Respondents to a major consultation on the future
of services for adults in southern England with severe personality
disorders have strongly backed the retention or
expansion of residential services.
The news follows the
closure last May - albeit on a temporary basis -
of the Henderson Hospital in Sutton, south London of one of
the two residential units serving the client group across the
South.
A draft report on the consultation found majorities of
respondents supported providing two or four residential units
across the four regions concerned: London, South East Coast, South
East Central and East of England.
The 62 primary care trusts, which launched the consultation in
April, believe the current model of care -
with services concentrated in London in two residential units
with no community outreach teams - is financially unsustainable, at
£10m a year, and fails to meet need.
Regional outreach teams proposed
They have proposed creating specialist regional outreach teams
to provide care closer to home, and offered four options for
additional residential services - no, one, two or four units.
While indicating no preference, the consultation paper said
having one unit, alongside community services, at a cost of £6m to
£7m a year, "might provide the right number of spaces to be stable
in the long-term".
However, 57% of respondents backed having four residential
units, an option that would cost £12m a year, while 56% supported
two units, at a cost of £8m a year. Respondents were allowed to
state more than one preference. Just 28% supported one unit and 16%
no units.
Henderson closure
The issue has proved controversial since a campaign led by staff
and former users failed to stop the closure of the Henderson, due
to falling resident numbers.
Like the other service - the Cassell Hospital in Richmond - the
Henderson was a "therapeutic community", in which residents help
run the centre and take part in group therapy sessions.
Consultation respondents raised concerns that having one unit
would provide insufficient capacity to meet needs and mean service
users would be too far from their local communities.
Universal agreement on reform
The consultation found near universal agreement on the need for
changes in the way such "tier four" services are organised and on
the proposal to create outreach teams in each region, though there
were concerns that region-wide teams would be stretched.
A committee of NHS representatives has been set up to consider
the way forward in November. The draft consultation report said the
committee would consider feedback from respondents alongside "other
evidence such as the reasons for change, assessment of needs,
financial projections and suggestions from primary care
trusts".
RCP: No simple solution
The Royal College of Psychiatrists' Faculty of
Psychotherapy said in its response to the consultation: "There is
no simple solution to these problems which patients and society
faces. There is a need to develop a range of options and to be
aware of how bureaucracy can undermine progress."
There were 373 responses to the consultation, 49% from health
professionals and managers and 29% from service users and families.
Not all respondents answered all questions.
Consultation options:
- No residential units, community outreach teams in each region,
investment in day services, and acute inpatient beds on standby for
people in crisis. Cost: £6m a year.
- One large unit, with 20-30 places, plus community outreach
teams in each region. Cost: £6m-£7m a year.
- Two units, with 15-20 places in each, plus regional outreach
teams. Cost: £8m a year.
- Four units, with 10-15 beds in each, plus outreach teams. Cost:
£12m a year.
Currently, there are two units, with 44 beds in total, no
community outreach teams, and beds purchased from the private
sector when necessary, at a cost of £10m a year.
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