COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

Regional Resettlement Team

12 March 2009

Members present for all or part of the proceedings:

Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Alex Easton
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Ms Claire McGill
Ms Sue Ramsey

Witnesses:

Dr Maura Briscoe, Department of Health, Social Services and Public Safety
Mr Aidan Murray, Eastern Health and Social Services Board
Mrs Miriam Somerville, Belfast Health and Social Care Trust

The Deputy Chairperson (Mrs O’Neill):

Our next evidence session is with the regional resettlement team. Members will recall that, following meetings with the Association for Real Change (ARC) and Triangle Housing Association, they agreed to invite the regional resettlement team to brief the Committee on its work. Members have a briefing paper from the team, along with a record of the Committee’s meeting with ARC and Triangle, copies of responses from the Minister to the issues raised by those groups, and a briefing paper from the Society of Parents and Friends of Muckamore Abbey.

I welcome Maura Briscoe, director of mental health and disability policy in the Department of Health; Miriam Somerville, co-director of learning disability, Belfast Health and Social Care Trust; and Aidan Murray, assistant director of learning disability, Eastern Health and Social Services Board.

Dr Maura Briscoe (Department of Health, Social Services and Public Safety):

I will start by going through some of the issues in the paper that I gave you. The regional resettlement team deals with the resettlement of learning-disability patients who have been long-stay patients in hospital. Miriam Somerville has operational experience from Muckamore Abbey Hospital, and Aidan Murray has experience in commissioning. We are all on the resettlement team, of which I am the chairperson.

It is been a long journey. It started formally and informally around the early 1970s, when the programme of discharge of patients into the community got under way. It is important to remember that that has not just happened in the last couple of years: it is a much bigger programme that goes back a number of years.

I will give an example of that journey and the success that has taken place. There were 1,700 patients in learning-disability hospitals in 1978, and there are 400 in 2009. I will put that in the context of the resettlement programme. The primary target list for resettlement, which governs the work of the regional resettlement team, was determined in March 2007 at 345 patients. A number of targets have been set over several years, including 2007-08 and this comprehensive spending review (CSR) period, for the resettlement of patients within the community. The figure has been reduced from 345 to 271, which is our current long-stay figure at 1 March 2009. We anticipate that, by the completion of the current CSR period in 2011, that figure will be down to approximately 225. It has been a long journey, and it is important to remember that, although the journey has been one of successes, clearly there is more to be done beyond 2011.

Resettlement in the community is in the spirit of the Bamford Review, of social inclusion and of human rights. People are entitled to reside in the community, with appropriate services as determined by need. However, one must also emphasise that no patient is resettled in the community without extensive planning, and the principle of betterment applies to the whole resettlement programme. That means that any resettlement must be in the interests of the individual and be clinically appropriate.

Mrs Miriam Somerville (Belfast Health and Social Care Trust):

Many of the Committee members visited Muckamore Abbey Hospital and heard some of the patients talk about their wish for resettlement. A significant number of the people at Muckamore — between 160 and 170 people — want to leave, and, when we plan for them to go, a multi-disciplinary approach is taken. The patient and their family are involved, and we recognise that, when someone has been in hospital for a long time, families can find it difficult to think about their leaving.

Therefore, we use a patient-centred plan, under which the patient talks about what they want to do on leaving hospital. Some people want to get jobs and live on their own with minimal levels of support, and other people who are more significantly disabled, with complex needs, know that they want to be somewhere where they are sure that they will have staff who have the skill to properly support them. Those are the sorts of factors that are taken into account. Considerable discussion takes place with families.

The chairperson of the Society of Parents and Friends of Muckamore Abbey attends the resettlement steering group, and he has visited a number of developments in the community. At the most recent meeting, he said that his advice to families was always to go and look at such developments and then come back and talk about things that needed to be added to a development or to a person’s plan to make it suitable. Resettlement is a comprehensive process, and it does not happen quickly. Normally, it takes anything up to 18 months to resettle a ward from the hospital.

Once the plan is set and the patient has seen the place to which they are going, they spend a night there and return to the hospital, then perhaps spend a weekend there. Gradually, they make the step. Some patients, of course, decide that they want to stay on the first night when they are there, and that is fine, but, in the main, it is a slow and comprehensive process.

