Title of report: South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) Review of Rehabilitation & Recovery Services

Transcription

1 Name of meeting: Health and Social Care Scrutiny Panel Date: 4 August 2015 Title of report: South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) Review of Rehabilitation & Recovery Services Is it likely to result in spending or saving 250k or more, or to have a significant effect on two or more electoral wards? Is it in the Council s Forward Plan? N/A Report produced by SWYPFT No Is it eligible for call in by Scrutiny? No Date signed off by Director & name Is it signed off by the Director of Resources? No The report has been produced by SWYPFT Is it signed off by the Acting Assistant Director - Legal & Governance? Cabinet member portfolio Prevention, Early Intervention and Vulnerable Adults Electoral wards affected: All Ward councillors consulted: N/A Public or private: Public 1. Purpose of report 1.1 To brief members of the Health and Social Care Scrutiny Panel on the SWYPFT review of its Rehabilitation and Recovery Services. 2. Key Points 2.1 The review has taken place over an 18 month period and has involved service users, carers, staff and other key stakeholders and has included consideration of how to increase the effectiveness of the wider rehabilitation pathway and out of area placements. 2.2 The review has also analysed the use of SWYPFT s three in-patient rehabilitation units that are located in Wakefield, Calderdale and Kirklees.

2 2.3 Representatives from SWYPFT will be in attendance at the meeting to provide the Panel with details of the work that has taken place. 2.4 A report that provides an overview of the review and the work that has taken place is attached for information. 3. Implications for the Council This is a report for information. 4. Consultees and their opinions Not applicable 5. Next steps That the Panel take account of the information presented and consider the next steps it wishes to take. 6. Officer recommendations and reasons That the Panel consider the information provided and determine if any further information or action is required. 7. Cabinet portfolio holder recommendation Not applicable 8. Contact officer and relevant papers Richard Dunne, Principal Governance & Democratic Engagement Officer, Tel: richard.dunne@kirklees.gov.uk 9. Assistant Director responsible Julie Muscroft, Assistant Director: Legal, Governance & Monitoring

3 Summary of Proposals for Rehabilitation & Recovery Enfield Down Sam Jarvis, Rehab and Recovery Transformation Project Lead, Calderdale and Kirklees BDU Ryan Hunter, Transformation Programme Manager July, 2015

4 2 Introduction This brief report outlines the purpose, findings and initial recommendations of the Trust wide Rehabilitation & Recovery Services Review. The review has taken place over an 18 month period involving service users, carers, staff and key stakeholders, and has considered how SWYPFT services can be most effective within the wider rehabilitation pathway, including out of area placements for those with high level rehabilitation needs. The project has included the future of the three current rehabilitation units at Wakefield, Kirklees and Calderdale and the needs of existing service users and what is required in the future to meet the needs of services users in a safe and sustainable manner. This review has also considered the impact of partnerships across health and social care, public and third / independent sector, and the role of innovations developing out of the Implementing Recovery through Organisational Change (ImROC) programme such as Recovery Colleges and drawing on lived experience in delivering services. The overall aim has been to explore options for providing care closer to home in the community. Mental Health Rehabilitation can be defined as: A whole systems approach to recovery from mental illness that maximises an individual s quality of life and social inclusion by encouraging their skills, promoting independence and autonomy in order to give them hope for the future and leading to successful community living The components of a whole systems rehabilitation pathway include a range of services across inpatient and community, health and social care, public and third / independent sector provision:

5 3 Current Service Model The Trust provides a number of elements of the rehabilitation pathway: Acute Service Acute Wards, Psychiatric Intensive Care Unit (PICU) Forensic Services Medium / Low Secure In-patient rehabilitation Units (mixed long term / short term) Community Teams Assertive Outreach Team (AOT), Community Mental Health Team (CMHT) including Care Package Approach (CPA) coordination / case management of individual placements in other out of area and in-area inpatient and residential placements depending on level of need One of the strands of the review was an analysis of in-patient rehabilitation units provided by SWYPFT. These units exist in three of the four localities: Wakefield, Calderdale and Kirklees. The Trust does not provide dedicated rehabilitation beds in Barnsley due to the proposed enhanced community model having already been implemented working with service users, carers, Clinical Commissioning Groups (CCGs), Local Authorities and other key stakeholders. Out of scope are the high dependency placements with other providers, although data in relation to this is referenced. The review looked at the service delivered across the units and found that they shared common issues which impacted on their ability to deliver an effective rehabilitation service. Working in partnership with Mental Health Concern, a third sector provider of rehabilitation services in the north east, we were able to identify issues about the way services are presently delivered. We found a variation in levels of need and acuity within the units ranging from respite through to acute step down and long term care. This has been a major challenge for units trying to deliver effective outcomes for all service users. The service user mix and the suitability of estate in each area has also hindered the flow of service users moving from out of area placements back to their local area and back into their communities.

