Health chiefs say a controversial shake-up of psychiatric services across Tayside is being hampered by “significant workforce challenges” – exactly as opponents predicted more than a year ago.
NHS Tayside pressed ahead with its planned review in January, despite concerns that many staff would be unwilling or unable to make the move to new cities.
Under the scheme, leading disability inpatient services will be provided at Murray Royal Hospital, Perth, while services are being transferred out of the Mulberry unit at Stracathro Hospital near Brechin and general adult psychiatry acute admissions centralised in Dundee
However, members of the Perth and Kinross Integration Joint Board have now been told that the majority of staff – around 55% – are unable to move for a variety of reasons.
At a meeting on Tuesday, Gordon Paterson, chief officer of the Perth and Kinross Health and Social Care Partnership, said: “The progress of implementing the redesign programme has been slow and that is partly because of some of the significant workforce challenges, in relation to the proposed transfer of patients and wards from one site to another.
“We need to ensure that we have adequate staffing in place. We need to engage with nursing staff and clinical staff to ensure that that they can transfer from Perth to Dundee, or Dundee to Perth. If they can’t we have to make sure we can suitably redeploy them and there are some alternative options.”
He said: “We recognise that this is an upheaval for staff and we recognise that some staff can’t travel.”
Mr Paterson said it was crucial to get to the next phase of the plan, which involves shifting a ward from Carseview to Murray Royal.
“We are anticipating we will be in a position to progress this early in the new year, notwithstanding the fact we are sensitive to the impact and implications for staffing,” he said.
Independent councillor Xander McDade described the situation as “quite disturbing”.
He said: “At the meeting in January 2018, the main rationale for the redesign – which we were given repeatedly – was that the only way we could safely staff the service was to go ahead with this model.
“That was the clinching argument.”
NHS Tayside’s Alan Drummond said: “This was raised as a red risk prior to that meeting.
“It wasn’t a case that staff didn’t want to carry on their care for patients, they were just unable to make the move.
“We raised this as part of the consultation and we were told that the risk would be managed. This is not the unknown we are dealing with, this was raised three years ago.”
Mr Paterson said he was also aware that an independent inquiry into mental health services, led by Dr David Strang, was due to be published in February and could make further recommendations.
Dr Strang said earlier this year that the redesign should be halted to allow for a wider review of health services.
It said the key themes were patient access to mental health services, patient sense of safety, quality of care, organisational learning, leadership and governance.
Referring to risk management, the report said: “Patients report telling staff they were suicidal but the risk was not taken seriously until they made a serious attempt to take their own life.”
‘Violated and traumatised’
In relation to patient safety, the report noted: “Some patients report being frightened of certain staff on the wards who have a poor attitude to the patients in their care.
“Others mentioned that another patient had assaulted them whilst they were on the ward.”
The report said the use of restraint within inpatient facilities was of “great concern” to patients, who had experienced it or witnessed it taking place.
It said: “Patients feel violated and traumatised, particularly if they have personally suffered violent abuse in the past.”
It added that staff seemed unable to control the availability and use of illegal drugs on the wards in the inpatient facilities.
“Both patients and families report seeing drugs delivered, sold and taken within the Carseview Centre site,” the report said.
“Staff confirm this is a serious issue which is not being adequately addressed.
“There is a lack of support from management for frontline staff attempting to address this issue and it is having a detrimental effect on patient care and treatment regimes”.
‘Unexpected and concerning’
In a section on the Crisis Service, the report said that the Crisis team “struggles to respond to sudden surges in demand on the service.”
It said: “There are occasions when the length of time to wait to be seen is long and families supporting someone in crisis are advised to phone the police or NHS24, if they are worried.
“This advice is unexpected and concerning to carers coping with a crisis in a domestic situation.”
The report said the centralisation of the out-of-hours Crisis team to Carseview Centre has had a “detrimental effect on those patients in Angus and Perth & Kinross who are experiencing mental health crisis”.
It said: “There is a perception that whilst the Crisis service has expanded in recent months, the situation has worsened in terms of patients being assessed then not being offered any crisis intervention, or referred back to the GP.”
Inquiry chairman David Strang said: “The themes which have been identified will shape the next stage of the inquiry.
“Our final report will include conclusions and recommendations which will lead to the improvement of mental health services in Tayside.”
NHS Tayside chief executive Grant Archibald said: “We are taking on board all comments in the interim report, alongside the feedback we received from the Health and Social Care Alliance (the Alliance) published in their report in December 2018.
“The key themes which have been identified in both the Alliance report and in today’s interim report are recognised by the board and the mental health leadership team – and we are taking action on these.
“I also recognise and want to thank the many staff who are already working really hard to improve services and look forward to their continued support.
“It is clear that we have further work to do but since I came to Tayside, I have made mental health a top priority and I am confident we can learn lessons, strengthen our engagement with patients, service users, families and the public and make the right kinds of changes, at the right time, to transform our mental health services.”
He added: “We would like to thank everyone who has shared their experiences so far and we look forward to the independent inquiry’s final report and recommendations which will be a major influence on the future shape of mental health services in Tayside.”
Doctors in Tayside have warned psychiatric services in the region may be unsustainable due to staff shortages.
Inspectors from Healthcare Improvement Scotland were told the service relies on locum doctors but there are concerns about the number of these available.
They were told the shake-up of psychiatric services in Tayside, currently under way, may take years to bear fruit.
