WANDSWORTH BC HEALTH OVERVIEW AND SCRUTINY COMMITTEE Report

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WANDSWORTH BC HEALTH OVERVIEW AND SCRUTINY COMMITTEE Report

Post  Karl on Sat Feb 09, 2008 5:30 pm

Page 1 of 6 (Paper No. 08-165)
PAPER NO. 08-165
WANDSWORTH BOROUGH COUNCIL
HEALTH OVERVIEW AND SCRUTINY COMMITTEE – 6TH FEBRUARY 2008
Report by the Chief Executive and Director of Administration on the proposed closure of the
Henderson Hospital, Sutton
SUMMARY
The South West London and St George’s Mental Health NHS Trust agreed in December
2007 to close the Henderson Hospital, a specialist service for people with a personality
disorder. Subsequently Wandsworth PCT has written to the Council to enquire whether
the Health Overview and Scrutiny Committee would allow the closure to proceed
without requiring formal consultation.
The rationale for the closure is that the number of clients using the hospital has dropped
dramatically since commissioning of the service was delegated from the national level to
a consortium of Primary Care Trusts. The Primary Care Trusts involved with the
consortium have agreed that, from 1st April 2008, the service will be funded only on a
cost per case basis. The South West London and St George’s Mental Health NHS Trust
calculates that this will mean it is making a loss on the service of over £100,000 per
month.
Whilst the number of Wandsworth clients using the service is small, this is inevitable
with a service that serves a catchment area including most of the south of England.
Whilst the proposed replacement service would include access to the Cassel Hospital,
which also offers inpatient treatment for people with a personality disorder, as well as
strengthening of community-based personality disorder services, doubts have been
expressed as to whether this will meet the needs of all clients who would otherwise have
used the Henderson Hospital. The proposed closure of the Henderson Hospital has
received national media coverage and has been criticised by some of the major national
mental health charities.
The Chairman of the Health Overview and Scrutiny Committee has been consulted on
the matter and believes that there the closure of the Henderson represents a significant
change in service, and that formal consultation on the change will therefore be required.
In view of the very wide catchment area of the Henderson, he recommends that contact
be made with Health Overview and Scrutiny Committees throughout the catchment area,
with a view to establish a Joint Overview and Scrutiny Committee as required by the
directions on consultations on such services.
1. Recommendations. The Health Overview and Scrutiny Committee are recommended to
agree that:
(a) formal consultation is required over the proposal to close the Henderson Hospital;
Henderson Hospital closure
(Paper No. 08-165) Page 2 of 6
(b) the Wandsworth Primary Care Trust and the South West London and St George’s
Mental Health NHS Trust be advised of this view; and
(c) the Health Overview and Scrutiny Committees within the Henderson Hospital
catchment area be contacted with a view to the formation of a Joint Overview and
Scrutiny Committee for the purpose of scrutinising the closure proposal, including
the commissioning decisions which underlie it, and responding to the formal
consultation.
2. If the Overview and Scrutiny Committee approve any views, comments or additional
recommendations on the report, these will be submitted to the Executive or to the relevant
NHS body as appropriate for their consideration.
3. Introduction. On 7th December 2007, the South West London and St George’s Mental
Health NHS Trust Board received a paper setting out the case for the closure of the
Henderson Hospital in Sutton. The Henderson is a specialist residential service with 29
beds, functioning as a therapeutic community for people with a personality disorder,
although there are currently only ten inpatients. The consortium of PCTs responsible for
funding of the service has agreed to dissolve on 31st March 2008, with the result that
funding thereafter will be on a ‘cost per case’ basis. The paper presented to the Trust Board
warned that keeping the Henderson open after this change in funding arrangements would
cost the Trust just over £100,000 per month more than it could expect to receive. The Trust
Board therefore agreed the proposal in the paper, that the Hospital should close on 31st
March 2008.
4. Background to the closure proposal. Until recently, the Henderson was a nationally
commissioned service funded through the National Specialist Commissioning Advisory
Group. In 2006/07, responsibility for commissioning of the service had been delegated to a
consortium of Primary Care Trusts. In the first year, this did not lead to any significant
change but, in 2007/08, many of the PCTs that had been involved opted to withdraw from
the consortium and to purchase places at the Henderson for individual patients as required.
Following this, there has been a sharp decline in the number of patients, leading to the
current low level of occupancy

Karl
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Re: WANDSWORTH BC HEALTH OVERVIEW AND SCRUTINY COMMITTEE Report

