Item 13 - Mental Health Hospital Based Complex Care Contracted Beds
North Lanarkshire Council · 30 November 2022
Back to Health and Social Care Integration Joint Board — 30 November 2022 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: 13 SUBJECT: Mental Health Hospital Based Clinical Complex Care TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer Ian Nicol, Programme Manager DATE: 30th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB Sub-Committee For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: the Health and Social Care Partnership Core Management Team 3. RECOMMENDATIONS The Board is asked to: 1) Approve the attached business to consolidate the provision of Hospital Based Complex Clinical Care for old age psychiatry patients at Hatton Lea Care Home, providing a pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. 2) Approve the termination of the existing contract with Four Seasons for HBCCC beds at Cumbernauld Care Home. 3) Approve the use of a proportion of the savings achieved to establish an enhanced multi- disciplinary staffing model at Hatton Lea. 4. VARIATIONS TO DIRECTIONS? No directions required at this stage. Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 BACKGROUND 5.1.1 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 is the last outstanding action from the plan, delayed due to the onset of the pandemic. 5.1.2 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. 5.1.3 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. 5.1.4 At present, NHS Lanarkshire has two contracts for the provision of HBCCC beds, which were originally established in the early 1990’s. These contracts were originally devised to assist in the transition from centralised facilities in Hartwood Hospital and other older outlying facilities such as Cleland Hospital to more modern community placements throughout Lanarkshire. The contracts relate to: Cumbernauld £2,021,180 per annum originally for 60 beds, now reconfigured to 52 beds. Hattonlea Care Home in Bellshill which is operated by HC-One at an annual cost of £3,138,067 per annum originally for 90 beds, now reconfigured to 75 beds. The total cost of both contracts is £5,159,247. Both contracts have a 12-month notice period. 5.1.5 The requirements for inpatient services for this patient group have reduced as alternative clinical models have developed and the occupancy levels within both facilities are now low. As at October 2022: Cumbernauld Care Home: 5 out of 52 available beds occupied (10% occupancy). Hatton Lea Care Home: 46 out of 75 available beds occupied (61% occupancy). 5.1.6 In addition to the contracted HBCCC dementia beds, NHSL has 30 functional illness beds based in Cleland hospital. Within Care of the Elderly (COTE), any beds in can be classified as HBCCC, including those in the off-site facilities. Beds are not cohorted and each case is managed on an individual basis. These COTE beds are not part of the review. 5.1.7 A number of Health Boards/partnerships across Scotland have undertaken similar reviews since 2015 due to the impact on demand of the definition changes.
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3 5.2 DEVELOPING PROPOSALS 5.2.1 Based on this falling demand, the NHS Board and IJBs agreed in March 2020 that a business case be developed for the consolidation of contracted HBCCC provision onto the site at Hatton Lea, providing an enhanced pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. 5.2.2 However, due to the impact of the pandemic, the planned work was delayed as it was not possible to undertake any consultation work within the Care Home environment due to the risk of Covid-19 spread. Work commenced again at the end of 2021. 5.2.3 An Engagement Planning Group was established with patient and carer representatives and staff to work through an options appraisal process to ensure that all options were identified, to test the original proposal against these and carry out an Equalities Impact Assessment. 5.2.4 The options appraisal confirmed the preferred option of consolidating provision establishing an enhanced MDT care model at Hatton Lea Care Home. The business case for the proposed service change is attached at Appendix 1. 5.2.5 The EQIA identified potential disadvantage to carers/family members through centralisation onto a single site. Options the provision of transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea will be agreed by the Engagement Planning Group as part of the implementation plan. 5.2.6 The wider benefits anticipated from this development are as follows: 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 Hatton Lea 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. 5.2.7 The health care needs of patients in Cumbernauld Care Home have been reviewed in order to identify those requiring complex clinical care and others who may be able to transition to more traditional care environments. Nearly all of the patients in the Cumbernauld Care Home could now be managed in a mainstream care home and will, therefore, not transfer to Hatton Lea. Families will be fully involved in discussions to agree the future care arrangements for each individual patient. 5.2.7 The Engagement Planning Group will support the implementation of the enhanced model of care at Hatton Lea Care Home to ensure continued engagement with those with a stake in a
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4 new model of contracted hospital-based complex clinical care for older people and to provide a feedback loop on progress to partner organisations and people potentially affected by the service change. 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. 6.2 The IJB is asked to approve the attached business case for the consolidation of contracted HBCCC inpatient provision service onto one site for both North and South Lanarkshire residents, subject to endorsement by South Lanarkshire Integration Joint Board and Lanarkshire NHS Board. 7. IMPLICATIONS 7.1 NATIONAL 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 their 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 provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing 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) Associated measures include bed occupancy and rates of admission and discharge. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The total cost of the existing contracts totals £5,159,247 per annum. This includes £2,021,180 per annum for 52 beds in Cumbernauld Care Home. £269k will be invested to enhance the multi-disciplinary teams.
