UHB Service Update 24 April

From Ian Wile:

General Information

  • Director of Operations currently chairing a twice weekly meeting in Mental Health following the dissolution of the UHB clinical board structures – who are now reporting to 4 HUBs for the main hospital sites and one for community which were constituted in the pandemic emergency operations situation of 4 weeks ago – Mental Health reports into 3 of these but is effectively self-managing. Although Mental Health is not being part of the covid admission and treatments pathways as with physical health care, who have stood down many of their core services, Mental Health services is keeping all services running still, (if limited), whilst at the same time protecting our in patient population from the virus. This has been a great challenge to the directorates who have had to establish covid care and treatment wards, & covid stepdown in-patient areas - and staff them and train them. The community services have prepared for a ‘worse outbreak’ scenario where services would have to prioritize in-patient cover. This has required emergency measures of establishing localities in Cardiff to mimic the Vale position with emergency referrals going to the Crisis Teams at Hafan Y Coed, Urgent referrals to Gabalfa for Cardiff North and Links for Cardiff South. Routine work is organised from the remaining CMHTs. The Clinical Board Director has kept teams on alert to continue being prepared for the ongoing unpredictable behaviour of the virus but felt reassured that the quality the Mental Health leads would continue to make decisions based on ‘patient first’ ethos and direction from the WG. The Welsh Government is also rightly encouraging services to use this period of organisational ‘unrest’ to look at new and innovative ways of working as well as accelerating strategic work where possible as these situations do not arise often.
  • Community Health Council – Ian Wile reported that this NHS watchdog organisation has been in touch to keep abreast of the service changes – and requested a meet with the mental Health services in May to go through this – probably virtually. Ian Wile will be in touch with the Directorates in mental health to prepare for this.
  • News from the UHB – Dr Annie Procter reported back from the Health Board that Public Health Wales are reflecting that the peak of the spread of the virus has now happened with a follow up peak in the death rate probably still to be seen. This pattern reflects one of the best scenarios predicted for the UHB which has circa 200 empty general hospital beds and a delay in the opening of the Dragons Heart Hospital until 28th April. Discussion moving to ‘recovery’ and ‘continuity’.
  • Welsh Government Update – Ian Wile confirmed all tier 1 mental health targets remain suspended but encouraging services to continue collating the data – again reinforced the responsibility to use this period to accelerated legitimate strategic change work.

Directorates

  • Adult Services –IW reiterated that the MHCB transformational agenda is based on the strength and collegeacy of the MDT, from direct clinical care through directorate decision making and reflected in the way the CB functions. In this way open MDT communications and decision making are key to managing this crisis and pursuing out transformation agenda. The directorate reported that staff absences are down to 40 or so (down by 50%) - and no further covid positive patients on Pine ward (the covid positive care ward). This is a remarkable achievement within Hafan Y Coed with only 3 patients testing positive.
  • MHSOP – Reported a reduction in Covid positive patients on east 10/12 to 9 from 23 - with a number over 14 days for step down back to their treatment wards. The directorate was congratulated on its notable success in containing the spread of the virus after a worrying initial couple of weeks. MHSOP to work with Medicine over the next few days in deciding on a patient by patient basis any patient who may be better off being transferred to medicine where their medical needs outweigh their mental health needs. The directorate is 72 staff down at the moment and mostly from Inpatients so are still very much ‘in the thick of it’ – thanks given to adult services to continue helping out with staff where possible. Community services continue to be under pressure. Ongoing relationship with medicine in UHL continues to improve
  • Psychology & Psychological Therapies – No significant changes to the service model from last reporting – low referrals numbers continue. Temporary counsellors contracts extended in anticipation of an escalation in low need referrals. Extraordinary PTMC being arranged to be chaired by Ian Wile to look at effective new digital practice and other methods of working including how we build capacity to meet a rebound in primary care referrals.

Nursing – 93 students due to start mainly in in-patients –No PPE issues. Updated on the visit to the Dragon Heart Hospital today to get a better sense of the liaison team requirement.

Future Planning – Ian Wile reported that the Welsh Government dashboard covid dataset submitted last week had received feedback which could be used as the frame work of a recovery plan for the service – with templates to structure thinking. Ian to arrange a meet of clinical and operational leads to discuss following circulation and comments on the document – to blend in the transformational funding to the discussions where appropriate. Jayne Bell as the consultant nurse for complex risk has behind the scenes prepared a report in relation to suicide and self-harm training to consider as part of these discussions. Ian to contact CAVAMH to discuss SU and Carer representation within these future planning meets