Not considered by the Executive Team

Transcription

1 Agenda Item: 2.1 MENTAL HEALTH & LEARNING DISABILITIES COMMITTEE Date of Meeting: Oct 2016 Subject : Approved and Presented by: Prepared by: Other s and meetings considered at: Considered by Executive Team on: REPORT OF THE ADULT MENTAL HEALTH NHS MANAGEMENT ARRANGEMENTS PROJECT Joy Garfitt, Assistant Director for Mental Services Joy Garfitt, Assistant Director for Mental Services Tanya Summerfield, Adult Mental NHS Management Manager Not considered at other s and meetings Not considered by the Executive Team PURPOSE: 1. To provide the with a summary of progress on the Adult Mental as at the end of August The Mental and Learning Difficulties is also asked to approve that: Primary Mental returns to PTHB by 1 November 2016; All other services (including Psychology) return to PTHB by the end of the 16/17 financial year in order to ensure a safe and effective transfer of services. Approval/ Ratification/ Decision Discussion Information THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): 1 Mental & Learning Disabilities

2 Strategic Objectives: and Care Standards: EXECUTIVE SUMMARY: 5. Improve the mental health & emotional wellbeing of the people of Powys 10. Maximise opportunities for integrated working with Powys County Council Governance, Leadership and Accountability Theme 1: Staying y Theme 2: Safe Care Theme 3: Effective Care Theme 4: Dignified Care Theme 5: Timely Care Theme 6: Individual Care Theme 7: Staff and Resources A safe and effective transfer is dependent on robust Out of Hours arrangements. OOH model options have been shortlisted: (1) Pan Powys rota; (2) Separate North and South rota; or (3) a commissioned service. Agreement on the model is expected by mid-september A readiness assessment of Powys Teaching Board (PTHB) to conduct the transfer of the Aneurin Bevan University Board (ABUHB) commissioned Mental Service took place in July 2016 and has been considered against the planned transfer date of October Assessment was conducted on the position of the out of hours (OOHs) medical cover; the medical and nursing recruitment; the clinical leadership structures; and essential clinical governance policies and procedures. Following detailed consideration, recommendations were put forward to the Joint Transition Board and Executive Boards of both ABUHB and PTHB. Both health boards agreed that PTHB is not currently in the position to transfer all Mental Services back to PTHB in October 2016; but agreed that the transfer of the Primary Mental Service, which is not reliant on OOH arrangements, will be complete by 1 November 2016 (subject to a risk and improvement plan). The early return of Psychology was not agreed. All other services are expected to be transferred by the end of the 16/17 financial year. A key risk for phase 2 (ABUHB) is the recruitment to pre-existing vacancies, predominantly medical staff (Older Adult and Specialty grade). Job descriptions are being redesigned to make the posts more attractive to Doctors. 2 Mental & Learning Disabilities

3 DETAILED BACKGROUND AND ASSESSEMENT:`b6 This report provides a brief update on progress for the period up to the end of August The key area of focus is on the Readiness Assessment recommendations for Phase 2 and any key risks. Progress this period - Phase 2 (ABUHB) A safe and effective transfer is dependent on robust Out of Hours (OOH) arrangements. During the period April to July 2016 a series of workshops have taken place with Medical Staff, Senior Nurses, CRHTTs and Managers to identify the most appropriate service model for Mental OOHs patient care for Powys. Three potential options were shortlisted and agreed: 1. Pan-Powys rota (requiring a minimum of Doctors). 2. Continue the existing North Powys rota (6 Doctors) and establish a South Powys rota (minimum of 9 Doctors). 3. Commission an OOH service from an external NHS provider or alternative. Negotiations are underway with Doctors on the proposals. Formal negotiation meetings concerning the rota have been organised (Local Negotiation meetings), to seek the opinion of Consultants and Specialty Grade Doctors on the proposals, and to ascertain their willingness to participate in the rota if either a Pan Powys rota or North/South rota is selected. Readiness Assessment A working group was established to consider the readiness of PTHB to conduct the transfer of the commissioned Mental Service, and maintain safe patient focused services (which had been proposed for October 2016). Membership of the working group comprised of the Chief Executive; Medical Director; Clinical Director; Senior Managers from the Mental Service; Programme Management Office; Workforce Development; and the General Manager for Mental from ABUHB. The assessment took place during July, where key elements of service delivery were examined including: 1. Ability to deliver a robust and effective OOHs medical cover for Mental. 2. Recruitment to vacant Medical and Nursing posts. 3. Implementation of effective clinical leadership structures. 4. Development and implementation of essential clinical governance policies and procedures. 3 Mental & Learning Disabilities

