resources led consultation, including views on who wished to transfer to the new unit and who wished to remain with KMPT or another NHS service locally. Anyone not wanting to be transferred would not be made redundant.


There were clear rules on safe staffing levels and staff to patient ratios. This would still be met in the new unit with the capacity increase of two more beds. There were also clear policies on gender separation. Staff worked with older patients across Kent and Medway based on the needs of patients and there were other wards which were either single gender or mixed. It was important to provide an environment where there was a safe separation of male and female patients, something not possible at the current Ruby Ward but which could be achieved in a new facility.


There were approximately 26 FTE staff in the service now and the same number was proposed for the new unit. If necessary, they could be supported from other units on the same site. In response to a comment that this meant the same numbers of staff would be caring for an additional 6 patients, KMPT advised that the staff would be dedicated to the ward and they did not expect to see a significant increase in workloads. The environment in the new unit would be greatly improved and would make it easier to care for and monitor patients and the current staff ratios for 14 beds also applied for 16 beds.


The priority was to have the right staff and skills in place to provide care. The proposal would mean an increase of 2 beds from the current 14 beds. The new unit would continue to care for patients across Kent and Medway with a focus on meeting needs. Access to the service would remain for everyone in Kent and Medway and this would not change if the location of Ruby Ward changed. An assurance was given that if it was found to be more difficult to manage the potential increased number of patients then staffing levels would be increased as the Trust had a responsibility to make sure patients were safe.


Whether staff were trained to spot signs of severe depression which could lead to their or others’ safety being compromised was questioned. Members were advised that staff were required to undergo mandatory training. Many were registered and qualified and there was a strong culture of supervision of staff to ensure skills met national standards to deliver care.


·       Site in Medway – concern was expressed that not enough had been done to find a site in Medway. The CCG responded that various premises in Medway had been evaluated against the criteria, including Medway Maritime Hospital but there had not been enough space there, or appropriate sites elsewhere in Medway despite an extensive search. However, releasing Ruby Ward would free up space to help the Medway Maritime Hospital increase its capacity for supporting patients with physical health needs and to help reduce waiting lists etc. 


·       Travel – KMPT advised that a travel analysis had been commissioned to look at this in detail and the impact of the proposal on different parts of Kent and Medway and the catchment population for Ruby Ward. While Ruby ward was located in Medway it was not solely for Medway residents. When acute admission was needed for mental health patients it was key that this should be to a ward and clinical team that best suited the clinical needs of that patient. Members heard how visiting arrangements for those on mental health wards were different to those in hospital for physical health treatment and care. Visits were planned and scheduled as part of care planning for mental health patients, and the Trust worked with families on how best they could maintain contact. If visitors needed help with travelling to visit there was a volunteer driver service run by the Trust. The CCG had not yet finalised its response to the consultation but was looking at a travel and transport policy to address these concerns.


·       Timescales for a decision – a point was made that the timescales for submitting a bid for funding may have affected the decision to propose moving the service to Maidstone. Whether an extension of the timescale KMPT was working to would have allowed more time to look at sites in Medway was queried. Members were advised that the CCG and KMPT had been faced with a very tight timescale. Considerable work had taken place with partners to look at possible sites in Medway before it was clear that the proposed site was the best option to consult on and engagement with the Committee took place. This work had started over 12 months ago when the announcement of a bid for capital funding had been made. Given the criteria set by the Government, the CCG and KMPT did not believe more time would have made a difference.


·       Release to community care - how the concerns raised in the consultation on increased travel distance aligned with releasing people into community care was queried.  Reference was also made to the importance of timing for acute admissions. KMPT gave a commitment that patients were admitted as close as possible to where they lived but there were not units in every part of Kent and Medway and their admissions policy was ‘needs led’ first. It was rare to place patients out of area though.


·       Funding for new unit – in response to a question, Members were advised the CCG was confident the capital funding for the new unit was available and not at risk of being lost. Whether there had been a gap between KMPT becoming aware of the funding and the chance to apply for funding. KMPT responded that they were not aware of any gap and had submitted a bid as soon as they had been notified.


·       Volunteer driver service – whether this service operated in Medway and how many drivers were available was questioned. KMPT advised they would report back to Members on numbers but that the volunteer driver service had operated since 2006 and operated on a request basis. An analysis had shown some areas were not as well served (e.g. Dartford) where it was difficult to recruit drivers. It may be necessary to invest more and carry out some targeted recruitment. At present there was a small level of demand for the service, but this would be monitored to see if demand increased significantly if the proposal was agreed. A point was made that the last time a ward had closed, the same assurances had been given on help with travel, but no evidence was ever seen of Medway residents being able to use the service. The importance of transport provision being provided was emphasised, particularly as buses from some parts of Medway could take 2.5 hours to get to Maidstone. It was pointed out that there was a long-established voluntary driver service already operating in Medway.


