INITIAL AGREEMENT
REDESIGN OF MENTAL HEALTH SERVICES ARGYLL AND BUTE CHP
Rev 1.3 October 2010
INTENTIONAL BLANK PAGE
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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
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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
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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
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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.
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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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2 THE STRATEGIC CONTEXT
2.1 ORGANISATIONAL OVERVIEW
2.1.1 Argyll & Bute CHP Argyll & Bute CHP is one of four CHPs within NHS Highland. It manages acute, primary, community health and mental health services across Argyll and Bute. The population served is 91,000 people and the CHP budget of £171m is the largest of the four CHPs and employs the largest number of staff at over 2,000. The CHP is co-terminous with the Argyll and Bute Council and there is a strong operational partnership between the two organisations.
Community Health Partnerships
Community Health Partnerships will put the healthcare needs of patients and local communities first and involve communities in decisions that effect them.
North Highland South East Highland • Budget: £ 43m • Budget: £ 85m • Population: 40,000 • Population: 90,000 • Staff: 750 • Staff: 1,300
Mid Highland Argyll & Bute • Budget: £ 70m • Budget: £ 171m • Population: 80,000 • Population: 90,000 • Staff: 900 • Staff: 2,000
2.1.2 Geographical characteristics and local organisation Argyll and Bute is one of the most attractive and beautiful areas of Scotland. It is some 2,600 square miles in area so is sparsely populated area with many remote and rural localities. The diverse range of settlements includes 6 towns, 46 villages, 156 small settlements and 26 inhabited islands. During the summer there is an influx of tourists which temporarily increases the population significantly.
In order to meet this geographical challenge The CHP organises its services into 4 localities, the better to focus services close to the communities served.
Localities of the Argyll and Bute Community Health Partnership
• Oban, Lorn and the Isles population 20,094
• Mid Argyll, Kintyre and Islay population 21,330
• Cowal and Bute population 22,872
• Helensburgh and Lomond population 26,740
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2.1.3 Health status and demography The proportion of people of pensionable age is above both the NHS Highland and Scottish average at 24% of the population. Generally levels of morbidity and deprivation are below the Scottish average but health inequalities associated with rural deprivation do exist. NHS Highland’s strategic plans are aimed at tackling these inequalities while delivering appropriate care to the diverse and widely scattered geographical area. One characteristic of morbidity in NHS Highland is the above average hospital admission rate for alcohol misuse. While Argyll and Bute CHP has a rate lower than the other CHPs in Highland, at 840 hospital admissions per 100,000 population it is still well above the Scottish average of 723 per 100,000. (NHS Highland DPH Report 2008/09)
2.1.4 Mental health services in Argyll and Bute Mental health services are provided firstly as a range of locality based community services. The modernisation strategy for mental health services is already being implemented and so the shape of the service is already beginning to change. Community Mental Health Teams are being developed in each of the four localities and there are initiatives to developed Guided Self-Help and to increase support for third sector organisations/voluntary support agencies.
2.1.5 Argyll and Bute Hospital In-patient services for mental health are currently provided from the Argyll and Bute Hospital in Lochgilphead. The current in-patient provision is: Acute Adult Mental Health In-patients – 24 beds in use in Succoth Ward (26 bed complement) Intensive psychiatric care unit – 7-9 beds in use in ward of maximum 12 beds Rehabilitation – 12 beds in Tigh-na-Linne Elderly - dementia assessment service – 12-14 beds in use in Cowal ward (16 bed complement)
In addition to these beds in the specialist hospital there are elderly mental health beds in the Mid Argyll Community Hospital and Integrated Care Centre, Knapdale Ward (12 beds), Cara ward (8 beds).
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2.1.6 Locality Hospitals in Argyll and Bute The CHP manages one Rural General Hospital, the Lorn and Islands Hospital in Oban and six Community Hospitals distributed in the 4 localities. The community hospitals are Campbeltown Hospital, Dunaros Hospital on Mull (shared facility with Argyll and Bute Council), Cowal Community Hospital Dunoon, Islay Hospital (shared facility with Argyll and Bute Council), Victoria Hospital and Annexe in Rothesay and Mid-Argyll Community Hospital and Integrated Care Centre in Lochgilphead. Helensburgh and Lomond locality does not have a locality hospital but The Victoria Integrated Care Centre in Helensburgh provides outpatient facilities and is a base for NHS and social work staff including a Community Mental Health Team.
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2.2 BUSINESS AND HEALTH STRATEGIES
The CHP’s Mental Health Modernisation programme sits directly within National, Health Board and local priorities to improve health.
2.2.1 Tackling Inequalities in Health: Equally Well Equally Well: The report of the Scottish Governments Ministerial Task Force on Health Inequalities (2008) identified five strategic objectives corresponding to the Government’s aims for a Smarter, Wealthier and Fairer, Greener, Safer and Stronger and Healthier Scotland. The Argyll and Bute Mental Health Modernisation Programme will directly impact the following Task Force recommendations.
2.2.2 Potential Impacts of the Mental Health Strategy on Tackling Inequalities: A) Smarter Scotland: Early Years and Young People: Recommendations 3, 7, 8, 9, 11 and 15 These recommendations are all aimed at supporting vulnerable families, especially those where alcohol and drugs are misused. A key determinant of mental health in later life is conditions in the family of origin. The Mental Health programme aims at providing holistic and supportive care for patients at risk which will directly impact on the health and wellbeing of children in these families.
B) Wealthier and Fairer Scotland: Tackling poverty and increasing employment: Recommendations 22 and 26 As an employer vital to the local economies, Argyll and Bute CHP has the opportunity to act as exemplar in increasing and supporting healthy employment. The modernisation programme will offer job opportunities which are sustainable and rewarding because they are in new forward-looking effective programmes. The capital investment project will offer local employment and training opportunities through the PSCP partner and its subcontractors.
C) Greener Scotland: Physical Environments and Transport: Recommendations 27, 28, 29, 30, 32 The project to provide a new in-patient facility for Mental Health Care is a great opportunity to create an exemplar environment for human habitation, albeit temporary habitation by any individual. The project brief will address all aspects of the use of greenspace to affect well-being and encourage exercise and it will connect the new environment with other community initiatives. The brief will promote efficient energy usage and sustainability initiatives.
D) Safer and Stronger Scotland: Harms to Health and Well-being: Alcohol, Drugs and Violence: Recommendations 38, 39, 40 and 43. These recommendations will be directly impacted on by the Mental Health Strategy.
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E) Healthier Scotland: Health and Wellbeing: Recommendations 49, 50 These recommendations are specific to mental health and are direct drivers of the Mental Health Strategy of both NHS Highland and the CHP: Recommendation 49: NHS interventions to address depression, stress and anxiety should be increasingly targeted in deprived communities, ensuring that approaches to and materials used are appropriate. Recommendation 50: The next phase of Government- led work, following the National Programme for Improving Mental Health and Wellbeing should apply evidence of what works, in particular for those in disadvantaged groups and areas whose future health is at risk.
2.2.3 NHS Highland’s Response to Equally Well: Fit with the CHP’s Mental Health Strategy The Implementation Plan for “Equally Well” identified four priority areas – Early years, Big killer diseases, Drug and alcohol problems and links to violence and Mental Health. The Report of the Director of Public Health for NHS Highland for 2008/09 identifies that the Board’s response to the latter two priorities included being an Active Partner in the Drug and Alcohol Action Team covering Argyll and Bute Council area and implementing the Mental Health Delivery Plan.
2.2.4 Other National Policy Drivers of the Strategy The strategy was developed in response to the guidance and models set out in: Better Health, Better Care Scottish Government 2007 Delivering for Mental Health Scottish Executive 2006 Rights, Relationships and Recovery Scottish Executive 2006 Standards for Integrated Care Pathways in Mental Health Scottish Government 2007 National Standards for Integrated Care Pathways: Mental Health Scottish Government 2007 With Inclusion in Mind Scottish Government 2007 Realising potential: An action plan for allied health professionals in mental health Scottish Government 2010 NHS Performance (Health, Efficiency, Access, Treatment) targets
2.2.5 Locally Agreed Key Strategic Drivers for the CHP Mental Health Strategy From these National Policy Drivers a list, or a distillation, of the key messages and actions from this guidance was created. The list aims to provide an intelligible check-list of changes for all stakeholders. • Giving stakeholders a role and voice in the process • Provide services in partnership (voluntary and statutory) • Anticipating care needs and planning for them • Intervening earlier through health promotion and self-help • Provide direct support for primary care teams • Care for more people at home
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Locally Agreed Key Strategic Drivers (continued) • Provide crisis response out of hours • Provide more psychotherapeutic services (talking therapies) • Reduce number of admissions to acute mental health hospital • Reduce the length of stay of people in hospital • Re-provide modern, in-patient facilities • Provide community services for people who need long-term support or help (but don’t need to be in hospital) • Further develop the mental health nursing contribution to the therapeutic process • Implement and meet national standards for care & implement care pathways • Provide efficient and cost-effective services • Reduce inefficiency in resource use • Make better use of the assets of the CHP including the estate • Ensure that new business plans fit with and complement existing plans • Produce ‘synergy’ from other parts of the organisation’s business to complement mental health plans, e.g. locality hospitals, primary care, wider Mental Health Network. • Meeting the expressed needs of service users, families and carers, staff and the community. • Addressing ‘access’ issues where rurality and population sparsity create barriers • Ensuring service provision is comprehensive
2.2.6 The Process of Service Re-design The above National and Local Strategic drivers form the first point of a “Reference Compass” that guided the process of service re-design.
