Henderson Campaign 2007

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CAMPAIGN 2008

Current Campaign

CAMPAIGN 2007

Rex Haigh Letters and Supporting Information


Letter to Lord Warner: Facilities for treating severe personality disorder, October 2006

Lord Warner The House of Lords London SW1A 0PW

Dear Lord Warner

Facilities for treating severe personality disorder

In response to your "Review of Commissioning Arrangements for Specialised Services" I would like to raise some issues about critical mental health services that are falling into the gap between national commissioning processes and local arrangements.

I am a psychiatrist who has been closely involved with development of non-forensic personality disorder treatments since 1994, including as a clinical advisor to the Department of Health Personality Disorder Development Programme for the last four years. I would like to make some points that seem to have been missed in the recent hurly-burly of NHS change.

1 Reduction in services. Despite the National Personality Disorder Development Programme, the current commissioning machinery has increased geographical inequity, and reduced provision for the most severe non-forensic patients with personality disorder.

  • The number of NHS beds nationally for those serious cases needing residential treatment has been cut from 123 to 84 in the last 2 years and is likely to reduce to 55 at the end of March 2007, as a result of devolvement from NSCAG to PCT commissioning, with impending closure of Henderson Hospital. This is not driven by lack of demand, and it has happened without proper consultation.
  • Despite considerable efforts to broker a suitable risk-spreading arrangement by the National Personality Disorder Development Programme team earlier this year, it fell apart within weeks - when other pressures on PCTs made them need to draw money back.
  • It appears that the committees making these decisions have no suitable clinical input. In the South of England, they have had no clinical input whatsoever for the last two years.
  • In my own clinical work (13 years working in PD day units), it is clear that there are a small number of cases – probably between five and ten percent – who need partial inpatient hospitalisation, and are too high a risk to be in intensive treatment without 24 hour cover.
  • These beds are for the most severely disturbed patients who are not safe in the new non-residential services (which only cover very limited geographical areas, in any case). Untreated, they remain socially excluded and many kill themselves; treated in mainstream mental health services, they often behaviourally deteriorate and consume considerable resources in the process.
  • Cost effectiveness research shows that such treatment saves money in the long term, as well as in areas apart from health^ ^. No joined-up or strategic long term planning is allowed by current commissioning arrangements.


2 Ways forward Essentially, I am arguing for coordinated regional commissioning of these services, with close clinical integration across the different tiers of need. For example, in the East Midlands, a group of clinicians and managers are at an early stage of considering what could be "an ideal service" for the whole range of personality disorders.

  • A network of local and regional services was proposed in 1999^ ^ and meta-analysis of research evidence supports the model of service.^ ^ The East Midlands has, by luck as much as planning, an excellent base of expertise and experience – ranging from the DSPD unit at Rampton to service user self-help groups in the Notts community PD pilot service, with all levels between.
  • It has 15 of the 84 residential beds (at Francis Dixon Lodge in Leicester), which would seem better suited to designation as a regional than national resource. They have developed a new model of partial inpatient hospitalisation, with patients spending four nights per week as residents. This is practicable on a regional basis, but would not be so as a national service.
  • There is no easy way to decide the population need of residential beds, but this number has been in steady state for some years, and comprises referrals from across the East Midlands and a few beyond. It is therefore likely to be a "best guess" starting point for further evaluation.
  • Detailed planning for close clinical collaboration across the five counties (Derbys, Leics, Lincs, Northants and Notts), and between forensic and community services is already happening.
  • There is excellent capacity for research and evaluation. So what I am proposing is that this is seen as a "regional pilot" which is closely evaluated and modified as necessary (probably over 3-5 years) before being implemented elsewhere. Then units such as the Cassel, Henderson Hospital and Main House could find a long-term and secure place in a rational system of provision.

Some other regions are drawing together similar coordination: in the Thames Valley, there is a three hub and multiple spoke model of day provision – and recognition that occasionally residential treatment is needed out of the region (at Henderson, Cassel or Main House). In the West Midlands, Main House and the Birmingham PD Service are developing a coordinated range of provision. However, in London, to a relative outsider, there appears to be no clinical or commissioning cooperation.

So although "No Longer a Diagnosis of Exclusion" is leading to new and creative locally-sensitive regional solutions where there is sufficient resource and experience, the inflexibility of the commissioning arrangements is likely to destroy some extremely valuable resources before they have time to reorganise themselves into suitably modern networks with the required clinical, managerial and commissioning cooperation. I particularly fear a destructive situation in London, where vulnerable people will be reinforced in their chaotic lives by chaotic services.


