Archived decisions
Hampshire County Council Health Overview and Scrutiny Committee Item 4 31 March 2009 Proposals to Develop or Vary NHS Services Report of the Chief Executive |
Contact: Denise Holden ex 7338
e-mail: [email protected]
1. Summary and Purpose
1.1. The purpose of this report is to alert Members to proposals from the NHS to vary or develop health services provided to people living in the area of the Committee.
1.2. Proposals that are considered to be substantial in nature will be subject to formal public consultation. The nature and scope of this consultation should be discussed with the Committee at the earliest opportunity.
1.3. The response of the Committee will take account of the Framework for Assessing Substantial Change and Variation in Health Services agreed by the Hampshire, Isle of Wight, Portsmouth and Southampton Joint Committee in March 2005. This places particular emphasis on the duties imposed on the NHS by Section 11 of the Health and Social Care Act 2001.
1.4. This Report is presented to the Committee in 2 parts:
_ Items for information: these alert the Committee to forthcoming proposals from the NHS to vary or change services. This provides the Committee with an opportunity to determine if the proposal would be considered substantial and assess the need to establish formal joint arrangements
_ Items for action: these set out the actions required by the Committee to respond to proposals from the NHS to substantially change or vary NHS services.
1.5. This report and recommendations provide members with an opportunity to influence and improve the delivery of health services in Hampshire and therefore support the delivery of the Corporate Strategy aim of maximising well being.
Items for Information
2. Hampshire Partnership NHS Trust - Foundation Trust Status
2.1. Hampshire Partnership NHS Trust will give a short presentation on progress being made with its Foundation Trust status application.
Recommendation
2.2. To note the progress being made with the Foundation Trust status application.
3. Winchester and Eastleigh Healthcare NHS Trust: Outpatients Department relocation
3.1. Proposals to relocate The Royal Hampshire County Hospital Outpatient Services to Avalon House, Winchester are still being considered by the WEHT Board. An update was presented to the Board when it met on 25 February 2009 which is included as Appendix One.
3.2. Issues to be addressed previously identified by the HOSC in relation to this proposal include:
_ Access, including car parking and access for people with a disability or using public transport
_ The supporting diagnostic and other services to be provided on the site (e.g.. phlebotomy, x-ray) and the logistics to relocations these to a distant site
_ Clear patients pathways to ensure that patient flows are easily planned and managed. Not all out-patient consultations would be suitable for a remote site
Recommendations
3.3. That WEHT continues to provide the HOSC with regular updates on the proposals to relocate outpatient services.
3.4. That any additional issues raised by members receive a full response from the Trust.
4. Assisted Conception Services in South Central Strategic Health Authority area
4.1. Following the last meeting the Committee no member identified any issues associated with the proposed changes that were considered to be substantial. The Chairman therefore wrote to the Specialist Commissioning Group to confirm this on 26 February 2009. The matter was also considered at a recent meeting of South Central HOSCs and the consensus of opinion was that it was not substantial.
Items for Action
5. Surrey and Borders Partnership NHS Trust: Proposals to reconfigure 24 hour assessment and treatment (inpatient mental health services)
5.1. At its meeting in November 2008 members expressed a number of concerns about proposals from Surrey and Borders NHS Foundation Trust to reconfigure in patent mental health services to three sites based in Surrey.
5.2. Key stakeholders, including local district councils, GPs and patient groups also expressed concerns about the proposals.
5.3. Hampshire PCT and Adult Services were unclear about the impact that the proposed changes would have on Hampshire residents.
5.4. As a consequence of this feedback Surrey and Borders agreed to undertake further consultation and provide additional information about the impact of the revised arrangements on people living in Hampshire. A document setting out this information was previously circulated to members and shared with stakeholders.
5.5. Surrey and Boarders NHS Foundation Trust will be attending the meeting to ascertain if the committee is satisfied that the changes proposed are in the interests of the Hampshire population that has been affected.
5.6. Key stakeholders have also been invited to attend the meeting to give their views.
5.7. One of the main sources of concern highlighted by stakeholders related to access. A report produced by the Trust is included as Appendix Two. The equalities impact assessment is included at Appendix Three.
5.8. Additional feedback from a local GP commissioning group is attached at Appendix Four and feedback from Hampshire PCT at Appendix Five
Recommendations
5.9. Members confirm is they are satisfied that
_ The content and conduct of the consultation has been sufficient to meet the statutory duties of the Trust
_ If the changes are in the best interests of the Hampshire population affected.
5.10. The Trust confirms how it intends to respond to any further action identified by the HOSC.
6. West Sussex PCT: Acute Service Reconfiguration: West Sussex Primary Care Trust - Acute Service Reconfiguration
6.1. The merger of the Royal West Sussex NHS Trust (St. Richards Hospital, Chichester) and Worthing and Southlands Hospitals NHS Trust has now been agreed and is on course to take place on 1 April 2009. It is not expected that any changes resulting from the merger would lead to changes in services to patients. The response of the Independent Reconfiguration Panel to the referral from the Joint Health Overview and Scrutiny Committee has been suspended by the Secretary of State pending the outcome of the proposed merger. West Sussex Primary Care Trust is now considering the implications and the issue of a revised Fit for the Future plan.
