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.
A probe into serious abuse allegations at Carseview could impact a controversial shake-up of mental health services.
The first phase of a planned review, which will see general adult psychiatry acute admissions centralised in Dundee, is due to begin in June.
However, health chiefs say they are prepared to make changes if necessary,when the findings of an independent investigation into claims patients were pinned to the floor and mocked by staff at the Carseview mental health unit in Ninewells.
The Perth and Kinross Integration Joint Board heard preparatory work on the mental health review is already under way, with the first phase due to begin in June.
The plan was agreed in January 2018, following months of consultation and protest. Learning disability inpatient services will be provided at Murray Royal Hospital Perth, after services were transferred out of the outdated Mulberry unit at Stracathro in Angus.
The board was given an update by the four-person panel leading the review.
Conservative councillor Colin Stewart asked: “We’ve heard that we need to work quickly to address risks, but we are also told there are delays to the redesign programme.
“I understand there is going to be an interim report on the independent inquiry published later this month.
“Have you had any indication that there may be points raised for action in this report, that might have implications for the redesign programme?”
Arlene Wood, associate director for mental health, confirmed she had not had any feedback or update on the review. “The clear steer that we have had from the chief executive is that we continue, for now, on the quality improvement and redesign programme because we know there are inherent risks in the system and this work needs to happen,” she said.
“It would be remiss of us to wait for the report. If there are things raised that require us to change our course of action, then we would address that at the time.”
The board heard the heads of health partnerships in Dundee, Perth and Angus were working on a Tayside Mental Health Alliance, to tackle a range of challenges facing the sector.
Professor Keith Matthews, associate medical director for mental health services said: “It would be a mistake to underestimate how challenging the environment is for mental health services.
“We have issues with recruitment and there are emerging difficulties with retention of staff.”
He said the Scottish Government was attempting to address a national shortage of psychiatrists with an international recruitment campaign.
“Although many efforts are being taken to resolve these matters, the likelihood of anything being resolved soon are pretty low.”
He added there was a need to move away from a workforce reliant on high-cost agency work.
NHS Tayside has fallen well short of targets set for seeing children referred for mental health treatment
According to new statistics from NHS’s child and adolescent mental health services, NHS Tayside fell below the 90 per cent target, by only seeing 41.5 per cent of children and teenagers referred for mental health treatment within 18 weeks between October and December last year.
In a review of all health boards across Scotland, NHS Tayside failed to provide the information requested on child mental health due to “IT system changes”. However, the Information Services Division estimated 172 young patients would have started treatment for mental health in Tayside during this time.
It also estimated the average wait in Tayside to receive mental health treatment was five weeks. The overall figure for Scotland was 4000 children and young people.
The children’s charity Barnardo’s Scotland now say more needs to be done to improve the support on offer for young people’s mental health and wellbeing.
Kirsten Hogg, the charity’s head of policy, said: “The statistics on children and adolescent mental health services waiting times are just a small part of the bigger picture of children and young people’s mental health and wellbeing.
“We believe a multi-disciplinary approach to children and young people’s mental health is required, one which utilises the knowledge and skills from a range of professionals and agencies including health, education, social work and the third sector.
“Not all children and young people with mental health difficulties will need a specialist children and adolescent mental health service, and we must make sure that we make use of the relationships and expertise present in other services, to ensure that these children and young people have access to appropriate support. This is not an issue for health alone to deal with.”
Laura Falconer, the charity’s assistant director for mental health and wellbeing, also said: “In other parts of the UK Barnardo’s works corroboratively and in partnership with children and adolescent mental health services to jointly deliver services for children and young people who require support for their mental health. Through these models of working we are seeing an increase in engagement and improvement in access to services for children needing support.
“We know that not all children and young people with mental health difficulties will need a specialist children and adolescent mental health service. If the right support, and joined-up referral pathways are in place for these children, then the dedicated staff within children and adolescent mental health services will have more capacity to work with those children who really need them.”
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”.