The “Reference Compass”
REFERENCE POINTS FOR STRATEGY DEVELOPMENT
Core Service Principles
“Fit” with National Policy existing & Local service Strategy
Stakeholders
In addition to National and Local Policy and Strategy, the other three reference points were defined as follows:
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Core service principles These were agreed with all stakeholders and constitute a consistently applied and easily understood reference point. • Respect the views and wishes of partners • Promote recovery & inclusion • Services will be provided locally by Argyll & Bute CHP and it’s partners • Meaningful involvement of the Voluntary / Third sector • Individuals will have equitable access to services • Service provision will be integrated across health and social care • Care will be predominantly provided in the individual’s community or own home, and hospital admission will be for the few • Where periods of hospital care are needed this will be provided is an environment that is modern, fit for purpose, relaxing, therapeutic and safe • Holistic care which takes account of the individual as a family member, a member of society, a worker, a carer, • Staff, users and carers will be involved in developing plans for services • Overall service provision will be comprehensive • Challenging choices will be faced openly and honestly
Stakeholders were identified as: • People who use the service • People who provide the service • People who support the service • People who want assurance that the service is there
“Fit” included fit with existing service provision such as healthcare services, social work, housing and leisure services, and also the voluntary sector.
These four reference points were used to formulate a Strategic Development Plan which was agreed with partners and conducted in 3 stages. An external consultancy, Research and Design in Mental Health (RDMH) was appointed in January 2008 to assist.
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2.2.7 The Strategic Development Plan
The Strategic Development Plan had three important and distinct Phases: Phase 1: Needs assessment and local engagement This included gathering information and talking with staff and the public to elicit their views Phase 2: Options Development and Appraisal – This phase focussed on agreeing the key themes and messages arising from Phase One, and using them as discussion themes for workshops. From this was identified a long list of options, which were appraised, and reduced to a short-list. All of these activities were undertaken with staff, service users, carers, members of local communities, voluntary sector and other partners. Phase 3 – Public Consultation A formal public consultation process on five service options, commencing on 12th January 2009 and concluding on 10th April 2009.
Each of these stages was viewed as vitally important to the process, but none more so than the extensive consultation that was undertaken.
Service Model Diagram A clear service model was developed that satisfied all the strategic drivers and core service principles:
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Options considered A broad list of service options was considered and reduced to a short-list of five for scoring and costing. The short-listed options were: 1. Minimal change
2. Localised services, including in-patient beds in community hospitals
3. Flexible, central in-patient facility and enhanced community mental health service
4. Flexible, central in-patient facility (with specialist day treatment and education centre) and enhanced community mental health service
5. No in-patient beds within Argyll and Bute with community focused treatment with access to beds out with the area on an as required basis
A detailed Option Appraisal exercise was then undertaken including assessment of benefits, costs, risks and constraints. (The Option Appraisal report is available from the CHP.) The option which scored most highly was Service Option 4 During consultation local communities reiterated the high importance they gave to service accessibility. As a result of this Service Option 4 was enhanced to include the facility for (up to) 48 hour assessment in the local community hospital where this is clinically appropriate.
Details of the Selected Strategy “Service Option 4”
The key elements of Service Option 4 are: Primary and Community based care • Train a group of community volunteers in “guided self-help” to enable them to work with and support people with mild depression. • Provide additional training for staff to provide treatment for people with mild/moderate mental health issues. • New specialist primary mental health workers working closely with individuals experiencing distress from mild mental health problems, and guiding/supporting GPs, other health professionals and staff in voluntary organisations. • Existing Day Care and support services such as the Link Clubs and local mental health community projects reviewed to ensure they focus on promoting well being and independence and to ensure they are reaching people who might not otherwise seek out this type of service.
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Community Mental Health Teams (CMHTs) • Put in place in all localities a range of professional staff operating a core service Monday to Friday, with an “out of hours” crisis response service operating 7 days. • These teams to provide full community mental health services to service users, carers and families in partnership with other agencies and primary care. • Teams help people in crisis, support them at home, provide rehabilitation, medicine management, and psychological therapies. • Admission to Locality Hospitals to provide (up to) 48 hours assessment (recommendation arising from formal consultation process) when clinically appropriate.
Hospital Services • There will be one hospital site in Lochgilphead which would include the following hospital beds; o Acute o Rehabilitation o Intensive care o Dementia assessment • The design to aim to offer therapeutic interventions that meet people’s needs, in a purpose built unit, offering a modern environment, with domestic and independent living areas. • Staff to support patients in Arran Ward (Rehabilitation) and their carers to find alternative ongoing care in a more homely setting, in their own home, in very supported housing, or, if not possible, in a Care Home.
Specialist Day Therapies and Education Centre • A specialist day assessment and therapy service, (to be known as the Specialist Therapies Centre) and an education centre to be developed alongside the inpatient service. • This will be a focus for very specialist psychological therapies for groups and individuals (“talking therapies”). • People living at a distance from the day service may have homely accommodation if needed for overnight stays, e.g. local B&Bs, hotels. • Patients’ travel and accommodation costs to be covered by the Highlands and Islands Travel Scheme. • The Centre for staff training to be a permanent and local base for staff development and training of NHS staff and colleagues in other partner agencies.
The selected strategy was named: “Mental Health Services in Argyll and Bute 2010: Everyone’s Business”.
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2.3 THE APPROVED SERVICE STRATEGY: MENTAL HEALTH SERVICES IN ARGYLL AND BUTE 2010: EVERYONE’S BUSINESS
2.3.1 Support and Approvals 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.
2.3.2 Scottish Government Approval 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.
2.3.3 How the Strategy has moved forward since approval Following receipt of Scottish Government approval of Service Option 4the original Project Board was re-constituted and an Implementation Team established.
Five Service Redesign Groups were created. Three of these began to directly addressing the “tiers” of the service model: Group 1 addressed Tiers 1/2; Primary care, early intervention, health improvement, self help Group 2 addressed Tiers 2/3; Managing mental illness in the community, crisis response. Group 3 addressed Tiers 3/4; Planning for long-term care, managing severe and enduring conditions, In-patient care, specialist psychological treatments
Group 4 (Interface Group), addressed services which interface and connect with acute mental health Service (Addictions, Learning Disability, Dementia, Child and Adolescent Mental Health)
There was also a support services or Infrastructure Group addressing non-clinical support services currently provided from the Argyll and Bute Hospital campus
To assist and support the Service Design groups a Workforce Planning group is in place drawing expertise from Community and Inpatient Mental Health services, Lead Nurse and AHP, Finance, Learning and Development, and HR.
Finally a Resettlement group has been formed as a sub-group of Tier group 3/4. This is a key piece of work as the aim is to discharge Long stay patients to the community, resulting in resource release.
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2.3.4 Contributing to Highland NHS Board’s Objectives for Mental Health In a report to the Highland NHS Board in December 2009, the CHP General Manager summarised how the Mental Health Strategy was contributing to meeting the following Board Objectives: 1. Improve the health of the most disadvantaged a. By services providing a wider range of care to people with mental health problems b. By supporting services to better meet the needs of individuals at risk of psychiatric hospital readmission 2. Shift the Balance of Care a. By continuing work to reduce readmissions, and by increasing community treatment options 3. Improve Access to Therapies a. By increasing availability of psychological therapies by redesign of processes, including working across teams b. By increasing the efficiency of diagnostic processes in dementia 4. Continue to develop sustainable and safe services a. By realigning existing older adult services with current needs b. By obtaining best value from the existing investment in psychological therapies.
Success in meeting these objectives will in part be measured by HEAT targets:- over/
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2.3.5 Contribution to the Local Delivery Plan and HEAT targets The following table indicates the local HEAT targets that might be expected to be impacted upon by the Mental Health Project. Through the OBC process, the actual likely impacts and how they are to be measured will be assessed.
