County’s mental health services left ‘in chaos’

Mental health services are 'in chaos'
Mental health services are 'in chaos'
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A lack of staff, beds and cash have left mental health services in Lancashire “in chaos”.

That was the view of councillors who grilled a senior doctor over a catalogue of complaints about support for patients in the county.

The Harbour

The Harbour

Members of Blackpool Council’s health scrutiny committee heard plans to turn services around included reopening some services at the former Parkwood mental health ward at Blackpool Victoria Hospital.

But councillors criticised an improvement drawn up by Lancashire Care NHS Foundation Trust on the back of a damning inspection report by the Care Quality Commission (CQC) –and said it did not go far enough.

Following a visit from inspectors in January and February, the report, published in May, gave the trust a “requires improvement” rating and found eight breaches of legal requirement across three core services – plus another at “provider level”.

It also listed 22 areas the trust must improve to address its concerns.

Committee members grilled the trust’s clinical director, Dr Leon Le Roux, about a series of failings, including the way The Harbour mental health unit on Preston New Road, Blackpool, has been run.

The meeting, at Blackpool Town Hall, heard patients with mental health issues were turning to A&E for help because there were no beds available at The Harbour, which provides specialist services for people across Lancashire.

Staff morale was described as low, there was a recruitment crisis and money from shutting wards had not been re-invested in community mental health services, the meeting was told.

Blackpool Council’s director of public health Dr Arif Rajpura said Lancashire Care was letting residents down.

He said: “Our GPs are deeply unhappy with the access their patients are getting from Lancashire Care.

“And if they don’t get the support in the community, patients are going to end up in crisis in the hospital.

“This is about our residents. We need to do something about this and we can’t have the current level of service provision going forward.”

According to Blackpool Clinical Commissioning Group (CCG), there are currently 13 patients in Blackpool waiting for mental health beds.

Coun David O’Hara told the meeting: “We were told there would be outreach places to ease the pressure on The Harbour.

“But The Harbour seems to be in chaos and these are problems we have been having for the last three or four years.

“It has got to the point where something must be done urgently.”

Coun Michelle Scott said: “These are people’s lives we are talking about, or people’s deaths. I get the impression you have been trying to struggle on with staffing difficulties that have given huge risks to patients and that’s not acceptable.”

Coun Amy Cross said the trust had failed to engage with the council to tackle issues in the town.

She added: “They are discharging patients without even telling them they are being discharged. How does that make someone feel when they are suicidal?”

Dr LeRoux said the service was “under-resourced” and it was difficult to attract doctors and nurses to work in Lancashire.

At the end of 2017, four consultant doctors had left the trust in three months and Dr Le Roux said: “We were simply unable to fulfil our legal obligation to detain patients.”

He said the decision to put 262 beds into The Harbour based on population figures from 2006/7 had not worked due to people needing to stay longer on the ward than expected. Speaking after the meeting, he added that the current provision would be suffient, if adequate additional services were in place, such as substance misuse and rehabilitation beds.

Around £16m that became available due to the closure of other mental health wards had not been reinvested into community services as it should have been, councillors heard.

Dr Le Roux said: “The model is skewed because investment in the community has not happened.”

He added it had been difficult to recruit staff because people preferred to take jobs in cities such as Manchester.

Paul Bronson, chief operating officer at Blackpool CCG, said it had commissioned 15 beds from The Priory, a 38-bed independent mental health hospital in Preston, to help ease the crisis.
Dr Le Roux also revealed the plans to bring Parkwood back into use.

He said: “That building has been empty since the move to The Harbour.

“In the last year or so we have developed plans around Parkwood.

“We are looking at a two-phase plan. A relatively small investment, but quick, would bring in a liaison and crisis team to strengthen the front-facing acute offer.

“Then develop the rest of the building and bring in a more robust home treatment team, bring in social services, housing, the police and the third sector to have a diverse service.”

Lancashire Care said the plans could see the ward house an extension to the existing mental health decision unit already based at the Vic, where patients can be supported for up to 23 hours.

Parkwood is being considered as a “potential option” for the location of the extended service, if it goes ahead. No decision will be made until an ongoing independent review of the county’s mental health services is completed.

Mental health campaigner Stuart Clayton, from Bispham, who represents the Fylde Family Support Group, warned the meeting: “There are a lot of vulnerable people out there who are on the verge of giving up and thinking things are never going to improve.”

He called for more health care assistants on the wards at The Harbour.

Mr Clayton added: “A lot of people are saying they don’t see that reassuring face. They can wait a week to see a psychiatrist and in the meantime there is no-one to talk to.”

