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181/11 IMPROVING SHORT AND MEDIUM TERM REHABILITATIVE MENTAL HEALTH CARE The Senior Programme Manager (Mental Health) presented this report which outlined proposals to change and improve the pathway for short and medium term health care at Lyndhurst, Wells House and in the community. It was reported that this was one of the commissioning priorities and was part of the Mental Health QIPP Plan.

The report referred to a 2011 NHS Confederation publication which was critical of the use of Out of Area placements in terms of patient/health outcomes (e.g. clients’ dislocation from their families and communities due to the physical distances involved) and on financial grounds.

It was noted that the PCT currently commissioned services from SWYPFT provided at Lyndhurst, a 14 bedded 24 hour nursing care unit which provided low secure residential accommodation easing patients towards more independent living. Although Lyndhurst presently provided care with some capacity to detain, that capacity was limited so a number of clients had to be accommodated in out of area placements.

The report outlined a proposal to improve the staffing levels and skills mix and make building adaptations at Lyndhurst so as to increase its capacity to accommodate clients with more complex needs (thus enabling the repatriation of some clients presently accommodated out of area). There were also proposals to strengthening provision at Wells House and in the community so as to enable an earlier “stepping down” of some of the clients with less complex needs presently accommodated at Lyndhurst and to reduce the length of stay at Lyndhurst. Additional investment proposed at Wells House was also outlined in the report.

Discussion took place upon the anticipated costs and savings outlined in the report. It was noted that SWYPFT had agreed to fund the one-off capital costs of £195,960 and that an additional £145,438 was required in 2011/12 to pump prime the proposals (comprising staff recruitment and training costs). There would also be additional recurrent costs of £581,753 to fund the additional staffing costs for Lyndhurst, Wells House and community care. However it was anticipated that from 2012/13 onwards significant savings would be made from a reduction in out of area placements. The report outlined the anticipated savings based on higher and lower estimates of the out of area costs. With regard to the costs breakdown provided on page 19 of the report, the Senior Programme Manager advised that SWYPFT had agreed to fund all the medical costs.

Discussion took place on the risks associated with the proposal, which were outlined in the report. A Non Executive Associate referred to the issue of the use of Lyndhurst being commissioned on a block contract basis, so the potential savings would not be realised if out of area clients were not transferred to Lyndhurst and/or its occupancy level fell. The Senior Programme Manager advised that there were provisions for penalty deductions to be made if occupancy fell below 90% (and, to discourage bed blocking, if the average length of stay exceeded 18 months). A CCG Board member asked about the admission criteria and the possibility of beds being filled by new clients as opposed to repatriated out of area clients. It was reported that a residential 6