Indicator HEAT Measure & Detail
Health Improvement H4.KPM1 - Specific Alcohol Brief Interventions Mental Health Achieve 3691brief interventions in line with SIGN 74 guidelines by 2010/11 Target H5.KPM1 - Specific Suicide Prevention Mental Health 50% of key frontline staff educated & trained in using suicide assessment Target tools/prevention training programmes by 2010 Efficiency E5.KPM1 Financial Performance Operate within agreed revenue resource and capital resource limits, and meet cash requirement. E6.KPM1 Cash Efficiencies Meet cash efficiency target. 2% per annum E7.KPM1 Electronic Management of Referrals Increase the % of new GP outpatient referrals into consultant led secondary care services managed electronically to 90% from Dec 2010 E10.KPM1 KSF and Personal Development Plan 80% of staff to have had a KSF/PDP review, completed and recorded on E-KSF by March 2011 Access to Services A11.KPM1 Drug Treatment: Referral to Assessment. By Dec 2010, 99% of clients referred for treatment will receive a date for assessment that falls within 4 weeks of referral received . A11.KPM2 Drug Treatment: Assessment to Treatment By Dec 2010, 90% of clients will receive a date for treatment that falls within 4 weeks of their care plan being agreed. A11.KPM3 Alcohol Treatment: Referral to Treatment By Dec 2010 90% of clients referred for treatment will receive a date for treatment that falls within 4 weeks of their care plan being agreed A12.KPM1 - Specific Faster access to Mental Health Services Mental Health By March 2013 no one will wait longer than 26 weeks from referral to treatment for Target specialist CAMHS services. During 2010/11 the Scottish Government will work with NHS Boards to develop an access target for psychological therapies for inclusion in HEAT in 2011/12. Treatment Appropriate for Patient T9.KPM1 - Specific Dementia Mental Health Increase nos. of patients' with an early diagnosis & management of dementia to Target 825 by Mar 2011 Specific Mental Prescribing of Antidepressants Health Target Reduce the prescribing rate (DDD per capita) of antidepressants to 29.3 by March 2010. (This target is being replaced in April 2010 by access to Psychological Therapies.) Specific Mental Reduction in Psychiatric Readmissions Health Target Reduce the number of readmissions (within 1 year of stay of at least 7 days) by 10% by Dec 2009 (Actual reduction achieved was 30% v national average of 26%)
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2.3.6 How the Mental Health Project relates to the Asset Management Strategy
The following extract from the Property Strategy 2007-2012 is pertinent to the Initial Agreement
Issue Action
Argyll & Bute Hospital Closure plans need to be progressed Mental Health modernisation project to as a matter of urgency as there are major issues in relation to support progression of new service model the estate on this site. It may be helpful to develop short, and estate requirements medium and long term plans for the site thereby enabling the most urgent issues to be addressed quickly (e.g. Health & Safety) and potentially releasing some of the financial resources from the site to contribute towards other A&B hospital short term site developments. Plans need to take into account the current rationalisation and decommissioning plan under utilisation of the Mid Argyll Community Hospital and to be developed and enacted Integrated Care Centre
Mid Argyll Community Hospital and Integrated Care Plans for alternative use should be Centre - The main issue relating to this new facility is its progressed so that the under utilisation current under-utilisation of the long term care ward and day issue can be resolved. This could also hospital. provide opportunities for resolving some of the issue in relation to A&B Hospital.
2.3.7 Conclusion of the Strategic Context The new mental health strategy for Argyll and Bute CHP “Mental Health Services in Argyll and Bute 2010: Everyone’s Business” (Service Option 4 of the strategic appraisal) has been approved by NHS Highland and by the Cabinet Secretary following wide consultation and agreement to the proposals. Some of the community and organisational changes have begun to be implemented.
An important component of the strategy is the provision of suitable accommodation for the specialist in-patient and specialist therapies services. Suitable accommodation is also required for the operational bases of the CMHTs in each locality. The Property Strategy has identified serious shortcomings with existing provision for inpatients.
This initial agreement proceeds to set out the preliminary economic case for investment, noting that:
Implementation of the changes described in this document will contribute to • The reduction of Inequalities in Health • Meeting the health improvement objectives of NHS Highland • Delivery of the Mental Health Strategy for Argyll and Bute • The Achievement of HEAT targets for Argyll and Bute CHP • More efficient Asset Management within the CHP • Increased Partnership working with Argyll and Bute Council through integrated service delivery.
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3 THE CASE FOR CAPITAL INVESTMENT
The aim of the proposed capital investment is to deliver the in-patient, specialist day and education services and CMHT base component of the Mental Health Strategy.
3.1 KEY PROJECT OBJECTIVES
Workshops Two workshops to agree SMART Investment Objectives for the Project were held.
Business and sustainability objectives were discussed on 9th September 2010. The workshop was attended by a broad range of staff and user representatives, all of whom had had an involvement through the Visioning stage of the project. Attendees included clinical staff; locality managers; user representatives from the Public Partnership Forum and ACUMEN (the mental health users’ network; the project director and project manager; a range of allied health professionals; social worker from Argyll and Bute Council; Community Mental Health Team representatives and others.
A second workshop to agree an early Design Statement was held on 13th September 2010. This was attended by an even broader range of staff including more clinical and ward managers and representatives from operational and estates staff. The Design Statement will be submitted to Architecture and Design Scotland as the Initial Agreement is submitted to the Capital Investment Group. A summary of the early ideas around Design Objectives is included here.
Investment objectives The objectives for the project were considered therefore under three main headings and the following tables list the Investment Objectives under these three main headings
• Business/operational objectives • Sustainability objectives • Design Quality objectives
Investment objectives/over
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3.1.1 SMART objectives – Business Objectives
Class Description of Objectives Measured by When delivered Strategic/ • Deliver the defined in-patient service as part of The Mental Health Progress in introduction of mental } Effectiveness Strategy, to ensure health needs are met health strategy by: } A) Improvement in Reports of SG } • Develop a Specialist Therapies & education centre in line with the Review visits to NHS Highland } strategy, to ensure health needs are met } Track at B) Improved HEAT targets for } 3, 6 and 12 • Develop fully functioning CMH Teams in each locality readmissions; drug & alcohol } months treatment and dementia early } operation • Compliance with the Mental Health Act assessment and treatment } } • Facilitate Joint working Council KPIs and targets – team } targets will be set; not currently } available } Business/ • Accommodate all appropriate admissions & meet target bed Admission rates } Operational utilisation } Meet discharge policy for } • Facilitate flexibility: lengths of stay in the specialist } o Flexible for different numbers of male/female patients service and reduced number of } o Accommodate different age groups readmissions (HEAT target) } o Accommodate different morbidities } Track at } 3, 6 and 12 • Adaptable to service changes Remain within revenue limits and } months meet future savings targets } operation • Shift the balance of revenue from inpatient care to community-based } care } } • Ensure a sustainable & well developed staffing model Staff retention levels; absence } rates
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3.1.1 (cont) SMART objectives – Business Objectives (continued)
Class Description of Objectives Measured by When delivered Operational/ Provide facilities/services that are “Fit for purpose”; designed using Compliance with all statutory Full design stage Environmental evidence based design and meet the requirements of the Design guidance Statement. This includes: Meets discharge model including } • Facilitates use of recovery approach in model of care reduced lengths of in-patient stay } } Track at • Therapeutic environment for inpatients Improved Recovery Index } 3, 6 and 12 o Promotes mental and physical well-being } months o High standards of privacy & dignity; Reduction in levels of prescribing } operation - pharmacy audit } • Support safe & effective clinical working Reduction in episodes of } o Appropriate clinical settings to manage different aspects of challenging behaviour } patient behaviour - Datex incidents reduced } - Level of complaints } reduced
Patient feedback – audit 6 months
Monthly HAI audit Operational Enable innovative • Implement full CMHT model by providing a base for the CMHT in } ways of working each locality that is clinically functional and efficiently used and Reduce readmissions (HEAT } accessible for patients; complies with stat standards target) } Track at } 3, 6 and 12 • Implement full Crisis Response model Number of CBT therapists } months employed } operation • Improve access to Specialist Psychological Therapies } Admissions with agreed } • Facilitate admissions where appropriate to Locality Hospitals diagnoses }
Improve estates • To ensure the CHPs assets are developed to maximise performance Improvement in HFS Energy 3 months performance and improve efficiency Report • Elimination or ameliorisation of the problems with the uneconomic Improvement in Estate Code state of A&B Hospital - problems of backlog maintenance, stat Survey: physical condition; stat 3 months compliance & functional unsuitability – Vacate as much as possible requirements/H&S; functional of A&B site & maximise disposal of site suitability and space utilisation
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3.1.2 SMART objectives – Sustainability
Description of Objective Measured by When delivered • Maximise energy BREEAM excellent Pre-Assessment – OBC, actual efficiency BREEAM certified rating – post construction.
EnCO2de Energy Targets Reviewed at each project milestone – OBC and FBC
Energy Performance Certificate Project Completion
• Introduce best practice Low Carbon design – Building Emission Rate (BER):- to reduce CO2 Planning Requirements to reduce the Target Emissions Rate (TER) by at least 15% emissions & meet Outline and Detailed planning targets under the New Technical Standards Requirements to reduce the TER by 30%. stages Carbon Reduction Commitment Ene1 – Reduction of CO2 Emissions (Required Credit for BREEAM Excellent) Ene5 – Low or Zero Carbon Technologies (Required Credit for BREEAM Excellent) Building Warrant Submission stage • Reduce lifetime costs Energy costs – measure of revenue savings due to reduced consumption when compared Status Quo option should be against the “energy cost” of the status quo option. known now from ERIC returns, but if not, quantified as part of Man11 – Ease of Maintenance OBC Life cycle review of all Man12 – Life Cycle Costing options considered. Ene5 – Low or Zero Carbon Technologies (Required Credit for BREEAM Excellent) Ene15 – Provision of Energy Efficient Equipment • Meet Green Transport BREEAM excellent Green Travel Plan production objectives as part of Planning submission Tra1 – Provision of Public Transport Tra2 – Proximity to amenities Tra3 – Cyclist Facilities Tra4 – Pedestrian & Cyclist Facilities Tra5 – Travel Plan (Required by Scottish Government) Tra6 – Maximum Car Park Capacity Tra7 – Travel Information Point Tra8 – Deliveries & Manoeuvring
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3.1.2 (cont) SMART objectives – Sustainability (continued)
Description of Objective Measured by When delivered • Positive impact on local BREEAM excellent Separate assessment for economy, leading to No specific credits, but sourcing local materials etc would have a positive impact on the construction stage and for final social benefit local economy, similarly with local amenities and public transport provision. project
Development of social enterprise initiatives 1-2 years • Positive impact on local BREEAM excellent Ecology study as part of EIA ecology LE1 – Reuse of Land submission to planners LE2 – Contaminated Land LE3 – Ecological Value of Site & Protection of ecological features LE4 – Mitigating Ecological Impact (Required Credit for BREEAM Excellent) LE5 – Enhancing Site Ecology LE6 – Long Term Impact on Biodiversity
Sustainability Objectives – Ranking by Project Team The Sustainability Objectives were prepared by the technical advisors to the CHP. In order to engage users and the project team with the issues and objectives, a ranking exercise was performed to determine those elements of sustainability that already enjoyed the support of the team and which would require further exploration during the course of the project.
