Report to Governing Body

CCGs applicable to NHS West Sussex CCG

Meeting date 09 February 2021

Report title West Sussex Mental Health Inpatient Bed Reconfiguration – Decision Making Business Case

Report from Jessica Britton, Executive Managing Director, NHS East Sussex CCG (Mental Health Executive Lead)

Clinical lead Bikram Raychaudhari, – Clinical Lead, NHS West Sussex CCG

Report author Harpreet Kaur – Interim Integrated Care Partnership (ICP) Programme Director, NHS Brighton and Hove CCG (NHS West Sussex CCG Redesign Programme Lead)

Item number 2.2

Recommendation/action required: The Governing Body is asked to:

• Approve the post-consultation Decision Making Business Case (DMBC Appendix 2) to: a) For older people with mental health problems - Move services from the Harold Kidd Unit in Chichester to Mixed-sex wards at Meadowfield Hospital, Worthing, and Langley Green Hospital, Crawley. b) For male patients with Dementia - Move 10-bed single-sex ward at Harold Kidd Unit, Chichester (Grove Ward) to a refurbished single-sex ward at Salvington Lodge (The Burrowes), Worthing – Dementia Centre of Excellence. c) For female patients with Dementia - Move services from Iris Ward at Horsham Hospital to new single-sex ward at First Floor, Salvington Lodge, Worthing - Dementia Centre of Excellence. d) For male and female adults with mental health problems to move to 16-bed Oaklands Ward, Chichester. All adult wards at Langley Green, Crawley, and Meadowfield Hospital, Worthing, remain mixed-sex wards.

• Note the consultation findings report (Appendix 3) and how these have informed the DMBC and resulted in the post-consultation proposal.

• Note and approve additional actions to further mitigate any potential adverse impacts of the post-consultation proposal on groups highlighted in the Equality and Health Inequalities Impact Assessment (EHIA) (Appendix 4).

• Note and approve the Quality Impact Assessment (QIA) (Appendix 5) for the proposed change.

• Approve the submission of the Governing Body’s decision to the West Sussex Health and Adult Social Care Scrutiny Committee (HASC) for their consideration on whether the CCG decision is in the best interest of the local population.

Executive summary Overview:

The West Sussex Inpatient Bed Reconfiguration programme commenced in 2018 when NHS Coastal West Sussex, NHS Crawley, and NHS Horsham and Mid-Sussex CCGs (now the NHS West Sussex CCG), in partnership with Sussex Partnership NHS Foundation Trust (Sussex Partnership/ SPFT), began developing a preferred option to improve mental health services in West Sussex for adults and older people, including those with dementia.

The programme has been subject to NHS England (NHSE) ‘Planning, Assuring and Delivering Service Change for Patients’, March 2018 guidance and has ensured progress updates through governance and approval processes since 2019 and the DMBC (Appendix 2) has been assured by NHS England/Improvement (NHSE/I).

The DMBC builds on the work undertaken when developing the Pre-Consultation Business Case (PCBC), which was agreed by NHS Coastal West Sussex CCG, NHS Crawley CCG and NHS Horsham Mid Sussex CCG in June 2019. It outlines the consultation and engagement process and addresses the key themes from the public consultation held between 17 July and 11 October 2019. The DMBC describes how the proposal has changed since the PCBC was written to ensure feedback from the Public Consultation has informed a refined proposal. It also details the process undertaken and additional information and evidence sought to form the final proposal, recognising the pause in the programme in responding to Covid-19, in line with reconfiguration regionally.

The SPFT Board of Directors considered the proposals outlined in Section 3 on the 2 December 2020 and formally wrote to the CCG recommending that the DMBC is progressed through CCG Governance and Approval processes and submitted to the West Sussex HASC to consider whether the CCG decision is in the best interest if the local population.

Accordingly, the Governance Timeline for approving the DMBC through internal and external processes is described in Section 4 and the Next Steps in Section 6 of this report.

In the interest of managing the overall size of papers for this meeting, Pack B includes all supporting papers for this agenda item. This includes the Independent Report of Consultation 2019 Improving Mental Health Services in West Sussex, EHIA MH inpatient bed consultation 2019 and The Quality Impact Assessment.

Previously considered by [governance/ engagement pathway to date] Org./Group/ Name Date Outcome NHSE Assurance Stage 2 28 May Assured 2019 North LMT 28 May Noted 2019 North Clinical Strategy 4 June Noted Committee 2019 Sussex and East Surrey 10 June Approved subject to agreed updates (SES) EMT Meeting 2019 Costal Clinical Operations 11 June Noted Meeting 2019 Health and Adult Social 12 June Agreed that the proposals set out constitute a Care Select Committee 2019 substantial change or development of service, and should be subject to a full public consultation Governing Body (NHS 25 June Approved for Public Consultation to commence Coastal West Sussex 2019 from 8 July 2019. CCG) Governing Body (North 27 June Approved for Public Consultation to commence Place) 2019 from 8 July 2019. LMT West Sussex 15 January Update and outcome of the Public 2020 Consultation noted. Quality and Safety 21 January Update and outcome of the Public Committee (NHS Coastal 2020 Consultation noted. West Sussex CCG) Briefing Paper for Gold 7 April Approval of suspension of activity due to Meeting 2020 Covid-19. NHSE/I Assurance 20 October Approved subject to changes and updates. Meetings – approval of 2020 DMBC CCG EMT 9 Progress update and next steps. November 2020 West Sussex LMT 16 Noted the update and noted that Draft DMBC December was being updated and developed for 2020 submission to EMT on 21 December 2020. EMT 21 Approval to proceed subject to minor changes December to the Draft DMBC. 2020 Sussex CCGs Quality 13 January Endorsed the recommendations to the NHS Committee 2021 West Sussex CCG Governing Body within the DMBC.

What happens next? Next Steps outlined in Section 13 to: • Present final DMBC and GB decision to West Sussex HASC to consider whether the

CCG decision is in the best interest of the local population.

Implications Corporate A. Improved population health outcomes and patient experience goals this B. Restoring high quality and safe services prioritised to meet clinical relates to needs D. Delivering system reform Financial The Commissioners and Provider have two main financial priorities to achieve from the reconfiguration of beds:

1) Reduce the use of out of area beds that are expensive and not good for patients' social support.

2) Ensure that dementia services develop at a growth rate that allows mitigation of the pressure on capacity and quality that arise from an aging population.

This proposal addresses these issues, generates value for money and is affordable within the current financial planning assumptions of the Commissioners.

The post-consultation preferred option will by the end of 2022/23 cost £328,000 more in revenue terms per annum. The build-up of revenue costs is set out in Appendix 1 and can be summarised by year as follows:

Revenue Impact of Changes Opening Closing Closing Closing Closing 19/20 19/20 20/21 21/22 22/23 £'000s £'000s £'000s £'000s £'000s

Revenue increase per annum 0 -131 -73 -604 480 Cumulative Cost increase -131 -204 -808 -328

Sussex Partnership has discussed with the NHS West Sussex CCG options to fund within current plans so we can implement the post- consultation preferred option.

The revenue funding sources for the development are explained below.

Funding Source for additional costs

Revenue Impact of Changes Opening Closing Closing Closing Closing 19/20 19/20 20/21 21/22 22/23 £'000s £'000s £'000s £'000s £'000s

Cumulative Cost increase -131 -204 -808 -328

Funding Source : Reduced system spend on Out of Area placements 131 204 712 328 Dementia services growth allocation (non-recurrent only) 96

The two funding sources outlined above indicate that there are sufficient funds available in operational planning to support the costs of the development, with very real tangible benefits for patients from this

investment.

This post-consultation option will cost circa £6.6m in capital expenditure. The funding for capital supporting this service development has been approved as part of the programme to eliminate dormitories in mental health care by the Department of Health and Social Care. Risk, legal The programme is subject to NHSE ‘Planning, assuring and delivering and other service change for patients’, March 2018 guidance. This process has compliance been followed to mitigate any risks of Judicial Reviews against the NHS. A risk register for the programme is reviewed at monthly Programme Board Meetings. Quality and The programme addresses the requirement to improve quality and safety safety of inpatient wards for Adult and Older People’s mental health services across West Sussex. A detailed QIA (Appendix 5) has been completed through the PCBC stage and published as part of the Public Consultation. Equality, The EHIA has been completed and updated in response to the outcome diversity and of Public Consultation (Appendix 4). It included the feedback around health gender categorisation in response to original proposals around the single inequalities sex wards and this has further informed the final proposals in the DMBC. Patient and Detailed patient and public engagement carried out pre-consultation. 12 public week Public Consultation completed from July to October 2019 with an engagement Independent analysis report with outcome of public consultation attached as Appendix 3. Health and This programme relates to the West Sussex Health and Wellbeing wellbeing Strategy, Place Based Plans and the Mental Health Five Year Forward View.

List of appendices • Appendix 1 - West Sussex Mental Health Inpatient Bed Reconfiguration • Appendix 2 - Decision Making Business Case [DMBC] (Improving mental health services for adults and older people in West Sussex)

Pack B: Supporting papers - • Appendix 3 - Independent Report of Consultation 2019 Improving Mental Health Services in West Sussex o Independently analysed by Public Perspectives Ltd. The outcomes have been reflected in the draft DMBC as the revised preferred option. • Appendix 4 - EHIA MH inpatient bed consultation 2019; o Reflects the feedback of the Public Consultation and additional actions to further mitigate any potential adverse impacts of the post-consultation proposal on groups highlighted in the EHIA • Appendix 5 - The Quality Impact Assessment o Outline how the proposals impact the patients population in terms of Safety, Effectiveness and Experience

West Sussex Mental Health Inpatient Bed Reconfiguration

Date: 16 December 2020 Version: 8 – FINAL FOR CCG GOVERNING BODY Name of originator/ author: Harpreet Kaur – West Sussex Redesign Programme Lead

Contents

1.0 Background ...... 3 2.0 Outcome of the Public Consultation ...... 4 3.0 The Decision Making Business Case – Revised Proposals (Post Consultation) ...... 7 4.0 Governance and Approval Timeline ...... 9 5.0 Implementation Timeline, subject to approval ...... 9 6.0 Next Steps...... 10 7.0 Recommendation/Action required ...... 10

1.0 Background

In January 2018, NHS Coastal West Sussex, NHS Crawley, and NHS Horsham and Mid- Sussex CCGs (now the NHS West Sussex CCG), in partnership with SPFT, began developing a preferred option to improve mental health services in West Sussex for adults and older people, including those with dementia.

The original preferred option focused on moving old and poor-quality wards in Chichester and Horsham to more modern, safer wards in Worthing and Crawley. It also gave the service the opportunity to create single-sex wards across West Sussex to meet national guidelines and develop a Centre of Excellence for Dementia Care in Worthing.

The preferred option supported plans to strengthen community services, underpinning SPFT’s Clinical Strategy for mental health service in West Sussex to ensure we care for people in their own homes where possible by providing greater access to crisis and urgent care and home treatment services.

NHSE/I Stage 2 Assurance to secure approval of the PCBC was completed in May 2019, followed by the NHS Coastal West Sussex CCG Governing Body meeting on 25 June 2019, NHS Crawley and Horsham and Mid Sussex and NHS East Surrey Governing Body meeting on 27 June 2019 and HASC in July 2019 to agree whether or not the proposals set out constituted a substantial change or development of service, and consider whether or not the proposals outlined should be subject to consultation and a full public consultation. The CCGs and SPFT commenced the Public Consultation for 12 weeks between July and October 2019, engaging with more than 500 people during this period. A particular focus was on engaging with service users, carers and their families, charities and interested parties such as MPs and individual members of the public.

There was also a concerted effort to engage with representative groups, including communities that are sometimes harder to hear. These groups included those from the LGBTQ+, Black, Asian and Minority Ethnic (BAME) and rural communities.

A Communications, Engagement and Equalities Steering Group was established to oversee the public consultation and respond to questions from the public and media during this period. Before consultation began, our documents and plans were independently reviewed and endorsed by the Consultation Institute.

The group commissioned Public Perspectives Ltd., a consultancy which specialises in research and community engagement in the public and third sectors, to carry out an independent analysis of the consultation feedback. All responses were independently analysed by Public Perspectives who presented a final report, which provided valuable feedback, and input that was used to develop a refined proposal which better represents the needs of people in West Sussex.

Also accompanying this paper is the independent analysis report on the findings of the consultation (Appendix 3), the EHIA (Appendix 4) which was reviewed throughout the consultation process to make sure we meet the needs of seldom heard, minority and

vulnerable groups in the most appropriate way and the QIA (Appendix 5) outlining how the proposals impact the patients population in terms of Safety, Effectiveness and Experience.

2.0 Outcome of the Public Consultation

The public consultation ran for a 12-week period from 17 July to 11 October 2019. This was preceded by a lengthy period of pre-consultation engagement with a range of stakeholders including service users and carers, their representative bodies, charities, staff and other interested people. This helped inform our proposals before, during and after the formal consultation was complete.

A range of activity took place during the 12-week consultation period. This included:

Pre-consultation activity and publicity: • Producing a consultation document with questionnaire for responding to proposals. • Contact with more than 60 interested people, groups and organisations about the consultation and engagement during the consultation period through emails and letters. • Production of hundreds of leaflets, flyers, posters and advertisements promoting the consultation. • Articles and adverts in all local West Sussex newspapers and their (this was supported by articles in selected titles). • Information available in all local libraries and other community centres throughout West Sussex. • Bus stop ads in the areas most affected by the proposals including Worthing, Horsham and Chichester.

Public and private meetings held across West Sussex with organisations and interested groups:

• Public consultation meetings held since July 2019 in four key locations; Horsham, Worthing, Crawley and Chichester. - Chichester, 13 August, 5pm-7pm. (25 people attended) - Worthing, 19 August 6pm-8pm (20 people attended) - Horsham, 20 August, 2pm-4pm (18 people attended) - Crawley, 4 September 2pm-4pm (20 people attended)

Further events held with the following: • Capital Projects Meeting (service user group) • Sangam Women (Alzheimer's Society) • Capital Projects Meeting (Coastal) • Crawley Thinking Group (Alzheimer's Society) • Selsey Care Shop • Capital Projects (Northern) • Crawley Carers Group • Our Café (Age UK) • Coastal West Sussex MIND (The Corner House) • SPFT Annual General Meeting (AGM)

• Capital Projects (Western) • East Grinstead Rotary Fit4Life • Healthwatch Market Place

Total attendance across all meetings was about 400 people

Online Activity: • A dedicated website detailing the consultation promoting an online survey appeared on the Sussex Partnership website as well as the websites of the West Sussex CCGs. • Almost 5,000 visitors saw these, with 150 people contributing to the survey. • Social media campaign on Facebook, Twitter and Instagram, radio interviews on local radio and a feature on BBC South Today. • A short video was developed and uploaded on YouTube, which was watched by more than 200 people.

Throughout the design and consultation phase, the Communications, Engagement and Equalities Steering Group continually tested the proposals and consultation approaches against an EHIA (Appendix 5) which was updated accordingly in line with good practice.

A key question for which the CCG and SPFT sought a response were:

To what extent do you agree or disagree with our preferred option for the provision of mental healthcare for adults, older people and those with dementia?

The response to this question was as follows:

Agreed 35% Disagreed 48% Neither Agree or Disagree 17%

While people generally supported the principle of improving care and services and modernising facilities, as well as accepted the benefits of a Centre of Excellence for Dementia Care, they raised a number of issues which were considered as part of the revised proposals.

The main themes emerging from the public consultation The key issues are outlined here with a clear response to the issue shown in section 3 below.

Transport and travel: There was a general view that moving services from certain areas would increase the amount of travel some service users, staff, carers and families would need to take. This presented a particular issue for residents of Chichester where access to public transport is already challenging. Having to manage travel inconveniences while a family member is unwell created more anxiety for people.

Single-sex wards: Many respondents to the consultation (including staff) raised concerns around the proposed changes to make all inpatient wards into single-sex wards. In their view, the proposals did not accurately reflect a real life environment for the patients while some felt that by creating single-sex environments might inadvertently reinforce negative gender stereotypes. How to meet the needs of trans or non-binary patients was also raised as a concern.

Although there was considerable negative feedback for single sex wards, there was strong support for the need to have single-sex wards for those patients with dementia in order to give these patients the privacy and dignity they deserve.

Safety concerns about increased number of beds: Concerns were raised, that increasing the ward sizes, as set out in the preferred option, might have implications for the therapeutic environment and staff morale and any subsequent impact on recruitment and retention.

Importance of strengthening community services: Almost 80 percent of people who responded to the survey believe that people should be cared for in their own home wherever possible. They said that there should be investment and improvements in community provision to help mitigate against any negative aspects the final preferred option.

Other issues

Parking and traffic concerns: Some people, those living near Sussex Partnership's Swandean site in Worthing, said the site is at more than full capacity. The increase in cars due to the plans will make matters worse and cause road safety problems.

In response, SPFT has agreed to meet local residents to discuss their concerns. It is also developing a parking strategy to identify potential solutions and create more parking provision on the site. This will enable staff to make use of any potential transport solution, which is organised, between relevant sites.