I would be very interested to hear your views on the matter.

Yours sincerely

Rex Haigh

cc Louis Appleby, Director of Mental Health, Department of Health

Mike Harris, Chief Executive, Notts HC Trust

Peter Houghton, Chief Executive, SW London & St Georges MH Trust

Duncan Selby, Commissioning Lead, Department of Health

Nick Benefield, Policy Lead, National Personality Disorder Development Programme

bcc Jan Birtle, Clinical Director, Birmingham PD Service

Penelope Campling, Clinical Director, Leicestershire PD Service

Chris Evans, Consultant Psychotherapist, Nottinghamshire PD Network

Kevin Healy, Clinical Director, Cassel Hospital

Eddie Kane, Director, National PD Institute

Nick Manning, R&D Director, Nottinghamshire Healthcare Trust

Diana Menzies, Clinical Lead, Henderson Hospital

Tom O\'Reilly, Consultant Psychotherapist, Nottinghamshire PD Network

Frankie Pidd, Commissioning Lead, National PD Development Programme

Notes on possibilities for coordinated PD services across the East Midlands - Adobe pdf document

Henderson Board Report 1 Feb 2007

Henderson Board Report, February 1 2007 Adobe pdf required. 85kb


Campaign Do-List

Ian Milne 12:39, 2 December 2006 (GMT)

  • Letter to Mr Blair done - text below
  • Letter to MP - template on the list and below - just personalise and send to your MP - text below, just copy and paste.
  • Letter to Primary Care Trust - not yet done
  • email sent to request information and papers acknowledged. Can you please inform me as to whether the services provided at this hospital are under any threat and what papers exist on its future. I understand it may be being discussed imminently next week. I would like to see the papers under the freedom of information provisions Yours sincerely Ian Milne
  • Letter to Lord Alderdice - needs composition
  • Action Committee? - to be formed
  • Users Support Group - to be formed
    • Fran, with offers of support to individuals and to widen the issue out to people in the Borderline UK Group

New SW London and St Georges Trust Board member for users.

Why not write to her and insist on proper consultation with users/carers and friends.

7 November 2006 A new Associate Non-Executive Director has been appointed at South West London and St George’s Mental Health NHS Trust to champion the voice of service users.

Dr Diana Rose has joined the Board this month and will be responsible for user involvement and young people. Diana, a social scientist and Senior Lecturer at the Institute of Psychiatry at King’s College London, is also a mental health service user. She has been active in the service user movement for 20 years and is a member of a number of committees and panels to promote the wellbeing of service users. She is Co-Director of the Service User Research Enterprise (SURE), the first research team in Europe to carry out research with and by users in a collaborative relationship with clinical academics.

Chairman John Rafferty said: “I would like to welcome Diana to the Trust Board and look forward to working with her. Strengthening the voice of the service user on the Board is imperative to ensuring our services meet the needs of those who we serve.”


Recent Correspondence

Ian Milne 12:01, 5 January 2007 (GMT)

St Georges Trust disclosure under the Freedom of Information Act - more requested

Paper for Executive Team Discussion

Ian Milne 15:31, 4 January 2007 (GMT)

Here is a response from the Department of Health to our letter to Mr Blair

Department of Health, Richmond House 79 Whitehall London SW1A 2NS Tel: 020 7210 3000


2 January 2007

Dear Mr Milne,

Thank you for your letter of 2 December to Tony Blair regarding Therapeutic Communities. As you will appreciate, Mr Blair receives large amounts of correspondence daily and cannot respond to all of this mail personally. Your letter has been passed to me and I hope that the following reply is of help. I should like to state at the outset that mental health remains one of the top three clinical priorities for the Department of Health. Since the publication of the National Service Framework for Mental Health (the NSF) in 1999, we have invested over £1 billion more in mental health services, and have put in place many of the improvements that we promised. Planned expenditure on adult mental health services increased by nearly 25 per cent in real terms between 2001/02 and 2005/06, and in October 2005 we announced £130million funding to update the mental health estate.

As you may know, current funding arrangements mean that Strategic Health Authorities (SHAs) are responsible for overall financial balance in their area. Primary Care Trusts (PCTs) are allocated resources on the basis of the relative needs of their local populations. It is for PCTs, in partnership with SHAs and other local stakeholders, to determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. I should suggest that you contact local PCTs and SHAs with your concerns about Therapeutic Communities. '

I hope that this information is of help Yours sincerely, Kierran Horner Customer Service Centre

Ian Milne 14:05, 9 December 2006 (GMT)

Here is a response to our letter from Mr Blair's aides:

10 DOWNING STREET, LONDON SW1A 2AA

Dear Mr Milne

The Prime-Minister has asked me to thank you for your recent letter.

