What did Manthorpe ward offer?

• 18 bed ward for dementia patients to receive assessment and treatment when their needs escalated beyond the care of existing community mental health teams and what their carers could manage at home, or in a care home.
• Although based in Grantham, it was one of two wards in Lincolnshire that provided a service to the whole county. 
• The other is at Langworth Ward in Lincoln which remains open.
• The ward offered a 24/7 hospital-based care, with a team of professionals including medics, nurses, support workers and allied health professionals (such as occupational therapists or physiotherapists).
• While Manthorpe ward has been temporarily closed since April 2020, Langworth ward in Lincoln still provides care to anyone living with dementia in Lincolnshire who needs hospital level care to assess and treat severe behavioural and psychological symptoms of dementia. 

What does the Dementia Home Treatment service offer?

• Care in people’s home environment, including care homes, when their needs are escalating beyond the care of existing community mental health teams, or what their carer is able to support.
• Based across three hubs in Boston, Grantham and Lincoln, but provides a countywide service.
• Able to support up to 18 people at a time, the same as the previous ward.
• Team of professionals including medics, psychologists, nurses, support workers and allied health professionals (such as occupational therapists or physiotherapists), as well as transition workers who help people coming out of hospital.
• Provides multiple visits to someone’s home a day (approximately three to four times a day), depending on need. 
• Provides education and support to carers.
• Uses a range of recommended assessment tools to establish what may be causing, or aggravating, people’s symptoms, and implements techniques that could improve these.  
• Prevents hospital admissions or enables a quicker return home after hospital treatment.
• Supports access to other community support organisations and helps people establish local support networks or meaningful occupation. 

Impact to date

Hospital bed use

Despite the temporary removal of beds at Manthorpe ward, our remaining ward in Lincoln has not needed to use all its available beds over the last five years. There has also been no need for anyone to travel outside of the county to receive hospital care, except where personal circumstances have required this.
Bed use at Langworth ward since has remained around 75%, meaning the ward has plenty of flexibility should there be increases in demand.

Travel for hospital care

Both wards provided a countywide service, rather than just to the local area. Since the temporary closure of Manthorpe ward, there have been 346 people admitted to Langworth ward, 18 of whom have been from the Grantham area.

By providing a more intensive home support option, many more people are being supported in their home environment and avoiding what would have previously likely been a hospital admission. This includes over 100 people from the Grantham and surrounding areas who have received support from the dementia home treatment team at home.

Increased support at home

Between April 2020 and December 2024, the dementia home treatment team received 1,091 referrals. Following assessment or intervention, only 13% (146) of people have then required hospital admission to Langworth ward, with the remainder being successfully treated or discharged to their own home.

The average period of care from referral to discharge is also 50% shorter compared to hospital admission, with an average of 39 days, compared to 78 days on the ward. This means that while the team only supports a similar case load to a ward environment at any one time, the team is able to support more people due to the reduced length of input required.

Feedback from people using the service

Throughout the temporary closure the Trust has not received any complaints in relation to service access, or the alternative delivery of the dementia home treatment model. 

General feedback about the new hospital at home approach has been positive and is enabling people to remain at home for longer, when it is safe for them to do so.
 

Engagement to develop our proposals

Over the last five years we have carried out extensive engagement with patients, carers, staff, the general public and partner organisations to understand their views on the current service and how this could be improved in the future.

During the temporary closure of Manthorpe ward, we have also used this as an opportunity to understand any impact people have experienced and what additional support might have needed to be in place.

Events have taken place across a variety of locations in Lincolnshire, including online, and we have also been out and visited many local groups and charities that specifically work with people living with dementia to chat about current and future services.

All of this valuable feedback has been considered and used to develop our preferred proposal for our future service offer, which we are now asking for your views on in this consultation.

What we have heard and done so far

• People recognise the benefits of keeping people at home rather than in hospital.
• People would prefer an intensive community support offer, but still want to access hospital care when they need it.
• Having additional support to help with transitions between hospital care and home or a care home would be beneficial. 
• The support and education for carers that the dementia home treatment service can provide is helping people know how to better manage difficult behaviours and prevent future escalation of need. But more practical support, information and advice is needed on a day-to-day basis, not just when someone’s needs escalating. 
• While some people in Grantham would prefer not to have to travel to visit someone in hospital in Lincoln, they recognise the numbers needing hospital admission will reduce and more people will not require hospital care at all.
• A request for the home treatment service to review operating hours to support with ‘sundowning’ behaviours in the summer months. 
• There are still some gaps in wider dementia care such as respite care or crisis support that need addressing. 
• In response to any increasing demand from our ageing population, consideration of flexibility to increase hospital beds in the future. 