Recommendations
6.2. That the Committee be kept appraised of the situation.
7. South Central SHA: Consultation on proposals to fluoridate drinking water in Southampton and South West Hampshire
7.1. The SHA Board met on 26 February 2009 to consider the outcome of the consultation and make a decision on whether to add fluoride to drinking water as requested by Southampton City PCT. The reports considered by the Board can be found at http://www.southcentral.nhs.uk/page.php?id=364.
7.2. Copies of the analysis of responses to consultation have been included with the agenda papers (Appendix Five) for ease of reference.
7.3. Following consideration of the reports before them the SHA Board decided to proceed to add fluoride to the drinking water in parts of Southampton and southwest Hampshire. The Water Fluoridisation Panel has been reconvened to meet on 23 March 2009 to discuss the decision of the SHA and the options for further action by Hampshire County Council or the HOSC. The conclusions of the Panel will be reported orally at the meeting.
Recommendations
7.4. Members agree any further action to be taken.
Section 100 D - Local Government Act 1972 - background papers
The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.
NB the list excludes:
1. Published works
2. Documents that disclose exempt or confidential information as defined in the Act.
File Location
None
STATEMENT FROM WINCHESTER AND EASTLEIGH HEALTHCARE NHS TRUST: REPORT TO FEBRUARY TRUST BOARD 2009
Update on outpatient services
RHCH Outpatients - possible relocation
The Trust is committed to improving the facilities for its outpatient services. As
part of our estate reconfiguration we have the opportunity to look at different
options for the location of our outpatients department, one option being to
move the department from the RHCH to a city centre location. This could
considerably ease parking and access at the RHCH, as around 3000
outpatient consultations are carried out each week which brings a lot of traffic
onto the site. Also, the Department of Health is keen for outpatient services to
be provided outside of the traditional acute hospital setting where feasible.
We have commissioned an in-depth feasibility study to ascertain whether
Avalon House in Chesil Street could be a suitable location.
Parking, access and drop off will be key priorities in determining the feasibility
of any option. The service will be provided along a `one stop shop' model
where appropriate so that patients do not have to travel between the RHCH
and Avalon House.
There is circa 1,200 square metres of space at Avalon House and this could
accommodate (approx) 16 consulting rooms, three treatment rooms, offices
and reception, etc
Access problems appear to be solvable particularly emergency access (which
we expect to be needed only very rarely) and public access at the front of the
building.
Work is currently underway to look at what services could be provided on this
self-contained site (which would have X-ray and some other diagnostic
facilities) and which services would need to remain on the RHCH site - the
fracture clinic, for example. Pharmacy services could be provided from a
pharmacy in the city centre.
In terms of cost and access, leasing is far cheaper than fitting out Burrell Wing
and parking is nearby and more plentiful at Chesil Street than the RHCH.
Plus, public transport links are good and there is the additional benefit of
reduced traffic on the RHCH site which we know creates stress and frustration
for patients and staff.
Full Equality Impact Assessment
Name of Service |
Development of new inpatient hospitals for 24 Hour Assessment & Treatment Programme |
Purpose (Why are we doing it?) |
We are planning a major investment programme to deliver new purpose built inpatient hospitals over the next five years. The hospitals will provide a high quality, modern environment to assess (find out what the problem is) and treat (helping people to get better). These hospitals will be for adults and older adults with mental health problems (including people who may also have a learning disability) and people who have drugs and alcohol problems who are referred to our services. Our existing hospitals are spread over 6 locations in comparatively poor accommodation which are not fit for purpose; for example they have very limited access to outside space, and have insufficient space to provide a full range of person centred therapeutic services in a single setting. We believe that the implementation of the 24 Hour Assessment and Treatment Programme will achieve the Trust's aim of developing hospital services with a consistent model of care, modern standards and a sustainable approach. The anticipated benefits for people are: · Modernised care, which promotes effective and high quality clinical interventions within the context of an integrated, whole system model · Inpatient wards, which improve privacy, dignity, autonomy, therapeutic activities and safety for services users, and achieve modern standards of design · Improved visitor experience with purpose-built environments offering private space for meeting with patients and car parking · Working environments for staff, which are modern and safe, provide all necessary facilities, and promote engagement and development in their careers · A better and fuller range of services by having scarce specialist resources brought together onto fewer sites · A new strategic disposition of sites, which maximises access and provides flexibility for future use Our new hospitals will have an emphasis on providing safe, therapeutic surroundings to aid recovery and well-being. We are aiming to create a natural environment where people feel safe and have privacy. Key features of the new hospitals include: · Single bedrooms with en-suite shower rooms · Direct access to safe gardens and outside space · Natural light and ventilation · Areas for recreation, socialising, quiet time and spiritual practise · Space to meet visitors and families · Art rooms and multi-purpose therapy spaces · Assisted daily living skills kitchens · Individual therapy spaces · Fitness room, computer room and library · Drinks and snacks areas The Trust is committed to providing sustainable developments for the future. The vision for our new hospitals is that they will be energy efficient, low carbon, easy to maintain and represent value for money over the lifetime of the buildings. |
Intended Outcomes (What results do you expect to achieve?) |
