Mental health trust pulls out of chronic fatigue service - East London Foundation Trust

Sly Saint · Mar 5, 2018

04/03/2018

East London Foundation Trust (ELFT) has stopped taking referrals for patients with chronic fatigue syndrome in City and Hackney and will cease running the service from April this year.

City and Hackney clinical commissioning group (CCG) said the mental health trust had decided to end the service because it considered the provision ‘not part of their core business.’

The CCG is planning to commission a new Complex Chronic Conditions service locally that would include the existing pain clinic service at St Leonards Hospital.

In the meantime GPs have been told to refer new patients to the Royal Free Hospital.

Chronic Fatigue syndrome, also known as ME or myalgic encephalomyelitis, is a debilitating long-term illness with a wide range of symptoms including extreme tiredness.

Around 70 patients a year in City and Hackney are referred to the chronic fatigue service. Around 50 of these patients go on to receive treatment for Chronic Fatigue.

Under-18s who show symptoms of chronic fatigue will continue to have an initial assessment with the child and adolescent mental health services (CAMHS).

Children who require treatment will be referred to the Royal Free Hospital's all-age service.

A CCG spokesman said: ‘It is planned that a City and Hackney-only service will be provided locally as part of the Homerton pain clinic.

‘Joining pain and chronic fatigue together makes clinical sense as the two share some similarities in terms of treatments. It also means that we will be able to retain local provision.’

He said the new service was expected to be operational ‘later this year’ but in the meantime local GPs had been asked to refer patients with Chronic Fatigue to the Royal Free Hospital.

Read about treatments available for Chronic Fatigue Syndrome on the NHS Choices and ME Association websites.
Click to expand...

http://www.healthwatchhackney.co.uk...-out-city-and-hackney-chronic-fatigue-service

Esther12 · Mar 5, 2018

So getting rid of White's clinic is surely a good thing...

but the CCG are doing all they can to make things even worse than they were.

"The CCG is planning to commission a new Complex Chronic Conditions service locally that would include the existing pain clinic service at St Leonards Hospital."

"‘Joining pain and chronic fatigue together makes clinical sense as the two share some similarities in terms of treatments. It also means that we will be able to retain local provision.’"

MEMarge · Mar 5, 2018

One of the first MUS Clinics?!!!!!!!!

lunarswirls · Mar 6, 2018

2. Replacement of the Chronic Fatigue Service

2.1 Background and Current Position

Having given the CCG notice to terminate delivering the service, on 31st March 2018 ELFT will cease to operate its Chronic Fatigue Service for ELC CCG’s (Newham, Tower Hamlets and City & Hackney). As of December 2017, ELFT is no longer accepting referrals for City and Hackney Patients and the CCG will be spot purchasing from its Non-Costed Activity Budget.

The new service model will replace the tri-borough model with a City and Hackney only service. It will also combine chronic pain and chronic fatigue within a Complex Chronic Condition Services. Recommended treatments for chronic fatigue and chronic pain share important similarities such as the use of physiotherapy, psychology and occupational therapy with required medical input. The new combined service will therefore allow expertise to be shared between chronic pain and chronic fatigue. It is also essential that the service is commissioned locally as this patient group find it hard to travel. Combining fatigue and pain services will also lead to economies of scale meaning the service offers better value for money than if it was procured.

The Homerton University Hospital are the only local provider of a chronic pain service and are a provider that is fully integrated into the Hackney and City integrated commissioning arrangements. As a provider they also have locally accessible clinical space that can be used to deliver the services.

2.2 Key issues

Spot purchasing is 82% more expensive compared to a locally commissioned services. City and Hackney receive approximately 70 patients per year for Chronic Fatigue Assessment and Treatment. The average cost of a full treatment from a spot purchase arrangement is £4,258 compared to an estimated cost of £2,327 for a locally commissioned service. Although it is possible a local service could lead to a higher volume of demand, nevertheless it seems likely that a local service would be less costly than spot purchase arrangement. Service level agreements are only marginally less expensive. Furthermore, Chronic Fatigue patients tend to find travelling problematic particularly in the initial phases of treatment and hence there are strong advantages to providing a local service. Therefore providing a replacement service will be significantly less expensive than the alternative of spot purchasing arrangement and better for patients. Economies of scale can be realised by aligning the new service to HUH’s pain clinic.

