Hywel Dda Health Board Mental Health & Learning Disabilities Service 1. INTRODUCTION Service Structure Reconfiguration October 2013 This paper has been prepared following the decision taken in September 2013 to realign the management of Mental Health and Learning Disabilities (MH&LD) services to a 3 counties position, as part of a wider reconfiguration of services across the Health Board. The future structure described within this document has resulted from discussions with the existing County Directors, County Heads of Mental Health Services, Senior Nurse (MH&LD), Operational and Strategic Medical Leads and partner organizations. The existing county structure whereby the locally delivered mental health and learning disability services are managed separately by each of the counties has been in place for approximately 3 years. Within this agreed structure a number of MH&LD services continued to be delivered across the Health Board managed centrally, by the Corporate MH&LD Team. It is timely to review the benefits and risks associated with the county structure for MH&LD services and implement a future structure which will assist the organization in meeting the challenges facing mental health services in order to deliver safe and sustainable services for the future. The Specialist Child and Adolescent Mental Health Service (S-CAMHS) is currently managed as part of the Child and Family service and although there is no immediate plan to realign the management of this service within MH&LD, the future structure proposed for MH&LD will ensure strengthened operational, managerial and strategic relationships with S-CAMHS. The introduction of the Mental Health (Wales) Measure 2010 has impacted significantly on the existing service models and has created opportunity to develop innovative alternative services for all ages across primary and secondary care. Additionally the Together for Mental Health strategy provides a real opportunity to work collaboratively with our partners to design services via a mixed economy of sectors and providers. Service redesign of this magnitude requires the utilization of resources across the Health Board in order to ensure efficiency including any opportunity to maximise economies of scale alongside alternative routes of funding where appropriate. These challenges have not been easy to address within the existing structure, despite vigorous efforts by all managers involved to work within a matrix operating framework between the three county teams and the central mental health team. The areas of progress and positive impact on MH&LD services resulting from the existing countybased structure will be firmly acknowledged and reinforced within the future structure. The success of the delivery of the partnership agenda required to implement the Mental Health and Well-Being Strategy is dependent on the strengthening of existing networks within the counties. However, the county-based structure has weakened the quality and safety arrangements for MH&LD services, and therefore the future structure will ensure a robust assurance framework for MH&LD services across the Health Board. There will also be increased opportunity and organization of the movement of resources between services to address clinical issues in a timely manner. Service delivery has developed inconsistently across each of the county MH&LD services despite clear strategic direction which has created unnecessary, though often understandable tensions between services. The future structure will aim to address all identified inequalities of
service delivery and ensure the reallocation of resources where required alongside the development of standardized care pathways for all services. 2. FUTURE STRUCTURE The future structure will address the challenges and opportunities facing MH&LD services and will ensure a robust clinical, managerial and professional framework within which to develop and grow (appendix 1). The progression of the integration agenda is key to the delivery of services and whilst this has progressed at a different pace within each of the counties, the future structure for MH&LD will align itself closer to the regional collaborative arrangements, and in doing so will be fit for purpose in going forward. 2.1 Roles and Responsibilities The future structure will create four Head of Service roles for Acute Care and In-Patient services, Community services, Older Adult Mental Health services and Substance Misuse services that will be responsible for the operational management and development of these services. The responsibility for Learning Disability services will be retained by the Deputy Assistant Director due to the extensive programme of decommissioning and redevelopment that is underway. Each Head of Service will have a service manager and clinical improvement lead as part of their team to ensure the delivery of safe, sustainable, efficient and clinically effective services. The Head of service for Acute Care & In-patient services, Community services and Older Adult MH services will retain a designated County Lead role and will continue to engage in the associated County Management Team and Health & Social Care meetings to ensure that established networks are maintained, and that the County Teams are briefed on developments within all service areas. The Partnerships and Psychological Therapies Manager will be responsible for the operational management of all Psychological Therapy services and will ensure that services are developed as directed by the Psychological Therapies Management Committee. This role will also lead on the delivery of the partnerships agenda defined within the Together for Mental Health strategy and ensure engagement at a county level in all service planning. The Partnerships & Psychological Therapies Manager will be responsible for co-coordinating and progressing each of the county Mental Health Partnership Groups, ensuring consistency across the Health Board area. These service roles mirror the modernized medical roles created as part of the reconfigured medical structure, the implementation of which is in progress. The S-CAMHS service will remain within the Child & Adolescent Directorate (appendix 2), although operational and strategic relationships will be formally strengthened in order to deliver on quality and safety, and service development agendas. Existing MH&LD meeting and reporting arrangements will be reconfigured to ensure that all services are fully engaged in joint planning and delivery. 2.2 Professional requirements The Head of Nursing for MH&LD will return as a core role within the future structure, as part of a robust professional leadership structure across professions within MH&LD. The recent creation of professional lead roles for psychology, psychotherapy and learning disability nursing alongside the existing Occupational Therapy and newly appointed Operational Medical Lead roles provide a robust professional governance framework within which services will be developed. The