The workshop users ranked the key objectives for sustainability as follows:
Most Important 1 Improved Energy Efficiency 2 Lower Energy Costs 3 Green Travel Plan/Positive effect on local economy 4 Lower Carbon Emissions 5 Positive effect on local ecology Least Important
3.1.3 Design Quality Objectives/Design Statement An initial design workshop was held on 13th September 2010. The Design Statement requires to be developed further during the Outline Business Case process but certain objectives have been identified at this early stage:
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3.1.3 SMART objectives – Design Quality – Initial List for Development
Class Description of Objectives/quality expectation Measured by/benchmarks Ethos Oriented towards recovery and return to the community; These ideas will be developed by visits to Offering peace, healing and sanctuary, safe and reassuring; other facilities; workshops with artist and Connected to the physical environment – seasons and wildness. architect and continued interrogation of the Connected to human life activity model of care for means by which the “Earthy”, grounded, promoting mindfulness and connection with reality environment can contribute to this. Space - respectful of individual privacy, yet offering community AEDET of existing facilities to be undertaken Therapeutic – functional and promoting well-being as a benchmark. Location and Connected with the wider community; convenient to Mid Argyll Community Hospital Easy to reach on foot from town centre and Access and Integrated Care Centre (MACHICC) and to Lochgilphead town; accommodates bus stop. Main entrance visible and staff/visitors for Mental Health Tribunal; accommodates arrivals of outpatients, visitors accessible. Suitable for patients to attend and staff. Also emergency admissions which may arrive by ambulance - potentially MACHICC for X-ray etc.; adequate car parking separate entrances from main entrance for emergency admissions and service traffic including for tribunal Externals Three levels of external environment are required: Specific requirements will be determined in 1) “Close”, ward access, planned therapeutic external spaces – courtyards may be consultation with various user groups. suitable for some patients who require close passive observation especially in intensive care unit. Balance to be created between security/control 2) Wider gardens and planned external environment with walking paths, varied and patient privacy and opportunity garden areas, sitting, communal, contemplative 3) Relationship with wider natural landscape especially Blarbuie Woodland, longer views to Loch Gilp; existing forest and hill landscape Public Ease of wayfinding balanced with controlled access/privacy for wards AEDET – weighting to be developed spaces & Welcoming and comfortable; intimate rather than grand; offering choice for visitors – visitors cafeteria, family-friendly visiting, quiet space Patient Range of spaces from private, safe and secure to more open, suitable for AEDET – weighting to be developed spaces conversation or dialogue, to community spaces; Offer choice; Not stark but comfortable and reassuring; No noise intrusion into private spaces Control of environment, opening windows, control of lighting Art Art integrated into design – choice of materials, colour palette, interior design, AEDET – weighting to be developed integrated artworks, opportunities for placement of art. User involvement in Art strategy Arts Accommodates visual art therapy, music therapy, other arts AEDET – weighting to be developed Staff Functional and Practical, Flexible spaces, Adaptable spaces, control of environmental AEDET – weighting to be developed conditions – ventilation, heat and lighting levels
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3.2 EXISTING ARRANGEMENTS FOR THE SERVICES AFFECTED BY THE INVESTMENT OBJECTIVES
3.2.1 In-patient mental health services The existing mental health in-patient unit in Lochgilphead is situated in the Argyll and Bute Hospital. This hospital is 150 years old and at its zenith had over 400 beds. As was typical of hospitals of its era it has an extensive supportive estate that provided rehabilitation and occupation for its patients whose stay in the hospital may have extended to months and even years. There was a hospital farm, green houses, laundry, chapel, mortuary, recreation hall and concert stage. As the model of care for mental health has changed the number of beds has gradually retracted to 60-70 beds. Many wards are completely empty and most space is grossly underutilised.
The following extract from the Estate Information Manual (v7.2 August 2009) gives a snapshot of the current situation: Estate Key Performance Indicators Performance 2007/8 Site Area (Hectares) 32.96 Building Areas (sq.m) 14,468 sq.m Physical condition - % of area in C/D (unsatisfactory) 96% Compliance with Statutory Standards - % of area in C/D 100% (unsatisfactory) Energy performance GJ/100 cu.m (Target 65 GJ/100 cu.m) 54 Energy Cost (£ per Annum) £237,857 Functional suitability - % of area in C/D (unsatisfactory) 91% Space utilisation - % of area unused or empty 30% Space utilisation - % of area under utilised (over time) 85% Quality of environment Poor Backlog Maintenance Expenditure Requirement (£000) £8,691 High Risk Items Fire, DDA, H&S
Space utilisation and Functional Suitability From this table it can be seen that 30% of space unused, with 85% of the space in use being underutilised. The accommodation is not functionally suitable for the management of acute mental health patients with 91% being graded as C/D (unsatisfactory)
The key factors that led to this categorisation of these sites were: • Privacy and dignity issues – multi-bed wards/bays and a lack of single rooms with en-suite WC/bathrooms • Inadequate provision of support facilities – number of toilets, wash hand basins, storage areas etc. • Poor internal layouts – travel distances, departmental relationships, patient observation, security etc • Patients in dispersed areas of the site with numerous access points • Poor quality of internal environment – standards of décor, lighting, furniture and fittings etc. The buildings are sufficiently outdated as to be highly unlikely to be easily adapted to meet modern standards.
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Physical Condition, Compliance and Backlog Maintenance The Physical Condition of 96% of the hospital is in category C/D unsatisfactory and the overall quality of environment for patients and staff is poor. As over £8m worth of backlog maintenance has been identified, it is highly unlikely that the environment could be economically improved. There are several high risk items of Statutory Compliance which require to be addressed.
3.2.2 Specialist Therapies and Education Centre The service proposals for much of this element are for a new service not currently provided by the CHP. The geography of the region presents particular challenges in providing accessible but sustainable specialist services. An example might be that there are 1 or 2 clinical psychology/psychological therapy staff with expertise in the management of trauma. Such staff are likely to be offering a general service to a specific locality, but the demand for their service is CHP- wide. The new service model will offer: • A specialist day assessment and treatment service alongside the inpatient service which will be a focus for those very specialist psychological therapies for groups and individuals which are not available in Community Mental Health Teams. • An education centre for staff and partner (including voluntary) organisation training To ensure local & easy access for the vast majority of individuals requiring psychological therapy the most frequently used therapies will be provided in CMHTs by Cognitive Behavioural Therapists and Primary Mental Health Workers. The Argyll and Bute Hospital does have accommodation for outpatient groups and individual consultations. There are also rooms where seminars and teaching are carried out. As with the in- patient accommodation, most of the available accommodation is functionally unsuitable and in poor physical condition. However there is no day patient facility to provide focussed specialist treatment or to assist in the avoidance of inappropriate admissions.
3.2.3 Support Services and Infrastructure The Argyll and Bute Hospital currently provides the supporting infrastructure to the mental health in- patient service at present. These services include: • Reception and operational admin offices, medical records, clinical and management offices • Patient recreation and coffee areas, personal clothes laundry facilities • Facilities for the Mental Health Tribunal and • Staff facilities – changing and dining/rest areas, on-call The hospital covers a significant estate and there are buildings used for grounds and building maintenance, receipt and distribution, cleaning, portering, laundry etc.
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3.2.4 Services wider than the mental health service Catering There is a full production kitchen in the Argyll and Bute Hospital and meals are cooked and supplied to: • Mental health and Mid Argyll in-patients – current in patient numbers fluctuate between 90 and 100 patients • Mental health and Mid Argyll staff – Staff meals number 100 to 120 per day , primarily breakfasts and lunches, served from two staff canteens and including approximately £15,000 of hospitality per annum • Other canteen activity includes small transactions (coffees etc) and small amounts of public sales.
3.2.5 CHP centralised services Estates Department This is a function covering the whole CHP and includes Estates Management and Planning and Performance Monitoring. Facilities exist for 3-5 staff working and there is storage and archiving of all CHP estate records and a technical reference library. Central Stores The central store in the A&B Hospital currently serves Mid-Argyll, A&B hospital and some community bases. There are loading docks, offices, filing and records and warehousing space of 100 sq.m. Integrated Equipment Store There is a store operated jointly by Argyll and Bute Council and the CHP which stores and provides equipment for independent living – wheelchairs, bath aids etc. Medical Gas Store A central store for medical gas cylinders for use throughout the CHP is located on site.
3.2.6 Community Mental Health Teams Community Mental Health Teams are operational in some localities and are being developed and appointed in others. In some localities suitable accommodation is available. In other localities there is no suitable accommodation.
