We want your thoughts on inpatient mental health services in West Cumbria

We have not made any decisions yet about the future of Yewdale Ward.
It is true that despite our best efforts, we have so far not been able to solve the challenges facing the ward which are described above. These challenges mean that, at the moment, it is difficult to provide care at Yewdale that is up to the levels of safety and quality that we need to meet.
We are doing this engagement so that

• People in Cumbria can understand the challenges inpatient mental health services in the West are facing, and what we have done so far to try to address those challenges.
• People can share their experiences and opinions to inform any future changes.
• We can hear and reflect on different perspectives and ideas which have not been considered before.

It is your opportunity to ask questions and share thoughts about how we can meet the challenges we face to provide excellent care.

Because Whitehaven is in quite a rural, isolated area with a fairly low population, it is very hard to recruit suitably trained and qualified staff to work there. This is a problem we have faced for a long time.

Some of the things we have done to try and recruit more staff are:

• International recruitment, to relocate qualified nurses from overseas to the area
• Offering financial incentives to encourage new staff to join us
• Ongoing recruitment campaigns to attract Healthcare Assistants

These efforts have improved the number of nursing and Allied Health Professional staff that we have on the ward. We also use temporary staff from agencies, and staff who are usually based at the Carleton Clinic, to make sure there are enough staff on the ward to deliver care safely.

However, although we now have more nurses and Healthcare Assistants on the ward, there is still not a permanent consultant psychiatrist based on the ward. There is only limited support available from on-call doctors, and no junior doctors supporting the ward. This has been a problem for many years, despite our best efforts to recruit doctors to work permanently at Yewdale.

In a psychiatric hospital with several wards, each ward can call upon the support of other staff who are experienced in a wide range of mental health care. This is important in an emergency, or if a ward has unexpected staffing issues. Yewdale cannot draw upon this kind of support because there are no other mental health wards nearby.

It is also harder for senior managers to regularly be present to give oversight and support when a ward is far away from other services. At the moment, we are using extra staff and stretching our resources as much as possible to have senior managers at both Yewdale and Carleton Clinic. But we cannot keep working this way long-term.

Yewdale Ward is part of West Cumberland Hospital. This hospital is not run by CNTW. It is run by North Cumbria Integrated Care NHS FT (NCIC). This means we cannot carry out repairs or upgrades ourselves.

We have a Service Level Agreement with NCIC’s estates service to carry out repairs and improvements, but how requests are prioritised is not our decision. 

There is also limited access to capital funding (money to spent on building and maintaining hospitals).

However, even if we could make all the improvements that the building needs, it would not fix the other challenges of staffing and being far away from the support of other mental health wards.

Over the past four years there has been a lot of work to improve West Cumberland Hospital, which is run by North Cumbria Integrated Care NHS Foundation Trust (NCIC). We have been pleased to see this investment in facilities in West Cumbria for both patients and staff at the hospital.

As a separate NHS Trust, our capital budget is separate from NCIC’s, and the money allocated to develop NCIC’s services at West Cumberland Hospital could not be used to improve Yewdale Ward.

There is very limited budget available for capital developments (i.e. upgrades to hospital estates), and projects have to be prioritised. Unfortunately, investing in a standalone ward like Yewdale, where there are other challenges such as staffing which cannot be resolved through changes to the building, is hard to prioritise above other projects. We have invested in improvements and increasing the number of beds available at Carleton Clinic, our specialist mental health hospital in Carlisle, to improve inpatient services in Cumbria.

In June 2023 we introduced some restrictions to help us provide care as safely as possible on Yewdale.

The ward only receives planned admissions and transfers. Requests for admission or transfer are screened every day by the clinical team. People can only be admitted or transferred to the ward before 3pm on weekdays.

In the short-term this has helped the ward manage and ensure the safety of our patients. But it means we cannot make the best use of this inpatient ward. At the moment, we cannot guarantee that local people who need an urgent, emergency admission can be admitted at Yewdale Ward because of these restrictions.

We recognise how vital people’s local community support networks, family, carers and friends are to their wellbeing and recovery.