4 Following detailed consideration, the recommendation of the working group was that PTHB is not currently in the position to transfer all Mental Services currently delivered by ABUHB back to PTHB in October A safe and effective transfer of services requires robust OOHs arrangements and whilst this is operational in North Powys, we are not yet in a position to implement an OOHs service in South Powys. Urgent work is underway to develop these arrangements, including a contingency plan for a commissioned service, in the event that an agreement cannot be reached with medical staff. An outcome is expected during September. Although it was the view of the working group that a full transfer was not recommended, a partial transfer of services may be feasible for services that were not reliant on the OOHs arrangements. This includes Psychology; Psychological Therapies; and Primary Mental Services. These recommendations along with feedback from staff at engagement events were presented to the JTB, and to both ABUHB and PTHB Executive Boards. The outcome is that both Boards agreed: To delay the transfer of the Psychology service until the end of the 16/17 financial year on the basis that a Service Improvement Plan is put in place by ABUHB detailing how waiting times are improved during the next six months; The transfer of the Primary Mental health service will be complete by 1 November 2016 subject to an improvement and risk plan; Effective leadership and governance arrangements are in place for our directly delivered services. All other services are expected to be transferred by the end of the 16/17 financial year. [The latest Project Plan is available on request.] Engagement meetings with ABUHB staff have been held during July and August. Meetings were informal and provided staff with an update on the current status of the transfer arrangements; any work underway; any challenges we are facing; and to answer any queries that staff may have. The readiness assessment was discussed with staff and they were also advised of the recommendations that were being put forward to JTB. Positive feedback was received from staff on the current assessment of readiness to return to PTHB. Primary Care practitioners agreed with the recommendations and would like to transfer back as soon as possible. Although staff from Psychology are keen to return to one Powys, concerns were raised about transferring back without Clinical Leadership in place. Staff were in agreement that a safe and effective transfer of services requires robust OOHs arrangements and that we are not yet in a position to 4 Mental & Learning Disabilities

5 implement an OOHs service in South Powys. However, a key message from across all meetings is that staff are feeling in limbo and it is important that a transfer is not delayed any longer than is necessary. Managers highlighted the difficulty faced in managing teams with this level of uncertainty. Other concerns raised included the assumption that solutions to issues are not being sought under ABUHB and are being delayed until the return including vacancies being held up which impacts on ward staff. There is a fear of losing access to some of the training programmes currently available under ABUHB; and there were queries around access and sign up to the nurse bank system; and which clinical policies will be adhered to on return. Following agreement of the transfer position, a further briefing will go out to ABUHB staff shortly. Team Leads and Managers will be invited to engage again in person following the October JTB meeting to update their teams on the transfer position and to address any concerns regarding recruitment, service delivery etc. Progress this period - Phase 3 (ABMUHB and BCUHB) Following the transfer of management responsibility involving North Powys and Ystradgynlais on the 1 December 2015, periodic reviews have taken place on outstanding activity. The main area of concern continues to be operational issues taking priority, with limited capacity of team members to carry out project activities. At the latest review point (August 2016), outstanding activity included the approval and adoption of Powys wide Policies. On the last transfer, permission was granted for Powys to use the former organisations policies for 12 months. PTHB seek to continue this approach for a further 12 month until the end of March When in post, the Quality & Safety Clinical Lead role will be a key resource for progression of this work. Concerns were also raised with regard to the Mental Act Administration governance support arrangements (to ensure compliance with MH legislation). The concern is around capacity (staff resource) and an interim solution is being sought to ensure measures are in place for a safe and efficient service. [The latest Project Plan is available on request] Key Delivery Risks and Issues Phase 2 (ABUHB) - The key area of risk for this phase is the inability to recruit to pre-existing vacancies, predominantly medical (Older Adult and Specialty grade) which is rated as an extreme risk on the Risk Register. There is work underway to redesign the Job Descriptions to make the posts more attractive to Doctors. As a result there are financial risks also rated as extreme which include higher cost for agency staff. There is a risk of 5 Mental & Learning Disabilities

