How wrong does something have to be before they CHANGE it?

This is a quick summary of the main points made in this blog with links to the relevant posts.

In his interview with BBC Radio Lancashire, Keith Dibble, Deputy Network Director of LCFT was asked "Do you accept that moving these women further away from their families and children could be damaging?"  He replied "We believe not".

Well we are telling you that it is damaging, Keith.  We believe removing all local inpatient care for the women of Lancaster and the surrounding area is wrong and damaging because...

It discriminates against women.
http://bedsintheorchard.blogspot.co.uk/2014/11/the-equality-act-2010-how-is-this-not.html

It punishes women and families on low incomes.
http://bedsintheorchard.blogspot.co.uk/2014/11/closing-female-beds-punishes-women-and.html


It can lead to increased detentions under the Mental Health Act.
http://bedsintheorchard.blogspot.co.uk/2014/10/can-closure-of-female-inpatient.html

It deters women from seeking, or accepting help.
http://bedsintheorchard.blogspot.co.uk/2014/10/is-based-on-need-self-fulfilling.html

It affects families and children.
http://bedsintheorchard.blogspot.co.uk/2014/11/away-from-family-and-early-release.html
http://bedsintheorchard.blogspot.co.uk/2014/11/so-i-asked-my-children-what-was-it-like.html 
http://bedsintheorchard.blogspot.co.uk/2014/11/clares-story-near-miss-distressed.html


It damages women by isolating them from their support networks.
http://bedsintheorchard.blogspot.co.uk/2014/11/the-full-article-published-today-on.html

And lets not forget that even some LCFT Staff agree with us. 
http://bedsintheorchard.blogspot.co.uk/2014/11/views-of-worker-in-lancashire-care-nhs.html

How wrong does something have to be before Lancashire Care NHS Trust will change it?

A letter from a worker in the Trust

Again we receive an anonymous email from someone at The Trust, again we have no idea who this is from, but have sent our thanks. "BananaJam" shares their thoughts.
[Edit - While we really appreciate messages from the trust, we really don't want to get people in trouble!]

I am following your blog with interest.

Following local news, This is Trust wide knowledge, and County wide is public knowledge.  It has filtered down through the grapevine that staff at the Orchard have been given a "talking to" to say nothing to anyone even inside the trust.

I work for LCFT.

What are senior management afraid of in this campaign. The truth is the truth. Public knowledge of Truth AND Lies is essential, especially in public sector services. If a health service is so afraid of a simple truth (truth already in the public domain) that it feels the need to order staff to keep silent, the question has to be begged, why?!

Nothing said to date that I am aware of has been anything other than public knowledge. By it's very nature, the whole issue being campaigned for is public knowledge.

Women, take heart, many of us working within the Trust are behind you! Women and Men. Many people are discussing it within the general public too. In the last week, I have heard people talking about it in my local town.

You have strong cross-gender support for an story that clearly has a major gender thread, in a subject area of Health and Wellbeing.

This is a campaign for fairness

The Beds in the Orchard campaign is run by a group of local service users, both male and female.  We are campaigning for the fair treatment of women in our area.   Our position is that both men and women should have access to local inpatient psychiatric care.  That both groups have equal rights to local inpatient care and that sending all of one group out of the area is discriminatory.

We are grateful for the support and interest people have shown our campaign.

North Lancashire; the area surrounding, Lancaster has been served by a mixed sex ward since c2008 when the Lancaster Unit opened at Ridge Lea hospital, in Lancaster.  Before then, there was a mix of provision in Lancaster, including both male and female wards. 

The Lancaster Unit had 17 beds, and throughout it's service, all 17 beds were used by a mix of men and women.  10 beds were used for men, and 7 were used for women.  At no point was the Lancaster Unit made male only, or female only.  Both sexes had the opportunity for local inpatient care.

In June, the Lancaster Unit at Ridge Lea was closed and the service users were all moved into a new unit – The Orchard in Lancaster.  The Orchard was a unit for anyone with an acute mental illness from age 18 onwards (no upper limit) and also including people with learning disabilities.