Outcome 1: Accessibility - Satisfactory access to all inpatient hospitals by public and private transport - programme will provide hospital locations which offer the best fit for clinical effectiveness / affordability and acceptability (access) Outcome 2a: Creating Respectful Places - The accommodation will reflect the differing requirements of a diverse population - the accommodation will support delivery of a non discriminatory model of care based on needs - creating respectful places Outcome 2b: High Quality Therapeutic Environments - The design and the built environment reflects diversity in all areas (gender, race, religion, sexual orientation, disability, age, transgender and human rights) - the design and build will provide high quality, purpose built environments able to meet diverse needs of those using them Outcome 3: Diverse Expert Staff - Staff recruitment and retention is based on merit and experienced staff are recruited and retained - the new hospitals will provide centres of excellence concentrating staff specialist skills and creating respectful places to work in |
Stakeholders (For whom is it intended?) |
People who use our services with Mental Health issues and their carers and families, staff, visitors, the public from our diverse communities. The Trust serves a population of 1.3 million which is characterised by largely affluent and well informed communities. Most boroughs have low deprivation however there are pockets of significant deprivation across Surrey and North East Hampshire and in particular areas the of Woking, Aldershot, Spelthorne, Epsom and Ewell, Reigate and Banstead, and Guildford. Diverse ethnic communities are developing in Surrey, notably the Asian and Afro-Caribbean communities in the Woking and Epsom areas. In the Fleet and Aldershot areas of North East Hampshire many Nepalese families (from the army Gurkha community) have settled. In addition, Surrey has one of the largest populations of Gypsies and Travellers in the country. Analysis of population growth indicates that the working age adult population will increase by about 2% over the next 20 years. The older adult population presents a different picture. From 2008 to 2029 it is estimated that there will be a 35% growth in the over 60s population across Surrey. In the shorter term, up to 2018, 14% growth is predicted for the over 60s. Within the relatively small numbers of people over 85 there is an anticipated increase of 34% for this population. The number of people with a learning disability is growing due in part to greater life expectancy. Emerson & Hatton, C; have estimated that there will be a growth in the number of people with a learning disability within the general population of 5-6% in the next decade (Estimating Future Need / Demand for Supports for Adults with Learning Disabilities in England, Lancaster University, 2004). More information and analysis of the population which we serve is provided in Fact Sheet 1, appended to this document, and has informed our impact assessment work. |
How our Impact Assessment has been Developed
This Impact Assessment has been developed as part of the Trust's 24/7 programme which is overseen by a multi agency Programme Board. Its development has been supported by two seminars involving people who use services and staff involved in the provision of the services and facilitated by the Associate Director of Diversity and Inclusion and also the ongoing feedback the Trust has received during the project involvement and engagement processes and public consultation.
A screening exercise was conducted using the Trust's screening tool before the full impact assessment was conducted.
The Impact Assessment is being published during the extended consultation period on the 24/7 programme. The Assessment considers the overall proposal to create 3 new hospital locations and notes the current recommended option which has emerged from the programme teams work to date. However the final location of the hospitals will be determined through the consultation and at this time the Impact Assessment will need to be revisited to consider the final recommended option. This Impact Assessment therefore is published as Version 1.0 but will continue to be developed as the programme progresses and revisions published periodically.
Evidence Used to Support Assessment
Appendix 1 to this Assessment lists the key evidence sources used to inform this assessment of the potential impact of these proposals on our community.
Summary of Findings
Outcome 1: Accessibility
The assessment and evaluation undertaken by the Programme Board, which has included people who use services, carers, staff and partner agencies and has been independently evaluated, is that 3 sites offers the best balance between the needs to achieve access and acceptability for the community, affordability and clinical effectiveness. These proposals will affect the relatively small number of people who require acute hospital assessment and treatment; each year c2, 100 hospital admissions take place across Surrey and North East Hampshire each year and c.599 staff. The majority of the Trusts services are provided in the community as close as to people's homes as possible through our network of community teams who will remain borough based; the number of admissions therefore compares with c260,000 community contacts and 1,856 contacts per annum Home Treatment episodes which offer an alternative to hospital care.
The reduction of the number of sites providing inpatient services from the current 6 to 3 will mean that some people will have to travel further for their hospital treatment than currently is the case; for some there will be no change and for others their hospital facilities will be closer. The same will be true for staff.
The importance of accessibility and the ease of transport has been recognized as one of the most important features for consideration in the development of the options for hospital location and was given the highest weighting in the benefits criteria against which options were shortlisted and the preferred option identified. Initial transport and travel analysis was done as part of the project and in response to concerns more detailed analysis has been commissioned to include costs. This assessment is due to be published in February 2009 and will inform final decision making. The Trust is committed to working to mitigate the impact of travel to the final hospital sites chosen through: influencing local public transport providers; developing links with community transport providers; ensuring access to the Hospital Travel Costs Scheme; the Trust will also consider how it might be able to support travel arrangements, particularly for people who use services and those with disabilities, with payments for travel arrangements.
The Trust's main commissioners, Surrey PCT and Hampshire PCT, have worked with the Trust to advise us of the number of acute hospital beds they require for their communities. These take into account: future commissioning intentions and population forecasts; the Needs Capacity Expenditure Analysis completed by MHS on behalf of the Trust in June 2007; and two reports from consultants Whole Systems Strategies produced in December 2007 on behalf of Surrey PCT: `Mental Health Services for Younger Adults Commissioned by Surrey PCT' and `Older People's Mental Health Services' Commissioned by Surrey PCT.