Some service users, carers and staff said they wanted continuing involvement in refining the plans and influencing how they are implemented to reduce any negative impacts.

Continuing involvement Sussex Partnership has responded positively and communicated a strong commitment to making sure service user, carer, staff and Governor engagement continues throughout any reconfiguration of services and for this to be reflected in the implementation plan. It is anticipated that a post-project evaluation will be undertaken which will involve service users, carers, staff and a full range of wider stakeholders.

3.0 The Decision Making Business Case – Revised Proposals (Post Consultation)

Following the independent analysis of the findings from the public consultation, the CCG and SPFT considered the feedback to develop the DMBC. The DMBC summarises the final proposals and demonstrates the changes made to the original proposal in response to the outcome of the public consultation. The feedback was considered alongside input from the clinical, operational, finance and estates teams to ensure that the final proposals in response to the feedback were viable, clinically safe and mitigate any potential risks that may arise.

The table below compares the revised proposals (post-consultation), with the original pre- consultation preferred option.

Patient Pre-consultation Preferred option - Post-consultation Patients to move group: configuration Patients were to proposed action: to: move to Older Move 12-bed Single-sex wards at Move 12-bed Mixed-sex wards at people mixed-sex ward at Meadowfield mixed-sex ward at Meadowfield with Harold Kidd Unit, Hospital, Worthing Harold Kidd Unit, Hospital, Worthing, mental Chichester and Langley Green Chichester and Langley Green health (Orchard) Hospital, Crawley (Orchard Ward) Hospital, Crawley problems Male Move 10-bed Refurbished single- Move 10-bed No change from patients single-sex ward at sex ward at single-sex ward at Pre-Consultation with Harold Kidd Unit Salvington Lodge Harold Kidd Unit, Preferred option dementia (Grove) (The Burrowes), Chichester (Grove Worthing Ward) Female Move 12-bed New single-sex ward Move 12-bed No change from patients single-sex ward at at First Floor, single-sex ward at Pre-Consultation with Horsham Hospital Salvington Lodge Horsham Hospital Preferred option dementia (Iris Ward) (Iris Ward) Male and 16-bed Oaklands Single-sex wards at 16-bed Oaklands No change from female Ward, Chichester, Meadowfield Ward, Chichester, preferred option adults to become 16-bed Hospital, Worthing remains male and estates but wards with male only ward. and Langley Green female. will remain mixed mental All other wards at Hospital, Crawley All adult wards at sex health Meadowfield, Langley Green, problems Worthing, and Crawley, and Langley Green, Meadowfield Crawley, to become Hospital, Worthing, single-sex remain mixed-sex wards

The revised proposals seeks to address the following concerns:

Single-sex wards During the consultation, people raised concerns about the plans to introduce single-sex wards for adults of working age and older people, in particular proposals to move females at Oaklands Ward in Chichester to wards in either Worthing or Crawley. Therefore, the revised proposals keep all wards for adults of working age and older people with mental health problems, other than dementia, as mixed-sex wards. To comply with the relevant

national guidance, enhanced segregated zones within existing mixed-sex wards, alongside both communal and female-only lounges will be created. There will also be flexibility to accommodate the needs of any transgender or non-binary inpatients.

All wards for people with dementia will remain single-sex to address the particular clinical needs of these patients so we can preserve their safety, privacy and dignity.

The CCG and SPFT proactively sought advice from the Care Quality Commission (CQC) with further support from Healthwatch West Sussex and Healthwatch England to ensure that any conclusion around this matter were not in contravention with national guidelines. The process to seek assurance around the guidelines was as follows; • Healthwatch West Sussex raised these issues with Healthwatch England, who were aware of similar issues elsewhere in the country. • Healthwatch England sought advice from the CQC about what would be acceptable to them. • Their advice was that our proposals to have segregated or ‘zoned’ wards, with communal lounges and separate lounges for females would be within the CQC guidance.

Transport and travel It was acknowledged at the outset that the preferred option would mean that for some people living in and around the Chichester and Horsham areas, travel and transport may be challenge if they needed mental health hospital care. It also meant that carers, families and friends may also have had to travel further in some circumstances to visit a loved one.

The consultation confirmed people's concerns that moving services to Worthing and Crawley may make it difficult for people living in and around Chichester and Horsham to travel to services in other parts of the county. After hearing these concerns, the proposals included a commitment to: • Pay any additional travel costs to partners and carers visiting people who will be inpatients at the time we transfer Orchard, Grove and Iris Wards. • Investigate the potential for providing community transport services at relevant locations. • Increase awareness and provide information about how partners and carers, particularly those on benefits, can claim back travel expenses through the Healthcare Travel Costs Scheme. • Work with West Sussex County Council's (WSCC) transport and Community Transport providers to look at how transport routes between relevant locations could be improved.

SPFT will closely monitor the situation and may introduce further transport solutions to replace or complement the solutions above, following further engagement with service users and carers and the WSCC transport team and Sussex Community Transport.

Creation of extra beds Concerns were raised in the consultation, particularly from staff and clinicians, about the increase in ward sizes proposed in the original preferred option, in particular for adults of working age. This increase would have provided the eight extra beds needed to make sure our original proposals did not result in any bed reductions. In light of this SPFT decided to retain the current ward sizes but address the concerns by reviewing their provider to

provider contract with Surrey and Borders Partnership NHS Foundation Trust (Surrey and Borders) to provide 13 adult of working age beds at Langley Green Hospital in Crawley.

This contract ended in March 2019, the plan was to renew the contract for three years from April 2019 to April 2022, and reduce the number of beds from 13 to nine beds (five male, four female) from December 2019. This has been revised and the contract will end earlier in May 2021 in order that the remaining 9 beds can be fully used within West Sussex. Surrey and Borders has put in place plans to re-provide inpatient hospital facilities for people living in East Surrey, from 1 May 2021 in line with its strategic plans.

4.0 Governance and Approval Timeline

The table below details the timeline for the CCG to review the case and to submit its decision to the West Sussex HASC for consideration.

Sussex Partnership Board 2 December 2020 Approved and NHS West of Directors consider Sussex CCG informed. summary proposals West Sussex Local 16 December 2020 Update noted and noted that Management Team (LMT) draft DMBC was being developed for submission to the Executive Management Team (EMT) on 21 Dec 2020 EMT 21 December 2020 Approved to proceed subject to minor changes to the DMBC. Quality Committee 13 January 2020 Endorsed the recommendations to the Governing Body within the DMBC West Sussex CCG 9 February 2021 Pending Decision Governing Body consider DMBC West Sussex HASC to 24 February 2021 Pending Decision consider the CCG decision

5.0 Implementation Timeline, subject to approval

Implementation February 2021 - July 2022:

Action Date Phase One Staff consultation February/March 2021 Close Grove and Iris wards March/April 2021 Implement agreed transport solutions March/April 2021 Project/Programme evaluation review April 2021 Start environmental/estates upgrades for First Floor, Salvington April 2021 Lodge

Additional nine adult working age beds provided through April 2021 termination of Surrey and Borders contract Start environmental/estates upgrades for adult mixed gender wards April 2021

Clinical and Human Resources (HR) evaluation review of Dementia May 2021 ward (Grove and Iris) moves Single gender zones created within adult mixed gender wards May 2021 (following completion of environmental upgrades) Completion of environmental/estates upgrades for adult mixed August 2021 gender wards Close Harold Kidd Unit and transfer Orchard ward to Opal ward, October 2021 Langley Green Hospital Clinical and HR evaluation review of Opal ward move November 2021 Project/Programme evaluation review December 2021

Phase Two Completion of environmental/estates upgrades for 1st Floor, April 2022 Salvington Lodge Transfer back Worthing patients from Brunswick Ward, Mill View to May 2022 dementia beds on Swandean Hospital site Create new West Sussex specialist dementia Centre of Excellence, June 2022 Swandean Hospital site Final Project/Programme evaluation review July 2022

6.0 Next Steps

The next step is to: • Present final DMBC and GB decision to West Sussex HASC to consider whether the CCG decision is in the best interest of the local population

7.0 Recommendation/Action required

The Governing Body is asked to:

d) For male and female adults with mental health problems to move to 16-bed Oaklands Ward, Chichester. All adult wards at Langley Green, Crawley, and Meadowfield Hospital, Worthing, remain mixed-sex wards.

• Note the consultation findings report (Appendix 3) and how these have informed the DMBC and resulted in the post-consultation proposal.

• Note and approve the Quality Impact Assessment (QIA) (Appendix 5) for the proposed change.

Delivering safe, effective, quality care

Improving mental health services for adults and older people in West Sussex

NHS West Sussex Clinical Commissioning Group and Sussex Partnership Foundation Trust

Date: 16th December 2020 Version: 8 – FINAL FOR CCG GOVERNING BODY Name of originator/ author: Harpreet Kaur – West Sussex Redesign Programme Lead

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 1 Contents

1.0 Executive Summary ...... 6 2.1 Who we are ...... 14 2.2 Aims of the decision-making business case ...... 14 2.3 From consultation to decision-making - planning, assuring and delivering service change to patients ...... 16 3.0 Case for Change ...... 19 3.1 Strategic and Local context ...... 19 3.1.1 Strategic and national drivers for change ...... 19 3.2.2 Current Provision ...... 21 3.2.3 East Surrey Beds ...... 22 3.2.4 1st Floor – Salvington Lodge (Burrowes, Meadowfield Swandean) ...... 22 3.2.5 Drivers For Change ...... 22 3.3 Clinical Model and Vision for Change ...... 23 3.3.1 Our vision ...... 23 3.3.2 Patient pathways ...... 24 3.3.3 Community care pathway ...... 25 3.3.4 Urgent care services ...... 25 3.3.5 Single Point of Access ...... 26 3.3.6 24/7 Crisis Resolution and Home Treatment Teams (CRHT) ...... 27 3.3.7 Haven at Meadowfield, Worthing ...... 27 3.3.8 Staying Well Crisis Cafes ...... 28 3.3.9 Psychiatric Liaison ...... 28 3.3.10 Ambulance Triage ...... 28 3.3.11 Street Triage ...... 29 3.3.12 Early Intervention in Psychosis Teams ...... 29 3.3.13 Suicide Prevention ...... 29 3.4 Mental Health Long Term Plan ...... 29 3.5 Centre of Excellence for dementia care ...... 31 3.6 Patients, carers and their families ...... 32 3.7 Hospital social work ...... 32 3.7 Workforce ...... 32 3.8 Training and development ...... 33 3.9 Workforce Issues ...... 33

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 2

3.10 Estate issues ...... 35 3.10.1 The Burrowes/ Salvington Lodge ...... 35 3.10.2 Harold Kidd Unit ...... 35 3.10.3 Iris Ward, Horsham Hospital ...... 36 4 Pre-Consultation Business Case & Engagement ...... 36 4.1 Pre-engagement in developing the pre-consultation preferred option ...... 36 Financial ...... 37 4.2 The Preferred Option in the PCBC for Public Consultation ...... 39 4.3 The Formal Public Consultation ...... 39 4.4 Summary of key themes arising from the Public Consultation ...... 40 4.4.1 Improving Care and Modernising Facilities ...... 40 4.4.2 Creating a Centre of Excellence ...... 40 4.4.3 Travel and Transport ...... 41 4.4.4 Single Sex Wards ...... 41 4.4.5 Community Provision ...... 41 4.4.6 Other Key Points ...... 41 4.5 Consultation Outcome and Responses ...... 41 4.5.1 Transport and Travel ...... 41 4.5.2 Single Sex Wards ...... 42 4.5.3 Safety concerns about increased number of beds ...... 42 4.5.4 Strengthening Community Services ...... 42 4.5.5 Parking and Traffic Concerns ...... 43 4.5.6 Continuing Involvement ...... 43 4.6 Equality and Health Inequalities Impact Assessment ...... 44 5.0 The proposal post-consultation ...... 45 6.0 Assuring the Revised Proposals ...... 49 6.1 Meeting the Five NHSE/I Tests ...... 49 Test 1 - Support from clinical commissioners ...... 49 Test 2 - Strengthened public and patient engagement ...... 49 Test 3 - Clarity on the clinical evidence base ...... 49 Test 4 - Consistent with current and prospective patient choice ...... 50 Test 5 - Proposals which include plans to significantly reduce hospital bed numbers NHS England will expect commissioners to be able to evidence that they can meet one of the following three conditions: ...... 51

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 3

Equalities Act duties ...... 51 External assurance - NHS England and Improvement (NHSE/I) ...... 52 7.0 External Assurance Timeline ...... 52 8. Assessing the implications of our Revised Proposals ...... 53 8.1 Bed modelling ...... 53 8.2 Surrey and Borders contract ...... 54 8.3 Transition ...... 55 8.4 Single sex wards ...... 55 8.5 Equality and Health Inequalities Impact Assessment ...... 56 8.5 Activity and Financial Implications ...... Error! Bookmark not defined. 8.5.1 Financial implications ...... 60 8.5.2 Post-consultation outcomes ...... 61 8.5.3 Workforce ...... 63 9. Implementation of Revised Proposals (Post-Consultation) and Benefits Realisation ...... 63 9.1 Implementation Approach and Governance ...... 63 9.2 Post Project Evaluation Reviews ...... 64 9.2 .1 Project/Programme Reviews ...... 64 9.2.2 Estates Improvements ...... 64 9.2.3 Workforce ...... 64 9.2.4 Clinical and HR Reviews ...... 65 9.2.5 Surrey and Borders beds transition ...... 65 9.2.6 Implementation Plan: Timeframe ...... 65 9.3 Implementation Challenges and Risks ...... 67 9.3.1 Implementation Risks and Plans for Mitigation ...... 67 9.4 Implementation Risks ...... 67 9.4.1 Estates – 1st Floor, Salvington Lodge Development ...... 67 9.4.2 Travel times and transport ...... 67 9.4.3 Programme Implementation and Stakeholder Engagement ...... 68 9.4.4 Workforce ...... 68 9.4.5 Communicating Changes ...... 69 9.4.6 Benefits Realisation Plan ...... 69 10. CCG statutory duties ...... 70 11. Summary and Conclusion ...... 70

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 4

Appendix 1 – Independent Report of Consultation results: October 2019 ...... 75 Appendix 2 – Equality Health Inequality Impact Assessment ...... 76 Appendix 3 – Travel and Transport Survey ...... 77 Appendix 4 – Benefits Realisation Plan ...... 78

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 5

1.0 Executive Summary

This Decision-Making Business Case (DMBC) was produced by NHS West Sussex Clinical Commissioning Group - following the merger of NHS Coastal West Sussex, NHS Crawley and NHS Horsham and Mid Sussex Clinical Commissioning Groups (CCGs) from 1 April 2019 - in partnership with the SPFT NHS Foundation Trust (SPFT). It proposes changes to improve mental health services for adults and older people, including those living with dementia, across West Sussex. These proposals should also be considered in the context of SPFT’s community redesign programme for West Sussex.

Case for Change – Strategic and Local context

The most pressing driver for change as outlined in the Pre-Consultation Business Case (PCBC) is:

• Poor quality of inpatient environments at both the Harold Kidd Unit, Chichester (which consists of two wards, Orchard and Grove), and Iris Ward at Horsham Hospital. • The isolation of Iris Ward is another factor that needs to be addressed for both clinical and patient safety reasons.

Other primary drivers for change were: 1. the need to comply with Care Quality Commission guidance on eliminating mixed-sex wards 2. to make sure there are enough beds to meet current and projected future demand, and 3. to make sure that our proposals will enable us to enact the overall aims and objectives of SPFT’s Clinical Vision and Strategy (outlined in section 3.3).

Therefore, following a comprehensive appraisal, scrutiny and governance process, we developed a preferred option (outlined in the Pre Consultation Business Case [PCBC]) which was subject to formal public consultation between July and October 2019. The preferred option was to:

1. Move services from the Harold Kidd Unit in Chichester to: • Dedicated dementia care wards for men and women in single-sex wards in Worthing, and • Modern single-sex wards for older people in Worthing and Crawley.

2. Move services from Iris Ward at Horsham Hospital to: • A new modern ward for women with dementia in Worthing.

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In making these changes, we could:

• meet national standards that say that people should be cared for on single-sex wards • further improve and strengthen our community services so we care for people in their own homes where possible and help people remain independent • provide an opportunity to create a Centre of Excellence in Worthing for people living with dementia, and • contribute to the overall success of SPFT’s Clinical Vision and Strategy.

Public Consultation and Engagement The public consultation relating to the improvement of inpatient bed provision in West Sussex began on Wednesday 17 July 2019 for 12 weeks, ending on 11 October 2019. This was preceded by a lengthy period of pre-consultation engagement with a range of stakeholders including service users and carers, their representative bodies, charities, staff and other interested people. This helped inform our proposals before, during and after the formal consultation was complete.

We have also engaged with West Sussex HASC and ensured feedback has informed our proposals.

