Police can take people (under the Mental Health Act) from a public place to a health based place of safety (PoS) or 136 suite if they are in extreme mental distress and need to be detained for their own safety and the safety of others. A health based place of safety is a place where mental health professionals can assess people's needs and work out the best next steps. A health based place of safety is not an admission ward. An individual may be detained using the 1983 Mental Health Act for the purposes of assessing whether they have a mental disorder and if so whether they require further assessment or treatment. People taken to a place of safety are in crisis and usually highly distressed. Most are presenting a risk to themselves and sometimes to others.
People detained are not patients. They are detainees until a decision is made as to whether they have a mental disorder that requires further assessment or treatment. A bed is available in the place of safety suite, not as a bedroom, but rather to allow rest. It is extremely rare that a person in a place of safety suite would be visited by relatives during their brief stay.
In AWP our health based place of safety units are located and aligned to the two police constabularies that we work with, namely Avon and Somerset Constabulary and Wiltshire Constabulary. For Avon and Somerset – which serves Bristol, North Somerset, South Gloucestershire and BaNES - we provide a 24-hour staffed, four capacity health based place of safety at Mason Unit on the Southmead Hospital site, Bristol.
Across Wiltshire we have previously provided three single health based places of safety at Sandalwood Court in Swindon, Green Lane Hospital in Devizes and Fountain Way Hospital in Salisbury. We are currently operating a single 24-hour staffed, four capacity health based place of safety at Green Lane Hospital in Devizes for a 12 month pilot.
Pilot Place of Safety in Wiltshire and Swindon
The pilot started in March 2017 for 12 months. Due to quality issues identified by the Care Quality Commission (CQC) following an inspection of the Avon and Wiltshire Mental Health Partnership Trust (AWP) in 2016 and 2017, NHS England authorised the temporary consolidation of two of three health based places of safety suites in Swindon and Salisbury to a third site in Devizes for 12 months.
This will provide an opportunity to address the CQC's improvement requirements, particularly around assessment times. A key element of this will be to support the delivery of the Policing and Crime Act 2017 that amended the Mental Health Act to reduce the maximum period someone can be detained from 72 to 24 hours (this came into force on 11 December 2018).
The refurbishment at the Devizes site and the temporary closure of the Salisbury and Swindon suites occurred in early 2018 with the pilot suite opening on 26 March 2018. An engagement period is being undertaken with people in Swindon and Wiltshire and individuals using the service during the pilot, with interim reports to the Swindon Overview and Scrutiny Committee and Wiltshire Health Select Committee during the 12 months as required and an interim report after nine months. This will then lead to recommendations to NHS England and NHS Improvement. Longer term arrangements in relation to these health based place of safety suites will be subject to an NHS England assurance process.
What are the benefits of the temporary closure?
The main drivers for the temporary closure are improvements to the experience and the reduction in the length of time a person is detained. The changes to the model of care will also address the quality issues to the place of safety service identified in the CQC reports of 2016 and 2017.
There are several other benefits the service change will bring which have been highlighted under the CQC domains. These are as follows:
• A purpose-built environment at Devizes that offers improved safety and quality of environment
• Consolidating PoS on one site would enable the establishment of a dedicated team of staff who will ensure consistency in safe care
• Recruitment to a specialist team is more likely to be successful due to skills/experience opportunity available
• Recording of data in relation to performance incidents will be improved from one service/site
• The environment allows for staff from other agencies to be in the PoS for support without being in the direct clinical space
• An Approved Mental Health Professional (AMHP) will undertake assessment to avoid travel between PoS
• A specialist team of staff will ensure that screening, assessment and planning for discharge will occur immediately on arrival thereby improving flow. This is essential to meet the 24-hour limit for assessment
• Consolidation to one site offers the opportunity to develop a training matrix which recognises PoS as a specialist area
• Development of best practice across two PoS services in Swindon and Wiltshire
• Provision of a dedicated clinic room within the unit enables physical health monitoring as required
• A single consolidated unit will enable more effective communication with community teams and Urgent Care Clinical Hub
• Provides opportunity for more dedicated medical time to be established
• The provision of a dedicated skilled team will improve the quality of care provided
• The environment enables gender specific areas and space for people to be away from their individual rooms
• Improved environmental facilities such as a courtyard for accessing fresh air, a kitchen, a communal space, an assessment room with a bed and an ensuite bathroom
• Space for other agencies to be in the environment in separate areas without encroaching on people's personal space
• Co-located AMHPs to increase speed of assessments undertaken with a dedicated team of staff
• Dedicated space to enable the Intensive Support Team to undertake crisis community assessments
• Improved time to assessment more likely to reduce conversion rate (to admission/detention). Multi-agency model will reduce the likelihood of breach to detention time limits
• Dedicated team available 24/7
• Increased capacity by 33 percent (one bed)
• Opportunities for synchronicity with other services in the pathway
• Single service will enable better system resilience
• Patients will be provided with transport home
• Single clinical leadership structure with identifiable Clinical Lead and Clinical Director
• The dedicated team will enable supervision to be tailored to the work and requirements of the service
• A dedicated team manager and single locality management structure
• Identifiable management will improve inter-agency relationships and enable a responsive escalation process for partners
• Improved ownership of performance for place of safety activity by single management structure
• A dedicated team will enable staff development to be tailored to the work and requirements of the service
Please share your views and comments with us
We would like to hear your views and comments about the temporary closure of the Swindon place of safety suite. Contact us in the following ways:
By email: firstname.lastname@example.org
By telephone: Chippenham: 01249 468 261 or Freephone: 0800 073 1778
By writing to:
Places of Safety Feedback
Avon and Wiltshire Partnership Mental Health NHS Trust
Langley Park Estate