Dr Briscoe:

Considerable additional resources were allocated to learning disability and mental health in the three-year CSR period. An additional £33 million was allocated to learning disability, which is £17 million recurrent over the next three years. Those resources are really designed to help people to live independently; they contribute to the resettlement programme and the respite programme, and there are a number of additionalities in relation to autism and other issues.

We recognise that there is an interface between the resettlement programme, the development of community services, and all that goes with that — including respite care. There is a co-ordinated approach to the resettlement programme. The regional resettlement team is comprised not just of my health and social care colleagues, but, for example, Mencap, the Department for Social Development and the Northern Ireland Housing Executive (NIHE), in addition to the service users and carers. That is the structure of the team.

There are, of course, interdepartmental structures in relation to the Bamford Review, of which resettlement is a part. There is also an inter-ministerial group in relation to the deliverability of the Bamford Review across the patch. Although this is very much a health and social care presentation, we recognise, in line with other Bamford recommendations, that there is a cross-governmental element to a lot of the work — particularly, in this area, between the Department of Health and the Department for Social Development (DSD).

Mr Aidan Murray (Eastern Health and Social Services Board):

Beneath the regional resettlement team, each of the three hospitals in Northern Ireland has its own active discharge team, which constitutes the trusts responsible for the care within that particular hospital. It means that each patient who needs to go back into the community will have a social worker dedicated to looking to, and planning for, the future, with them and their families. We know those people quite well; we know what their needs are and what is required to make sure that, over the next number of years, there is a place in the community that meets those needs.

Central to that is not just the care that we provide on the health and social care side, but housing solutions. Many of those people need housing which has some special adaptation to it. However, it would be really unfair, unkind and wrong to say that all those people need very specialised housing. Indeed, over the past number of years, many of the most successful resettlement enterprises that we have undertaken, and which reflect how that target has come down, are in ordinary housing solutions. Those have been put in place in partnership with the NIHE, which is funded by DSD.

To make that formal, and to make that happen in line with the Bamford Review and other policy objectives, the Supporting People partnership is crucial. That is a fund and a programme which is primarily the responsibility of DSD, and which is based — the clue is in the title — on partnership. The programme includes health and social care professionals, through the boards and trusts, and the Probation Board for Northern Ireland. Over a five-year basis, it plans for social housing in a number of target areas, not just resettlement and learning disability. It is since that partnership came into being six years ago that many of the developments which you will be aware of — I know that some you have been to visit the developments — have largely been developed.

The key to that partnership is that we agree the priorities in advance. During the last CSR period, we were very glad that the Bamford Review’s recommendations around mental health and learning disability, in addition to older people’s services, were jointly prioritised by us, DSD and the NIHE. Going forward, that is what is required. We know who the people are who remain in hospital and have to come back to the community; we know what their needs are, as a broad group and on an individual basis. In going forward, we need to continue to work with DSD and the NIHE, through the Supporting People partnership. We need to make submissions in the next CSR bidding process to put in place the housing solutions that are required to accompany the care.

Effectively, it takes a number of years for housing — in the right places, as well as being the right type of housing — to be developed to meet the needs of those patients. That is why it is a five-year rolling programme. The CSR is a three-year programme of allocation, so there is a little bit of a mismatch. However, we know that there is a target for resettlement to be met, so we need to look ahead. We know the number of people who are in that target group, so we have to do the work to ensure that the resource is available over the next four to five years on both the health and social care side, which is down our Department’s line, and the NIHE side, which is down the DSD line. That is a large part of the work in which we are now engaged.

Dr Briscoe:

The infrastructure is there for us to liaise with our colleagues in DSD and the NIHE at different levels. However, we are in the current CSR cycle, which runs until 2011. The paper contains the Programme for Government target that:

“By 2013, anyone with a learning disability is promptly and suitably treated in the community and no-one remains unnecessarily in hospital.”

Beyond the current CSR, there is a phase that will require additional Health and Social Development resourcing to fulfil the Programme for Government commitments.

The Deputy Chairperson:

You mentioned that you are all from a health background. At the start, that concerned me; I wondered why nobody was here from DSD and the housing end of things, because this is a cross-departmental issue. I am not taking anything away from your presentation — you presented it very well — it was just something that I immediately noticed.

That is why I want to ask about the team. Do you have good tie-in? I know that you said that there was a good infrastructure. Is there a very good working relationship, or are there any problems with cross-departmental working?

