Should The Henderson Hospital be closed

Should The Henderson Hospital be closed???

You are welcome to post an ideas you might have in this thread.

Dear All,

What I don't understand about the debate is the fact that a much-loved, respected and successful service that is world-renowned is facing closure because it is not economically viable. By which I imagine the St George's NHS Trust is arguing that that the PCTs that fund the referrals are not prepared to pay anymore, because they have evidence that suggests that the alternatives are more cost-effective. Is the decision to close therefore a rational one, by the PCTs, and that to fight to keep the hospital is illogical and can only be sucessful at the expense of service-users in other areas and with other conditions? So where's the evidence and is there evidence of success that can be argued along the same lines that the Trust argues their case? For example the point of view put by one of the staff that I have seen that the success of the Henderson approach ensures that there are future costs that are avoided e.g. drugs, acute psychiatric admissions and so on.
I appreciate that it cannot all be about hard cash, but to be successful, and create a long term viable future, the fight to keep the Henderson has also got to argue in the language that the decision-makers cannot dismiss as emotional, subjective, populist or whatever.

I write as someone who in the past managed NHS mental health services in various parts of the country, opening and closing units over the years, but always trying hard to make sure that increased efficiency went hand in hand with improved efficacy and effectiveness.

I hope the campaign succeeds. It deserves to because the Henderson has a well-deserved international reputation over many years that is a credit to the staff, residents and the wider NHS.

Jeremy Taylor

First off, I would like to thank you for taking the time to post here. It’s great to have someone that has had first hand knowledge of how these things work or don’t for that matter.

From what I understand, referrals dried up because of confusion over who will provide funding. Therefore PCTs have stopped sending referrals because they cannot afford to fund the cost themselves.

One of the problems we face here, is not being privileged enough to have access to the figures needed give accurate statistics on both cost and effectiveness. All we can do is give first hand accounts of exactly what The Henderson did for us, which we have done. All I can say from my point of view is this, in 5 years I spent 4 years hospitalized and the cost of medication alone would have funded a small country. After 8 months at The Henderson, I have only been back to hospital once.

What I don’t understand is this. The PCT would have received funding from central government and I presume funding would have included funding to run The Henderson for another year. If so, would that mean that the PCT is getting funds for services not being supplied? Also in turn, if The Henderson is closed and the land sold of for development, who would get the proceeds of the sale?

There is also an issue about fair consultation here, the fact the PCT seemed to sneak the proposal to close The Henderson under the cover of the seasonal madness which we call Christmas, in the hope that people would be too busy to notice (Wrong)

Lastly,

With a total of 59 beds nationwide for residential, drug free treatment for people with personality disorders, we should be opening more places and not flushing the ones we do have down the pan because we’re not capable of securing funding.

Dear Karl, and all,

Thanks for your kind words. For what it's worth as far as I can tell the process that the Trust has followed has been, as I would expect, conducted scrupuloulsy according to the rules. The Trust Board on December 13th reviewed the Business Plan of February 2007 and basically said "it isn't going to work" and so announced that, from the Trust's perspective they couldn't maintain the Henderson as a viable service, due to income defecits.

They will thus now be asking the local PCT to undertake formal consultation on closure, under Section 11 of the 20001 Health and Social Care Act. The PCT will issues the consultation, I imagine, in the next month and aim it predominantly at the Local Authority's Health Oversight and Scrutiny Committee and also the Patient and Public Involvement Forum (PPI), amongst others. Then, again I am making an informed guess here, the local PCT will give a defined period for views to come in and then make a recommendation, based on their public consultation (it's the local "host" PCT's job to do the consulting with the public, not the NHS Trust's that runs the hospital).

The services at the Henderson are classed as "Tier 4" services and are commisisoned (i.e. "bought") on a regional basis through a regional specialist commissioning consortium, that is a group of PCTs acting together. They took a decsion last year that the Henderson would lose its "block" funding and would have to "sink or swim" through a "cost per case" charging system. This basically withdrew the safety net for The Henderson, and since then the cases that have been referred have not come in at the required number from the various referring PCTs i.e. the home PCT of where the patients live that get an NHS funded referral, or the rate is too low per case to meet expenditure. Either way it looks as if there are economic forces at work which have an inevitability about them.

You need to target the campaign at the public consultation period and muster all the evidence you can get. The economic case is a good one if you can access research which indicates the total actual costs before admission of individual cases to the Henderson and the costs during and after e.g. medication or acute psychiatric admisisons that were avoided. I don't know if there's current research along those lines that would be useful.

The "Henderson model" is of course not being "got rid of", and that will be a key feature of the "case for closure", because the service will continue on a non-residential, or much limited residential basis. Also the charity / NGO / independent health sector provider "Turning Point" have been in talks with the Trust to establish a joint venture / integrated care package, with some residential component. Turning Point are good - I've worked with them successfully for years - but its hardly the same thing.

The proceeds from any sale of the Hospital and other associated fixed assets, will not go automatically to the NHS Trust, unless it were a Foundation Trust, which I don't think it is. The Trust will have to argue with the PCT and the DoH to keep the money for reinvestment in other needy care areas (and of course be able to meet the revenue costs of making a capital reinvestment), because getting a "lighter" balance sheet i.e. reducing the Trust's property portfolio, means getting your overheads down = reducing your costs.

Hope this makes some sense. I can't guarantee I've got it exactly right but it's near enough I think.
All the best

Jeremy

Your post gives me a lot to ponder and for the moment, that's just I'll do just that. I shall be writing some letters in the coming week, once I have some news, I shall be putting together an update on where we go next.

Again, I’d like to thank you for your posts, they have given a certain insight into the way these cogs turn., lets just see where we go from here.