6 4 Mapping of people with rehabilitation needs across units, community teams and in out of area placements, also showed a significant concentration of people with cluster* 13 (Psychosis with High Level Need) and cluster 17 (Psychosis and Affective Disorder Difficult to Engage), who were typically supported by the assertive outreach teams, and in future, if the recommendations are accepted, within the enhanced community pathway. *[clusters are a methodology that describes needs based groupings and support care pathway and packages design] The project also noted a significant out of area spend by Clinical Commissioning Groups on rehabilitation in-patient services in each area. Key to an effective pathway and the repatriation of service users, is the ability of the units and the community teams to facilitate timely return to each district in appropriate accommodation to the needs of the service user. Issues with current model Needs Specialist Rehab / High Dependency Long Term Complex Care Short Term Complex Care (+ step down) Intensive Community Support Issues The community rehab units that we have are trying to meet a diverse range of needs for people in a broad mix of clusters. This impacts on effectiveness. The mix of needs includes; long term complex care, people ready to move on to intensive community support, acute overspill, and in some cases people requiring specialist rehab placement. Higher levels of acuity than intended. Intensive Community Support is not present in our current model. Bed based alternatives are not in tune with Trust vision and values and leads to fewer people living in own home in their community. Leads to inappropriate diversion of community teams and blocking the acute pathway, with knock on impacts on use of Out of Area Treatment which is costly, socially dislocating and in some cases unnecessary. Market for long term care requires development in some areas Traditionally people in Kirklees with rehabilitation needs are cared for and supported within inpatient units both locally and out of area. Working with Mental Health Concern and engaging with service users and carers, the project recognised the need to: Ensure SWYPFT in-patient provision has a clear focus within the rehabilitation pathway Identify potential for reducing in-patient provision and maximising capacity for supporting people in their own tenancies Improving patient/service user flow within the pathway

7 5 Enfield Down The community rehabilitation unit in Kirklees is located at Enfield Down, in Huddersfield. The building is owned by Kirklees Council and was formerly an Older Peoples Home. The site was established as an NHS facility following the closure of Storthes Hall Hospital in the early 1990s, with the repatriation of a number of historical Storthes Hall long term beds. The bed base was originally split between Older People and Working Age Adult beds, but over time the site has moved away from providing an Older Persons service to focussing on Working Age Adults. The building had also been used to provide crisis beds to avoid hospital admission and as several of the original Storthes Hall cohort of people have now died, the unit has now shifted its focus to offer its current rehabilitation service. There is currently capacity for 31 service users in a main building of 28 single bedrooms and an annexe building of 3 flats. 28 of the beds are commissioned by the CCG and there are 3 social care beds. The unit is occupied by 28 people currently. It serves the whole of Kirklees, with Kirklees residents only. The building has been recently redecorated and refurbished cosmetically. However there are a number of issues including no potential to further develop the building in its current capacity, a lack of personal space, a lack of bathrooms and toilets, no potential for en suite facilities, and difficulties in managing the single sex agenda. Access for wheelchair users or people with physical disabilities is poor due to confined spaces and corridors internally. Enfield Down Bed Utilisation 01/04/14 31/12/14 Kirklees CCGs commission 28 Adult Rehabilitation beds at 85% occupancy equating to 23.8 beds, actual occupancy for the period 1 st April to 31 st December 2014 is slightly above the commissioned level of activity at Length of Stay Length of stay Reporting period 01/01/ /12/2014 (current inpatients at end of reporting period and clients with an episode on the ward during reporting period) Sum of Ward LOS (Days) Count of Clients Count of episodes Length of stay on ward (current and discharged clients) Enfield Down Note the length of stay only relates to count of OBD s on the above ward (an individual may have had further ward stays on other wards during their inpatient episode but this has not been counted in the above). *OBD = occupied bed days Reporting on length of stay on each unit is problematic as this ranges from short / medium and long stay reflecting the mixed levels of need.