Dr Briscoe:

That was a misunderstanding on our part. We understood you to have invited me within the Department of Health; we did not realise that that could have been extended out to as many members as we wanted. Had we known that, we would have brought a much bigger team.

I have been in this job since June 2008, so I am relatively new. However, we have good working relationships with colleagues in DSD and the NIHE. People are active participants in the commissioning partnership, the area partnerships and our resettlement team. As I said, our resettlement team includes both the NIHE and DSD.

We recognise the importance of this. In the context of the final Bamford response, we contacted all Government Departments, because Bamford is not just a health and social care response; it is a cross-Government response. That is why there is an interdepartmental group as well as the inter-ministerial group on Bamford that is chaired by Minister McGimpsey.

The Deputy Chairperson:

If we were unsure of whether a blanket approach could be taken to resettlement before we visited Muckamore, we were certainly not unsure after our visit. Everybody fully supports care in the community. On numerous occasions, people from Muckamore’s Tell It Like It Is group visit or write to us. They are lovely people. One, Sammy, said that he had been waiting on his discharge for six years, and that it had fallen through twice. Obviously, that is very disappointing and concerning. We invited you along today because we want to do everything that we can to support that and take that forward.

Dr Deeny:

The Bamford Report, ‘Equal Lives’, is a noble report. It aims at something that would be wonderful, if it could be achieved. I have worked in community healthcare for 28 years. It seems to me — and I am not trying to be cynical or negative — that, at present, the intention is that everything should be done in the community: physical health, mental health and learning disability will all be looked after in that way. I work in this area and know fine well the problems, deficiencies and difficulties involved in community healthcare.

You all stressed consistently, almost in every second sentence, the importance of the family. I recall when patients were being moved out into the community from huge mental health institutions that held hundreds of patients. Many of them should rightly have been placed in the community, but I remember one gentleman who really had no one to look after his needs. For years, he walked aimlessly around the town of Omagh; for him, that was the wrong move. Certain people have severe learning difficulties: how will they manage if they have no family, a family that has completely broken up, or a dysfunctional or unsuitable family? It seems that there is a heavy, almost total, reliance on families to enable people to manage in the community. However, that is a utopian aspiration: it would be great if it worked. Who takes responsibility for the individual where there are no family members?

Dr Briscoe:

I, too, am a former GP, so I know about the general problems that arise in community settings, with regard both to mental health and to learning disability. If it is clinically appropriate for someone to be acutely admitted to a hospital, whether they have a learning disability or a mental health problem, and if no other mechanism such as crisis response is available, then an acute admission should take place and a bed should be made available. However, you are right in saying that the general thrust is increasingly towards support in the community. That does not rely solely on families. You referred to dysfunctional families and those with older relatives; in planning the resettlement programme, the needs and wishes of family members and the wider carer group have of course to be taken into account. That is what supported living is all about: meeting the needs of the individual and taking account of individual circumstances.

Mrs Somerville:

I can speak only for Muckamore Abbey Hospital: that is my responsibility. Many of those we resettle have complex needs. In none of those cases will we ask families to take patients home. Many of the patients have been away from their families for a very long time, and often their parents are ageing. We are not looking at people leaving hospital and going home. In one or two instances, it may be right and proper for them to go home, but in the main that is not the case. Dr Deeny’s point about community care is well made. In the past, community care was not all that we hoped it would be. We have an opportunity — perhaps because we are that little bit behind — to make sure that we get it right.

I will give you an example of the sort of support that I am talking about: in Belfast, during the coming year, we will open nine one-person bungalows for people who come out of Muckamore Abbey Hospital. A tenth bungalow will be staffed 24 hours each day by high-level personnel who are able to provide the sort of support that the people who live in the other nine bungalows need. We certainly do not expect that anyone will be left to their own devices to wander the streets at night. That is why things have slowed down and why we have said that it is a costly exercise. That level of support, which, perhaps, in the past, would have been provided by a family, does not come without a price tag.

We must remember that the Department has just funded Muckamore to develop 87 assessment and treatment beds in new, purpose-built facilities that offer a wonderful environment for people who need treatment. We are not saying that there is never a need for inpatient admissions, but those people will not live in the hospital. They will come in for a period of assessment and treatment in the same way that any of us might go to an acute hospital, and then go home again.

Mr Easton:

I believe that care in the community is probably the way to go, although I am, certainly, no expert. Do you find that it is usually relatives, rather than patients themselves, who do not want them to be treated in the community?

