Older people and frailty mental health consultation

Who are we?

We are Lincolnshire Partnership NHS Foundation Trust (LPFT) and we provide mental health and learning disability services for Lincolnshire. 

We provide care and treatment for a local population of around 719,000, as well as specialist services for people who live in other areas of the East Midlands.  We are focused on helping people towards recovery, enabling them to live well in their community as much as possible.
 

What are we consulting on?

We are specifically seeking your views on the plans for our home treatment service to provide a permanent county wide service.This means that Rochford Ward at Pilgrim Hospital will no longer be required. 

All patients will be cared for in accordance with their needs but will have the option of home treatment team support if risks can be managed within a community setting. People will still have access to an inpatient bed if required.
 

What is the home treatment team?

The team provides an alternative to hospital for older people with complex and severe mental health needs, who can be managed safely in the community setting with enhanced and intensive bespoke support. The service is available seven days a week and is made up of a psychiatrist, mental health nurses, occupational therapy, physiotherapist and support workers, who provide practical assistance for people in our care.
 

What do they do?

They work closely with patients, their family or carer and other professionals (such as the existing older people’s community mental health teams) to provide intensive support, assessment and treatment during periods of increased need. When the care of the CMHTs alone is not enough, the home treatment team works with and supplements the existing community support to provide more intensive and frequent support. They work with the patient and family in their own home and community, to draw on their strengths and skills to improve and maintain their mental health and independence.

While under their care patients can access the team seven days a week 8am – 8pm, Monday to Friday and 10am – 6pm, Saturday and Sunday.

The care they provide is short term, intensive and flexible to meet individual needs. The length of time will be agreed with the patient, their family, carers and the community mental health team.
 

More about the home treatment team

The team will help patients manage and resolve this stage of their illness through assessment and treatment in their home, as an alternative to hospital admission. They also support people being discharged from psychiatric hospital, helping them to continue their recovery at home.

The home treatment service provides:

• An alternative to hospital for older people with severe and complex mental health needs.
• Close monitoring of patient’s mental health.
• Support, education and advice for patients and their family/carer.
• Help with managing medication management.
• Help with personal care if this has been impacted on by the patient’s mental health.
• Assessment of activities of daily living. 
• Support with effective coping strategies.
• If the patient has a care team, the home treatment team will work closely with them to make sure the patient has the best possible care.
• Where someone is not currently receiving Trust services but requires longer term support, the team will refer them to the most appropriate service(s) to meet their needs.

How did the home treatment team begin?

A major refurbishment of one of our older adult mental health wards in Lincoln (Brant Ward), presented the opportunity to pilot a new home treatment model during October 2018 which delivers increased community support, enabling service users to stay at home safely. This has greatly reduced the need for people to be admitted to hospital and the number of beds required; enabling the provision of the enhanced community offer over seven days and extended hours of access. The service has received positive feedback from service users, carers, our partners and clinical staff. 

The Home Treatment Team has evidenced that fewer people need to be admitted to hospital and thus we need less inpatient beds. For those people where home treatment has not proved effective, we are able to use the best of our inpatient wards for our patients.
 

Why do we need to make these changes?

Like many NHS organisations up and down the country, we are working hard to transform services, so that they are better for patients, deliver the right care, in the right place, first time and improve value for money.

This is a difficult balancing act, especially in a large area such as Lincolnshire where many people’s homes are spread across the countryside and in small villages. The development of increased community support aligns with national, regional and county priorities to provide greater support direct to people’s own homes and communities and reduce the number of people unnecessarily admitted to hospital.

Why do we want to make the home treatment service permanent?

The home treatment service has clearly demonstrated that there is no longer a need for the number of inpatient beds previously provided, before the extended community support was offered by the home treatment team. This means that the beds previously provided by Rochford Ward are no longer required. Furthermore, Rochford Ward does not meet essential quality standards for mental health wards, because it is based on the first floor and has no access to safe outside space. The ward has dormitory style bedrooms with issues of privacy, dignity and safety for patients. This is something which has also been identified by the Care Quality Commission in various national reports and during their inspection of Trust premises. 

Given these outcomes and factors, Lincolnshire Partnership NHS Foundation Trust is proposing that Rochford Ward would no longer be used and instead the recently refurbished modern, accessible and therapeutic space at Brant Ward would be used as the main older adult mental health unit, for those fewer patients who still need hospital care. This consultation will gather public, service user, staff and stakeholder views on this proposal.

Supporting information

Reduction in out of area patients

For the six months prior to the introduction of the home treatment team (April to September 2018) nine patients had to travel out of Lincolnshire for hospital care (an average of 1.3 per month). 

This compares with only ten patients in the  19 month period following the introduction of the team (an average of 0.5 per month).

Before the creation of the home treatment team the average days patients spent in hospital out of area was 23 days, compared to an average of 14.5 days since the team started operated.

Patient experience

The patients’ experience of the older people home treatment team has been consistently high. 

Based on the nationally used patient experience friends and family test (FFT); the team are recommended by 95% of patients accessing the service*.

(*based on 203 responses of either exrtemely likely or likely to recommend the service.)

There has also been:

• a reduction in the amount of medication patients use
• significant reduction in patient incidents 
• and improved clinical outcomes.

Admission avoidance

Since the older people home treatment team commenced, of 394 referrals only 28 (7%) of these patients required a hospital admission. 

This represents a potential 93% of patients being able to be treated in the comfort and familiar surroundings of their own home and family.

Engagement work plan

Download a list of all the engagement activity that has taken place with our service users, carers, staff and stakeholders.

Download our engagement work plan by using this link