In response to the feedback, the Trust has already acted on some of the comments and is working with health and care partners as part of a wider Lincolnshire Dementia strategy on some of the wider improvements needed.

• Transition workers added to the team as part of the extended pilot to help with the transition from hospital.
• Raising awareness with system partners of potential commissioning gaps for respite beds and crisis support. 
• Monitoring impact of the new NHS 111 mental health crisis line and the type of out of hours calls received in relation to older adults. This will support discussions on future crisis provision. 
• Using a demand and capacity tool to understand any potential need for extending operational hours during the summer and considering future population health projections. 
• An extension and re-design of the existing Langworth ward is being considered to help meet any future increase in demand.
• Carers’ drop-in group established by the Carer Engagement and Development Lead to provide additional help, advice and support.

Proposals for the future

Like many NHS organisations up and down the country, we are working hard to transform services so that they are better for patients and deliver the right care, in the right place within the resources available.

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 intensive community support aligns with national, regional and county priorities to provide greater support directly to people’s own homes and communities and reduce the number of people unnecessarily admitted to hospital.

The Trust and commissioners are therefore considering two options following an analysis of demand, patient outcomes and feedback on how the dementia home treatment service has been working since the temporary closure of Manthorpe ward. These are:

• Option 1: Reopen Manthorpe ward as an 18- bed dementia inpatient service and discontinue the dementia home treatment service.

  There is currently not enough resource or demand to have both the county wide home treatment service and two dementia assessment and treatment wards in the county.

• Option 2: Permanently close Manthorpe ward and transition from a pilot to a permanent  dementia home treatment service. 

  Patients will either receive their care via the home treatment team in their own homes, or at Langworth Ward in Lincoln if a hospital stay is still required. (This is our preferred option)

These proposed changes do not affect the wider older people’s mental health hospital or home treatment teams.

This consultation will gather public, service user, carer, staff and stakeholder views on both options above, including our preferred proposal of permanently closing Manthorpe ward and continuing the county wide dementia home treatment service.

Why option 2 is our preferred option

We have seen during the temporary closure of Manthorpe ward that with the introduction of the dementia home treatment approach there has been less need for people to be admitted to hospital. The remaining ward in Lincoln has rarely been full and no one has had to travel unnecessarily outside of Lincolnshire to receive hospital care for dementia.

With Manthorpe ward remaining closed, we would be able to continue to offer the countywide dementia home treatment service within our current finances, continuing to reduce the need for people across Lincolnshire to be admitted to hospital.

When choosing which unit would be the most appropriate to close, Manthorpe ward has been highlighted as not currently fit for purpose. Its design and layout are outdated and it does not meet modern standards for this type of ward. If Manthorpe were to be reopened, further investment would need to be sought to bring Manthorpe ward up to the required standards as soon as possible. 

Langworth ward, however, already meets the standards required and continues to be further developed to improve patient experience. As part of a developing countywide strategy for dementia care, we are also hoping to look for funding on how the ward capacity could be slightly increased to meet any future increase of dementia in our population. This would require a slight increase in staffing, rather than needing a full additional team.

The dementia home treatment service has been an added service for many patients who would have previously been admitted straight to hospital when their needs increased because an intensive home in-reach approach had not been available. This removes the need for many people to travel to one of the units in Grantham or Lincoln and having an extended hospital stay.

Clinicians also believe that the hospital at home approach is an essential part of the range of service we should offer and feel that this would help us only use hospital care for those with high levels of need for whom it would not be safe to remain at home.

Both Manthorpe ward and Langworth ward have provided a service to the entire county, not just to those in their local area. There is an acknowledgement that given its locality, any permanent closure of Manthorpe ward might mean that a small number of Grantham residents may need to travel further than previously to the alternative unit in Lincoln if hospital care was still required. However, many may need to travel less with the support of the dementia home treatment service.

If the Trust were to reopen Manthorpe ward and restore the previous service, the dementia home treatment team would have to be stopped until alternative funding and staffing sources could be found.

Initially, the ward would have to remain temporarily closed until sufficient staffing could be recruited to reopen. Many staff who previously worked at Manthorpe ward during their redeployment have applied for and been successful in getting alternative permanent roles across the organisation, affecting the number of staff available to immediately reopen.

Staffing across our hospital wards is a significant challenge, both locally and nationally, and this has led over recent years to us needing to move staff across different wards at periods of increased need or sickness. With Manthorpe ward being a stand-alone ward, it is more difficult to manage staffing levels during periods of increased sickness or incident.

Langworth ward is co-located with other teams and our older people mental health ward at Witham Court in Lincoln, and it is therefore much easier to move staffing around when required.