Outcomes of the public consultation

The following engagement activities were undertaken and responses received as part of the public consultation process as illustrated in the table below;

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The consultation feedback was pulled together into final report that identified six overarching themes. The full report is available on the CCG website and at Appendix 1 of this DMBC.

The six overarching themes were:

Transport and travel: There was a general view that moving services from certain areas would increase the amount of travel for some service users, staff, carers and families. This presented a particular issue for residents of Chichester where access to public transport is already challenging. People also shared that having to manage travel inconveniences while a family member is unwell created more anxiety.

Single-sex wards: Many respondents to the consultation (including staff) raised concerns around the proposed changes to make all inpatient wards into single-sex wards. In their view, the proposals did not accurately reflect a real-life environment for the patients while some felt that by creating single-sex environments might inadvertently reinforce negative gender stereotypes. How to meet the needs of trans or non- binary patients was also raised as a concern. Most staff expressed a view that patients in single sex wards can be more difficult to manage too.

Safety concerns about increased number of beds: Concerns were raised that increasing the ward sizes, as set out in the preferred option, might have implications for the therapeutic environment and staff morale and any subsequent impact on recruitment and retention.

Importance of strengthening community services: Almost 80 per cent of people who responded to the survey believe that people should be cared for in their own home wherever possible. They said that there should be investment and improvements in community provision to help mitigate against any negative aspects the final preferred option.

Parking and traffic concerns: Some people, those living near SPFT's Swandean site in Worthing, said the site is at more than full capacity. The increase in cars outlined in the plans will make matters worse and cause road safety problems. In response, SPFT has agreed to meet local residents to discuss their concerns. They are also developing a parking strategy to identify potential solutions and create more parking provision on the site. This will enable staff to make use of any potential transport solution, which is organised, between relevant sites.

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Some service users, carers and staff said they wanted continued involvement in refining the plans and influencing how they are implemented to reduce any negative impacts.

Continuing involvement: SPFT has responded positively and communicated a strong commitment to making sure service user, carer, staff and Governor engagement continues throughout any reconfiguration of services and for this to be reflected in any implementation plans. It is anticipated that a post-project evaluation will be undertaken which will involve service users, carers, staff and a full range of wider stakeholders.

Addressing themes from the public consultation and adapting our proposal

We have reviewed each of the public consultation themes to assess their impact upon the proposal as set out in the PCBC (this is described in detail in section 5 of the DMBC).

The consultation confirmed people’s concerns that moving services to Worthing and Crawley may make it difficult for people living in and around Chichester and Horsham to travel to services in other parts of the county. We have ensured this feedback has informed our final proposals as outlined in section 5.

Our proposals remain consistent with all relevant strategies and plans put in place by the Sussex Sustainability and Transformation Partnership (now the Sussex Health and Care Partnership), the West Sussex Clinical Commissioning Groups (CCGs), the SPFT and the wider NHS.

The independent analysis report on the findings of the formal public consultation is included at Appendix 1 together with the Equality and health Inequalities impact assessment (EHIA) at Appendix 2. This has been reviewed throughout the consultation process to make sure we understood any differential impacts on our communities and has been further reviewed in line with these proposals. Also accompanying the document will be a travel and transport survey report for both service users and carers and is included as Appendix 3.

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In summary, the post-consultation proposal is as follows:

Patient Pre-consultation Preferred option Post- Patients to group: configuration - Patients were consultation move to: to move to proposed action: Older Move 12-bed Single-sex Move 12-bed Mixed-sex people mixed-sex ward wards at mixed-sex ward wards at with at Harold Kidd Meadowfield at Harold Kidd Meadowfield mental Unit, Chichester Hospital, Unit, Hospital, health (Orchard) Worthing and Chichester Worthing, and problems Langley Green (Orchard Ward) Langley Green Hospital, Hospital, Crawley Crawley Male Move 10-bed Refurbished Move 10-bed No change patients single-sex ward single-sex ward single-sex ward from Pre- with at Harold Kidd at Salvington at Harold Kidd Consultation dementia Unit (Grove) Lodge (The Unit, Preferred Burrowes), Chichester option Worthing (Grove Ward) Female Move 12-bed New single-sex Move 12-bed No change patients single-sex ward ward at 1st single-sex ward from Pre- with at Horsham Floor, at Horsham Consultation dementia Hospital (Iris Salvington Hospital (Iris Preferred Ward) Lodge Ward) option Male and 16-bed Single-sex 16-bed No change female Oaklands Ward, wards at Oaklands from preferred adults Chichester, to Meadowfield Ward, option estates with become 16-bed Hospital, Chichester, but wards will mental male only ward. Worthing and remains male remain mixed health All other wards Langley Green and female. sex problems at Meadowfield, Hospital, All adult wards Worthing, and Crawley at Langley Langley Green, Green, Crawley, to Crawley, and become single- Meadowfield sex Hospital, Worthing, remain mixed- sex wards

Proposed Implementation

At this stage, no decision on the post-consultation proposal has been made.

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This DMBC presents our proposals following the public consultation feedback together with additional information and evidence that were collated as part of this DMBC development and in response to the consultation. The purpose of the DMBC is to enable and support the CCG’s Governing Body decision-making process. Should the CCG’s Governing Body support the post-consultation proposal and approve the DMBC, we will take the following steps to implement the decisions: Implementation February 2021 - July 2022: Action Date Phase One Governing Body (GB) to consider the Decision-Making Business February 2021 Case in Public. West Sussex Health and Social Care Scrutiny Committee (HASC) meeting to review the CCG Governing’s Body decision DMBC plan and proposals reviewed and decision made February 2021 Staff consultation February/March 2021 Close Grove and Iris wards March/April 2021 Implement agreed transport solutions March/April 2021 Project/Programme evaluation review April 2021 Start environmental/estates upgrades for 1st Floor, Salvington April 2021 Lodge Additional nine adult working age beds provided through April 2021 termination of Surrey and Borders contract Start environmental/estates upgrades for adult mixed gender wards April 2021

Clinical and HR evaluation review of Dementia ward (Grove and May 2021 Iris) moves Single gender zones created within adult mixed gender wards May 2021 (following completion of environmental upgrades) Completion of environmental/estates upgrades for adult mixed August 2021 gender wards Close Harold Kidd Unit and transfer Orchard ward to Opal ward, October 2021 Langley Green Hospital Clinical and HR evaluation review of Opal ward move November 2021 Project/Programme evaluation review December 2021

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Recommendations

The following recommendations are presented to the Governing Body for consideration and approval:

1. Approve the post-consultation Decision Making Business Case to:

a. For older people with mental health problems - Move services from the Harold Kidd Unit in Chichester to Mixed-sex wards at Meadowfield Hospital, Worthing, and Langley Green Hospital, Crawley b. For male patients with Dementia - Move 10-bed single-sex ward at Harold Kidd Unit, Chichester (Grove Ward) to Refurbished single-sex ward at Salvington Lodge (The Burrowes), Worthing – Dementia Centre of Excellence c. For female patients with Dementia - Move services from Iris Ward at Horsham Hospital to New single-sex ward at 1st Floor, Salvington Lodge - Dementia Centre of Excellence d. Male and female adults with mental health problems to move to 16- bed Oaklands Ward, Chichester. All adult wards at Langley Green, Crawley, and Meadowfield Hospital, Worthing, remain mixed-sex wards

2. Note the consultation findings and how these have informed the DMBC and resulted in the post-consultation proposal. 3. Note and approve additional actions to further mitigate any potential adverse impacts of the post-consultation proposal on groups highlighted in the EHIA 4. Approve the submission of the Governing Body’s decision to the West Sussex Health and Social Care Scrutiny Committee (HASC) for their consideration.

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2.0 Introduction

2.1 Who we are

West Sussex Clinical Commissioning Group (CCG), along with Brighton and Hove CCG and East Sussex CCG, work closely together as Sussex NHS Commissioners. Each CCG is responsible for planning, developing, and buying high quality, safe and sustainable health services for local populations. From 1 April 2020, we formed as the West Sussex CCG, comprising Coastal West Sussex CCG, Crawley CCG and the Horsham and Mid Sussex CCG. We are a membership organisation, made up of 82 GP practices, led by local doctors and health professionals and are responsible for the health and well-being of more than 860,000 people. SPFT provides mental health services which care and treat people with conditions such as psychosis, depression, anxiety, and dementia and personality disorder. Its specialist learning disability services provide community and inpatient care for people with complex health needs which cannot be met by other services. It also has a number of services that provide very specialist care for people with complex health conditions and social care needs. SPFT provides care in people’s homes, in specialist clinics, hospitals, GP surgeries and prisons. Services are aimed at children, young people and adults of all ages and many are provided in partnership with other local health, care and voluntary sector organisations. We are part of the Sussex Health and Care Partnership (SHCP), which comprises all Sussex-wide CCGs and acute, community and mental health providers

2.2 Aims of the decision-making business case

This Decision Making Business Case (DMBC) sets out the information necessary for our Governing Body to decide on our proposals for the future of Mental Health Services in West Sussex. This DMBC was produced by NHS West Sussex Clinical Commissioning Group in partnership with the Sussex Partnership NHS Foundation Trust (SPFT). It proposes changes for improving mental health services for adults and older people, including those living with dementia, across West Sussex. These proposals should also be considered in the context of SPFT’s community redesign programme for West Sussex.

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The DMBC builds on the work undertaken when developing the PCBC, which was agreed by the Coastal West Sussex CCG, Crawley CCG and Horsham Mid Sussex CCG (prior to the merger) in June 2019. This document summarises the case for change, as outlined in the PCBC, including the national drivers and local context. It describes any new services and how services have changed since the PCBC was written, including the impact of Covid-19, to establish what bearing they have on the case for change. The DMBC also outlines the consultation and engagement process and addresses the key themes from the public consultation and West Sussex Health and Social Care Scrutiny Committee (HASC) recommendations. It also details the process undertaken and additional information and evidence we sought to form our proposals and final recommendations as well as the high-level implementation plans. • The most pressing driver for change is the poor quality of inpatient environments at both the Harold Kidd Unit, Chichester (which consists of two wards, Orchard and Grove) and Iris Ward at Horsham Hospital.

• The isolation of Iris Ward is another factor that needs to be addressed for both clinical and patient safety reasons.

• Other primary drivers for change were:

o the need to comply with Care Quality Commission guidance on eliminating mixed-sex wards o to make sure there are enough beds to meet current and projected future demand, and o to make sure that our proposals will enable us to enact the overall aims and objectives of SPFT’s Clinical Vision and Strategy (outlined in section 3.3).

Therefore, following a comprehensive appraisal, scrutiny and governance process, we developed a preferred option which was subject to formal public consultation between July and October 2019. The preferred option was to: • Move services from the Harold Kidd Unit in Chichester to: o dedicated dementia care wards for men and women in single-sex wards in Worthing, and o modern single-sex wards for older people make and female in Worthing and Crawley.

• Move services from Iris Ward at Horsham Hospital to: o a new modern ward for women with dementia in Worthing.

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In making these changes, we could: • meet national standards that say that people should be cared for on single- sex wards • further improve and strengthen our community services so we care for people in their own homes where possible and help people remain independent

2.3 From consultation to decision-making - planning, assuring and delivering service change to patients

This DMBC sets out the information necessary for our Governing Body to decide on our proposals for the future of improving West Sussex Mental Health Services. In line with the NHS England guidance on Planning, Assuring and Delivering Service Changes for Patients (2018)1, the Governing Body needs to satisfy itself that the process set out in the DMBC meets the statutory duties and responsibilities of the CCG and delivers the required improvements for local people. These duties include: • ensuring there is early public involvement in planning the service change • ensuring that the service change has regard to the Joint Strategic Needs Assessment (JSNA) and is in response to the local health need • assuring the proposed service change satisfies the NHS Four Tests for service reconfiguration + one additional test for beds • ensuring there is engagement with the local authority on the proposed service changes, and • ensuring full and consistent engagement and consultation with key stakeholders, including the public, patients, clinicians, and other system partners. The table below summarises the actions and work we have undertaken to meet our duties and responsibilities while developing this DMBC.

1 https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service- change-v6-1.pdf

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Table 1: Actions taken to meet the CCG’s duties and responsibilities Summary of responsibility How did we meet it? and duty Ensuring there is early public • The development of our PCBC proposal was informed by the involvement in planning the feedback and outcomes from our engagement programme. service change Since March 2018, the CCGs and SPFT in particular have carried out communications and engagement activity with a range of stakeholders including GPs, charities and other third sector organisations, West Sussex Health and Social Care Scrutiny committee, Healthwatch and other partners. There has been a particular focus on talking to service users, carers their families and/or representatives who have been involved in reviewing the options considered. • Our pre-consultation engagement process and how we developed our consultation proposal is described in the PCBC, which is available on our websites (www.westsussexccg,nhs.uk and www.sussexpartnership.nhs.uk ) Ensuring that the service • We assessed local health needs for the PCBC and have change has regard to the refreshed this assessment for the DMBC and this is outlined in Joint Strategic Needs section 3. Assessment (JSNA) and is in • The CCGs commissioned Niche Consultancy to complete a response to the local health simulation modelling exercise, the key objective of which was need to develop an objective, data driven understanding of the current system challenges and potential solutions which would influence the Mental Health Programme commissioning, planning, financial investment, strategic approach and quality improvement across Sussex in 2019/20 and beyond. • We have carefully considered the consultation feedback to inform our post-consultation proposal. As part of this process we have gathered new evidence to better understand local services and local needs. Assuring the proposed service • Our PCBC went through assurance process with NHS change satisfies the NHS Five England (NHSE) and additional scrutiny from the South East Tests for service Clinical Senate. reconfiguration • The DMBC has also gone through the NHSE assurance process prior to the submission to the CCG Governing Body. Section 6.1 presents the evidence of meeting the NHS Five Tests for service reconfiguration. • Our DMBC was reviewed and endorsed by the Executive Management Team of Sussex CCGs, with additional scrutiny undertaken by the Sussex CCGs Quality Committee around the Quality Impact Assessment and the Equality and Health Inequalities Impact Assessment prior to the submission to the CCG Governing Body. • Although not part of the formal assurance process, we shared the findings of the public consultation and tested our post- consultation proposal with the CQC, Healthwatch England and West Sussex Healthwatch in regards to proposals around mixed sex wards prior to submission of the DMBC to the CCG Governing Body. Ensuring there is engagement • Throughout the development of PCBC and DMBC we have with the local authority on the continued to engage and liaise with the West Sussex Health proposed service changes and Social Care Scrutiny Committee and its dedicated Review Board.

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Summary of responsibility How did we meet it? and duty • The scrutiny of the Review Board has resulted in several recommendations which were considered when developing this business case. Ensuring full and consistent • Building on early public involvement outlined previously, we engagement and consultation commenced public consultation for 12 weeks from the 17th with key stakeholders, July 2019 to 11th October 2019. A Communications, including the public, patients, Engagement and Equalities Steering Group was established clinicians and other system with fortnightly meetings scheduled to oversee the public partners consultation and respond to questions from the public and media during this period. This group included Healthwatch West Sussex to provide independent oversight. • Prior to Consultation our documents and plans were independently reviewed and endorsed by the Consultation Institute. • The Steering Group commissioned Public Perspectives Ltd, a consultancy which specialises in research and community engagement in the public and third sectors, to carry out an independent analysis of the feedback. All responses were independently analysed by Public Perspectives who presented a final report, which provided valuable feedback, and input that was used to develop refined final proposals, which better represent the needs of people in West Sussex. • We received over 149 valid responses to the consultation questionnaire from a range of stakeholders. In addition to the consultation questionnaire we undertook 4 public meetings and 13 small group meetings with local people, community groups and voluntary sector organisations with a total of over 400 people in attendance. • Our consultation process is detailed in section 4 of the DMBC outlines how we have considered the consultation feedback. Ensuring service change • We completed an Equality and Health Inequalities Impact proposals address inequalities Assessment to inform our PCBC, which we then updated after and fulfil the Public Sector carefully considering the feedback from the public consultation Equality Duty to identify any additional mitigating actions to inform our post- consultation proposal. The summary of EHIA is provided in section 7.1.2. • We assessed the impact of the post-consultation proposal on patients and the benefits we believe it will bring to local people

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3.0 Case for Change

3.1 Strategic and Local context

According to the West Sussex Joint Strategic Needs Assessment 2014. West Sussex currently has a population of more than 860,000 people. This figure is estimated to rise to more than 950,000 by 2036. The number of people aged 50 and over will rise from 358,000 to more than 460,000 in the same period. The number of people aged 90 and over alone will rise from 11,271 to 28,137 during the same period. There are currently 78 GP practices serving West Sussex. It is estimated that there are 13,000 people living in West Sussex with dementia. This is predicted to rise by 26 per cent by 2021. The Dementia Framework West Sussex 2014 sets out the priorities for providing health and social care to those affected. This includes supporting individuals to maintain their independence for as long as possible, making sure they receive high quality compassionate support with timely diagnosis. They should also have access to good information and advice and be able to live in supportive communities where people feel able to participate in community life without stigma. The health of people in West Sussex is generally better than the England average, according to Public Health England, with life expectancy of both men and women being higher than the national average.