Post  Karl on Sat Feb 09, 2008 5:31 pm

5. Trust and PCT views on consultation. The paper agreed by the Trust Board suggested
that formal consultation would not be required if suitable alternative provision was made
available and that, if there were to be formal consultation, it would be the responsibility of
primary care trusts to lead it. On 2nd January 2008, Wandsworth Primary Care Trust wrote
to the Council’s Health and Drug’s Policy Co-ordinator, asking if the Council would agree
to the closure taking place without formal consultation. The arguments advanced for this
were that:
(a) the number of Wandsworth clients using the Henderson Hospital was very low – at
the time of writing there were two inpatients from Wandsworth and four
Wandsworth patients awaiting assessment prior to admission;
(b) discussions were taking place with the Cassel Hospital (located in Richmond but
managed by the North West London Mental Health NHS Trust) with a view to
securing places for people with a personality disorder who would otherwise have
required admission to the Henderson Hospital; and
(c) steps were being taken to strengthen community-based personality disorder services,
which meant that there would be a continuing decline in the need for residential
treatment of the kind provided at the Henderson Hospital.
Henderson Hospital closure
Page 3 of 6 (Paper No. 08-165)
6. Concerns about the closure. Following the receipt of this letter, representations were
received from representatives of the staff team at the Henderson, who met with the
Chairman of the Health Overview and Scrutiny Committee. They argued that the decline in
the use of the Henderson Hospital had come about, following delegation of funding
responsibility to PCTs, not because of a reduction in need, but because PCTs lacked an
appreciation of the needs of clients with serious problems of personality disorder. Evidence
in support of this was the high number of clinical referrals made to the Henderson Hospital
which PCTs had refused to fund.
7. A number of concerns were raised about the proposal to close of the Henderson Hospital:
(a) that, if the hospital were closed, the level of inpatient provision for people with
personality disorders across the South of England would fall below the clinically
recommended level;
(b) that negotiations over alternative provision at the Cassel Hospital were only at an
early stage. In particular, the future of the Cassel itself is uncertain and, as it
includes a family unit in which children are resident, it would not be a suitable
location for some of the Henderson’s patients, a number of whom have a history of
offending; and
(c) that no additional resources had been committed to strengthening community-based
personality disorder services in Wandsworth.
8. PCT Response. The Chairman agreed that responses to these concerns were required
before the Overview and Scrutiny Committee could reach a decision on the need for formal
consultation. A letter was sent to the Wandsworth Primary Care Trust and a response, dated
22nd January 2008, has been received. PCT responses were as follows:
(a) therapeutic communities of the kind provided at the Henderson Hospital are an
evidence-based treatment for people with a personality disorder. However, there is
no universally agreement of the amount of such provision required per head of
population. It is likely to be appropriate only for a very small number of clients and,
with the strengthening of community-based services, this number is declining;
(b) the Cassel has indicated that it has capacity to take the clients currently
accommodated at the Henderson Hospital. The Cassel service is cost-effective in
that the programmes it offers are tailored to individual patient need and generally
shorter than those at the Henderson. At least one commissioner from another PCT
has indicated that the Cassel is capable of taking patients with a similar risk and
history to those at the Henderson but, if it were not possible to accommodate a
particular patient at the Cassel, alternative provision would be available at Main
House, Birmingham; and
(c) it is acknowledged that the planned strengthening of community-based personality
disorder services does not involve the commitment of additional resources. Instead,
the strengthening will involve a three-stage process:
(i) bringing together three existing community-based services for people with a
personality disorder into a single service with clearly defined care pathways,
directly managing the care of some clients and supporting community mental
health teams and community drug teams in caring for clients with a
personality disorder;
(ii) appointing a specialist clinical psychologist to provide training so that
clinical teams that do not specialise in personality disorder are able to offer
Henderson Hospital closure
(Paper No. 08-165) Page 4 of 6
‘Dialectical Behaviour Therapy’, an intervention that is effective in the
treatment of clients with a personality disorder; and
(iii) conversion of a hostel to increase efficiency in the management of patients
with a personality disorder who are in crisis.
9. The letter from the PCT also advised that one of the two clients from Wandsworth had been
discharged and that the second would be discharged prior to 31st March. The number of
Wandsworth clients on the waiting list for admission was now reduced to three. If the
closure were confirmed they would be advised of this and alternative options would be
explored with them, in line with their individual needs assessments.

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Re: WANDSWORTH BC HEALTH OVERVIEW AND SCRUTINY COMMITTEE Report

