Steve Shrubb

We have just completed a challenging round of contract negotiations with our commissioners and I want to talk to you about what this means for our work at the trust and work with colleagues across health and social care.First let me summarise the contract position. Following discussions with those who commission services at Broadmoor Hospital we know that we need to make savings of £2.6m in 2013-14. This is about 6% of our budget and so we’re acting responsibly by looking at the various options available to find a way to manage costs, without reducing quality of care.

In specialist and forensic services we need to save over £2m this year which represents about 5% of our budget. There we’re working with our commissioners on the challenges of improving care pathways to reduce lengths of stay and on reducing delayed discharges.

In local services our initial discussions with commissioners suggested that we needed to make 19% savings across the nine contracts we have with the clinical commissioning groups (CCGs). Through further negotiation we managed to reduce that figure to a saving of £2.6m, which is about 4% of income. The challenge of achieving this saving is made more complex by the work we’re doing with our partners to transform our local services.

Clearly these are challenging times. Last year colleagues across north-west London started planning how we increase the provision of mental health care across this part of the capital when money will be tight over the next three years. (North-west London mental health services need to save about £40 million in the next three years at a time when costs are increasing by 5-6% each year.)

At the same time we need to treat more people – a quarter of a million people with common mental health problems such as depression and anxiety as well as 16,000 more people who are affected by organic disorders such as dementia. And the numbers are growing.

Commissioners, clinicians, service users and managers have been working together to develop these plans. We are trying to bridge the gap within three main work streams, the first of which is called “Shifting Settings of Care”.  This means providing care for people with mental health problems that is safe and effective and closer to home through local GPs and their primary care teams, working in collaboration with the trust. 

The trust wholeheartedly supports the direction of travel of this work, but it is important to recognise that the key consideration throughout these changes is the wellbeing and safety of service users.

We are currently discussing how people whose mental health is stable and who do not need specialist mental health services can be cared for (with their agreement) by their GP and a range of community services to support their further recovery. (This may include creating roles for primary care mental health workers.) In Hounslow and Hammersmith and Fulham we estimate that a handful of service users will be transferred to each GP practice, which should be manageable.

In Ealing, the challenge is of a different order. The numbers of patients we are looking to transfer is significant and may include several hundred people. The scale and pace of change are very challenging, with plans to begin the transfer of service users in August 2013, beginning with those who have the least complex needs. Each service user will have a full discharge plan and service users will still have a route back into secondary care if they need more help.

We are very aware of the scale of this challenge but will work closely with our commissioners in Ealing to support delivery of this work.

To that end, project groups are looking at support for service users and GPs which includes establishing an advice line for GPs to ring consultant psychiatrists; creating a team of primary health care workers to support people with mental health problems in the community; developing shared arrangements for prescribing medications; engaging the voluntary sector to support patients in the community and seeking advice on the impact the changes may have on welfare benefits from specialists in that field.  

Getting this right is vital for service users who will transfer to primary care and those who need our specialist services as well as our staff ]]> http://www.wlmht.nhs.uk/week-in-focus/working-with-commissioners/feed/ 0 http://www.wlmht.nhs.uk/news-events/further-call-for-witnesses-for-joint-broadmoor-hospital-department-of-health-investigation-into-jimmy-savile/ http://www.wlmht.nhs.uk/news-events/further-call-for-witnesses-for-joint-broadmoor-hospital-department-of-health-investigation-into-jimmy-savile/#comments Tue, 18 Jun 2013 07:48:40 +0000 candy http://www.wlmht.nhs.uk/?p=13961 The investigator looking into Jimmy Savile’s activities including possible sexual abuse at Broadmoor Hospital in Berkshire is urging anyone with relevant information including former patients and staff to come forward.

Dr Bill Kirkup said he wants to hear from people who have information relevant to the investigation of Jimmy Savile’s activities at Broadmoor Hospital.

The appeal is to former patients and staff of Broadmoor Hospital as well as former Department of Health employees who may have worked with Broadmoor Hospital at the time of Jimmy Savile’s involvement there. Any information provided by witnesses will be investigated thoroughly and sensitively and the identity of patients who contact the investigation will remain confidential, said Dr Kirkup.

He added: “A number of people involved in Broadmoor Hospital have already contacted our investigation and we are interviewing them now. 