Mr Blair would like to reply personally, but as you will appreciate he receives many thousands of letters each week and this is not possible.

The matter you raise is the responsibility of the Department of Health, therefore he has asked that your letter be forwarded to that Department so that they are also aware of your views.

Yours sincerely

R. Smith

--



Letter to Mr Blair, Prime Minister

Rt. Hon. Tony Blair Prime Minister 10 Downing Street London SW1A 2AA

2 December 2006

Dear Mr Blair

Therapeutic Communities for People with Personality Disorders

The Therapeutic Community Open Forum is a forum open to all those involved with the concept of “therapeutic community”. It has international membership and represents ex residents, residents, carers, staff and academics.

As a representative of the above International Forum I am writing to you personally to express alarm that a number of British Therapeutic Communities for people with personality disorders are facing the risk of imminent closure. This is due to the fact that responsibility for their funding as from next year is falling to local Primary Care Trusts whereas now they are funded centrally.

These Communities, both historically and now, are known as centres of excellence and their work has been an inspiration worldwide. At a time when the French are opening 20 new Therapeutic Communities, here in Britain we run the risk of losing our few centres of excellence in this field. Their demise will be a tragedy. Their cost benefits are well known and their efficacy well proven.

Social policy is cyclical and re-creation of these communities in the future will be more expensive than retaining them. The loss of capital, networks, experience and resources both human and other will be enormous. It would cost very little to maintain these communities on a national basis however.

In the words of one of our ex-users “I think it is also important to stress how much of a life saver Therapeutic Communities can be and how they enable individuals to learn the tools to be able to turn their lives around and be able to start to live as opposed to merely existing in a chaotic life. If Therapeutic Communities close then in effect they are removing those tools which so many people need to be able to benefit from.’’

Could you please intervene in this situation personally as the outcome means so much to this socially excluded and disenfranchised group?

Yours sincerely

Ian Milne M.A.


Letter to MP for you to send to your local MP

Dear

Therapeutic Communities for People with Personality Disorders

The Therapeutic Community Open Forum is an open forum open to all those involved with the concept of “therapeutic community”. It has international membership and represents ex residents, residents, carers, staff and academics.

As a representative of the above International Forum I am writing to you personally to express alarm that a number of British Therapeutic Communities for people with personality disorders are facing the risk of imminent closure. This is due to the fact that responsibility for their funding as from next year is falling to local Primary Care Trusts whereas now they are funded centrally.

We have written to Mr Blair asking for his personal intervention and we await his reply. Time is running out and closure decisions are imminent.

These Communities, both historically, and now are known as centres of excellence and their work has been an inspiration worldwide. At a time when the French are opening 20 new Therapeutic Communities, here in Britain we run the risk of losing our few centres of excellence in this field. Their demise will be a tragedy. Their cost benefits are well known and their efficacy well proven.

Social policy is cyclical and re-creation of these communities in the future will be more expensive than retaining them. The loss of capital, networks, experience and resources both human and other will be enormous. It would cost very little to maintain these communities however.

In the words of one of our ex-users “I think it is also important to stress how much of a life saver Therapeutic Communities can be and how they enable individuals to learn the tools to be able to turn their lives around and be able to start to live as opposed to merely existing in a chaotic life. If Therapeutic Communities close then in effect they are removing those tools which so many people need to be able to benefit from. “

Could you please take up this situation personally as the outcome means so much to this socially excluded and disenfranchised group?

Yours sincerely




email to Lord Alderdice

This is the content of the email that I sent:

Dear Lord Alderdice,


I am a Clinical Nurse Specialist in Personality Disorder working in North Wales. I will be shortly taking up the post of the manager of a therapeutic community in Manchester. I am also a former member of staff of the Henderson Hospital.


I write to express my concern at the imminent closure of the Henderson Hospital in Sutton, Surrey. This is a therapeutic community (TC) specialising in the treatment of severe personality disorder. As you may be aware the Henderson developed 2 further units, one in Crewe and the other in Birmingham. These units opened in 2000. These were funded centrally. When the central funding was reorganised to regional funding the change resulted in the closure of the TC in Crewe, despite preliminary evidence of the effectiveness of the new TC’s. The 2 other units (Main House, Birmingham and Henderson Hospital, Surrey survived this process, although they had to develop a wider range of local services as well as their residential treatment.


