The Redesign and Modernisation of Mental Health Services

THE REDESIGN AND MODERNISATION OF MENTAL HEALTH SERVICES

IN ARGYLL AND BUTE

DRAFT REPORT FOR CONSULTATION

September 2008

Contents:

Page No.

1. Summary and overview 3-6

2. Introduction 7

3. How the project was undertaken 8-14

4. Vision 15-17

5. Modern mental health services 18-21

6. National policy context 22-24

7. Local context and Where are we now? Description of current service 25-30

8. Themes from pre-engagement feedback 31-42

9. Future options considered 43-56

10. Outcome of options appraisal process; the two future service models 57-61

11. Financing the strategy 62-64

12. Workforce issues 65-66

13. Next steps and Consultation 67-68

Appendix

Option appraisal report 69-90

1. SUMMARY AND OVERVIEW

1.1 In July 2007 the Argyll and Bute Community health Partnership (CHP) and the Argyll and Bute Council developed a new vision for mental health services; “Building on our experience”, a vision for mental health services in Argyll and Bute. The priority was to develop a modernised adult mental health service.

1.2 It was decided to undertake the work with help from an external consultancy and Research and Development in Mental Health (RDMH) commenced work early in 2008.

1.3 The new vision for mental health services had a number of core principles:

§ Respect the views and wishes of partners

§ Promote recovery & inclusion

§ Services will be provided locally by Argyll & Bute CHP and it’s partners

§ Meaningful involvement of the Voluntary / Third sector

§ Individuals will have equitable access to services

§ Service provision will be integrated across health and social care

§ Care will be predominantly provided in the individual’s community or own home, and hospital admission will be for the few

§ Where periods of hospital care are needed this will be provided is an environment that is modern, fit for purpose, relaxing, therapeutic and safe

§ Holistic care which takes account of the individual as a family member, a member of society, a worker, a carer,

§ Staff, users and carers will be involved in developing plans for services

§ Overall service provision will be comprehensive

§ Challenging choices will be faced openly and honestly

1.4 The project has three stages. Phase one needs assessment and local engagement is complete and phase two options development and appraisal is complete to the point of report going to NHS Highland for approval for options for consultation.

1.5 Phase One – Needs Assessment and Local Engagement. Phase one began with a series of launch events and public drop-in events held across Argyll and Bute. Qualitative information and perspectives were gathered through staff, stakeholder, user and carer interviews and team meetings. User and Carer and GP questionnaires were widely distributed. There was a process of patient data gathering, including a Community Caseload Needs Assessment audit and resourcing information was gained from the CHP and local authority.

1.6 Phase Two – Options development and appraisal. Phase two began with a Service User and Carer event in preparation for their involvement in the process of workshops through phase two. Themed workshops followed on primary care and community support services; rehabilitation, recovery and specialised community treatment; and preventing admission, dealing with crisis, supporting discharge. The workshops sought to distil potential service elements for future service models. On completion of the workshops a series of service model options were developed and taken through the options appraisal process. The completion of that work has resulted in this report for NHS Highland approval of options for consultation.

1.7 Phase Three – detailed programme of public consultation. Once a set of options is approved for consultation there will be full public consultation over three months with a broad range of users and carers, the public, staff and other stakeholders. On completion of public consultation there will be a final document about the preferred options for NHS Highland decision on the future service model.

1.8 There has been regular publicity regarding the project to staff and externally to other stakeholders, users, carers and the general public. Since April 2008 monthly newsletters have been published, the CHP has a web page on the project and there have been posters, flyers and press releases to publicise aspects of the project. An interim report is available covering the findings from phase one.

1.9 The full report provides the outcome of the work in phases one and two and sets out:

· The CHP and Council vision for mental health services

· How a modern mental health service is configured

· The current service

· Feedback from phase one, clarifying expectations and needs for service change

· The options for developing new service models

· The option appraisal of those new service models

· The financing of the service models

· Addressing the workforce implications

1.6 Expectations for change expressed through phase one by Users, carers, staff and other stakeholders were very similar and in line with national policy requirements and a modernised mental health service. Reflecting those expectations a set of planning assumptions were established as essentials to be addressed within any new service model developed:

· Services to be as local to people’s communities as is safe & achievable

· Seven day a week community mental health services

· Crisis response, ideally including home based treatment to both prevent admission and facilitate discharge

· Development of services at the different tiers of Mental Health need, such as promoting health & wellbeing, mild/moderate conditions (primary care) as well as for more severe (community mental health team)

· Development of psychological therapies service, (including both the “talking therapies” and creative therapies)

· All services, but specifically day support, to be focused on promoting independence and promoting integration

· Services/agencies are closely linked to promote joined up working, provide a consistent service model and efficient use of resources

· Develop stronger links with generic services in the communities

· Increased usage of the voluntary sector, particularly befriending and buddying

· Adequate support for both formal and informal carers

· Continuing development of service user involvement in service planning, service evaluation and delivery including discussion as to the potential role of peer support

· Community Mental Health Teams to be integrated with local authority and with a broad range of multi disciplinary membership and exploration of the potential role of peer support models

· A single point of access to the mental health services of both statutory organisations

· Recovery focus to be the basis of all services

· Access to specialist in-patient care when required

· Systematic, resourced staff training in both statutory training and clinical development

· Services for the Helensburgh and Lochside area must follow the same service model, principles and philosophy. However it is acknowledged that actual service delivery and pathways for in-patient care will be different from the other localities of Argyll & Bute. This is due to the current service level agreement with NHS Glasgow & Clyde and the more urban nature of that community

o Options do not include services specifically for Addictions, Learning Disability and Dementia care (both continuing care and assessment)

o The CHP will continue to access out of area highly specialised in-patient services for High and Medium Secure care (Carstairs and Rowanbank), Child and Adolescent Mental Health (Gartnavel and Yorkhill Hospitals), Perinatal care (Glasgow).