professional structure will be further strengthened through the retention of core professional responsibilities by each of the Heads of Service for their respective service area. This professional structure is imbedded within the future management structure for MH&LD service going forward. Whilst the structure defines the professional arrangements, it is also fundamental that each service manager has a professional element to their role to ensure that professional and practice issues are embedded and addressed across services. 2.3 Quality and Safety The creation of a quality and safety lead role for MH&LD, reporting directly to the Head of Nursing will strengthen the management of incidents, accidents and complaints and ensure that there is a robust framework to ensure that investigations are completed in a timely manner, lessons are learnt and services are improved as a result of actions identified. Quality and safety will be implicit in each of the Head of Service and Service Manager roles and will be reflected both in Job Descriptions and PDR objectives. This will ensure that quality and safe practice and the management and reporting of such issues are embedded and owned by all practitioners. 2.4 Integrated Governance The existing Planning, Performance and Delivery Board for MH&LD (PPDB) will be reconfigured to reflect the wider Health Board integrated governance agenda, and the direction of the Local Mental Health Planning Board. There will be a fortnightly Performance and Delivery Dashboard meeting (PDD) engaging all Heads of Service, the Operational Medical Lead, the Head of Nursing and designated finance and Human Resources representation, in order to pull together all service information previously managed separately through Individual County and Central management teams. The PDD will ensure robust reporting to the MH&LD PPDB on the following for all service areas: Service budgets in month position and movement Efficiency targets progress and deliverability Variable pay / temporary / bank / agency usage On-call issues and expenditure Non-pay pressures (capital / study / expenses / supplies) SWAFF exception reporting Sickness monitoring and management Activity against performance targets (MH Measure / AQF / DToC) Clinical and organizational risk (incidents / accidents / complaints / no surprises) Recruitment (alternatives / cover / redesign) Continuing Health Care (weekly movement reports / use of core services) Quality, safety & practice (SUIs, risk register, inspections, fundamentals of care, care metrics, audit) The PDD will also ensure that timely reports are available for key forums, namely: CTP Board MH Measure Monitoring and Delivery Group Service and Strategic Forum
Budget Holder meeting Welsh Government Performance and Delivery CHC eligibility, commissioning and scrutiny panels County Management Team Health & Social Care Board Local Partnership Groups 3. NEXT STEPS The implementation of the future structure for the MH&LD service will be progressed in line with the Organizational Change Policy. Job descriptions will be developed for the reconfigured roles and responsibilities and individuals will be identified to fill these roles based on their current posts, knowledge, skills and experience. A consultation paper will be produced for circulation to all affected staff and for consideration by the Partnership Board. However, due to the immediacy of the realignment of the services there will be an interim structure implemented from the 21 st October 2013. This will change the line management arrangements for the existing County Heads of Mental Health and the associated service budgets to the Assistant Director for MH&LD. The County Head of Mental Health roles and responsibilities to their designated service areas will remain unchanged until the future structure has been formally implemented.
KEY Appendix 1 Professional lead Psychology Professional Lead Occupational Therapy Head of S-CAMHS / Professional Lead Population Health Group Lead MH&LD Assistant Director MH&LD MH&LD Medical Operational Lead Head of Nursing MH&LD Business Administrator MH&LD Deputy Assistant Director MH&LD Quality & Safety Lead Professional Lead Nurse - LD MH&LD CHC Team Manager LD Service Manager LD Clinical Improvement Lead Head of Substance Services / Professional Head of Acute Care & In- Patient Services Head of Community Services Head of OAMHS Services Substance Acute Care Service Manager Acute Care Clinical Community Service Manager Community Clinical OAMHS Service Manager Partnerships / OAMHS KEY Adult MH Service Professional Structure Learning Disability Service Partnerships and Psychological Therapy Services Manager Substance Misuse Service Psychological Therapy Service Older Adults MH Service S-CAMHS Service Psychotherapy Lead LPMHSS Manager
Appendix 2 Gwasanaethau Arbenigol Iechyd Meddwl Plant a Phobl Ifanc Cyfarwyddiaeth Iechyd Plant a Phobl Ifanc Specialist Child & Adolescent Mental Health Child & Adolescent Health Directorate County Director Carmarthenshire Director of Nursing General Manager Child & Adolescent Health Directorate Assistant Director Midwifery & Safeguarding Children Head of Specialist CAMHS & Professional Lead Assistant Director MH&LD Assistant Head of Specialist Child & Adolescent Mental Health Service Assistant Head of Specialist Child & Adolescent Mental Health Service