Western Isles Health Board members this week backed the ‘Enhanced Community’ model as the preferred model for Mental Health services in the Western Isles.
NHS Western Isles Medical Director Jim Ward presented a Mental Health Consultation Report to members, which described the current Mental Health service, the proposed Enhanced Community service and the outcome of the recent consultation process, as well as financial and workforce implications.
Board members agreed that the next steps should be taken in terms of identifying the necessary funding to implement a new and improved Enhanced Community Mental Health Service.
The case for changing the configuration of Mental Health Services is based on an understanding that the way services are currently set up in the Western Isles does not allow for an effective, locally delivered approach to mental health service provision.
NHS Western Isles therefore set out to modernise the service and carried out a detailed option appraisal process with members of the local community, staff, and different service providers, after which, the ‘Enhanced Community’ model was identified as the preferred option. This was followed by a full consultation process on the preferred option, with meetings held across the islands, in Lewis, Harris, Uist and Barra, so that anyone with an interest could comment or ask questions about proposals.
At yesterday’s Health Board meeting in Stornoway, Dr Ward explained: “Our aim is to maintain the best of what we have and deliver the best of what we need.
“Our mental health staff deliver excellent care within the current model, but the configuration is completely imbalanced, as 95 per cent of our patients are based in the community; and between 85 and 90 per cent of our resources are in the hospital. To deliver the care that patients need, we must address this imbalance.”
The Enhanced Community model maintains inpatient capacity within Western Isles Hospital and continues to provide the current range of care on the same site. However this care will be provided by a single team of practitioners (rather than two teams as at present), allowing for the redeployment of a significant number of staff into community teams, providing care where it is needed most; in the communities of the Western Isles where our communities live.
In terms of current inpatient bed numbers, there are currently 14 beds in Clisham Ward (older age psychiatry unit) and five beds in the Acute Psychiatric Unit in Western Isles Hospital in Stornoway.
Dr Ward explained how this would change under the new model: “We have spent a lot of time modelling what we need in terms of inpatient bed numbers. It is, quite understandably, a sensitive matter and it is important that we got this absolutely right. Our APU has five beds and a 60 to 70 per cent bed occupancy rate. We are therefore confident that we could safely reduce that number to four APU beds, which would release resources to invest into the community service.
“In terms of dementia patients, national evidence shows that one per cent of the population who have dementia will require inpatient hospital care. The majority of people with dementia are much more safely, appropriately and effectively cared for in the community; either in their own homes with support, or in another community setting. Based on dementia projections for the Western Isles, and taking into account the projected number of dementia patients who will require hospital care into the future, we should need approximately five beds for dementia provision in the Western Isles. However, we feel that eight beds would be a more appropriate number and gives us a lot more flexibility into the system into the future.”
Dr Ward continued: “One of the concerns raised during the consultation was the worry that different groups of patients would be cared for within the same area of the hospital. I would like to assure that this would not be the case. There would be three distinct ‘zones’ within a single mental health inpatient unit (which would include en-suite single rooms) and the patients would be cared for by a single team. The unit could be located in the current Clisham Ward area. This would be an innovative and groundbreaking model in terms of mental health services in Scotland.”
In terms of community services, Dr Ward indicated that there would be two community teams; one covering Lewis and Harris and the other covering the Uists and Barra. The teams, which would require financial investment and training, would be very closely linked with GP Practices. Teams would have a range of skills, so that a variety of mental health issues can be managed safely and effectively in the community, helping to prevent inappropriate hospital admission.
Dr Ward added: “It is important to point out that there are a number of different mental health conditions that we do not treat in the Western Isles, such as patients who require intensive care, patients who have significant forensic components to their care and patients who have severe eating disorders. These patients are currently transferred to specialist units on the mainland for care, and this would continue to be the case.”
The mental health modernisation project will require capital funding in the region of £900,000, and an application will now need to be made to the Scottish Government for this funding. In addition to this, additional revenue funding would be required for the first two years of the new model as well as ‘bridging finance’ or brokerage to cover double running costs. This funding will also need to be identified.
Once funding has been confirmed and implementation plans developed, changes would take place over a period of around 18 to 24 months, to ensure patient safety and comfort throughout. The pace of change will therefore depend upon the availability and approval of necessary funding by the Scottish Government, the development of detailed plans for the redesign of the mental health inpatient area, and most importantly, the development of an interim care arrangement plans for patients, while changes take place.
Dr Ward assured: “We will continue to work with staff, the public, patients and carers to make sure that interim care arrangements are provided safely, effectively and professionally during the transitional period. I would strongly reassure that patients will continue to be cared for safely and with compassion and sensitivity throughout this entire process. Providing the best possible care for our patients is at the heart of this project, and patients, their families and their carers will continue as our partners in all decision-making in terms of patient care as this important project progresses.”
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