“But there may be other former patients and staff as well as former Department of Health staff who had contact with Jimmy Savile during the time he was involved with the hospital who have not yet come forward but who may want to share their experiences, however minor they might believe them to be.

“We are working to ensure we have the fullest possible picture of Savile’s time at Broadmoor Hospital so that we are aware of any offences he may have committed during his involvement at the hospital, and any other inappropriate behaviour. Any issues identified by the investigation will be acted upon and appropriate systems will be put in place. Our aim is to reassure the public, patients and staff that our policies and safeguarding procedures are fit for purpose and will prevent recurrence in future.

“We can be contacted via a confidential telephone line, by email or by post and I would urge anyone who wants to contact us to do so now, while we are still gathering evidence and conducting interviews.”

Initial enquiries suggest that Savile first had contact with Broadmoor Hospital in 1967 after a patient wrote to him. At the time Savile was a presenter of the BBC programme ‘Top of the Pops’. Savile’s last visit at Broadmoor is believed to have been in around 2004.

Any former member of staff or patient who wishes to contact the investigation can either:

• Call the investigation office on 01344 754122
• Call the confidential telephone helpline on 0800 783 5865
• Email savileinvestigations@dh.gsi.gov.uk
• Write to Savile Investigations. Department of Health, Richmond House, 79 Whitehall, London SW1A 2NS

- ENDS -

Notes for Editors:

1. The Board of West London Mental Health NHS Trust and the Department of Health announced last December that they had commissioned a joint investigation into the role Savile played at the hospital following allegations that he sexually abused patients.
2. The investigation at Broadmoor has been commissioned jointly with the Department of Health because the hospital reported directly to the Department of Health up to 1989, to the Special Hospitals Service Authority between 1989 and 1996 and to the Broadmoor Hospital Authority between 1996 and 2001. Broadmoor Hospital has been part of the West London Mental Health NHS Trust since 2001.  The investigators are independent of both organisations.
3. Separate investigations are taking place at Leeds General Infirmary and Stoke Mandeville Hospital into the role Jimmy Savile played at those NHS trusts.
4. A local oversight panel of independent members is offering challenge and advice to the investigation as its work progresses. The Secretary of State for Health, Jeremy Hunt, has asked Kate Lampard, a former barrister, to provide independent oversight of all three NHS investigations.
5. West London Mental Health NHS Trust is one of the largest mental health trusts in the country. It provides a full range of mental health services for children, adults and older people living in the London boroughs of Ealing, Hammersmith & Fulham and Hounslow, in addition to specialist and forensic mental health services, including high secure services at Broadmoor Hospital. It aims to meet the diverse needs of a local population of nearly 700,000 people and employs around 3,500 staff across 29 sites.

 Contact details: Helene Feger, Director of Communications, T. 020 8354 8847, M. 07817 393 861, E. helene.feger@wlmht.nhs.uk.

Our contractors have now reached a stage where they need to dig up the western lane on the A3095, this means there is currently only one lane available.

This has resulted in the 24 hour traffic light system being put in use. We would like to apologise for  any inconvenience this may cause and let you know that we are working closely with  our contractors to make sure they are doing everything they can to complete this aspect of the work as quickly as possible so that local residents and commuters do not experience any further delays than absolutely necessary.

Your patience and understanding is very much appreciated whilst this aspect of the project is carried out, please also ensure you allow additional time for you journey or where possible, seek alternative routes.

Broadmoor Hospital opened its doors for the first time in 1863, providing care for mentally ill men and women who had committed acts of violence or seemed in some way to threaten society.

The hospital was purposefully set outside London on a hill with views of the Berkshire countryside in Crowthorne. Patients benefitted from the idyllic calm of the surrounding landscape and worked in the kitchen gardens and on the hospital farm as part of their therapy.

The modern-day hospital has outgrown its Victorian setting. So subject to final approval by the Department of Health, redevelopment of the hospital is due to begin this year, which will allow it to offer improved therapeutic care in setting that meets 21^st century healthcare standards to patients in the new hospital when it opens in 2017.

Clinical treatment has greatly evolved over the years and today NHS care is provided at the hospital to 210 male patients by specialist teams in conditions of high security.

