Additional disclosures: emergency and temporary service changes

During the last year the Trust has continued to have temporary ward closures at Ashley House in Grantham and Manthorpe unit, also in Grantham. These have been alongside the additional temporary closure of the Hartsholme Centre, our psychiatric intensive care unit in Lincoln.

Both Ashley House and Manthorpe were temporarily closed as part of business continuity arrangements during the Covid-19 pandemic, in order to support safe staffing levels.

Ashley House is a 15 bedded mixed sex, low dependency open mental health rehabilitation ward. It was temporarily closed in February 2021 to enable staff to be redeployed to support other adult mental health wards during the pandemic and allowed for the temporary extension of the community rehabilitation service to support further parts of the county during its temporary closure.

In January 2023, following an analysis of demand and the positive impact the expanded community rehabilitation model was having on patient outcomes and admissions, the Trust, in discussion with commissioners, NHS Lincolnshire Integrated Care Board, put forward proposals for the future of the unit.

The two options were:

• Re-opening Ashley House as a 15 bedded open rehabilitation unit, but not expanding the community rehabilitation service to the rest of the county. There is currently not enough resource or demand to have both the countywide community rehabilitation service and two low dependency mental health rehabilitation units in the county.
• Permanently closing Ashley House as an inpatient unit and re-investing the resource into the community rehabilitation service to provide a countywide service. Patients will either receive their care via the community rehabilitation service in their own homes, or at Maple Lodge in Boston, if a hospital stay is still required. (This is the Trust’s preferred option).

With agreement from the Health Scrutiny Committee for Lincolnshire, the Trust conducted a locally led, targeted consultation between January 2023 and March 2023. At the time of writing this report the Trust is analysing the feedback received, in anticipation of making a final decision in the summer of 2023.

Similarly, the Trust also needed to temporarily close Manthorpe Ward (dementia) in Grantham in April 2020, in response to the impact of COVID-19 on staffing availability. 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 impacts of the Covid-19 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 inpatient beds.

In early 2023, the Trust discussed with commissioners the possibility of extending the pilot of Dementia Home Treatment Team for a further 12-months and expanding the clinical model, to allow a full evaluation of impact and consider next steps. If approved the pilot will be independently evaluated by the East Midlands Clinical Senate as part of future proposals being developed for consultation.

In October 2022, the Trust also 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.

Since this temporary closure the Trust has engaged extensively with staff, service users, carers and a wide range of stakeholders regarding the impact of the unit’s temporary closure, and what more the Trust could do to support staff and improve patient experience on its wards. This is in addition to extensive workforce planning on future pipelines of staff, increased recruitment advertising and work on staff retention.

At the end of March 2023, whilst improvements in staffing availability were being seen, the Trust was not yet able to re-open the psychiatric intensive care unit with sustainable safe staffing. Further work will take place over the coming months and the Board will continue to closely monitor the situation, with a view to re-opening the ward as soon as it is safe and sustainable to do so.