Modernising Inpatient Mental Health

Some of the environments where we provide inpatient care could be better.

Despite the best efforts of our fantastic staff, our current environment does not always promote privacy, dignity and recovery.

This is an opportunity to focus on creating spaces that reflect the needs of our service users and staff.

We have services spread across four sites – five including London.

This includes standalone, isolated units at Oakley Court and Townsend Court.

By moving to two centres of excellence we could provide the right concentration of staff and expertise to provide the best care and support.

It would also deliver more joined-up care through closer links with physical health and community mental health services.

People in Bedford and the north of Central Bedfordshire and their families currently have to travel long distances to current inpatient units at Townsend Court, Oakley Court, the Luton Centre for Mental Health and at times to London.

These proposals will mean adults from Bedford who need to be admitted for hospital care could be admitted to a new hospital built on Bedford Health Village.

Adults from Luton would be admitted to Luton.

Adults from Central Bedfordshire would be admitted to the facility closest to home.

There are no inpatient units for children and young people in Bedfordshire, Luton and Milton Keynes.

A temporary facility is being planned but our proposals will provide a long-term site enabling children and young people from across Bedfordshire, Luton and Milton Keynes to be admitted much closer to home.

We are also developing our community mental health services so we can provide a recovery focused, locally based inpatient service.

The Trust is working with partners to change how care is provided and prevent more people from needing to be admitted in the first place.

This involves community mental health services working in a joined-up way across the voluntary sector, GPs, mental health services and social care.

It also includes inpatient centres of excellence that provide cutting edge treatment and support, rooted in the communities in which they are based.

How are you improving and developing mental health services in Bedfordshire & Luton?

Bedfordshire, Luton & Milton Keynes (BLMK) Clinical Commissioning Group (CCG) and the East London Foundation Trust (ELFT) are working in partnership through the Bedfordshire, Luton & Milton Keynes Integrated Care System (ICS) to deliver significant improvements to mental health over the next several years. Through the NHS Long Term Plan, we expect to invest circa £37m to mental health across the ICS between 2019/20 and 2023/24, with substantial development and improvement of mental health services for pregnant women and new mothers, children & young people, adults with common mental health problems and adults with serious mental illness, including crisis and community services.

What is the ‘modernising inpatient mental health services in Bedfordshire & Luton’ programme?

As part of our whole system approach to improving mental health services, BLMK CCG and ELFT are committed to improving inpatient mental health services, and to returning inpatient mental health services to Bedford following the closure of Weller Wing at Bedford Hospital in 2017. We want to develop a new inpatient mental health service in Bedford and to further improve the quality of our existing Luton Centre for Mental Health, adjacent to the Luton & Dunstable Hospital.

What is the ambition for the project?

Our vision is to develop a new inpatient mental health service at Bedford Health Village, built-in line with current clinical and architectural best practice, with sufficient capacity to meet the current and future needs of our populations, and strong links into the communities we serve; and to further improve the quality of our established inpatient services at the Luton Centre for Mental Health adjacent to the Luton & Dunstable Hospital. The Bedford and Luton centres for inpatient mental health services would form part of our comprehensive mental health offer, and be supported by, and complement, community mental health services across Bedford Borough, Central Bedfordshire and Luton.

We also want to develop our inpatient services as a centre of excellence, where expert health and care professionals work together to provide the very best clinical care and therapeutic support.

What is the current provision?

ELFT currently provides the following inpatient services for adults with mental health problems in Bedfordshire and Luton:

In addition, over the last three years, roughly 10% of all admissions1 for people whose inpatient stay is commissioned by Bedfordshire or Luton Clinical Commissioning Groups have been towards based in London.

Where would the new centre be built?

We have identified Bedford Health Village as our preferred option. The project would include using land on and neighbouring the derelict Shires House site within the health village. We are in advanced discussions with NHS Property Services to secure a long-term lease for that part of the health village site.

The proposals would not affect other health services based on the health village site.

What are the benefits of using the Bedford Health Village site?

