ITEM 4B (ii)
HPFT - Report for Scrutiny Topic Group
20 January 2011
Proposals to Vary and Fast-Track Changes
to Investing in Your Mental Health
1. Introduction
Hertfordshire Partnership NHS Foundation Trust (HPFT) provides mental health and specialist learning disability services across the county of Hertfordshire, and specialist learning disability services in Norfolk and North Essex. The Trust employs over 3000 people with a turnover in excess of £200m.
HPFT is committed to providing excellent health and social care. We aim to provide services which make a positive difference to the lives of service users and their carers.
The existing partnership arrangements with Hertfordshire County Council underpin our ability to develop a recovery approach based on holistic assessment of both health and social care needs in the county. We apply the principles of choice, control and independence for service users and carers who we involve in the way we provide their care and in the process of developing services.
HPFT has a vision ‘to be the leading provider of mental health and specialist learning disability services in the country’ which drives our commitment to high quality care, with excellent treatment outcomes, within a safe environment which meets the needs and expectations of service users.
2. Hertfordshire Mental Health Strategy
‘Investing in Your Mental Health’ (IiYMH), the strategy for mental health services in Hertfordshire, was originally agreed in 2006 following a formal public consultation, and then reviewed and reconfirmed in 2008.
The 2006 IIYMH strategy envisaged three new-build acute inpatient units with an indicative 144 beds in three locations - Welwyn Garden City, Hemel Hempstead and Stevenage. It identified the QE11 Hospital, Welwyn Garden City, but did not specify sites in Stevenage and Hemel Hempstead. Table 1 (below) identifies the number of beds in each area:
Table 1
Location / Potential BedsWelwyn Garden City / 64
Hemel Hempstead / 64
Stevenage / 16
The aim of the IIYMH strategy is to transform all mental health services to provide improvements in quality that will be sustainable in the new economic environment. The transformed services will provide care and treatment closer to home, reduce the need for people to be admitted to hospital, and help to prevent people becoming ill at an earlier stage.
IIYMH confirmed that, acute mental health inpatient assessment and treatment services will continue to be needed for people not well enough to recover within their home environment and when in periods of crisis. IIYMH recognised that current facilities were/are inadequate and of poor quality. It recommended as essential that these inpatient facilities are improved as soon as possible to meet modern environmental and clinical standards, enabling people to return home in a timely manner and to continue with their recovery plan.
Many of the buildings are out-dated and of poor standard and do not offer any meaningful contribution to the therapeutic healing environment. Many do not provide en-suite facilities and whilst meeting the basic tenants of single sex accommodation, do not embrace its full intentions because of structural deficits.
It is quite clear that in order for us to deliver accommodation that is deserving of people who are acutely ill there needs to be significant refurbishment or rebuilding of existing premises in the very near future.
The Investing in Your Mental Health’s time line, indicates that the replacement facilities would in part only be achieved in QEII in 2017 at the earliest, which would include a two-year decant of inpatient beds into alternative accommodation. Furthermore there are no specific plans for the 64-bedded proposal in Hemel Hempstead and given the current economic climate it could be assumed that this building would not materialise before 2020, if at all.
For all people in both the health and social care community, whether Commissioners, providers or recipients of service, the prospect of continuing in the current environment for that length of time is of grave concern. Issues have been raised by service users and carers, the MHA Commission and now the Care Quality Commission who support our concerns and are wholly supportive of us fast tracking Investing in Your Mental Health plans to reprovide these facilities.
3. The Proposal
As a consequence of our shared concerns, HPFT have been working to try and formulate long term proposals that would enable us to fast track plans within IIYMH whilst at the same time meeting the core principles of IIYMH.
HPFT has used its Foundation Trust status to be able to provide an alternative option that it believes will enable Commissioners and Providers to have high quality inpatient accommodation for people who are acutely ill.
It is envisaged that the plan outlined below would be achieved by the end of 2012, or early 2013, some five years before part of current plans would be realised.
HPFT has an immediate opportunity to acquire land on the Harperbury, London Colney site, which has enabled the development of this proposal to build the new inpatient unit at Harperbury, London Colney rather than on the QEII site. HPFT will use this opportunity to develop a new broader Hertfordshire plan for acute inpatient services based on one main ‘new build’ along with a number of reconfigured units that would be more widely distributed across the county. This plan provides better care more quickly and cost effectively than the original proposal, in more locations that are close to where service users live. It also provides greater flexibility to respond to changing future needs and economic circumstances.
Specifically the new proposal envisages that:
· There will be five inpatient units for all ages across Hertfordshire at: Harperbury London Colney, Hertford, Stevenage, Hemel Hempstead and St Albans
· Harperbury London Colney will be new-build with the development of smaller units, providing more local services through the reconfiguration of existing sites.
· In total the five units will provide at least 156 beds with flexibility to vary bed numbers according to need. Table 2 (below) gives an estimated number of bed in each location:
Table 2
Location / Potential BedsHarperbury, London Colney / 64
Hertford / 20
Stevenage / 32
Hemel Hempstead / 20
St Albans / 20
Whilst the timelines are ambitious this proposal, underpinned by the availability of suitable land, enables HPFT the opportunity to lead and determine the future quality of our inpatient services. HPFT have a strong track record of new build and refurbishment, with the recently built Oak and Beech unit winning a national award.
4. The Advantages
· Better Facilities Sooner
The earliest that a new inpatient unit could be open in the redeveloped QEII would be 2017 with a requirement for a two year decant, but a new unit could open at Harperbury, London Colney by the end of 2012. This new proposal allows reconfiguration of four other acute inpatient sites to appropriate standards much more quickly. The reconfigured Hemel and Stevenage units could be open by the end of 2013.