At the Orchard there were 10 male beds, but now only 6 female beds.  There were two swing beds that could go from male to female, so they became female at that time to accommodate the 7 women who had been transferred from Ridge Lea.  Another woman was admitted, so the totals were 10 male and 8 female beds.  When there is a peak in demand, The Orchard can swing the two beds back to male, giving them 12 male beds and 6 female beds.

Treatment under Lancashire Care NHS Trust is ‘county-wide’.  This means that if there isn’t a bed in your local unit, you can be sent anywhere else in the county where there is a bed.  When a bed became available in your local unit, you would be transferred closer to home.  Beds in the Orchard has never said or implied this is not the case. However;

There has always been inpatient provision for the women of North Lancashire either at Ridge Lea or The Orchard.  So there has always been the opportunity to be treated close to home.

We are campaigning, because in Oct 2014, the NHS Trust didn’t ‘swing’ the two beds at The Orchard, they closed the whole unit completely to women, creating an 18 bed male unit.  This means that all women from our area are transferred to hospitals a significant distance away with no chance of local care, for the first time ever.

The Trust say that it is due to a Peak in Demand for male beds, however such a peak in demand has never resulted in completely removing services to either men or women before and it come after them closing 15 male beds elsewhere in the county.

The Trust said in a Radio Interview on Monday 4^th November that there had been a peak in demand for female beds earlier this year and now there was a peak in demand for male beds, but when the peak in demand for female beds happened they did not reduce the number of male beds in Lancaster or close The Orchard and make it women only, and women were sent as far away as Manchester for treatment.  They kept the 10 male beds in both units.

We at Beds in the Orchard are the family and friends.  We are the service users it is affecting.  We want inpatient care for men and women and for one group not to be denied local care because of their sex.

Orchard Beds Goes National in The New Statesman

Beds in the Orchard started out as a small campaign to stand up for the women of North Lancashire after all the inpatient beds in the The Orchard psychiatric unit were closed to women and it became a male only ward.

We have documented all the way through our blog about why this is so harmful to the women of our area and why, even though the Trust has now said it's temporary, it should never have happened in the first place.

We were thrilled when our cause was taken up by the brilliant folks at BBC Radio Lancashire, but it seems that our issue has touched a more national nerve and today our campaign has been publicised in The New Statesman.

http://www.newstatesman.com/health/2014/11/orchard-psychiatric-ward-closure-women-bear-cost-unchecked-male-dominance

Everyone at Beds In the Orchard would like to pass on their grateful thanks to everyone who has supported us.  The women of North Lancashire deserve to be heard.  A special thanks to Tim Padfield and Graham Liver at BBC Radio Lancashire and Glosswitch at The New Statesman for making our voice a loud one.

Is the decision to close the Unit to women vulnerable to a judicial review?

One of our supporters thinks this may be the case, as they raise it in a letter to Heather Tierney-Moore, Chief Exec of Lancashire Care NHS Trust.  The full letter is below.

Ms Heather Tierney-Moore, Chief Executive,

Lancashire Care NHS Foundation Trust,

Sceptre Point,

Sceptre Way, Walton Summit,

Preston,

PR5 6AW

Dear Ms Tierney-Moore

Re The Orchard Unit

I do not make a habit of writing to complete strangers at the other end of the country to complain, but I am writing at the prompting of my sister. She has been a patient on several occasions in the old Ridge Lea Hospital and may well need a bed in the future.

As I understand it, the new Orchard Unit has been made exclusively male suddenly and without consulting with the public or service users. If so, I would note that this decision is of dubious legality and may be vulnerable to judicial review.

The account given is that there is a pressing need for beds for male patients and women are being excluded on the grounds that they are vulnerable to the male patients in such an environment. If this is so then I believe that the decision is entirely the wrong way round; the vulnerable patients need to be protected and if, in an extreme case, the men (in general) are liable to prey on women then it is the issue of the male patients that needs to be addressed. To exclude women is to punish the vulnerable, surely?