The site provides the space for a large, modern and recovery-focused inpatient centre to be developed. We believe there are significant opportunities for enhancing the quality of our inpatient mental health services given the range of other services on-site, from primary care, community health services and other mental health services including Fountains Court, our 26-bed acute assessment ward for older people with mental illness, and Cedar House, our rehabilitation ward, are also on the site or nearby and provide further opportunities to connect care. It is in a central location with good parking and good transport links.

Have any other sites been considered?

Work to identify a suitable location has been taking place 2017. A range of other options have been explored and detailed discussions held with a range of organisations and land owners. The health village has been identified as the best available location which would meet all of the requirements.

Who would the site be for?

We are currently developing our case for change in which we will lay out our initial proposals for consideration. At this early stage, our clinical view is that the new centre at Bedford Health Village would potentially include:

• Adult inpatient services for residents of Bedford Borough and Central Bedfordshire
• We also believe this is a significant opportunity to create new, local, inpatient facilities for children and young people with mental health problems - at present, there are no beds for children and young people in Bedfordshire, Luton or Milton Keynes, and as a result, children and young people requiring inpatient admission are placed in out of area beds, which can sometimes be far from home.
• It could also potentially provide a Psychiatric Intensive Care Unit (PICU) and health-based place of safety (Section 136 suite) to support people from Bedfordshire and Luton

What could be included within the new Bedford centre?

Our preliminary view is that the new centre could potentially include the services detailed below. However, this is an early view and is in no way final or definitive. Definitive plans will be developed jointly and made in agreement with commissioners and developed through co-production with service users and carers, but the sites across Bedfordshire and Luton could potentially include:

What other benefits would the centre bring?

Our hope is that by creating a centre of excellence using recognised best practice, ELFT’s own experience in developing leading centres including the renowned Coborn Centre for Adolescent Mental Health, and drawing on inspiration from projects across the world, we would create a cutting-edge centre that attracts high calibre staff – including some harder to fill roles including psychologists, doctors and social workers.

What will happen to existing Bedfordshire inpatient sites if the new centre opens?

Our proposed model would be to have two inpatient centres to serve the residents of Bedfordshire and Luton, one at the existing Luton Centre for Mental Health, and the new build at Bedford Health Village. We would anticipate that when requiring an inpatient mental health admission, residents of Bedford Borough and large parts of Central Bedfordshire would be admitted to the Bedford Health Village site and residents of the south of Central Bedfordshire and Luton would be admitted to the Luton Centre for Mental Health. We anticipate the existing sites at Oakley Court (Ash and Willow Wards) and Houghton Regis (Townsend Court) would close or change use.

Will there be a reduction in the current number of beds for Luton and Bedford?

There are no proposals to reduce mental health beds. This development must ensure we have sufficient high-quality mental health inpatient bed provision across Luton and Bedfordshire for many years to come. We are undertaking an analysis of demand and capacity. The analysis, when complete, will identify the inpatient mental health needs. This may indicate a necessity to increase, but there are certainly no plans for any loss of beds.

What are the challenges with the existing Bedfordshire inpatient services?

Oakley Court and Townsend Court are situated some distance away from our main inpatient services. Our staff work very hard to ensure that we maintain the very best service possible in these isolated sites, however the fact that they are isolated means that they face a range of clinical issues such as access to medical and specialist support out of hours and recruitment and retention. The sites also have challenges associated with the nature and design of the buildings, including line of sight and outside space. Finally, Oakley Court is in the middle of a residential area and the location can be challenging for neighbours concerned about noise and activity. It can also be challenging for individuals accessing care who may have vulnerabilities and concerns about having to walk through a busy residential area when leaving the ward

What will happen to Poplars Ward, which is on the same site as Townsend Court in Houghton Regis?

Poplars Ward is a Luton and Bedford service and provides an assessment inpatient service for older people with a functional or organic mental illness.

How we provide that service – including the best location for service users – would form part of our conversations with staff, service users, carers and other stakeholders. At present we are examining options to potentially relocate Poplars to the Luton Centre for Mental Health.

