NHS rethink on Darataigh

NHS Dumfries and Galloway have postponed their plans to close the Dartaigh unit in Stranraer, that treats patients with dementia, for six months to engage with the public on a new model of service.

An NHS F&G statement reads:

“The Existing Model of Dementia Care

In Wigtownshire the NHS offers a wide range of mental health services through local GPs, primary care teams and the community mental health team (CMHT) which includes psychiatrists, psychologists, nursing staff and other health professionals). The CMHT undertakes assessment, diagnosis and clinical treatment as well as offering additional support in partnership with colleagues in the social work department Third and Independent Sectors.

“Referrals to the CMHT come from GP practices. We know for example that in 2013 / 14 a total of 246 people aged over 65 were assessed by the CMHT for the first time at home or at clinics across Wigtownshire. Following these initial assessments the local team had 1400 contacts with these people to offer advice, support, assessment and treatment. Of these new referrals five were admitted to Midpark hospital in Dumfries and three were subsequently transferred to Darataigh. We also know that over the past three years only eight people have been admitted to Darataigh after assessment at Midpark. In the meantime the CMHT provided support to over 600 people.

“When a diagnosis of dementia is confirmed there are a number of options available to people, their families and carers to support them to live well with dementia, to maximise their independence and remain at home for as long as possible. We have strong partnership arrangements with a range of other agencies including Alzheimer Scotland.

“When an inpatient mental health assessment is required this is provided at Midpark hospital. Admission to Midpark is only arranged when all other available community options have been explored. Following a period of assessment most people are discharged to another care setting or returned to their own home. Of the 40 people from Wigtownshire who were assessed at Midpark over a three year period only eight were transferred to Darataigh.

“Proposed Service Changes

NHS Dumfries and Galloway aims to provide a modern, community based service for people with dementia across the region. Our proposals for Wigtownshire include increasing nursing and support staff in the CMHT so we can provide an enhanced service to support people when they are experiencing a crisis. This is in addition to the services we will provide to support people with dementia and their carers either at home or in a homely setting.

“The proposals to enhance the community based service mean we have to withdraw from the inpatient provisions at Darataigh and increase our community resource. It is important to note that these proposals have been developed by clinical teams who firmly believe that the shift to the new model of care will provide a more effective service to the people of Wigtownshire. One of the key aims of this redesign is to provide care and treatment in a way that reduces the need for hospital admissions.”

Dr Alan Duncan, Consultant Psychiatrist and Lead Clinician for Older People’s Services said: “Our proposals are all about supporting people to live well with dementia at home for as long as possible. The increase in community based services in Wigtownshire will mean that there is less reliance on a bed-based model. As a Consultant Psychiatrist, my focus is to ensure that the highest quality services are available for the patients of Dumfries and Galloway and I believe that these changes deliver this by taking account of current innovations and best practice in dementia care.”

Denise Moffat, Lead Nurse for Mental Health said: “As a lead nurse I recognise that families often wish to support their loved ones to remain at home for as long as possible. The proposed increase in community nursing and support staff will enable us to offer an improved service to people in Wigtownshire in their own homes. These changes will also enhance the support we can offer on a regular basis to carers. From a professional nursing perspective I would fully endorse these proposals.”

The NHS statement continues: “On Monday 2 November the Health Board decided to not reopen the beds at Darataigh following a failure in the boiler which meant that three patients had to be transferred to other facilities. The NHS Board fully understands and supports the clinical model being proposed by the mental health directorate. We also appreciate that, due to the failure of the boiler, we have not had the opportunity to undertake a full programme of engagement to ensure that the public understands the rationale behind the proposed change to service provision. The Board apologies for any distress or concern caused by the poor communication on this matter.

“Next Steps

The Board is now committed to a six month period of extensive engagement on the new model of service. We will ask the Scottish Health Council to support us in designing this programme to ensure we follow best practice in public involvement.

In order to ensure a smooth change to the new model of care the Board will complete the boiler repair and associated works in Darataigh. This will ensure we have the potential to accept an admission from Midpark to Darataigh if this is deemed appropriate by the clinical team during the six month engagement period.”

NHS D&G Frequently Asked Questions:

1.How do we care for people with dementia?

GPs refer around 250 people per year to the Community Mental Health Teams in Wigtownshire. Between 10 and 20 people each year need extra support through an in-patient assessment. These are provided at the region’s specialist facility, Midpark Hospital in Dumfries. Following assessment and creation of a care plan, patients are usually moved back to their home or care home with additional support as needed. Over the last three years, eight people were instead moved to the Darataigh Unit as an interim step. There were no direct admissions to Darataigh from the Wigtownshire community.

2.Why are services being changed?

Dementia care has improved substantially in recent years. We know that with the right support more people can be helped to live well for longer in a homely setting and that stays in a clinical environment can be reduced. Our plan is to use Darataigh’s clinical teams to provide extra support in people’s own homes, care homes, the Galloway Community Hospital as well as providing support to family carers so that we can deliver best care without the need for as many inpatient admissions.

3.Why did Darataigh close so suddenly?

The unit’s boiler failed at the end of September and this left us with no hot water or heating. We had to decide whether to introduce the new model of care there and then or potentially move patients back into the unit, only to fairly rapidly move them out again. Multiple moves are particularly disruptive for people with dementia and we chose to close the unit. Unfortunately, this did not give us time to engage with the community in the usual way. We have though kept in close contact with all of the three families affected.

4.So in the future will people have to travel more to Dumfries?

No. We understand that people want to stay as close to home as possible for as long as they can. Our aim is to avoid unnecessary admissions to Midpark and we know that if additional community support is available we can avoid the stress and distress that in the past would have led to a hospital stay. Following any admission to Midpark, our aim is to discharge back to our community teams as quickly as we can. Again, it’s important to remember that anyone at Darataigh had already been to Midpark for their specialist assessment and care planning.

5.Did Darataigh also provide respite care? What happens to this?

Respite care is not normally provided by the NHS. Through a unique arrangement, Darataigh staff provided respite care for three families of people with a learning disability. We are working with each of these families and have committed to ensuring that they can still access local high quality respite care at a facility of their choice.

6.What will happen to Darataigh staff?

Our staff will be redeployed into new roles in the local area. We need their skills and commitment to deliver training and support into care homes, the Galloway Community Hospital and to carers themselves.

7.What wil happen to Darataigh itself?

There are a number of potential uses in health and social care services and we will evaluate these to find the best option.

8.How can I learn more and engage with plans?

A six month engagement programme will start soon. This will give local people the chance to find out more about the new model and to help shape dementia services in Wigtownshire.