There is clearly a need for more beds for the mentally ill in the Preston Area as there is such competition for the beds and maybe the closure of Ridge Lea should have been preceded by an analysis of future needs and the level of peak demand (NOT average demand, as this will always fall well short of actual need). I can appreciate that in an era of budget pressures (and when were there not such pressures?) providing beds is always difficult, but I believe the recent political statements reveal by the targets being introduced for mental health treatment, there is more political will to improve mental health treatment than for many years. It surely ill behoves a chief executive to follow a policy that seemingly reduces the capacity let alone the quality of care. I believe it may well be that The Orchard Unit needs a companion unit for female patients and probably larger and preferably in advance of provision for male patients.

I worked as a chief officer in the Probation Service for many years. My experience is that men do not present with as many mental health issues as women but they have almost an exclusive hold on severe personality disorders. If the rise in male patient numbers is in any way a reflection of this I would strongly suggest that they are not amenable to treatment, that they will remain in your care for as long as they can manage it to avoid the courts/prisons and will likely pose a major threat to staff, other patients and themselves. It is not sensible, in my view, to have such people in contact with the generally mentally ill, and especially if those mentally ill people are in any way vulnerable (which they surely would be) and women.

I look forward to your comments.

Temporary or not, this is a closure that should never have happened

We do wonder whether Lancashire Care NHS Foundation Trust is feeling more secure now. 

They have told us publicly that it’s a temporary move that won’t last for weeks and weeks.  That it’s to cope with a peak in demand for male beds, that of course has nothing to do with them closing 15 of them elsewhere in the county.  And they’ve publicly stated that it’s not having a negative impact despite the women telling them that it is.

In their eyes this is surely a non-story now.  It’s a temporary peak in demand with no impact.  Our campaign is just an overreaction by a group of women to a perfectly rational and sensible decision by the Trust. 

Now where have we heard that kind of thing before?

Women!  You are overreacting to us putting the needs of male service users before yours!
Women!  You are overreacting with your anxiety at being treated away from your homes and families!
Women!  You just don’t understand how these things work, so do go ahead and STFU now won’t you!

Well, we’re not going to shut up.

Temporary or not, the closure should never have happened.  Temporary or not, the needs of male service users are not more important than female service users.  Temporary or not, the worry and anxiety felt by the women is real and harmful. Temporary or not, the costs incurred by families to visit their relatives are real and harmful.  Temporary or not, the emotional distress of the families is real and harmful.

Temporary or not, denying women access to local inpatient care is harmful, discriminatory and should never have happened in the first place.

Temporary doesn't make it better.

More Freedom of Information

Another Freedom of Information Request has been sent to the Lancashire Care NHS Trust this morning.  Today, we are looking for answers about equality, who is filling the beds and how Home Treatment has been expanded to meet the needs of the men and women no longer treated on Ward 18 or at The Orchard.

Dear Sir/Madam,

Please can you provide me with the following information.

1. The Equality Impact Assessment of closing female inpatient beds at The Orchard in Lancaster conducted by the Lancashire Care NHS Trust before the beds were closed to women.

2. The number of male patients from the East Lancashire region treated, or being treated in hospitals run by the Lancashire Care NHS Foundation Trust elsewhere in the county (Preston, Chorley, Ormskirk, Lancaster and Blackpool etc.) since the closure of Ward 18 at Burnley General Hospital.

3. The number of male patients transferred from Ward 18 in Burnley to The Orchard in Lancaster when Ward 18 was closed.

4. The number of male patients from East Lancashire treated in The Orchard since 01/09/14 to date.

5. The FTE of staff in the Crisis, Home Treatment and CCTT teams in Burnley and the surrounding area the months before, and then after the closure of Ward 18 in Burnley.