Through the therapeutic process, patients admitted to Broadmoor Hospital gain an understanding of their offending behaviour and the nature of their illness. They are supported by a range of experts at the forefront of psychiatry and mental health treatment. Staff at the hospital work with patients to reduce risk of harm and self-harm, promote recovery and rehabilitation and offer hope to some who have lost their place in the family and society.

Patients at Broadmoor Hospital present some of the most complex and challenging needs in mental health care; many have multiple conditions, or combinations of symptoms that have proved resistant to treatment.

The hospital is a leading contributor to current thinking on recovery in secure services, and regularly hosts national events and conferences on the subject.

Broadmoor frequently welcomes international visitors from the healthcare and criminal justice systems of other countries seeking to better understand optimal ways of supporting recovery in high security mental health services.

Our staff use the opportunity this complexity presents to understand more about severe mental illness and the personality disorders that disrupt patients’ lives and wellbeing. A number of research studies, for example, on empathy, on attention deficit and hyperactivity disorder and on brain functioning associated with different conditions, have furthered understanding of the causes, treatments and management of mental illness.

Leeanne McGee, executive director of high secure services at Broadmoor Hospital says: “We’re extremely proud of the nationally recognised clinical care we provide and the research work we do at the hospital. We will mark the 150^th year with a series of events for patients, staff and guests from organisations in the local community, to celebrate the past, present and future of Broadmoor Hospital.

“We’ll launch our celebrations on Thursday 6 June with a multi-faith ceremony in the hospital chapel and a lunch for patients, staff and invited guests.

“Our patients have worked with staff to plan and organise the year’s events. Patients have designed a flag to mark the 150th anniversary, they’re working on a commemorative version of The Chronicle (the patient magazine) and they’re working with staff to direct and plan sporting, music and other events to take place during the year.

“Patients are also working on sculpting a time capsule which will be filled with items and not to be opened for 70 years. We’ll put the time capsule on display in the reception area of the new hospital when it opens.”

Joe Ayres, from Crowthorne has worked at Broadmoor Hospital for almost 30 years, as an occupational therapist. He says: “This is a really special year in the history of Broadmoor Hospital where I have had a long and rewarding career.

“There have been many changes throughout my time here including more emphasis on patient centred practice, development of recovery focussed collaborative working, greater patient involvement at all levels and a stronger emphasis on clinical governance, leadership and multi-disciplinary team working. I have been afforded many opportunities in terms of the numerous roles I have had over the years and the variety of training and educational opportunities as well as working with some very experienced colleagues from whom I continue to learn.”

This week we’re launching a year of celebrations at  Broadmoor to mark the 150th anniversary of the hospital. This is an important point in the life of the hospital and during the year of events being planned we’ll take time to look back at the historic past of the place, the outstanding work of the staff there and we’ll look ahead to a better future for patients as we continue the works to completely redevelop the hospital.‪

Leeanne McGee and her team have much to be proud of at Broadmoor Hospital and we’ll share with you the highlights of the year ahead as events happen.‪

On Thursday we’ll begin the celebrations with an inaugural event for patients, staff and guests from organisations in the local community – who like us are very proud of the internationally recognised work done by the staff, many of whom live locally to the hospital.

I know we’re expecting patients to join in on Thursday and I hope many of the hospital’s staff will be able to come along, even if only for a short period of time, at some point during the day. We’ll hear from a number of speakers including Mark Stevens from the Berkshire Records Office who will talk about the hospital’s colourful history, and Vivienne Mowatt from the redevelopment team who’ll talk about the project to re-develop the site.‪

I know there has been a great deal of work done behind the scenes and I’ve heard from Leeanne that patients have been involved every step of the way – which is very good news. Not only have patients designed a flag to mark the 150th anniversary, but they’ve been working on a commemorative version of The Chronicle (the patient magazine) and they’ve worked closely with staff to direct and plan sporting, music and other events to take place during the year. Patients are also working on sculpting a time capsule which will be filled with items and not to be opened for 70 years. The time capsule will be put on display in the reception area of the new hospital when it opens – which I think is a great idea.‪

Members of the board and I are looking forward to coming to the hospital to celebrate with patients and staff during the year and meeting staff past and present who will be taking part in events in July and August; Broadmoor has many friends that want to be a part of this. I hope everyone involved enjoys the anniversary year and I’d like to thank the team at Broadmoor for all the work they’re doing.

