North by North West: Festering relationships harm patients

Spotlight turns to mental health

Lancashire will this week admit serious and deep-rooted problems with its mental health services, in the hope of making a fresh start and finally getting key organisations to work together.

A wide-ranging external review, due to be published this week, will outline multiple shortcomings right across the system; from community teams ill-equipped to prevent patients tipping into crisis to wholly inadequate care for those who subsequently do tip over.

HSJ revealed some of the worst effects of this last week; with patients being illegally detained in seclusion rooms for more than seven days, getting stranded in an emergency department for more than 12 hours without appropriate support; and being sent to an inpatient bed many miles away from their family.

It also takes a huge toll on staff – not just those working for Lancashire Care Foundation Trust, but also the exhausted police officers and accident and emergency staff left to cope with highly-distressed patients who desperately need specialist support.

If there is a positive to be found in all this, it is that the pressures now being experienced in A&E departments – particularly in Blackburn and Blackpool – have created enough noise and regulatory heat for people to start taking a serious look at what is going wrong.

Lack of crucial bed capacity

The most fundamental issue seems to be a lack of suitable bed capacity. Although the trust has a higher than average number of acute mental health beds for its population, it does not have any high dependency or complex care rehab beds. There are also fundamental inpatient gaps for learning disabilities and substance misuse, which all means acute mental health beds are frequently occupied by patients needing other types of inpatient care.

This causes blockages right through the urgent care pathway, which manifest primarily in A&E and the Section 136 suites.

So why haven’t these beds been commissioned?

Rivalries

Part of the answer to that is likely to be the poor relationships that have been allowed to fester for far too long, and which seem to have gotten in the way of crucial investments being negotiated.

The NHS and public body rivalries in Lancashire could probably give the football teams a run for their money. Several senior sources in the north west tell HSJ years of conflict and mistrust have prevented collective action being taken.

The recent retirement of Heather Tierney-Moore, Lancashire Care’s long-standing chief executive, offers an opportunity for a fresh start to be made by Caroline Donovan, who has arrived from the “outstanding” North Staffordshire Combined Trust. A new chief operating officer has also arrived from Northumberland Tyne and Wear, which conducted the review into Lancashire Care. 

Better relationships at board level, with commissioners, the councils, the police, and acute trusts, will hopefully start filtering through to front-line interactions between the organisations.

It should also lead to more funding being secured.

More funding due

According to NHS England’s mental health dashboard, the proportion of Lancashire’s overall funding allocation spent on mental health is below the national average, and well below the national average for the north of England.

Planned spend in 2018-19 (actual figures are not yet available) was 13.4 per cent. If raised to the national average of 13.8 per cent, this would equate to around £10m of extra investment in those much-needed beds. If raised to the 14.4 per cent average for the north of England, this would be around £25m more.

The new leadership at Lancashire Care now have a better chance at getting this sort of money, and this is what they should be demanding.

But, with the four acute trusts posting a combined deficit of more than £100m for the year just closed, there will be some tough deals to broker for CCG leader Amanda Doyle and the county’s integrated care system.