Agenda item

The Leicestershire Partnership Trust and the Integrated Care Board will provide an update on the system pressures experienced by mental health services in the Bradgate Unit through the winter period.

The lead for Mental Health Services, Adults and Older Persons for the Leicestershire Partnership Trust presented the report on system pressures at the Bradgate Mental Health Unit. It was noted that:

·       The Bradgate Unit comprised six acute Adult Mental Health Wards.

·       A detailed activity pack was developed outlining practical support provided across LLR during the winter period. A paper on this was due for release following a validation process.

·       During the winter period, an average of six patients were waiting within a 24-hour period. On some occasions, this increased to ten patients.

·       The OPEL (Operational Pressures Escalation Level) framework was used to standardise pressure levels, with four defined levels. The service operated at OPEL 3 (severe pressure) for 93% of the time.

·       OPEL 4 (critical pressure) was escalated and triggered additional support for three days over winter.

·       Activity levels and bed demand were illustrated through graphs showing pressure on flow and length of stay.

·       The average stay was 47 days, in December, the average length of stay rose to 66 days.

·       Planning for winter 2025 had already begun in line with the new financial year.

·       As part of the additional winter funding for 2024/25, the following shift patterns were made available to all core and bank staff within the Mental Health Liaison Service to enhance service coverage during peak periods:

­   06:00 – 12:00

­   18:00 – 02:00

­   16:00 – 00:00

·       In addition, the service received investment funding for the recruitment of two Link Worker posts. These roles were designed to provide dedicated support to patients within the Emergency Department and to further strengthen collaborative working with colleagues at University Hospitals of Leicester (UHL). Recruitment to these posts was successfully completed in March, with both positions scheduled to commence in June 2025.

·       The OPEL framework was reviewed prior to winter to assess robustness, supported by a national review in December.

·       Governance arrangements were strengthened and aligned with national standards, with actions identified to help de-escalate pressure levels.

·       The Psychiatric Intensive Care Unit (PICU) ward underwent extensive refurbishment work. Block purchasing arrangements with a private provider were made to minimise disruption to patients and families. Additional acute bed capacity was commissioned due to the temporary closure of the unit, including external placements when necessary. The service worked to avoid out-of-area placements where possible, though this was sometimes unavoidable.

·       Sole access to a number of beds was secured to support families in maintaining care at home.

·       There were 18 adults clinically ready for discharge per day, with 40% being city patients.

·       Some patients could not be discharged due to housing and support issues, despite not requiring hospital care.

·       Clinical discharge was managed effectively compared to other areas.

·       Multi-professional teams, including housing providers, local authorities, and practitioners, collaborated to identify support needs early and facilitate timely discharge.

·       On 13 occasions, B&Bs were used to accommodate patients, with an average stay of six days.

In response to questions and comments from Members, it was noted that:

·       The OPAL scoring reflected pressure risk more than clinical risk. Mental health services nationally were experiencing consistently high OPAL levels due to a new benchmarking system. Members were informed that the new framework had standardised OPAL scoring in mental health for the first time, leading to more consistent use across the country, but also resulting in more frequent high-level alerts.

·       Bed availability, discharge readiness, and the number of people waiting for admission were all factors in the OPAL algorithm, with occupancy often reaching 99%.

·       Changes that had taken place March, including a dormitory eradication programme and reconfiguration of two wards, had led to an increase of five additional beds at a minimal cost, which had helped to reduce pressure.

·       Despite these changes, the trust continued to operate at approximately 98% acute bed occupancy. Members were reassured that this was consistent with national benchmarks and reflected the high demand across mental health services nationally.

·       Members raised concerns around the sustainability of operating at such high occupancy levels and questioned whether this level of pressure was affecting staff and patient wellbeing.

·       The Trust performed well nationally in managing out-of-area placements, often operating at 98–99% occupancy without sending many patients out of area. The Trust had been asked to present their approach to other trusts due to their performance and significantly lower costs compared to others.

·       Although higher pressure levels did not release extra funding, they triggered practical actions, such as increased engagement with local authorities and redeployment of staff to support discharges and care transitions.

·       There was a current contract with St Andrew’s in Northampton for PICU beds, as this is the nearest unit to LLR.

·       Concerns were raised about the potential loss of funding for the Mental Health Wellbeing Recovery and Support Service, noting it served around 1,500 people and could affect pressures on Bradgate if withdrawn. The proposals to end the contract were part of wider ICB savings considerations driven by an £11 million funding gap. It was noted that no final decisions had been made and that all proposals were undergoing quality and equality impact assessments.

·       It was noted that population density in Leicester supported the argument for expanding service boundaries, as it may exceed that of larger cities.

AGREED:

·       The Commission noted the report.

·       That better use of trend data be used in future reports, rather than year on year snapshots.

·       An item on winter pressures with the impact on staff and patients to come to a future meeting.