Outcome 2a: Creating Respectful Places
The Trust's current hospital facilities are of low quality and constrained by their dated design to achieve the types of welcoming and therapeutic environments in which we would all like to be cared for when we are most sick. Whilst much has been done to make the most of these environments, for example the Trust now has no "poor" PEAT (Patient Environment Action Team) rated environments, we know we can never achieve Excellent ratings without new builds; for example a number of our units are unable to provide appropriate safe, outside space or the dedicated single sex recreational space expected of modern therapeutic environments and en-suite bedrooms to ensure privacy and dignity.
The new units will enable the Trust to create respectful environments and offer flexibility to ensure that people irrespective of their age, gender or disability will receive appropriate assessment, treatment and care based on their needs. The new units will therefore be able to improve the experience of all people who use services and staff.
Outcome 2b: High Quality Therapeutic Environments
The Trust's inpatient hospital buildings are of low quality and are constrained by their age and dated design. None of these units were originally designed to meet the needs of people with mental health needs. These constraints present challenges in terms of creating sufficient space to meet the diverse needs of people who use services, carers and families, visitors and staff.
The new hospitals will provide an opportunity for the Trust to create modern, purpose built facilities which through their design will improve the experience of all who use them. This design will take advantage of the latest developments in good architecture and design for providing therapeutic and respectful environments. This includes meeting the needs of people with physical disabilities, people's spiritual and religious needs and need for privacy and dignity.
Outcome 3: Diverse Expert Staff
The Trust's staff dedicated to providing inpatient hospital care are spread across its current multiple sites and different multi-disciplinary teams, specializing in the care of older people, working age adults and people with learning disabilities are not co-located in the majority of cases. There is therefore not equitable access to for example; the provision of dedicated therapy staff and space on each of the Trust's inpatient units. The reduction to 3 hospital sites provides an opportunity to increase co-location and concentrate a hub of specialist knowledge and expertise for the benefit of people who use services, making the best use of the resources available. This concentration on fewer sites will support the ability of the hospitals to implement the model of supporting people based on their individual needs rather than age, disability or primary diagnosis. Centres of excellence are known to assist with the recruitment and retention of expert staff.
Currently c33% of the Trust's staff are from Black and Minority Ethnic backgrounds. Analysis of workforce data indicates that staff from BME backgrounds are under-represented in roles graded above Band 7. The Trust is currently reviewing its recruitment and selection processes and procedures, including fully impact assessing them, to mitigate any potential areas of disadvantage influencing this. This work is being overseen by the Trust's Equality and Human Rights Steering Board and forms part of its action plan for improving the experience of staff from BME backgrounds.
The reduction of the number of sites providing inpatient services from the current 6 to 3 will mean that some people will have to travel further for their hospital treatment than currently is the case; for some there will be no change and for others their hospital facilities will be closer. The same will be true for staff. The Trust will work with its staff side to ensure that staff are well informed and supported through any change. This will ensure that they are able to make informed choices about the personal impact and opportunities of any changes for them. (see also transport mitigation in Outcome 1 above)
What evidence will tell us if outcomes are being met? |
What questions do we need to ask of the evidence to assess if the intended outcomes are being met for all stakeholders? |
Assessment of level of impact and justification for taking or not taking action |
Proposed actions for addressing disadvantage | |
Outcome 1: Accessibility Satisfactory access to all inpatient hospitals by public and private transport |
Locations of the new hospitals determined through public consultation to offer "best fit". Patient Surveys & Visitors Surveys as well as staff questionnaires that compare satisfaction rates with regard to travel access in comparison with the existing sites. Conduct studies that assess whether visitor numbers have increased or decreased. Travelling times and transport study Easy access to public transport between the new hospital and centres of population Availability of visitor's parking spaces Number of carers and others visiting service users in hospital. Disability and ethnicity data on service access. Disability Discrimination Act (DDA) audits Feedback from service users / carers / staff / others Complaints from service users / carers / staff / others. |
Have the proposals been presented to the diverse local communities and their views sought and recorded? Are the evidential measures presented in such a way that people can give feedback if they have a learning disability, a sensory impairment or if their preferred language of communication is not English? Are the visitor numbers remaining static or showing signs of increase / decrease? Do the site locations pose problems or create barriers to get to them for a diverse range of individuals or groups (minority ethnic communities, disabled people and communities living in deprived and neglected neighbourhoods) from the local community? Will the site locations exclude any group of people from easily accessing the new hospitals? What positive steps have been taken to ensure that people with mobility problems can access the hospitals? What dialogue has there been between the local bus and other public transport operators, local authorities and the Trust to enhance or develop transport links? Has the Trust developed appropriate policies to fund the cost of using taxis for service users, carers and other visitors where there are no other adequate means of transport to access the new hospital? What is the current position at existing hospitals in terms of access? Will the proposed new hospital locations worsen or improve the overall position? What does periodic satisfaction surveys of service users, carers and other visitors indicate? How satisfied are the staff who do not have private transport to access the hospital for shifts starting and finishing at non-standard daytime hours? Does the Trust have proposals to provide Trust operated bus services to certain locations without public transport? Has an independent audit been carried Out? And if yes, have the recommendations from this audit been accepted and acted upon? |