Blackpool GP Dr Neil Hartley-Smith, of Bloomfield Medical Centre, told the meeting that mental health issues were one of the main reasons patients visited the practice.

He said: “This is due to multiple factors – deprivation, someone’s upbringing, substance misuse.

“All of this is producing patients in need of help. It leaves people in limbo when it’s difficult to find any help.

“We see some patients going to A&E in crisis. Then they have to wait to be seen by someone from the mental health team from The Harbour.

“There should be some people in A&E to see these people as they come through the door.”

The committee asked Dr Le Roux to come back to a future meeting with a more detailed update on action being taken by Lancashire Care to improve its services.

The former Parkwood Psychiatric Unit at Blackpool Victoria Hospital.

Dr Leon le Roux, consultant psychiatrist at Lancashire Care NHS Foundation Trust.

The Harbour psychiatric hospital in Marton.

Failing facility replaced

The Harbour opened in Blackpool in March 2015 as a replacement for the old Parkwood ward at the Vic.
At the time, bosses highlighted the fact Parkwood was not built to provide mental health services, while the new facility on Preston New Road had been specially designed for the purpose.
In 2006, plans were put forward for a new “super hospital” to replace facilities in Blackpool, Lytham and Fletwood, including the ageing Parkwood unit.
The following year, Blackpool was given the go ahead to build the new hospital, which bosses said were badly needed.
The existing wards was described as “not fit for purpose”.
In 2008, it was revealed that the new facility would be built at Whyndyke Farm, Marton, following a public consultation, with plans unveiled the following year.
In 2012, a damning CQC report criticised failings at a female-only ward at Parkwood
Later that year, it was revealed 44 beds had been lost in the previous 12 months following the closure of two wards, with the remainder closing once The Harbour opened.

Damning conclusion into state of services

Not safe, not effective and not well led. That was the damning conclusion of a report into the Lancashire’s mental health services by the Care Quality Commission.
The watchdog inspected services run by the Lancashire Care NHS Foundation Trust , which include Guild Lodge in Preston, The Harbour in Blackpool and The Cove in Heysham.
The trust was given a “requires improvement” raiting in three areas – safety, effectiveness and quality of leadership – while it was rated “good” in the caring and responsive categories.
Problems listed in the report included:
++ Patients having to sleep in chairs in communal areas because of a lack of facilities
++ Lack of beds meaning that patients detained under the Mental Health Act could not be admitted
++ Staff not able to manage certain patients
++ Staff not monitoring patients after the use of rapid-tranquilisation
++ Broken and boarded up doors in one unit
++ On the child and adolescent ward staff did not always refer to patients in a respectful manner
++ Poor quality food and no access to snacks and drinks for in-patients
++ Low staff compliance with essential training in some core services
++ It was not clear that lessons learned from adverse incidents were effectively shared.
Trust chief executive Heather Tierney Moore said at the time the report was “disappointing”.
She added: “We have dedicated and hard-working people at Lancashire Care and this was recognised by the inspection team who saw first hand how caring and responsive our employees are towards patients.
“We are clear about what needs to be done to ensure that the people using our services have a good experience and receive high quality services.
“I personally, along with my colleagues on the Board and senior managers are committed to ensuring that frontline teams are supported to take the learning from this inspection and working together to make the required improvements and build on the positive aspects of it.”

Mental healthcare concerns

Earlier this year, Blackpool’s coroner wrote to mental health chiefs over concerns about record keeping after a man committed suicide.
This week, bosses at Lancashire Care NHS Foundation Trust apologised amid criticism that his suicidal tendencies had not been “clearly documented”.
Coroner Alan Wilson has previously voiced concerns that mental health teams in the region are struggling to cope in the face of overwhelming demand.
Lancashire Care receives twice as many referral as other similar trusts, with services across the country facing high levels of demand .
And that demand for help has seen patients sent out of the county – as far away as Somerset – because of a lack of beds, The cost of sending patients out of the county, or to be treated privately, cost the NHS £4m last year.

What the trust said

A Lancashire Care NHS Foundation Trust spokesman said: “An improvement plan has been developed to address some of the fundamental issues in the delivery of mental health services and part of this involves looking at how we can increase capacity within services to respond to current demand.
“The committee also discussed wider challenges including staffing and this referred to issues at the end of 2017 in our medical workforce. This has been addressed by introducing a new medical model. This new approach has proved favourable with our consultants and patients who now benefit from increased continuity of care from the same consultant.
“We recognise the committees’ concerns about the CQC inspection of the Trust and offer our assurance that there is a full comprehensive action plan that is being delivered to make the required improvements.
“This has yet to be shared with the committee and a meeting is being convened for us to have a full and detailed discussion about the progress we have made since the inspection took place.”