Cedar House Engagement Programme

Cedar House is a mental health rehabilitation service that helps people recover from the difficulties of longer-term mental health problems, supporting them whilst accepting that they may have serious difficulties which need ongoing help.
 

Cedar House is based on the Bedford Health Village (BHV) site in Kimbolton Road, Bedford.

Cedar House was first established in 2006 to accommodate 16 ‘Homes for Life’ mental health service users following the closure of the Fairfield Asylum.

It operates as a mental health inpatient ward, with care provided by mental health professionals 24 hours a day, seven days a week.

Following the closure of asylums, NHS England adopted a ‘Homes for Life’ policy which gave a commitment to provide mental health inpatient care for those mental health service users for life.
 

The NHS England approach to providing mental health rehabilitation care has changed to a focus on recovery-oriented care that provides help and support for individuals to achieve greater independence. 

NHS England now follows NICE guidelines which say care should be offered in the least restrictive environment and services should aim to help people progress from more intensive support to great independence through the rehabilitation pathway.

Cedar House operates as a mental health inpatient facility and currently supports the following service users:

• 6 ‘Homes for Life’ service users
• 3 long stay/non-rehabilitation service users - Service users who have resided at Cedar House for a long time, sometimes due to a lack of opportunity to find appropriate alternative supported accommodation. For this group, Cedar House has effectively become home
• 6 mental health rehabilitation service users – individuals with significant mental health difficulties

They are all receiving active rehabilitation treatment.

A plan is put in place from the point of admission, which aims to ensure that each service user is transferred to a more appropriate setting, preferably living independently with support from our community mental health services.

The average length of stay for these service users is 18 months.

The Homes for Life service users and those who have become residents of Cedar House limit the potential for the unit provide rehabilitation care, including supporting or accepting service users still requiring active treatment who may present as moderately unwell.

It is not felt appropriate to have medical input and qualified nurses on rota 24 hours a day for service users in a rehabilitation setting.

Flow through the service is low, with many service users having a very long length of stay. For some service users, Cedar House has now become their home.

As time has progressed, the needs of the Homes for Life service users have evolved and they now have more physical and personal care needs than mental health needs but remain in a mental health inpatient setting, Many of the Homes for Life services users are now quite elderly.

The Trust has now secured funding for a specialist community-based rehabilitation pathway that would enable service users to be well supported in the community as an alternative to long inpatient stays.

The Trust is considering sub-contracting care at Cedar House to a Voluntary Community Sector Organisation (VCSO) to provide high quality care personalised to the needs of individuals.

ELFT would retain responsibility for the commissioning of the setting and for the monitoring of quality standards, to ensure they remain high. 

Having analysed activity data and considered the capacity required, it is proposed to reduce bed numbers at Cedar House from 16 to 12 as part of the sub-contract process. 

The six Homes for Life residents would remain, with the remaining six beds used to support flow through the system for service users who need short-term step-down rehabilitation care.

The Trust believes that sub-contracting care at Cedar House would achieve the following:

• We currently have several service users occupying acute ward beds and waiting for appropriate supported accommodation. The Trust is also funding several high cost, low quality placements. Both groups of service users could temporarily be accommodated within the new model, if required. This would help to ease current bed pressures, reduce costs, and improve the experience of care for service users
• This option could allow funding to be utilised more flexibly to provide enhanced community-based specialist rehabilitation support for service users in Bedfordshire, including being able to work with the accommodation provider to provide additional support for those clients identified as ready to move to more independent settings
• Cedar House service users would continue to be eligible for support from a CMHT in this model. The current cohort of 16 service users all fall into this category and there is therefore anticipated to be no impact on CMHT practices and workload in a sub-contract arrangement.

The sub-contracting to VSCO approach would allow the existing service user cohort to continue to be accommodated together, should this be their preference.

For many of the current Cedar House residents, the unit has become their home. Many of the Homes for Life cohort are now quite elderly and relocation at this stage of their life could prove quite disruptive and distressing. 

Specialist placements are being actively sought for the three long stay/non-rehabilitation service users.
 

At this early stage, it is difficult to determine the impact on the current ELFT-employed Cedar House staff team. It is possible that the identified third sector provider would already have staff in place to run this unit.

It is also possible that the unqualified members of the ELFT staff team would be subject to a Transfer of Undertakings (Protection of Employment) [TUPE] process into the third sector organisation, once a consultation exercise has been carried out and the preferences of the individual staff concerned have been understood. 

In both outcomes, ELFT would ensure that all staff affected were able to secure alternative employment and a number of staff could be transferred into vacant ELFT posts where the Trust is currently utilising high-cost agency workers. 

The qualified nurses and medical staff who currently form part of the Cedar House team would be retained by ELFT and redeployed into vacant ELFT posts.

There are high levels of vacancies across the directorate currently and we are confident that we could find suitable alternative employment for all staff impacted by this change. It would, in turn, also help to reduce agency staffing spend and increase the size of our permanent workforce. 

No. 

Before any decision is made the Trust is engaging with stakeholders to ensure all factors are considered.
Stakeholders include:

• Our Cedar House service users, carers and advocate
• Cedar House staff
• Mayor of Bedford Borough
• Bedford Borough Council
• Central Bedfordshire Council
• Healthwatch Bedford Borough and Healthwatch Central Bedfordshire
• Bedfordshire, Luton and Milton Keynes Integrated Care Board (ICB)
• MPs
• Carers in Bedfordshire

Other potential outcomes following the engagement programme could be that ELFT retains Cedar House and redesigns the existing model, or that no changes are made to the Cedar House.

The engagement programme will run until June 23.

All comments will be considered and the outcomes will also be shared with BLMK ICB, Bedford Borough Council and Central Bedfordshire Council before a final decision is made.

Any questions or comments can be emailed to glenn.mitchell2@nhs.net
A response will be provided to all comments within two working days.