We want your experience of our services to be consistently good, but we know there are things we could do better.

These electronic feedback tools make it easier and more convenient for you to tell us what you think.

The surveys are anonymous and we can use the results to help us plan improvements and change the way we work so that we give you the right support, at the right time, in the right place.

And because we receive your feedback in real-time, we can sort problems sooner and tell you what we’re doing to put things right.

We will use the iPads and surveys regularly to monitor whether the quality of our service is improving. We will work with service users and carers to develop actions that make sure we are providing an excellent level of care.

As well as some set questions, there is an opportunity to make comments and suggestions about what we could do differently.

If you use services at one of our community sites, or you care for someone with mental health needs, you can also give feedback on our website.

Go to the feedback area to give your views online and to look at our overall patient experience results.

We will display the results of recent surveys on special noticeboards and tell you what we are doing to address any concerns.

Find out more

For more information about the Meridian project, please get in touch:

Tel: 020 8354 8102
Email: meridian@wlmht.nhs.uk

This interests me not only because of the responsibility we have for patients with dementia at the trust but also because my dad was recently diagnosed with the illness. I know how frightening and sad it is to see the health of someone you love deteriorate and am grateful to those who help care for him in Sussex where he lives.

The real difficulty with the diagnosis for me is that I don’t live near my dad so have to rely on others to provide care – and then we have the uncertainty of not knowing how the illness will progress. My mum is still alive and lives with him, although she’s not in great health herself – which is why they’re now in independent living accommodation.

We had our suspicions that he had dementia but it was still a big shock to us when it was confirmed.

It’s always interesting as an NHS chief executive to be on the other side as a user of health services – and what really struck me is that while most of the NHS staff we’ve spoken to along the way have been extremely caring, knowledgeable and helpful,  the biggest challenge has been identifying what services are available from health and social care, who to contact and how to get things sorted so that we’re sure he’s getting the best help the NHS and social care services can give.

I also understand better the need to integrate services because whilst health input is important the on going day to day care that makes a real difference is social care. I would be really interested to hear from you about how we can improve integration between health and social services.

My personal experiences have made me all the more aware of the real value of the service we run for people with dementia at Brentford Lodge. This is a specialist dementia service that brings together our clinical and research expertise in dementia into one place. Anyone can be referred into the service over the age of 18 years because although it is common in older people, unfortunately some people do develop memory problems at a younger age.

The value of the service is that patients and their families have all the information they need in one place where the expertise is centred.

Another thing which my dad’s situation has confirmed is that little things can make a big difference. Having some one who could do small DIY jobs around the house would make such a big difference. Maybe we should be looking at providing a “handy man “ service as part of the care we provide in community?

During dementia awareness week, the focus is on talking about memory problems so diagnosis happens as early as possible – so treatment can begin. This is something we’re working closely with our GP colleagues on – making sure that when people are referred they’re seen quickly. We’ve also been working to share best practice across the three boroughs with colleagues in the liaison services in acute hospitals and our partners such as the voluntary sector.

We know that with our ageing society demand for dementia services is likely to rise and that’s why all of our dementia patients are invited to be involved in clinical trials or research programmes related to memory problems. Research in this area is looking to improve the quality of life for people with dementia, investigating good practice in care and treatment of dementia, and let’s hope one day find a cure.

Download the Board agenda and papers

And she’s equally proud to be taking part in research into a new form of treatment for Alzheimer’s disease because, as she says with a smile, she likes to keep busy and: “It may help me and it may help others, they have made advances with so many drugs and this is how it all started.”

Her participation in the trial followed a conversation with her community psychiatric nurse, Frances Thorne, about joining a research register, DemReg, that puts researchers in touch with volunteers.         

The study Janet’s taking part in – into a new drug that it’s hoped could stop deterioration caused by dementia at an early stage – means she receives injections once a fortnight under the supervision of the clinical trials team at Brentford Lodge, including her usual old age psychiatrist, Dr Bryan Corridan.

It’s due to begin shortly and, along with other patients taking part, Janet will receive regular memory tests to help measure the trial drug’s effectiveness. They will only know afterwards if the drugs taken during the trial are real or a placebo.

Janet’s daughter, Ann McCormack, supports her decision to take part.  

She said: “It has all been explained very well to us. If there are side effects mum can leave the trial and if we decide we don’t want to take it further we can walk away at any time. We’re both pleased she’s taking parting in this.”

