A SENIOR mental health consultant has expressed her concerns over plans that could see the closure of a Monmouthshire dementia ward.

Dr Pauline Ruth, consultant for older adult mental health in north Monmouthshire, was Aneurin Bevan University Health Board’s chief of staff for mental health services when the health board opened beds at Chepstow Community Hospital’s St Pierre ward in order to bring dementia assessment beds to the county.

But now, as part of a move to centralise the health board’s dementia beds, the Chepstow ward is set for closure.

If the plans go ahead, patients in north Monmouthshire would be relocated to Ysbyty Tri Chwm in Ebbw Vale, while those in the south of the county would move to Sycamore Ward, St Woolos in Newport.

The move would see an overall reduction of four dementia beds in addition to the beds temporarily closed due to a significant temporary reduction in beds since January 2016.

The report, The Redesign of Older Adult Mental Health Services, acknowledged that the move would increase travel time for a small number of south Monmouthshire patients with dementia requiring admission to hospital.

St Pierre was chosen as the preferred ward to close as the remaining dementia assessment wards would provide the best coverage of wards across the geographical patch.

“At the moment the problem is that there’s enormous pressure on the service because we can’t recruit nursing and medical staff and there is a real gap in nursing numbers,” Dr Ruth said.

Dr Ruth also has concerns about the consultation process, which was held last week. She says that while there was widespread discussion at the Chepstow consultation, the event last Wednesday in Monmouth was “very poorly attended”.

Furthermore, there are concerns about the existing community transport system – which does not cross county borders and would therefore not allow dementia patients to use the service to travel to the proposed new units – and the process surrounding the discharge process.

“We have worked out that it’s a four hour 14 minute journey by bus, with four buses, to get there [to Ebbw Vale] from places like the Narth, Trellech, if there is a bus, and other places around Monmouth if you have to go by public transport.

“Not only that but many of their carers are elderly and frail, and quite often their family live at a distance, so actually they are reliant on public transport if they can’t drive themselves. Some do drive, but quite a lot don’t anymore.”

Another issue is that of the continuity of care when it comes to dementia patients. The current system means patients are cared for by the same people, who know both them and their conditions. This, Dr Ruth says, is important for when patients are discharged from hospital.

“When you admit people out of area you don’t know about them, you don’t get a proper history from the community team, you can’t attend the ward rounds, it’s much more difficult to plan their discharge safely into the community,” she says.

“The plan always in the long run was to move Chepstow into Nevill Hall [in Abergavenny], it’s a district general hospital where we could be next to physical health services; so you’d have older adult mental health and physical health. All my patients with heart disease, chest disease, Parkinsons, strokes, cancer, can get access easily to the physical healthcare that they need.

“At Chepstow there are some physical health wards, there’s some outpatients clinics, some GP surgeries, there’s a staff-grade doctor in physical health who will come and see our patients.

“In Blaenau Gwent its a standalone mental health unit... there’s no general physical health ward or setup, so there’s also the worry that we won’t be able to get the same level of physical health support.”

While there is acceptance of the need for change, there are also fears the closure of the ward will upset the possibility of dementia beds staying in the county in the future.

The opening of the £350m Specialist and Critical Care Centre near Cwmbran in four years time will mean a number of services will move from Nevill Hall to the new ‘super hospital’, freeing up space for other units.

“The whole purpose of moving to Nevill Hall of course was that when the Specialist Critical Care Centre opens, a lot of things will debunk from Nevill Hall onto this specialist critical care centre which will be in four years time,” Dr Ruth adds. “We were thinking we’ll go in there then, and we’ll be able to make use of empty space, but what they’re saying is because it’s such a crisis now with the nursing staff we can’t wait for four years, so they’re going to shut our unit. Our concern is that we may end up in Ebbw Vale and then something else comes up and they make use of it in some other way at Nevill Hall and we never get the chance to get into Nevill Hall.”

The report by the Chief Operating Officer and Director of Nursing says that: “The option provides greater sustainability of staffing and enables a better redistribution of beds with a concentration of functional beds in the centre of the county.”

The report concludes that the current service configuration of older adult mental health service is unsustainable. The current staffing problems have resulted in the need to reduce older adult mental health beds on a temporary basis. Work undertaken with stakeholders has confirmed that a more permanent consolidation of beds onto a reduced number of sites is seen as the best way of maintaining safe and sustainable inpatient services