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Initial Agreement Redesign of Mental Health Services

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Initial Agreement Redesign of Mental Health Services INITIAL AGREEMENT REDESIGN OF MENTAL HEALTH SERVICES ARGYLL AND BUTE CHP Rev 1.3 October 2010 INTENTIONAL BLANK PAGE A&BCHP: MH-IA Rev 1.3 DRAFT Page | 2 Document Control Information Version Version Date Author Approved 0 2nd September 2010 Rev 1 16th September 2010 Rev 1.1 20th September 2010 Rev 1.2 After 24th September Rev 1.3 18th October 2010 Final for NHSH&CIG David Ross Josephine Bown Lead Contacts Supervising Officer and Enquiries to: David Ross CHP Project Manager Planning, Contracting and Performance Victoria Integrated Care Centre 93 East King Street Helensburgh G84 7BU Telephone: 01436 655011 Fax: 01436 673877 Email: [email protected] Project Director Josephine Bown Head of Service Integration Lorn Medical Centre Soroba Road Oban PA34 4HE Telephone: 01631 570082 Fax: 01631 562708 Mobile: 07818 008796 Email: [email protected] Organisation Headquarters Argyll and Bute CHP NHS Highland Health Board Aros Offices Blarbuie Road Lochgilphead PA31 8LB Telephone: 01546 605646 Fax: 01546 605658 A&BCHP: MH-IA Rev 1.3 DRAFT Page | 3 CONTENTS 1 INTRODUCTION AND OVERVIEW 2 THE STRATEGIC CONTEXT 2.1 Organisational Overview 2.1.1 Argyll & Bute CHP 2.1.2 Geographical characteristics and local organisation 2.1.3 Health status and demography 2.1.4 Mental health services in Argyll and Bute 2.1.5 Argyll and Bute Hospital 2.1.6 Locality Hospitals in Argyll and Bute 2.2 Business and Health Strategies 2.2.1 Tackling Inequalities in Health: Equally Well 2.2.2 Potential Impacts of the CHP’s Mental Health Strategy on Tackling Inequalities 2.2.3 NHS Highland’s Response to Tackling Inequalities 2.2.4 Other National Policy Drivers of the Strategy 2.2.5 Locally Agreed Key Strategic Drivers 2.2.6 The Process of Service Redesign: The “Reference Compass” 2.2.7 The Strategic Development Plan Phases including Public Consultation Service Delivery Model Options to provide the Service Details of the Selected Service Option: “Option 4” 2.3 The Approved Service Strategy - Mental Health Services in Argyll and Bute 2010: Everyone’s Business 2.3.1 Support and Approvals 2.3.2 Scottish Government Approval 2.3.3 How the Strategy has moved forward since approval 2.3.4 Contribution to NHS Highland Objectives for Mental Health 2.3.5 Local Delivery Plan and HEAT targets 2.3.6 “Fit” with the Asset Management Strategy 2.3.7 Conclusion of Review of Strategic Context 3 THE CASE FOR CAPITAL INVESTMENT 3.1 Key project objectives 3.1.1 SMART Service/Business Objectives 3.1.2 SMART Sustainability Objectives 3.1.3 SMART Design Quality Objectives 3.2 Existing Arrangements – the Status Quo 3.2.1 In-patient mental health services 3.2.2 Specialist Therapies and Education Centre 3.2.3 Support Services and Infrastructure 3.2.4 Services wider than the mental health service - Catering 3.2.5 CHP centralised services 3.2.6 Community Mental Health Teams A&BCHP: MH-IA Rev 1.3 DRAFT Page | 4 3.3 The Business Gap between the Status Quo & the Strategic Objectives 3.4 Business Scope and 3,5 Resultant Key Service Requirements 3.5.1 Adult Acute Inpatient Services 3.5.2 Dementia Assessment Services 3.5.3 Intensive Psychiatric Care Unit (IPCU) 3.5.4 Rehabilitation services 3.5.5 Specialist Therapies and Education Centre 3.5.6 Essential integral support accommodation for the Inpatient and Specialist Therapies 3.5.7 Argyll and Bute Site Services 3.5.8 CMHT (Community Mental Health Team) Bases 3.6 Summary of service specification 3.7 Expected Benefits for patients and staff 3.8 Initial Identification of Risks 3.9 Initial identification of Constraints 3.10 Initial identification of Dependencies 4 THE WAY FORWARD 4.1 Critical Success Factors 4.2 Capital Development Options, Workshop and long-listing 4.3 Long List of Options, advantages and disadvantages of each option 4.4 Assessment of Options for Short-Listing 4.5 The Preferred Way Forward, Shortlisted Options 4.6 Financial Case 4.6.1 Capital Cost Estimates 4.6.2 Optimism Bias 4.6.3 Revenue and Life Cycle Costs 4.6.4 Available Funding Resource 4.6.4 Indicative Cost of New Service Design 4.7 Commercial Case 4.8 Project Management Arrangements 4.8.1 Project Governance and Structure 4.8.2 Project Board 4.8.3 Project Implementation Team 4.8.4 Service Redesign Groups and Areas of Action 4.8.5 Workforce and Organisational development 4.8.6 Principal Supply Chain Partner 4.8.7 Partnership Working 4.8.8 Project Timetable 4.8.9 Diagrams of Project Structure, Project Board and Implementation Team A&BCHP: MH-IA Rev 1.3 DRAFT Page | 5 1 INTRODUCTION AND OVERVIEW The Redesign and Modernisation of Mental Health Services in Argyll and Bute is a high priority for Argyll and Bute Community Health Partnership (the CHP), NHS Highland and for their partner organisations. It has already received significant development work and investment from all parties. A Strategic Vision for Mental Health In 