ITEM 19 Mental Health Hospital Based Clinical Complex Care
North Lanarkshire Council · 27 March 2024
Back to Health and Social Care Integration Joint Board — 27 March 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 REPORT Item No: 19 SUBJECT: Mental Health Hospital Based Clinical Complex Care TO: Integrated Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer, NL HSCP Author(s) of Report Ross McGuffie, Chief Officer, NL HSCP DATE: 27 March 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ This paper has been prepared by Ross McGuffie, Chief Officer and has been shared with partners of the NHS Lanarkshire Board and North Lanarkshire Council. 3. RECOMMENDATIONS The IJB is asked to: 1) Acknowledge that HC One have formally notified us of their intention to terminate the existing contract for HBCCC services at Hatton Lea. 2) Note the proposed next steps include patient and family consultation and development of a new model to support HBCCC patients.
Page 2
2 3) Note the use of a proportion of the savings achieved to establish an alternative delivery approach for the impacted patients. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 BACKGROUND 5.1.1 NHS Lanarkshire’s Mental Health services are hosted within the North Lanarkshire Integration Joint Board, in line with the respective integration schemes of the two Lanarkshire partnerships. 5.1.2 Mental Health HBCCC beds are largely used for patients with dementia exhibiting aggressive or challenging behaviours. Previously, patients would largely remain in HBCCC beds for life, but following a definition change in 2015, when a patient’s presentation changes they are now expected to be moved to a more suitable and homely environment, such as a mainstream Care Home. There is now a simple eligibility question of ‘can your care needs be properly met in any other setting than a hospital?’, and if so, the aim is to support the patient to be moved to a less intensive setting, which is very positive for improving the quality of life of the individual. 5.1.3 Pre-pandemic, NHS Lanarkshire developed a Bed Modelling Plan which was signed off by the NHS Board in 2017, which included a specific action around reviewing the model of Mental Health Hospital Based Complex Clinical Care (HBCCC). This resulted in the aim of the consolidation of contracted HBCCC provision onto one site, at Hatton Lea care home in Bellshill. 5.1.4 In November 2022, approval was granted by both Lanarkshire IJBs to terminate the contract at Cumbernauld Care Home, taking effect in July 2024. 5.1.5 On 25th January 2024, HC One notified NHS Lanarkshire of its intention to terminate the contract for HBCCC beds at Hatton Lea. Extensive discussions have been taking place with the provider since this date. 5.1.6 At present, there are 39 patients supported at Hatton Lea, with an annual contract cost of £3,270,493. 5.2 NEXT STEPS 5.2.1 Following notice of the termination of the contract with Hatton Lea, a review of the HBCC model across Lanarkshire has commenced in order to ensure that there is limited impact to patient care and wellbeing. Yes ☐ No ☒ N/A ☐
Page 3
3 5.2.2 As part of their engagement planning, HC One contacted all families impacted on the 19th March, and issued a follow up letter on the same day. 5.2.3 There is a planned face to face sessions for families on 26th March with representation from HC One, NHS Lanarkshire and the Social Work departments from North and South partnerships. 5.2.4 All HBCCC patients at Hatton Lea will be reviewed individually by Health and Social Work staff to agree suitable next steps. 5.2.5 Any patients identified at the review stage as being able to be stepped down to mainstream care (in line with the 2015 HBCCC guidance) will be fully supported on that journey. 5.2.6 Work is already underway to repatriate this service back into the NHS Lanarkshire estate. 5.2.7 An appropriate Equalities Impact Assessment will be undertaken in association with the Engagement Planning Group. 5.2.8 Following the notice of the contract termination, the aim is to ensure the new model is able to maintain the wider benefits anticipated from the original review of HBCCC services: Care on one central site with good transport links will be easier to access for families and carers as well as to assess and follow up by all disciplines of NHS Lanarkshire staff and partners in both North and South Lanarkshire. Opportunity exists to reinvest a proportion of the savings achieved in the service through employment, skills and training to provide best evidence care, treatment and rehabilitation. By consolidating some functions under a single site, the organisation eliminates the possibility of different standards and practices being applied in different areas. This is a major benefit to the patient’s wellbeing. Enhanced medical/nursing/AHP input within the current NHS Lanarkshire Mental Health estate would enable an improved care pathway, including robust multi-disciplinary assessment prior to admission and review focussed resident’s individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes. Meeting each patient’s changing care needs through robust multi-disciplinary assessment will ensure more positive patient /carer outcomes whilst identifying changing care requirements that would precede residents moving to future clinically appropriate care settings. Achievement of NHS Lanarkshire’s strategic objective of achieving best outcomes and value for money, ensuring that all resources are deployed to best effect, achieving transformational change in desired outcomes and value for money.
Page 4
4 6. CONCLUSIONS 6.1 Following the national change in definition of HBCCC, demand for Mental Health Continuing Care has continued to decrease, resulting in reducing occupancy levels in the contracted beds in Cumbernauld Care Home and Hatton Lea. The number of HBCCC patients has halved since the changes in 2015. 6.2 The termination of contract between HC One and NHS Lanarkshire has resulted in the need for a further review of the HBCCC model to ensure patient care is continuously delivered and patient needs are being met as per the HBCCC guidelines. 6.3 A multi-agency group is in place to coordinate individual patient reviews, engagement with families and the development of a new in-house model for HBCCC services. 6.4 The IJB is asked to acknowledge the termination of the contract between HC One and NHS Lanarkshire and note the next steps being proposed within the paper. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL
Page 5
5 This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Yes ☒ No ☐ N/A ☐
Page 6
6 ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1– Hospital Based Complex Care (HBCCC) in Lanarkshire FAQs CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk Yes ☐ No ☒EQIA will be developed N/A ☐ Yes / Date added ☐ No ☐ N/A ☒
Page 7
7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
Page 8
8 Appendix 1 Hospital Based Complex Clinical Care (HBCCC) in Lanarkshire FAQs What is HBCCC? It is the care of old age psychiatry patients with a dementia diagnosis and associated behaviours requiring clinical support. This group requires specialist on-going healthcare and care provided in a specialist nursing home or care facility. What is the current service provision? University Health & Social Care North Lanarkshire currently has a contract with a care company called HC-One to provide the HBCCC service across the whole of Lanarkshire. HC-One provides the service at its Hatton Lea Care Home in Bellshill. What is changing? University Health & Care North Lanarkshire’s intention was for this contract to remain in place. However, HC-One has issued notice that it intends to terminate the contract and no longer provide the service in Lanarkshire. This decision was not the choice of University Health & Social Care North Lanarkshire. When is this change taking place? We are now working hard to identify a new location for the service in a comfortable and homely environment. A key consideration in identifying a new location for the service is that care is provided on one geographically central site with an appropriate environment for the patients and good transport links. This will provide easier access for families and carers from both North and South Lanarkshire.
Page 9
9 Once a new location is identified for the service, we will let you know. We are providing support as necessary to staff to ensure the service’s patients remain everyone’s number one priority throughout this process. Will all the patients remain in the HBCCC service when it moves to a new location? A multi-disciplinary team (MDT) group has been established to carry out a full review of each patient’s care. This MDT group is made up of a consultant and a range of clinical and social work staff. Our overriding priority for each and every patient is ensuring their continued safety, minimising any distress and supporting them and their families/carers through this process. While some patients in the HBCCC service will remain in the service to continue receiving complex care that can only be provided in a specialist setting, others may benefit from transferring to a mainstream care home. What is the criteria for establishing if my relative/person I care for still requires HBCCC? Receiving long-term care in a hospital or hospital-style setting should always be the last resort. This led to NHS Continuing Healthcare being replaced by HBCCC across Scotland on 1 June 2015. Assessment on whether a patient continues to require HBCCC focuses on one key question: can a person’s needs be properly met in any other setting than a hospital/hospital-style setting? Patients in the HBCCC service are reviewed regularly to see if this is the most appropriate care for them. Your relative/person you care for will be assessed by one of our consultants and our older peoples’ MDT to determine if they still require the specialist intensive on-going healthcare provided in HBCCC. This assessment may find that because their care needs are no longer as complex they can now be cared for in a mainstream care home. Our consultant and other members of the team will be able to discuss this further with you if you have any questions. if my relative/person I care for no longer requires HBCCC what is the next step?
Page 10
10 Following assessments, some patients may now be best placed to have their care needs met in a mainstream care home. This is because our multi-disciplinary team which manages their care believes their symptoms are now more manageable. We will work with our colleagues in social work to help support your decision making and the necessary processes for moving in to mainstream care. If my relative/person I care for no longer requires HBCCC can they move to the mainstream Hatton Lea Care Home or do they need to transfer to another care home? We understand that patients in the HBCCC service may have built up relationships with the staff and any move or change is an anxious time for both patients and their relatives/carers. It is important for us to allow time for you to consider your preferred option regarding the best future place of residence for your relative/person you care for. If my relative/person I care for moves in to a mainstream care home what happens next? If your relative/person you care for can now have their needs best met in a mainstream care home, University Health & Social Care North Lanarkshire will pay the full costs of their care until they move in to another care home. This is to ensure a smooth transition into mainstream care. From this point, this payment will stop and responsibility for funding the care home bed will transfer to you. Your relative/person you care for will be offered a financial assessment to support income maximisation to check which, if any, benefits they are entitled to. We will have staff available to help you through this process. There are also local money advice services available to you plan future funding: North Lanarkshire residents can access: https://www.northlanarkshire.gov.uk/benefits-and-money South Lanarkshire residents can visit: https://www.southlanarkshire.gov.uk/info/200150/managing_your_money/1850/mone y_matters_advice_service
Page 11
11