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3.3 THE BUSINESS GAP BETWEEN THE EXISTING ARRANGEMENTS & THE STRATEGIC OBJECTIVES
Investment Objective Existing Arrangement Business Gap Clinically effective, “fit Argyll and Bute Hospital – was over A&B Hospital for purpose” and 400 beds functionally unsuitable efficient centralised in- with extensive backlog patient mental health maintenance issues and service – 32 beds costs Clinically effective, “fit Use of dispersed accommodation No locus for specialist for purpose” and throughout the CHP interventions, no efficient centralised No suitable central specialist unit. opportunity to avoid/limit Specialist Therapies & admissions by use of Education Centre day treatments. Patient access to service varies with “postcode”. Clinically effective, “fit Oban, Lorn and the Isles Unidentified or for purpose” and Oban base will be insufficient when insufficient premises for efficient CMHT base in team expand CMHT in 4 out of 7 4 localities Mid Argyll, Kintyre and Islay - potential locations Campbeltown provided but inadequate Lochgilphead – current provision adequate Islay – provided but inadequate Cowal and Bute Dunoon – current provision is inadequate Bute – inadequate due to split site Helensburgh and Lomond – already provided Modernise catering Argyll and Bute kitchen If inpatient beds are re- service to A&B and provided, unchanged MACHICC kitchen would preclude release of A&B site for demolition & disposal Modernise provision of Argyll and Bute outbuildings No action on these central services of services would preclude Estates and Stores release of A&B site for demolition & disposal Efficient Management Underutilised and requiring major Either requires massive of Argyll and Bute site investment investment or retraction from the site and disposal
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3.4 THE BUSINESS SCOPE OF THE PROJECT The above assessment of the Business Gap determines the scope of the project as follows: • To provide the single central specialist inpatient facility for the modernised mental health strategy of Argyll and Bute CHP. • To provide the Specialist Therapies and Education Centre for the modernised mental health strategy of Argyll and Bute CHP. • To provide the physical requirements for the CMHT bases in each of the 4 localities within the CHP. • To provide the necessary supporting services to allow the core clinical services to operate. • To provide a sustainable solution by relocating/re-providing any other supporting services currently delivered from the Argyll and Bute site which will allow the CHP to withdraw from this functionally unsuitable site and to dispose of it to its maximum value.
3.5 RESULTANT SERVICE REQUIREMENTS FROM THE BUSINESS SCOPE The single central specialist inpatient facility for Argyll and Bute CHP will provide the following services:
3.5.1 Adult Acute Inpatient Services Hospital admission for people of all adult ages, including older people with an acute mental illness living in the Argyll and Bute catchment area who require: • Assessment , care and treatment within a setting that offers 24-hour medical and nursing care. • A safe physical environment that manages risk • Management of acute symptoms and clinical risk that are not amenable to management in a community setting • Care under the Mental Health (Care and Treatment) (Scotland) Act 2003 Bed numbers for Adult Acute Bed numbers were assessed under the Strategic review and 14 beds identified to meet current and future needs. The bed modelling will be reviewed during the OBC phase.
3.5.2 Dementia Assessment Services Accommodation for people aged 65 and over living in the Argyll and Bute catchment area who require: • Assessment , care and treatment within a setting that offers 24-hour medical and nursing care. • A safe physical environment that manages risk • Management of acute symptoms and clinical risk that are not amenable to management in a community setting • Care under the Mental Health (Care and Treatment) (Scotland) Act 2003
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Bed numbers for Dementia Assessment Bed numbers were assessed under the Strategic review and 10 beds identified to meet current and future needs. The bed modelling will be reviewed during the OBC phase.
3.5.3 Intensive Psychiatric Care Unit (IPCU) Accommodation to provide • Detention under the Mental Health (Care and Treatment) (Scotland) Act 2003 requiring a level of safety offered within IPCU. • Presentation of behavioural difficulties which seriously compromise their physical or psychological well-being or that of others, and which cannot safely be assessed or treated in an open acute in-patient facility Bed numbers for IPCU Bed numbers were assessed under the Strategic review and 4 beds identified to meet current and future needs. The bed modelling will be reviewed during the OBC phase with reference to results of the Service Profiling exercise (NHS Quality Improvement Scotland, November 2009)
3.5.4 Rehabilitation services Accommodation to provide • A locus for individuals to gain the necessary skills in self-care and social integration to be able to return to successful living in the community. Bed numbers for Rehabilitation Bed numbers were assessed under the Strategic review and 4 beds identified to meet current and future needs. The bed modelling will be reviewed during the OBC phase.
The proposal is to provide the total of 32 beds functioning within a single operational unit
3.5.5 Specialist Therapies and Education Centre The service requirement is for consulting/interview space, group rooms and multi-purpose rooms for the specialist therapies. Some of these spaces will be suitable for use as educational spaces. The accommodation will also be suitable for patients to use on a day basis when travelling from a distance for specialist therapies. Accommodation will be available from hotels or B&Bs in the town.
3.5.6 Essential integral support accommodation for the Inpatient and Specialist Therapies For Patients, Visitors and Staff Entrance, coffee area, visitor WCs Reception and operational admin offices, medical records Mental Health Tribunal Staff facilities – changing and dining/rest areas, on-call
Continued over/
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3.5.6 (cont) Essential integral support accommodation (continued) FM/Hotel services Personal clothes laundry and linen supply & collection Cleaning, catering, supplies, waste collection Building and Grounds Maintenance Offices, Clinical and Management – integrated or in adjacent buildings
3.5.7 Argyll and Bute Site Services The relocation or re-provision of any other supporting services currently delivered from the Argyll and Bute site to will allow the CHP to withdraw from this functionally unsuitable site and to dispose of it to its maximum value. This results in a service requirement as follows: A catering solution for The Mental Health Project and the Mid-Argyll Hospital Relocation/re-provision of CHP-wide support services & retraction of site CHP Estates Department CHP Central Stores and Medical Gas Store Integrated Equipment Store
3.5.8 CMHT (Community Mental Health Team) Bases The facility requirements are relatively modest and include an administration base; interview rooms and an examination/treatment room. Utilisation factors make it possible that accommodation will be able to be shared with other services.
3.6 SUMMARY OF BUSINESS SCOPE AND SERVICE REQUIREMENTS Business Scope Service Requirement Core or Minimum Requirement Single central specialist Acute Beds for Adult, IPCU, 32 beds as a single operational inpatient unit Rehabilitation and Dementia unit Assessment Access to Specialist Specialist Therapies & Consulting, group, seminar rooms Therapies Education Centre Support facilities for Patient & visitor services Sufficient to allow operation of clinical core FM/hotel services; staff services clinical facilities Offices Sustainable future for Modernisation of Catering, Catering service for A&B and Argyll and Bute site – Central Stores and Estates; MACHICC; Estates Department & maximise disposal Disposal of underutilised site Central Store system CMHT service CMHT base accommodation Access to Consulting, treatment developed and administration facilities
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3.7 EXPECTED BENEFITS ACCRUING FROM IMPLEMENTATION OF THE PROJECT:
The key benefits for patients, relatives and carers: • Access to more appropriate care locally for most levels of need reducing need to travel • Community Mental Health Team available locally • Admission to hospital avoided if possible • Appropriate admission to locality hospitals avoiding travel to Lochgilphead for some patients • Specialist in-patient care provided when this is required in a central purpose-built unit • Modern environment for mental health with single rooms, en-suite facilities and privacy • Significantly improved disabled access to all facilities • Specialist therapies available as an out-patient or on a focussed day-treatment basis • Purpose designed accommodation for assessment of patients with dementia and management of those patients with challenging behaviour • Welcoming modern accommodation for visitors and relatives
Key benefits for staff: • Improved working environment for staff and the opportunity to enhance effectiveness through a purpose built environment • Improved security and standards of health and safety • Enhanced future recruitment opportunities
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3.8 INITIAL IDENTIFICATION OF RISKS The main risks associated with the project at this initial stage were identified during the service options appraisal. A joint risk register will be created by the CHP and the PSCP and updated and managed through the life of the project.
The initial risk identification is: Risk category Risk Likelihood of Impact occurrence Business Risks Capacity and demand for services Low High i.e. the strategic risks which exceeds or does not reach remain with the CHP predicted levels Unable to recruit and retain Low High appropriately trained staff Patient and staff safety issues High if no High change Inappropriate services for patients High if no Moderate change Reputational risks High if no Low change Political change/agreement to Low High strategy withdrawn Financial situation deteriorates Moderate High Site infrastructure requirements Moderate Moderate difficult or expensive to resolve Service Risks i.e. the risks Service disruption Moderate if Moderate associated with the project, change shared by business Lack of financing Low High partners External Environmental Greater than anticipated High High Risks reductions in public sector funding
3.9 INITIAL IDENTIFICATION OF CONSTRAINTS • The mental health strategy is approved and already being implemented, thus the project must meet the recommendations of the strategy • Revenue costs to be kept within funding envelope • The capital funding will be outside the usual capital allocation
3.10 INITIAL IDENTIFICATION OF DEPENDENCIES • Insufficient provision of independent sector nursing care beds for patients with dementia in Argyll and Bute may jeopardise full implementation of the discharge model • Matching the timescale for resettlement of existing long stay patients in Argyll and Bute Hospital. The resettlement of long stay patients is being led jointly by the NHS & Argyll & Bute Council and a resource release will be available to support the transfer of these individuals to more appropriate care in the community, • Workforce planning and retraining • Resolution of provision of catering, central stores and estates may require service or accommodation to be provided from other providers or from other locations in the CHP.
