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Bootham Park Hospital closure – the regulatory background

29/10/2015
CQC has ordered a mental health facility, offering both inpatient and outpatient services, to close immediately. At the same time its services, commissioned by a local CCG, were transferred between CQC has ordered a mental health facility, offering both inpatient and outpatient services, to close immediately. At the same time its services, commissioned by a local CCG, were transferred between providers. The closure has now prompted a complaint to Monitor. We examine the different regulatory schemes involved.

Bootham Park Hospital was one of the first mental health hospitals in the world, built in 1777 as York Lunatic Asylum. More recently, it provided inpatient services to 29 people as well as outpatient services to approximately 400 people as part of Leeds and York Partnership NHS Foundation Trust ("the Foundation Trust"). However in recent years there have been concerns about the safety and suitability of its premises, at least partly due to the age of the Grade I listed building, which prevented some structural improvements being made.

Its services, which were commissioned by Vale of York CCG, were last inspected by CQC in December 2013, when it required significant improvements to facilities. Due to the age of the building there were ligature points that could not be removed and not all inpatients on a ward were visible from the nurses' station; CQC had required the provider to review the wards and remove all ligature points. Despite this, in 2014 an inpatient died after hanging from a ligature point in her room. The coroner recorded an open verdict after the Foundation Trust accepted that the ligature point should have been removed earlier. There were significant delays in making the improvements required by CQC, and due to its listed status English Heritage became involved in the discussions of how to implement the improvements. The Foundation Trust had informed CQC and Monitor of the delays (part of its operational plan with Monitor was to move inpatient services from Bootham Park), and on 9 September 2015 CQC began an unannounced inspection of inpatient services.

The inspection report has not yet been published, but a CQC statement notes that there was a risk of suicide or serious harm to patients as not all potentially dangerous building features could be removed. In addition inspectors found a risk of scalding, lack of call alarms, insufficient staffing and poor hygiene and infection control. Local media has also reported that, during the inspection, parts of the ceiling collapsed on inspectors. As a result of the inspection, on 24 September the Foundation Trust was informed that CQC required all patients and services, both inpatient and outpatient, to be transferred from Bootham Park by 30 September.

As part of a pre-agreed tender process by Vale of York CCG, on 1 October the services provided at Bootham Park transferred from the Foundation Trust to Tees, Esk and Wear Valleys NHS Foundation Trust ("TEWV"), despite the fact that at that point services were not operating. The tender process itself was the subject of a complaint to Monitor, the financial regulator of Foundation Trusts, about a potential conflict of interest. The next day TEWV applied to CQC for the registration of non-inpatient services; CQC have stated that this is being considered as soon as possible, and have since requested further information from TEWV. Local press has reported that potential sites for a new psychiatric hospital have also been identified.

While the care of Bootham Park's service users is clearly the priority, from a legal perspective it is interesting to note the range of regulatory regimes in play. CQC is the most obvious, as the regulator of the services involved, while Monitor has also been involved as the financial regulator. In addition, there has clearly been a conflict between building regulation and healthcare regulation – many of the improvements could not easily be made because of the building's listed status. What makes this particularly poignant is that the shortage of mental health beds in England may make this situation even harder for mental health patients in York; local press report that people are instead being admitted to hospitals 70 miles away.

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