2007, the CHP and Argyll and Bute Council together set out a broad picture of the future of mental health services in the region in a discussion document entitled “Building on Our Experience – A Vision for Mental Health Services in Argyll and Bute.” This Vision reflected the national strategic direction set out in “Delivering for Mental Health” which had been published the year before. The Vision is wide-ranging but broadly the direction of change is towards delivering services as locally as possible; offering tiered services which match the various tiers of need; increased use and integration of resources in the voluntary, local authority and community sectors; greater involvement of service users and their families; the provision of effective new models of crisis response; and the development of appropriate specialist interventions – increased access to psychotherapies, re- designed outpatient and day programmed interventions and appropriate in-patient care. The new Vision and its approach to delivering change was approved by the CHP, the Council and NHS Highland. Thereafter in the early part of 2008 the CHP embarked on a detailed and extensive exercise which delivered three things: an assessment of the needs of the service, the identification of potential options to deliver the service and a wide public consultation on the options. Five possible service options were identified, all of which were based on developing services in the community supported by different ways of providing the specialist in-patient component. Options for the in-patient beds ranged from providing the service within existing community hospitals to having no dedicated mental health in-patient beds in the region with an agreement to obtain the service from neighbouring health boards. Selection of the Service Strategy In April 2009 a formal option appraisal process identified “Service Option 4” as best meeting the new vision for the service. Strategy “Service Option 4” is to provide a flexible, central in-patient facility (with day treatment and education centre) in Lochgilphead and an enhanced community mental health service throughout the region. The option appraisal report and the results of the public consultation were entitled “Mental Health Services in Argyll and Bute 2010: Everyone’s Business”. The proposals were approved by NHS Highland in June 2009 and submitted to the Scottish Government for approval. The submission was supported by an independent report from the Scottish Health Council which endorsed the way in which the CHP had consulted widely and effectively at each stage of the proposals. A&BCHP: MH-IA Rev 1.3 DRAFT Page | 6 Approval of the Service Strategy: “Mental Health Services in Argyll and Bute 2010: Everyone’s Business”. In a letter of 15th July 2009 to the chair of NHS Highland the Cabinet Secretary for Health and Wellbeing gave approval to the plans as being consistent with national policy and suitable for the provision of a modern, fit-for-purpose service that will benefit patients. The Need for Investment This Initial Agreement document sets out the case for the capital investment necessary to deliver certain key elements of the approved strategy. The existing mental health in-patient unit in Lochgilphead is situated in the Argyll and Bute Hospital. This hospital is around 150 years old and unsurprisingly is functionally unsuitable for modern in- patient care. The current Property Strategy identifies 30% of space unused, with 85% of the space in use being underutilised. The Strategy identifies over £8m of backlog maintenance and several high risk items of Statutory Compliance which require to be addressed. The Argyll and Bute Hospital is not suitable to provide the new flexible in-patient unit and highly unlikely to be an economically favourable option. In addition to providing clinical services for mental health, the hospital also provides catering services for the adjacent Mid-Argyll Hospital and houses two centralised CHP functions, Estates management and storage and distribution. The strategy to replace the hospital requires to address solutions for these elements in addition to the clinical elements. Finally, the proposed strategy for mental health anticipates the development of Community Mental Health Teams in each of the four localities within the CHP. Investment is likely to be needed in some of the localities to facilitate the operation of the new model of care. Conclusion Argyll and Bute CHP is seeking approval from the Scottish Government to proceed to the production of an Outline Business Case for the Mental Health Project which will identify the preferred option to: • Provide a modern flexible in-patient and specialist day therapies centre in Lochgilphead • Provide solutions for the wider CHP services of catering, estates management and storage and distribution currently located in the Argyll and Bute Hospital • Provide effective accommodation for Community Mental Health Teams within the localities served.
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