1.7 The service model options developed were:

1. Minimal change

Community and inpatient services broadly the same with only small incremental changes.

2. Localised services, including in-patient beds in community hospitals

Strengthened primary care mental health support including primary care mental health workers. Enhanced community mental health services, seven days a week operating extended daily hours. Small, self contained mental health specific patient units would be developed within the community hospitals and Lorn and Isles District General Hospital, with no central inpatient unit in Argyll and Bute. Access to specialist mental health services such as Intensive Care would be available.

3. Flexible, central in-patient facility and enhanced community mental health service

4 Flexible, central in-patient facility (with day treatment and education centre) and enhanced community mental health service

Strengthened primary care mental health support including primary care mental health workers, Enhanced community mental health services, seven days a week operating extended daily hours. A specialist rural mental health centre would be developed within Lochgilphead, catering for people within acute, intensive psychiatric care and rehabilitation areas of treatment. With the addition of a day treatment and educational centre which has a number of functions including delivering formal individual and group therapies, assessment of people needing admission and supporting staff clinical development.

5 No in-patient beds within Argyll and Bute with community focused treatment with access to beds out with the area on an as required basis

Strengthened primary care mental health support including primary care mental health workers, Significantly enhanced community mental health services within each population centre, seven days a week operating extended daily hours. There would be no mental health in-patient beds within Argyll & Bute. When specialist mental health in-patient treatment is required this would be accessed within NHS Glasgow and Clyde mental health facilities.

1.8 Each service model option was considered under the option appraisal process:

Option 1 the minimal change option was discounted as it did not meet either national policy requirements or local service needs and expectations.

Option 2 was considered to have strong benefits for users and carers, although there were concerns about the costs associated with option 2.

Options 3 and 4 were similar, with option 4 having the added benefit of the Education and Specialist Day Treatment Centre. Option 4 was considered to deliver more benefit overall than option 3 without being significantly more expensive in revenue terms.

Option 5 offered potential cost savings to the CHP, and the largest cash releasing potential for investment in local community services. However option 5 had scored below options 2, 3 and 4 on non-financial benefits and risk assessment, and option 5 was discounted as it scored below other options in two out of three areas.

1.9 After much consideration the options put forward further development for public consultation are:

Option 2. Localised services, including in-patient beds in community hospitals.

Option 4 Flexible, central in-patient facility (with day treatment and education centre) and enhanced community mental health service.

2. INTRODUCTION

2.1 In July 2007, at the request of Argyll & Bute Joint Mental Health Planning Group and

Argyll & Bute CHP, a vision for the future of Mental Health Services was prepared in

partnership with Argyll & Bute Council; and described in detail in “Building on Our Experience, A Vision for Mental Health Services in Argyll & Bute”.

2.2 The document described the key drivers for initiating a service modernisation programme, including national policy such as Delivering for Mental Health (2006) and With Inclusion in Mind (2007) and the local context. In particular was the need to develop a portfolio of clinically effective services, at all levels of intervention (Tiers), including Primary Care, (presently no specific service exists within Argyll & Bute). It also pointed to the need to replace the ageing and under-utilised estate with safe, modern and user-friendly in-patient facilities. The lack of development of the different Tiers being in some part due to the level of investment in the present estate, much of which is no longer required for in-patient care, and no longer fit for purpose.

2.3 It was agreed that the priority was to develop a model for Adult Mental Health Service provision and that this should be the focus of the first stage of the developmental work acknowledging that further work would then be required to develop plans for a building infrastructure for all community (all locations) and in-patient services.

2.4 It was proposed that the best way forward was to seek the help of an external consultancy to assist with the Modernisation and Redesign work. Research and Design in Mental Health (RDMH) commenced work early in the 2008.

2.5 RDMH developed a project plan agreed with the project board to undertake the work, and divided the work into three stages.

3. HOW THE PROJECT WAS UNDERTAKEN - PUBLIC INVOLVEMENT AND ENGAGEMENT

3.1 Argyll & Bute Community Health Partnership (CHP), Argyll and Bute Council and the appointed external consultants Research & Development in Mental Health (RDMH) developed a comprehensive Communication and Engagement Strategy which was used and updated regularly throughout the course of the Mental Health Redesign project.

3.2 The Strategy was essential to demonstrate evidence that the engagement and consultation phases of the redesign project provided an opportunity for all stakeholders, including the local community, to engage meaningfully in the project. It also helped to identify and address any potential obstacles and barriers to engagement during the course of the project and process.

3.3 The following is a list of guiding principles used when the design of the Communication and Engagement Strategy was considered:

· Strategy to be based on the Standards for Community Engagement;

· Comprehensive range of stakeholders to be contacted and involved;

· Maximise attendance and involvement at key events by undertaking locality based activities and assisting people to attend events in a central place;

· Ensure stakeholders could contribute in an informed way; that they knew well in advance when and why they were involved, and received supporting information formatted appropriately to allow them to participate and contribute in a meaningfully way;

· Ensure that the CHP was seen to follow a robust mechanism satisfying any formal pre-consultation/engagement and consultation requirements from the Scottish Government, Scottish Health Council (SHC) and other interested organisations such as the Independent Scrutiny Panels (ISP);