The drugs trial is one of a range of important research projects into mental health and cognitive disorders being undertaken by the trust’s research and development department.   

Nurse Frances’ role

Community psychiatric nurse Frances Thorne, based at Elm Lodge clinic, put Janet and her daughter Ann in touch with the drug trial research team.

 She sees dozens of patients each year at home or at the clinic in Greenford and believes introducing them to the DemReg research register is part of her professional role. The register operates across several NW London Trusts, supporting medical research into dementia and cognitive impairment.

She said: “I’m an old style nurse in many ways. I really care about my patients and their carers and I want to do the best for them. I’ve seen some of my patients really benefit from the research they’ve taken part in.”

She first talks them through the process and answers their questions face to face – a process which takes around 20 minutes – and can result in an immediate new member. 

Says Frances: “I find it’s the best way to do it, to talk them through what joining means. It’s up to them if they want to take part in any piece of research they are approached about as a result, but if they are not on the register, there is much less chance they will hear about it.”

She said: “I know that, if I was 75, and had dementia or if Janet was my relative I would want someone like me to come around and ask if I’d like to take part in research. It’s part of the reason why I’m a nurse because I want to beat this disease and I want to help keep my patients in their homes for longer.”

Lisa Curry, research communication, recruitment and feasibility team manager for the trust said the research registry enables patients to be contacted about relevant research projects as and when they come up.

“It makes it much more likely that they will be asked,” she said. “We’re really grateful to professionals like Frances who encourage their patients to join as it helps get important research off the ground faster.”

If you’d like to join the Dem Reg research register or tell your patients about it, please contact Lisa Curry by email: lisa.curry@wlmht.nhs.uk 

The research – the first to investigate whether nature or nurture has a greater influence on the production of the brain chemical dopamine– was carried out by Dr Paul Stokes, an academic consultant psychiatrist at the West London Mental Health NHS Trust and Imperial College, and his team.

Dr Stokes’ paper, ‘Nature or Nurture? Determining the Heritability of Human Striatal Dopamine Function’ won in the psychiatry section for mental health research.

Dopamine transmits nerve signals and its function in the part of the brain known as the striatum is important in signalling reward, integrating information from other parts of the brain, and in movement. Critically, it is involved in a number of mental health disorders, including schizophrenia, attention deficit hyperactivity disorder (ADHD) and addiction.

Dr Stokes used brain imaging to measure dopamine function in healthy identical and non-identical twins. The research, which was funded by the Medical Research Council, found that dopamine function is more influenced by environmental factors specific to an individual than by genetic inheritance. Dr Stokes also found that environmental factors shared between family members had no influence on dopamine function in the striatum.

Dr Stokes said: “My study indicates that changes in dopamine function in the striatum, which may underlie important mental health problems such as schizophrenia and addictions, are more likely to be related to environmental influences that a person may experience in late childhood or early adulthood rather than inherited genetic risk factors for these conditions.

“This supports evidence in the research literature that preventing drug misuse and cannabis use and addressing other environmental factors in adolescence and early adulthood could potentially have an impact on reducing serious mental illness.”

The research found the greatest influence of genetics in an area of the striatum which regulates habit formation and that the effect of individual environmental factors was greatest in an area of the striatum which is involved in emotions, especially in reward and pleasure.

Information for news editors

‘Nature or Nurture? Determining the Heritability of Human Striatal Dopamine Function: an {18F}-DOPA PET Study’ was published in the highly respected journal Neuropsychopharmacology in October 2012. Neuropsychopharmacology. 2013 Feb ;38(3):485-91. doi: 10.1038/npp.2012.207. Epub 2012 Oct 24.

The research used [18F] positron emission tomography (PET) to determine the heritability of presynaptic striatal dopamine function by comparing variability in uptake values in 9 pairs of identical twins and 10 pairs of non-identical twins.

Dr Paul Stokes MB ChB BSc (Hons) MRCPsych DIC PhD, divides his work between research and clinical practice. His clinical work is with the Ealing east recovery team, part of West London Mental Health NHS Trust, where he spends two days a week.

Contact: Tara Ferguson Jones, head of communications

Tel: 020 8438 2283
Email: tara.ferguson-jones@wlmht.nhs.uk