The location of the new hospitals is a very important factor, and has formed an important part of the consultation. c2, 100 hospital admissions take place each year. People are usually admitted for short periods of time. Reducing sites will mean that people will be differently affected by the final location - some will travel further, same less and some will experience no change. This impact could affect some groups of people differently e.g. people on Section 17 leave (this has been raised through the consultation), older people, people with a disability and the less well off. The choice of locations will inevitably be slightly constrained by factors such as land ownership and planning consents; the Trust would need to put in place measures to address any areas of disadvantage within specific sites once the final option is determined at the end of the consultation. This impact assessment will need to be revisited at this point. The location of the proposed hospitals may have an adverse impact if the service user, carer or visitor was accessing the site on foot because of the topography of the site. There has been informal and formal dialogue with the local authorities as a part of the public consultation process on the options put forward as preferred through the Programme Board involvement processes. An independent travelling and transport study has been completed and has provided details of financial implications for individuals and the Trust. The Trust would look sympathetically towards reimbursements of costs where appropriate. Some of the current hospital sites are very isolated and are poorly served by public transport links and are not well supported by local amenities e.g. Ridgewood Centre. And some existing hospitals are poorly served by public transport at evenings and weekends e.g. Chertsey. With regards to the current proposal the staff at West Park site, Department of Psychiatry (DoP) and Ridgewood Centre would be most affected. They have expressed some concerns about the accessibility to alternative sites e.g. currently Redhill or Guildford using public transport. The numbers of beds proposed have been developed by the Trusts Commissioners and will result in some changes in beds commissioned for some care groups. This data takes into account the anticipated changes in the population in the years ahead but will however, require investment in community services for older adults as we have seen in recent years for adult mental health services. |
Accessibility recognized through Programme Board processes and identified as a critical success factor and highest weighted benefit criteria for evaluating and shortlisting options for the hospital locations. This evaluation was independently facilitated and involved people who use services, carers, staff, partner agencies and other stakeholders. Proactively engage with individuals, communities and organised groups representing the local diversity of the community to share the Trust's proposals and seek and take into consideration their views. Public consultation to provide a good interaction with the diverse community to enable Trust to hear and take on views regarding the best fit for the final location. Use the consultation period to seek views on the proposed locations and determine the impact on particular stakeholders in accessing the new sites. Commission an independent travel times and access study to assess the impact that certain locations have on travel times and access using public / private transport. Develop plans to meet transport requirements of disadvantaged groups to mitigate as an integral part of the detailed planning process e.g. influencing public transport, community transport providers ventures, travel schemes. The Trust is required to submit a Green / Transport Plan. The Trust to ensure that people who use services are made aware of the Healthcare Travel Costs Scheme as this will assist some people to travel to the new Hospitals. The Trust to adopt a consistent approach for assessing the needs, available options and payments for travel arrangements for accessing our services for people with disabilities. There are plans to conduct dialogue with the public transport (buses) operators in respect of potential development of services. Following selection of the preferred option for hospital location analysis will be done to identified the specific issues and potential disadvantage associated with those sites as part of the Full Business Case. This will put forward modified proposals or mitigation plans to address any uneven and disproportionate disadvantage for any specific diverse group(s).
The Trust will ensure that the disabled people are treated more favourably than others in accordance with the Disability Equality Duty and provide alternate arrangements where appropriate. Once final hospital locations determined the Trust will work with local transport providers as a part of the planning process. The Trust will work with its staff side to ensure that staff are well informed and supported through any change. This will ensure that they are able to make informed choices about the personal impact and opportunities of any changes for them. This impact assessment will be kept "live" during the planning process and reviewed once final option is determined to fully impact assess the specific features of the sites which offer "best fit". The proposed bed numbers also take into consideration the impact of the implementation of the Trust's Community Services model for adults and older adults, which will continue to allow people to be treated in their own homes wherever possible. The overall aim is to ensure that community services are equitable, efficient and effective across the Trust irrespective of location, diagnosis, age, gender or disability. |
What evidence will tell us if outcomes are being met? |
What questions do we need to ask of the evidence to assess if the intended outcomes are being met for all stakeholders? |
Assessment of level of impact and justification for taking or not taking action |
Proposed actions for addressing disadvantage | |
Outcome 2a: Creating Respectful Places The accommodation will reflect the differing requirements of a diverse population |
Provision of single sex wards. Results and analysis of the Count me In Census data. Provision of faith/quiet rooms and individual spaces. Feedback from service users / carers / others Complaints from service users / carers / others. Results of surveys. Periodic audits Involvement and consultation with staff and people who use services and their carers in the design and build decisions |