6 insufficient funding for safe delivery and commissioning of services which has been escalated to the Director of Finance. Sign off of the LTA (current year) is expected by the end of September. There is also risk of increased payment due to the proposed changes to the OOH model for medical cover. Negotiations are underway with Doctors via LNC meetings during August and September on the proposed OOH model and their participation in the rota. The position will be clearer following this. Further investment is required to stabilise the service. Other areas of risk include Interim medical staffing as opposed to permanent staffing which remains the responsibility of ABUHB; the sign off of SLAs; funding of additional overheads; and Psychology leadership. A piece of work has been ongoing to review both the operational and the clinical leadership structure. Information gathered from this will inform us to enable delivery of a high quality service and to address current concerns, i.e. waiting times. This information will be included in a formal consultation document. [The latest Risk and Issue Register is available on request.] Phase 3 (ABMUHB and BCUHB)- The key risk for phase 3 is the capacity of the Quality & Safety Unit to manage work generated as a result of the transfer without a supporting resource within the Mental Dept (Q&S Clinical Lead post), which is resulting in loss of pace. This risk is rated extreme on the Risk Register. The latest position is that the Job description is going through consistency checking, following which it will go out to advert. There is a risk of being unable to access services already commissioned (for both BCUHB and ABMUHB) which remains a high risk until the ABUHB LTA currently under revision and near completion is signed off. Other areas of risk include the re-phasing of ABUHB transfer on the ABMUHB LTA; the professional leadership arrangements for Psychology; and the delays in recruitment in PTHB also due to the re-phasing of ABUHB. [The latest Risk and Issue Register is available on request.] RECOMMENDATION(S): The is asked to note the progress of the Adult Mental NHS Management for Phase 2 (ABUHB) and Phase 3 (BCUHB and ABMUHB). The is also asked to approve that: Primary Mental returns to PTHB by 1 November Mental & Learning Disabilities

7 All other services (including Psychology) return to PTHB by the end of the 16/17 financial year in order to ensure a safe and effective transfer of services.. NEXT STEPS: Phase 2 (ABUHB) Following confirmation of the proposed timeline, activity will commence to deliver the transfer of the Primary Mental Service by 1 November 2016 (subject to an improvement and risk plan), and all other services by the end of the 16/17 financial year. Negotiations with Doctors will continue through formal LNC meetings. Doctors will be provided with a proposal for the OOH rota by mid-september and will confirm their participation in the rota if either a Pan Powys rota or North/South rota is preferred. If an agreement is not reached, the commissioning arrangements process will commence to commission an OOH service from an external NHS provider or alternative, to ensure a solution is in place by the end of the 16/17 financial year. Following agreement of the transfer position, a further briefing will go out to ABUHB staff. Team Leads and Managers will be invited to engage again in person following the October JTB meeting by which time the position on the OOHs arrangements will be clearer. Phase 3 (BCUHB and ABMUHB) Next steps for Phase 3 of the project is to appoint a Q&S Clinical Lead as this resource will be key to progression of the outstanding policy work. An interim solution will be sought around the Mental Act administration governance support arrangements (capacity issue) to ensure measures are in place for a safe and efficient service. A progress report will be brought back to the next meeting. Impact Assessments Equality Act 2010: 7 Mental & Learning Disabilities

8 Quality and Safety: Welsh Language (Wales) Measure 2011: Financial Implications: Legal Implications: Well-being of Future Generations (Wales)Act 2015: N/A as the project is concerned with a change of management arrangements for Mental. 8 Mental & Learning Disabilities