A mental health trust in a rural location has opened 15 rehabilitation beds to implement a “unique” model of care which it says will eliminate the need for inappropriate out of area placements.
Cornwall Partnership Foundation Trust has not sent any patient out of area after opening Cove Ward, a £1.9m step-down facility for previously acute patients, in Redruth six weeks ago.
Celice McDermott, clinical director for inpatient services at the trust, said she was “fairly confident” the trust would no longer send inappropriate patients out-of-area for treatment.
Up to 16 patients have previously been treated out of area at the same time due to a lack of beds in Cornwall.
The government has set English mental health trusts the target of eliminating inappropriate out of area placements by 2020-21.
The funding for the ward is a one-off investment, but the CCG will evaluate its performance and potentially provide further investment.
Under Cornwall Partnership’s care model, patients at the trust’s acute unit are assessed after 28 days to see if they can be safely looked after at Cove Ward.
Once admitted to the Cove Ward, they are given a targeted length of stay of 28 days, and encouraged to manage their own care.
They are admitted if they are allowed unescorted leave during their treatment.
Admitting patients to the rehabilitation unit frees up beds at the trust’s acute unit for patients who would otherwise be sent out of area for treatment.
After admission to the ward patients are helped to identify areas of life they need help to work with, and strategic meetings take place with medical staff at various points of the 28 days.
Dr McDermott said the model improves the flow of patients throughout their treatment, rather than just adding extra bed capacity.
“We use the principles of rehabilitation psychiatry which are to encourage and enable people to take back control of their lives after an episode of mental illness,” she said.
“Progress is controlled by the patient themselves and the team working with them,” Dr McDermott said.
“Goals for discharge are developed with the person. They need to decide for themselves what needs to happen for them to be discharged. It could be something practical like getting accommodation in a certain area, or that they can’t be discharged until they have a good understanding of why they were admitted in the first place and make a plan around that, or it could be controlling symptoms.
She added: ”We’re also looking at bringing in a system of red and green days to signify when a patient has made progress. There are processes here being used that I’m not aware are being used elsewhere.”
The trust’s average length of stay for patients on the acute unit is around 44 days, but Dr McDermott wants that reduced to the national average (around 31 days) as a result of the new model.
“There has to be a purpose to opening new beds,” she said.
“It’s about looking at the whole system and working out how to use the beds you’ve got more efficiently
She added: “If you just open more acute beds you end up filling them with more people and there’s no change to how the system flows.
“People’s thresholds for admission changes, but no one does anything about making length of stay shorter.”
Funding for the ward came from Kernow Clinical Commissioning Group.
A CCG spokeswoman said: ”The benefits will be much more than the value invested and the additional quality impacts for our patient group will also be significant as we move care closer to home and reduce the length of stay for people in acute care.”
The ward’s team comprises around 30 different health professionals, some of whom also work with the community mental health teams.
Information provided to HSJ