Do you record the gender, transgender, sexual orientation, disabilities and ethnicity of people who use services and their carers so that you know how well your service is being used by people from minority groups? Have you thought about the prayer needs or the need for a quiet space for people who use services and their carers? Is your service religiously and culturally sensitive to meet the needs of people who use services and their carers from various religious backgrounds? Does accommodation reflect the differing needs of the diverse community? Have you identified any specific dietary or religious needs for people who use services and their carers / colleagues or any other specific requirements that you need to be sensitive to? Is the accommodation suitable for women / men, transgender, lesbian, gay, bisexual, practicing religious needs, culturally appropriate services to meet needs of minority communities? Are all stakeholders being treated with dignity and respect regardless of their age, disability, race, background, sexual orientation etc Does the accommodation provided offer significantly different experience for some members of our diverse community? |
The Programme is intended to have a positive effect on the experiences of all people who use them including people who use services, carers, families, staff and visitors. The Trust's involvement of stakeholders at its establishment to determine our shared aspirations for the Trust identified Creating Respectful Places as one of our four core values. These discussions emphasized how important high quality environments are for people requiring our services, particularly when they are most ill. The Trust's current buildings are not purpose built to provide therapeutic environments for people with mental ill health but were originally intended for other health use e.g. maternity, surgical wards. The buildings are constrained by their current architecture and space and as such are unable to provide features considered necessary to meet modern expectations for privacy and dignity and therapy e.g. en suite bedrooms, recreational space, outside space, quiet space to meet visitors, single sex recreational space, religious and faith rooms. In order to create respectful places the Trust needs to invest in its hospital facilities to create modern, fit for purpose therapeutic environments that can meet the diverse needs of the population it serves i.e. race, gender, disability, sexual orientation, spiritual and religious needs. |
The Trust collects data and analyses it to understand and address any apparent under or over representation and disadvantage in experience e.g. complaints data, Mental Health Act data, Count Me In Census, SHiFA research project, Surae. This includes the Trust's work as a Focussed Implementation Site for delivering Race Equality in Mental Health Services and Pacesetters programme. The Trust is working to improve its ability to routinely collect and analyse its activity data for all services. This work is being overseen by the Trust's Equality and Human Rights Steering Board. Positive and pro-active steps will be taken to develop engagement of people from minority groups to improve access to our services. We aim to look at the barriers and difficulties these groups have in accessing the services and to develop more culturally appropriate, gender related and interesting therapeutic environments for diverse groups. The Trust is committed to respecting people's privacy within the new inpatient environments, avoiding overlooking and ensuring that there are quiet, calm places. It is intended that respect will also be encapsulated in the design which will avoid an institutional feel. The new facilities will also enhance patient choice providing facilities to prepare beverages and snacks, meet visitors, engage in social, spiritual and recreational activities and shop for personal items. The dietary and religious needs have been well understood and the proposals will not disproportionately disadvantage any specific group. The project is not yet at the design stage. The designers are fully committed to delivering designs that reflect diversity. Stakeholders representing the diverse needs of the people using the new facilities will be engaged in the design process to make their contributions and are treated with respect and dignity. The proposed accommodation is to be designed to provide equal and positive experiences for all groups to aid speedier recovery. Active engagement in the design process of staff and people who use services and their carers will be overseen through the user groups and the Programme Board. The Outline Business Case for 24hr Assessment and Treatment Services. The environmental changes will be complemented by the Trust's on-going staff training and development programmes designed to improve the cultural competency of its staff and understanding and application of equality and human rights in their practice. This is underpinned by the Trust's Vision and Values. |
What evidence will tell us if outcomes are being met? |
What questions do we need to ask of the evidence to assess if the intended outcomes are being met for all stakeholders? |
Assessment of level of impact and justification for taking or not taking action |
Proposed actions for addressing disadvantage | |
Outcome 2b: High Quality Therapeutic Environments The design and the built environment reflects diversity in all areas (gender, race, religion, sexual orientation, disability, age and inclusivity). |
Inclusiveness of design Involvement of service users, cares, staff, chaplains and members from our diverse community in design development Compliance with all statutory obligations, including provisions under the Disability Discrimination Act.. |
Is there gender separation in wards, recreation and social areas? Is there a process that views sympathetically the views and needs of transgender persons? Is there provision of quiet and contemplation places to exercise a person's faith in appropriate settings? Is there signage and wayfinding in a variety of forms (including ethnic languages)? Have you managed to communicate and share the design proposals with representatives from the diverse community? |
The Trust's involvement of stakeholders at its establishment to determine our shared aspirations for the Trust identified Creating Respectful Places as one of our four core values. These discussions emphasized how important high quality environments are for people requiring our services, particularly when they are most ill, and staff. Our staff values conversations also emphasise this. The proposals will offer an improved experience and environment for all those who use them. The proposed design will provide greater opportunity for flexibility and space to meet the needs of individuals - for example it will ensure gender separation in terms of en-suite rooms, gender specific wings, gender specific sitting rooms etc it will also provide space to be better able to meet the spiritual and religious needs of those using the facilities e.g. provision of faith/quiet rooms. |