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5 Transition costs and consequently the potential savings available for reinvestment will be dependent on the outcome of engagement with Four Seasons and HC-One which may include potential renegotiation of the existing contract and include funding the ongoing care of current patients not meeting complex care criteria. All savings will be split 51/49 between North and South IJBs respectively in line with current funding arrangements. 7.4 PEOPLE There are currently 51 individuals supported through the current arrangements, 5 resident in Cumbernauld Care Home. The health care needs of patients in Cumbernauld Care Home will be reviewed in order to identify those requiring complex clinical care. The next of kin of all Cumbernauld Care Home HBCCC patients will be invited to attend an individual meeting to discuss the outcome of the review and agree ongoing care arrangements. NHS Lanarkshire responsibilities in relation to Four Seasons staff and their existing employment contract which could be protected under the Transfer of Undertakings (Protection of Employment) Regulations have been reviewed, with TUPE unlikely as the current provider is keen and able to retain the staff group in other local Care Homes. 7.5 INEQUALITIES EQIA Completed: Yes No N/A A full Equality Impact Assessment has been completed as part of the business case development (attached at Appendix 2). 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1: Business case Appendix 2: Draft EQIA ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact: Ross McGuffie Chief Officer 01698 858 143
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Appendix 1 Older Adult Hospital Based Complex Clinical Care Beds Business Case Author: Ian Nicol/Marie Rooney Contact: ian.nicol@lanarkshire.scot.nhs.uk marie.rooney2@lanarkshire.scot.nhs.uk Date: 17th Nov 2022 Version: v0.8
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Business Case Page 7 of 26 Contents 1. Purpose .......................................................................................................... 8 2. Background .................................................................................................... 8 3. Strategic Objectives ...................................................................................... 9 4. Benefits .......................................................................................................... 9 5. Risks ............................................................................................................. 10 6. Available Options ........................................................................................ 10 7. Preferred Option .......................................................................................... 12 8. Estimated Costs .......................................................................................... 13 9. Net Benefit Forecast .................................................................................... 13 10. Document Control Sheet.................................... Error! Bookmark not defined.
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Business Case Page 8 of 26 1. Purpose The purpose of this business case is to set out the benefits to be delivered by the proposed changes to contracts with private sector providers for Hospital Based Complex Clinical Care (HBCCC) beds, the risks to achieving the benefits, the costs of delivery, and timescales. 2. Background Pre-pandemic, NHS Lanarkshire developed a Bed Modelling Plan which was signed off by the NHS Board in 2017. This included a specific action around reviewing the model of Mental Health Hospital Based Complex Clinical Care (HBCCC). This is the last outstanding action from the plan, delayed due to the onset of the pandemic. 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. 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. At present, NHS Lanarkshire has two contracts for the provision of HBCCC beds, which were originally established in the early 1990’s. These contracts were originally devised to assist in the transition from centralised facilities in Hartwood Hospital and other older outlying facilities such as Cleland Hospital to more modern community placements throughout Lanarkshire. The contracts relate to: Cumbernauld £2,021,180 per annum originally for 60 beds, now reconfigured to 52 beds. Hattonlea Care Home in Bellshill which is operated by HC-One at an annual cost of £3,138,067 per annum originally for 90 beds, now reconfigured to 75 beds. The total cost of both contracts is £5,159,247. Both contracts have a 12-month notice period. The requirements for inpatient services for this patient group have reduced as alternative clinical models have developed and the occupancy levels within both facilities are now low. As at October 2022: Cumbernauld Care Home: 5 out of 52 available beds occupied (10% occupancy). Hatton Lea Care Home: 46 out of 75 available beds occupied (61% occupancy). At the most recent census (March 2022), the average length of stay of patients in the two care home was: Cumbernauld Care Home: 6 years 4 months Hatton Lea Care Home: 3 years 2 months In addition to the contracted HBCCC dementia beds, NHSL has 30 functional illness beds based in Cleland hospital. Within Care of the Elderly (COTE), any beds can be classified as HBCCC, including those in the off-site facilities. Beds are not cohorted and