“Deep concern” has been expressed over a 10% drop in acute mental health beds across Tayside over the past five years.
The number of beds for men and women dropped from 99 in 2013 to 90 last year.
Health chiefs said the reduction was due to a reconfiguration in Perth and the interim relocation of the Mulberry Unit in Angus to the Carseview Centre and insisted most patients were now treated in the community.
However, Angus MP Kirstene Hair is seeking a reassurance from NHS Tayside that the numbers will not fall any further.
She said a total of 44 beds were likely to be relocated from Murray Royal Hospital and the Mulberry Unit at Stracathro in Angus as part of a shake-up of mental health care, while a similar number will be set up in Dundee at Ninewells Hospital.
But she added: “This research finds that the number of beds for a growing problem is reducing anyway – which is of deep concern.
“There needs to be a reassurance from NHS Tayside this number will not shrink any more.”
Conservative MP Ms Hair said she was also concerned that there are no eating disorder beds locally, meaning people are still having to go to Aberdeen for specialist treatment.
“It’s my concern and that of many of my Angus constituents that local health services are disappearing in the background,” she added.
“It is only huge change, such as ward closures, which makes people sit up and take notice.”
Closure of the Mulberry ward at Stracathro Hospital has been identified as the preferred option in a programme to address what officials have described as an unsustainable model for mental health care across the region.
Perth and Kinross integration joint board will have the final say on the package next week.
The move is likely to mean the axe for the Angus unit while general adult psychiatry acute care will be provided from four wards at Dundee’s Carseview Centre, along with learning disability inpatient services from three wards at Murray Royal Hospital in Perth.
Chief officer for Perth and Kinross health and social care partnership Robert Packham said only around 6% of people who access mental health services each year need hospital care.”
He acknowledged there had been a small reduction in the number of acute general adult psychiatry beds in the last five years, adding: “This is due to the reconfiguration of Moredun Ward at Murray Royal into separate male and female environments, and the interim relocation of the Mulberry Unit to the Carseview Centre.
“We have also been redesigning services to adapt to the changing needs of our populations and new services have been introduced to manage people in crisis and support people to remain at home,” said Mr Packham.
“Our communities would expect treatment to be available to them and their families when it is required and we remain committed to ensuring our patients can access the best treatment in the most appropriate place.”
A controversial restraint technique has been used on patients in NHS Tayside psychiatric hospitals almost once a week.
In the first 10 months of 2017, 53 patients were subjected to “floor — face-down” restraints in psychiatric institutes across the region.
The practice can be dangerous as a person is restrained, face down, with the weight of one or more people on top of them, which can lead to the person’s breathing being restricted.
The technique is generally carried out when a person is acting as a danger to themselves or others.
In the 2016, it was used 39 times across Tayside’s mental health facilities.
Research by the mental health charity Mind found that some mental health trusts across the UK no longer use face-down restraint because it is considered “too dangerous and traumatic” and the charity previously called for a ban.
Calum Irving, director of See Me — which tackles mental health stigma and discrimination — said: “When people are struggling with their mental health they deserve to be treated with dignity and respect, free from discrimination of any kind.
“This is especially true in health and social care settings, therefore restraint should always be a last resort and every effort made to avoid it.”
Colin McKay, chief executive of The Mental Welfare Commission (MWC) for Scotland, which protects and promotes the human rights of people with mental illness, said: “Any form of restraint must be legally justified, and be the minimum which is reasonably necessary, for the minimum possible time.”
A spokeswoman for Perth and Kinross Health and Social Care Partnership said: “In some instances, it is necessary for staff to use a reasonable level of force to restrict a person’s movement to avoid a greater harm occurring.
“The ‘floor – face down’ restraint is a response to a high level of physical risk from a patient and is used only when all other options have failed. It is generally considered to be the last resort and is used for the shortest-possible time to ensure the safety of patients and staff.
“All physical interventions are taught from the perspective of being the last resort for the shortest period of time using the lowest level of force/restriction and the smallest number of staff.”