As regards the 271 long-stay patients who await resettlement, are there any who, because of their learning difficulties, will never be able to be cared for in the community? Is it cheaper for the Health Service to treat people in the community than in institutions? What will happen to the staff who care for people in institutions? Will they be transferred to the community to care for people there?

Dr Briscoe:

There are a number of questions there; I hope that I remember them all. Certainly, I would preface any remarks on funding by saying that it is about the principle of betterment and about addressing individuals’ needs. No placement in the community would happen without adherence to the principle of betterment.

Mr Murray:

There is no doubt that community care is not a cheap option with this population. We do not make placements on the basis that people will go into the community and fall into further difficulties. An independent evaluation was carried out by Queen’s University at an earlier stage of the resettlement programme. It looked at what happened to people after they left mental-health hospitals and learning-disability hospitals. It built on work that had taken place in other parts of the United Kingdom, and showed clearly that post-hospital care in Northern Ireland is good —keeping in contact with people after they have left hospital and continuing to provide services for them in the community — although it adds to the cost. That is exactly what still happens in learning disability. Therefore, as I said earlier, people who leave hospital do not leave the service or the system; they actually enter another part of the service or the system. Therefore, to answer your question on finances directly, it is more expensive.

It is worth paying attention to one particular point for a minute or two, because it affects decisions that will need to be made during the next couple of years: we anticipate that costs for the people who are now on the list of those who are ready to be resettled within the next five or six years will be higher per person than for those who have already been resettled. That simply reflects the need for community services to be built up to enable people to be resettled, and, indeed, those services have been built up to some degree over the past number of years. The figures in our paper indicate that the scale of investment that is required on the part of DHSSPS and DSD in the next few years is greater, on average, than it has been over the past number of years.

We are not alone in this approach; it is very much in line with resettlement policies in other parts of the UK and across North America, Canada, other parts of Europe and Australia. Added expenditure towards the end of the process is a very common feature of the financial planning of hospital resettlements. Given the numbers that we started with in the early 1980s, and the fact that we are at the latter end of a long-term process, those costs are to be expected. From now on, it will always be more expensive to properly and safely support someone with learning-disability care needs in the community than it would be to keep that person in hospital.

Dr Briscoe:

As we move through this CSR period and into the next one, it is important that the Committee recognises the significant complexity of the community service’s need in respect of the long-stay population.

Mrs Somerville:

Again, I am speaking for Muckamore Abbey; I cannot speak about the other two hospitals. Alex asked whether it is relatives who do not want people to come out of hospital, and, indeed, it is usually relatives who have concerns. We can all understand the anxiety of relatives whose family member has been very well looked after in hospital for years. They are concerned about their family member and quite protective, which is often why the process can take a long time.

However, the people involved in planning — social workers, community nurses and ward staff — spend a lot of time working with relatives. They may encourage relatives to consider a particular development and ask what would need to be added in order for them to be happy with that package. So far, we have been able to meet the needs and requests of relatives of the people who have been resettled in Belfast. We would not be achieving betterment if we were not able to do that, and the principle of betterment is very important in this process.

Relatives must be asked what they deem to be betterment and what they want for their family member. It can be a complex and lengthy process, but we have lots of examples of relatives who were anxious at the outset but are now glad that they went down that road. We have families who are happy to reassure other families that, although they will be anxious at the start, they should work with it.

Are there some people who cannot come out of hospital? I believe that no one should live in a learning-disability hospital. Everyone should come out, as long as we can get the resources for them to be properly supported in the community. Those people must be safe, properly occupied and — if required — well looked after. In Muckamore, we believe that anyone for whom it has been deemed clinically appropriate to come out of hospital should come out of hospital.

Having said that, there are approximately 20 people in Muckamore who are frail and who have high nursing needs. We must look carefully at their needs; they require a high level of nursing-home care. Keeping the betterment principle in mind, we must ask whether it is right to move those people from the hospital ward to a nursing home, or whether there is something else that we could do for them. Other than those 20 people, everyone in Muckamore for whom it has been deemed clinically appropriate should and could go, as long as we get the community provision right.

The other question was about staff. Two things are happening in relation to the staff at Muckamore. First, many of them are keen to go out and care for the people whom they have got to know over the years and whom they have supported. A considerable number of staff are going to support the children who are moving out into the community setting. It is pleasing that the staff want to take on that new challenge.

