Mental Health Services Old Age Psychiatry – Acute Admission
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Mental Health Services Old Age Psychiatry – Acute Admission Option and Benefits Appraisal 30 January 2014 1. Introduction NHS Lanarkshire currently provides older people’s mental health acute admission inpatient services based in a number of sites across Lanarkshire. Although these services continue to meet the needs of patients it is recognised that the demand for inpatient services is changing as more care is delivered in community settings closer to where people live. It is also recognised that continued developments in therapeutic interventions, and the provision of appropriate environments to meet the strategic aspirations for these services, are limited within the current inpatient estate. NHS Lanarkshire has, therefore, undertaken an Option Appraisal exercise to consider the future provision of these services. This report sets out the process which was undertaken and identifies the outcome of the event. Participants in the process included representation from patient and carers, clinical service leads, staff side, Local Authority and NHS Lanarkshire Mental Health and Learning Disability management. 2. Background Admission services for Old Age Psychiatry are provided from a total of 124 acute admissions beds which are located at: Location Available beds Wishaw General Hospital 23 Coathill Hospital, Coatbridge 20 Airbles Road Centre, Motherwell 16 Udston Hospital, Hamilton 60 Hairmyres Hospital, East Kilbride. 5 Total 124 On average only 70 of these beds are in use each night. The demographic landscape has changed significantly in recent years and the clinical requirements of patients have progressed similarly. The current Scottish Government and NHS Lanarkshire strategy via the Reshaping Care of Older People (RCOP) initiative, Scotland’s Dementia Strategy and The Quality G Johnston 2 300114 - final Strategy is to deliver a range of clinical services within patients’ local communities to allow patients to remain in their own homes as long as possible. Admission to hospital should be only when clinically appropriate and for as short a period as required without undue delays in returning home. Significant investment has been made in developing the capacity and capability in community settings through both the mental health modernisation programme and most recently through the Change Fund for Older People. These developments have enabled more people to be cared for at home and in turn has lessened dependence on in-patient provision. Given the strategic direction of travel and current bed occupancy it is appropriate to review how these services should be provided and to consider which hospital sites would provide the best future locations for old age psychiatry admission wards. There is also recognition that there should be a continued shift in the balance of care with the provision of community services for older people with mental health issues continuing to develop as part of the wider RCOP strategy. Note 1: It is important to differentiate between the requirement to consider how the clinical service can be best delivered and the service configuration required to provide this, and the actual inpatient bed capacity required to meet the needs of the patient population. This Option Appraisal has been undertaken to review the method and location of service delivery recognising that bed requirements are significantly less than are currently available. The final assessment of bed requirements will emerge once the optional appraisal process is completed and a definitive direction of travel is agreed. Note 2: Patients in the Northern Corridor, Cambuslang and Rutherglen will continue to be able to use the same hospital services as they currently do when these areas transfer from NHS Greater Glasgow and Clyde to NHS Lanarkshire on 1 April 2014. Announcing the changes to boundaries, Cabinet Secretary Alex Neil stated that patients will “stay with the same GP Practice and continue to receive treatment in their local hospital, even if their catchment area has changed.” Therefore a key commitment is that there will not be any changes to hospital flows as a direct result of the changes to health board boundaries and patients will continue to be able to access the same local hospital after 1 April 2014. The NHS reviews services on an ongoing basis to ensure they provide the right level of care for patients. Any future reviews relating to acute hospital flows would be carried out with the involvement of patients and carers. G Johnston 3 300114 - final 3. Option Appraisal process In line with Scottish Government requirements on engagement and consultation with stakeholders an Option and Benefits Appraisal process to determine available options and then assess these against a number of agreed benefits criteria was undertaken by NHS Lanarkshire in a clear and structured manner. The process was fully inclusive with representation from patient representatives and carers, clinical service leads, staff side representation, Local Authority and locality management team members. The process