Question 1: What inpatient mental health resources are there currently in Somerset?
Answer: Our acute in-patient beds are a small but important part of our new model of adult mental health care. They are a countywide resource of four wards, which are currently located in Taunton (two wards), Wells (one ward) and Yeovil (one ward). Nothing within our proposals see the number of beds, within Somerset change.
Question 2: St Andrews Ward has been operating as a ‘stand-alone’ unit in the same way for a number of years – why can this not just carry on?
Answer: Clinical staff have been concerned around the safety of St Andrews for some time. It is isolated (there is no adjacent ward to provide support staff in the event of a crisis), a long way (22 miles or 45 minutes) from the nearest Emergency Department at or A&E at Bath RUH, and there is no out of hours medical cover on site. There are processes in place to support the functioning of the ward, but they are by no means ideal and patients on acute mental health wards will need acute medical support as well as mental health support. We need to take into account both patient and staff safety.
While Rowan Ward in Yeovil is also a stand-alone ward (and carries some of the safety risks of St Andrews), it’s also very close to Yeovil Hospital Emergency Department.
By relocating all 14 beds from Wells to Yeovil, we can co-locate the two wards. This will provide support to staff on either ward in the event of an emergency, extend medical cover to 24/7 and ensure that our wards are close to an Emergency Department in case of a physical health need.
We firmly believe that this relocation will help us to provide safer and better quality care to people who need this level of mental health support across the whole of Somerset.
Question 3: What was the proposal and when was it agreed?
The proposal to relocate the fourteen adult mental health inpatient beds from Wells to Yeovil was formally agreed at our Governing Body meeting on 24 September 2020.
At the meeting, the Governing Body approved the following recommendations:
- The mental health inpatient unit for adults of a working age at St Andrews Ward in Wells should be relocated to Yeovil where it will be operated alongside the existing Yeovil unit in refurbished and fit for purpose modern facilities, which can be used flexibly to create male and female ward space preserving privacy and dignity.
- A service user and carer reference group should be put in place to support the implementation of the proposal, and particularly to review how the potential negative impacts of increased travel time can be mitigated.
Question 4: How were local people involved in the decision making process?
Answer: The decision made at this meeting followed a two and half-year period of engagement and consultation with staff, patients, carers and colleagues in the voluntary sector as well as with people who have an interest in mental health to co-create a new model of mental health care in Somerset.
Further information on the proposals, as well the details of the consultation, which were widely publicised across the county, can be found on this website (FFMF) as well as in the Governing Body papers, which are publicly available on the Somerset Clinical Commissioning Group website. A link to the consultation approach and further details around the proposal are below.
Question 5: What is the change in provision?
Answer: There will be no change in provision of this resource for adults and these beds will remain available to anyone in Somerset who may need this support. Patients do not currently go to the ward nearest to where they live (although this is considered), instead the go to the ward that best meets their needs and where there is bed availability – this approach will not change.
Question 6: Who monitors the decisions the Clinical Commissioning Group make?
Answer: The proposal to relocate the 14 adult mental health beds from Wells to Yeovil was scrutinised by the South West Clinical Senate and NHS England & Improvement, prior to formally consulting with the public in January 2020. We also shared this proposal Healthwatch Somerset, prior to a decision being made by Somerset Clinical Commissioning Group’s Governing Body in September 2020.
Question 7: How are you going to reflect the concerns raised in relation to transport and travel?
Answer: We recognise and appreciate the concerns raised in relation to transport and travel time, including how we plan to address this and take into account the needs of those who may need to access the service without personal transportation.
Somerset is a rural county with relatively poor public transport links and we are aware that the implementation of the proposal, while not affecting patients themselves, might have an impact on the travel time for carers, family members and friends. We also recognise that for some people there will be a negative impact in terms of travel times and costs as a result.
This issue was identified in the consultation feedback and a service user and carer reference group, (as requested in the Governing Body meeting) will be established to support the implementation of the proposal.
Question 8: What is the timeline for the relocation?
Answer: At the Governing Body meeting on 24 September 2020, the proposal to relocate the fourteen adult mental health inpatient beds from Wells to Yeovil was formally agreed. During this meeting, no set date for the relocation was given.
Expectation was that the development of the implementation plan could take around 18 months. We do not anticipate anything realistically will happen before late 2022 at the earliest.
Question 9: What are your plans for mental health provision going forward?
