AGENDA ITEM: 4.1 MENTAL HEALTH AND LEARNING DISABILITIES COMMITTEE DATE OF MEETING: 29 JANUARY 2018 Subject : REPATRIATION PROJECT Approved and Alan Lawrie, Director of Primary and Community Presented by: Care and Mental Health Prepared by: Other Committees and meetings considered at: Considered by Executive Committee on: Joy Garfitt, Assistant Director for Mental Health Services Tanya Summerfield, Adult Mental Health NHS Management Arrangements Project Manager Executive Committee Mental Health and Learning Disability Assurance Committee 25 October 2017 PURPOSE: The purpose of this paper is to provide the Mental Health and Learning Disabilities Committee with a summary of the key learning outcomes following the closure of the Mental Health Services repatriation project. Approval/ Ratification/Decision Discussion Information THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Page 1 of 7
Strategic Objectives: Health and Care Standards: 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 Healthy 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 EXECUTIVE SUMMARY: In February 2015, Powys Teaching Health Board (PTHB) approved the recommendation that the Health Board should return to directly managing Powys based Mental Health services. These included all primary care mental health services, community mental health teams, crisis resolution and home treatment services, inpatient services as well as psychology and psychological therapies. This decision was based upon the information contained in the paper to Board on 25 February 2015 entitled Adult Mental Health NHS Management Arrangements and specifically due to the increasing concerns over the effectiveness of Mental Health arrangements, the ability of the service model to deliver the Together for Mental Health strategy and the quality of service patients experienced. Following this decision, the first transfer took place on 1 December 2015 for services provided in the Ystradgynlais area (from Abertawe, Bro-Morgannwg UHB) and in North Powys (from Betsi Cadwalader University Health Board BCUHB). On 1 November 2016, primary care services in South East Powys returned to direct management by PTHB (from Aneurin Bevan University Health Board ABUHB) followed by the remainder of inpatient services, community services and psychological therapies on 1 June 2017. A Closure Report and a Legacy Statement have been produced and provides further detail on closure activities including the transition from project management to service management and the benefits that have been met inline with the original Project Initiation Document (PID) (available on Page 2 of 7
request). DETAILED BACKGROUND ASSESSMENT: In 2009, the delivery of Mental Health services in Powys was transferred from the direct management by PTHB to three neighbouring Health Boards; Betsi Cadwalader UHB (services in north Powys), Aneurin Bevan UHB (services in south east Powys) and Abertawe Bro-Morgannwg ABMUHB (services in the Ystradgynlais area). The reason for the transfer out of services was connected with deficiencies in service quality, the ability of the health board to recruit psychiatrists and gaps within clinical and professional leadership of the Mental Health department. At this point in time (2009) it was anticipated that by aligning Powys mental health services to the Mental Health directorates of larger neighbouring health boards difficulties in medical recruitment would be resolved and service quality would improve. Through the original (2009) service transfer, these anticipated outcomes were never sustainably realised and in 2015, the PTHB made the decision to repatriate Mental Health services, back to the direct delivery of PTHB in order to regain full control over service delivery, service improvement and financial management. The original project timeline for service transfer expected all services to be repatriated on 1 December 2015. While services in North Powys and Ystradgynlais were transferred BCUHB and ABMUHB on this date, services in South East Powys remained under the management of Aneurin Bevan UHB until 1 June 2017. The repatriation of services in South East Powys was delayed by difficulty in securing agreement with ABUHB on the provision of Psychiatry on call psychiatry services to patients in South East Powys. Consequently without the provision of Psychiatry on call services to South East Powys, the transfer could not take place as expected on 1 December 2015. During the period April 2016 to March 2016, a period of extensive service design (in respect of out of hours services) was undertaken and the final transfer of services took place over two stages; Local Primary Mental Health Support Services transferred from Aneurin Bevan UHB on 1 November 2016, followed by secondary Mental Health services and Psychological therapies on 1 June 2017. Legacy Statement and Closure Report Page 3 of 7
A Legacy Statement has been produced that summaries the key learning gained from the delivery of the project and its subsequent closure. There are several key success factors which are set out in detail in the Legacy statement, providing an opportunity to reflect; to learn from what has worked well and not so well; to note residual responsibilities; celebrate successes and to describe the challenges and opportunities ahead. A formal Closure Report provides further detail on the closure activity, including the benefits that have been realised in line with the original Project Initiation Document (PID). Mental Health Management Arrangements project The Mental Health Management Arrangements project has been the largest change management process that PTHB has completed in recent years and has been subject to considerable scrutiny, pressures and changes. The service is currently 6 months post full service transfer and some significant service improvements have been achieved during this period; Part 1 (Mental Health Measure) performance has significantly improved, and the tier 1 targets are the closest to being fully achieved for the first time in over a year, with assessments at 90.1%, and interventions at 78.1.