3.2 Strategic and national drivers for change

Mental health affects one in four of us, and that does not include those caring for someone with mental health needs or with a family member or friend who needs mental health support. During the initial COVID-19 lockdown, we saw a decrease in demand for mental health inpatient services in Sussex but as the situation has changed, that demand has increased, with a rise in the number of out-of-area placements. This reflects national concerns around a 'surge' in mental health cases due to the effects of the pandemic. Although most people with mental health conditions are supported and treated by primary care or by Improving Access to Psychological Therapies (IAPT) services, 3.4 per cent of the adult population in England were in contact with dedicated adult mental health and learning disability services at some point last year.

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As the population gets older, so more people will need mental health care. In West Sussex, there are about 94,000 people aged between 65 and 74 and 89,000 people aged 75 and over. There are some small areas of the county where more than 50 per cent of people are aged 65 or above. National best practice is that people receive high-quality care close to home in the most appropriate place for their needs. National standards also state that if people need to be admitted for hospital care then they should be looked after in modern, high-quality wards that provide single-sex accommodation. Like a lot of the NHS, we have buildings and accommodation which are old, of poor quality and, even if they are upgraded, will not meet the standards we expect for our patients, carers and families. This is something we need to address urgently and has been previously highlighted by the Care Quality Commission (CQC). The NHS Long Term Plan was published in January 2019 and commits £2.3 billion a year for mental health services. It states: ‘Much of our estate consists of world-leading facilities that enable the NHS to deliver outstanding care for patients. But some of our estate is old, in parts significantly older than the NHS itself, and would not meet the demands of a modern health service even if upgraded.’ Top priorities of the Long Term Plan (LTP) include: • Improving access to talking therapies for people with anxiety, depression and other common mental health problems.

• Access to 24/7 mental health crisis support through NHS 111 by 2028/9.

• An increase in other forms of support such as crisis cafes.

• More community support for people with mental health problems.

Sussex Health and Care Partnership has developed its own five year plan for delivering mental health services to the people of Sussex, which is aligned to and part of the Mental Health Collaborative priorities. The final recommended proposals should be seen within the context of SPFT’s 2020 Vision which is set out in its latest Clinical Strategy. Also relevant is its Estates Strategy January 2019 which sets out an overall strategy to improve patient care. The final proposals also reflect one of the main priorities of the NHS West Sussex CCG to transform local services by integrating local care and support for people across the area. It also sets out SPFT’s ambition to have the right property in the right location so that it can provide safe, secure and effective environments for all patients and staff, supporting financial sustainability of the service. That is why it seeks to improve its estate so that it provides high quality environments which are the most appropriate for patients and staff as well as developing more

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environmentally sustainable buildings and services. At the same time, SPFT wants to generate income from its property where possible and to enhance security across all of its estate. The proposals also respond to concerns expressed by NHS Providers - the membership organisation for the NHS acute, ambulance, community and mental health services that treat patients and service users in the NHS. At its annual conference in October 2019, it highlighted evidence that mental health patients are being placed at increasing levels of risk from ageing and often unsafe mental health buildings

3.2.1 Current Provision

Inpatient mental health services are provided by SPFT t. The services, representing a total number of 156 beds, which are relevant to these final proposals are:

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3.2.2 East Surrey Beds

Within the current provision in West Sussex, 13 beds are allocated to patients from East Surrey. Since September 2008, SPFT has had provider-to-provider a contract with Surrey and Borders Partnership NHS Trust (SABP) to provide 13 beds for working age adults from East Surrey at Langley Green Hospital, Crawley. This contract is ending in April 2021 and Surrey and Borders has now identified local alternative provision for the nine beds to support care closer to home for their community and which gives scope to enable implementation of these proposals should the proposal be approved. To make sure that no patients are unduly disrupted during this process, should the proposal be agreed, we would maintain the nine beds at Langley Green Hospital until Friday 30 April but SPFT will stop accepting admissions on Wednesday 31 March. This means that based on an average length of stay of 35 days, we should not be transferring any patients from Langley Green Hospital to the new provider. In addition to this, analysis shows that this preferred option means that the travelling distances for East Surrey patients in future will be considerably shorter than the current travelling distances to Langley Green.

3.2.3 1st Floor – Salvington Lodge (Burrowes, Meadowfield Swandean)

SPFT also provides the Sussex Community NHS Foundation Trust (SCFT) with accommodation for two wards providing physical continuing care for adults and older people in Salvington Lodge. These wards are made up of 38 beds, equally divided across the two wards. The current operational inpatient capacity is 18-22 beds. SCFT also has two outpatient services on the site.

3.2.4 Drivers For Change

The primary driver for changing our current arrangements is the need to improve the environment of some of our inpatient services in West Sussex. Harold Kidd Unit (Chichester) is an old building with poor layout, outdated dormitory accommodation, no en-suite bathrooms and inherent ligature risk. The nature of the building (which cannot be changed) precludes improvement work such as creating en-suite bathrooms and open plan areas. Furthermore, the fact that SPFT owns the building as part of a Private Finance Initiative makes any improvement works prohibitively expensive.

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Iris Ward (Horsham) has shared bedrooms and shared en suite bathrooms. Moreover, the ward is located within a stand-alone unit at Horsham Hospital with no other mental health services on site. This level of isolation is disadvantageous in terms of quality of patient care for a number of reasons, including:

• The absence of immediate support that can be called on from other mental health wards in the event of a serious incident or emergency • A lack of staffing flexibility and capacity, particularly in relation to the support that inpatient teams on multi-ward sites are able to draw on to address short- term, unforeseen staffing problems or provide cover for training, and • The additional difficulties this creates in recruiting staff, given the understandable appeal and career development opportunities associated with being part of a much wider clinical team

Another driver for change was Care Quality Commission guidance on eliminating mixed sex inpatient wards for adults of working age and older people, including those living with dementia, thereby improving their privacy and dignity. SPFT needs to comply with CQC guidance. In its latest Inspection Report – CQCinspectionreportJanuary2018 - the CQC advised that SPFT should make sure that all older adult wards comply with national guidelines on eliminating mixed sex accommodation. A final driver is for SPFT to meet the broader aims of its Clinical Strategy, particularly in relation to strengthening community services and reducing hospital admissions where possible. SPFT is making good progress to strengthening community services and crisis care.

3.3 Clinical Model and Vision for Change

3.3.1 Our vision The final proposals should be seen within the context of SPFT’s 2020 Vision which is set out in its latest Clinical Strategy. Also relevant is its Estates Strategy January 2019 which sets out an overall strategy to improve patient care. SPFT has set itself five core goals within the Clinical Strategy. They are: 1. Safe, effective, quality patient care – we will treat everyone as an individual, focusing on their strengths and helping them with the recovery and wellbeing in a safety focused culture. 2. Local, joined up patient care – we want to understand the needs of the communities we serve, working with service users, carers and partners to consistently provide good quality services.

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3. Putting research, innovation and learning into practice – we will learn from our research and innovative practice to ensure that this learning is embedded across our services. 4. Being the provider, employer and partner of choice – we want to be the provider that people choose to work with and to seek services from. 5. Living within our means – living within our means involves being responsible with public money, using our resources widely, and demonstrating value for money in what we offer.

The final proposals also reflect one of the main priorities of the NHS West Sussex CCG to transform local services by integrating local care and support for people across the area.

3.3.2 Patient pathways

Our Clinical Vision needs to make sure inpatient services offer the best possible patient experience by delivering treatment as part of an extended community intervention. This will ensure inpatient care is fully aligned with a person‘s community treatment plan, with community clinicians playing a key role in the inpatient admission and supporting discharge. Inpatient pathways will continue to be triaged by our existing crisis teams who act as the gate-keepers for all admissions and assess suitability for less restrictive options. Admission is considered where it is unsafe to manage risk in the community, where specialist services can only be delivered within an inpatient environment or where community teams require a period of planned assessment work that would require a 24 hour safe environment, for example taking people off medication or introducing a new medication regime. For dementia, it is where the impact of the condition has increased, symptoms that cannot be managed outside of an acute environment or a period of assessment and intensive support and intervention is needed in order to maximise the options for the person returning to a less restrictive environment as possible. Generally, admissions consider risk, treatability, carer burden, complexity of presentation and severity of symptoms, plus known history. Every patient is considered individually and our focus is always on providing the least restrictive option. That is why we decided that crisis team should continue their role as gatekeepers to acute services. Our strategy is to increase their availability and provide more capacity for face-to-face gatekeeping assessments. The community services and inpatient services work as one system. Community services are critical to both reducing admissions and length of stay. West Sussex community services are being enhanced over the next three years.

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3.3.3 Community care pathway

SPFT is a key partner in the Sussex Health and Care Partnership Mental Health Programme, (formerly the Sustainability and Transformation Partnership) which takes a system-wide approach to transforming mental health services in Sussex. We want our community services to keep the service user at the centre of everything we do. We will bring in specialist care to support the individual as needed, minimising duplication of information gathering. This will also help maintain continuity of staffing wherever possible, provide treatment as close to home as possible and ensure collaborative care plans set out a clear road map for the recovery journey. Our ambition is to: • pilot new models where community teams remain with the patient throughout their mental health care, even if they go into hospital or need other crisis care • reduce barriers between teams and review current structures, such as the separation between our community and assertive outreach teams, so that service users have a care team that stays with them throughout the recovery journey • pilot different ways of wrapping crisis care around community services • fully meet the needs of people in our community services, regardless of disability • work with Recovery Colleges to build support for people coming out of secondary care into community services • do more of our work in the wider community to see people in places that are comfortable, safe and non-stigmatising, and • Identify and develop closer links to community-based resources to help people in their recovery.

This work to modernise acute and community services means we will be able to meet future demand as the proposal will not only remain bed-neutral but, in fact, provide three extra beds for adults of working age.

3.3.4 Urgent care services There is an investment plan in place for urgent care services across West Sussex during the next year. The Sussex Health and Care Partnership invested £1.1m in Crisis Resolution and Home Treatment (CRHT) teams across Sussex in 2019/20 and £2.4m recurrently. As well as this, there have been further community service developments including: - Havens - facilities which are open 24/7 to provide mental health assessments for people experiencing mental health crisis. Havens provide a more clinically appropriate alternative to Emergency Departments (ED) for people in mental health crisis with no physical health need to attend ED.

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- Staying Well - third sector provided crisis cafes available at evenings and weekends. These services are designed to support crisis prevention ensuring people stay well. - Increased provision of psychological interventions within CRHT services though increasing funding to these services. This investment is intended to increase the clinical effectiveness of CRHT services so that people can be supported through their mental health crisis while staying at home. - Street and Ambulance triage services are also being enhanced to ensure that there is consistent provision across Sussex. This will mean where emergency services are required to attend people experiencing mental health crisis, they will have access to senior mental health expertise, ensuring the most appropriate care plan is put in place.

All these initiatives are expected to improve the urgent care pathway for patients and reduce reliance on inpatient beds. There are a number of significant developments currently taking place to streamline the community services pathway and impact positively on patient flow and patient outcomes.

3.3.5 Single Point of Access There will be a single point of 24/7 access for people in mental health crisis through NHS 111 by the end of 2020/21, providing a ‘no wrong door’ approach. On calling the 111 mental health option, people will get support from a team of mental health professionals who in most cases will be able to provide the support needed over the phone and provide resolution. In cases where people require more intensive intervention, the 111 mental health team will be able to refer into the full range of urgent care services. A West Sussex triage hub is being established with an e-referral system which will allow triage to the appropriate provider – third sector, Improving Access to Psychological Therapies (IAPT), secondary care or social care – and appointments arranged. There will be an opportunity through these new access arrangements, particularly in West Sussex, to help people access the service they need without delay. Through ensuring people access the services they need in a timely manner, deterioration in their condition can be avoided. Through improved access arrangements, it is anticipated far fewer people will be assessed once by a service and have no further contact with SPFT services. This initiative attracted Mental Health Investment Standard of £770k in 2019/20 and a further £550k in 2020/21.

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3.3.6 24/7 Crisis Resolution and Home Treatment Teams (CRHT) Significant investment was made in the three West Sussex CRHTs (Worthing, Crawley and Chichester) in 2019/20 to provide 24/7 care based on the nationally recognised best practice model. In addition to undertaking urgent assessments and acting as gatekeepers to inpatient care, they will be resourced to provide intensive home treatment as an alternative to hospital admission, according to the following national standards: • At least 50 per cent of service users will be visited twice a day for a period of three consecutive days during their episode of care. • The team will visit service users more than twice a day when needed. • At least 50 per cent of service users will be seen or visited at least seven times during their first week of receiving support. • At least 50 per cent of service users will be seen five times a week on average throughout their period of care (until visits are tapered off as care becomes no longer necessary).

Local analysis has shown that deployment and success rates for intensive home treatment are currently far lower for people with psychotic disorders compared to those with non-psychotic disorders, despite the fact that this group represents the single highest number of acute admissions and hospital occupied bed days.

In response to this, additional funding has been made available to enable selected teams to enrich their skill-mix and capacity to deliver specialist clinical interventions especially aimed at people with psychotic disorders, as well as for all people ‘stepping-down’ from their involvement. The enhancement of CRHTs should significantly impact on inpatient admissions. If 10 per cent of those now being admitted (not detained) were to be provided with successful home treatment, we suggest that nearly 2,000 occupied bed days could be saved each year, equivalent to five beds at 90 per cent occupancy. Similarly, but in relation to those being admitted who are currently detained, if five per cent could be safely provided with successful home treatment as an alternative, then 14,000 occupied bed days, equivalent to 34 beds at 90 per cent occupancy could be saved.

3.3.7 Haven at Meadowfield, Worthing As part of SPFT’s response to Covid19, a Haven was established on the Meadowfield hospital site, open 24/7. Due to the rapidity of the development, a temporary facility has been established by converting a meeting room within the hospital. Work is underway on a purpose-built Haven space ensuring that the highest quality environment is available.

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The Haven provides an opportunity for crises to be de-escalated through an extended period of assessment, and to help people better access community-based services including intensive home treatment to prevent avoidable hospital admissions. Staffing includes qualified nurses and support workers dedicated to the facility 24/7 in an environment that is welcoming and relaxed as well as safe. Investment of £498k for each lounge has been allocated for this purpose.

3.3.8 Staying Well Crisis Cafes The Staying Well service in Worthing is now operational offering a blend of face-to- face and virtual/telephone support based on individual risk assessment. A further Staying Well service is currently being procured for North West Sussex with expected go-live in late 2020/21. These are informal spaces in which mental health crises can be de-escalated. Staying Well services are based on an evaluated model in Aldershot and will be provided by the third sector as an enhancement to the already well-established networks of third sector provision, with in-reach provided by qualified mental health clinicians to ensure risk is managed and a safe environment maintained. Both facilities will be open for 46 hours per week, every evening and at weekends, with access made possible through the new 111, triage hub arrangement and self- referral. They will provide early support to those people in crisis who do not need nor wish to go to a statutory sector urgent care service.

3.3.9 Psychiatric Liaison Psychiatric liaison services in acute hospitals are being enhanced across West Sussex. The Royal Surrey Hospital (used by North West Sussex patients), Worthing Hospital and St Richards Hospital are all being brought up to ‘Core 24’ national standards of 24/7 care in 2020/21 with recruitment underway. The Princess Royal Hospital has also begun recruitment to enhance its liaison service following securing additional investment.

3.3.10 Ambulance Triage There has been a pilot in North West Sussex which was extended to the end of the 2019/20 financial year. In addition, funding is available to enable a Sussex-wide model of ambulance triage to be established once the operating model is agreed with the local ambulance service provider. Ambulance triage involves qualified psychiatric nurses being called to, and attending, incidents at which crews have found a person who has no further need of medical or paramedic attention, but appears to be experiencing some form of mental health crisis and might otherwise be conveyed to A&E. It is intended to roll out ambulance triage across West Sussex following evaluation.

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3.3.11 Street Triage Sussex was one of the first areas in the country to develop and roll-out street triage which is a joint scheme between the police and mental health services, and involves a police officer and qualified psychiatric nurse attending incidents where a person appears to be experiencing some form of mental health crisis. Before its introduction, the police had few other options than to detain such people under section 136 and convey them to a Place of Safety for assessment under the Mental Health Act. More often than not, such people were not detained or admitted to hospital. The incidence of section 136 detentions and conveyances to Places of Safety has reduced significantly since its introduction, although the hours of operation are variable across Sussex. We will be extending street triage to operate for 84 hours everywhere in the county in between now and 2021, and Sussex Police have already indicated they would be willing to ‘match-fund’ this by providing officers as necessary under a partnership model.

3.3.12 Early Intervention in Psychosis Teams We will enhance early intervention in psychosis teams in Bognor, Worthing and Horsham between now and 2021 so that they can provide the full range of NICE recommended treatments (level 3) and provide a three year service.

3.3.13 Suicide Prevention There are a range of initiatives during 2019/20 and 2020/21 to address suicide prevention. These include greater support to people who self-harm, expansion of post-bereavement by suicide support services, social media campaigns aimed at middle-aged men, primary care education and the development of an innovation fund.

