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Health Scrutiny Committee – 6 January 2012 Evaluation fol owing the closure of day services provided by South Staffordshire and Shropshire Healthcare NHS Foundation Trust 1. That the Health Scrutiny Commit ee consider and comment on the at ached evaluation fol owing the closure of mental health day services, and transition to other services, in What is the Scrutiny Committee being asked to do and why? 2. As part of their focus on the provision of a coherent mental health service in the county, in March 2010 the Health Scrutiny Commit ee previously responded to engagement by commissioners on improving support for people with mental health problems in south Staf ordshire. They requested an evaluation report be provided in due course, being most concerned that existing service users were supported through the transition and had immediate access to other services that met their needs when the day services closed. An interim update was provided at the end of September 2011. The evaluation report is now available for the Commit ee to consider. 3. On 30 March 2011, South Staf ordshire Primary Care Trust (PCT) board, fol owing a period of public engagement, approved the closure of the day services that were provided by South Staf ordshire and Shropshire NHS Healthcare Foundation Trust (SSSFT). Those services included the Chartley Centre in Staf ord, Spring Meadow day service in Cannock, the Friary in Lichfield, George Bryan day service and Albert House in Tamworth, Burton Task Group in Burton, and St David’s in Wombourne. 4. The majority of these services closed on 1 May 2011, with the exception of Albert House which closed on 30 September 2011 whilst a new service was commissioned and 67 people were transitioned across. Burton Task Group wil cease to be delivered by SSSFT on 31 December 2011 and wil be reprovided as a social enterprise by Sherrat ’s Wood Care Farm organisation on 3 January 2012 when 37 people wil be transitioned across. 5. As part of the agreement to pursue the closures that were planned for 1 May 2011, commissioners requested assurance that al individuals at ending those services at the time, a total of 169 people, were transitioned across to alternative services such as the newly commissioned social inclusion and recovery services provided by the third sector, and continued to be supported through care planning by the Community Mental Health Teams (CMHTs). To that end we requested evidence of this, and were provided with detailed information that reviews had taken place with each service user. An additional request was also made of the Joint Commissioning Unit (JCU) to revisit al of those individuals to determine what impact not being able to at end the SSSFT day centres may 6. To give that assurance, we developed three processes. Firstly, every individual that had been accessing the services at the point of closure was reviewed again in October and November 2011. This was done by individual NHS number and care co-ordinator, and included revisiting their day care needs, looking at what activities they were engaging in; and what had changed in their mental health needs since the first review in March-April (see Appendix 1). Secondly every service user was of ered the opportunity to fil in a pro- forma about their views and experiences independently of their care co-ordinator which was sent directly to JCU (see Appendix 2). Thirdly in partnership with the South Staf ordshire Network for Mental Health, we advertised drop in sessions in each locality that were af ected by the closure during October 2011, so that people could come along 10 people were accessing St David’s day service at the time of closure. Of that number: 2 people have been discharged as they have reached a level of recovery; 5 individuals are accessing either Richmond Fel owships Staf ordshire Life Links, or Quest; 1 individual is accessing Learning Disability support services; al those that remain in the care of SSSFT ‘ I don’t think the closure was handled very wel , I found out quite late it was closing, I’d heard rumours but these had been going on for some time. I felt I needed more notice. I was devastated by the closure and very upset. I was seeing my workers at the CMHT every 2 weeks and had my medication increased. I’m not angry that’s St David’s closed, just the way it was handled. I now go to Richmond Fel owship, and I’m a lot busier, and I now do lots of volunteering, I run a peer support group with others at Mid Staffs Mind and the South Staffs Network for Mental Health and I’m applying for a volunteer role at Richmond Fel owship too. Richmond Fel owship are going to do 4 steps to recovery In Wombourne, its so smal , people are used to the old ways. I’m now travel ing to London for training with Richmond Fel owship, there are much more opportunities with RF that I would never have done at St David’s. My life is bet er now, but it was a hard transition because of the way it was handled. I get more support from RF, they are always there for you, they are there whenever 47 people were in at endance at the Friary Centre. At the time individuals at ended to receive medication management in the form of Clozaril Clinics and Depot Injections. Of those: 4 people have been discharged from services; 1 person is currently an inpatient; and 2 people are supported within the Learning Disability Team. The remainder continue with support from CMHTs under Care Planning Approach (CPA), and receive medication in clinics or at their own home, and 1 person is seeking employment with the help of the There were no individuals that wished to tel their personal story. There were 34 people accessing the George Bryan day service, who would be supported by CMHTs as part of the CPA, and 67 people accessing the drop in at Albert House, whose needs would be described as low and not requiring the support of specialist The George Bryan day service delivered time limited groups such as: Managing Depression; Confidence Building; and Anxiety Management. 22 of those individuals at ending completed the course and required no further additional intervention and were discharged from services. The remaining individuals al remain within CPA and CMHT support. For the drop in service a new service was commissioned delivered by Changes, a user led organisation, and al at endees have access to this service. ‘I used to go to Albert House for an Art group. I only used to speak to one person. Everybody made me feel welcome and good, I used to go 3 days a week and my carer would take me there. I go to Changes now, 4 days a week and I come on my own to Changes without my carer. I’m now volunteering with Changes which I have never done before, I’m doing administration. They make drinks for me, I like it, I’m happy, I feel safe here, I have friends here. It’s bet er than Albert House, I do more things here and I’m now get ing bet er.’ ‘I found the depression group at the George Bryan day service very helpful. I’m volunteering at Changes, I welcome people and make them feel comfortable. I was anxious about coming here, but now I come here every day. It gives me a focus to get up in the morning and I have more confidence. Before I used to sit in the flat, I didn’t want to go to Albert House real y, but now I look forward to going to Positive feeling in Changes, its more relaxed, not made to feel welcome at Albert The lit le things Changes do, make a dif erence’ ‘I’m starting to do groups at Changes and volunteering. The day hospital was successful and works,… and I was anxious about the changes in service provision, but Changes is good, it works, it provides a lit le bit of You get to form friendships and community – I felt when the day hospital closed we lost our community, but we have a community here at Changes.’ The Chartley Centre was supporting 18 people at the point of closure. It of ered time limited therapeutic interventions for self esteem or assertiveness for example. Of that number: 8 people have been discharged from services; 1 person is back at work ful time; and 1 person is actively seeking employment through the Employment Works service. The remaining 8 individuals continue under CPA with the support of CMHTs. There were no service users that wished to tel their personal story. 60 people were accessing Spring Meadow and the time of closure. 40 of those people at ended for medication management such as Clozaril Clinics and depot injections, 3 for Occupational Therapy input. Of the 43: 3 people have been discharged from services; and everyone else continues to be supported under CPA through the CMHTs. 17 people at ended for social groups, pot ery or Creative Art, or an Al otment group. Of those 17 people: 1 person has been discharged; 1 person has moved area; and 4 people are accessing Richmond Fel owship, Quest or Rethink; 1 person is unable to engage with similar activities and feels a loss around the closure of Spring Meadow. Al individuals that remain in service continue to be supported under CPA by CMHTs. ‘Going to Spring Meadow was a hard job at first, as my il ness prevented me from going out. Gradual y things became easier, and I got to know the staff and gained interest in what I was doing, art and pot ery, but since they have gone I’ve gradual y There was supposed to be a new group starting … I’ve searched Cannock for other ‘Since Spring Meadow day centre has been closed, I feel the network of support I had, has been removed. The present appointment system for administering medication which has replaced the ‘drop in’ is more pressurised because I have to come in at a set time and the room is used by different providers. If a member of staf is absent for any reason, I am left vulnerable because the replacement is often unfamiliar to me and causes me added stress. Everyone is very caring now, as before, but you can only work with what you have ‘It’s not fair that it was closed. Not fair for me, the people that worked there or I go to Quest farm group now – I like it bet er than Spring Meadow, there is more to ‘The closure of Spring Meadow was something of a surprise to me and af ected me After feeling let down and suf ering il ness as a result members of Park house put me in touch with Quest, they have given me hope in difficult times.’ ‘I did enjoy the day service. Now that it has closed I have had support to find other groups in town to at end. I enjoy the social and art groups.’ ‘I was a service user at Spring Meadow and thought they al done a good job they helped me and al the staff was very helpful. It was just a pity that the service users didn’t take the classes that was on of er. I was in the last class of assertiveness and there was about 8 people who at ended and there was just me at the end. I’m afraid it al come down to money again. Just sorry that it has closed and I would like to take this opportunity to say thank you to al the staff who helped me.’ ‘Spring Meadow started of providing care for a wide range of service users. There were people with severe and enduring mental problems … and those with depression/anxiety. Those with anxiety felt very grateful that their condition was not as bad as others, and those with more serious problems were able to share their experiences and gain peer support. By closing down day hospitals you have lost a valued place for those with more serious problems.’ ‘I have had 15 years of day centres, to me the change was required. We have now been to some very interesting places and are encouraged to mature’ ‘People wanted things to be the same, but with the closure of Spring Meadow does not affect the level of care to al users.’ 7. There is no evidence that individual’s mental health has deteriorated as a result of the closure of the SSSFT provided day centres. A number of individuals, 39, have reached a level of recovery, that has enable them to be discharged from specialist services, this represents 23% of those individuals at ending at the time of closure. The remaining individuals continue to be supported by CMHT or Learning Disability teams. On the whole people have engaged positively with the commissioned social inclusion and recovery services, and there is evidence of positive progression for many individuals. 8. Areas for continued improvement include ensuring SSSFT staff are ful y aware of other potential services that could benefit people with mental health needs and that commissioned services are adequately targeting their promotional and publicity materials. 9. Further learning would include al owing for a longer period between the decision making and the ef ective date of closure to ensure this is robustly communicated in a timely manner, and that individuals that had been familiar with a particular model of care for many 10. Link to NHS Trusts’ or Shared Strategic Objectives – The changes relate to the shared objective of improving the health and wel being of Staf ordshire residents. 11. Link to Other Overview and Scrutiny Activity – The Commit ee have recently considered consultation on changes to mental health inpatient beds in the north and south of the county, which has included discussion of secondary care mental health service provision in the community. A working group has also been looking at certain aspects of primary care mental health service provision. 12. In scrutinising this mat er, the Commit ee are encouraged to consider the fol owing: • Resource and Value for Money Implications Name and Job Title: Nicola Bromage Commissioning Manager


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