Cassel engagement document - West London Mental Health NHS ...

The Cassel Hospital
Engagement and information
document about the future of
the Familes Service

This document explains the proposed
changes to the Families Service at the
Cassel Hospital in Richmond, Surrey,
and asks for your views about its future.
About the Cassel Hospital and
the Families Service
The Cassel Hospital was founded in 1919 by Sir Ernest Cassel to
treat patients with `neurotic functional disorder’, originally based
in Kent.
The building on Ham Common was purchased by the Cassel
Foundation in 1947 and the Cassel Hospital moved to its current
location.
In 1948 it became part of the NHS. As well as treating adults
and adolescents, the Cassel Hospital commenced its clinical work
with families in 1949. In 1994 a separate Adolescent Service was
established for young men and women aged 16-21 years.
This was closed in 2006 and inpatient services for adults and
adolescents were combined to form the current ESPD Service
(Emerging and Severe Personality Disorder Service).
The purpose built Families Service buildings for parents and
their children was opened in May 2000 by Princess Alexandra,
the Patron of the Cassel Hospital, and a Children’s Centre for the
provision of pre and post school education opened in 1995. The
Cassel Charitable Trust raised the funds for these new buildings,
which were then matched £ for £ by the NHS.
As a specialist psychotherapeutic service offered nationally,
the Cassel Hospital provides the following inpatient, day and
outreach services:
1. Residential and day assessments, treatment and rehabilitation
services for severe and complex multi-problem families where
parents and their children suffer from a range of mental health
problems; and where there has been severe risk to a child’s
wellbeing, and there is current risk of significant harm or
separation from the parents (Families Service).
2. Residential and outreach psychotherapeutic treatment services
for adults with severe and complex personality disorders, and
young people (16+) with emerging personality disorders and
complex emotional needs (ESPD Service).
3. Training and consultancy services for clinicians and managers
working with these patient populations, including an MA
in Psychodynamic Psychosocial Nursing, validated by the
University of East London.
4. A research unit that provides a strong evidence base for this
specialised and intensive clinical work with adults, young
people and families, as described above.
Unfortunately for the last four years, the Families Service has been
unable to achieve the bed occupancy levels required to break
even, and so has required financial support from other parts of
the Trust.
In the current economic climate, this is not sustainable, and the
lack of funding for the assessment and treatment of families
makes providing this residential and day service too costly for the
Trust. Further financial detail can be found in the financial risk
part of the document.
West London Mental Health NHS Trust is therefore seeking views
on the future of the Families Service at the Cassel Hospital, which
includes potentially closing this service.
As part of our process of engagement and obtaining all relevant
information and views to inform our decision, we have prepared
this document and are also carrying out an Equality Impact
Assessment Screening (EIA) to assess the effects of closure on the
population it serves.
The Trust Board will be continually informed of the progress
of our engagement process, and will decide on further action
accordingly.
Contents
2 About the Cassel and the Families Service
4 About West London Mental Health NHS Trust
6 What are the main issues and risks?
8 Our vision: Meeting the needs of our local population
9 Working in partnership
10 Next steps: Your chance to respond
2 3