Will service users from the south of Central Bedfordshire be able to access Luton services?

Service users in this part of the county are closer to Luton than Bedford and looking at how and where they can access care will be a vital part of our engagement and planning.

What are the plans for inpatient care for people with a learning disability and/or autism in Bedfordshire and Luton?

The National ‘Building the Right Support’ plan formed the building blocks for the Transforming Care Programme (TCP). TCP aims to reduce the number of in-patient admissions for people with a learning disability and/or autism, and to also reduce lengthy admissions into specialist units. The development of a robust and resilient 24 hour crisis service in the community, working alongside local authority partners has had significant success in meeting the above national targets outlined in the TCP.

There will, however, be occasions when an admission into hospital will be required for someone with a learning disability and/or autism who is experiencing a mental health crisis and the new centre will support people’s mental health needs as part of an integrated admission pathway. The approach will be person centred care; the design of the environment will be sensitive to the specific needs of people with a learning disability, making reasonable adjustments in keeping with the Greenlight Toolkit.

When could the new centre open?

We would hope the new centre could be open by the end of 2024.

How much would the Bedford Health Village project cost?

We estimate the project would cost in the region of £60m.

Is the money in place?

This would be a large and significant capital development. We are in discussions with NHS England and NHS Improvement regarding the consultation and capital business case process.

How would the improved services connect with mental health community and crisis care?

The improved inpatient mental health service would form part of our comprehensive mental health offer, and be supported by, and complement, mental health provision across Bedford Borough and Central Bedfordshire, including:

• 24hr NHS 111 mental health crisis support for all ages across Bedfordshire and Luton
• a Bedford mental health crisis café and 24hr mental health assessment hubs (North and South of the County) providing walk-in mental health crisis support
• the expanded Bedfordshire and Luton Mental Health Recovery College
• Bedfordshire Wellbeing Service
• transformed community-based support and Child and Adolescent Mental Health Services (CAMHS) in line with the ambitions and investment of the NHS Long Term Plan, with particular emphasis on developing new neighbourhood mental health teams around primary care networks, integrated across primary care, social care, secondary care mental health and the voluntary sector

Would travel support be provided for service users, carers and relatives travelling to the new centre from Central Bedfordshire?

Transport and access to services is a key consideration, we will be carrying out a full transport impact analysis as part of our pre-consultation business case.

Have any decisions been made?

This project remains in its extremely early stages and all decisions will be made in collaboration and partnership with colleagues, service users, carers and partners.

Will service users and carers be involved?

Co-production and service user and carer involvement is at the heart of all we do at ELFT. All of our service improvement and transformation work is fully co-produced with service users, carers and people with lived experience of mental health conditions.

We had several public engagement sessions and focus groups at the very early initial planning stages and now have an active service user and carer steering group.

We also have service user and carer representation at all planning meetings and board meetings to ensure the service user voice is at the heart of all conversations. We have also started the recruitment process for a People Participation Lead for Bedfordshire Inpatient Redesign, who will work to ensure full co-production processes are embedded in the entire planning and delivery of the Inpatient service. This newly developed role will complement our existing and well-established People Participation Lead roles in Bedford, Central Bedfordshire and Luton.

What are the next steps?

The next step will see a Pre-Consultation Business Case (PCBC), reflecting feedback and input from stakeholders. The PCBC is a legal document that presents the business case for the proposed changes and will be submitted to NHS England and NHS Improvement for review and approval.

If approved, ELFT and the CCG would then hold a formal public consultation involving all stakeholders. A formal consultation invites people to respond to specific decision options and is a formal exercise within a set timetable. 

How can I get involved?

Involvement from all stakeholders is welcomed. Opportunities to share insight, ideas and opinions will be shared and promoted through social media, the media, partner organisations, open invitations and through this dedicated section on the ELFT website.

Questions and queries can be submitted through the ‘get in touch’ portal on this page or by emailing: elft.modernising_inpatientcare@nhs.net

You can also join the conversation on Twitter using #BedsForBedfordshire.