We hope that this engagement process will help us understand how we can best support people, and their families and carers, if future changes to services do mean they need to travel further to receive inpatient care.

We have already made a commitment that if changes do mean that people need to travel further to visit or support someone, we will pay for their travel or arrange alternative transport.

We know that many people leaving hospital rely on local voluntary organisations to support them and help keep them well.  We will work closely with our third sector partners in West Cumbria to make this support more accessible.

When someone in the West Cumbria area needs admitting to a mental health inpatient ward, they are triaged and discussed by our Enhanced Bed Management Team. The team always aim to admit someone into the most appropriate inpatient bed available.

That might be in Cumbria, or an inpatient ward in the North East.

It might also be appropriate for them to be admitted to hospital in another area of the country if:

• there were any safeguarding concerns if they were treated locally
• the person became acutely unwell when they were away from home
• the person is a member of staff from local services
• there are offending restrictions
• the person prefers to be treated in another area to be closer to family members, friends or other networks

If Yewdale Ward were to close, the process above would remain the same. The Enhanced Bed Management Team would admit each patient into the most appropriate bed available.

Since April 2024, a quarter of North Cumbria residents who have needed to be admitted to an adult acute mental health ward went to Yewdale. The other three quarters were admitted to beds elsewhere in Cumbria or the North East. (As of September 2024, there were 96 people from North Cumbria currently being cared for on inpatient wards.)

We have worked hard over the past year to reduce ‘inappropriate out of area placements’. These are where someone is admitted to hospital away from the usual local services, and the circumstances described above don’t apply.

We now consistently have no patients on ‘inappropriate out of area placements’, despite a reduction in the number of beds at Bede Ward in Newcastle from April 2024.

We hope that we would be able to continue this, and support people to be treated as close to come or a suitable support network as possible, if inpatient services in West Cumbria changed.

At the moment, there are 16 mixed gender beds at Yewdale, and 20 beds at Carleton Clinic in Carlisle (10 female beds, 10 male beds). That’s 36 adult mental health beds in total in Cumbria.

Work is currently underway which will add 12 beds at Carleton Clinic, from 20 to 32. (There will be 14 female beds and 18 male beds.) We expect this work to be finished by December 2024.

(There are also 25 beds at Carleton Clinic on our two other wards which provide specialist mental health services for older adults.)

Work is also underway on Bamburgh Clinic in Newcastle, which will add 6 beds in the North East. We expect this work to be finished by Summer 2025.

So, if Yewdale Ward were closed, increases to the numbers of beds in Carlise and Newcastle would still see an overall increase of 2 beds across the whole area CNTW serves.

There is no waiting list for people to be admitted to our inpatient mental health wards. Our Enhanced Bed Management Team triage and discuss each request for someone to be admitted to an inpatient mental health bed. The team always aim to admit someone into the most appropriate inpatient bed available.

Daily meetings are held to discuss each patient’s needs, and to help patients ‘flow’ through their care pathway without delay. Clinical and legal issues are also considered. For example, if someone needs treatment after being assessed under the Mental Health Act, they would be prioritised over an informal patient for access to a bed.

We are also working hard, alongside other health and social care providers, to reduce ‘delayed discharges’. This means making sure things are in place so that people can leave hospital as soon as they are ready. This means patients can move smoothly onto the next step in their care. And hospital beds will available for people who need them. We have recruited two case workers who will be dedicated to supporting discharge planning in more complex cases.

Thanks to this work and our Enhanced Bed Management Team, we now consistently have no patients on ‘inappropriate out of area placements’, despite a reduction in the number of beds at Bede Ward in Newcastle from April 2024.

Yewdale has space for 16 patients. As of October 2024, all 16 beds were occupied.

If the decision was made to close Yewdale, all patients on the ward at the time would be fully assessed. Patients who were ready would be discharged. Anyone who still needed to be in hospital would be transferred another bed in the most suitable area possible.

The vast majority of people who need mental health care in North Cumbria are supported by primary care and our community services.