3.4 Mental Health Long Term Plan

The Mental Health Long Term Plan for Sussex includes a number of other transformation priorities including: • enhanced perinatal mental health services • bolstering core community services such as personality disorder, eating disorder services and psychological therapies for severe mental illness • developing an integrated community model with Primary Care Networks • increased access to IAPT, employment support and physical health checks

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• improved therapeutic input on the wards, and • improved children and young people’s services.

West Sussex has recently also been successful in a Public Health England funding bid to support rough sleepers. SPFT is looking at developing standards which will make sure that staff can better support patients as they return to GP care or voluntary sector support. It wants to reduce active caseloads for Assessment and Treatment Services clinicians to make sure patients receive more high-quality care. SPFT will also look at using its buildings and IT better so staff can be more efficient and effective when treating patients. The overarching aim will be for urgent care services in each area to meet core fidelity standards and resource will be allocated in response to shortfalls in existing service provision. We have already funded and employed 40 support workers and peer workers in Sussex and we intend to employ 30 more by March 2021. SPFT has developed a set of core standards for urgent care services and is working to meet these standards within its crisis teams. One main priority is to reduce barriers between acute and community teams and, to achieve this, SPFT is launching two Quality Improvement projects which include the roll out of an acute- community trusted assessor model.

There will also be increased direct work with West Sussex County Council Approved Mental Health Professionals (AMHP) service with the aim of reducing the need for detention and admissions. Across West Sussex all acute services can directly take on the crisis team caseload including street triage, A&E liaison, and ambulance triage and, in North West Sussex, the AMHPs can also access crisis teams directly (this is the trusted assessor model in action). SPFT aims to roll out a trusted assessor model across all services and strengthen the provision of acute focused support groups across weekends and Bank Holidays. It’s dementia/later life community services are working on delivering a seven-day per week service to maintain people as safely, and for as long, as possible in their home environments. This work should be completed in the next 6-12 months. There are weekly multi-disciplinary team (acute-community) clinical meetings and SPFT continues to review its estate to consider how to co-locate community and crisis teams. The 80 practices in West Sussex have formed themselves into 20 Primary Care Networks and since April 2020 have continued working towards developing their network services. The focus of the networks is to ensure that they each have integrated teams that mean general practice workforce and community nursing teams work together on providing services to their network populations.

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 30 It will be important that mental health services are working closely with the networks and community teams and with the Local Community Networks that sit around primary care networks There are system-wide changes planned for the NHS in Sussex that will affect commissioning. Sussex-wide, the Primary Care Programme Board reviews the issues around Primary Care Networks including workforce, a shared patient record platform and communication and estates issues. In West Sussex we are continuing to develop our Local Community Networks (LCNs). This is a model that draws together partners and services at a District and Borough Council level to focus on the health and wellbeing of their resident population, taking a specific focus on health inequalities. Primary Care Networks are key members of their respective LCNs. Work is currently underway to refresh LCN governance arrangements which will include the West Sussex Health and Wellbeing Board going forward

3.5 Centre of Excellence for dementia care

As part of the vision and ambitions for the Mental Health Long Term Plan and our aspirations for the local system, we are proposing to set up a Centre of Excellence at 1st Floor, Salvington Lodge, and The Burrowes in Worthing for people living with dementia, SPFT continues to work with Sussex Community NHS Foundation Trust (SCFT). SCFT has a physical health continuing care unit based at Salvington Lodge as well as two outpatient units. Under our final proposals, we will create a specialist dementia centre of 30 beds, i.e. two 10-bed wards in the Burrowes Unit (ground floor) and one 10-bed ward with improved physical health input through effective multi-agency working between the mental health and physical health clinicians. This would have a significant positive impact on the outcomes for people with dementia who have physical health problems as well as those with long-term physical health conditions who have cognitive and/or behavioural difficulties. It could also help streamline referral and assessment processes, and reduce unnecessary bureaucracy and access/care pathway difficulties between the two organisations. This is supported by good clinical evidence from acute and some mental health trusts demonstrating that specialist centres deliver better outcomes for patients and facilitate improved multi-disciplinary and multi-agency working. There are a number of specific benefits, as we set out below. As part of the vision and ambitions for the Mental Health Long Term Plan and our aspirations for the local system, we are proposing to set up a Centre of Excellence on the Swandean site at 1st Floor, Salvington Lodge, and The Burrowes in Worthing for people living with dementia. SPFT continues to work with Sussex Community

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NHS Foundation Trust (SCFT) with SCFT has a physical health continuing care unit based at Salvington Lodge as well as two outpatient units. Under our final proposals, we will create a specialist dementia centre of 30 beds, i.e. two 10-bed wards in the Burrowes Unit (ground floor) at Salvington Lodge on the Swandean site and on the 1st Floor one 10-bed ward with improved physical health input (provided by SCFT) through effective multi-agency working between the mental health and physical health clinicians. This would have a significant positive impact on the outcomes for people with dementia who have physical health problems as well as those with long-term physical health conditions who have cognitive and/or behavioural difficulties. It could also help streamline referral and assessment processes, and reduce unnecessary bureaucracy and access/care pathway difficulties between the two organisations. This is supported by good clinical evidence from acute and some mental health trusts demonstrating that specialist centres deliver better outcomes for patients and facilitate improved multi-disciplinary and multi-agency working. There are a number of specific benefits, as we set out below.

3.6 Patients, carers and their families A Centre of Excellence will provide improved physical environments which are modern, safe and of a high-quality. It will also provide better support for carers and families as they will have greater confidence in the care and treatment provided because of the expertise on offer. Also, the range of care will be wider and provide patients with improved choices about treatment.

3.7 Hospital social work Initial conversations with West Sussex County Council have suggested that the council would see a Centre of Excellence as an opportunity to employ a hospital social worker dedicated to the one site. At the moment, they have to cover three sites. We believe this would have a positive knock-on effect on reducing length of stays and delayed transfers of care but also enable us to have a better perspective on services across the area such as nursing homes and levels of need. The changes to hospital social work teams will form part of the phase 1 and 2 Implementation Plan.

3.8 Workforce At present, SPFT faces workforce challenges, in particular managing consultant cover for annual leave and study days. Therefore, a Centre of Excellence will help us create a working together culture so each consultant knows what is happening throughout the building.

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The Centre of Excellence will be more attractive to staff wanting to specialise in this clinical area. This is likely to increase staff recruitment and retention and reduce the number of vacancies. A Centre of Excellence provides the benefit of ward and multidisciplinary team cross-overs. This means that wards will run more efficiently as there will be less reliance on agency cover and morale will improve as each ward will actively support the others when there are incidents or emergencies. It also means that all multi-disciplinary teams will work together so they can learn from each other and have standard access to the resources they need to work more effectively. There will also be standard operating principles which will result in more equitable and consistent services across West Sussex.

3.9 Training and development A Centre of Excellence helps develop expertise, meaning staff focusing solely on treating people living with dementia. With all staff being in once place means they can become more efficient, develop more expertise and staff competencies and enable better supervision. We also know that Centres of Excellence attract more students as they enjoy their placements and want to work in the area. So this will have a positive impact on recruitment and retention. There will also be research opportunities plus the ability to develop partnerships with R&D departments and medical schools because there will be enough expert and experienced staff to make projects more viable, for example undertaking national research projects.

3.10 Workforce Issues

To deliver the aspirations set out in the NHS Long-Term Plan and the community service programme set out previously, SPFT will need to recruit 727 additional staff. In view of this, SPFT’s priorities are to focus the skills of the most experienced staff on those who are most unwell and pilot new roles such as peer support workers, associate physicians and non-medical prescribers. The new roles are aimed at meeting the challenges with its workforce which are placing pressure on the quality of care and its finances. Some of the key challenges include difficulties in being able to recruit qualified staff and doctors. The high number of vacancies brings associated financial pressures as SPFT relies on bank and agency staff cover. Substantive staff cover a number of bank shifts but working additional hours may have an impact on their wellbeing. High sickness rates are a concern which again puts pressure on the service to ensure safer staffing numbers.

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Another factor that is likely to be impacting on recruiting staff is the environment and the location of the buildings, as staff chose to work in areas where it is more accessible, coupled with modern facilities. Our statistics inform us that, despite the number of bank and agency hours on Orchard Ward at Harold Kidd Unit and Iris Ward at Horsham Hospital, both wards are working below establishment headcounts. One of the best ways SPFT can improve recruitment is to place staff in one unit, giving us the ability to flex staff across wards. This is more achievable if there were wards based on one site. Currently, there are dementia services at Grove Ward in Chichester and Iris Ward in Horsham, spreading specialist resources across two units which are 30 miles apart. This means it is more difficult for each unit to have the appropriate number of consultant sessions and registered nurse input to deliver care seven days a week, 24 hours a day. Having three wards on one site will improve the delivery of high- quality services as staff resources will be pooled to guarantee cover and comply with safer staffing level guidelines. While these workforce shortfalls focus on consultant staff and qualified nurses, it is simply a reflection on the difficulties in recruiting and retaining all qualified and unqualified staff across all grades. In terms of staff retention, SPFT record this information across two West Sussex teams, Coastal and North West. In September 2020, Coastal West Sussex has an average turnover rate of 14 per cent and North West Sussex is 15%. Although retention in the Coastal West Sussex area remains at around 14 per cent and North West Sussex is about 17 per cent, for every starter gained, SPFT loses on average the same number of leavers. Retention is an area that is being reviewed not only locally but Trust-wide and is a key priority to make sure we have a staffing structure that is stable and consistent to support the delivery of excellent patient care and experience. To support this, SPFT has an HR Workforce Strategy, along with a Recruitment and Retention Strategy. SPFT anticipates that, through these initiatives, retention figure will improve. It is optimistic that a new dementia Centre of Excellence will improve staff morale, development and satisfaction which will, in turn, support staff wanting to remain working for SPFT. Sickness is a significant cost to SPFT. In August 2020, Coastal and North West sickness rates were running at just over 4 per cent and 5 per cent respectively which is above the Trust average of 4 per cent. The main reasons for sickness are anxiety, stress, depression and other psychiatric illnesses. At retention meetings held in 2018, the top concerns among staff were heavy workloads and not having enough staff. Therefore, full staff capacity will

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benefit wellbeing, improve care and, ultimately make better use of our resources save money. Another factor having an impact on SPFT is an ageing workforce, which is a greater issue in the Coastal area. Between October 2019 and September 2020, Coastal had 104 starters and 96 leavers - and North West had 59 starters and 47 leavers. In Coastal, 24 out of the 96 leavers left due to retirement. With an ageing workforce it is likely that the number of staff leaving due to retirement will increase and this will have a significant impact on our future staffing numbers. This is made worse when services are so far apart and there is no option to pull staff from other wards to cover. The highest reason for leavers is voluntary resignation. Coastal had 67, 23 of who left for reasons of work life balance and North had 43, and 16 who left for work life balance reasons. Recruiting to doctor posts continues to be a challenge, although we did recruit four doctors in the week beginning Monday 5 October 2020 for the Coastal area. Having a Centre of Excellence for Dementia Services will be more appealing to consultants and junior doctors who want to specialise in this field. Also, having a building which provides more opportunity for collaborative and adaptable working will be more cost effective and, ultimately, improve care alongside patient and staff experience.

3.11 Estate issues

This proposal is in line with SPFT’s Estates Strategy which recognises that specialist facilities are required to support the delivery of outstanding healthcare services in appropriate care settings. Providing a high quality working environment for all of our staff is essential to delivering a consistently high standard of care. The proposal achieves some key objectives in improving patient environments, in particular accommodation for older people. Deficiencies in the current estate include: 3.11.1 The Burrowes/ Salvington Lodge These are currently under-utilised for inpatient use. This proposal seeks to make better use of the available space and facilities. This unit is being refurbished to deliver high-quality, single sex, en-suite accommodation, good recreational and therapy spaces as well as a dementia-friendly garden.

3.11.2 Harold Kidd Unit This unit suffers from poor ward layouts which negatively affect patient experience.

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The unit is under a Private Funded Investment (PFI) agreement which makes it very expensive to adapt from its current single and shared-style configuration which only affords poor levels of privacy and dignity for patients. There is only one bathroom per ward, and no en-suite accommodation available. The building is not energy efficient, and it is very difficult to cool down in the summer and keep warm in the winter. This means patients often suffer with being too hot or too cold depending on the season. Improvements have been made but the cost of regulating the temperature in the building is expensive.

3.11.3 Iris Ward, Horsham Hospital SPFT rents this accommodation from NHS Property Services. This means there are limited options for adapting the space, and there are significant challenges about who should meet the cost of carrying out required essential works. The ward needs to either install or upgrade heating and cooling systems, staff response/call system, nurse call bells and falls prevention technology. All of these things are required to get the accommodation up to the standard SPFT requires. The ward also has a mixture of en-suite and shared accommodation with some shared en-suite rooms, as well as a number of ligature risks which potentially put patient safety at risk. The windows on the ward are of a poor standard which also presents issues for control of the ward temperature in summer and winter. SPFT is also seeking to undertake further improvements to other accommodation to support the implementation of this reconfiguration including at Langley Green Hospital, Crawley and the Oaklands Centre, Chichester.

4 Pre-Consultation Business Case & Engagement

4.1 Pre-engagement in developing the pre-consultation preferred option

It is important to show the processes we have undertaken since the beginning of 2018 to come to our final preferred option. Initially, before coming to a decision on our original preferred option, we had an initial long-list of nine options. In considering these, we looked at the following criteria: DECISION-MAKING CRITERIA FOR OPTIONS LONG-LIST 1. Clinical quality and patient experience • Does the option improve quality of care and patient experience by delivering fit-for-purpose accommodation and complying with our own requirements and those of the Care Quality Commission (CQC)? • Does it improve patient choice by removing mixed-sex wards and making sure we comply with CQC guidance?

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• Does it create centres of excellence and/or specialist centres? • Does it remove stand-alone units which present clinical risks to patient care? • Is it consistent with SPFT clinical strategy, including the provision of local, joined-up services? • Is it clinically viable and deliverable, including implications for number of beds? 2. Carer and family experience • Does it have a positive impact on the experience of carers and families? • Does it have a positive impact on access and transport for carers and families? 3. Staff • Does it improve staff morale? • Does it improve recruitment and retentions – and reduce vacancies? 4. Estates • Does it make best use of the estates available? • Does it create fit-for-purpose environments? • Can the accommodation be easily configured to suit the intended purpose and within the existing footprint (if applicable)? 5. Financial • Is it value for money? • Is it affordable, i.e. in capital investment terms, on-site deliverability and impact on transitional and recurrent revenue? • Does it achieve savings targets and make sure the Trust gets the right money for the level of service provided? 6. Trust reputation • Does it adversely affect the Trust’s reputation, including political implications for the Sustainability and Transformation Partnership (STP) and relations with other Trusts?

7. Surrey and Borders NHS Foundation Trust (SABP) contract

• Does the option include provision for SABP beds?

After discounting a number of initial considerations, including refurbishment and relocations, we arrived at the following options long list, as shown overleaf:

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4.2 The Preferred Option in the PCBC for Public Consultation

In light of the above, the preferred option was: Patient group: Proposed action: Patients to move to:

Older people with mental Close 12-bed mixed-sex ward at Single-sex wards at Langley health problems Harold Kidd Unit, Chichester Green Hospital, Crawley, and (Orchard Ward) Meadowfield Hospital, Worthing

Male patients with Close 10-bed single-sex ward at Refurbished ward at dementia Harold Kidd Unit, Chichester (Grove Salvington Lodge (The Ward) Burrowes), Worthing

Female patients with Close 12-bed single-sex ward at New ward at 1st Floor, dementia Horsham Hospital (Iris Ward) Salvington Lodge, Worthing (subject to agreement with Sussex Community NHS Foundation Trust)

Although we did not formally consult on single-sex wards, we felt that, as we would be engaging with a wide range of stakeholders, we thought this a good opportunity to see feedback on our plans to create single-sex wards.

4.3 The Formal Public Consultation

The CCG and SPFT successfully completed the NHSE/I Stage 2 process to secure approval of the Pre Consultation Business Case (PCBC). The PCBC was further reviewed by HASC, SPFT Board of Directors and the CCGs Governing Bodies to seek agreement to enter into a formal public consultation to consult on the preferred option outlined in the PCBC. A 12-week formal public consultation on the preferred option was launched on Wednesday 17th July and ended on Friday 11th October 2019. We undertook a range of engagement activity during the consultation and encouraged as many people as possible to make their views known to us throughout the public consultation period. Our methods were intended to be inclusive and to offer opportunities across the demography, diversity and geography of local and neighbouring populations. These included an open consultation questionnaire, available online, as a paper copy and in Easy Read and British Sign Language (BSL) formats, providing a dedicated telephone number and email address and FREEPOST facilities.