We do not believe that the resettlement agenda will present any problems for the employment of staff. That is because the development of the 87 assessment and treatment beds at Muckamore required staff who were more highly qualified and skilled than we might have had before. Many of the staff who want to do the very pure clinical assessment and treatment are able to do that in the new hospital service, and people who want to go out and care for patients also have that choice. We have been doing a lot of planning for these changes since the 1980s, and we have worked through them with staff.

Ms S Ramsey:

I do not for one minute doubt your commitment; I am sure that there will be an outcome to your work. In saying that, I believe that both Ministers have failed to achieve the targets and commitments that were set in the Programme for Government. That is a serious issue. You and I have roles to play, and we must ask questions about some of the issues that have been raised.

We are dealing with people, not statistics. Having read the briefing that you submitted, I have three or four questions. You might not have the answers today, so I would appreciate a written response in that case. In your briefing, you say:

“The infrastructure required for successful resettlement is much wider than health alone and work is ongoing between DHSSPS and the Department for Social Development to ensure that appropriate accommodation is available”.

Can you tell us what that means in more detail? You may be able to answer some of my questions today. Further on, you say:

“The Equal Lives report identified the need for 100 additional supported living places to be developed on a regional basis each year for the next 15 years.”

You say that work is ongoing between DHSSPS and DSD, but then you tell us this. You then say that it will not be achieved. When we talk about the CSR, the Minister tells us time and time again that the money will not be lost to the system, and that it will come back in.

On the last page of your briefing you say that the Programme for Government target for 2013 will be difficult to achieve. If we are being told that over the three-year CSR period, the money will go out and come back in again, how can you tell us that a target for 2013 will be difficult to achieve? I take your point about the Housing Executive’s five-year rolling plan, but when you say that:

“an early commitment is required to enable new houses to be built”,

we need to know where that is sitting.

You say that DHSSPS and the Housing Executive:

“co-operated in submitting bids to their respective Departments in line with the agreed priorities.”

We need to know what those priorities were in order to have an idea of what we are talking about. I take it that the bids were not successful.

Your submission states that the Department is collating information on the cost of the resettlement programme from 1 April 2007 that has been provided by health and social care trusts and the Housing Executive. It is important that the Committee receives that information.

Your submission also states that only existing schemes that have already commenced will continue. Can the Committee be provided with a list of those schemes? We need to live in the real world. The Bamford Report, was seen as the be-all and end-all, and the Minister always tells the Committee that the money will not be lost, that cuts will not be made and that any money going out will come back in. However, we have been told that commitments for 2011 and 2013 cannot be met, so it appears to me that the money will be lost.

Dr Briscoe:

You asked quite a number of questions; I shall answer them as I remember them.

Ms S Ramsey:

The meeting is being recorded by Hansard, so you can have a copy.

Dr Briscoe:

For individual patients, there is a health-and-care component to the issue, but there is also a supported-living component, which encompasses housing and some of the revenue costs that go with that to provide people with information, advice and other support from the NIHE on the package for an individual person.

In 2007-08, roughly £200 million each was allocated to mental health, learning disability and dementia. The overall figure was in the order of £600 million. The additionality is in relation to the comprehensive spending review, which covers a three-year period starting in 2008-09 and extending to 2010-11. That is the way the financial cycle works when bidding for additional resources. The additionality that was allocated to learning disability was £33 million over the three-year period, and £17 million recurrent. The services in respect of resettlement are driven by that additional figure.

Ms S Ramsey:

I appreciate that, but my point is that bids were made and that commitments were made and targets were set under the Programme for Government. Are Ministers setting targets without the money being available? If the targets of the Programme for Government are not going to be met, that must be looked at. Whether the bids have been made or not, the Minister said recently in the Assembly that the money is not lost.

Dr Briscoe:

If you are referring to efficiency savings, I reiterate that those are not cuts to the system. The Minister has made a commitment that efficiency savings, which all Departments must make, will be re-profiled into front line services. Indeed, mental health and learning disability services are a priority for the Minister and, therefore, do well in respect in the overall additionality that is made available.

Ms S Ramsey:

So the Minister made a commitment under the Programme for Government that he did not have the money to meet.

