Archived decisions

Item 6

1. Hampshire Partnership Trust: Secure Adolescent Mental Health Services for the South of England

1.1. The Committee has been alerted to proposals for the development of secure adolescent mental health services across the region.

1.2. The imitative is at the very early stage of development and is not due to be completed until January 2007: it is therefore unlikely to be subject to formal consultation until 2005/06. A brief summary of the proposal is attached at Appendix One. Full details of the project initiation bid have been circulated to lead officers.

1.3. The catchment population has yet to be determined, however the project manager is aware of the responsibilities of the Trust in relation to the duty to consult with all Health OSCs whose population may be affected.

1. Recommended Action

1.1. Through the Joint Committee the Trust be asked to

_ Provide an up-date on on progress on a regular basis

_ Provide information on the process for discharging section 11 responsibilities as the project rolls forward

_ Ensure that all partners (e.g. social services) are engaged

1.2. The Trust be thanked for contacting the Joint Committee at this early stage of developing a proposal

Appendix A

SECURE ADOLESCENT MENTAL HEALTH FACILITY FOR THE SOUTH OF ENGLAND

PROJECT INITIATION DOCUMENT

1. INTRODUCTION AND PURPOSE

The purpose of this document is to describe the key objectives for the development of a secure in-patient adolescent mental health service to serve the population of the South of England who meet the criteria as outlined below in the Project Brief.

The document describes the approach and methodology being taken to effectively plan and implement the project objectives. Formal approval of the Project Initiation Document by the Project Board, will give confirmation of the approach to achieving the project goals and the facilitation of the service development proposals.

2. PROJECT BRIEF

The project brief is described in the Strategic Outline Case (SOC) dated October 2003.

An extract from the Executive Summary is included as follows:

2.1 Outline of Proposed Service

The proposed service is to offer secure in-patient forensic facilities for adolescents who meet the criteria agreed by NSCAG as outlined below:

· detainable under parts 2 or 3 of the Mental Health Act 1983

· aged between 12-18 (this means 17 for referral purposes really)

· require care and treatment for a period of between 1-12 months in a secure environment by reason of the risk they pose (2.5 months median)

· all other more local facilities have been exhausted (not on availability

of beds but on ability to treat/contain)

· not Learning Disabled, Aspergers or brain injury

· normally, not personality/conduct disorders unless with mental illness

· usually with a worrying forensic history/index offence (although not necessarily with a conviction).

This would usually mean that the young person presented a risk to others that required their detention in conditions of security. This risk would normally include risk of the following:

· Direct violence to others, including homicide

· Seriously sexually aggressive behaviour

· Destructive and life threatening fire setting

The service will include:

· Case management

· Assessment and treatment by a full multi-disciplinary team

· Access to appropriate education

· Occupational and life skill activities

· Psychological testing and treatment

· Individual and Family therapy

· Medication

2.2 Health Service Need

The service development proposals described in the SOC/OBC respond to identified health service need as they provide:

· Better Access to Services

· Improved Clinical Quality

· For Improved Environmental Quality

· For Development of Existing Services and Provision of New Services

· For Improved Strategic Fit of Services

· To Meet National and Local Policy Imperatives

· To Make More Effective Use of Resources

· To Meet Training, Teaching and Research Needs

The consequences of not prioritising the proposal are:

o Unmet targets

o Failure to meet requirements of Safety, Privacy and Dignity in Mental Health Units

o Inappropriate placement of patients

o Inappropriate models of care

o Investment blight - does not enable repatriation to services closer to home

o Service quality and human rights issues, inappropriate detention

2.3 Needs Assessment

Although there have been a number of studies that have looked at the need for Secure Adolescent facilities, there has been no definitive national study that has been accepted by all.

The most comprehensive in scope of these studies was that undertaken by Philip Vaughan for the Wessex consortium in June 2001 and this has been the basis of this assessment of need. This study was a very thorough survey of need within Hampshire and the Isle of Wight identifying all those who on 1^st January 2001 who:

· "were detained in conditions of security or who need to be detained because of the risk they posed to themselves or others, or who are likely to abscond from an open facility, and;

· "whose mental disorder is of a nature or degree that warrants in-patient treatment and care in a setting appropriate to their age and clinical need."

The study identified 23 young people who met his criteria of whom 14 were boys and 9 girls. The 23 were then matched against the NSCAG criteria outlined above. This identified 5 young people who met the criteria of whom:

· one was in a Young Offenders Institution

· two were in Local Authority secure accommodation

· only two were appropriately placed in specialised adolescent secure psychiatric units, one in the NHS and the other in the private sector.

So for a population of approximately 2 million people the report identified a group of 5 young people who required secure inpatient psychiatric adolescent services and met the current draft criteria as outlined by NSCAG.