Please also see Outcome 2a The design will reflect best practice championed by Commission for Architecture and Built Environment (CABE). The Outline Business Case for 24hr Assessment and Treatment Services provides more details. The first meeting on Equality Impact Assessment provided an improved understanding in respect of transgender people and the operations policies and the design will reflect this. Feedback from People who use services at various disability forums indicates the need to improve signage all needs e.g. Dyslexia, visual impairments etc A variety of input will be taken to ensure that the new hospitals have appropriate signage that meets the needs of a diverse community. The outline proposals have been shared as a part of the public consultation. There has also been representation at a number of user group meetings. There will be continuing and more intensive engagement with diverse community during the design stage. |
What evidence will tell us if outcomes are being met? |
What questions do we need to ask of the evidence to assess if the intended outcomes are being met for all stakeholders? |
Assessment of level of impact and justification for taking or not taking action |
Proposed actions for addressing disadvantage | |
Outcome 3: Diverse Expert Staff Staff recruitment and retention is based on merit and experienced staff are recruited and retained. |
Staff satisfaction survey Quality supervision and Appraisals.. Staff complaints and grievances. Staff data analysis. |
How do you ensure that all staff are given equality of opportunity with regards to the proposed changes? How do you ensure that Human Rights Principles and standards are at the heart of your practices? o Ensuring accountability o Empowerment o Participation and involvement o Non-discrimination Do the proposals result in disproportionate disadvantage for any member of the diverse community? Are there processes and procedures in place that alerts to any unintended disadvantage for any member of the diverse community? What action is taken in response to the findings from the staff data analyses? |
The reduction to 3 hospital sites provides an opportunity to increase co-location and concentrate a hub of specialist knowledge and expertise for the benefit of people who use services, making the best use of the resources available. This concentration on fewer sites will support the ability of the hospitals to implement the model of supporting people based on their individual needs rather than age, disability or primary diagnosis. Centres of excellence are known to assist with the recruitment and retention of expert staff. The reduction of the number of sites providing inpatient services from the current 6 to 3 will mean that some people will have to travel further for their hospital treatment than currently is the case; for some there will be no change and for others their hospital facilities will be closer. The same will be true for staff. Currently c33% of the Trust's staff are from Black and Minority Ethnic backgrounds. Analysis of workforce data indicates that staff from BME backgrounds are under-represented in roles graded above Band 7. The changes that will affect staff may be seen as positive or negative on an individual basis. Analysis with regards to involvement in disciplinary action and the proportion of staff in higher and managerial grades seems to suggest there is a disadvantage for staff from Black and Minority Ethnic backgrounds. There is a perception that suggests there are frequent instances of lack of support from line managers and lack of enthusiasm in addressing development need for staff from minority groups to create a level playing field when re-applying for posts. The Trust is committed to improving the experiences and satisfaction of all its staff and addressing the apparent disadvantage experienced by its BME staff. Evidence suggests there are still some practical short-comings in practice. A cultural change is essential through training and zero tolerance policy. The South East Coast BME Network Race Equality Service Review report and Action Plan indicates that there are gaps and areas of improvement. Link for above: http://www.sabp.nhs.uk/aboutus/diversity-inclusion |
The Trust will work with its staff and their representatives to ensure that staff are well informed and supported through any change. This will ensure that they are able to make informed choices about the personal impact and opportunities of any changes for them. (see also transport mitigation in Outcome 1 above) Line Managers to provide support and address personal development needs through supervision, team building and quality appraisals. Ensure fair, equitable and non-discriminatory practices when putting appropriate policies into practice where staff will be re-located, ring-fenced, offered redundancies, early retirements or any other options. The Trust's action plan in response to these findings, as part of its ongoing work on Equality and Human Rights is due to be published shortly. The Trust is currently reviewing its recruitment and selection processes and procedures, including fully impact assessing them, to mitigate any potential areas of disadvantage influencing this. This will ensure the core principles of Human Rights are included when applying any changes: Dignity, Equality, Respect, Fairness and Autonomy. This work is being overseen by the Trust's Equality and Human Rights Steering Board and forms part of its action plan for improving the experience of staff from BME backgrounds. |
Further regular reviews of EqIA will be carried out to refine and strengthen the position as the project progresses.
Appendix 1
Key Evidence Sources included
Demographic data Surrey County Council
Demographic data Hampshire County Council
Trust's Integrated Business Plan
Trust's Strategic Direction
Outline Business Case - 24/7 Programme
Programme Board options development work
Mental Health Strategies reports - Health Needs Assessment, Travel Assessment
Joint Health Needs Assessments - Surrey and Hampshire Health and Social Care
Trust's Annual Workforce Data Annual Report
South East Coast BME Network Race Equality Service Review
Trust's Race, Gender and Disability Equality Schemes
Count Me In Census
National Staff Surveys
National Patient Surveys
Trust's Membership Development Strategy
DoH Pacesetters Programme - Baseline Audit Report - Health Inequalities
Public consultation discussions
Our Future Your Say consultation document - September 2008
Our Future Your Say Case For Change - January 2009
Our Future Your Say Case For Change for North East Hampshire - January 2009
Appendix Four
Surrey Heath GP Commissioning Group- response to extended consultation on the provision of inpatient mental health services.