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4 THE WAY FORWARD
The Project Objectives, Business Need and Service Scope having been identified, a workshop was held to develop the Critical Success Factors and Options for delivery of the project.
4.1 CRITICAL SUCCESS FACTORS
At the workshop on 9th September 2010 attended by key stakeholders, the following critical success factors emerged as essential to the delivery of the scheme:
Critical Success Factor Description Implementation of the Mental Options must facilitate or allow the full implementation of the Health Strategy agreed Mental Health Strategy “Option 4” which depends upon a central in-patient & specialist therapies service in Lochgilphead Implementation of Estates Options must deal with the Estates Strategy which is to remedy Strategy or eliminate backlog maintenance and compliance issues on the Argyll and Bute site & maximise disposal of site Value for Money Options must deliver value for money in terms of being: Clinically effective in supporting the strategy, Sustainable in terms of the staffing model, Able to provide economies in revenue costs. Affordability Options must be deliverable within the revenue funding envelope which is concerned with the re-distribution of the balance of funding from an in-patient centred model to a community-centred model Timetable Options must deliver the in-patient side of the strategy to match implementation of other elements by 2013 Supply side capacity Options must be realistic in expectations of private providers of community care being able to match the discharge model Functional Suitability, safe and Options must result in the provision of accommodation for clinically effective accommodation patients, relatives and staff that is functionally suitable, safe, clinically effective and provides a therapeutic environment Flexibility Options must offer the possibility of flexible accommodation which will enable implementation of the admission policy in a reduced number of beds and with more specialisation and increased complexity of the patient population.
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4.2 CAPITAL DEVELOPMENT OPTIONS
The workshop contributors proceeded to consider a Long List of Possible Options. The Business Scope and Service requirements were divided into 3 separate categories as follows: 1. New Mental Health Facility for Clinical Services including • Central In-patient • Specialist Therapies • All necessary integral support facilities for the mental health service 2. CHP Support Services - Catering and CHP-wide services of Estates and Stores 3. CMHT base accommodation in the localities
Rationale for considering options in three categories The New Mental Health Facility for Clinical Services is the most significant element of the business case by a wide margin.
The CHP-wide services of catering for the Lochgilphead Hospitals and the CHP-wide Estates Services and Storage, Receipt and Distribution Services require to be provided by modern delivery methods irrespective of the clinical options chosen. However, the development options for the clinical service may affect the choice and rationale for selection of the appropriate options for the CHP Support Services. For example there is a range of possible ways to develop the Argyll and Bute site for the clinical services and depending upon the area of site chosen, the right solution for the support services may be varied.
Options for the CHP-wide services may also include re-location of parts of the service from Lochgilphead, for example Estates management could be in alternative accommodation within the CHP. This could be the preferred option for Estates irrespective of which clinical service options emerges as preferred.
The CMHT accommodation is relatively modest in each locality. In some localities it is already partly provided. In others there are fairly obvious opportunities for sharing or provision. In one locality the appropriate solution is dependent on the outcome of a separate option appraisal exercise.
The options for individual CMHT bases are also effectively independent of the choice of options for the clinical and CHP support services.
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4.3 LONG LIST OF OPTIONS
Clinical Service Options – Long List
Scoping and Service Delivery Options This range of options had been considered by the Strategic Option Appraisal. These service options included: Service Option 1 – Minimum Change Service Option 2 - localised services including in-patient beds in community hospitals Service Option 3 - flexible, central in-patient facility and enhanced community mental health service Service Option 4 - flexible, central in-patient facility (with Specialist Therapies & education centre) and enhanced community mental health service Service Option 5 - no in-patient beds in Argyll and Bute with community focused treatment with access to beds outwith the area on an "as required" basis
Service Option 4 was selected as the preferred strategic option and had ministerial approval so these alternative service options were not considered further.
Service Implementation Options – Long List
Implementation Minimum Change - Benchmark Option Option 1 Description In-patient services continue from Argyll and Bute Hospital (A&BH) No specialist therapies centre, existing accommodation in A&BH used Advantages Disadvantages Does not satisfy business, sustainability or design objectives Does not meet Estates Strategy Does not meet Critical Success Factors
Implementation New Central Mental Health Facility - Reference Option Option 2 Description New flexible central in-patient unit, 32 beds complemented by selected acute admissions to local hospitals New Specialist Therapies and Education Centre Clinical support accommodation to provide stand alone central in-patient unit Advantages Meets business, sustainability and design objectives Matches Estates Strategy Meets all Critical Success Factors Disadvantages Requires capital funding
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Implementation Use of 10 bed rehab ward in MACHICC for dementia patients Option 3 Description The existing 10-bed Rehabilitation/ Care of the Elderly ward (Glassary) in MACHICC is vacated by rationalising general medical services into one clinical area (Glenaray Ward). Glassary ward is refurbished for 10 beds for mental health patients, specifically for dementia assessment & challenging behaviour. Sub-options for the balance of the clinical services are as follows: 3A Extend MACHICC for remaining new 22 in-patient beds and specialist therapies with sharing of support facilities between GP-led facilities and mental health 3B New stand alone 22 beds and specialist therapies and full clinical support on A&B site 3C New stand alone 22 beds on A&B site but specialist therapies and clinical support are provided from refurbished accommodation in the Argyll and Bute Hospital (potential areas for re-use include Tigh na Lynne, Succoth Ward, Firgrove) Advantages Virtually all new accommodation or less than 5 years old for clinical Improves utilisation and efficiency in MACHICC (PFI building) Potential quick start to implementing clinical model All dementia services on single site (MACHICC) Argyll and Bute site released in entirety in 3A and largely in 3B and 3C Potentially lower capital costs Reduced running costs because of sharing of facilities Disadvantages Complexity of integrating with PFI hospital & contract 22 beds in new build may be less flexible Two-site split may affect efficiency of support services such as pharmacy May compromise rationalisation of site services May not be adequate space for expansion of MACHICC in 3A Disruption to MACHICC during project
Implementation Partial Re-Use Of Accommodation In Argyll And Bute Hospital Option 4 Description 4A P a t ient accommodation all new on A&B site - new 32 in-patient beds and Specialist Therapies Clinical support services use refurbished existing accommodation (Similar to 3C but 32 beds rather than 22, and Specialist Therapies also new build) 4B In-patient accommodation all new - new 32 in-patient beds. Specialist Therapies Centre created in refurbished A&BH accommodation Clinical support services use refurbished existing accommodation (Similar to 3C but 32 beds rather than 22) Advantages Potentially more affordable Potentially quicker to provide Disadvantages Services more dispersed May compromise rationalisation of site services May not be good value for money – less sustainable, lower design quality in some elements May not achieve functional suitability in refurbished elements
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Implementation Convert whole of ground floor of MACHICC to accommodate all Option 5 Mental Health Clinical Services Description 30 beds in ground floor of MACHICC currently provide 20 beds for dementia continuing care and 10 beds Rehabilitation/ Care of the Elderly. Most of the continuing care patients could be re-located to community care if such care was available. Rehabilitation/ Care of the Elderly ward (Glassary) in MACHICC is vacated by rationalising general medical services into one clinical area (Glenaray Ward). Refurbish 30 beds +/- extend for mental health inpatients Extension of MACHICC for Specialist Therapies and for certain elements of support services as required for Mental Health Tribunal, Clinical offices etc Advantages Potentially lower capital option Potentially very efficient space utilisation Efficiencies from shared facilities and running costs Disadvantages Supply side highly unlikely to deliver discharge of 30 patients to the community Time to implement may be too great – 3-5 years Disruption to MACHICC during project Public dislike GPs unlikely to be supportive Unlikely to achieve 100% single rooms
CHP support services – Long List Catering To be provided by modern delivery methods. A detailed Option Appraisal to be undertaken during OBC to determine appropriate service delivery option, but physical options are likely to include: 1. Minimal change 2. Production kitchen supplying NHS facilities in Lochgilphead: a. as “FM” building with estates and stores or b. as part of new clinical facility 3. Re-place Production kitchen in refurbished area of site convenient to new build 4. Outsource Production Kitchen
Estates To be provided by modern delivery methods. A detailed Option Appraisal will be undertaken during OBC to determine appropriate service delivery option, but physical options are likely to include: 1. Minimal change 2. Re-provide new accommodation for CHP Estates services in Lochgilphead a. as “FM” building with stores/catering or b. part of new build clinical 3. Re-provide in refurbished accommodation for Estates services in Argyll and Bute Hospital 4. Re-locate Estates services elsewhere in CHP, provide only maintenance accommodation for mental health facility 5. Outsource maintenance element and re-provide Estates Planning Service elsewhere in CHP
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Stores, receipt and distribution To be provided by modern delivery methods. A detailed Option Appraisal will be undertaken during OBC to determine appropriate service delivery option, but physical options are likely to include: 1. Minimal change 2. Re-provide new accommodation for CHP Stores/Receipt and Distribution services in Lochgilphead a. as “FM” building with stores/estates or b. part of new build clinical 3. Re-provide in refurbished accommodation for CHP Stores/Receipt and Distribution in Lochgilphead 4. Re-locate CHP Stores/Receipt and Distribution elsewhere in CHP, provide only receipt and distribution area for mental health facility 5. Outsource service
There is no indication to discount any of these options at this stage and the choice of option is to some extent dependent upon the choice of option for delivering the clinical services.