About West London Mental
Health NHS Trust
West London Mental Health NHS Trust was formed in 2001 from
a merger of Ealing, Hammersmith and Fulham and Broadmoor
Hospital Authority, and was further expanded by the absorption
of Hounslow mental health services in 2002.
We employ around 4,300 staff across 32 sites and have an annual
budget of £252m. It aims to meet the diverse needs of a local
population of nearly 700,000 people.
We provide local mental health services for adults, older people
and children in the boroughs of Ealing, Hammersmith & Fulham
and Hounslow. These services are jointly commissioned by primary
care trusts and local authorities.
We also provide forensic mental health services, including high
secure services at Broadmoor Hospital in Berkshire. Our forensic
services in London and at Broadmoor Hospital have a catchment
area of London and the south of England.
We also provide two national specialist services: Families and
Personality Disorder services at the Cassel Hospital in Richmond
and a Gender Identity Clinic in Hammersmith.
The Trust is divided into three Clinical Service Units (CSU): Local
Services (Ealing, Hammersmith and Fulham, and Hounslow);
London Forensic and Specialist Services; and Broadmoor.
The Trust is, at the same time, responding to expectations
from the Department of Health that all Trusts should become
Foundation Trusts by 2013, and is in the process of submitting an
Integrated Business Plan to NHS London, as part of the Foundation
Trust application process.
The Trust is aiming to become a Foundation Trust in 2012. To
support this, we are currently re-designing our management
and clinical service structures, and undertaking three key
programmes of work to improve the way we deliver services to
our service users:
1. London services transformation.
2. St. Bernard’s redevelopment.
3. Broadmoor Hospital re-development.
These programmes aim to improve the patient journey and
experience, and improve efficiencies to meet the considerable cost
savings the NHS has been asked to make.
How to have your say
Write to us at:
Cassel Families Service Engagement
Communications Department
West London Mental Health NHS Trust
Uxbridge Road
Southall
UB1 3EU
Email us at:
casselconsultation@wlmht.nhs.uk
4 5

What are the main issues
and risks?
Financial Issues/Risks
The Families Service has not been able to generate enough
income to cover its cost for at least four years, and despite
marketing initiatives to commissioners etc, the referrals have
continued to decline.
Currently there are seven patients in the Families Service, and the
graph below shows the bed occupancy over the past four years:
Residential placements at the Cassel Hospital are funded on a
cost-per-case basis: The funding for families referred has, in the
last five years or so, been adversely affected by the House of
Lords decision in 2005 that a court can require that the inpatient
assessment of a child and his/her family be funded by the Local
Authority under 38(6) of the Children Act 1989, but not the
treatment of the parents and their children.
Most families assessed and treated have been funded by a local
authority, with primary care trust (PCT) funding on a cost per case
basis being more problematic as the family has been in the local
authority, rather than the mental health system.
To break even financially, the Cassel Hospital Families Service
must have on average 21 in-patient beds filled. Currently there
are only seven in-patients in the Families Service. Due to the
on-going financial difficulties, an application was submitted
in July 2010 to the National Specialist Commissioning Group
for national health funding for the Families Service, from April
2011 for the next five years.
The decision was originally expected in October/November 2010,
but was deferred until January 2011, and was announced in
February 2011. The application was turned down, on the basis
that “we need a model of care that is appropriately accessible
to the whole population. Decision makers did not think that this
would be the case, given the significant commitment that long
periods of residential treatment would mean for families based a
long distance away from London.”
Without national funding, the Trust is unable to financially sustain
the Cassel Families Service.
Cassel equivalent beds occupied: Feb 2007 to Nov 2010
Break-even family beds = 25 until tariff
increase in 10/11, then reduces to 21.
25
20
15
10
5
0
Clinical Issues/Risks
Current Service Users
The families currently staying at the Cassel Hospital for
treatment would continue with their assessment/treatment
package as planned. Discharge and follow-up care would be
dealt with accordingly.
The Trust is committed to supporting them, and to providing
them with information regarding the potential changes to the
provision of the Families Service, and with the opportunity to
comment and make suggestions about potential changes which
may need to be made.
Family equiv beds occupied
Break-even family beds linear (family equiv beds occ)
Fe Ap Ju Au Oc De Fe Ap Ju Au Oc De Fe Ap Ju Au Oc De Fe Ap Ju Au Oc De
2007 2008 2009 2010
Staff
The staff at the Cassel Hospital, both within the Families Service and
the other services the Cassel provides, are experienced and senior.
They have been advised of the financial position of the Families
Service, and of the difficult position that this has put the Trust in.
They will continue to be supported and given the opportunity to
comment and make suggestions throughout this process.
The Cassel Hospital Families Service works alongside the Cassel
Emerging and Severe Personality Disorder Services and forms a
whole hospital ‘Therapeutic Community’ of patients and staff.
The impact of clinical dynamics within the ‘Therapeutic Community’
and within the Families Service itself, as a result of the potential
closure, will require ongoing assessment by the responsible
Consultant Medical Psychotherapist in consultation with the
multidisciplinary Senior Management Team at the Cassel Hospital.
Equality Impact Assessment Screening Tool
An Equality Impact Assessment Screening has been completed
for the Families Service at the Cassel Hospital, to help inform the
process. This identifies any vulnerable/minority groups who may
be affected by the proposed closure of the Families Service.
The key findings of this screening are that children and women
are the groups who may be adversely affected by the closure of
the Families Service at the Cassel Hospital, especially those who
are socio-economically deprived.
After the engagement and consultation process has closed, notice
will be taken of any further information regarding this which
may impact on disadvantaged groups, appropriate changes made
if required and the assessment reviewed as necessary to take
account of this information.
6 7

