STP proposes to centralise city’s mental health beds 23 miles away

Somerset Clinical Commissioning Group is planning to relocate the 14-bed St Andrews unit in Wells to Yeovil, which would leave no inpatient mental health provision in England’s smallest city.

The city’s representative on Somerset County Council, Tessa Munt, said she was “horrified” by the plan.

It comes as Somerset’s NHS prepares to spend an extra £17m over three years on its mental health services after a successful bid for money from NHS England. The plans are under the banner of the county’s Fit For My Future programme, which is run by Somerset Sustainability and Transformation Partnership.  

The proposal to move the beds from Wells to Yeovil stems from a desire by health chiefs to reconfigure the 62 inpatient adult mental health beds in the county. In addition to St Andrews in Wells, there is one 18-bed unit in Yeovil and two more facilities in Taunton.

Chiefs believe moving St Andrews to Yeovil will improve patient safety because the ward would only be a mile away from Yeovil Hospital. Currently, the nearest acute hospital to St Andrews is Royal United Hospital Bath, which is a 45-minute drive away.

In its consultation document, the CCG also highlighted “challenges [at St Andrews] for recruitment and retention of medical staff”, with out-of-hours specialist cover only provided by a GP and an on-call psychiatrist by telephone. This is not the case in Yeovil, where training accreditation is provided, and junior doctors are on site 24 hours every day.

Medical staff at Somerset Partnership Foundation Trust, the county’s community and mental health provider, “unanimously” agree that the current situation at Wells is “very unsatisfactory”, according to a letter published in the document by Sarah Oke, the trust’s medical director for adult mental health.

Crisis cafe

Under the CCG’s proposals, a crisis cafe would be established in Wells to “provide significant support for people at and just before they reach crisis points which would otherwise result in an admission to hospital”.

The cafe will be open “at times of peak need” and will be developed with the voluntary sector, specialist mental health services and people who have experience of receiving support.

A second such cafe would be set up in Bridgwater — 21 miles west of Wells — and a “particular focus will be adopted to enhance the support in the community to avoid hospital admissions”.

There is “no expectation [of] compulsory redundancies” because of the plans and staff who do not wish to transfer from Wells to Yeovil will be offered alternative roles within the “expanded” community mental health services.

While the CCG acknowledges a “workforce risk” within its proposal, it believes consolidating resources on two inpatient sites will “create more attractive options for recruitment and sustained retention”.

Moving the ward to Yeovil will cost £5m, while carrying out necessary investments at St Andrews in Wells would cost £3.4m.

The CCG has committed to not reducing the number of inpatient beds overall, but it will have “the ability to reduce bed numbers by a small amount” if the expected improvements in the community-based services allow for this.

‘Utterly opposed’

Ms Munt, a Liberal Democrat, told HSJ: “I am utterly opposed to it. How is anyone going to get themselves to Yeovil in a rush?

“We have the unit here because enough of the population in and around Wells needs the facility.”

Between November 2017 and March 2019, there were 299 admissions to St Andrews, of which 188 were from Mendip, the area that surrounds Wells.

Ms Munt added: “I would leave it as it is because — in time — people will recognise the need for these services in a greater way. There are an awful lot of people who are in crisis and I can’t think that’s going to reduce, and therefore it’s better to have wards in different places in the county.

“Somerset is a big and rural county, and if you’re in the villages at the top of the Mendips it is such a long way to get to Yeovil.”

Meanwhile, health chiefs have also agreed to subcontract some community mental health provision to an alliance of 10 charities in a bid to help people who would not previously have been treated for their condition.

The alliance, which was the only bidder for the two-year £2m contract, will provide step-down care for people recovering from more intensive support and people with conditions such as depression, anxiety, eating disorders, and personality disorders.

The alliance is led by Rethink.

• Article updated at 1.50pm after incorrect spelling of Bridgwater.