was led by NHS Lanarkshire’s Head of Management Services and was attended by a Scottish Health Council representative in an observational capacity. The process comprised 3 separate phases which were designed to ensure that stakeholders were fully aware of the Option and Benefits Appraisal process and had full opportunity to participate. The phases were: Engagement 5 events were held to describe the process/timescale and to Process provide the opportunity for patients, carers, staff and members of the public to register to attend the formal option appraisal events. The events were publicised in advance in local newspapers, the NHS Lanarkshire web site and through various staff, service user and carer groups. The events were held at: Coathill - 7th August 2013 Udston - 8th August 2013 Carluke Health Centre - 9th August 2013 St Andrew’s Community Hall, Motherwell - 22nd August 2013 Alona Hotel, Bellshill- 18th September 2013 A series of briefings also took place outlining the background to and process of the options appraisal at the North Lanarkshire Dementia Cafés Benefits criteria/ A workshop event was held on Thursday 12th September Long Listing 2013 at St Andrews Church, Motherwell and a list of attendees is attached at Appendix 1. The event commenced at 11.00am and finished at 3.00pm. Option appraisal A formal option appraisal event was held on Friday 20th G Johnston 4 300114 - final & scoring September 2013 at NHSL Headquarters, Kirklands and a list of attendees is attached at Appendix 2. The event commenced at 14.00pm and finished at 16.30pm. 4. Benefits Criteria and Development of long List of Options Following a presentation setting out the current service requirements and patient activity levels it was agreed that the attendees would define suitable benefits criteria and weighting, and then develop a long list of possible options. The results of these exercises would then from the basis of the formal Option and Benefits Appraisal which would be undertaken by a sub-group. The rationale and purpose of benefits criteria were explained in detail and the importance of weighting each criterion appropriately was fully discussed. The group agreed that they understood the concept as explained and spent a considerable time discussing the definition of individual benefits criteria and relative weightings. The group agreed a definitive list of benefits criteria and weightings and these are set out in the table below. The group also agreed to apply a simple scoring of 0 – 5 where a score of 5 represents a strong achievement of the relevant criteria. Agreed Benefit Criteria Agreed weighting Delivery of quality integrated clinical services 30% Accessible by transport 20% Flexibility/future-proofing 10% Operational Sustainability 15% Feasible to implement 10% Affordability 15% The group also agreed a detailed description for each of the Benefits Criteria and these are set out at Appendix 3. The group was then tasked with developing a long list of options for further consideration and broke into 4 groups to take this forward. Each group had a facilitator who recorded the options agreed by the group. The output of each group work session was formally fed back to the wider group and all comments noted were formally recorded. The full list of outputs is attached at Appendix 4 and details which options were proposed by each group. A summary long list of the options proposed for further consideration is set out in the table below: G Johnston 5 300114 - final Draft Long List Options 1 Do nothing (status quo) 2 Collocate with acute units 2a 1 Unit – NHSL wide located at Hairmyres, Monklands or Wishaw 2b 2 Units – Hairmyres & Monklands 2c 2 Units - Hairmyres & Wishaw 2d 3 Units – Hairmyres, Monklands & Wishaw 3 Geographical Units 3a 1 North/ 1 South – Non Acute sites 3b Coathill & Udston 4 Include Satellite Units 4a Option 2a + 1 satellite 4b Option 2a + More than 1 satellite 4c Option 2b + 1 satellite 4d Option 2b + More than 1 satellite 4e Option 2c + 1 satellite 4f Option 2c + More than 1 satellite 4g Option 2d + 1 satellite 4h Option 2d + More than 1 satellite 5 Utilise existing Local Authority units 6 Purchase service from Third party 7 Redevelop Hartwood site 8 Portable hospital/Hospital at home 9 New build The benefits criteria & weightings, the full list of outputs and the summary long list of options were issued to all attendees on Tuesday 17th September 2013 in order that they could review these in advance of the Option Appraisal & Scoring event on Friday 20th September 2013. Formal comments on proposed changes were requested by close of play on Thursday 19th September 2013. 5. Option Appraisal & Scoring No formal comments were received from any of the attendees at the initial event and it was agreed that the sub-group would carry out a formal option G Johnston 6 300114 - final appraisal of each of the long listed options using the previously agreed benefits criteria, weighting and scoring. The sub-group elected initially to score all options included in the long list and undertook a full benefits analysis and agreed a collective score for each option in respect of every benefit criteria.