With the modernisation of the National Health Service (NHS), much of the proposed changes in the mental health services are positive and benefit patients. Changes are not always debated fully within the health community and with service users, however. Changes introduced have repercussions elsewhere, which may not have been foreseen.
Within old age psychiatry, NHS continuing care has been less frequently considered necessary in recent years. Therefore, fewer dementia sufferers continue receiving their care within NHS facilities and are discharged to privately-run care homes. This shift leaves continuing care wards within the NHS unoccupied.
The majority of continuing care wards in recent years were purpose-built in the community, occupying isolated local hospital facilities. They were designed and built to accommodate medically-stable dementia sufferers and other long-term mentally disordered patients. These units do not have the same medical cover, nursing staffing levels and investigative facilities as centrally-located dementia assessment facilities. What future use should these sites be put to?
There may be expectation in many parts of the country to convert these units into dementia assessment facilities. The location, design and staffing (particularly outside working hours) of these units makes them far from ideal for this purpose. The Royal College of Psychiatrists' guidance is certainly at variance and raises clinical risk worries.
At the Faculty of Old Age Psychiatry meeting in London, this was a commonly shared anxiety expressed in the new consultants group. Perhaps other old age psychiatrists are unclear about the future fate of their previously continuing care units. If so, what are the future options? Can we have an options appraisal and informed debate within the profession with recommendations?
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