Healthcare Improvement Scotland carried out a review of general adult psychiatry services in Carseview and community mental health services in December last year.
The watchdog returned for a follow-up inspection in June, the results of which were published this month and lay bare the full extent of the crisis in psychiatric services.
NHS Tayside has ordered an independent inquiry into mental health services following a campaign by the relatives of patients who took their own lives but the new HIS report reveals staffing issues remain a major problem at Carseview.
It states: “The management team spoke about the continued challenges in maintaining a consistent medical psychiatrist workforce. They told us that the use of locum psychiatrists remains high and has increased since the review visit in December.
“They also told us that there were real anxieties about the sustainability of the medical service and a real concern that the availability of locum psychiatrists is reducing.”
It continues: “There continues to be ongoing challenges in recruiting psychiatrists, whether it be in a permanent post or a locum post.
“We have significant concerns about those ongoing challenges and the use of locum staff.
“The inconsistency of psychiatrists will continue to impact on patients being able to build and sustain therapeutic relationships with their psychiatrist and will lead to inconsistency in medical leadership in clinical teams.”
Inspectors were also told staff believe patients will not see the benefit of the redesign of psychiatric services for several years.
The report states: “The general consensus was that the plans being put in place today will not see immediate rewards but will take years to come into effect.”
A spokesperson for NHS Tayside said: “Like many other Health Boards, NHS Tayside is affected by a national shortage in some specialist services and professions, including consultant psychiatrists.
“To help address this, the Tayside Mental Health and Learning Disability Services Redesign Transformation Programme, approved by Perth and Kinross Health and Social Care Partnership in January this year, is redesigning how services are delivered in line with the current and future availability of medical staff.
“While our transformation plans are implemented, locum staff continue to be employed to ensure we can provide clinically safe and effective care for our patients.”
She said the health board has appointed a permanent medical director to oversee psychiatric services.
She said: “Locum psychiatrists in Dundee have been managed by an interim associate medical director however Professor Keith Matthews, an experienced consultant psychiatrist and senior academic has now been appointed permanently into this role.
“As an experienced and effective clinical leader, Professor Matthews will be instrumental in leading the redesign and improvement of mental health services across Tayside.”
Gillian Murray, whose uncle, David Ramsay, died after being turned away from Carseview in 2016, said NHS Tayside must address shortfalls in its psychiatric services.
Ms Murray, who played a prominent role in the campaign that led to a review into mental health services in Tayside, said: “How long has this mental health crisis gone on for?
“How many cases have been swept under the carpet?”
David Strang has been appointed chairman of the inquiry, which NHS Tayside has stressed will be fully independent.
Youngsters in Tayside are facing an “alarming” mental health crisis after care bosses admitted standards have plummeted in six months.
The number of kids getting help for mental health problems within a reasonable time frame dropped from 96.6% in June 2017 to 43.9% in December.
The rate covers the proportion of youngsters who are referred to and seen by NHS Tayside’s child and adolescent mental health services (CAHMS) team within a target of 18 weeks.
Across Scotland, the target health boards are expected to meet is 90%.
Keiran Watson, of youth support charity Eighteen and Under, said he found it “alarming” that less than half of kids were being seen on time.
He said: “As it is, the 18-week timescale is too long.
“If you’re a young person who is feeling depressed or has delusions, or is self-harming or even feeling suicidal — or if you are a parent of a young person like that — can you imagine being faced with an 18-week wait?
“The fact that less than half of young people are being seen within that 18-week target is shocking. It’s really quite alarming.”
Lorna Wiggin, NHS Tayside’s chief operating officer, told the health board at a meeting this week the slide was due to staff shortages equivalent to 3.3 full time workers.
She said: “Previous attempts to recruit have been unsuccessful. However, the posts have been re-advertised and interviews are due to take place in March.”
Ms Wiggin said significant improvements would not happen until those positions are filled, but added that high-priority children can be seen within five days of referral if their case is judged to be an emergency. We’re expecting a slight improvement in the next three months, but not a major one.
“We were able to rely on adult (mental health) services for some support but they’re not able to do that now.”
NHS Tayside may well reach out to other health boards for support with CAMHS in the near future.
Chief executive Lesley McLay said she had requested a review of the system with managers to avoid any further repeats of the situation.
She added: “We recognise that action is already happening (to improve performance). We may involve another health board as well.”
Health chiefs in Tayside have stated having two centres of excellence is the only safe way forward for inpatient mental health services.
The decision was taken at a meeting of Perth and Kinross Integration Joint Board following months of consultation, campaigning and protest.
It will see general adult psychiatry acute admissions centralised at the Carseview Centre at Dundee’s Ninewells Hospital.
Learning disability inpatient services will be provided at Murray Royal Hospital in Perth alongside other specialist services, including rehabilitation and substance misuse.
The decision will see services relocated from the outdated Strathmartine Hospital and the Mulberry unit at Stracathro Hospital in Angus.
The board voted five to one (an abstention) in favour of the preferred option.
Clinicians believe the steps will secure the future of inpatient services, improve the quality of service and environment available to patients and make services more attractive to potential staff.
Individual health and social care partnerships in Angus, Dundee and Perth and Kinross will be working to enhance mental and health and learning disability services in local communities, where 94% of mental health care is delivered.
More than 100,000 people took part in an often-criticised consultation process and more than 57% of those who responded said they were against the proposals.
NHS Tayside’s medical director Andy Russell, however, said the present model of care could not continue, with the redesign proposed “the only safe option”.