Dr Briscoe:

The Minister’s targets and priorities for action relate to the 2008-2011 span, for which additional resources are in place to endeavour to modernise and reform services and drive the pace of change in respect of those targets. Our paper outlines the priorities for action target that trusts should, by March 2009, resettle 60 patients from hospital to appropriate places in the community compared to the 2006 total. We will have exceeded that target by the end of the financial year, which is the end of March. The target is very clear, and we have exceeded it.

There will be further resettlement of 30 patients in 2009-2010, and an additional 30 after that. That will bring the total figure for the period from 1 April 2007 to the end of the CSR period — which is the end of March 2011 — to 120. That is the way in which the financial system works. It is right to have a target in place that drives reform and modernisation beyond that, which is very much in keeping with the Bamford vision, which spans a 10- to 15-year period.

It is acknowledged in ‘Equal Lives’ and all the other related subsidiary documents, and Bamford’s other documents on mental health, that the journey will take 10 to 15 years. Therefore, I believe that it is correct that the Programme for Government focuses on targets, because it drives service improvement, reform and modernisation, and that was very much in keeping with ‘Equal Lives’ and the other Bamford reports. As you know, the consultation on the Bamford Review, which was endorsed by the Executive, has now closed, and the final response will be in the system in the next couple of months.

It is difficult for us to project beyond 2011, but we have certainly worked to establish the costs of the current programme, which has run from 1 April 2007. We know that the current costs, both for our Department and DSD, for that period are of the order of £13 million. We have said to colleagues here that it is notable that the complexity of need as regards patients in long-stay hospitals is significant, and will continue to be significant as we move forward. Therefore, we anticipate that additional resources will be required beyond this CSR cycle — in fact, we do not anticipate it, we know it.

Ms S Ramsey:

You actually said it there: the issue of funding has had an immediate impact on this year’s plans for new services to be delivered. So, it is having an impact.

Dr Briscoe:

I know that you have been aware of the commitments made by Minister Ritchie in relation to the Supporting People programme, which was debated in the Assembly recently. She has recognised the need and has given a broad commitment to a number of schemes for learning disability patients, all of which, I think she said, amounted to a figure of £38 million, in both revenue and capital.

However, she also said that that was “resources permitting”. It was acknowledged that one should not underestimate the planning required to complete the resettlement programme, and that includes practical things such as getting planning permission for new capital builds, etc, along with the revenue and capital required from DSD, which she acknowledged was a significant amount.

Ms S Ramsey:

I will leave it at that.

Mrs McGill:

One of my questions was on the point that Ms Ramsey raised, and it has been well aired.

There has been a lot of comment about Muckamore, and I have no difficulty with that. I want to highlight Lakeview Hospital on the Gransha Hospital site in the Western Health and Social Care Trust area, which has 31 long-stay patients. Can you give me an update on that situation? Will a whole wing close?

Dr Briscoe:

I was speaking to one of my colleagues from the Western Trust this morning. In general, that trust feels that it is on target to meet all its commitments in respect of long-stay patients. A number of capital facilities are being developed to supplement what was in Stradreagh Hospital and moving out into new buildings, both as replacement and in relation to people with challenging behaviour. The trust feels that its resettlement programme is on target.

Mrs McGill:

I was asked about the capacity of Lakeview Hospital a considerable time ago. What is its capacity, and how many patients will remain after those 31 have been resettled?

Mr Murray:

A bed validation exercise was carried out across Northern Ireland in 2005. I am from the Eastern Health and Social Services Board, so I am talking about that from general information and what I know about it from colleagues, as opposed to my own board area. The notion was that the Department asked each of the health boards to look at what the population’s needs would be in the future for assessment and treatment — acute beds, if you like — after that population of long-stay patients had gone.

Each of the hospitals was in a different stage of building for the future. As we have heard, Muckamore had embarked on getting its 87 beds, and those are up and running. As regards the west, the Stradreagh Hospital was looking at closing the old wing. All of the patients who need to move out into the community are being nursed and cared for in the older accommodation. Stradreagh Hospital has opened its new hospital building with 38 beds. It is commissioned for 38 beds by the Western Board and by the Department, as it includes the assessment and treatment requirement for the whole Western Board area.

The patients in the older accommodation — the old wing — will all move out into the community. That is what is being referred to here. There are developments already. It was not affected by the recent changes in DSD funding, because the move was so far advanced and the buildings were being built. That was part of the funding planned on both sides of the house — DSD and DHSSPS. It is going ahead, and those patients will be able to move out.

