Risk and challenges
The Board regularly monitor risks through its Board Escalation and Assurance Framework. The top risks faced by the Trust and how these are monitored and mitigated are laid out in more detail in the Annual Governance Statement however focus on the following key areas:
Increasing demand for mental health services
There has been a significant increase in demand for mental health services in recent years which has put pressure on services to provide care in a timely manner.
Services are completing detailed demand and capacity modelling and using new population health data to inform the planning, development and transformation of services.
Workforce
As with all NHS organisations recruitment of registered professional staff across many disciplines has become increasingly challenging, especially in some of our more rural and coastal areas. Some specialist services have particularly struggled with a lack of available professionals nationally and attracting them to work in Lincolnshire.
Whilst positive improvements have been made which you can read about in our performance overview there still remains some fragile services where workforce remains a substantial risk.
Privacy and dignity
Whilst the opening of our two new wards at Peter Hodgkinson Centre during the year has made significantly positive progress in tackling our outdated dormitory accommodation on some of our remaining acute wards. Ward 12 in Boston continues to use this shared accommodation model.
The capital investment to build a new ward in Boston to replace Ward 12 was agreed in year and work has begun on our new site at Norton Lea to provide a new 19 bed ensuite individual bedroom ward. The build is due to be completed by the end of 2025 and operational by early 2026.
Information and data
Cyber security is a risk many organisations constantly battle with, especially when they hold sensitive patient data. It is essential that our systems and processes are robust to prevent the loss and protection of this data.
The Trust regularly completes Information Governance and Cyber security audit exercises and testing to ensure what we have in place is robust and staff understand their role in protecting people’s information.
Delivery of our strategy
The Trust has ambitious plans for our mental health, learning disability and autistic communities through its new strategy, however there are significant financial and operational challenges which may impact our ability to deliver.
We have ensured that our strategy is aligned to the system Joint Forward Plan and other system plans and is an active part in system conversations to support Lincolnshire meeting financial and operational demands, whilst ensuring parity of esteem for our services.
Important events during the year
The Trust has made additional disclosures later in this report and within the Annual Governance Statement in regard to significant events and decisions.
It is useful to note however that we continued to have two services temporarily closed during 2023/24.
Manthorpe Ward - Specialist dementia unit in Grantham
Manthorpe was temporarily closed as part of business continuity arrangements during the pandemic, in order to support safe staffing levels.
Staff were redeployed to increase resilience on the remaining wards, and to enhance the Older People and Frailty Community Mental Health Teams to reduce the need for admission and provide a seven day a week provision.
Due to the ongoing duration and impact of the pandemic on services, the enhanced seven-day Older People and Frailty Community Mental Health Team model was amended in November 2020 to create a new dedicated Dementia Home Treatment Team (DHTT). This model has demonstrated consistent positive clinical outcomes, with significantly fewer patients admitted to hospital as a result.
In early 2023, the Trust agreed with commissioners the extended pilot of Dementia Home Treatment Team for a further 12-months, to allow a full evaluation of impact. This pilot is ongoing until July 2024 after which it will be independently evaluated by the East Midlands Clinical Senate as part of future proposals being developed for consultation.
Hartsholme Centre – Male Psychiatric Intensive Care Unit (PICU) in Lincoln
In October 2022, the Trust took the urgent decision on the grounds of safety, to temporarily close Lincolnshire’s male Psychiatric Intensive Care Unit (Hartsholme Centre) due to concerns on staffing levels across the adult inpatient wards. The unit, which provides psychiatric intensive care for up to ten males, was chosen as the least disruptive ward closure due to the number of patients likely affected and the skilled workforce this would release to be redeployed to support the other adult mental health wards.
Following the temporary closure the Trust engaged extensively with a wide range of stakeholders regarding the impact of the unit’s temporary closure, and what more we could do to support staff and improve patient experience on our wards. This is in addition to extensive workforce planning on future pipelines of staff, increased recruitment and work on staff retention.
Following a successful recruitment campaign, we were in a position to reopen the unit at the end of 2023. Unfortunately, at the time water quality issues were identified that prohibited the reoccupation of the site. Extensive work by our estates team to disinfect and replace many parts of the water system have taken place since and it is hoped that the ward will reopen to patients in early June 2024.
Decision to permanently close Ashley House in Grantham
Following extensive public consultation, the Board made the decision to permanently close Ashley House, a mental health rehabilitation ward in Grantham and expand the community rehabilitation service to a countywide offer.
Ashley House was temporarily closed in February 2021, following staffing pressures during the pandemic. During this time the Trust had been piloting a new community rehabilitation approach.
The community-based service had such a positive impact that the Board and local commissioners, decided the additional beds provided at Ashley House were no longer required and instead an expanded community rehabilitation team covering the entire county would have a more beneficial impact on our local community.
Ashley House previously provided 15 beds for people from across the county with serious and long term mental illness, who were learning how to live independently again following significant periods in hospital. The Trust also runs a twin unit in Boston at Maple Lodge, which continues to provide the same level of care and support as Ashley House for those still requiring hospital treatment.