% (Target: 80% of assessments and interventions commence within 28 days). Waiting times for access to Psychology have significantly reduced in both North and South Powys, from 80 weeks to 31 weeks in the North and 172 weeks to 10 weeks in the South. Reduced bed occupancy and length of stay in for adult acute admissions in South Powys and no acute patient (requirement assessment and treatment of their mental health needs) has been admitted to an out of county bed since service repatriation (including during out of hours). In terms of financial management, the service is expecting to end the financial year in a balanced position. Summary of Key Success Factors The most successful factor of this highly complex project was the final transfer of Adult Mental Health Management Arrangements taking place for services delivered by Aneurin Bevan University Health Board (ABUHB) in South Powys. Page 4 of 7
There were two main enablers and these were: 1. The buy-in of key stakeholders. Doctors, Managers, and Practitioners though a series of engaging monthly workshops and sub groups held during the period April 2016 to March 2017. Task and finish groups were formed that cut across organisational hierarchy and comprised of front line Nurses, Social Workers, Consultants as well as Senior Managers. These task and finish groups proved highly effective in identifying the options available to deliver an operationally effective and sustainable out of hours medical cover for Mental Health Services in Powys. Clinicians and practitioners from across the service were actively engaged in development of the service model. Subgroups of the workshops empowered clinicians and gave them the autonomy to develop pathways and identify solutions to challenges. In addition to the workshops a consultation exercise with Powys-based Psychiatrists was undertaken with the engagement of the Local Negotiating Committee and the British Medical Association. This led to an agreement regarding their participation in the Powys out of hours on-call rota. 2. Readiness Assessments aided the successful transfer. These were undertaken at crucial points to assess key elements of the project and establish whether the service was fit to return. The first assessment undertaken in July 2016, saw the return of the Local Primary Mental Health Support Service (LPMHSS) staff, on 1 November 2016. The second assessment undertaken in January 2017, saw the return of all remaining ABUHB staff, on 1 June 2017. Other contributing success factors included: Daily management team conference calls (pre and post transfer) proved highly effective, quickly identifying and addressing some minor difficulties, mainly around systems and processes as they embedded within the service. Dedicated leads working collaboratively and driving the project forward under the management of the Joint Transition Board. The project team and board performed well at all times, and were professional, dedicated and determined to support the project. This contributed towards the successful delivery of this very highly complex project. Effective systems and processes in place - the rolling monthly cycle of meetings with key representation present to review progress against the plan, and monitor and address any risks. Page 5 of 7
Informal engagement sessions with staff proved effective and were very well received. A further series of sessions followed the June 2017 transfer giving a one Powys message and to highlight the key objectives within the Integrated Medium Term Plan and the Together for Mental Health Strategy. Feedback from staff has been extremely positive. Lessons Learnt The key lessons of the project are set out as follows: Ensure a timely transfer by (1) gaining the buy in of key stakeholders by (1) by empowering Doctors, Clinicians and Practitioners (service experts), creating ownership and giving clinicians autonomy to find solutions to challenges; and (2) by undertaking Readiness Assessments at crucial points of the project. Gaining formal contractual agreement of key suppliers, prior to setting a service transfer date. Engaging with staff to keep them updated on progress avoids confusion, and staff feel included and informed. Ensure that effective systems/processes are in place to manage the project meeting cycles, documentation and reporting processes. RECOMMENDATION(S): It is recommended that the Mental Health and Learning Disabilities Committee REFLECTS on the learning outcomes of this project and NOTES the successful completion of the repatriation of Adult Mental Health NHS Management Arrangements. NEXT STEPS: The projects Evaluation and Closure activity is now complete (including a full evaluation of the benefits) and a Legacy Statement has been produced that provides the opportunity for reflection. Page 6 of 7
Impact Assessments Equality Act 2010: Quality and Safety: Welsh Language (Wales) Measure 2011: Financial Implications: Legal Implications: Well-being of Future Generations (Wales)Act 2015: There is no direct impact from the management transfer of Mental Health Staff from Aneurin Bevan University Health Board staff to Powys Teaching Health Board on groups with protected characteristic. Direct management of mental health services in south Powys will act as an enabler to pan Powys service improvement and the safe delivery of Mental Health functions. N/A Additional financial resources of 150,000 will be required to fund the South Powys medical on-call arrangements. This resource has been built in to the 2017/18 financial plan. N/A N/A Page 7 of 7