Post  Karl on Sat Feb 09, 2008 5:31 pm

10. Determining the need for formal consultation. Department of Health guidance indicates
that there are two grounds on which the NHS may implement a change in services without
the need for formal consultation:
(a) Urgency. This refers to circumstances beyond the control of the provider and
commissioner that make it unsafe or highly undesirable that a service should
continue to function. The guidance is explicit that financial problems do not
constitute grounds for urgency; or
(b) Limited impact. Formal consultation is not required when a change is not
considered to be substantial. There are no defined rules on what is to be considered
substantial. Factors are likely to include the number of people affected and the
extent of the impact on those who are affected.
11. Grounds for urgency. There do not appear to be any good grounds for claiming that the
proposal to close the Henderson satisfy the ‘urgency’ criterion, as the case advanced has
been primarily a financial one. The second letter from the PCT suggests that there is a risk
that, on present trends, the number of clients admitted to the Henderson may fall to below
the level where it is viable as a therapeutic community. However, that point does not yet
appear to have been reached.
12. Is the change substantial? The claim in the report to the Board of the South West London
and St George’s Mental Health NHS Trust that consultation would not be required if
suitable alternative provision is made available was a clear under-statement of the Trust’s
statutory duties in this respect, as the guidance is explicit that a change may be considered
substantial if it involves either a different model of service or delivery of services in a
different location. There is a face validity to the claim that the change is not to be regarded
as significant for Wandsworth, as the number of Wandsworth clients is so small. However,
this is likely to be the case with any highly specialist service drawing patients from as wide
an area as the Henderson. It would be perverse if the most specialist services were
excluded from the consultation requirements applying in all other parts of the NHS. Thus,
the Overview and Scrutiny Committee will need to take a view on whether the overall
service change is a substantial one. Given the fact that the change involves the closure of a
29-bed hospital offering a highly specialist model of care, that it has been criticised by two
major national mental health charities (Mind and SANE), and that there has been substantial
coverage in both national newspapers and broadcast media, it appears that the threshold for
considering the change substantial has been easily reached.
13. Is there any alternative? The consideration of whether there is any alternative to a
proposed change in health services is more properly considered as a part of a consultation
process than in deciding whether consultation should take place. Nevertheless, it would be
Henderson Hospital closure
Page 5 of 6 (Paper No. 08-165)
unfortunate if dogmatic adherence to rules on consultation forced the Mental Health Trust
to incur additional costs of just over £100,000 a month with no realistic possibility of a
different outcome to that it is currently putting forward. Given the reduction in funding for
the services provided by the Henderson, it may be appreciated that, from the perspective of
the Mental Health Trust, there is no apparent alternative to closure. However, a formal
consultation would be concerned not just with the Trust’s closure decision, but also with the
commissioning decisions that underlie it. It would thus provide an opportunity to explore
whether the reduction in use of the Henderson Hospital reflected a real strengthening of
community-based personality disorder services or was simply a money-saving exercise at
the expense of very vulnerable patients.

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Post  Karl on Sat Feb 09, 2008 5:32 pm

14. Consultation arrangements. The rules governing formal consultation dictate that, where
the proposal being consulted on affects more than one local authority area, the consultation
powers should be vested in a Joint Overview and Scrutiny Committee established by the
local authorities whose populations are affected. Given the large area served by the
Henderson Hospital and the number of PCTs which are members of the commissioning
consortium, the establishment of such a Joint Overview and Scrutiny Committee would be a
logistical challenge. It is likely that the most effective way of managing the process would
be to keep the number of meetings to a minimum, with much of the business of the
committee being managed through electronic communication.
15. Chairman’s comments and recommendation. The Chairman has been consulted on this
matter and is of the opinion that the Overview and Scrutiny Committee should require
formal consultation on the closure of the Henderson Hospital. Whilst acknowledging the
difficulty faced by the South West London and St George’s Mental Health NHS Trust, the
closure of the Henderson Hospital is clearly a significant change in health service provision
and no satisfactory argument has been advanced as to why the duty to consult should not
apply in this case. Accordingly, he recommends that Wandsworth PCT and the South West
London and St George’s Mental Health NHS Trust be advised of the need to conduct formal
consultation and that other PCTs within the Henderson Hospital catchment area be
contacted with a view to the establishment of a Joint Overview and Scrutiny Committee for
the purposes of responding to this consultation.
16. Conclusion. The closure of the Henderson Hospital has received considerable national
media coverage and appears to represent a significant change in service, which would
therefore require formal consultation. However, given the reduction in the volume of
treatment commissioned by PCTs, the South West London and St George’s Mental Health
NHS Trust expects to make a loss of just over £100,000 per month if the Henderson
remains open beyond 1st April 2008. The Trust is therefore anxious to be able to proceed
with the closure without the delay that a formal consultation would entail. The Chairman,
nevertheless, recommends that formal consultation requirements should be adhered to, as
such a consultation would not just examine the closure decision but also the commissioning
decisions of Primary Care Trusts that have led to the reduction in the number of patients
being treated in the Henderson Hospital.
Henderson Hospital closure
(Paper No. 08-165) Page 6 of 6
Town Hall,
Wandsworth,
SW18 2PU
29th January 2008
G.K. JONES
Chief Executive and
Director of Administration
Background papers
The following background papers were considered in the preparation of this report:
Letter dated 2nd January 2008 from the Associate Director of Commissioning, Wandsworth PCT,
to the Council’s Health and Drugs Policy Co-ordinator. Available from Dr. Richard Wiles (020
8871 6020) (rwiles@wandsworth.gov.uk)
Letter dated 15th January 2008 from the Council’s Health and Drugs Policy Co-ordinator to the
Associate Director of Commissioning, Wandsworth PCT. Available from Dr. Richard Wiles (020
8871 6020) (rwiles@wandsworth.gov.uk)
Letter dated 23rd January 2008 from the Associate Director of Commissioning, Wandsworth PCT,
to the Council’s Health and Drugs Policy Co-ordinator. Available from Dr. Richard Wiles (020
8871 6020) (rwiles@wandsworth.gov.uk)
All reports to Overview and Scrutiny Committees, regulatory and other committees, the Executive
and full Council can be viewed on the Council’s website (www.wandsworth.gov.uk/committ)
unless the report was published before May 2001 in which case the committee secretary can supply

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