The South of England covers a population of approximately 14 million and so if this study were projected upward we would see a need of 35 places.

In preparing this report commissioners across the area were asked to identify the number of young people in secure adolescent mental health facilities in January and February 2003. This stock take identified current usage as 24 beds as outlined below:

Area	No. of Adolescents in secure accommodation 28th Feb 2003
Kent, Surrey and Sussex	9
Berkshire	2
SW Region	7
Wessex	3
Oxfordshire/ Buckinghamshire	4
Total	25

The former South West Region undertook a detailed stock take of the current use of secure adolescent facilities in January 2003. This showed 7 youngsters currently in NHS medium secure provision (St Andrews and Huntercombe) of which 2 patients would not have met the NSCAG criteria as they had both had drug and alcohol addition. In respect of the other 5 there was insufficient information to be able to determine.

Considering these factors it is believed that the initial need within the South of England would be met by the provision of 20 beds especially taking into account the other increases in such beds with the new developments in London and Birmingham.

During the preparation of the report clinical and commissioning colleagues have also expressed a need for secure services for a group of young people with problems of mild learning disability or Asperger's Syndrome and who require a secure mental health facility but who do not meet the current NSCAG criteria. This need has not been fully researched and is not directly dealt with in this proposal however an element of flexibility is called for in the design that would allow some consideration to be given to these groups of young people in the future.

2.4. Strategic Context/ National Initiatives

The underpinning national policies relevant to these interim developments are:

· The promotion of effective assessment and treatment of young people who require admission under the Mental Health Act (1983) and whose behaviour represents a direct and serious risk to others and who require treatment within conditions of security;

· The promotion of social inclusion and prevention of exclusion;

· Equity of access to mental health services closer to home;

· Improving the care of children and young people with mental health problems.

2.5. Service Benefit/Option Appraisal

A number of options were considered but those outlined below were considered to be feasible and reasonable to be formally appraised

The options identified are as outlined in the table below:

As can be seen there were five agreed options with sub options that related to the location of the proposed unit(s). These options were considered and appraised according to agreed criteria at a meeting of stakeholders held on 8^th April 2003.

At a meeting on 11^th July 2003 with representatives of NSCAG there was an informal agreement from them to revenue fund 20 places in the South of England at a cost of approximately £250K per place per annum plus set up/project costs. This has now been confirmed.

The agreed Preferred Option was:

· To build one unit of 20 beds located in a suitable location in the south of England.

This option was agreed because:

1. This gave good accessibility across the South of England;

2. The south coast proposal was far enough from the London proposals to improve the national spread of these units;

2.6 Design and Flexibility

The design of the establishment will need to take full account of

· the needs of this client group

· the need for appropriate privacy and gender separation

· flexibility for future growth, change of use and changing service requirements

The unit will be dealing with young people with a range of needs and it is essential that the unit is designed to offer flexibility to support the clinical team in dealing with these divergent demands. It is believed that a `pod' system would most likely offer the flexibility required although alternative designs will be considered.

2.7 Design Champion

The trust has appointed a non executive director as the design champion whose role will include a responsibility to ensure that:

· The building promotes civic pride

· Consumerism is taken into account

· Patients and staff are consulted and their views addressed

· The building fits into the local surroundings and settings

· The building is fit for purpose

· The building takes on board modern technology

The design champion will ensure that:

· All procedures encourage the achievement of high design quality

· An assessment is made of the current environment for patients, staff and visitors

· The `Achieving Excellence Design Evaluation Toolkit' (AEDET) is used where appropriate

· A trust design action plan is produced and delivered

· The evaluation of tenders when necessary is based on best value and not lowest cost

· Budgets and timetables are realistic

· The trust has the right skill mix to deliver the design agenda

· A design vision is established in order for the trust to produce a clear brief

· The scheme includes the full involvement of the local community and the support of clinical and other staff

2.8 Procurement Process

Following debate at the Catchment Group, LSCGs in the 2 areas listed were approached to invite local providers to respond with initial interests. Hampshire Partnership NHS Trust was selected as preferred provider for the delivery of the service by 05/06.

The process to select the partner to support the Trust in the development of this facility will be selected via LIFT or P21. The Trust will use consistent principles and criteria by which an NHS Trust may select a NHS ProCure21 Principal Supply Chain Partner (PSCP). The selection will be made by taking into account relevant experience, the team actually proposed, the planned approach and the availability of resources.

The main objective of the process is to select the PSCP judged by the Trust as most likely to effectively deliver the scheme identified by the Trust whilst minimising the resource input required by both parties.

3. OBJECTIVES

The main goals for the project are to:

· Deliver an operational 20 bed secure adolescent unit by early 2007

· Deliver within affordability envelope

· Be a centre of excellence for secure adolescent unit

· Ensure participation and ownership of public, patient, staff and key stakeholders, throughout the project