London Eye: Missing the police

The NHS isn’t the only thing with financial problems (and in the context, £1.7bn overspent nationally might actually be a heroic achievement).

The Metropolitan Police have a much lower spend per head of population than they did a decade ago and many more local authorities are thought to be going the way of Croydon (bankruptcy) than previously thought.

A locus of these pressures is, of course, mental health patients waiting for days at a time in accident and emergency departments, which is no good for anyone.

HSJ has reported on the causes of this (increased demand, lack of beds, resulting poor flow, housing issues) and some of the responses (trusts renting housing, re-opening closed beds) – all very expensive.

What is being trialled from the start of this month is an attempt to rebalance who does what in the current system, specifically with the police.

The Right Care, Right Person programme started elsewhere and was introduced in London following the Met issuing a public ultimatum earlier this year.

New Scotland Yard reportedly got legal advice saying it was doing more than comparable forces in terms of responding to mental health calls and would likely win any legal challenge, if one were made.

The police seem to have got a lot of what they demanded in May, and officers will no longer respond to requests to look for a vulnerable patient who has walked out of an emergency department before discharge, unless there are exceptional circumstances. And welfare checks will no longer be undertaken by police unless there is an immediate threat to life or a risk of serious harm.

While the new agreement commits officers to not leave an emergency department until a handover for section 136 patients (commonly known as “sectioned” patients) has been agreed with health staff, psychiatric liaison services are expected to see a patient within one hour of arrival.

This latter agreement in particular is likely to be a crunch point in terms of resourcing.

The RCRP has already been introduced in Humberside, where a police inspectorate report found encouraging results.

At the risk of sounding knee-jerk conservative, Humberside and London are quite different places and this is potentially a very significant policy change in the care of the most vulnerable people in the city introduced at pace.

NHS sources told London Eye while there hadn’t been much difference on the ground so far, it seemed the Met had so far been cautious in staying with patients where there is a risk of violence or similar, and it was too early to see what the impact would be of winding down welfare checks.

Unlike, say, in maternity services, the safety of mental health patients has received too little focus. Let’s pay attention to what happens to them and to staff when it’s been in place a while.

NE takers?

London has some strong rebukes to the idea that, in trust terms, big is beautiful. Not just from difficulties at some of the giants but, even more striking, the strong performance of small trusts like the Homerton or Kingston. Lewisham and Greenwich Trust, although multisite, offers district general hospital services and is much improved.

So the departure in the spring of the Homerton’s chief executive Louise Ashley (for family reasons) is potentially an interesting one, not for the departure itself but what it could mean for the organisation of services in north east London.

It has long looked a little odd that while the multisite behemoth Barts Health Trust continues to integrate with Barking, Havering and Redbridge University Hospitals Trust to the east (a shared chair, shared chief exec), the Homerton sits as an independent island in the middle.

Maybe the idea is not to change anything. Homerton (hospital rated “outstanding”, trust overall rated “good”) has always had some of the best results in the country across most metrics. In no way a given for quite a challenging bit of the city in terms of health need.

It has exported this as well. Former Homerton finance director Jo Farrar seems to have made a similar success of the one-borough trust model in the opposite corner of London in Kingston.

Kingston Hospital also performs well compared to neighbours. The fact it works so well with its system on sharing elective demand, without anything more formal than a non-statutory provider collaborative, augurs well for the continued independence of the Homerton.

But planners sometimes like simplicity. There is talk of having both north west London’s mental health trusts brought under one leadership team when the current incumbents retire.