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The formal public consultation was guided by a Communications and Engagement Plan and led by communications and engagement teams from the three West Sussex Clinical Commissioning Groups (CCGs) and SPFT. The plan and activity were designed to adhere to NHS England and government guidance on best consultation practice. The proposals and consultation were also subject to an Equality and Health Inequalities Impact Assessment (EHIA) which helped make sure that our activity targeted protected characteristic groups outlined in the Equality Act 2010 as well as disadvantaged or marginalised groups or communities. Development of materials and implementation of planned activity was overseen and governed by a Communications and Engagement Oversight Group comprised of CCG and SPFT representatives as well as Healthwatch. We also appointed Public Perspectives, a research and community engagement organisation specialising in the public and third sectors, to independently analyse the feedback and responses to the pre-engagement and the formal public consultation. This is included in the document as Appendix 1. The results from the consultation were considered by the West Sussex Service Redesign Programme Board as it revised the original proposals to meet a range of concerns expressed by those who responded. These revised proposals are now set out in this Decision Making Business Case document. Although not required as part of the formal assurance process, we shared the findings of the public consultation, our DMBC and tested our post-consultation proposal with NHSE on 26th November 2020. This approach has provided us with further confidence that we had undertaken a robust and transparent process when developing the DMBC. We accommodated their feedback and advice was accommodated in our final post-consultation proposal. We are now in a position to recommend the proposals outlined in the DMBC to the CCG’s Governing Body, SPFT Board of Directors and for consideration to West Sussex Health and Social Care Scrutiny Committee.

4.4 Summary of key themes arising from the Public Consultation

4.4.1 Improving Care and Modernising Facilities There was a general approval of the principles of improving care and modernising facilities. Acknowledgement that both Harold Kidd and Iris Ward need improving.

4.4.2 Creating a Centre of Excellence Most people supported the proposal to create a Centre of Excellence for dementia care

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4.4.3 Travel and Transport Concerns were raised that moving services from some areas would increase the amount of travel needed by service users, carers and families and may some staff members too.

4.4.4 Single Sex Wards There were mixed views about moving to single-sex wards. Some people supported them to improve patient care, dignity and safety, as well as complying with national guidance. But the majority including staff members felt that single-sex wards did not reflect real life and can reinforce gender stereotypes. This was a particular issue for those people that classified themselves as Transgender or non-binary and they felt the proposal to move to single sex wards did not reflect their individual choice.

4.4.5 Community Provision The Majority of people supported improved community services, including a focus on prevention to help reduce the demand for inpatient services.

4.4.6 Other Key Points Parking concerns around Sussex Partnership’s Swandean site in Worthing were raised because of possible further increase in traffic due to the proposed moves.

4.5 Consultation Outcome and Responses

In answer to the main question: to what extent do you agree or disagree with our preferred option for the provision of mental health care for adults, older people and those with dementia?, 35 per cent of people agreed with the proposal and 49 per cent disagreed. These figures included 12 per cent that ‘strongly agreed’ and 22 per cent that ‘strongly disagreed’. 17 per cent of people neither ‘agreed nor disagreed’. While people generally supported the principle of improving care and services and modernising facilities, as well as accepted the benefits of a Centre of Excellence for dementia care, they raised a number of concerns which influenced their views on the proposals.

4.5.1 Transport and Travel

Some people raised concerns that moving services from some areas would increase the amount of travel that service users, carers and families, as well as some staff, would need to take. However, some people acknowledged that some service users,

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carers and families already have to travel – and that there can be benefits for certain people with mental health difficulties receiving support outside their localities. People felt that this issue will be made worse in Chichester due to the loss of services in that area, especially for women, as the preferred option means that there will be no female inpatient facilities in Chichester. Also, people were concerned that the proposals could have a negative impact on health outcomes and long-term recovery as patients are away from their normal support mechanisms.

4.5.2 Single Sex Wards

People, including some staff, were concerned that plans to make all wards single- sex would make it difficult for transgender, non-binary and intersex patients to access mental healthcare inpatient services and are in contrast to an increasing acceptance of gender fluidity and diversity.

Similarly, some people said that single-sex wards do not reflect real life and can reinforce gender stereotypes. Some staff said that single-sex wards can be more difficult to manage and that dignity, privacy and safety can be achieved without moving to single-sex wards. However, there was support for single-sex wards, particularly for those patients with dementia.

4.5.3 Safety concerns about increased number of beds

People expressed safety concerns about increasing the number of beds per ward following implementation of the original proposals. They said it would also have implications for the therapeutic environment as well as staff morale and subsequent challenges for recruitment and retention. This view was also shared by members of SPFT staff who attended staff engagement and other public events during the consultation.

4.5.4 Strengthening Community Services

Almost 80 per cent of people who responded to the survey believe that people should be cared for in their own homes whenever possible. People supported improved community services with a focus on prevention and early help to reduce the demand for inpatient services. However, people said there is a lack of information about community provision which makes it difficult to make a fully informed judgement on the proposals. Therefore, they wanted more detailed information about the current community service provision and future plans. They also said there should be investment and improvements in community provision, in the first instance, to help facilitate change and mitigate against any negative aspects of the proposals.

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4.5.5 Parking and Traffic Concerns

Some people, particularly local residents living in High Salvington next to Sussex Partnership’s Swandean site, said that Swandean is already at more than full capacity. And the increase in cars due to the new proposed services will make the matter worse and potentially cause problems for road safety.

4.5.6 Continuing Involvement

Some service users, carers and staff said they wanted continuing involvement in refining our proposals and influencing how they are implemented to maximise their benefits and reduce any negative impacts of the proposals.

Feedback Theme How we responded and how the feedback informed the final proposals Transport and Travel • We decided to maintain the 16-bed Oaklands Ward in Chichester as a mixed-sex ward which means that there will still be inpatient facilities for women in the area.

• We have also decided to keep mixed-sex wards across the county for adults of working age and older people which means that service users based at Chichester will now only have to move to existing wards in Worthing, subject to bed availability and patient choice.

• Those most affected by the need to travel further will receive help in the form of mileage and public transport allowances and possible community transport/minibus shuttles between relevant locations.

Single Sex Wards • Following advice from the Care Quality Commission (CQC) and further support from Healthwatch West Sussex and Healthwatch England, we determined that we could keep all adult and older people wards as mixed-sex, although bedrooms, bathrooms and female lounges will be segregated and there will also be segregated single sex zones and mixed-sex communal areas.

• There will also be flexibility to accommodate the needs of any transgender or non-binary inpatients so they can maintain their dignity, privacy and safety.

• All our dementia wards will remain single-sex.

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Feedback Theme How we responded and how the feedback informed the final proposals Increased bed numbers We have reviewed the arrangement with Surrey and Borders partners to release 9 beds occupied at Langley Green Hospital from April 2021. Surrey have secured alternative provision locally for their patients in line with their strategy for hospital improvements. This means we will have an extra nine adults of working age beds in West Sussex, negating the need to increase ward sizes for adults of working age.

Strengthening Community In our final proposal recommendations, we have set out how Services we intend to improve and strengthen community services in future. We have also provided details about how government funding has been used to introduce new measures to support our community services, see section 3.

Parking and Traffic Concerns We have promised to meet with local residents to see how we can address their concerns.

SPFT is developing a parking strategy to identify potential solutions and create more parking provision on the Swandean site to alleviate the pressure on surrounding roads. It will also enable staff to make use of any potential transport provision which is organised between the affected sites.

This is currently on hold because of COVID-19. Continuing Involvement Both West Sussex CCG and SPFT are committed to making sure service user, carers, staff and governors’ engagement will continue throughout any redesign of services and this will be reflected in the implementation plan for these proposals.

We will carry out a post-project evaluation which will involve service users, carers and staff and a full range of wider stakeholders.

The full analysis report is available in Appendix 1.

4.6 Equality and Health Inequalities Impact Assessment

Throughout the design and consultation phase, we continually tested our proposals and consultation approaches against an Equality and Health Inequalities Impact Assessment which was reviewed and updated throughout the process, in line with best practice.

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The final document is attached as Appendix 2

5.0 The proposal post-consultation

In the PCBC we set out a proposal:

1) Move services from the Harold Kidd Unit in Chichester to: • Dedicated dementia care wards for older men and women in single-sex wards in Worthing, and • Modern single-sex wards for older people in Worthing and Crawley.

2) Move services from Iris Ward at Horsham Hospital to: • A new modern ward for women with dementia in Worthing.

We have now assessed the feedback from the consultation and as such, we have adapted our original proposal to move the services and wards. Keeping all adult and older people wards as mixed-sex, although bedrooms, bathrooms and female lounges will be segregated and there will also be mixed-sex communal areas. The dementia wards will remain single sex to ensure that we meet privacy and dignity standards.

The table below describes the changes from the pre-consultation preferred option to post-consultation Revised Proposals in response to the feedback received.

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Female Move 12-bed New single-sex Move 12-bed No change patients single-sex ward ward at 1st single-sex ward from Pre- with at Horsham Floor, at Horsham Consultation dementia Hospital (Iris Salvington Hospital (Iris Preferred Ward) Lodge Ward) option Male and 16-bed Single-sex 16-bed No change female Oaklands Ward, wards at Oaklands from preferred adults Chichester, to Meadowfield Ward, option estates with become 16-bed Hospital, Chichester, but wards will mental male only ward. Worthing and remains male remain mixed health All other wards Langley Green and female. sex problems at Meadowfield, Hospital, All adult wards Worthing, and Crawley at Langley Langley Green, Green, Crawley, to Crawley, and become single- Meadowfield sex Hospital, Worthing, remain mixed- sex wards

5.1 What this means for service users We strongly believe that the post-consultation revised proposals provide the best possible route to improving care for local people, providing opportunities for new ways of working and addressing the challenges that we are currently facing. It would:  Provide the improvements to the quality of care by addressing the poor environments in the Harold Kidd Unit and the Iris Ward.  Allow a more flexible approach to ward environment which will create segregated areas for both sexes, with both female and communal lounges.  Provide an opportunity for a Centre of Excellence for dementia care in Worthing.

Currently Sussex Community NHS Foundation Trust has up to 22 beds at Salvington Lodge in Worthing for older people with long-term physical conditions. By moving patients from Iris Ward to a new ward at Salvington Lodge means that we can treat people with both mental and physical health problems in one location. The maps overleaf set the bed provision currently, what it would have been under the pre-consultation preferred option and what they would be under the post- consultation preferred option.

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Following NHSE/I guidelines, we assessed the post-consultation revised proposals against the five key NHSE/I tests as well as complying with our duties under the Equalities Act.

6.1 Meeting the Five NHSE/I Tests

Test 1 - Support from clinical commissioners The proposal continues to receive support from the NHS West Sussex CCG at all stages of the process with local GPs and the CCG’s Clinical Reference Group engaged for their views throughout.

Test 2 - Strengthened public and patient engagement We consulted formally on these proposals for a 12-week period between July and October 2019 and we received more than 500 responses from service users, carers and their families as well as representative groups, including those that are seldom heard, charities and interested people such as MPs and individual members of the public. Responses have been independently analysed and this analysis has provided us with valuable feedback and input. We have used this to refine our proposals further and we believe they now better represent the needs of local communities and will more effectively deliver our vision for mental health services across West Sussex.

Test 3 - Clarity on the clinical evidence base As part of the Pre-Consultation Business Case development the preferred option was scrutinised by the South East Clinical Senate. The DMBC and final revised proposals have also been critically reviewed by a member of the Clinical Senate who was also a panel member for the NHSE/I Assurance process throughout both pre and post consultation. While this proposal seeks to address specific issues within West Sussex, it is being developed in the context of the Sussex Partnership’s wider clinical strategy and the West Sussex CCG's own strategic priorities. It is also happening during a period of sustained, significant demand being experienced across all our services. We need to ensure that any changes to clinical services do not further exacerbate this pressure.

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Test 4 - Consistent with current and prospective patient choice This proposal should be seen in the context of SPFT’s wider Clinical Strategy and the work it is doing with the Sussex Health and Care Partnership (formerly the Sussex and East Surrey STP). We want our community services to keep the service user at the centre of everything we do. We will bring in specialist care to support the individual as needed, minimising duplication of information gathering. This will also help maintain continuity of staffing wherever possible, provide treatment as close to home as possible and ensure collaborative care plans set out a clear road map for the recovery journey. Our ambition is to: • pilot new models where community teams remain with the patient throughout their mental health care, even if they go into hospital or other crisis care • reduce barriers between teams and to review current structures, such as the separation between our community and assertive outreach teams, so that service users have a care team that stays with them throughout the recovery journey • pilot different ways of wrapping crisis care around community services • fully meet the needs of people in our community services, regardless of disability • work with Recovery Colleges to build support for people coming out of secondary care into community services • do more of our work in the wider community to see people in places that are comfortable, safe and non-stigmatising, and • identify and develop closer links to community-based resources to help people in their recovery.

This work to modernise acute and community services means we will be able to meet future demand and this work will determine how the voluntary sector, local authorities and NHS can work better together as a local health and social care system to provide greater choice when meeting the needs of the local community. The proposals have been changed to consider the feedback from the public Consultation surrounding plans to introduce single sex wards. The public consultation raised a number of issues around the move from mixed to single sex wards, with most respondents favouring the former (apart from dementia wards). Healthwatch West Sussex raised these issues with Healthwatch England, who were aware of similar issues elsewhere in the country. Healthwatch England sought advice from CQC about what would be acceptable to them and their advice was filtered back down to Healthwatch West Sussex who advised that our proposals to have segregated or ‘zoned’ wards, with communal lounges and separate lounges for females would be within the CQC guidance.

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Test 5 - Proposals which include plans to significantly reduce hospital bed numbers NHS England will expect commissioners to be able to evidence that they can meet one of the following three conditions: i. Demonstrate that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it; ii. Show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions; or iii. Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting it Right First Time programme). i) This proposal will provide three additional beds for adults of working age and maintain current provision for older people. This will: • Address the likely population growth in West Sussex to ensure it is future proof • Allow for bed flexibility based on the current use of beds and average length of stay, as well as the proposed improvements in acute and community services.

Resources are moving from acute to community services, making the most of the opportunity to help people to remain at home rather than in hospital (unless admission is the most clinically appropriate option). This is a key part of our community pathway development work and the final proposals must been seen in that context because this is better value and the ‘saved’ resources can be used for community to support growth in population cited at beginning of paper.

Equalities Act duties As already stated, throughout the design and consultation phase, we continually tested our proposals and consultation approaches against an Equality and Health Inequalities Impact Assessment which was reviewed and updated throughout the process, in line with best practice. For example, concerns raised during the consultation about the needs of people who are trans or non-binary, meant we created a bespoke survey to seek their experiences and views on mental healthcare. The final document is attached as Appendix 2.

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External assurance - NHS England and Improvement (NHSE/I) Before the preferred option progressed to public consultation, we had to meet the governance and assurances processes set out in NHSE/I’s guidance document, ‘Planning, assuring and delivering service change for patients’, published in March 2018. The NHSE/I service reconfiguration assurance process is an additional level of assurance scrutiny to give confidence to patients, staff and the public that proposals are well thought through, have taken on board their views and will deliver real benefits. This required producing a Pre-Consultation Business Case (PCBC) document which set out the clinical case for change, the full options appraisal and decision-making process, financial implications, transport review findings, communications and engagement plan, plus supporting documents including EHIA and QIA. It also included the conclusions from the CCG-led independently-chaired panel which was established to scrutinise and challenge how we arrived at our preferred option and provide assurances that the process was robust and fair. The panel underwent the same options appraisal decision-making process as ourselves and arrived at the same preferred option. We presented our proposals to NHSE/I Stage One strategic sense check meeting on Monday 14 January 2019. Feedback was provided on the draft PCBC, the proposed plans and timelines for consultation. Expectations for the required detail for Stage 2 were also discussed. We attended the NHSE/I Stage Two assurance checkpoint meeting on Tuesday 19 March 2019. At this meeting, it was agreed that our proposals would be subject to further scrutiny by an informal clinical senate review to provide further external assurance that our proposals were clinically sound. This review was undertaken during April/May 2019 and made 26 recommendations to improve the PCBC further before final sign-off. All 26 recommendations were implemented and approved by the Clinical Senate members and NHSE/I. To make sure that the consultation document met the necessary requirements, we appointed The Consultation Institute to provide advice and support in preparing our final document. Its advisor reviewed the consultation document against its best practice checklist and confirmed that the document met their guidance.

7.0 External Assurance Timeline

Once the NHSE/I Stage Two process was complete, the West Sussex Health and Adult Social Care Committee (HASC) formally considered the proposals at its meeting on Wednesday 12 June 2019 and it is worth noting that the HASC Business Planning Group had already agreed that the proposals represented significant service change and would need to go to full public consultation.