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Business Case Page 9 of 26 each case is managed on an individual basis. These COTE beds are not part of the review. 3. Strategic Objectives The overall objective of this proposal is to optimise NHS Lanarkshire contracted HBCCC bed provision to establish a high quality, person-centred, safe, flexible and cost-effective model of contracted hospital-based complex clinical care for older people diagnosed with dementia that will better meet the needs of patients and staff. It will contribute to the achievement of the following NHS Lanarkshire strategic objectives: 1. Modern fit for purpose NHS Lanarkshire, focussed on prevention and speed of treatment – Delivering services that listen and respond to the needs of individuals, patients and carers to continuously improve experiences and outcomes. 5. Achieve best outcome and value for money – ensuring that all resources are deployed to best effect, achieving transformational change in desired outcomes and value for money The case for change also aligns with the three ambitions of NHS Scotland’s Quality Strategy: Safe - There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time Person-Centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision- making Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. 4. Benefits Consolidation and centralisation onto a single site to enable multi-disciplinary team- based working that will benefit the patients/residents. A single care provider will allow improved communication and monitoring ensuring continued meaningful and sustained engagement between the provider and NHS Lanarkshire. Care on one central site with good transport links will facilitate easier access for families and carers as well as staff of NHS Lanarkshire and partners in both North and South Lanarkshire to assess and meet the care needs of each patient. Reinvestment of a proportion of the savings achieved in the service through employment, skills and training. Enhanced medical/nursing/AHP input on a single site enabling 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.
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Business Case Page 10 of 26 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. 5. Risks Business Risk: There is a risk that the inpatient clinical model is not fully funded resulting in the objectives of the project being significantly threatened. Mitigation: Development of a high quality clinical and social care model and robust business case. Patient Care There is a risk of some disruption in service resulting in an unacceptable impact on patient care. Mitigation: Development of retraction plan to ensure smooth transition to include individual meetings with Cumbernauld patients/carers/families to agree the best ongoing care arrangements for each patient, negotiation with providers, a detailed communications plan, engagement with staff, recruitment and training. Staff There is a risk that we cannot recruit or retain staff with the necessary skills and experience. Mitigation: Reinvestment of a proportion of the savings achieved in the service through employment, skills and training. Reputation There is a risk of unfavourable local media coverage resulting in a significant effect on staff morale and public perception of NHS Lanarkshire. Mitigation: Work with HSCNL communications team and providers to develop a communications plan establishment of an Engagement Planning Group to involve with patient groups, communities, staff and other stakeholders in the options appraisal process; engagement with the local community in Cumbernauld, including meeting local elected representatives and attending the Cumbernauld Community Forum. 6. Options Appraisal An Engagement Planning Group was established with patient and carer representatives and staff to work through an options appraisal process to inform the development of the business case. Options The following long list of options was identified: 1. Do nothing. 2. Establishment of an enhanced single-site MDT HBCCC model at Hatton Lea Care Home 3. Repurpose an existing vacant NHS Lanarkshire property
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Business Case Page 11 of 26 4. A new purpose-built facility 5. Smaller, purpose-built units in different parts of Lanarkshire 6. Purchase of Cumbernauld Care Home 7. Purchase beds in private care homes across Lanarkshire The Group took the view that Option 1 could be ruled out as Four Seasons Healthcare intend to close Cumbernauld Care Home. As that will release resources, the best use of these resources can be taken into account in considering each of the other options. Similarly, the Group took the view that Option 7 would not release the resources for the development of an MDT model of care and could also be ruled out. Benefits Criteria The following benefits criteria were agreed to appraise the short-listed options Safe – The extent to which the option will ensure that here will be no avoidable injury or harm to people, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time Person-Centred – The extent to which the option will enable mutually beneficial partnerships between patients and all those involved in their care, which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making Effective – The extent to which the option will ensure that most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated Sustainable – The degree to which the option supports the delivery of the service in the medium to long-term (5-10 years plus) Accessible – The extent to which the option would ensure relatives/carers/the wider care team can be actively involved in the individual care of residents Perception of success – The extent to which the option would be welcomed by stakeholders; is the change achievable and does it have the potential to impact positively on the service?
