"Discounting the voice of the vulnerable disadvantaged"

About: Nottinghamshire Healthcare NHS Foundation Trust

(as the patient),

Disabled people in continuing care are facing a new and worrying situation. It has long been the situation that disadvantage has been recognized and remediated by providing community care, which safeguards against relapse and a worsening situation for which statutory bodies like social services and Healthcare incur a multiplication of costs if they do not implement preventive intervention and provide a social base for vulnerable people to focus and rebuild their lives.

In my opinion, for mental health the last few years have seen these bases for social and specialist support falling like a house of cards. In our area, first the Resource at Duncan Macmillan House changed its independent basis for clients and carers to being reclaimed by the Healthcare Trust to serve the trust’s interests (I think) as an Involvement centre. Next went Manor Road Day Centre for older people, not replaced, and its clients moved in the direction of the Broad Street Centre, which in turn closed a year ago last March, with no efforts as far as I'm aware being made to relocate a vulnerable clientele and all the specialist infrastructure that SPAN had built up with many years’ experience of working with our needs. I feel the Healthcare Trust needs to Protect its Investment, instead of sweeping it all away, which I feel sets in motion a slide in care standards and a proliferation of costs which have to be met later.

These personal and social costs show in rates of relapse - the old ‘revolving door’ - and social problems which are left unmet and unmeasured except in high profile catastrophies like suicides and violations of the Law.

I feel we now have an underclass of ignored people which is very damaging to social cohesion and devastating for the people so ignored. Where the situation is changing I feel it is in being not simply ignored but in being actively targeted with inappropriate expectations that the disabled ‘must work’, that Day Care should produce outcomes that move people on - when these people are there with incurable illnesses and recognized vulnerabilities when working functionality is an unrealistic expectation.

The protection of these people is safeguarded by Statute. The extent to which the catalogue of pre-meditated closures described here is in violation of statute is contended here to highlight what some people are hoping will not come to light, but I believe this is something which is reaching scandalous proportions.

As the futures of Beeston Day Centre and the Jewel in the crown of community provision - SPAN Foster Drive currently lie in the balance, the conclusion here is that statutory commitments to continuing care in the community are jettisoned each time a day care facility is swept away.

These outcomes unfortunately serve to hit the most vulnerable people the hardest! Withdrawal of the investment in specialist provision that these have afforded I feel recklessly throws a proliferating social and financial cost into an indeterminate future, with maximum distress and hardship for the blameless targeted people who deserve better than to be mal-treated in this way.

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Response from Julie Grant, Head of Communications, Nottinghamshire Healthcare NHS Trust

Thank you for your comments. We are very proud of how we involve people at the Trust and of the Involvement Centre at Duncan Macmillan House. We have set the centre up on the basis of what service users told us they wanted. We developed the centre and run it in partnership with service users and carers.

We now have more people connected with the centre than ever and get very positive feedback from service users about our approach and what the centre means to them. In fact, the Involvement Centre was so successful that we opened a second centre in the North of Nottinghamshire.

Through both centres we ensure that people are informed about developments in the Trust and have opportunities to be involved in a wide range of activities to shape the culture of the Trust and the services we provide.

We are also committed to providing opportunities through involvement so that people can develop their skills, knowledge and experience and progress in their recovery.

In response to your wider views: Adult Mental Health Nottingham City is faced, as are all public sector organisations, with the challenge of providing services with greatly reduced income. One strategy that has informed our cost improvement programme has been to close buildings rather than reduce staffing as this has less impact on service users. The Broad Street Centre did close but the community groups formerly running from this centre all continue in community locations.

The Wellbeing and Social Inclusion Service based at the SPAN building on Foster Drive supports approximately 750 service users but less than 100 attend the building. Alternative locations are actively being sought for the groups that are currently held in the SPAN building.

I hope this information helps you to see the challenging environment in which we try and provide the best services we can.

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