Answer: The experiences of the last 12 months have reinforced that the direction of travel in Somerset’s mental health services is the right one for our people. The pandemic has affected everyone’s mental and physical wellbeing both here in Somerset and across the country. We have continued to receive significant increases in funding to transform our adult mental health services, in addition to the original £13m awarded in 2019, and this funding will continue for future years. This has helped us accelerate many of the positive transformational plans we had in place.
Our focus is firmly on additional support being available to more people as early as possible. This will ensure that they are supported to manage their mental health at home or in their local community, meaning that people’s mental health does not deteriorate to the point where they require inpatient treatment and care.
Last year we launched our Open Mental Health service. This provides access to specialist mental health services, housing support, debt and employment advice, volunteering opportunities, community activities and exercise for any adult in Somerset who are suffering from mental health problems.
As part of this proposal, we are also expanding community mental health services across the county. We now have more mental health workers based in GP practices, people can access mental health support and services via digital technology and there is a new community based talking therapies service for people with complex mental health trauma. The breadth of these proposal help to ensure that access to mental health support is available to all who need it, not just those who have access to the internet.
We have commissioned additional community support across Somerset. In the Mendip area alone, we:
- have recruited 35 additional community based staff located in the area
- have four community Crisis Safe Spaces (two in Shepton Mallet, one in Wells, and one in Glastonbury). These centres are open to anyone over 18 who need face-to-face support and staffed by mental health professionals, (see Mental health crisis – Somerset NHS Foundation Trust (somersetft.nhs.uk) )
- are piloting the use of four step up/step down beds to provide a bridge between inpatient wards and local services
- have set up an all age 24/7 mental health line providing wellbeing support (Tel. 01823 276 892 and see Mindline – Mind in Somerset)
More information on the Open Mental Health work can be found using the following link – https://youtu.be/MdooCvn9zpg
Question 10: Why can’t beds be moved from Yeovil to Wells instead? It would give a fairer and more equal spread of services between the north and the south of the county.
Answer: We understand why people might think that would be a better solution but unfortunately, the biggest obstacle is the distance from Wells to the nearest Emergency Department – 22 miles or 45 minutes. There is nothing we can do to change that.
Analysing the real experience of patients who used the services at Wells and Yeovil during 2018/19, it is clear that all patients would have a longer journey by private transport if beds were to be moved either to Wells or Yeovil.
Moving beds from Wells to Yeovil: On average, a person previously admitted to Wells would face a longer journey of an extra 6 minutes if they had to go to Yeovil instead; 77 patients in all would have a longer journey time, 28 of them with an increase of more than 20 minutes.
Moving beds from Yeovil to Wells: On average, a person previously admitted to Yeovil would face a longer journey of an extra 7 minutes if they had to go to Wells. 145 of them in all would be affected, 111 of them with a journey increase of more than 20 minutes.
Calculations of the time for the people who used the service during 2018/19 to get from home to either Wells or Yeovil by public transport on a weekday afternoon show that around 36% of the patients could do the journey to each in less than 60 minutes.
Question 11: Why doesn’t Wells have the same out of hour’s medical cover as Yeovil – they’re both described as ‘stand-alone’ wards?
Answer: Out of hours, medical cover at both Taunton and Yeovil is provided by doctors enrolled on psychiatry training programmes with support from consultant psychiatrists as needed. St Andrews is not eligible for accreditation as a training site due to its isolation and size, and is unable to provide the breadth of experience or supervision required by the training providers to enable out of hours cover to be safely provided.
Question 12: There is a ward, Phoenix Ward, lying empty at the St Andrews site. Why can’t this be returned back into use?
Answer: This was one of the options we looked at in detail but the cost of bringing the ward up to a standard that is fit for now, and the future was much higher than the cost of converting Holly Court, which is adjacent to Rowan Ward on the Yeovil site. Even if it were a less expensive option, there is still the problem of distance from the nearest Emergency Department at Bath RUH, 22 miles and a minimum of 45 minutes’ drive by ambulance.
Question 13: What will happen to the Wells site?
Answer: There are many more services provided at the Wells site and these will continue. There are no plans to sell the site.
While we appreciate that in Wells and the surrounding area there were strong feelings about the proposal, we firmly believe that this relocation will help us to provide safer and better quality care to people who need this level of mental health support across the whole of Somerset.