Patients were let down by NHS structure, says new Bootham Park report

John Ransford, who was commissioned by a City of York Council committee to investigate the closure, said no person or agency took charge to minimise its impact and said the structure of the NHS was a factor in the difficulties that arose.

Bootham Park closed on October 1 after the building was deemed no longer fit for purpose, leading to the mental health facility's patients being moved as far away as Middlesbrough.

That was also the day Tees, Esk & Wear Valleys NHS Foundation Trust (TEWV) replaced Leeds & York Partnership NHS Foundation Trust (LYPFT) as the provider of the majority of York's mental health services.

Mr Ransford, a York resident and former director of social services and chief executive of two Yorkshire councils, was appointed as a voluntary independent expert adviser.

He said: "If all organisations had worked together in partnership to deliver a plan based on the needs of patients and local people, more suitable solutions would still have been difficult, but surely not impossible to achieve."

Mr Ransford added: "An action plan to identify and manage the important issues was devised and followed, but no one person or agency ‘took charge’ in order to ensure that it was delivered in an effective manner.

"There was a lack of strategic leadership, which contrasts with the role taken by Margaret Kitching (chief nurse for NHS England) after the event.

"All of the organisations involved contributed in some way to the unintended consequence of the sudden closure of hospital facilities.

"The Vale of York Clinical Commissioning Group (CCG) is responsible for commissioning the service. The lack of strategic leadership must rest primarily with it."

According to Mr Ransford:

• LYPFT "did not take responsibility for the building at the commencement of its contract" and "lost focus on safe service provision during the process and outcome of re-contracting".
• TEWV "did not achieve sufficient due diligence before taking on this contract".
• NHS Property Services "significantly underestimated the logistic and practical challenges of upgrading a Grade 1 listed building where shortcomings had been identified over many years".
• The Care Quality Commission (CQC) "gave insufficient attention to the particular issues raised by formal de-registration and registration of facilities, triggered by the transfer of services between agencies".

Mr Ransford said: "Tje current organisation of the NHS is a factor in the difficulties which developd in this situation. Relationships between the various groupings are both complex and fragmented, which makes patient-centred care difficult to achieve in an integrated manner."

He added: "In my view a lack of strategic grip is the key problem here. An overall view was not taken as to how patients and the community could be best served given the challenging factors which were well known to all concerned.

"It was assumed these were being addressed satisfactorily, but there was insufficient rigour in checking this was in fact the case.

"All the agencies involved focused on their particular role without sufficient attention to the big picture.

"It is now evident that some services were re-provisioned at Bootham Park within three months of the enforced closure and TEWV has a resourced plan in place to provide inpatient facilities in York during 2016.

"Why was this re-provisioning not put in place to avoid services being significantly disrupted and inpatients having to move at short notice, many as far as Middlesbrough?

Mr Ransford's report will be one of five documents discussed by the council's health and adult social care policy and scrutiny committee on Monday, April 25.

The others include Healthwatch York's report into the closure and NHS England's Reflection, Learning and Assurance Report, which contains various lessons for the organisations involved.

It tells Vale of York CCG: "The provision of services from BPH should have ceased when concerns were first raised by the CQC (if not before).

The report says LYPFT "should not have delivered services from unsafe premises – concerns were raised but action should have been taken to move out sooner.

"LYPFT should have been more forceful in taking action in line with their accountabilities as a provider."

NHS Property Services is told is must ensure contractors meet agreed deadline.

"Assurance was given that refurbishments would be delivered to timeframes when this was not the case," the report states.

TEWV replaced LYPFT as the provider of the majority of York's mental health services, including Bootham Park Hospital, last year.

The NHS England report states: "Relationships between directors at the Vale of York CCG and LYPFT were professional but strained by the outcome of the tender process."

Regarding the closure of Bootham Park, it states: "patients they were transferred at short notice to other premises outside of the York area.

"This is a poor patient experience and could be detrimental to the health of users of the service."

But it later adds: "The closure of a hospital, such as Bootham Park Hospital, has the potential to cause serious harm to patients.

"While there is no evidence, at the current time, that harm occurred the risk and concern about the poor patient experience is such that coordination of the process of closure by a single agency is important."

The report criticises delays in carrying out improvements, which the CQC identified as required in September 2014.

It states: "The plans to upgrade the building were originally due for completion in July 2015, this slipped and the suggested date for completion (although slippages could still occur and were not taken into consideration) was February 2016.

"This was 17 months post the 2014 inspection when the hospital was considered ‘unfit for purpose’."

Paul Doughty, chairman of the council's Health and Adult Social Care Policy and Scrutiny Committee, said he found some aspects of the NHS England report questionable, including the suggestion that patients suffered no harm from being transferred, but said: "I am pleased to see a clear recommendation that aside from all the previously highlighted failings of some of the organisations involved, in the future the CQC should consult with local providers and commissioners before taking such drastic action."

He said: "Had this happened at the time alternative solutions may have been found so that the residents of York continued to get the care and the support they need closer to home and their families.

"I am deeply concerned by John Ransford's conclusions around the lack of strategic leadership and will be writing to the Chief Executives of the CQC, Vale of York CCG and LYPFT to ask they attend the committee again before the end of the year to advise how they have changed in light of the recommendations made by NHS England in their published report.”

Margaret Kitching, chief nurse for NHS England – North, said: “The closure of the hospital, and transfer of services in the period up to 1 October 2015, was a complex process involving a number of different organisations that collectively worked hard to try to minimise the impact the closure had on service users in the hospital and their families."