Now a further funding change to PCT commissioning looks like it will result in the closure of the Henderson. I urge you to act to ensure the continued operation of the Henderson, which has a long history of over 50 years of treating the unloved and the unlovable. Given the recent policy guidance (PD: No longer a diagnosis of exclusion, DoH 2003) it seems incredible that a centre of excellence is threatened with closure.


Please contact me if you require any further information.


Yours faithfully,


Steve Paddock


Please adapt or use any part of this.

Steve --Cartoonmonkey 12:47, 2 December 2006 (GMT)


International Support

Dear

Re: The proposed closure of the Henderson Hospital Therapeutic Community for People with Personality Disorders

I am an Italian doctor, a member of the Association of Therapeutic Communities - London who practises in Italy and applies a Therapeutic Community approach to rehabilitation in psychiatry.

Since 1998 Italian residential places for psychiatric patients have grown from 1,056 in 1998 to present 1,552. Many of them are Therapeutic Communities.

Italian practitioners in this field look up to Henderson Hospital and regard it as a Teaching Community: Many would love to have a chance to acquire the 60 years old skills this place has developed in helping impossible and costly behavioural problems, virtually all derived from a society which turns a blind eye to the deterioration of its human values.

As it took me months to understand why a Therapeutic Community approach is unique and how it works I do not expect any economist to be able to judge the piece of golden therapeutic jewellery they are about to throw away with the dirty water.

This ought to remind us of what Lord John Vaizey, a well known English economist, calls 'the toilet principle': If in a house the rate of profitability of every square metre is measured, the toilet area would be one of the least in value because used only 10 minutes a day. According to this well consolidated economic principle toilets are not economic, and in the best interest of economic efficiency should be abolished.

As a specialist in group dynamics the decision to close Henderson Hospital down as if it were a 'toilet' feels as ominous as the idea to shut Buckingham Palace down because it also is too expensive to run.

I hope you would forgive my irony, but to keep quiet about this does clash with the civilised principles I know and still appreciate of the English culture.

Sincerely,

Dr. Aldo Lombardo

Medical Director

'Raymond Gledhill'

Therapeutic Community - Rome"


Yvonne M. Agazarian Systems-centered Training & Research Institute 553 North Judson Street, Philadelphia, PA 19130 Phone 215-561-7428 Fax: 215-561-3618

I would like to add my voice to the concern about the closing of Henderson, particularly In the light of the long and important history that Henderson has, and the extraordinary contributions it has made to the field of therapeutic change. Yours sincerely Yvonne Agazarian.

Email from Community of Communities

To: Lord Alderdice, Peter Houghton (Chief Executive, SW London and St Georges Trust), Sue Denby (Sutton Service Director), David Kemsley (Head of Specialised Commissioning, NW London Sector), Sue McLellen (Head of Commissioning - London Specialist Commissioning Group) and David Brindle (Society guardian)


Dear

I am writing to express my concern about the timing of the possible closure of the Henderson Hospital in Sutton.

The Community of Communities is a quality network for therapeutic communities based at the Royal College of Psychiatrists' Centre for Quality Improvement (http://www.communityofcommunities.org.uk) We have worked closely with the Department of Health, under the auspices of the National Specialist Commissioning Advisory Group, to develop standards that support the commissioning of therapeutic communities (TC). This work is reported in NSCAG’s annual report 2005/2006 (http://www.dh.gov.uk/assetRoot/04/13/93/79/04139379.pdf) and is clearly outlined in the briefing paper (http://www.personalitydisorder.org.uk/assets/Resources/78.pdf). These standards have been piloted as a self-review tool and this year have been integrated into a rigorous accreditation process for TCs in the NHS . The process evaluates the community against an agreed set of core TC standards and audits the policies and procedures at the interface between the community and its umbrella organisation, using the commissioning standards (http://www.rcpsych.ac.uk/pdf/Accreditation%20Process%20aug06.pdf)

The Henderson Hospital has been members of the Community of Communities since 2002 and have engaged in the quality improvement every year. Their first accreditation visit is imminent and it seems that they have not being given time to engage with this important piece of work which was essentially designed to aid the process of securing funding once financial responsibility was handed over from NSCAG to local PCTs.

I would ask that the Henderson be supported to work through the accreditation year and that the final decisions about its future be made once this information is available.

Kindest Regards

Sarah Paget

Programme Manager

Community of Communities

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