2.3 Service Objectives

To provide an equitable specialist CFS/ME service across City and Hackney

To provide specialist input based on need in proportion to the population profile

To implement NICE guidance

To improve Health and wellbeing promoting social inclusion and improving economic productivity

To ensure, that appropriate targets are met

To ensure people with CFS/ME have improved health and wellbeing outcomes including social inclusion, and access to mainstream health and social care systems

To ensure sufficient capacity, utilised productively to:

Provide timely response

Promote Patient Choice

Avoid Waiting lists

Provide specialist therapy skills where required

2.4. Service Model

2.4.1 Provider: The replacement service will managed by Homerton University Hospital NHS Foundation Trust

2.4.2 Location: Chronic Fatigue Service, 'A' Block, St Leonard's, Nuttall Street, London, N1 5LZ

2.4.3 Days / hours of operation
Monday – Friday 9am-5pm

2.4.4 Referral processes
GP or other medical practitioner (Medical test conducted and included in referrals)

The therapies and treatments offered are consistent with the NICE guidelines
(http://guidance.nice.org.uk/)

2.4.5 The Model of Care

The NICE (2007) guidelines describe a specialist CFS/ME service as:
‘A service providing expertise in assessing, diagnosing and advising on the Clinical management of CFS/ME, including symptom control and specific interventions. Ideally this is provided by a multidisciplinary team, which will have appropriate access to clinicians with a special interest in the condition’

The service will offer a stepped approach dependent on need and based on the levels of severity as defined in the NICE guidance. Providing a person-centred programme that aims to:

Sustain or extend the physical, emotional and cognitive capacity based on their needs, the type, duration, complexity and severity of their symptoms and the presence of co-morbidities

Manage and treat the physical and emotional impact of symptoms and their underlying cause.

Signpost to appropriate local support networks, health, social care, employment and voluntary organisations dependent on need.

Facilitate effective management which includes engagement with family and carers

Meet the identified needs of adults (18+) in the City & Hackney and be equitable across this area.

Liaise with children’s services regarding transitions to adult services and the development of children’s services

3.3.6 The Care Pathway

The care pathway is shown in the diagram below. As can be seen the first stage of the diagnostics involving bloods and a general assessment is conducted by the GP. This avoids unnecessary referrals into secondary care and keeps the first stage accessible and close to the patient’s home. If there is diagnostic uncertainty the GP can refer to a secondary care. If there is physical health diagnostic uncertainty this might be to HUH rheumatology or general medicine. On the mental health side this might be to psychiatry within ELFT’s Primary Care Liaison Service or CHAMRAS assessment service.

If there are clear diagnostic indicators for Chronic Fatigue a referral is made to the Complex Chronic Condition Service where a further assessment will be done. Again if there is diagnostic uncertainty a referral to psychiatry, general medicine or rheumatology will be made. Once the diagnosis is clear the service will complete NICE recommended chronic fatigue treatments.

Figure 1: Chronic Fatigue Care Pathway (refer to source PDF for flowchart)

Supporting Papers and Evidence:

NICE 22 Aug 2007: Chronic Fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management.

Sign-off:

[Papers for approval by the ICBs must be signed off by the appropriate senior officers. Any paper with financial implications must be signed by the Members of the Finance Economy Group.

If there are any legal implications which require consultation with legal counsel, please make reference to that below.

Copies of email sign-off should be sent to the Secretariat (matthewhopkinson@nhs.net) along with the papers. Papers which have not been
signed-off by the appropriate officers will not be considered by the Committee.]

Workstream SRO - This paper has been approved by the Mental Health Co-ordinating Committee, which includes the Workstream Directors. It has also been approved by the CCG Finance and Performance Committee and the CCG Clinical Executive. The following people have been cited and had an opportunity to input into the proposals.

Planned Care Workstream Director: Siobhan Harper
Unplanned Care Workstream Director: Nina Griffith
Prevention Workstream Director Gareth Wall
City and Hackney CCG: Dr Mark Ricketts, Chair, City and Hackney CCG
City and Hackney CCG: David Maher, Acting Managing Director
City and Hackney CCG: Dr Rhiannon England, Mental Health Clinical Lead
East London NHS Foundation Trust: Dr David Bridle, City & Hackney Clinical Director
London Borough of Hackney: Nicole Klynman,
London Borough of Hackney: Lesley Hill, Strategic Commissioning Lead for MH, Homelessness, Advocacy
City of London Corporation: Chris Pelham, Assistant Director of People, Department of Community and Children’s Services
City of London Corporation: Mark Davidson, Senior Commissioning Manager
Click to expand...

http://www.cityandhackneyccg.nhs.uk/Downloads/About Us/Board Papers/Friday 26 January 2018 Governing Body Agenda and Papers.pdf

NelliePledge · Mar 6, 2018

This has happened/is happening across England already

JamBob · Apr 27, 2018

Seems like they are recruiting for a Band 8 psychologist with experience in Chronic Fatigue..... http://jobs.homerton.nhs.uk/job/v1027196

Esther12 · Apr 27, 2018

JamBob said: ↑

Seems like they are recruiting for a Band 8 psychologist with experience in Chronic Fatigue..... http://jobs.homerton.nhs.uk/job/v1027196
Click to expand...

