Wiltshire Clinical Commissioning Group (CCG) has been told it must hold a ‘formal’ consultation on the first stage of implementing its new strategy for dementia care in the county.
A three month consultation on the draft strategy as a whole ended on Monday (May 19 – see below). But the risk register presented to the CCG’s board meeting the next day warned that options for changes in inpatient dementia care were likely to face judicial review and that further consultation was necessary.
“This dementia project has had to readjust its focus due to the advice received from Wiltshire Council and lawyers in which we were advised to undertake a formal public consultation on all three inpatient options.”
It went on to tell the board’s directors: “Legal advice and informal advice from Healthwatch [Wiltshire] has confirmed that the project has a strong risk of a legal challenge and a high possibility of judicial review.”
Under ‘Actions required to mitigate risk’, the register suggests: “Seek and maintain legal advice throughout the process i.e. from April-October 2014 and longer if judicial review is undertaken.”
It is understood that the consultation will start in July and – due to the summer holiday period – be extended beyond the usual three months ending in October. The three options for inpatient care will probably not be published until the consultation starts.
A major issue is the future of inpatient care following the ‘temporary closure’ last year of Charter House – an inpatient facility in Trowbridge run by the Avon and Wiltshire Partnership Mental Health NHS Trust (AWP.)
Charter House, situated in a residential part of Trowbridge, provided “inpatient assessment and treatment for older people who have mental illness. Some people are detained under the Mental Health Act 1983.”
This closure will be one issue addressed during the consultation. As the CCG’s risk register notes: “The storyline is being developed jointly [with Wiltshire Council] and will address reasons for the protracted temporary closure of CH [Charter House] and what analysis the CCG has undertaken to ensure that the options presented to the public are a full and open record of what has taken place.”
When Charter House was closed as a temporary measure in February 2013, under use was one of the reasons put forward for the closure – at the time just four of its 24 beds were occupied.
AWP explained: “Delivering consistently high quality care to dementia patients in Charter House is proving increasingly difficult as a result of low occupancy, environmental problems and the stand alone nature of the site.”
In February 2013, the charity Alzheimer’s Support (based in Trowbridge) was uneasy about the closure: “We understood that closing the beds at Charter House was one proposal as part of a consultation into the best way to treat dementia patients with complex needs…Closing them now, ahead of the consultation and before the extra services are in place, would seem premature.”
CCGs are legally bound (under the Health and Social Care Act 2012) to work to the government’s mandate. This gives four tests which proposed service changes must meet:
• strong public and patient engagement;
• consistency with current and prospective need for patient choice;
•a clear clinical evidence base; and
•support for proposals from clinical commissioners.
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Consultation on the CCG’s dementia policy for 2014 to 2021: Up to May 16 the consultation had received 92 responses to its survey. It had also used discussions at a number of events and received written feedback from groups involved in dementia care and from Healthwatch Wiltshire. Now the consultation has closed, a full analysis of responses will be made. However, the feeling is that people have been “positive and very supportive” of the changes proposed. People have not found it easy to prioritise issues but do believe that priority should be given to people with dementia living alone and who feel isolated in rural areas. Meanwhile the CCG’s push to improve Wiltshire’s poor rate for diagnosing dementia is recording further successes. And the GP leading the CCG’s dementia programmes, Dr Celia Grummitt, is pleased with the progress being made by local surgeries. The draft dementia policy will be reviewed and amended in the light of reposnes to the consultation. It will then be formally agreed and accepted by Wiltshire Council and the CCG. |
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