A detailed appraisal of each service for options for both service delivery and accommodation needs will be carried out during the OBC stage
CMHT – Team Bases Appropriate Team Bases are required to be provided in all locations by a mix of refurbishment, re-use of existing accommodation, sharing of facilities or re-location to other premises. The basic requirements are for admin space for staff and access to some outpatient consulting, interview and treatment/examination rooms.
A detailed appraisal of each location for needs and suitable available accommodation will be carried out during the OBC stage.
4.4 ASSESSMENT OF LONG LIST AGAINST OBJECTIVES AND CSFS The Options Workshop proceeded to assess the long list of options against the Investment Objectives and Critical Success Factors.
The results of the assessment are shown in the following table:
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4.4 Assessing Long List against Project Investment Objectives and Critical Success Factors
X – Does not meet Project Investment Objectives or Critical Success Factor Y – Meets Project Investment Objectives or Critical Success Factor ? – Judgement not possible at this stage
Implementation Option Option 1 Option 2 Option 3A Option 3B Option 3C Option 4A Option 4B Option 5 Minimum New Use 10 beds Use 10 beds Use 10 beds New 32 beds New 32 Full ground floor of Change standalon in MACHICC in MACHICC; in MACHICC & therapies; beds. MACHICC converted e 32 beds & extend 22 beds new 22 beds new support in Therapies; for in-patient beds + & MACHICC on A&B site; on A&B site; refurbished support in extend/re-use therapies for remainder new refurb existing refurbished elements for & integral therapies & therapies & existing therapies and support support support support Invest- Strategic X Y Y Y Y Y Y Y ment Sustainability X Y Y Y ? ? ? Y Objec- All new or All new or Part Part Part All new or <10 yrs tives <10 yrs <10 yrs conversion of conversion of conversion of old buildings old buildings old buildings Design X Y Y Y ? ? ? Y Part refurb Part refurb Part refurb Critical Business need X Y Y Y Y Y Y Y Success Implementation X Y Y Y ? ? ? Y Factors of Estates May be less May be less May be less Strategy site released site released site released Value for Money X ? ? ? ? ? ? ? existing PFI existing PFI existing PFI existing PFI building building building building Affordability ? ? ? ? ? ? ?
Timetable X Y Y Y Y Y Y X
Supply side Y Y ? ? ? Y Y X capacity 10 beds to 10 beds to 10 beds to 30 beds to community community community community Functional X Y ? ? ? Y Y ? Suitability single rooms single rooms single rooms single rooms
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4.5 THE PREFERRED WAY FORWARD – SHORTLISTED IMPLEMENTATION OPTIONS
Clinical Service Implementation Options Option 1 is the Benchmark option Option 2 is the Reference option at this stage until the cost-benefit analysis is completed during the Outline Business Case Option 3 A-C satisfies the investment objectives and may potentially satisfy all the critical success factors. It remains on the short-list for appraisal. Option 4 A and B also potentially satisfy all the objectives and so remains on the shortlist. Option 5 fails to meet two Critical Success Factors of timescale to provide and the capacity of the supply side to deliver 30 places in the community. For these reasons it can be discounted. It is also noted that it is likely to meet with strong resistance from the community and from the general practitioners in MACHICC. There may also be concerns from providers of the mental health service about providing this care in a general hospital setting.
The Short List of Implementation Options for the clinical services is therefore Option 1 Minimum Change – Benchmark option Option 2 New Stand-Alone Central Mental Health Facility - Reference Option Option 3 Use of Underutilised Ward In Mid Argyll Community Hospital (MACHICC) Plus one of the following: 3A Extend MACHICC for remaining accommodation 3B New stand alone 22 beds and specialist therapies and full clinical support on A&B site 3C New stand alone 22 beds on A&B site but specialist therapies and clinical support are provided from refurbished accommodation in the A&B Hospital Options 4 Partial Re-Use Of Accommodation In Argyll And Bute Hospital 4A Patient accommodation all new on A&B site - new 32 in-patient beds and Specialist therapies; Clinical support services in refurbished existing accommodation 4B In-patient accommodation all new - new 32 in-patient beds. Specialist Therapies Centre & support in refurbished A&BH accommodation
CHP support services – Catering, Estates, Stores A detailed appraisal of each service for options for both service delivery and accommodation needs will be carried out during the OBC stage
CMHT – Team Bases A detailed appraisal of each location for needs and suitable available accommodation will be carried out during the OBC stage.
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4.6 FINANCIAL CASE
Indicative costs have been prepared for each short-listed implementation option. These account for the clinical service solutions and also include the “worst case” scenario for the CHP-wide service options which is likely to be complete replacement of the accommodation without service re-design. As such the costs are a conservative estimate of the capital required to replace the services.
An estimate for CMHT base costs has been included. During the OBC stage a functional suitability/space utilisation exercise will be carried out in each locality to determine if any investment is required.
4.6.1 Capital Cost Estimates Summary of Short-listed Options Implementation Description Option Number 1 Minimal Change – Benchmark Option 2 Reference Option – New Central Health Facility, 32 beds, Specialist Therapies and Integral Support; New service model for catering, estates and stores; CMHT bases provided 3 A,B,C Use MACHICC for 10 beds plus new 22 beds on range of sites and options for provision for Specialist Therapies and support services. New service model for catering, estates and stores; CMHT bases provided 4 A, B New 32 beds on Argyll and Bute Hospital site and options for provision for Specialist Therapies and support services. New service model for catering, estates and stores; CMHT bases provided
The range of capital costs for the short-listed implementation options is £13.0m to £16.0m.
These costs assume a capital-funded build of the proposed New Central In-patient and Specialist Therapies Centre. The capital is required from 2010/11 to 2013/14 and has been included in Argyll & Bute/NHS Highland Local Delivery Plan for 2010/11. The capital cost estimates have been derived with support and advice from our Principal Supply Chain Partner using their extensive database of costs on Mental Health Facilities.
The capital requirements exceed NHS Highland’s delegated authority and will require approval by SGHD Capital Investment Group. It is assumed that subject to approval of the Full Business Case all capital funding for this proposal would be provided by SGHD as any land disposal and generated income could only be realised after the completion of the new mental health facility.
The Capital Cost estimates include: - Construction, Professional Fees, equipment & furniture, Optimism Bias and VAT
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4.6.2 Optimism Bias Optimism Bias has been assessed in accordance with SGHD and HM Treasury “Green Book Supplementary Guidance – Optimism Bias”. This adjustment accounts for the tendency for project appraisers to be overly optimistic in the estimation of capital cost during a project’s early stages.
4.6.3 Revenue and Life Cycle Costs The estimated revenue and annual life cycle costs for the mental health facilities are anticipated to decrease on completion of the New Mental Health Facility. This will be achieved through the reduction in maintenance and repair of existing building stock, much of which is significantly beyond serviceable repair.
During the OBC stage the lifecycle property costs will be calculated over a 60 year period of the project. 60 years is considered to be the most appropriate period to best suit Argyll & Bute CHP/NHS Highlands strategic and operational requirements. Discounted cash flow techniques will be used in accordance with the Scottish Capital Investment Manual (3.5% discount rate) to arrive at a Net Present Cost (NPC) for each option. The lifecycle costs for the property will be identified as follows:
Facility Revenue Costs will include: Rent, Rates & Service Charges, Running Costs (Utilities & Building Plant/Maintenance), Removals, Dilapidations and Write Off.
4.6.4 Available Funding Resource The recurrent funding available for the redesign of Mental Health Services within Argyll & Bute CHP is approximately £13.6m. This figure can be broken down over the following headings;
Wte £ Argyll & Bute Hospital In-Patient Services 188.83 7,291,000 MACHICC Dementia In-Patient Services 15.40 756,000 In-Patient Services provided by NHS GG&C 1,524,000 Community Mental Health Services 25.28 1,192,000 Other Community Services 18.30 918,000 Resource Transfer to Argyll &Bute Council 645,000 SLA’s with NHS GG&C 1,161,000 Services Commissioned from Private Providers 146,000
Total 247.81 13,633,000
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4.6.5 Indicative Cost of New Service Design
A significant amount of work is currently being undertaken to cost the proposed new service model. It is already clear from this work that the redesign will result in a shift of resources from hospital to community services. Detailed analysis of staffing requirements has yet to be completed however the various redesign groups are aware of the total revenue funding available and are committed to working within budget.
The CHP General Manager is satisfied with the progress of this work to date and is confident that the revenue costs of the redesign will be contained within available funding.
4.7 COMMERCIAL CASE
A variety of construction procurement methods is available for the delivery of this facility including Capital-Funded either by traditional procurement or Frameworks Scotland, NPD and HUB. The NPD option was dismissed at this stage on account of project size and the required delivery programme. We consulted with the Scottish Government and with Health Facilities Scotland and were advised to proceed with the engagement of a PSCP to assist with the progression of the facility through Outline and Full Business Case.
The appointment of a PSCP will allow the delivery timescales to be maintained during the exploration of the options of the ultimate delivery of the project through the NHS Frameworks route or through the HUB initiative.