From the job description:

2.1 Clinical responsibilities:
 Provide specialist psychological assessments of patients referred to the service based upon the appropriate use, interpretation and integration of highly complex data from a variety of sources including psychological and neuropsychological tests, self-report measures, rating scales, direct and indirect structured observations and semi-structured interviews with patients, family members and others involved in the patient’s care.
 Formulate and implement plans for the formal psychological treatment and/or management of problems, based upon an appropriate conceptual framework of those problems derived from a broad theoretical knowledge of psychology, employing evidence based practice and using cognitive-behavioural plus at least one other theoretical model (ACT, systemic).
 To provide consultation and joint interventions as appropriate with members of pain service/locomotor service.
 Be responsible for implementing a range of specialist psychological interventions for individuals, families and groups within primary and community care settings, including psycho-education sessions.
 Evaluate and make decisions about treatment options taking into account both theoretical and therapeutic models and highly complex factors concerning historical, developmental and cultural processes that have shaped the individual, family or group; taking the lead in providing psychological input for patients with chronic fatigue.
Click to expand...

adambeyoncelowe · Apr 27, 2018

It all sounds so complicated for a model so patently imaginary!

MEMarge · Apr 27, 2018

Locomotor Service? That's a new one to look out for!

Trish · Apr 27, 2018

MEMarge said: ↑

Locomotor Service? That's a new one to look out for!
Click to expand...

As a Harry Potter junkie, my mind immediately gives me two options for this:
- Locomotor mortis - the Leg locker curse which binds the legs of the victim together.
- The Locomotor charm which enables the witch or wizard to raise a chosen object a few inches off the ground and move it to the required location.

I hope they are teaching the charm, not the curse.

Alvin · Apr 27, 2018

adambeyoncelowe said: ↑

It all sounds so complicated for a model so patently imaginary!
Click to expand...

Never underestimate the appeal of alternative facts

Sly Saint · Sep 2, 2018

NHS West Essex
Service Restriction Policies
Documents
"
Chronic Fatigue Syndrome/Myalgic encephalomyelitis
(CFS/ME) Inpatient Treatment Status:Not Routinely Funded

Funding for inpatient care will not be funded.

Patients should be diagnosed and managed in a community setting.

Referral for a local specialist opinion may be required if there is doubt about the
diagnosis, or the patient is not improving despite management in primary care.
There is limited high quality evidence relating to the effectiveness of intervention in CFS.
There is evidence of effectiveness from randomised controlled trials of cognitive
behavioural therapy (CBT) and graded exercise therapy (GET). Guidance on the
management of patients is provided in the latest clinical guideline from NICE1."

reviewed May 2018
https://westessexccg.nhs.uk/health-...ephalomyelitis-cfsme-inpatient-treatment/file

Wonko · Sep 2, 2018

Yes, there is evidence of CBT/GETs effectiveness - it shows it isn't effective.

Anecdotal evidence also suggests that not only is it not effective it is defective, and causes harm, and possibly future lawsuits.

ladycatlover · Sep 2, 2018

Sly Saint said: ↑

There is evidence of effectiveness from randomised controlled trials of cognitive
behavioural therapy (CBT) and graded exercise therapy (GET). Guidance on the
management of patients is provided in the latest clinical guideline from NICE1.
Click to expand...

rvallee · Sep 2, 2018

Esther12 said: ↑

From the job description:
Click to expand...

They totally got MBAs involved in this, right? This is basically the medical equivalent of a corporate word salad.

I can't tell their mumbo jumbo apart from sarcastic nonsense:

This clinic will objectively redefine one-to-one paradigms, efficiently myocardinate fully tested architectures that interactively mesh end-to-end functionalities and continually coordinate performance based clouds to promote progressively mesh error-free leadership, energistically formulate B2C paradigms that fungibly maximize user-centric methodologies.

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