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The Sub-Committee received a presentation from Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”), Lorraine Regan, Service Director – Oxleas NHS Foundation Trust (“Service Director“) and Helen Smith, Deputy Chief Executive – Oxleas NHS Foundation Trust (“Deputy Chief Executive”) regarding Oxleas proposals to implement the London-wide new model of care for Health Based Place of Safety (HBPoS).

Members were advised that a HBPoS was a safe place in which to assess people who had been detained by the police under section 136 (s136) of the Mental Health Act. The s136 order allowed detention for up to 24 hours, beyond which the person was free to leave or would be admitted to a mental health ward either informally (with their informed consent) or formally detained under the Mental Health Act.

Work was being undertaken by a Pan London Group to develop the ‘Mental Health Compact’ to care for people in crisis. The purpose of the London-wide work was to improve the efficiency and effectiveness of treatment and quality of care for people experiencing mental health crisis along the s136 pathway and the broader crisis care system. The Pan London Group involved cross-partnership engagement with the police, London Ambulance Service and Accident and Emergency Departments (A&E). Its key principles included:

-  Patients being taken to the nearest HBPoS.

-  The prompt transfer to mental health services, if necessary.

-  Dedicated HBPoS staffing, 24/7 to provide the best care and get the best outcome.

-  Physical health competencies to avoid unnecessary A&E referrals.

Currently there were two separate HBPoS sites in the Oxleas NHS Foundation Trust. One was based in the London Borough of Bromley, at Green Park House, PRUH and the second was in Woolwich, at Oxleas House, Queen Elizabeth Hospital. There was one bed at each site, which remained occupied until a person’s care was transferred onwards. During 2018, 86 Bromley patients used the Oxleas HBPoS, equivalent to 1.5 patients per week, and 20% of these patients were taken to Oxleas House. Of the 200 patients admitted to the Bromley HBPoS, only 68 were Bromley patients. Police took people that had been detained to the nearest HBPoS, and this indicated that the majority of patients accessing it were not Bromley residents. Bromley Adult Mental Health Professionals, who were employed by the Local Authority and generally work within the boundaries of the borough, were already attending Oxleas House to assess Bromley patients.

The Pan London Group was proposing to reduce the current number of HBPoS sites in London from twenty to nine, with an interim plan for thirteen sites. The interim plan included two beds based at Oxleas House, which would result in the closure of the bed based at Green Park House. The nine site option would see all nine beds based in Denmark Hill, run by South London & Maudsley NHS Trust. The local view was that a HBPoS needed to be maintained within the footprint of the Oxleas NHS Foundation Trust.

Local services had been introduced to support the HBPoS moving to Oxleas House. This included a fully operational Crisis Line for patients and professionals, that was staffed 24/7 by qualified nursing staff. It could take transfers from NHS 111, which allowed for instant referrals and engagement with patients. This also linked with the 24/7 Home Treatment Service which allowed for frequent home visits, at extended hours, to support people in crisis and involved liaison with the police and London Ambulance Service. Other support services included the Serene Integrated Mentoring (SIM) and Service User Network Groups, a specific aim of which was the personality disorder pathway. This had a significant impact on the system overall, and a high number of patients with this disorder would go into crisis and be subject to a s136.

A Member of the Sub-Committee asked what the frequency of both beds at Oxleas House being occupied was predicted to be, and if they were occupied, how often a third person needing to access them would need to be taken elsewhere. The Deputy Chief Executive said that it was a busy service, with 1.9 patients a day accessing the two beds at the HBPoS. Although a person could be detained for up to 24 hours, they sometimes needed to stay at a HBPoS beyond this while an appropriate place to go on to was arranged. Other patients may only be at the HBPoS for between four and seven hours. If a Bromley resident arrived at Oxleas House, and both beds were occupied, work would be undertaken to identify another HBPoS for them to be taken to, as they had a legal duty to put a response in place.

A Member of the Sub-Committee questioned if the reduction in the number of HBPoS sites was in order to save money. The Deputy Chief Executive said that the proposal was not to save money and that no budget had been allocated. Currently the demand was not sufficient to merit the HBPoS being staffed all the time, and the aim was to put a more efficient and safer service in place. The Associate Director noted that with regards to quality of care, the local police were keen for a HBPoS to be kept within the Oxleas NHS Foundation Trust. They did not mind where it was located within the footprint as long as they could get there quickly, and having two beds located on one site would be easier and result in fewer delays. In response to a question, the Deputy Chief Executive advised Members that the staffing mix at the two-bed Oxleas House HBPoS would still be the same as it was currently, but without the need to transfer the staff across from a mental health ward. The patient would be assessed by a qualified nurse and doctor, who would discuss the next steps. The most senior nurses were Band 6 or Band 7, who would be supported by unqualified nurses.

In response to a question, the Associate Director said that the proposals had been put together by a London-wide group, and that locally it was felt that a HBPoS needed to be retained in the area. It was noted that it was guidance to reduce, and not mandatory to do so. Following Oxleas House increasing to two beds, a review would be undertaken. A local response would be required to advocate for keeping thirteen sites, including the two beds at Oxleas House, which it was noted would be a completely refurbished unit with top specification facilities.

A Member of the Sub-Committee noted the new Homelessness Reduction Act, and asked if patients were assessed in relation to being homeless before they were ready to leave. The Associate Director responded that there was weekly bed management and processes which colleagues from Housing attended. Work was also undertaken on the wards to identify patients further care needs early on, to allow arrangements to be in place for when they were discharged. They also worked closely with Housing colleagues in terms of general housing, which was a challenge to manage as patients often struggled to retain their tenancies. For those patients with higher level housing needs, there was a well refined panel process to ensure these needs were met. The Deputy Chief Executive noted that the length of a patients stay in mental health wards was lower than the national benchmark, which highlighted that the teams worked well with their colleagues in Housing.

In response to a question, the Deputy Chief Executive said that alongside the new developments previously listed, another critical piece of work being undertaken was in regards to the safeguarding of children and adults. The intention was to streamline the process to allow issues to be looked at quicker.

The Chairman led Members in thanking Adrian Dorney, Lorraine Regan and Helen Smith for their presentation which was attached at Appendix B.