10 March 2009
Dr Malcolm Hawthorne
Medical Director
Surrey & Borders Partnership
NHS Foundation Trust
18 Mole Business Park
Leatherhead
Surrey KT22 7AD
Dear Malcolm and Rachel
Thank you for your attendance at the recent Board Meeting of the Surrey Heath Commissioning Group as regards the current consultation for in-patient mental health services. As you know, as local GPs in Surrey Heath, we are very concerned about the proposals for in-patient services and mental health. To put into writing the points that were made at the Group: we feel that this consultation is being led by an estate strategy rather than for clinical benefit. We feel that this is being led from a secondary care driven proposal without adequate consultation with primary care and patients. As Surrey Heath GPs the loss of our local in-patient mental health unit will be devastating to our patients, particularly as accessibility received the highest weighting in your consultation paper, I believe being 25%, several percentage points higher than any other factor. As the service is proposed to be lost from Surrey Heath this obviously will not achieve what you set out to do in your redesign of services. This is also particularly important as Surrey Heath has the second highest admission rate per head of population in the county. Recent Department of Health guidance suggests that change should always be to the benefit of patients, that it will be clinically driven, that change will be locally led, that local clinicians will be involved and that a difference will be seen first before services are lost. I think it is quite clear that the recent consultation does not follow this guidance.
As champions of our local health population we feel that an integrated health service with a single point of access would be beneficial for our patients, that a redesign of services should take this into account and should be driven from a community base rather than secondary care services. The most pressing needs of our local population are for increased funding and resources at that level not the redesign of secondary care services.
In summary, we feel that we have not been properly consulted but have merely been presented with a preferred option from the Surrey and Borders Partnership. We do not feel this is in the best interest of the local population and feel that you should reconsider your proposal.
Yours sincerely
Dr Andy Brooks
Chairman
Surrey Heath Commissioning Group
Copy:
Dr Rachel Hennessy
Deputy Director
Surrey & Borders Partnership
Abraham Cowley Unit
Guildford Road
Chertsey KT16 0QA
Dr Raj Persaud
Consultant Psychiatrist
Surrey Heath
The Ridgewood Centre
Old Bisley Road
Frimley GU16 5QE
Fiona Edwards, Chief Executive of Surrey and Borders Trust
18 Mole Business Park
Leatherhead
Surrey KT22 7AD
Derek Cunningham, The Surrey Health Overview and Scrutiny Committee
Anna McNair Scott, The Hampshire Health Overview and Scrutiny Committee
Chris Botten, Locality Commissioning Manager, Surrey PCT, Pascal Place, Randalls Business Park, Leatherhead KT22 7TW
Chris Bulter, Chief Executive, Surrey PCT, Pascal Place, Randalls Business Park, Leatherhead KT22 7TW
Michael Gove MP, House of Commons, London SW1A 0AA
LMC Director Julius Parker, Surrey LMC, Albion House, 1 Wathen Road, Dorking, Surrey RH4 1JU
Appendix Five: Hampshire PCT- Update on Response to Surrey and Borders Consultation `Our Future Your Say for Hospital Services - Case for Change
1. Background:
1.1 Surrey Primary Care Trust and Surrey and Borders Partnership NHS Foundation Trust have been consulting on proposals (Our Future Your Say for Hospital Services - Case for Change) to develop three new hospitals for people with mental health problems, learning disabilities and drug and alcohol problems living in Surrey and North East Hampshire.
1.2 The public consultation began in September and was extended until end of March 2009. In response to views from the public, other key stakeholders including the Health Overview and Scrutiny Committee in Hampshire a further document entitled a `Case for Change for North East Hampshire' was published. This included further details on the processes undertaken to determine the proposed hospital locations, the proposed bed numbers as well as additional information on the health benefits of the planned changes.
2. Detail:
2.1 For North East Hampshire the proposed changes would impact on the location of hospital inpatient services for working age adults with mental health, mental health for older adults and mental health intensive care. The proposals do not affect changes to the other services provided by the Trust to Hampshire residents.
2.2 NHS Hampshire has advised the Trust that there should be no change to the number of beds they commission for the residents for NE Hampshire. However, these bed numbers will continue to be tested with the latest information on best practice and demand indices as the programme develops over the next five years. The final decision as to future bed requirements will lie with NHS Hampshire as we move to commissioning services based on treatments and outcomes.
3. Current actions:
3.1 As part of the consultation extension, further stakeholder meetings were arranged during February and March, one with particular focus on North East Hampshire. This has enabled NHS Hampshire and local stakeholders a further opportunity to consider the proposals.
3.2 NHS Hampshire is supportive of the model of care and the proposed modern facilities which will enable improved quality of services. However, Hampshire service users continue to express concerns regarding the future travel consequence for inpatient care.
4. Next steps:
4.1 Pending the outcome of the consultation, if Surrey PCT and Surrey and Borders NHS Foundation Trust were to proceed with its proposals, NHS Hampshire would monitor the impact of the change in service on Hampshire residents. In the event that there were significant challenges including access issues, NHS Hampshire would need to review the future options for providing inpatient care more locally for NE Hampshire residents.
5. Equality and Impact Assessment:
5.1 Surrey and Borders NHS undertook an equality and impact assessment. The extract from their consultation document states:
`An equality and impact assessment (EIA) screening exercise on the impact of the 24 hour assessment and treatment programme on minority groups was conducted in November 2008. At the close of this workshop it was agreed that the trust would undertake a full EIA. This work was undertaken through a second seminar held in December 2008. The outcome of the assessment is due to be published in February 2009 and will form part of the information made available during the extended consultation period until 31 March 2009'.