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At the meeting, the proposals were presented by West Sussex CCGs and SPFT. Following discussions, the HASC agreed that the proposals should be subject to a formal public consultation. The proposals and the public consultation process were also considered by the three relevant CCG Boards and the SPFT Board of Directors at their meetings in June 2019 and they all approved the proposals for consultation. The formal public consultation began on Wednesday 17 July 2019. We developed the Decision-Making Business Case (DMBC) which was formally submitted to NHSE/I on Tuesday 12 November 2019. However, consideration of DMBC was delayed because the project was postponed due to COVID-19. The DMBC was shared again with NHSE/I for assurance on Friday 16 October 2020 and following feedback small amendments were made in relation to finance ready for final approval by the SPFT Board of Trustees and West Sussex CCG Governing Body before it is then submitted to West Sussex HASC for consideration on Wednesday 24 February 2021.

8. Assessing the implications of our Revised Proposals

In assessing the implications of the post-consultation revised proposals, we re- considered the following areas: 8.1 Bed modelling

SPFT carried out a detailed bed modelling exercise between April 2017 and March 2018 as part of the clinical case for change. This exercise reviewed how West Sussex adults of working age and older people, including people living with dementia, used the existing in-patient beds, their average length of stay and their gender. To obtain a more accurate utilisation of West Sussex beds and the bed pressures across Sussex, the analysis identified the in-patient bed utilisation of West Sussex residents in all wards across Sussex Partnership’s services and any use of non-West Sussex residents in West Sussex inpatient services. The exercise also considered the use of the 13 beds for adults of working age at Langley Green Hospital provided to Surrey and Borders Partnership NHS Foundation Trust (SABP) for its East Surrey residents. The bed modelling indicated that, based on utilisation (May 2018), patients in West Sussex occupied: • 95 per cent of available adult beds (this is constitutes 85 beds) • 93 per cent of older adult functional beds (39 beds) and • 89 per cent of dementia beds (32 beds).

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Historically, West Sussex has had comparatively low levels of out of area placements (ECRs). During this period there were 740 bed days used by adults of working age (equivalent to approximately 2 beds per day) and 61 bed days used by older adults with mental health problems (functional), equivalent to approximately 0.16 beds per day. There were no out of area placements (ECRs) for people with dementia during this period nor have there been historically for West Sussex. The bed modelling work was used to assess the impact on the bed numbers and the gender split of wards for each option considered in the options appraisal work. It also identified, based on the utilisation of beds, how many beds on each ward and the number of male and female wards were required to address a ‘bed neutral’ option for West Sussex. However, this ‘bed neutral’ position for West Sussex could only be achieved by reducing the number of beds provided for East Surrey residents at Langley Green Hospital from 13 beds to nine beds. This would have meant that we would still have to create eight additional beds (six adults of working age, two older people (functional)). As discussed earlier, this was not clinically possible so the contract with Surrey & Borders will be terminated at the end of March 2021, or April 2021, if required, which provides an additional three adult of working age beds for West Sussex. The bed modelling work indicated that that the West Sussex ‘bed neutral’ position is clinically viable. This is based on: • the current utilisation • reduction of SABP beds from 13 to 9 beds • available high-quality local inpatient environments • comparatively low levels of out of area placements, and • The proposed modernisation of acute and community services, as outlined in section 3.

Furthermore, it should meet demand over the next two to three years.

8.2 Surrey and Borders contract

Under the post-consultation revised proposals, we reviewed the provider to provider contract SPFT has with Surrey and Borders Partnership NHS Foundation Trust (Surrey and Borders) to provide 13 adult of working age beds at Langley Green Hospital in Crawley. Due to the concerns raised in the consultation, SPFT proposed to end the contract for the nine remaining beds earlier than planned at the end of March 2021, or April 2021, if required, rather than the original date of April 2022. In response to this Surrey and Borders have identified alternative provision locally that will provide care closer to home for their patients and supports their long term strategy for inpatient bed provision. The return of these nine beds would be valuable

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to Sussex in any case as is the reprovision of Surrey beds closer to home, valuable to their patients. Analysis shows that this preferred option means that the travelling distances for East Surrey patients will be considerably shorter than the travelling distances to Langley Green Hospital.

8.3 Transition

The SPFT and SABP provider to provider contract is currently monitored through monthly operational meetings with SABP bed management, acute and crisis care colleagues and SPFT representatives, including the ward consultant and manager, modern matron and nurse manager for the Hospital. The transfer of these patients back to Surrey and Borders' services will be phased over several months from January 2021, with the aim of discharging all patients by 31 March 2021, or 30 April 2021 if required. This is based on the current average length of stay of SABP patients (up to 35 days) and will ensure that inpatients will be able to complete their care and treatment package at Langley Green Hospital before being discharged to the relevant community team. There are already good working relationships and liaison between the inpatient staff at Langley Green Hospital and the community teams within SABP to facilitate safe and effective transfer of patients back to local teams.

8.4 Single sex wards

We have responded to the concerns raised through the consultation about our plans to introduce single-sex wards for adults of working age and older people, in particular, our proposals to move females at Oaklands Ward in Chichester to either Worthing or Crawley. Therefore, we intend to keep all wards for adults of working age and older people as mixed-sex. So we can achieve this, we will keep mixed-sex wards for adults of working age and older people with mental health problems other than dementia and we will create enhanced segregated zones within existing mixed- sex wards to make sure we comply with national guidance on safety, privacy and dignity. Older people with mental health problems (non-dementia) will be admitted to the mixed-sex ward at Meadowfield Hospital, Worthing first, subject to bed availability. We will then admit them to Langley Green Hospital, Crawley, if necessary. This will reduce the amount of travel for people from Chichester who would have previously been admitted to the Harold Kidd Unit. These wards will have both segregated and communal lounges.

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Wards for people with dementia will continue to be single-sex because of the need to preserve patient safety, privacy and dignity. This means that existing wards need to be modified to make them compliant.

All changes agreed in the final proposals have been made in consultation with Healthwatch West Sussex and Healthwatch England, who were aware of similar issues elsewhere in the country. Healthwatch England sought advice from CQC about what would be acceptable to them and their advice was filtered back down to Healthwatch West Sussex who advised that our proposals to have segregated or ‘zoned’ wards, with communal lounges and separate lounges for females would be within the CQC guidance.

8.5 Equality and Health Inequalities Impact Assessment

The Equality Health Impact Assessment (EHIA) for the post-consultation proposal has been updated since the PCBC to reflect the learning and actions arising from the consultation. The consultation feedback has helped us to identify specific areas where the proposal could have a negative impact. We have, therefore, refined our proposal so that included the development of mitigations to address these. Whilst the proposal changes are detailed fully elsewhere in the DMBC, the feedback received, and subsequent review of the EHIA has, in summary, led to proposal revisions that will: • Respond to concerns about provision of single sex wards by retaining mixed sex wards with single sex zoning • Ensure that consistent mechanisms for ongoing equalities based engagement is put in place • SPFT will ensure that feedback from service users, families and carers are built into any changes that are implemented • Those most affected by the need to travel further will receive help in the form of mileage and public transport allowances and possible community transport/minibus shuttles between relevant locations Traffic and parking at Swandean • Engagement with local residents in relation to traffic and parking concerns • Improved data collection by SPFT in line with protected characteristics of patients.

Summary of Equality and Health Inequality Impact Assessment Protected Consultation Feedback DMBC Proposal Post Consultation Characteristic Action Race No specific feedback for this Ensure any public Develop a consistent characteristic facing information on mechanism of robust the proposals is offered equalities based and provided in engagement to ensure

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Protected Consultation Feedback DMBC Proposal Post Consultation Characteristic Action appropriate formats if continued feedback is required sought and obtained appropriately Ensure links have been made with local faith communities or cultural groups in order to obtain feedback during the consultation period.

Ensure that Friends, Families and Travellers receive information on the consultation

Sex It was strongly felt by some It is proposed that all SPFT will ensure that that to move to single sex wards for adults of patients and carers are wards would be detrimental to working age and older involved in any the wellbeing of adult and people with mental implementation and older people inpatients, and health problems–other post implementation to that it would not prepare for, than dementia- as assess that their needs and reflect the reality off, care mixed sex words. To are considered after discharge. comply with national guidance, it is proposed It was felt single sex wards to create enhanced may make it difficult for those segregated zones within who are non-binary or existing mixed sex intersex to access mental wards, with both health inpatient services. segregated and communal lounges. There will be flexibility to accommodate the needs of people who are non-binary or intersex. All words for those with dementia will remain single sex in order to address the particular clinical needs of these patients.

Gender People, including some staff, It is proposed to There needs to be Reassignment felt that plans to make wards maintain mixed sex recognition of the single sex may make it wards for working age geographical clustering difficult for transgender adults and older of this community, but patients to access MH people. There will be also that there are inpatient services. Some felt flexibility to Trans individuals living that single sex wards accommodate the across the Sussex reinforced gender needs of trans people geography, and stereotypes. so they can maintain appropriate measures dignity, privacy and need to be supported to safety. recognise and respond to this, especially when admissions are made to single sex wards.

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Protected Consultation Feedback DMBC Proposal Post Consultation Characteristic Action SPFT will ensure there is access to specific advice and information to ensure that Trans individuals are supported appropriately

Age No specific feedback in No specific changes to Further work will be relation to this characteristic proposals in respect to carried out post this characteristic consultation to ensure we are obtaining feedback from both older people and the younger cohort, and acting on any points raised. Religion & Belief No specific feedback in No specific changes to Consider the religious relation to this characteristic proposals in respect to needs of patients in any this characteristic post consultation redesign work.

Disability It was felt by approx... 80% of The final Any modernisation of those who contributed that recommendations detail facilities will ensure that people with mental health how SPFT intend to required standards for issues should be cared for in improve and strengthen access and care for their own homes where community services. those with physical and possible. People supported Additional government sensory disabilities are community services with a funding has also been met focus on prevention and early used to introduce new help to reduce the demand for measures to support We will continue to inpatient services. community services. engage with patients following the redesign for feedback on changes in light of their disability Sexual No specific feedback in No specific changes to Continue to ensure that orientation relation to this characteristic proposals in respect to the needs of those with this characteristic differing sexual orientations are met.

Marriage or No specific feedback in No specific changes to No further action civil relation to this characteristic proposals in respect to partnership this characteristic Pregnancy No specific feedback in No specific changes to No further action and relation to this characteristic proposals in respect to maternity this characteristic Other There was feedback from It is proposed to: Recommendations of Disadvantaged or carers, families and friends- - Pay travel costs for the transport review will inclusion groups particularly those living in and carers and families be included in the around Chichester and who will be visiting consultation report and Horsham that they may have patients at the time will be reviewed in the to travel further in some cases of transfer light pf the decision to visit a loved one. - Investigate the made about future potential to provide services to assess community taking the transport/mini bus

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Protected Consultation Feedback DMBC Proposal Post Consultation Characteristic Action services between recommendations locations forward - Raise awareness about how patients and carers on benefits can get travel costs reimbursed - Work with West Susses County Council to discuss improving relevant bus routes. Look at travel options to improve access to Swandean site in Worthing.

Deprivation and There was feedback from It is proposed to: Particular attention will socio-economic carers, families and friends- - Pay travel costs for be paid on admission to disadvantage particularly those living in and carers and families the travel needs of the around Chichester and who will be visiting patient, family and Horsham that they may have patients at the time carers. to travel further in some cases of transfer to visit a loved one. - Investigate the In addition, all patients potential to provide and their carers will be community given information and transport/mini bus encouraged to apply for services between travel locations - Raise awareness about how patients and carers on benefits can get travel costs reimbursed - Work with West Susses County Council to discuss improving relevant bus routes. Look at travel options to improve access to Swandean site in Worthing.

Community Some people including SPFT have promised to No further action Cohesion residents local to the meet with residents to Swandean site, said that the see how concerns increase in cars due to the might be addressed. proposals will exacerbate SPFT is developing a existing problems and parking strategy to potentially cause road safety identify potential issues. solutions and create more parking provision on the Swandean site,

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Protected Consultation Feedback DMBC Proposal Post Consultation Characteristic Action and will enable staff to use transport provision that is being put in place to travel between sites.

8.6. Financial implications

The Mental Health Programme Board of the Sustainability and Transformation Partnership (STP) - now the Sussex Health and Care Partnership - has approved additional investment in urgent care services across Sussex of £ 1.4m in 2019/20, with a full year effect of around £2.4m. This investment means that our revised proposals can be implemented in a sustainable way.

This investment will increase capacity for crisis resolution home treatment in West Sussex and has been developed in conjunction with commissioners. Wider STP priorities highlight a number of services in West Sussex which need investment so we can achieve five year forward view priorities, and the ambitions of the NHS Long Term Plan for Mental Health. This will allow significant development of the community model.

Across Sussex, the NHS Long Term Plan will increase funding in mental health services by £67m (24%) over the next five years allowing the transformative work to be carried out.

The options longlist presented in our original proposals were all considered for financial viability. Capital costs were estimated for each option in conjunction with the impact on revenue streams. The options were scored on value for money, affordability, revenue impacts.

The table below summarises the capital and revenue implications of each of the options:

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Option Action Capital Revenue Conclusion Requirement Consequence 1 . Do nothing £ 0 2. Create two centres £ 5.1m Increase £1.1m No Return on of excellence Investment (ROI) 3a Move patients from £ 5.1m Increase cost Risk of operating at Harold Kidd Unit £100k reduction of 7 beds and transfer beds could lead to to Worthing and additional out of Crawley area beds , no ROI 3b £ 5.1m Saving of £ 200k Risk of operating at The same as 3(a) reduction of 10 but move patients beds could lead to from adult beds at additional out of Oaklands Ward in area beds Chichester 4 Refurbish Harold £ 13.1m Nil No ROI for Kidd Unit, close Iris significant capital Ward and move beds to Worthing 5 Move patients from £ 14.6m Increase £ 250k No ROI for Harold Kidd Unit significant capital and find a new site in Chichester 6 Build new unit in £ 19.4m Increase £100k No ROI for Chichester to significant capital house existing beds 7 Move patients from £ 5.1m Increase £400k No ROI, SABP Harold Kidd Unit/Iris Ward to beds in Crawley and Worthing 8 As Option 7 but £ 5.1m Saving of £300k ROI of 6% continue East Surrey contract for only nine beds not the current 13

8.6.2 Post-consultation outcomes

The commissioner and provider have two main financial priorities to achieve from the reconfiguration of beds: 1) Reduce the use of out of area beds which are expensive and not good for patients' social support

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 61 2) Ensure that dementia services develop at a growth rate that allows mitigation of the pressure on capacity and quality that arise from an ageing population.

This proposal addresses these issues, generates value for money and is affordable within the current financial planning assumptions of the Commissioners and the system. The post-consultation preferred option will, by the end of 2022/23, cost £328,000 more in revenue terms per annum. The build-up of revenue costs is set out in Appendix 3 and can be summarised by year as follows:

Revenue Impact of Changes Opening Closing Closing Closing Closing 19/20 19/20 20/21 21/22 22/23 £'000s £'000s £'000s £'000s £'000s

Revenue increase per annum 0 -131 -73 -604 480 Cumulative Cost increase -131 -204 -808 -328 SPFT has discussed with West Sussex CCG options around funding from within current plans so we can implement the post-consultation preferred option. The revenue funding sources for the development are explained below.

Funding Source for additional costs

Revenue Impact of Changes Opening Closing Closing Closing Closing 19/20 19/20 20/21 21/22 22/23 £'000s £'000s £'000s £'000s £'000s

Cumulative Cost increase -131 -204 -808 -328

Funding Source : Reduced system spend on Out of Area placements 131 204 712 328 Dementia services growth allocation (non-recurrent only) 96

1. Reduced system spend on out of area placements – at present the Sussex mental health system is facing an annual pressure in 2020/2021 of £5.5m on out of area beds, and has been using around 40 beds from other areas consistently since August. In 2019/20 the spend across the system on out of area placements was £5.3m. These proposals in West Sussex contribute significantly to addressing this. This development introduces three additional beds to the West Sussex mental health system. At present, an out of area bed costs around £650 per day. Providing three additional beds in Sussex will reduce equivalent out of area bed costs by £711,750.

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2. In 2021/22 cumulative costs for the implementation of the business case rise to £808,000 before reducing down to a final total of £328,000. Therefore £96,000 over the out of area savings will be required from an additional funding source. The CCG's operational planning includes growth for dementia services. In 2021/22 this growth is around £514,000, and £96,000 will be planned to be used as non-recurrent funding to support the system to the final stages of the business case.

This also includes re-providing the services of Sussex Community NHS Foundation Trust in the best configuration possible from existing buildings. This is being discussed across organisations as we seek the best capital solution to support the transformation of services.

8.6.3 Workforce

The workforce implications for the original preferred option and the post-consultation preferred option are the same.

9. Implementation of Revised Proposals (Post- Consultation) and Benefits Realisation

9.1 Implementation Approach and Governance

If the post-consultation revised proposals are approved, the oversight of the delivery of the implementation plan will be undertaken by the existing West Sussex Service Redesign Programme Board. This Board was set up in January 2018 and meets monthly to oversee the development and implementation of the service change proposals. This is chaired by SPFT’s Chief Operating Officer and West Sussex CCG is represented. A Project Group was also established and continues to report to the Programme Board.