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4.8 PROJECT MANAGEMENT ARRANGEMENTS
4.8.1 Project Governance Following receipt of Scottish Government approval of Strategy Service Option 4 the original Project Board was re-constituted with a revised remit and membership appropriate to the task. See diagrams following A&B CHP Mental Health Modernisation Project Structure Project Board – Remit and Structure Project Implementation team – Remit and Structure
4.8.2 Project Board The Project Board has created a Governance framework; to ensure identification of operational and resource requirements, create a communications and involvement plan, monitor progress against agreed timescales, outline reporting and accountability structures and ensure risks are identified and managed. The Project Board will ensure that the principles and service philosophy outlined in ‘Building on our Experience – a Vision for Mental Health Services in Argyll and Bute’ underpin the approach taken and the development of the service model.
The Project structure, as shown in the diagram overleaf, is complex and detailed, however the Project Board aims to deliver its remit in a meaningful way, making sense of the processes for participants – service users, families, staff and communities. Project Board members reflected that two actions had worked well in earlier work; the use of the Mental Health Tiered Model to understand need and focus discussion and responses and the active involvement of people who use, or are involved in, providing the service.
4.8.3 Project Implementation Team An Implementation Team has been established ‘To co-ordinate, direct and manage the project to deliver the required outcomes’. To ensure identification of future service operational and resource requirements it was agreed that five service design groups would be commissioned. Their focus and composition would again follow the mental health tiers, and there would be active involvement of staff, partner organisations and service user representatives.
4.8.4 Service Redesign Groups and Areas of Action Three of the Five Service Redesign Groups began to address the three “tiers” of the service model with a fourth group addressing services which interface and connect with acute mental health service (see section 2.3); The fifth, Infrastructure Group addressed non-clinical support services currently provided from the Argyll and Bute Hospital campus. A Resettlement sub-group was also formed as a sub-group of Tier group 3/4. This is a key piece of work as the aim is to discharge Long stay patients to the community, resulting in resource release.
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The Service Implementation Plan has continued to be developed and is currently at Version 18. The plan now details 22 “Areas of Action” with leads agreed to take these forward.
4.8.5 Workforce and Organisation Development To assist and support the Service Design groups a Workforce Planning group is in place drawing expertise from Community and Inpatient Mental Health services, Lead Nurse and AHP, Finance, Learning and Development, and HR.
The impact of this group is to advise on the workforce planning and development dimensions of proposals, to ensure that proposals from the groups are compatible and complementary across the whole service, and to advise on the details of specific posts and roles including Job Descriptions, KSF outlines and reporting structures.
Achievements within the group to date centre on developing current skills profiles of existing staff based on KSF and PDP information. Once more detailed information on staff establishments, Job descriptions and KSF outlines are presented from the Design groups, the work of this planning group will develop.
Development work has also been undertaken on workshops for both all staff, and for team leaders and managers to introduce the implications whole change process and to assist them understand and prepare for the impact of the change on them and their colleagues. There will also be opportunity for individual discussion with HR, staff representatives and managers.
Work is also being undertaken to explore enabling a small group of “Change Volunteers”, drawn from a wide range of staff affected by the new design, to prepare and support colleagues through the change processes. This group will be supported through workshops and coaching provided through an external OD consultancy to introduce a further dimension to the change processes.
4.8.6 Principal Supply Chain Partner RD Health were appointed in August 2010 to assist the CHP in the development of this Initial Agreement and the further stages of the Business Case. A project plan has been developed utilising Power Project to monitor the New Mental Health Service Strategy to ensure its delivery in line with expectations. The project plan has been developed to reflect accepted “Best Practice” taken from the OGC methodologies and “managing successful programmes” to provide assurance to the Project Owner. Joint Project Management arrangements will be set up in the next stage of the project.
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4.8.7 Partnership Working A&B CHP/NHS Highland is committed to Partnership Working with Professional & Community organisations, which is evidenced through the planning and implementation of the project through the involvement of Staff, user groups, Acumen, Argyll & Bute Council and other partners.
In addition all staff within the scope of the project will be fully involved in the Planning and Delivery of the agreed property option. A robust communication plan has been developed to ensure that not only affected staff but also the wider community are fully briefed as the project progresses.
Formal consultations will continue with all groups associated with the Mental Health Project in parallel with the development of the Outline and Full Business Cases.
4.8.8 Project Timetable A joint Project Timetable is being developed by RD Health and the CHP. An indicative target date for completion of the FBC has been set for March 2012 with a target service implementation date of July 2013. These timescales appear achievable and a target date for completion of the OBC will be set on approval of this Initial Agreement.
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4.8.9 A&B CHP Mental Health Modernisation Project Structure
CHP Committee CHP Manageme nt Structure CHP Project Board Chaired by CHP Principal Derek Leslie Management Supply Team Chain Partner Robertson Dawn Health Other CHP Functions
NHSS CHP Framework Implimentation Scotland Advisors Team Chaired Health by FacilitiesScotland Jo Bown
Gary Bushnell Robertson Dawn Health Principal HR/Org Change Group Supply CHP David Logue Chain Partner Cost Advisors Project Manager CHP Communication David Ross John s CHP Dreghorn Atkins David Ritchie CHP macmon Architects Project Turner Townsend Manager Operational Lead DSSR Principal Supply Chain Partner CHP Service Design Design Team CHP Workforce 22 Areas of Action Planning David Logue
CHP Finance Alistair Craig
CHP
Other Advisors CHP Equipment Team
A&B CHP Mental Health Modernisation Project Structure
Aim: Deliver a Project Brief, Business Case & Design Development & Construction of new Facility and Service redesign and implementation
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PROJECT BOARD Terms of Reference and Remit
Purpose • To direct and steer the work of the project to the agreed outcome; ensuring objectives are met within the agreed timescale and financial framework and that all areas of the project as described in the Project Brief (June 2009) are addressed and the principles and philosophy outlined in ‘Building on our Experience – a Vision for Mental Health Services in Argyll and Bute’ are incorporated and underpin the approach. • To oversee the work of the Implementation Team, direct actions required of the team and others receive reports and monitor progress. • To identify risks to the Project, report and analyse to minimise or remove, or identify alternative or voiding actions and maintain a Risk Register. • To report to o Argyll and Bute CHP Management Team and Committee o Argyll and Bute Health and Care Strategic Partnership o NHS Highland Membership Designation Name CHP General Manager & Project Board Chair Derek Leslie Project Director Josephine Bown Consultant Psychiatrist / Clinical Director Mental Health Dr Grace Fergusson Locality Manager – Mid Argyll Kintyre & Islay John Dreghorn Lead Nurse – Mental Health Peter Cartwright Head of Finance George Morrison Head of Planning, Performance & Contracting Stephen Whiston Clinical Director Dr Michael Hall Head of Human Resources David Logue CHP Lead Nurse Pat Tyrrell Service Manager – Mental Health, Argyll and Bute Council Allen Stevenson CHP Professional Lead Allied Health Professional Mary Wilson ACUMEN (user organisation) David Harrison Consultant in Public Health Dr Cameron Stark Staff Representative Ros Derham Patient & Public Forum Deputy Chair Katy Murray Head of Adult Care, Argyll and Bute Council Jim Robb In Attendance Communications David Ritchie Service Development Manager – Mental Health Dave Bertin Service Planning Manager/Project Manager David Ross PA to Clinical Director – Minute Secretary Fiona Broderick Scottish Health Council Alison McCrossan PSCP Robertson Dawn Neil McCormack To receive minutes Chair of NHSH Mental Health Network Dr Ken Proctor Management Team Staff Partnership Intranet Quoracy 50% of membership Review Date Annual – October 2010
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IMPLEMENTATION TEAM - Terms of Reference and Remit
Purpose • To coordinate, direct and manage the project to deliver the required outcomes within the resource envelope specified • To produce, update and implement project plan and timetable with key milestones and critical path issues identified • Commission service design groups and other fields of work as required • To identify risks to the project, produce a risk mitigation plan and performance manage risk • To establish a communication strategy for the project and implement the same • To identify resource implications, manage project budgets. • To produce reports and information on the project • To ensure PFPI engagement standards are met and best practice implemented • To ensure EQIA is applied to the project and its outcomes • Put in place process to deliver business cases and obtain approval for funding – transition bridging and capital • Take forward capital development process as per Scottish Capital Investment Manuel & National procurement processes HUB &/or HFS framework • To report to o Argyll and Bute CHP Mental Health Project Board on progress, risk and developments Membership Designation Name Project Director Josephine Bown Service Planning Manager/Project Manager David Ross Service Development Manager – Mental Health Dave Bertin Locality Managers John Dreghorn, David Whiteoak, Anne Helstrip, Viv Smith CHP Lead -Public Health Elaine Garman Service Manager–Mental Health Argyll & Bute Council Allen Stevenson Lead Nurse – Mental Health Peter Cartwright Senior Management Accountant Alastair Craig Clinical Services Manager (Mental Health) John Barnett Head of Adult Mental Health - Clinical Psychology Barbara Williams Consultant Psychiatrist /Clinical Director Mental Health Dr Grace Fergusson Team Leader - OT Mental Health Carrie Hill Primary Care Manager Joyce Robinson CHP Lead Pharmacist Fiona Thomson Clinical Governance Fiona Campbell Clinical Director Dr Michael Hall ACUMEN (user organisation) Lotta Leahy Human Resource Advisor Angela Dewsnap E-Health Bill Staley Link Club Member Graham Jones In Attendance Communications David Ritchie PA to Clinical Director / ASM & Minute Secretary Fiona Broderick PSCP Robertson Dawn Neil McCormick Distribution Attendees Project Board Quoracy 50% of membership Review Date October 2010
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