We are talking about two or three different targets at the same time. It may be helpful to tease them out. The Bamford Review has one set of exacting targets — I am not saying that they are wrong, but they are challenging. For example, there is the target for 100 additional places for people to live in the community each year. However, that is for the total population of people with a learning disability. That is a different target to the one that we have been given for this CSR period. I understand why members might think that, on one hand, the document says that we are meeting our targets, whereas in another part it says that we are not meeting, or cannot meet, the target. I suppose that that is true, but one must listen carefully to the nuances.

Ms S Ramsey:

Some people call it jargon.

Mr Murray:

I am spelling it out because I do not want members to think that I am trying some sort of jiggery-pokery. There is a three-year target. Members might say that the target should, perhaps, have been different, because Bamford says that it should have been different. However, it is not different, and the Bamford implementation programme has not yet been published and approved. That remains to be seen.

As I said earlier, we will meet the targets for this three-year CSR period. There is no doubt about that. We met our targets last year, and, this year, we will meet our overall targets and the target for the number of children who leave the hospital. We will meet those targets for the next two years of the CSR period, even amidst all the difficulties.

What we do not know is whether we will meet the larger target for 2013 that is outlined in the Programme for Government. We cannot give a commitment that we will meet the targets and keep in line with Bamford’s targets for people in Derry, the Southern Board area and those in the Eastern and Northern Board areas in Muckamore. We do not know about our Department’s commitment — and are not in a position to do that until the next CSR period — and that of the Department for Social Development. Although the Minister for Social Development has said that she wants to do that, it is dependent on what resource is available in that period.

I do not want to use jargon or trickery. The document uses the word “target”, the words “learning disability” and the word “resettlement”. However, there are different time phases, and we have been clear that we will be able to meet some targets in this three-year period. We know which people need to leave the three hospital sites. However, we do not know whether we will have a commitment to the resource in both funding streams to do it within the 2013 target period. That is a challenging target, and both Departments must commit to the funding streams so that we know as early as possible that funding is available. That will allow us to begin planning.

Mrs McGill:

I did not mention targets; I just wanted an update on the situation at Lakeview. Where have the 38 patients gone?

Mr Murray:

They are in the new part of the hospital site. The Western Trust has opened a new hospital —

Mrs McGill:

Are you talking about Spruce House?

Mr Murray:

I referred to it as Lakeview, because that is how I know it. I am talking about the site at Stradreagh, on which there are also mental-health services.

Dr Briscoe:

From memory, Spruce House is for acquired brain injuries; that is a different thing. Lakeview is primarily for learning disability.

Mr Murray:

It is all for learning disability.

Mrs McGill:

So, the 38 patients will remain at Lakeview? Is that correct?

Dr Briscoe:

Which 38 patients?

Mr Murray:

I mentioned 38, because that is the number for the Western Trust area within the assessment and treatment bed capacity, and it was to be reviewed in light of how many beds will be required in the future. In 2005, 38 were commissioned, and they are still available for the population of that area to use for assessment and treatment, in the same way that 87 are now available in Muckamore.

It is confusing because, although we know the number of beds that we want to put in the new hospitals, each hospital site in Northern Ireland has a resettlement population as well as those core assessment and treatment beds. In some hospitals, it is difficult to determine who is who because the wards are not necessarily divided between patients who will stay for assessment and treatment and patients who are ready to join the resettlement population. It is clearer in Derry because of the old ward accommodation and the new Lakeview hospital. The resettlement population is situated in one part of the hospital and the assessment and treatment beds are located in the new, improved part.

Mrs McGill:

I share the concerns of other members in relation to what happens in the community, because families are often simply left to cope. I am not a GP, but, through our constituency offices, we hear that families are very concerned about what will happen. I have read the letter from the Society of Parents and Friends of Muckamore Abbey, and I know that some people want their family members to remain there. There ought to be a mix to accommodate different people’s needs.

Mrs Hanna:

You have been very helpful. I share the Bamford vision, as well as promoting social inclusion and the betterment principle — which is a lovely way of putting it. However, like Kieran, I have concerns about how the community will cope, because it seems as though everything is being closed down, including residential homes. I do not know whether primary care is ready for it, because there is no doubt that there is still a huge focus on acute care here. I do not think that the culture change is being made for what is going to happen in the community, particularly with regard to dealing with the complex needs and with the level of care that will be needed.

