Commentary on Beacon Report

Commentary and Observations on the Beacon Report – June 2012

Sutton 1in4 Network would like to submit the following observations and comments relating to the Beacon Report

There has not been an opportunity for the Network or for other User organisations to question the authors of the report or to have any significant role in its production or to help shape its recommendations.

We think that such a report would have been better if it had been co-produced with users and carers across the South West London Cluster

We may of missed it but we could find no reference in the report to any of the local mental health commissioning strategies

First of all we acknowledge that the recent consultation relating to the configuration of mental health service in Sutton puts we are in a slightly different place than the other boroughs across the cluster area.

Our comments and observations hopefully reflect this position and current state of play.

The report is a weighty tome of 170 pages, full of data and facts but it was difficult to follow some of the arguments, in many areas we found the data and the recommendations contradictory. It is t full of statistics and lists but lacks detailed analysis of what they mean on the ground.

To be honest it felt that the report was a mishmash of different data that had been used to support the recommendations,

Some of our members felt the recommendations came first

We like to know who in NHS South West London or in the locality CCGs is reading and evaluating the report? It is easy to fall into the trap of thinking or assuming, “well we commissioned it, and we have paid for it so we must accept it

From our perspective, it would be easy to read the first part of the report then skip the main body of the report and go to the recommendations without really giving the rationale for them any robust analysis.

We were concerned that there was a broad statement to reduce beds to 20, but the rationale for this seems rather weak. This number seemed to been plucked from mid air, with no explanation on how that recommendation had been reached and what was the clear evidence to support it we find it strange that this is a whole number without any locality variation even if there may be different demographic profiles of need in each locality

It makes a statement saying that 70% of people fitting into the PbR clusters can be treated either via Home Treatment Teams or Community Mental Health Teams. How does this fit with the propsed service model now being developed by the Mental Health Trust.

Whilst this may be possible it is our view that this will not be possible if the resources and investment in community provision remains at the same level. There was no real view on what different community health and social care services should be commissioned both from statutory or third sector to bridge the gap.

It is not just the loss of beds that is the issue it is more importantly the level and types of care and support that is required in each locality to serve and meet the needs of their specific populations and how they can be accessed

We said this during the Sutton Consultation that any reductions to inpatient beds needed to be matched by a comprehensive review of community based services nd significant reinvestment in community provision

There are lots of references to the term  “level of care”, What is this exactly? What is the best level of care for the different care clusters. and how is this decided, and is it based on providing a high quality patient experience or on finances/budgets?

What does this mean in reality? There no mention of quality!

It seemed that the recommendation were finance and politically driven rather than on the clinical needs of those who do or will need services.

The report seemed to be biased and It felt strange to see talk about triage wards

Would there be 1 triage ward across the whole cluster. How would this fit in with providing care close to home . and how would this type of ward work operationally to a high level of care when each of the localities has different configurations of patients

When this option was explored in relation to Sutton and Merton it was rejected by various stakeholders

We feel that the reports treatment and evaluation of the idea of Safe Houses is flawed. Again it seemed to seek examples of models that did not work rather then explore or examine possible types of service models that could work. It seemed to be focused on provision that supported its view on triage and acute inpatient wards.

Again the Crisis House Concept was widely supported in the Sutton Consultation.

The report also was written it seems without any anyalsis of the impact that PbR clustering will have across the cluster

Do we have a clear picture yet of need in relation to each PbR cluster in each of the boroughs and have the care packages yet been costed and tested to ensure that they are both effective and can reduce the need for inpatient services

The report used a sample of 750 case notes is tis 750 different individuals or 750 admissions

We are concerned that the section of the report relating to Staffing Skills and Competencies only looks at Psychiatrists and Nurses rather than the whole range of disciplines and expertise including Occupational Therapists, Psychologists and other support Staff.

Sutton 1in 4 have consistently been calling for a review of the current skills and competencies of all professional groups within mental health services and what skills are needed in the future, especially in relation to emerging service models

What evidence was collected to ensure that the current provider has the leadership and its workforce has the range relevant skills to deliver a high quality service.?

It seems that the report has also not taken into account the work that has been undertaken regarding A& E services across the cluster? Better Services Better Value and how did the report take into account the current thinking emerging from this reveiw

What impact will the proposed new model have on the continuity of care? What impact will this have for Sutton Residents if their nearest A& E is at St Georges and Croydon? What impact will this have on communication with local CHMT and HTT?

The report also seems be saying that 49% of admissions to wards & referral to Home Treatment Teams comes via A& E. Is this correct. It was our understanding that A& E was used as a community focal point for people in crisis to meet with HTT & CHMT and it is these teams that refer individuals on towards?

We find it strange that little effort has been made by the authors of the report to consider patient experience, and to have any meaningful input from local service uses as experts by experience in the writing of the report and shaping its recommendations patient experience where it has been used seems to of been referred to only if it supports the report’s recommendations