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Scoring Short-listed Options Benefits Criteria Overall Weighted Score (out of 120) Safe Person- centred Effective Accessible Sustainable Perception of Success Weighting 20% 20% 20% 20% 10% 10% 1. Consolidation of HBCCC provision at Hatton Lea Care Home Score 103 106 104 86 90 87 97.5 Weighted Score 20.6 21.2 20.8 17.2 9 8.7 2. Repurpose an existing vacant NHS Lanarkshire property Score 78 82 79 73 79 79 78.2 Weighted Score 15.6 16.4 15.8 14.6 7.9 7.9 3. A new purpose-built facility Score 93 91 87 79 83 81 86.4 Weighted Score 18.6 18.2 17.4 15.8 8.3 8.1 4. Smaller, purpose-built units in different parts of Lanarkshire Score 85 87 81 85 66 78 82 Weighted Score 17 17.4 16.2 17 6.6 7.8 5. Purchase of Cumbernauld Care Home Score 76 74 68 52 51 53 64.4 Weighted Score 15.2 14.8 13.6 10.4 5.1 5.3 Preferred Option Option 1: Consolidation of contracted HBCCC beds at Hatton Lea Care Home
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7. Estimated Costs Multi-disciplinary staffing model to deliver enhanced model of care: Band WTE Cost (£)* OT 6 0.6 30,891 Consultant Psychiatrist n/a 0.4 57,921 Psychology 8a 0.6 41,847 Admin 3 0.8 24,694 HBCCC Liaison /Delayed Discharge Nurse 7 1 62,051 Physiotherapist 6 0.5 25,743 Pharmacist 6 0.5 25,743 Total 268,891 *Calculated at 2021/22 rates 8. Net Benefit Forecast Investment Capital / Revenue 2022/23 £000 2023/24 £000 2024/25 £000 Enhanced MDT team at Hatton Lea: additional staffing costs Revenue 0 269 269 Return on investment Capital / Revenue 2022/23 £000 2023/24 £000 2024/25 £000 Savings achieved from termination of Cumbernauld Care Home contract Revenue 0 505 2,021 Net financial benefit Capital / Revenue 2022/23 £000 2023/24 £000 2024/25 £000 Savings on Cumbernauld Care Home contract less MDT staffing costs Revenue 0 236 1,752 * Calculation assumes Four Seasons Healthcare notified of intention to withdraw from Cumbernauld in December 2022 and NHS Lanarkshire held to full year notice period; however, negotiations are underway with Four Seasons in relation to the notice period and the terms of the withdrawal.
