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Report to Governing Body 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
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