North by North West: Coming back from crisis

The mental health trust for Lancashire and South Cumbria has been in the process of reversing some of the bed closures which left its urgent care services in crisis a couple of years ago.

Problems came to a head in 2018-19, when Lancashire accounted for a third of all 12-hour breaches in emergency departments across England — the vast bulk of which were mental health patients needing urgent support.

Two external reviews identified multiple problems across the urgent care pathway, but the key finding was a severe lack of inpatient bed capacity.

Caroline Donovan was appointed chief executive of Lancashire and South Cumbria Foundation Trust amid the fallout, and has spent the last two years securing funding to open around 90 additional beds.

She told NxNW: “In the previous decade there had been a reduction in adult, older adult and psychiatric intensive care bed numbers, from something like 800 down to around 300.

“When you’re building new facilities there’s the opportunity to reduce bed numbers and try to transform the model of care, but you can’t do that without major investment in community services, and across the system there hadn’t been that corresponding investment.

“There has now been a significant investment into the community, but also building that bed base back up. We’re putting in about 90 additional beds for adults, older adults, rehabilitation, and PICU. So we’re growing these types of beds by around 20 per cent.

“It should end up being cost neutral because of the money we were spending on beds out of area currently — and we’ll be able to keep people nearer their homes.”

The additional beds include a 28-bed unit in Wesham, scheduled to open later this year, as well as 32 on the Calderstones Hospital site in Whalley.

The Calderstones site’s future has been uncertain since 2016, when NHS England said the hospital would close under its Transforming Care programme.

However, some of the buildings are less than 10 years old and are of good quality.

Ms Donovan confirmed LSCFT is to inherit the entire site from Mersey Care FT (which acquired the former Calderstones Partnership FT five years ago), as part of a deal in which Mersey Care has been granted some capital funding for their mental health services.

She said there was also potential to provide more mental health beds in addition to the initial 32, if some further capital funding could be secured.

The right narrative

It remains to be seen whether this will be enough for the system to cope, with the covid pandemic’s impact proving difficult to predict.

But some of the reports and figures coming through look pretty alarming. For example, mental health attendances in accident and emergency surged to 1,233 in June, compared to just 810 in June 2019, an increase of more than 50 per cent.

Ms Donovan said: “I worry we’re not landing the narrative right around what’s happening with demand. If you aggregate the mental health demand up nationally it looks fairly flat and that there isn’t an issue. But it’s so variable in terms of demand across the country and areas like ours are really struggling.”

With the LSC health system holding a financial deficit of more than £300m, the concern will be that further investment will be far more difficult to secure.

Sensitive subject

Part of what is driving the increase in A&E attendances is thought to be the continuing difficulty in getting face-to-face appointments with GPs or community services.

Ms Donovan said: “It’s fabulous that people have gone to digital modes, but primary care and community mental health services are seeing less people face-to-face. We think this is having an impact on the numbers of people presenting in services that they may not have done previously.”

Stats published by NHS Digital suggest the proportion of GP appointments happening face-to-face was 60 per cent over the summer months, which was higher than the pandemic low of 47 per cent last year, but still far below the pre-pandemic levels of around 80 per cent.

This will be a sensitive subject to raise with partners in the system, however, with the Lancashire and Cumbria Consortium of Local Medical Committees saying it is an “unfair” link to make.

It responded in a statement: “It is unfair to cite the increased presentation at A&E as being due to the lack of face-to-face appointments in general practice, who are pulling out all stops to deliver quality services to their patients.

“It should be noted that over the past decade or so, investment in community mental health services has been insufficient to meet the rising need and this will inevitably lead to increased attendance at both GP surgeries and A&E…

“Despite a reduced workforce, increased workload and demand for GP appointments, GPs have worked harder than ever and will always see patients face-to-face when clinically necessary.”

It said there is now more investment being made through primary care networks, and patients have welcomed the technological developments made in primary care.

Quick exit

Since the regulatory concerns over Liverpool University FT revealed in the previous edition of NxNW, chief executive Steve Warburton has announced his sudden departure.

In a message to staff last Thursday, he said: “After considerable thought and personal reflection, acknowledging there is never an ideal time for these decisions, now feels like the right point for this change to happen for me personally and for the trust.”

He left the trust on Friday and has been seconded to a role with Cheshire and Merseyside Integrated Care System. Will any other senior staff follow?

The trust said it would soon start a recruitment process for a substantive replacement, and has appointed Sir David Dalton, former Salford Royal CEO, in the meantime.

Sir David lives on the Wirral and had already been doing some consultancy work with the trust around patient safety.