Exception Report: Transforming Mental Health
Summary of the Project / Consultation AnalysisFormal Consultation for Transforming Mental Health finished on the 15th September 2017. An analysis of the consultation was undertaken by Hywlus, an independent organisation who produced a consultation analysis report which highlighted the following:
The proposed model of care
There was qualified support for the proposed model of care, with strong support for a 24/7 service. The questionnaire results highlighted that 61.2% of survey respondents either agreed or strongly agreed with the proposed co-designed model. 25.8% of respondents either disagreed or strongly disagreed with the proposed co-designed model.
It is important to note that whilst there is positive support for the proposed co-designed model, there are many people who expressed concerns with different aspects of the model. HDdUHB is therefore committed to ongoing engagement and co-production throughout any implementation to ensure that all views continue to be heard and considered. Some respondents from Pembrokeshire and Ceredigion raised concerns about centralisation of acute services in Carmarthenshire and the accessibility of these services via public transport. Further, the issue of bed numbers and service capacity at the new CMHCs and at the Central Assessment and Treatment Units is repeated across all strands of the consultation.
CMHCs
The development of the CMHCs was welcomed across all strands of the consultation. There was support for calling them ‘wellbeing centres’. The feedback called for them to be carefully sited within towns to ensure that they are easily accessible and embedded within local communities. There were concerns expressed about the number of hospitality beds contained within them with people asking for some flexibility to allow for a greater number of beds if demand increases.
Assessment & Treatment Units
There was an understanding of the need to provide high quality inpatient care within centralised units however people from Ceredigion and Pembrokeshire expressed their concerns about distance and travelling. The accessibility of Llanelli was a particular concern.
Single Point of Contact
The introduction of a 24/7 Single Point of Contact was welcomed. The feedback was that people wanted a combination of a single, easy to remember phone number that was staffed by professionals who would answer quickly, were empathetic and had good local knowledge in each county. Other means of contacting the Single Point of Contact were also welcomed, such as email, or text messaging. The need to accommodate individuals with hearing or sensory loss needs was also raised.
Future ways of working
The proposals to develop social enterprises as a part of the CMHCs was welcomed. There were recognised benefits for service users becoming actively involved in the running of them. A greater involvement of the voluntary sector within CMHCs was also welcomed provided any issues around management, finance, governance and confidentiality were addressed.
Workforce
Introducing people from the voluntary sector into the workforce was welcomed provided that there were clear governance arrangements in place.
Transport
Concerns around distance and travelling were clearly heard throughout the consultation. There was strong support for involving the voluntary sector in helping to provide transport solutions. Travel costs can be a barrier to those wishing to access centralised services, particularly for those in the more rural north and west of the HDdUHB area.
The use of technology and digital health
The use of technology to extend the range of options available with which to raise awareness of mental health problems was welcomed, particularly amongst the younger population, however it should not replace traditional face to face contact. It should also accommodate the needs of those with sensory loss, literacy problems or learning disabilities. Difficulties with access to reliable high-speed internet links, particularly in rural areas, were also noted.
Adapting the Consultation Proposals
Throughout November and December 2017 a series of staff, stakeholder and public drop-in sessions were held across the three counties to consider the anlaysis report. Specifically people were asked whether the consultation analysis broadly represented what they felt and whether the analysis findings should impact on the proposals put forward as part of the consultation. Youth groups and key equalities groups were also asked for specific comments in relation to any impact on protected characteristics groups. This was to ensure that all views were being heard and considered within the review of the consultation feedback and reflected accurately within a closing report and implementation plan required for Board.
Feedback from all these groups, including a formal response from the Community Health Council, were collated and discussed at a post consultation analysis meeting with multi-stakeholder attendance. A series of recommendations were made to amend the proposed co-designed model to take forward for implementation. These were as follows:
- To have flexibility in the number of crisis/hospitality beds proposed as part of the model
- To reconsider and extend the hours of operation in the Carmarthen Community Mental Health Centre
- To develop creative transport solutions to address concerns arising from the centralised assessment and treatment units
- To develop a business case for a co-located central assessment and treatment unit
- To have a central single point of contact aligning to local clinical expertise
- To align the single point of contact with existing single points of contact/systems already established within HywelDda
- To link closely with the Transforming Clinical Services programme.
A closing paper which covered our consultation processes, the adapted proposed model and an implementation plan were taken to Board on the 25th of January 2018. At board it was also noted that the Consultation Institute confirmed that HDdUHB has been awarded ‘Best Practice’ status for the Transforming Mental Health programme.
Board approved the closing paper and gave approval for implementation to begin. We will now be presenting at a number of scrutiny committees over the next few months as well as holding further staff and stakeholder drop-in sessions. Further, the Mental Health Implementation Group will be establishing working groups for implementation and developing work plans with the support of the Health Board and key stakeholders.
Period covered by the Report / January 2018
Summary of overall status / Project on track, with no significant cost overrun, slippage issues
Key Risks / There is a risk that during implementation of the Transforming Mental Health Programme business continuity will be affected. Capital works or changes in working practices may cause disruption to services and staff, and service capacity may be compromised. / / A strategic outline business case may need to be developed and agreed to overarch the proposed capital programme. Consequently HDdUHB will progress with the development of a critical path for the proposed implementation programme which will support any required phasing, scope wider opportunities to address funding constraints and allow sufficient time to test solutions.
Capital investment will be required to support the transformation programme with the potential sources being the All Wales Capital Programme (AWCP) and potentially the Health Board’s Discretionary Capital Programme (DCP). There is a risk other projects may be prioritised over TMH and the monies for development in line with the programme are not available within the estimated timescales put forward by the implementation plan. The significant commitments which are already placed on the All Wales Capital Programme are likely to have an impact on this proposed implementation plan and the phasing of delivery / / A strategic outline business case may need to be developed and agreed to overarch the proposed capital programme. Consequently HDdUHB will progress with the development of a critical path for the proposed implementation programme which will support any required phasing, scope wider opportunities to address funding constraints and allow sufficient time to test solutions.
Further, Members representing the Estates and Finance workstream will hold a business case scoping meeting with the Welsh Government Capital Team. This will take place pending Board approval to progress and agreement on the source and timing of capital funding.
There is a risk of agencies involved in the implementation of TMH not aligning priorities due to the individual organisational need and funding priorities. This is caused by competing priorities within organisational structures. The impact is delays in the project progressing. / / The MHIG is a multi-stakeholder group comprising of representatives of the key organisations. It will meet on a monthly basis to review progress and political pressures which may affect implementation timeframes.
Key Issues / Key Issues
Issue
(IS happening and must be resolved to move forward) / RAG
(insert RAG Status : Red/Amber/Green) / Action
Programme workstreams goals and membership need to be established following Board. This will be in order to meet the estimated timescales for programme work as indicated through the implementation plan. / / A terms of reference and governance structure has been finalised and agreed for the Mental Health Implementation Group.
Dedicated project management time will be allocated to oversee the development, progress and coordination of workstreams.
Key Milestones / Management Summary
Developments and achievements this month:
- Consultation analysis report completed
- Key stakeholder and staff feedback on consultation analysis gathered
- Closing Report and associated Board papers complete
- Implementation plan complete
- Board Approval for Implementation
- Implementation phase to begin
- Implementation workstreams established
- Estate option appraisal, workforce transport and informatics to commence in line with implementation plan
- Communication and Engagement Plan developed for implementation
Milestones achieved/Outputs (deliverables) completed in last period / As above
Shortfalls/Non-completions in last period / N/A
Forecast for next period / As above
Financial status