There is a concern about supported housing, and we know that there is no money in the budget for it, but that is only part of the problem. The bigger concern is that the healthcare is not there, particularly for people with learning disabilities and mental-health needs. Every time I walk out along the Lisburn Road, I meet people with those needs, and they tell me that they do not know which way to turn, as they have phoned their GPs and their out-of-hours clinics, but they have been labelled at that stage. There are a lot of people in that situation, but that is only one aspect of the problem.

There is a real nervousness about how the community will cope with the issue. Indeed, there is a real fear for families and carers. Today, I was talking to a woman who has a daughter with learning disabilities and mental-health needs. Her daughter attends a day-care facility four days a week, but her mother is scared that she will lose that facility, because everything seems to be collapsing. Those services will not work unless more of that type of support is available. That mother works; she said that she would be so isolated if she did not. Therefore, she has worries because there are threats to day-care provision. She has difficulty coping with her daughter, and, when her daughter is not at the day-care facility, she spends her time in bed. There are lots of people like that.

There is a real nervousness that everything is being thrown into the community, and that it will put a huge burden on GPs, psychiatric nurses and social workers. The facilities do not seem to be available to cater for people with more complex needs and for people who cannot cope. Furthermore, most of the available beds will be short-term beds. Windsor House is closing — it is a mental-health unit, rather than a facility for people with learning disabilities, but, nevertheless, there seem to be a lot of closures, and I am nervous about whether the community will be ready to cope with it.

Dr Briscoe:

I understand where you are coming from. That is why Bamford is a 10- to 15-year vision. We are not saying that hospital beds should be removed without an appropriate care environment being in place to meet the needs of individuals. All patients are assessed on an individual basis. That is why, as Miriam said, the care planning process and the discharge planning process are long journeys, which require trial in a particular setting before confirming that someone is suitable and ready to be resettled in the community.

Mrs Hanna:

There is already so much unmet need in the community, and all these other issues are coming in on top of that. However, it is very laudable, and it is the right way to go in the long term. However, I am just not sure.

Dr Briscoe:

I agree; there is an interrelationship between mental health and learning disability. As you know, there was an additional investment of £54 million within the CSR period in relation to mental health, which is £27 million recurrent. That money is for community infrastructure, and we acknowledge that there are different ways to deliver respite, for example — as you mentioned — day centres.

Mrs Hanna:

Respite and day care are very important.

Dr Briscoe:

There are a number of other models, such as family support, adult placement, and fostering arrangements in families, which deliver different forms of respite. Respite provides support not just for the individual patient with a mental-health condition or learning disability, but for their families and carers.

It is a journey, and one which, I think, will take time to achieve. However, I emphasise again that it is not about closures; it is about a remodeling of the service to ensure that it best fits the needs of patients, now and in the future. That is what it is all about.

Mrs Somerville:

Very briefly, you are absolutely right to raise the issue of people with learning disabilities, mental-health needs and more complex needs. There is a bit of good news in relation to that; as Dr Briscoe said, from 1 April, there will be investment coming into learning-disability services. Although there is never enough money, it is an additional investment to help strengthen community services to meet some of those needs.

Over recent years, learning-disability community services have not had a great deal of growth in that area. However, we recognise that that is part of the cost; when we talk about resettlement we are not just talking about putting a roof over your head and providing a staff team to support you in that house. Resettlement is about the next circle of support, which includes community learning-disability teams who perhaps have specialist skills around mental-health issues; people who can work with GP practices to help ensure that people with learning disabilities have the proper health screening under primary care; 24-hour support for people with challenging behaviour; and psychotherapeutic services for people with learning disabilities.

There is a long way to go in developing those services; however, I think that we are making a reasonably good start. You are right to say that that is a very important component of getting resettlement right so that people are properly supported to stay in the community.

Mrs Hanna:

I support the thrust of that, and we will never have a perfect world. However, an awful lot of that falls back on the families and carers. I meet those families all the time. For example, a daughter or son stops taking their tablets and there is a crisis. It is difficult to get that support in a crisis, particularly as that is when acute care is needed. We must ensure that there is a bed when it is needed.

Dr Briscoe:

We endorse that. In the final response to the Bamford Review we acknowledge that learning disability is a lifelong journey with many different component parts.

The Deputy Chairperson:

Thank you very much. You have been very informative; thank you for coming along.