KMPT clarified that volunteer drivers did not transport patients to the ward.


·       Criteria for bid -  why the new site had to be on land owned by KMPT was questioned. KMPT advised that the national criteria stipulated that the site had to be part of the Trust’s assets. The capital allocation granted did not include funds to acquire a new site and the availability of accessing capital funding in the NHS was very limited. 




The Committee:


a)    agreed the following comments and recommendations as the Committee’s formal response to the CCG on their proposal to relocate Ruby Ward from Medway Maritime Hospital to a new purpose-built facility in Maidstone:




i)      Welcomes the eradication of the last dormitory ward for mental health patients in Kent and Medway and also the £12.65m allocation to KMPT by the Government to allow a new facility to be built.

ii)     Deeply regrets that a site could not be found in Medway which met the agreed criteria.

iii)   Regrets that this proposal represents another service moving out of Medway, particularly as the highest proportion of admissions to Ruby Ward between 2016/17 – 2019/20 were from Medway and Swale.

iv)   Considers that earlier engagement with scrutiny may have led to a site being identified in Medway.


{It is acknowledged that the CCG, KMPT and MFT met with the Council in 2020, prior to engagement with the Committee, to attempt to find an alternative site in Medway. The first report to the Committee on this matter was in March 2021 when Members were asked to decide whether the proposed reprovision of services from Ruby ward at Medway Maritime Hospital to the Maidstone Hospital site was considered to be a substantial variation to services and were also advised of various sites in Medway which had been identified as a result of the earlier discussions with the Council referred to. However, none of these sites met the agreed criteria.


In addition, HASC members made some suggestions for possible alternative sites that were fully evaluated in Spring 2021 and discussed as part of a small sub working group comprising Medway HASC members and NHS officials. This process is outlined in earlier papers to HASC and the NHS’s pre-consultation business case for the proposed changes to Ruby Ward.


The agreed protocol between the Committee and NHS bodies in the case of substantial variation of health services says: “The NHS body will discuss any proposals for service change with the relevant OSC committee at an early stage as part of the Committee’s work programming process in order to agree whether or not the proposal is substantial and at this point there will be discussion about how consultation with the OSC will be undertaken.”}


v)    Welcomes the fact that the proposal was the subject of a formal public consultation, reflecting the wishes of the Committee and that this was more appropriate than the limited public engagement initially recommended by the CCG.

vi)   Expresses its disappointment that the public were consulted on a single option proposal and that this was phrased in terms of it being a relocation and not the closure of a service in Medway.




i)   That the alternative sites in Medway identified in the public consultation that have not already been assessed against the criteria (i.e., Gillingham Business Park, Chatham Dockside and Medway Campus), are assessed as a matter of urgency and this is included in the decision-making business case to be presented to Kent and Medway CCG Governing Body in November 2021.

ii) The outcome of this evaluation of potential alternative sites is reported to Members via a briefing note for information.

iii)    That service users and their families and carers are involved in the more detailed design process, including ensuring that the new site has a range of digital communications available to enable patients to contact their families and carers.

iv)   That a travel and transport strategy is produced during the planning process that addresses the travel and access needs of patients, staff, families and carers and that a report on the take up and effectiveness of this strategy be submitted to the Committee within 6 months of the new facility opening.

v)     That clarity is provided about the implementation process, especially around the relocation of patients and staff including how  patients who may be initially admitted to MFT in crisis after the service has moved from Ruby ward will be assessed and transferred.

vi)   That, for similar proposals in the future, the CCG (or successor organisation) works with the Committee to ensure, in line with Government Guidance on Local Authority Health Scrutiny, that there is constructive dialogue with health scrutiny when communicating on timescales for comments or decisions in relation to substantial developments or variations in order to help ensure that timescales are realistic and achievable.

vii)  That where in future the requirement to consult the Committee on a substantial variation to a health service is triggered, public consultation should then be seen as the default position and a decision on this, and the appropriate timescales, should be made alongside the Committee.


b)    agreed, in the event that the CCG disagrees with any of the Committee’s recommendations, to delegate to the Director of People – Children’s and Adults’ Services the authority, following consultation with the Chairman, Vice-Chairman and Opposition Spokesperson, to try to reach agreement with the CCG on behalf of the Committee.


Supporting documents: