ITEM 7 Mental Health Hospital Based Clinical Complex Care
North Lanarkshire Council · 25 September 2024
Back to Health and Social Care Integration Joint Board — 25 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 7 SUBJECT: Mental Health Hospital Based Clinical Complex Care (HBCCC) 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: 25 September 2024 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) Note the progress made since the last update with all patient reviews completed, a number of patients supported to mainstream care and a new in-house site (Udston Hospital) identified for the new HBCCC service model, with redevelopment plans now at an advanced stage.
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2 2) Note the ongoing engagement programme with families to ensure a co-design approach to the new facility. 3) Request further updates to show the finalised site plans and costings once complete. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 BACKGROUND 5.1.1 The IJB was updated at the meeting on 27th March 2024 that HC One formally notified NHS Lanarkshire of its intention to terminate the existing contract for HBCCC services at Hatton Lea. 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, which took place on 31st July 2024 as planned. 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 the time of HC One serving notice on 25th January 2024, there were 39 patients supported at Hatton Lea, with an annual contract cost of £3,270,493. Yes ☐ No ☒ N/A ☐
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3 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 taken place in order to ensure that there is limited impact to patient care and wellbeing. 5.2.2 All families affected were contacted by HC One on 19th March, with face to face sessions held on site at Hatton Lea on 26th March, with representation from HC One, NHS Lanarkshire and the Social Work departments from North and South partnerships. 5.2.3 All HBCCC patients have been reviewed on a multi-disciplinary basis, with current expectations that around 12 patients will transfer into ongoing HBCCC, with the remaining residents transferring into mainstream care. 5.2.4 At present there are now only 20 patients remaining in the HBCCC beds at Hatton Lea, following moves to mainstream care. 5.2.5 In creating a new model, the focus remains on ensuring the key aspects sought from the original review of HBCCC services are sustained: 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 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. 5.2.6 On 11th March, NHS Lanarkshire issued a preliminary market brief to invite expressions of interest for external provision of an HBCC service, but no notices of interest were received. On that basis, attention turned to providing an in-house model. 5.2.7 A ward at Udston Hospital has since been identified, with significant process made around agreeing the layout and design of the ward, creating a 17
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4 bedded ward with en-suite bathrooms and positive day space, including access to an outdoor courtyard. 5.2.8 Two information evenings were held with families on 17th and 18th July on site at Udston. Families were shown the floor plans and architect drawings to see what the space could look like and were also shown round the CAMHS suite to see what is possible with strong engagement. While the CAMHS facility clearly has a different focus, it was designed in collaboration with patients and families and feels very different to a normal NHS facility, whilst still meeting all Infection, Prevention and Control standards. 5.2.9 The Engagement Officer from the Children’s Services Unit that led the engagement with patients and families for the CAMHS suite is leading the same process for the HBCCC design. The first meeting with families was held on 2nd September and will now continue right through until completion. 5.2.10 Work is ongoing with NHS Lanarkshire estate’s team to finalise costs for the work, with a projected completion date of March 2025. 5.2.11 Positive meetings have continued with HC One to ensure continuity of care during this transition period towards the new opening of the new facility. 5.2.12 Monthly joint briefings are being shared with families from the partnership and HC One. 6. CONCLUSIONS 6.1 Since the last update to the IJB, the contract with Cumbernauld Care Home came to an end on 31st July 2024. 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 has been in place to coordinate individual patient reviews, engagement with families and the development of a new in-house model for HBCCC services. 6.4 A new in-house unit for HBCCC will be opened at Udston Hospital, with a projected date of March 2025. 6.5 Engagement continues with the families affected to ensure a positive co- design of the new space. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes
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5 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 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 Yes ☒ No ☐ N/A ☐
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6 ☐ 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 ☒ 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: Yes ☐ No ☒EQIA will be developed N/A ☐ Yes / Date added ☐ No ☐ N/A ☒
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7 8. BACKGROUND PAPERS None. 9. APPENDICES None. 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
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8 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