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The Board reviewed outcome of the feedback from the public consultation, the intended revised proposals and all final recommendations at its meeting on Wednesday 13 November 2019. When the Programme was re-activated after being put on hold for three months in April 2020 because of COVID-19, it was agreed to review the governance arrangements. At the subsequent August 2020 Programme Board, it was decided to establish new arrangements to oversee the final governance, scrutiny and assurance stages and the implementation of the Programme once the final proposals have been approved. The new arrangements meant that the Project Group will no longer meet but that individual work streams, such as workforce, finance and estates, will report directly into the Board via the Programme Director. . 9.2 Post Project Evaluation Reviews

9.2 .1 Project/Programme Reviews It is proposed to have three reviews: - After the first phase of implementation period in April 2021. - After second phase of implementation in December 2021. - After final completion of the implementation in July 2022.

The first review will focus on all projects stages from initial work around the case for change, option appraisal process, pre-consultation, formal public consultation, post- consultation and governance and assurance processes. It will aim to identify lessons learned and how these can inform and improve future projects and processes. The second and third reviews will focus on lessons learned from the delivery of implementation phases. The reviews will include engagement with patients, carers and families locally.

9.2.2 Estates Improvements To implement this plan, SPFT will undertake: • Environmental/estates upgrades for all mixed-sex wards, and • Environmental/estates refurbishment of 1st Floor, Salvington Lodge to create new dementia ward.

9.2.3 Workforce SPFT will undertake two comprehensive exercises to engage those staff affected by the post-consultation preferred option.

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 64 9.2.4 Clinical and HR Reviews In line with good clinical and HR practice and recommendations, two internal pre- and post- ward transfer reviews will be undertaken. The first will be led by a clinician and will focus on patients’ health and outcomes and the second will be led by an HR specialist and will involve staff affected by the proposals and those that transferred to the new wards.

9.2.5 Surrey and Borders beds transition The SPFT and SABP provider to provider contract for the remaining nine Langley Green beds will be terminated by the end of April 2021. Alternative provision that is more local, therefore providing better quality and care outcomes for patients has been agreed collectively by partners across Surrey and Sussex.

A joint mobilisation plan to safely transition patients from Sussex into the new provision has been agreed and includes patient quality and safety considerations on an individual and collective basis. This contract is currently monitored through monthly Operational Meetings with Surrey & Borders bed management, Acute and Crisis Care colleagues and SPFT representatives including the ward Consultant and Manager, Modern Matron and Nurse Manager for the Hospital. These meetings cover feedback from weekly bed calls, Safeguarding, Serious Incidents and complaints, interoperability with SystemOne (SABP) and Care Notes (SPFT), Delayed Transfers of Care, length of stay, and updates on changes in systems or personnel. In future, these meetings will also be used to monitor SABP's progress in relation to the local re-provision and the Deputy Operational Director for West Sussex will also attend. To ensure that the local contractual, operational and clinical arrangements have been developed with SABP and their new provider, it has been agreed to extend the contract by 1 month, i.e. end of April 2021 instead of March 2021 if this is required. As part of the transition plan, SPFT will maintain the nine beds at Langley Green Hospital up to Friday 30th April 2021. Surrey and Borders have been given notice to this effect and said that it will make suitable provision in its region for the remaining nine beds currently at Langley Green Hospital.

9.2.6 Implementation Plan: Timeframe The proposed timeframe has been updated in light of the new post-consultation proposals and the key dates are detailed overleaf. This new proposed timeframe finishes at a similar time to the original plan but the implementation of phases of work will be different because of the changes set out in the post-consultation proposals.

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Implementation February 2021 - July 2022: Action Date Phase One Governing Body (GB) to consider the Decision-Making Business February 2021 Case in Public and ratify the proposed preferred option. West Sussex Health and Social Care Scrutiny Committee (HASC) meeting to review the CCG Governing’s Body decision DMBC Plan and proposals reviewed and decision made February 2021 Staff consultation February/March 2021 Close Grove and Iris wards March/April 2021 Implement agreed transport solutions March/April 2021 Project/Programme evaluation review April 2021 Start environmental/estates upgrades for 1st Floor, Salvington April 2021 Lodge Additional nine adult working age beds provided through April 2021 termination of Surrey and Borders contract Start environmental/estates upgrades for adult mixed gender wards April 2021

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9.3 Implementation Challenges and Risks

9.3.1 Implementation Risks and Plans for Mitigation

A risk management process that facilitates effective recognition and management of risks is already in place and the West Sussex CCG and SPFT regularly review and monitor these risks at the West Sussex Service Redesign Programme Board. Where these risks have any corporate governance implications they will be included within the CCG and SPFT governance risk registers.

Risk management will be crucial throughout any proposed implementation. The high- level risks detailed here will form the initial list to be reviewed and updated on a regular basis.

9.4 Implementation Risks

9.4.1 Estates – 1st Floor, Salvington Lodge Development

Risk: There are currently two outpatient services located in the area that needs to be refurbished to create additional beds for people with dementia. There is a risk that alternative accommodation for these services cannot be found which would prevent the creation of the West Sussex specialist dementia Centre of Excellence on the Swandean Hospital site. Mitigation: SPFT and Sussex Community NHS Foundation Trust (who currently occupy the first floor) meet monthly to discuss this issue. We are now developing proposals which keep the outpatient clinics on the existing site while making sure that we can provide 10 SPFT dementia beds as well as 18 Sussex Community physical continuing care beds.

9.4.2 Travel times and transport

Risk: The proposals would affect some people in West Sussex, in particular those patients and their carers/families who currently travel to the Harold Kidd Unit in Chichester and Iris Ward, Horsham Hospital and will now have to travel to Worthing and Crawley. Mitigation: Travel time analysis has been carried out by the West Sussex County Council’s Intelligence Unit and a transport review group reviewed this analysis and made suggestions for transport solutions.

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The transport solutions were included within the formal public consultation and each option received similar positive feedback.

Four transport proposals/options are being offered in response to the consultation: 1. Pay travel costs to partners and carers visiting people who will be inpatients at the time we transfer Orchard, Grove and Iris wards, and 2. Investigate the potential for providing community transport services at relevant locations. 3. Increase awareness and provide information about how partners and carers, particularly those on benefits, can claim back travel expenses through the Healthcare Travel Costs Scheme, and 4. Work with West Sussex County Council and other relevant bodies to look at how transport routes between relevant locations could be improved. The above will be closely monitored and further transport solutions may be introduced to replace or complement these solutions following further engagement with patients and their partners/carers and West Sussex County Council’s transport team and the Chief Executive of Sussex Community Transport.

9.4.3 Programme Implementation and Stakeholder Engagement

Risk: There is a risk that the implementation plan is either not delivered in line with the timeframe or that the plan changes. This could be a reputational risk for both the CCG and SPFT and adversely affect stakeholder partnerships. Mitigation: The West Sussex Service Redesign Programme Board will be regularly overseeing delivery of the implementation plan and the Project Group will escalate any issues promptly to the Programme Board for resolution. There will be continued engagement and communications to all key stakeholders on implementation of the plan through existing routes and updates on progress will be provided publicly through the CCG Governing Body and SPFT Board of Directors meetings. A communications and engagement plan has been developed to cascade key messages and decisions throughout the implementation.

9.4.4 Workforce

Risk: Staff are not able to travel. There means there a risk of redundancy for some staff or that staff leave because they may find the new travel arrangements too difficult.

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Through the change management process, staff may object to being offered a suitable alternative post. Staff raising grievances to the change proposed with the potential to delay the process. With an ageing workforce, staff may be looking at redundancy as an option. There is a risk that there may not be the available staff and resources to cover the new Centre of Excellence for those living with dementia. Mitigation: Staff on the existing wards for people who have dementia are generally very positive about the new Centre of Excellence and working together as a new team. Where Centres of Excellence have been developed these tend to improve recruitment and retention of staff since they are often perceived as very attractive places to work and offer more research and staff development opportunities. Comprehensive recruitment plans are already in place and are being implemented to recruit to establishment levels. SPFT is keen to employ all the transferring staff and wants to avoid redundancy where ever possible. It also has vacancies in both inpatient and community services to offer staff. A staff transport time analysis has been undertaken and the one-to-one sessions with staff affected will be opportunities to consider different options, such as travel expenses, re-deployment locally or different job opportunities such as community.

9.4.5 Communicating Changes

The communications and engagement plan used during the consultation process will be built on to form the basis for a focussed, proactive and inclusive approach to stakeholder and staff engagement and management in support of the implementation plan. This originally involved a variety of different engagement activities to involve a wide range of stakeholders, including clinicians and other staff, service users and their carers and public representatives such as MPs and NHS England and Improvement. We will also aim to disseminate the information generated from evaluation reviews and produce regular updates on progress regarding delivery of the implementation plan.

9.4.6 Benefits Realisation Plan

A comprehensive Benefits Realisation Plan has been developed for consideration as part of the Post-Project Evaluation reviews outlined earlier. This is included in the DMBC as Appendix 3.

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 69 10. CCG statutory duties

As this proposal has developed, the CCG had remained mindful of its statutory duties in relation to consulting with local communities, reducing health inequalities, improving health outcomes, and promoting integration. The PCBC was developed with support from clinicians and Healthwatch. Patient groups with identified protected characteristics were engaged in the consultation process and encouraged to respond and provide feedback on how the proposed changes would impact them in future. The feedback from the consultation was thoroughly assessed and the identified concerns around inequalities fed into revisions of the EHIA and QIA documentation. Both assessments are provided as Appendices to this DMBC. The mitigations shown in those documents, then informed a review of the overall proposal to incorporate elements that would address the concerns with changes to the proposals, such as retaining mixed sex wards for adults of working age while developing single sex wards for older people with Dementia. Our governance process, which has included ongoing engagement from West Sussex HASC and NHS England and Improvement, has helped to make sure the CCG is considering the most appropriate solutions to address the concerns that have been raised. 11. Summary and Conclusion

The plans to improve mental health services in West Sussex, which began in January 2018, are now at a stage (subject to the necessary assurances and approvals) where we can plan implementation between February 2021 and July 2022.

Our proposals have been subject to rigorous scrutiny throughout the planning and consultation processes and have been refined as we listened to, and acted on, feedback from a wide range of stakeholders, particularly service users, carers and families. We believe our final post-consultation proposal, set out in this Decision-Making Business Case (DMBC), satisfactorily meets the primary driver for change, namely the need to address the continuing problem of poor quality inpatient environments at the two main sites in Chichester and Horsham. Furthermore, we believe that this will help us meet other drivers for change, particularly around meeting privacy and dignity standards by providing single-sex wards and making sure, we have enough beds to meet current and future demand.

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 70 We have achieved this while adapting our plans to address concerns from service users, carers, families and staff on both these issues. In response to feedback from the public consultation, we will now provide mixed-sex wards for adults of working age across the county while maintaining secure and safe segregation between males and females and, at the same time, providing patients with the opportunity to mix in communal areas. Our decision to end the SABP contract earlier than planned at the end of March 2021 (or April 2021 if required) rather than April 2022 means that we are able to create three extra beds for older people and three extra beds for adults of working age by utilising those 9 beds to meeting future demand, It also means that ward sizes for adults of working age will not increase.

The formal public consultation and pre-consultation activity raised a number of issues, which we have endeavoured to address fully in our final proposal. The following concerns were raised: • introduction of single-sex wards • impact on transport and travel for affected service users, carers and families • increased number of beds in some wards, and • need to strengthen community services.

Addressing all the above, our final proposals now mean we will have mixed-sex wards for adults of working age and older people at all our wards, including Oaklands Ward in Chichester, which was the focus of particular concern. However, the safety, privacy and dignity of patients will be maintained through segregated wards and female only lounges while having the choice to mix in communal lounges. We believe this also meets the concerns of people who would like to see single-sex wards and dementia wards remaining single-sex because of the particular vulnerabilities these patients face. Also, our post-consultation preferred option still provides the opportunity for us to create a Centre of Excellence for dementia care which received general approval throughout the consultation period. We have put forward travel solutions to help people who will be the most affected by the new proposals which are set out in this DMBC. We are also having continuing discussions with West Sussex County Council and Sussex Community Transport to investigate the potential for providing bespoke transport services between relevant sites. The issue of increased ward sizes has been addressed by our new proposals for the provider-to-provider contract with Surrey and Borders, set out previously. We have also set out very clearly in the DMBC the ongoing work we are undertaking to strengthen and improve the full range of community services to make sure people can stay in their own homes wherever possible.

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 71 We are now in a position to put in place our implementation plans for our post- consultation revised proposals, which are set out in this DMBC, should these proposals be approved. Once complete, we will have achieved our main aims of making sure our patients benefit from high-quality care in safe and modern wards while meeting national guidelines on single-sex wards. We will have created a Centre of Excellence for dementia care and put in place solutions to help people travel more easily to visit their loved ones. We believe that the proposed implementation plan is deliverable within the timescales outlined and is financially affordable for the local health economy. The proposals for continuing communication and engagement with service users, their carers, staff and the wider communities and stakeholders will also ensure that these plans will be effectively monitored and jointly delivered. This has been an excellent example of effective partnership working between the three West Sussex Clinical Commissioning Groups (now the NHS West Sussex Clinical Commissioning Group) and the SPFT NHS Foundation Trust. We have also been grateful for the support and guidance we have received from other bodies including NHSE/I, West Sussex Health and Adult Social Care Committee, SPFT Board of Directors, and its Board of Governors, the new West Sussex CCG Governing Body, West Sussex Healthwatch and others including The Consultation Institute and Public Perspective.

04/01/21 West Sussex Redesign Decision-Making Business Case FINAL (3) 72 Appendices Appendix 1 – Independent Report of Consultation results: October 2019

Please refer to PACK B

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Appendix 2 – Equality Health Inequality Impact Assessment

Please refer to PACK B

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Appendix 3 – Travel and Transport Survey

The Travel and Transport survey has been undertaken and is available at: https://www.sussexpartnership.nhs.uk/sites/default/files/documents/transportreviewgroupresponse .pdf https://www.sussexpartnership.nhs.uk/sites/default/files/documents/transportanalysis.pdf

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Appendix 4 – Benefits Realisation Plan

Desired Benefit Stakeholders Enablers required Outcomes Current baseline Who is Target date impacted to realise benefit displayed if benefit measure responsible? realised

Improved quality of Older patients with 1. Closure and High quality, Poor quality FN, Dementia Lead 1. March 2021 environment for the Dementia and transfer of modern and up to environments, as KS, Adult and Older three dementia and Functional problems, Grove and Iris date environments. evidenced by Adult Inpatient older people’s and their wards to the environmental audits Lead wards, through the carers/partners newly Improved levels of and CQC inspections. Estates Lead reconfiguration of visiting refurbished patient and staff wards. Multidisciplinary ward Burrowes Unit. experience. staff. 2. Closure and 2. October 2021 transfer of Orchard ward to Langley Green Hospital and Meadowfield Hospitals. Creation of new Older patients with 1. Refurbishment High quality, Wards are not co- FN, Dementia Lead, 1. April 2022 Dementia Centre of dementia and their of 1st Floor, modern and up to located with physical SPFT 2. June 2022 Excellence. carers/partners Salvington date environments. health inpatient AK, Dementia Lead, 3. October 2021 visiting Lodge services. SCFT – March 2022 Multidisciplinary 2. Combining the Integrated physical 4. April 2022 centre staff. three wards and mental health 3 separate and Estates Lead into an approach and geographically distant integrated service. wards. centre.

Desired Benefit Stakeholders Enablers required Outcomes Current baseline Who is Target date impacted to realise benefit displayed if benefit measure responsible? realised

3. Multidisciplina Improved levels of Iris ward is a stand- ry staff training patient and staff alone ward and joint satisfaction. training No formal partnership between SPFT arrangement in place & SCFT. between SPFT and SCFT 4. Development organisations. of joint operational models and ways of working between SPFT and SCFT trusts. 5. Additional capital through the Trust’s Capital Programme.

Page 79 Environmental Adult and older adult Estates Higher levels of Minimum levels of Adult and Older May 2021 modifications and patients and their enhancements/mo ward privacy, compliance with People Inpatient re-configuration to carers, in particular, difications on all safety and dignity national guidance. Lead enable enhanced transgender and non- adult and older compliance. Estates Lead privacy, safety and binary patients. adult wards. CCG dignity compliance Multidisciplinary ward Oaklands ward, Commissioning on all adult and staff. Multidisciplinary Chichester remains Lead older adult mixed ward staff training. mixed gender and gender wards. locally accessible. Staff recruitment Multidisciplinary staff 1. Training and 1. Services are 13% total vacancy HR Lead 1. Ongoing and retention groups. Development more attractive, factor OD Lead 2. June 2022 Programme. in particular, Adult and Older 3. May 2021 2. New Centre of Dementia Difficulties in People Inpatient 4. Ongoing Excellence. Centre recruitment and Lead 3. High quality 2. Improved retention, in particular, Dementia Lead environments. recruitment for dementia services. 4. New ways of and retention. working. 3. Reduction in sickness, absence and staff turnover. 4. Diverse workforce model 5. Higher levels of satisfaction

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