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EQUALITY IMPACT ASSESSMENT This is a legal document stating you have fully considered the impact on the protected characteristics and is open to scrutiny by service users/external partners/Equality and Human Rights Commission If you require advice on the completion of this EQIA, contact hina.sheikh@lanarkshire.scot.nhs.uk ‘Policy’ is used as a generic term covering policies, strategies, functions, service changes, guidance documents, other Name of Policy Contracted Hospital Based Complex Clinical Care Names and role of Review Team: Marie Rooney, Associate Nurse Director, Mental Health, Learning Disability and Addictions Tracey Truesdale, Service Manager, Mental Health, Learning Disability and Addictions Ian Nicol, Programme Manager Date(s) of assessment: 03/11/2022 SECTION ONE AIMS OF THE POLICY 1.1. Is this a new or existing Policy: Service Change Please state which: Policy Strategy Function Service Change Guidance Other 1.2 What is the scope of this EQIA? NHS Lanarkshire wide Service specific Discipline specific Other (please detail) ______________________________ 1.3a. What is the aim? To establish a high quality, person-centred, safe, flexible and cost-effective model of contracted hospital-based complex clinical care for older people diagnosed with dementia that will better meet the needs of patients and staff. 1.3b. What are the objectives? The objective of the proposed service change is to optimise NHS Lanarkshire contracted HBCCC bed provision by consolidating provision on a single, central site at Hatton Lea Care Home to enable multi-disciplinary team-based working that will benefit the patients/residents and those involved in their care, including carers and families. 1.3c. What are the intended outcomes? Appendix 2
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The planned new service model aligns with the three ambitions of NHS Scotland’s Quality Strategy: Safe - There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time Person-Centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. 1.4. How have the stakeholders been involved in the development of this policy? An Engagement Planning Group has been established in line with Healthcare Improvement Scotland’s Planning with People guidance, comprising patient and carer representatives and staff, to: Ensure all those with a stake in a new model of contracted hospital-based complex clinical care for older people have been identified and can access accurate information to enable them to engage appropriately and proportionately, in the development and implementation of the new service model; Ensure meaningful contributions, representation, ownership and buy-in from all partners and establishing a partnership approach to planning communications activities; Provide a feedback loop on progress in developing and implementing the new model of care to partner organisations and people potentially affected by the service change; Agree the range of options and carry out an options appraisal for the future provision of contracted hospital based complex clinical care to identify a preferred model of care that is robust, evidence-based and person-centred. To carry out an Equalities Impact Assessment of service redesign to consider the impact on different communities taking into consideration equality, human rights, sustainability and the environment, and ensure actions have been identified to mitigate any adverse impacts. 1.5 Examination of Available Data and Consultation - Data could include: consultations, surveys, databases, focus groups, in-depth interviews, pilot projects, reviews of complaints made, user feedback, academic or professional publications, reports etc)
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Name any experts or relevant groups / bodies you should approach (or have approached) to explore their views on the issues. NHS Lanarkshire Old Age Psychiatry Executive Group HBCCC Engagement Planning Group NHS Lanarkshire Equality and Diversity Manager Third sector patient and carer representatives What do we know from existing in-house quantitative and qualitative data, research, consultations, focus groups and analysis? Prior to the Covid-19 pandemic a review was completed by the Old Age Psychiatry Executive group which confirmed that the current provision of NHSL dementia HBCCC beds was now no longer suitable, it is outdated and clinically does not meet the needs of the increased acuity in the patient group. The Scottish Government and Alzheimer Scotland report ‘Transforming Specialist Dementia Hospital Care’ 2018, was clear in the direction of future care provision for patients with a diagnosis of dementia who require additional inpatient care through HBCCC. This report stipulated: lower bed numbers per ward, environmental specifics, & highly skilled multi-professional staff. Based on this falling demand, the NHS Board and IJBs agreed in March 2020 that a business case be developed that looks to consolidate the provision of services onto the site at Hatton Lea, providing a pan-Lanarkshire service within the existing terms and conditions of the contract with HC-One. However, due to the impact of the pandemic, the planned work was delayed as it was not possible to undertake any consultation work within the Care Home environment due to the risk of Covid-19 spread. Work commenced again at the end of 2021. What do we know from existing external quantitative and qualitative data, research, consultations, focus groups and analysis? In 2015, the Scottish Government was clear in its position that people should no longer live in hospital, as per DL 2015 (11). The aim of this guidance was to make the clinical decision regarding place of care more transparent, with the primary eligibility question: ‘Can this individual’s care needs be properly met in any other setting than a hospital?’ This position, and the intent that people should be discharged from hospital when ready, is embraced by the clinical community. However, the model of care currently in existence in Lanarkshire is residual from the previous NHS Continuing Care era, where the assumption was of ongoing care following admission, this assumption is further reinforced by the current provision being within a care home setting. A number of Health Boards/partnerships across Scotland have undertaken similar reviews since 2015 due to the impact on demand of the definition changes. 1.7. What resource implications are linked to this policy? Consolidation and centralisation onto a single site supports new opportunities for multi-disciplinary team-based working and a range of services provided that benefit the patients/residents. Reinvestment of a proportion of the savings achieved through the termination of the Cumbernauld Care Home contract will be invested in the service to put in place enhanced medical/nursing/AHP input within Hatton Lea to
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enable an improved care pathway, including robust multi-disciplinary assessment prior to admission and reviews focussed on patients’ individual needs; improved care planning leading to improved throughput; and improved patient and carer outcomes.
