Agenda item

Reports and information attached.

Offices explained the role of s. 136 health based places of safety which allowed the assessment of people detained with mental health problems to take place in a more appropriate environment. Currently, not all such places of safety were open 24:7 or allowed enough privacy and there were also some shortages of trained staff.

It was proposed to close the s. 136 suite at the Royal London Hospital which, being located next to the A & E department, was not considered fit for purpose. Extra staff would be allocated to the suite at the Homerton Hospital and the suite at Goodmayes Hospital (Sunflowers Court) would also retained. The future of the suite at Newham Hospital would be decided after a further year of operation.

The lead officer for mental health at the Metropolitan Police stated that police received over 4,000 calls a year relating to mental health issues. The detainment of a person under s. 136 arrangements could police offices for a full shift although it was wholly accepted that mental health issues were a core part of policing. Police currently found difficulties in transferring people to a place of safety and needed confidence that they could take people at any time to well managed and fully staffed suites with less waiting time for police officers.   

The Deputy Director of Quality and Nursing at London Ambulance Service (LAS) accepted that patients in a mental health crisis often received a very poor service. The LAS received around 400 calls a day from people in mental health crisis and there were cases of people with a mental health crisis waiting 12-14 hours to access a place of safety. The LAS wished to see a reduction in the number of places of safety but an increase in their capacity, opening hours etc. It was felt there had been a very good consultation on the issue with many people engaged. It was felt that the changes would free up ambulances but would also be better for patients. There would be some increases in travel time but it was noted that people could already often not obtain space in their local units. The LAS therefore supported the proposals.

It was felt that a better built environment would offer patients safety, privacy and dignity. The recruitment of more staff in places of safety would lead to reduced waiting times. Department of Health funding had been secured for two more rooms at Homerton and one more room at Goodmayes Hospital. Further modelling would be undertaken with the CCGs around whether to increase staffing at the Goodmayes suite.

It was felt that 40-50% of people taken to places of safety were not previously known to mental health services.  There was good cooperation between the police and the NHS and work on assessing the street triage service was continuing both across London and nationally. It was felt however that telephone triage services were more cost effective in many areas. The NELFT mental health helpline was available to patients (and police) on a 24:7 basis. It was suggested that an update from NELFT could on the Trust’s street triage service could be taken at a future meeting of the Committee. Mental health nurses had also now been introduced to the LAS which allowed better linkage of patients to mental health services.

Whilst the suite at the Royal London Hospital was not proposed to be kept due to a lack of space on the site, cost issues were also an important factor. It was not affordable for commissioners to staff a s. 1236 unit at the Royal London and officers wished to see fewer but better units across London. Individual configurations of service were the decision of the East London Health and Care Partnership. It was accepted that increased patient travel times posed a risk but the enhanced quality of care and patient experience outweighed this.

A travel time analysis from the Tower Hamlets area to the unit at Homerton Hospital had been undertaken and had shown that there would not be a huge increase in travel time. There was no hard and fast rule on border issues for s. 136 calls. The Police were reliant on health services to say place of safety a patient should be taken to. It was wished to phase out the use of police cells as places of safety although it was accepted cells were used more often in Essex than they were in London. Detailed data on mental health-related calls by borough was kept by the LAS and it was expected that there would be an average of two s. 136 admittances each day. The representative from the Police added that the Police accepted the need for rationalisation and that the proposals did not reduce the overall number of beds.

The Joint Committee noted the position.