Acute care ward closure at Leicestershire’s Bradgate Mental Health Unit - own thoughts

After being told by an ITV reporter, who had seen my tweets, that Leics NHS Partnership Trust was planning to close yet another mental health ward, I typed out the following thoughts.  J and I were also interviewed by the same reporter, more on this shortly.

(Not organised in any particular order, also these thoughts are influenced by earlier negative experiences with the wards, Crisis Team and the Community Mental Health Team)

The Leics Partnership NHS Trust is an organisation unfit for purpose, but they still have duty of care, they still have a basic role in providing essential care to mental health inpatients and outpatients.

A bed on an acute ward can be used fifty to hundred times a year for short term stays. Multiply that by the number of beds on a ward, 18 to 20, and that’s the number of very vulnerable people who will be put at risk, when they might have otherwise been helped. (Note, some of those will be readmitted several times a year bringing the number of total individuals down, but not admissions)

The LPT have a basic remit to keep unwell people safe and often they not able to do that.

There is no equivalent to acute care beds in the community. Hospitals and specialist units are the only places that an unwell person can be legally kept behind a locked door and their medication reviewed by a qualified psychiatrist.

Some of the wards at the Bradgate Unit are not fit for purpose and have probably been criticised (perhaps by Care Quality Commission regarding H&S), but to just shut wards instead of improving them is just walking away from the problem and creating more problems.

It’s neglect. The same offhand an short-sighted neglect which has allowed inpatients and outpatients to die (Google “Bradgate Unit death” and read the news articles). Usually we only learn a year later, when inquests have occurred. They think we don’t know. They probably hope we don’t read newspapers.

If it’s about funding, why aren't the managers pushing back against the funders? Why are they just treating this as a matter of course, is it just cold, basic, economics?

Ask anyone in the Trust, or anyone who has been on a ward recently, how they could save money and they will make suggestions. For starters, any manager should know not to waste money by continuously hiring round the clock bank and temporary staff, as well as the many locum doctors. They say this isn’t the case, when it clearly still is. Despite criticism, year after year, they are still sending patients out of county, we know this because we’ve talked to one very recently. They knock down and build new buildings and yet can’t fix leaks, which put whole areas out of commission for days (this happened at the end of last year, and we saw outstanding repairs and leaks this last Spring as well).  They built a pharmacy near the unit, but it still takes five hours for patients to receive take-home medications even when they have been prepared hours earlier (we have seen this first hand, again poor management of staff, in this case, porters and poor communication with wards).

Maybe it’s a dysfunctional organisation. Communication on the wards alone is poor, as is communication between the different teams, with the CMHT and GPs being the last to know what is happening.  Our letters and phone calls take months to be returned, with or without the help of Customer Services” (who have been renamed yet again, for the sake of inconsistency, I suspect).

In terms of support in the community, they can’t even provide a consistent out of hours phone line, something again the CQC requested (ongoing problems with this, complaints made).

This organisation is the shame of the county, it is just a matter of time before they become known nationally as a scandalous Trust. By closing wards (this isn’t the first) and shutting services down, or outsourcing them to the less qualified voluntary sector, they are absolving themselves of the responsibility of the tax paid role of looking after the most vulnerable mental health sufferers in the county. Maybe the decision makers worry more about lawsuits than lives?

The Crisis Teams are already overworked and jaded, and when there are a minimum of beds available they make outpatients feel bad for asking for help.  As if it's not difficult enough to ask for help when you suffer mentally.

What do we tell the paramedics, the policeman and the A&E staff who deliver the patients who are a danger to themselves, sometimes under Section (136), only to find later that they have been sent home? How will they be affected my these changes?

For an outpatient, two chats a year with a consultant in the community, and maybe the slim chance of being assigned a CPN, cannot replace the safety of an acute ward bed, even if it’s not long term. No amount of talking therapy can help a person in psychosis, someone who's meds need monitoring, or someone wanting to kill themselves.

The actual care and recuperative therapy within the Bradgate Unit’s wards is already extremely poor, but at least they have some experience treating patients, they have a pharmacy, and locked doors, which prevent patients leaving when they are unwell.

Don’t they also have a responsibility to other counties who also ring around the country when don’t have enough beds? 

(November 2015)