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SECTION TWO IMPACT ASSESSMENT Complete the following table, giving reasons or comments where: The Programme could have a positive impact by contributing to the general duty by – Eliminating unlawful discrimination Promoting equal opportunities Promoting relations within the equality group The Programme could have an adverse impact by disadvantaging any of the equality groups. Particular attention should be given to unlawful direct and indirect discrimination. If any potential impact on any of these groups has been identified, please give details - including if impact is anticipated to be positive or negative. If negative impacts are identified, the action plan in appendix 3 form C must be completed Equality Target Groups – please note, this could also refer to staff Positive impact Adverse impact Neutral impact Reason or comment for impact rating 2.1. Age Children and young people Adults Older People X X N/A The service change will establish a high quality, person-centred, safe, flexible and cost-effective model of contracted hospital-based complex clinical care for older people diagnosed with dementia. It will should also have a positive impact on the families and others involved in the care of these patients. However, given the age group of the patients, partners/family members/ carers may have mobility difficulties, may have lost their driving licences or may only drive within their local area/at certain times of the day.
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2.2. Disability (incl. physical/ sensory problems, learning difficulties, communication needs; cognitive impairment, mental health) X The new HBCCC MDT model of care will benefit all those assessed as requiring this form of care. The person-centred approach will identify any additional support needs pertaining to existing or acquired disabilities 2.3. Gender Reassignment X The impact of the policy is neutral and it impacts all equally irrespective of gender status, however i Use of gender neutral language, and Gender neutral clinical environment Will support an inclusive environment 2.4 Marriage and Civil partnership X The impact of the policy is neutral and it impacts all equally irrespective of marriage or civil partnership. Partners may need to be consulted in any decision-making process. 2.5 Pregnancy and Maternity (including breastfeeding) X Family members may wish to be on the premises and this could present a need for private space e.g. for breast-feeding. 2.6 Race/Ethnicity X We will need to ensure the centralisation of provision and the new model of care is sensitive to any religious and cultural factors and consider any potential additional support needs required i.e. interpreting services. 2.7 Religion/Faith X We will need to ensure the centralisation of provision and the new model of care is sensitive to any religious factors and consider any potential additional support needs required. 2.8 Sex (male/female) X The impact of the service change is neutral as it impacts all equally irrespective of their sex. Sex specific services may need to be considered for a number of factors.
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2.9 Sexual Orientation Lesbians Gay men Bisexuals X The impact of the service change is neutral as it impacts all equally irrespective of sexual orientation. 2.10 Carers X The impact of the service change on carers should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable both the carer’s role in supporting the patient and their own needs to be taken into account. Whilst Hatton Lea Care Home is in a central location in Lanarkshire, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea. 2.10 Homeless X Transitions from Hatton Lea will be to another care setting 2.12 Involved in criminal justice system X Patients subject to MAPPA – it is not thought that such patients will be admitted to Hatton Lea; therefore, not applicable. To be confirmed. 2.13 Literacy X The impact of the service change on those with literacy issues should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable each individual’s specific needs and capabilities to be taken into account in the planning and delivery of their care. Families/carers, etc. need to be involved, as appropriate, in decision- making.
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2.14 Rural Areas X Hatton Lea Care Home is in a central location in Lanarkshire; however, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea. 2.15 Staff Working conditions Knowledge, skills and learning required Location Any other relevant factors X X X Consolidation and centralisation onto a single site will enable multi- disciplinary team-based working that will benefit staff. A single care provider will allow improved communication and monitoring ensuring continuity of care and meaningful and sustained engagement between the provider and NHS Lanarkshire staff, improving patient experience and outcomes. Care on one central site will facilitate easier access NHS Lanarkshire staff of and partners in both North and South Lanarkshire; however, transport difficulties may present for staff, especially shift workers. Reinvestment of a proportion of the savings achieved in the service through employment, skills and training. 2.16. What is the socio-economic impact of this policy / service change? (The Fairer Scotland Duty places responsibility on Health Boards to actively consider how they can reduce inequalities of outcomes caused by socio-economic disadvantage when making strategic decisions) Positive Adverse Neutral Rationale/Evidence Low income / poverty X X Hatton Lea Care Home is in a central location in Lanarkshire; however, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Potential disadvantage to carers/family members through centralisation onto a single site for those who are economically disadvantaged by the centralisation at Hatton Lea. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea.