6. The FTE of staff in the Crisis, Home Treatment and CCTT teams in Lancaster and the surrounding area the month before, and after the closure of The Orchard to women.

Best regards,

"It is not the intention for this to run for weeks and weeks"

We've spent this evening going over Claire's interview on BBC Radio Lancashire and the response to our campaign from Keith Dibble, the Deputy Director of the Lancashire Care NHS Trust.

We were going to post a long reply, but can actually summarise quite swiftly.

The County
There were a number of mentions by Keith about the County, for example  "Balance across the county" and  "Cross county requirement".

If there is a cross county requirement then removing 15 male beds will have changed the balance across the county of male beds. 

We'll be submitting a FOI request about how many men from the Burnley area are being treated in the west and north of the county.

Home Treatment
Home treatment is indeed preferable.  Sadly the crisis and home treatment teams are not augmented when beds are closed.  Existing teams have an ever expanding case-load and less people are expected to look after more Service Users.

We doubt that when the male beds in Burnley were closed, the home treatment teams were expanded in that area and we doubt that when the female beds were closed in Lancaster that the home treatment teams were expanded in that area either.

Another Freedom of Information Request will be sent out tomorrow so we can confirm that to you.
(Our FOI person is going to have a busy day)

Clinical Priorities
Beds in the Orchard has never suggested that people requiring PICU care etc. should be treated at The Orchard.  We all have personal experience of being unwell and know that some women need to be treated in specialist units.

However the women being sent away from Lancaster for treatment do not all need specialist treatment and they would benefit more from local care. 

It appears that the trust position is that the Clinical Priorities are caring for the men of North Lancashire after the balance across the county was tipped by the closure of male beds.


Length of Closure
Keith stated that it is "Not the intention for this to run for weeks and weeks."

This goes against information we have been given, but will be pleased if this turns out to be correct.  We will continue to campaign for the female beds at The Orchard to be reopened until provision for women is restored and also to ensure that this statement from the trust is upheld.

We will continue to actively publicise the closure of the beds by the Trust and we will be further investigating at the treatment of women in Mental Health Services run by the Lancashire Care NHS Trust.

Financial Reasons
Keith said there were no financial reasons for the closure of beds.  However, since the Trust has to deliver a 25% cut in expenditure as directed by the Department of Health, we suspect that financial pressures may well be involved. 

Beds In The Orchard, Trying to change things for the better.

At the moment, I'm listening to the Lancashire Care NHS Trust's spokesperson on BBC Lancashire Radio this morning, going through all of his points so I can fashion a response.

But I'm going to take a moment to share a quote with our readers.

"Never doubt that a small group of thoughtful individuals can change the world.  Indeed, its the only thing that ever has."
Margaret Mead, US Anthropologist

That's us.  A small group of individuals just trying to make things better for vulnerable women in North Lancashire.  Here's to succeeding. 

Beds in the Orchard takes on the Trust on BBC Radio Lancashire

If you are from out of the county or just weren't awake at 7am this morning, you can listen again on their website - http://www.bbc.co.uk/programmes/p0293ql6.  The podcast is available for 7 days from today.

Listen to Claire speaking on behalf of the Beds in the Orchard Campaign at around 7am and the response from Deputy Network Director of Lancashire Care NHS Trust at around 8am.

A lot of what Claire said is already on this blog.  She's kicking herself slightly about missing some things out, but it was Live Radio and there was a lot to say in a small space of time.

A quick take on the Trusts response:

If this is 'county wide' care, then you really can't then argue that the closure of 15 male beds in the county wouldn't have an impact on the need for male beds in the county.

Travel expenses - If they have to be claimed back, then families without the money to pay up front will still be unable to visit their relatives.

We were delighted to hear that female beds will be open back in The Orchard 'as soon as possible'.  We've heard you say that now, Lancashire Care.  "As soon as possible" is NOT March 2015 when the Harbour is due to open.

This campaign will continue to run and will continue to apply pressure until the female beds are reinstated at the Orchard.