Our future vision: Meeting the needs
of our local population
West London Mental Health NHS Trust provides services to support
people of all ages with a wide range of mental health problems,
this includes providing the best possible services for people with
personality disorders.
These pathways would include supporting families with complex
needs, as well as link into the services provided by the Cassel
Hospital ESPD outreach and in-patient service, and possibly Tier 4.
Also, following a highly competitive application process, the
Trust has been selected as a national pilot site for Implementing
Recovery - Organisational Change (ImROC).
The ImROC recovery project is delivered by a partnership of
Mental Health organisations (NHS Confederation, the Centre for
Mental Health and the National Mental Health Development Unit)
and will run at the Trust for the next two years.
Working in partnership
The Cassel Hospital Families service is one that is offered
nationally, on a cost per case basis, with past referrers and
commissioners from Legal Services, Local Authorities, Partnership
Trusts, and Primary Care Trusts, etc.
There is, therefore, no lead commissioner or referrer who would
be deemed to be the key commissioner to lead this process.
Therefore, WLMHT will undertake to inform:
• Recent referrers and commissioners of the Families Service over
the last three years.
• Cassel Hospital Charitable Board.
• Current staff employed in the Cassel Hospital Families Service.
The project, which sets out to improve the quality of services to
support people more effectively towards recovery, will receive 20
days expert consultancy, additional training and learning networks
to facilitate the cultural change to recovery focus. This will help
support the focus of all our services for all ages.
8 9

Next steps: Your chance to respond
We want to hear the views of as many people as possible to make
sure we make the right decisions about what we do with our
services.
The engagement / consultation is for eight weeks, and will run
from 23 May 2011 until 18 July 2011.
Whilst this is not a formal public consultation, and the
engagement period is only running for eight weeks, West London
Mental Health NHS Trust has taken into account the Cabinet
Office’s code of practice on consultation.
What happens next?
During the process, all feedback and responses will be noted
and documented. At the end of the official process period,
a report will be produced identifying the themes and issues
raised which will go to the Trust Board of West London Mental
Health NHS Trust.
Once they have had time to consider the consultation feedback
and response, a final decision will be made by Trust that will be
made public.
Your notes
You can have your say by writing to us at the
following address:
........................................................................................................................................
........................................................................................................................................
Deadline for responses:
18 July 2011
Cassel Families Service Engagement/Consultation
Communications Department
St Bernard’s site
West London Mental Health NHS Trust
Uxbridge Road
Southall
UB1 3EU
You can also email us at:
casselconsultation@wlmht.nhs.uk
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10 11
Email us at:
casselconsultation@wlmht.nhs.uk

Communications Team
St Bernard’s site
West London Mental Health NHS Trust
Uxbridge Road
Southall
UB1 3EU
Tel: 020 8354 8737
Email: communications@wlmht.nhs.uk
www.wlmht.nhs.uk
65 / MAY 2011