That includes the Community Treatment Team (CTT), Psychiatric Liaison Team (PLT), Early Intervention in Psychosis (EIP) service, Crisis Resolution and Home Treatment Team (CRHT), and Child and Adolescent Mental Health Service (CAMHS), all of which have dedicated West Cumbria teams.

As of September 2024, there are 8,812 people in North Cumbria being supported by these community services. (This includes adults and children.)

Many people are also supported by Talking Therapies, their GP, and other local mental health support services and groups such as the Recovery College and services provided by the West Cumbria Mental Health Partnership.

There are currently no proposals to close or remove CNTW’s community mental health services in West Cumbria. We are working hard, alongside other organisations, to improve community services. (See below.)

‘Community Mental Health Transformation’ is one of our biggest priorities. We want to make our services much easier to access. We want them to respond better to what local people need. And we want people to have a better experience, and get better outcomes, when they are supported by our services.

To do this, we have developed a new ‘model of care’. This is our approach to how we will provide services.

This ‘model of care’ is based on these key principles:

• Working more closely with Primary Care (GPs, pharmacies, etc.) at a local level.
• Improving how quickly people can access our services.
• Making sure the treatments we provide are based on the best evidence.
• Identifying people’s problems earlier, and helping them sooner when things get worse.
• Supporting people to recover and live well in their local community.
• Offer alternatives to hospital admission.
• Making sure that if someone does need to be admitted to hospital, inpatient care is effective and purposeful.

We are working with other health and care providers in Cumbria on all of these things.

In West Cumbria, several of our services are ‘Pioneer teams’, some of the first to be taking forward the Trust’s Community Transformation programme. This includes working to make it easier to access support with our ‘getting help sooner’ approach. Our Community, Crisis and Psychiatric Liaison teams are working more closely, both together and with partners. This has seen an increase in referrals being accepted from local GPs. We have also developed more mental health support for local Primary Care Networks, such as mental health workers based in local practices.

We have also introduced our Recovery and Wellbeing Hubs, which include a regular weekly drop-in in Workington. These drop-in services offer a safe space to listen to people’s needs, help them understand mental health better, and learn ways to cope and look after their own wellbeing. The drop-in in Workington is at The Oval Centre, Salterbeck Drive, CA14 5HA from 10am – 12 noon every Wednesday in term time. We are also in the process of setting up a new, 24/7 wellbeing hub in Whitehaven town centre. This is being funded by NHS England, as part of a national pilot to provide more mental health support in local communities. The hub will bring together a range of services and staff from the NHS and other organisations under one roof. People who are struggling with their mental health will be able to get specialist support there without needing to see their GP. It will also offer help and advice with issues which often affect people’s wellbeing, like housing, money and employment. And there will be support for the families and carers of people who are unwell.  You can read more about the new 24/7 hub here.

No. The new 24/7 hub that will be opening next year gives us an opportunity to deliver radical change to our model of care and support working alongside our partners in the community.

Initially we’re being funded by NHS England, but we are committed to move this to a longer-term, sustainable model of care and support for the people of West Cumbria which will be groundbreaking and will develop the template for services across England. 

The hub will offer support to people in the community. It is not a replacement for an inpatient ward. But it will ensure that people get continuity of care and the right support as their needs change, so they don’t reach a crisis point where they need to be admitted to hospital. 

This new model of care is also in line with the development of the NHS 10-year plan to move services from hospital to community and move away from isolated wards and services so that people receive the right care, by the right people, in the right place at the right time. 

Inpatient treatment and assessment wards are for the most acutely unwell and most vulnerable people in our community, and anyone admitted to these services should only stay in an inpatient environment while they remain acutely unwell.

Sadly, we know that 75% of people who die by suicide are not already known to our services. Early intervention and support is the key to supporting people before they hit a crisis point and preventing deaths by suicide. The ‘community transformation’ work to improve local services, described above, is absolutely crucial in turning this around.

This engagement process (survey, listening events, and discussions with stakeholders) will be open until the end of December 2024.
In January 2025, we will gather all the feedback and review what people have said.
Then, we will use this feedback to inform future plans for adult acute mental health inpatient services in West Cumbria. We expect to be able to share more with you about what we’ve heard and what will happen next by Spring 2025.