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Living in deprived areas X As above Living in deprived communities of interest X As above Employment (paid or unpaid) X As above SECTION THREE CROSSCUTTING ISSUES What impact will the proposal have on lifestyles? For example, will the changes affect: Positive impact Adverse impact No impact Reason or comment for impact rating 3.1 Diet and nutrition? X The impact of the service change should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable each individual’s dietary requirements to be taken into account in the planning and delivery of their care. 3.2 Exercise and physical activity? X The impact of the service change should be positive as the enhanced person-centred approach enabled by the proposed new model of care will enable each individual’s specific needs and capabilities to be taken into account in the planning and delivery of their care. 3.3 Substance use: tobacco, alcohol or drugs? X N/A 3.4 Risk taking behaviour? X N/A
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SECTION FOUR CROSSCUTTING ISSUES Will the proposal have an impact on the physical environment? For example, will there be impacts on: Positive impact Adverse impact No impact Reason or comment for impact rating 4.1 Living conditions? X Hatton Lea is a purpose-built modern facility which more ably facilitates our planned model of care. The Cumbernauld facility is of an older design meaning it has limited scope to be reconfigured/adapt to changes as clinical models of care develop. Care on one central site with good transport links will facilitate easier access for families and carers. 4.2 Working conditions? X A single care provider will allow improved communication and monitoring ensuring continued meaningful and sustained engagement between the provider and NHS Lanarkshire. Care on one central site with good transport links will facilitate easier access for staff of NHS Lanarkshire and partners in both North and South Lanarkshire to assess and meet the care needs of each patient. 4.3 Pollution or climate change? X N/A Will the proposal affect access to and experience of services? For example: Positive impact Adverse impact No impact Reason or comment for impact rating Health care X Enhanced medical/nursing/AHP input on a single site enabling 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.
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Social Services X Care on one central site and development of the MDT model of care will facilitate stronger links with council and 3rd Sector social care partners in both North and South Lanarkshire. Education X N/A Transport X X Hatton Lea Care Home is in a central location in Lanarkshire; however, it may be less accessible for the families/carers of some patients who might have been admitted to Cumbernauld Care Home. Consideration will be given to providing transport and/or meeting the travel costs for those who are economically disadvantaged by the centralisation at Hatton Lea. Potential disadvantage to carers/family members through centralisation onto a single site for those who are economically disadvantaged by the centralisation at Hatton Lea Housing X N/A SECTION FIVE MONITORING How will the outcomes be monitored? Use of evaluation forms with service users to measure progress in terms of mental health and wellbeing recovery Data gathering – all aspects of service What monitoring arrangements are in place? Internal progress reports and external monitoring framework. Internal data collection tools. Who will monitor? The Project Manager and Clinical Lead for the service.
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What criteria will you use to measure progress towards the outcomes? Use of evaluation forms with service users to measure progress in terms of mental health and wellbeing recovery Attendance and evaluation of education and training for staff relating to promoting excellence Data gathering – all aspects of service Recruitment of team members and spend Use of quality improvement methodology to demonstrate continuous improvement PUBLICATION Public bodies covered by equalities legislation must be able to show that they have paid due regard to meeting the Public Sector Equality Duty (PSED). This should be set out clearly and accessibly, and signed off by an appropriate member of the organisation. Once completed, send this completed EQIA to the Equality & Diversity Manager Authorised by Title Signature Date Appendix 3: Form C Identified Negative Impact Assessment Action Plan Name of EQIA: Contracted Hospital Based Complex Clinical Care Date Issue Action Required Lead (Name, title, and contact details) Timescale Resource Implications Comments 18/10/2022 Potential disadvantage to carers/family members through Consider provision of transport and/or meeting the travel Tracey Truesdale TBC TBC Options to be explored/agreed to be developed as part of
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centralisation onto a single site costs for those who are economically disadvantaged by the centralisation at Hatton Lea. implementation plan Further Notes: Signed: Date: