35. Plans to move patients from Orchard House to Clinique Pinel

1240/5/1(35)

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY SENATOR S.C. FERGUSON

ANSWER TO BE TABLED ON TUESDAY 17th JANUARY 2017

Question

Will the Minister explain:

1. what plans, if any, there are to move patients currently located at Orchard House to Clinique Pinel;
2. whether the overall number of beds provided isto be reduced and, if so, why;
3. whether it is planned that the psychiatric patients from Orchard House are to be located in the same unit as elderly dementia patients and, if so, why, and whether such a move is in line with professional opinion from the Royal College of Psychiatry;
4. what consultations, if any, have been undertaken in relation to this matter, listing with whom such consultations have taken plan with a summary of the opinions provided;
5. the alternative locations considered, if any, for the relocation of psychiatric patients; and
6. what plans there are, if any, for St Saviour's Hospital?

Answer

The Mental Health Strategy, launched in November 2015, identified the need for purpose-built mental health estate and a feasibility study is to commence shortly to examine future long-term requirements. There will be a business case funding bid for capital in the 2020 MTFP.

However, in advance of completing new mental health estate there is a need to improve service provision and reduce risk at our current assessment and treatment in-patient provision. During the consultation process for the Mental Health Strategy, key stakeholder groups including external expert advisors, service users, carers, staff and the citizen's panel expressed concern regarding the current mental health estate.

The proposal to merge Orchard House and Clinique Pinel is therefore aimed at reducing risk and providing enhanced care to people with mental health problems for an interim period.

Orchard House is a standalone unit within the grounds of the original St Saviour's Hospital and is in the shadow of Queens House. Queens House has been empty for a number of years and with no other services on site Orchard House has become isolated.

There are three key risk areas that we are attempting to mitigate by moving out of Orchard House. These include:

Environmental risks

External lighting, roads leading to Orchard House, ongoing problems with the internal nurse alarm system (possibly due to the amount of granite), outside garden areas, limited low stimulus facilities and no enhanced care area, poor sight lines and inadequate windows, and isolation.

Operational risks

Due to its location, staff at Orchard House do not have direct support from other mental health colleagues during times of increased workload or when managing patient distress or challenging behaviours. Merging the units into Clinique Pinel would increase the availability of staff to support each other, particularly during night time shifts and at weekends.

Clinical Risk

The proposed redevelopment of Clinique Pinel would include enhanced care beds that would support the safe care and treatment of people who may present as hostile and aggressive due to their mental ill health. This would reduce potential risk to the patient themselves, their fellow patients and the staff providing the care and treatment. The proposed layout would allow flexibility in how care is provided, dependent on the needs of the patient population at that time.

In relation to the specific questions:

1. A feasibility study has commenced, sponsored by the Health and Social Services Department (HSSD) and being carried out by Jersey Property Holdings (JPH), to see if Clinique Pinel can be remodelled to appropriately accommodate all adult (working age and over 65s) inpatient assessment and treatment services. The outcome of the feasibility study will allow HSSD to make a decision on the appropriateness of relocating the working age assessment and treatment in-patient service from Orchard House to Clinique Pinel. Unless the feasibility study identifies significant restrictions on our requirements, HSSD envisages seeking planning permission before the summer of 2017.

3. If Orchard House is relocated within Clinique Pinel we will be reducing the number of beds provided for assessment and treatment of people with functional mental health problems (psychosis, depression, anxiety) and organic mental health problems (the dementias).

Currently, we have 17 adult and 14 older adult assessment and treatment beds in Orchard House and Cedar Ward respectively. We also have 11 assessment and treatment beds for people with organic mental health conditions on Beech Ward .

We have 300% more older adult assessment and treatment bed numbers than the NHS average for an equivalent population size. One of the reasons for this was because we did not have the community resource within the older adult's mental health team to support community packages of care. This is being addressed due to the significantly increased funding for older people's community mental health care as part of the P82 investment. Furthermore, the long-term care fund introduced in July 2014 supports domiciliary care packages. This will allow us to reduce organic assessment and treatment beds from 11 to 8 and functional assessment and treatment beds from 31 to 25.

3. A remodelled Clinique Pinel will provide separate units for people with functional mental health problems and dementia patients', within the same building. Each unit will have its own entrance. It is recognised that it would not be therapeutically appropriate for those people with dementia to share the same environment as people with acute mental illness and the patient groups would not benefit form interacting.
4. In March 2015 a workshop was held to discuss the challenges in continuing to provide in-patient assessment and treatment within Orchard House. Invitees to the workshop included representatives from all the key mental health professional groups including doctors, nurses, social workers and psychologists, senior managers within Community and Social Services as well as the head of governance and the patient advocate from MIND Jersey. The outcome of the workshop was a recommendation to HSSD Corporate Directors that services provided within Orchard House should be co-located within Clinique Pinel. Initial work was carried out by JPH to see if it was possible to co-locate Beech Ward with Rosewood House but this was not feasible. Once the current feasibility study is complete we will be in a position to hold detailed consultation. Arrangements are in hand for a workshop in February to present the proposals following which a staff reference group will be convened.

5. As described above, we explored the possibility of extending Rosewood House to accommodate Beech Ward , but this was not viable. The possible use of The Limes building was also considered, but the environment is not conducive to providing safe mental health in-patient care. We have also explored upgrading Orchard House, but to do so would not address a number of key risks described above.
6. As and when services provided within Orchard House are relocated and the south side of St Saviour's Hospital (which includes Queens House) is no longer accommodating services, the estate will be handed back to Jersey Property Holdings, which will look to utilise or dispose of the site in accordance with the Island Plan.