AGENDA ITEM: 2.5 BOARD MEETING Subject : Approved and Presented by: Prepared by: Other Committees and meetings considered at: Considered by Executive Committee on: DATE OF MEETING: 31 JANUARY 2018 MENTAL HEALTH SERVICE REPATRIATION: PROJECT CLOSURE Rhiannon Jones, Director of Community Care and Mental Health Joy Garfitt, Assistant Director for Mental Health Services Tanya Summerfield, Adult Mental Health NHS Management Arrangements Project Manager Mental Health and Learning Disability Assurance Committee 10 January 2018 PURPOSE: The purpose of this paper is to provide the Board with a closure report on the Mental Health Service repatriation project, including the outcomes achieved through the project and approval of the project s formal closure. Approval/ Ratification/ Decision Discussion Information Project Closure 1 31 January 2018
THE PAPER IS ALIGNED TO THE DELIVERY OF THE FOLLOWING STRATEGIC OBJECTIVE(S) AND HEALTH AND CARE STANDARD(S): Strategic Objectives: 5. Improve the mental health & emotional wellbeing of the people of Powys 10. Maximise opportunities for integrated working with Powys County Council Health and Care Standards: 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, PTHB Board 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 of 25 February 2015 entitled Adult Mental Health NHS Management Arrangements. This paper outlined 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 when they were delivered by the commissioned Health Boards. 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 UHB). On 1 November 2016, local primary mental health care services in South East Powys returned to direct management by PTHB (from Aneurin Bevan UHB) followed by the remainder of inpatient services, community services and psychological therapies on 1 June 2017. Project Closure 2 31 January 2018
A closure report and a legacy statement were produced and provide further information on closure activities including the transition from project management to service management and the benefits that have been delivered in line with the original Project Initiation Document (PID). This document is available on the intranet. BACKGROUND: In 2009, the delivery of all Mental Health services in Powys was transferred from the direct management by Powys to three neighbouring Health Boards; Betsi Cadwalader UHB, Aneurin Bevan UHB and Abertawe Bro-Morgannwg. The reason for the service transfer was connected with deficiencies in service quality, the ability of the health board to recruit psychiatrists and significant gaps in clinical and professional leadership for the Mental Health department. It was anticipated that by aligning Powys mental health services to the Mental Health directorates of larger neighbouring health boards these difficulties with medical recruitment would be resolved, governance would be strengthened and service quality would improve. Through the original 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 Powys Teaching Health Board 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 from BCUHB and ABMUHB on this date, the majority of services in South East Powys remained under the management of Aneurin Bevan UHB until 1 June 2017. These decisions were made with the full endorsement of the Board. The full repatriation of services in South East Powys was delayed due to the difficulty in securing agreement with ABUHB on the provision of out of hours Psychiatry on call in South East Powys and sufficient recruitment to medical vacancies. Consequently without the provision of a sufficient medical workforce and a robust Psychiatry on call service to South East Powys, the transfer could not take place as expected on 1 December 2015. During the period April 2016 to March 2017 extensive service design (in respect of out of hours services) was undertaken, along with a medical recruitment campaign. The final transfer of services took place over two stages; Local Primary Mental Health Support Services transferred from Project Closure 3 31 January 2018
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 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). The service is currently six 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 close 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 for adult acute admissions in South Powys. No acute patient in South Powys (requiring 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). Staff wellbeing improvements are evident since the transfer as there is reduced sickness. Staff have told us that they feel more involved in decision making and the transfer has enabled integrated working with the Learning Disabilities service. In terms of financial management, the service is aiming to end the financial year in a balanced position. An internal audit review was completed in 2017 and provided an overall assurance opinion of Reasonable Assurance of the effectiveness of the systems of internal control to manage the risks associated with the project. Mental Health Management Arrangements project and benefits realisation; Project Closure 4 31 January 2018
The Mental Health Management Arrangements project has been the largest change management process that PTHB has completed in recent years. A benefit review meeting took place six months following transfer to review the anticipated benefits of service repatriation. Each expected benefit has been assessed for the level of its achievement and it is clear from the level of detail and supporting information captured at the review meeting that all five benefits are fully realised. Benefit 1 - Accountability of PTHB clearer: simplified management arrangements that are common for all; Benefit 2 - Platform for Mental Health integration created with the local authority; This has been fully realised, as one organisation now delivers Mental Health Services in Powys. Consequently, there is clear accountability for service delivery and a platform for the integration of health and social care services. Benefit 3 - Swifter, more reliable performance reporting; Performance reporting is swifter and data quality is now validated and accurate. Regular performance and service delivery reports are submitted to the Mental Health Assurance Committee and Executive Committee. Benefit 4 - Pan Powys policies and procedures: Simplified policy environment and consistency for patients across Powys; Patient pathways are clear and there is greater service access and consistency across Powys. Policies and procedures are more streamlined, and polices relating to the management of serious incidents are now coherent and allow for Pan Powys learning. There is one approach to Datix, reducing risk to patient care. Benefit 5 - Greater mental health expertise within the organisation. A new senior leadership structure is in place across Mental Health that provides clinical and operational management to the service. Key Success Factors A key success 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. There were several critical success factors, and these were; The engagement and buy-in of key stakeholders: Task and finish groups that cut across organisational hierarchy were established and comprised of front line Nurses, Social Workers and Consultants as well as Operational Managers. These task and finish groups proved highly Project Closure 5 31 January 2018
effective in identifying the options available to deliver an operationally effective and sustainable out of hours medical cover for Mental Health Services in Powys. Readiness Assessments aided the successful transfer. These were undertaken at crucial points to assess key elements of the project and established whether the service was fit to return. Other contributing success factors included: Daily management team conference calls (pre and post transfer) proved highly effective, quickly identifying and addressing difficulties. 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. 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. RECOMMENDATION(S): It is recommended that the Board DISCUSSES the project closure report and NOTES the outcomes achieved to date. NEXT STEPS: A legacy statement has been produced following the completion of the project and this will be published on the intranet. Impact Assessments Equality Act 2010: Quality and Safety: Welsh Language (Wales) Measure 2011: 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 Project Closure 6 31 January 2018
Financial Implications: Legal Implications: Well-being of Future Generations (Wales)Act 2015: 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 Project Closure 7 31 January 2018