· Improved Experience of Inpatient Services for Service Users and Carers Harperbury, London Colney offers the opportunity to design buildings offering a wide range of therapeutic facilities and activities. The unit will promote improvement in assessment and treatment services.
· Better Privacy and Dignity and Improved Personal Space
Harperbury, London Colney offers much greater access to landscaped open space. Creative use of space and light will give the unit a feeling of openness. Wards will have single bedrooms with en-suite facilities and dedicated male and female areas. Service users will be able to lock their own bedroom through individual swipe cards or other mechanisms.
· Better Environment for Friends, Family and Staff
The development of the unit could give opportunities to develop social enterprises such as a café and a gym. It could allow for attractive grounds and plenty of other space to meet. The new unit will engender pride in their environment among staff and service users and provide a statement of the HPFT’s vision and philosophy of care.
· The Best Care Closer to Home
Creating five acute units allows beds to be more dispersed and closer to people’s homes. The majority of service users and carers will have less distance to travel, however all necessary additional transport will be put in place.
· Strengthened Focus on Providing Care at Home
Community services will continue to be developed in locations across the county with some services located in Welwyn Garden City, and a range of other services in the locality providing new alternatives to inpatient admission.
5. Engagement Plan
NHS Hertfordshire has agreed that HPFT will take forward engagement on the acute inpatient reprovision proposal. This will involve discussionstaking place withkey stakeholders includingservice users andcarers and their representative groups, commissioners, GPs,voluntary sector organisations, staff and other key partners in order to:
· explain the proposal
· ascertain their views
· assess level of support
· understand what issues might arise if a formal consultation is undertaken
With regard to NHS service reconfigurations, the Secretary of State has outlined criteria that all decisions on NHS service changes are expected to meet. These four key tests for service change are:
1) Support from GP commissioners
2) Strengthened public and patient engagement
3) Clarity on the clinical evidence base
4) Consistency with current and prospective patient choice.
This report demonstrates how the proposed changes meet the four tests and summarises the themes from the engagement process.
i. Support from GP Commissioners
GP commissioners are required to ensure that the trust has demonstrated that the people who will be affected by the service change are fully engaged in the process and that their views are taken into account in order to support the service change.
Discussions with all the local GP groups have taken place, including Welwyn and Hatfield, North, South, West and Central, North Herts, Stevenage, Watford and Three Rivers, Dacorum, The Red House, Hertsmere and St Albans localities and the East locality.
All localities consulted have recognised that the previous plans were not satisfactory. The HPFT plan was recognised as the most pragmatic solution, their issues and concerns reflected concerns raised by other groups HPFT stated. The GP groups welcomed the proposals to improve inpatient facilities. Indeed there was no disagreement with the plan, which was broadly welcomed.
ii. Strengthened Public and Patient Engagement
In order that the Trust meets this requirement, 38 engagement events have been held, including five locality events which were open to all stakeholders and the public. There have been 33 engagement events with specific groups, including GP groups (see above), service users, carers, LINk, Guidepost Trust and staff. The five locality events were advertised in nine local papers and over 3,000 information packs have been sent out, inviting a range of stakeholders to these meetings. The information packs containing the proposal document, a summary, questions and answers and a feedback form are also available through the Trust’s website. A list of engagement meetings is given in Appendix 1.
The 38 engagement events have now taken place, attended by over 580 people, and proposals have gained broad support both in the discussions and in the feedback forms (with an average of 80% support for the proposals).
iii. Clarity on the Clinical Evidence Base
The current inpatient units do not provide a pleasant and therapeutic environment. Most are 40 years old, with no en-suite facilities and long corridors; some have old-fashioned four-bed bays divided by curtains. There is little space outside or areas for therapeutic activity. Most units are not on the ground floor. A 2006 survey for Mind Buildings Solution reports that 29% of patients were dissatisfied with their ward’s state of repair. There is considerable evidence that being admitted to psychiatric inpatient units is an unpleasant experience if the physical environments are poor with limited opportunities for activity and exercise (Department of Health 2002; Rose 2001).
Poor standards of design and lack of space and access to basic amenities and comforts have contributed to negative experiences of inpatient care, as unsafe, uncomfortable and non-therapeutic. Inpatient wards/ units need to be risk-free environments; many can be eliminated at the design phase. The units need to comply with Department of Health guidance on improving safety, privacy and dignity.
It is important that buildings and the physical environment reflect a positive vision of mental health. The self-image of acute inpatient mental health services and how it is projected is powerfully made by the nature and location of the buildings. The design and physical appearance of the ward acts as a tangible statement of value (Karlin 2006).
Harperbury offers the opportunity to design buildings offering a wide range of therapeutic facilities and activities. The unit will promote improvement in assessment and treatment services. The intention is to develop a new, vibrant unit that is socially connected. People who really require an inpatient stay will be quite unwell. The stay will provide effective treatment, stability and safety. The design of the unit will allow for open spaces, landscaped gardens, good natural lighting, areas for physical activities, quiet spaces for individual therapy and single sex facilities. There will be social enterprises such as a café and a gym, attractive grounds and space to meet with family and friends. Each room will be en-suite with individual keys or fobs to enter each room. Attention to lighting, air quality, noise, having views of nature, design of corridors, outdoor spaces and gardens, space for new technologies, therapy and family meeting rooms can all help to improve recovery.
iv. Consistency with Current and Prospective Patient Choice
Those admitted to inpatient units will experience briefer, more purposeful admissions with a greater use of alternatives. Studies investigating the views of service users and carers indicate that they favour alternatives to traditional in-patient settings (Rose 2001).
This proposal enables greater choice in a number of ways. The five units give greater breadth of service across Hertfordshire and most people will have less distance to travel. The alternatives to admission and rehabilitation developments provide real choice in terms of how and where people receive their care. The new facilities will also give carers much greater choice and support.