8 6 Proposed Future Model Proposed components of future model Specialist rehab placements (including out of area) Community Rehab Team (Kirklees & Calderdale) Community Rehab Unit 20 beds (Calderdale Kirklees and Wakefield) LoS 1-2 years Combined capacity of 18 service users per annum. 14 concurrently/ 20% turnover p.a. Principal of additionality High Dependency Unit (in area) Community Rehab Team (Wakefield) Long Term Care Supported tenancies Consistent care co-ordination at all levels. Most with Assertive Outreach Team, but also Community Mental Health Team (enhanced pathway in future) and Early Intervention in psychosis Team. Psychosis clusters. With high dependency unit added get consistent medical responsibility throughout Following an options appraisal the model proposed by SWYPFT (but not yet confirmed with CCGs) involves four suggested changes to the Rehabilitation and Recovery Services delivered by the Trust in Wakefield, Kirklees and Calderdale. The preferred option offers the following services: 15 Long Term Complex care packages (Third Sector) for Kirklees & Calderdale 20 bed In-patient Rehabilitation Unit (SWYFT) for Kirklees, Calderdale & Wakefield short to medium term (proposed to be located at Enfield Down on the basis of the size of the unit, compared to those in Calderdale and Wakefield) 18 Enhanced Community Support packages (SWYFT) for Wakefield and Kirklees / Calderdale The project will result in the reduction of the bed base by 36 beds and as a consequence a reduction in the workforce, with resources being reinvested in an improved community service to support enhanced community packages of care. The function of the remaining unit, proposed as Enfield Down, will be to provide short term / step down in-patient rehabilitation for a period of 1-2 years. The above deliverables will require additional co-ordination capacity across existing community services, with the establishment of an Intensive Community Support service in all three districts. The function would be to deliver intensive rehabilitation support for people in their own tenancies over and above that delivered by health and social care at present in the community.

9 7 Discussion with CCGs A series of meetings have taken place with Kirklees CCG. The focus of these discussions has primarily been to review current provision for 42 Out of Area (OOA) Service Users with rehabilitation needs (which is higher than Wakefield / Calderdale who have 10 and 11 OOA placements respectively). A review of 10 of the OOA cases has been completed and a review of the panel process offer has also been undertaken. The Trust and CCG are focussed on who is going out of area and possible repatriation, stemming the flow of high cost packages, and keeping services users within their own communities. Conversations are ongoing about the potential to move resources into an enhanced community rehabilitation service and further conversations are planned with the CCG on 5 August to help establish how services can be reconfigured to meet service user needs. We are also currently completing a deep dive profile of all Enfield Down patients with a view to resettling service users in the community, supported by enhanced community care packages, wherever possible. Engagement with CCGs across the SWYPFT footprint are ongoing to establish if a shared 20 bedded unit can meet commissioners needs in the short term, or if an individual locality solution is the direction of travel. The detail of an enhanced community service is currently under review but will take account of the following three principles: Proactive care coordination to bring people back from out of area placements where possible. Reducing the flow of out of area placements by directing people into the community that might otherwise have been sent out of area or to a bed in Enfield Down Improving the patient flow, by stepping down some people from Enfield Down to the Community, which in turn releases bed space in Enfield Down. Delivering these changes should also enable further opportunities via improved patient flow across the wider pathways, to reduce out of area bed usage, promote earlier discharge and achieve stable tenancy support, a major cause of relapse and social stressors. The Intensive Community Support service would be suitable for: People with severe mental health problems resulting in a high level of disability including people with dual diagnosis. People with significant levels of assessed risk, where close risk management is required. People who services find difficult to engage. People for whom intensive, at times daily, assessment and support is appropriate to maintain mental wellbeing, relationships, social inclusion and general functioning. People who struggle to maintain a tenancy or cope with their chosen form of independent living including managing their finances. People who require assessment and support with significant aspects of activities of daily living, and would benefit from specialist health interventions.

10 8 Timescale / Plan for taking forward The focus of the next three months will be: Ongoing service user assessment CCGs support / consultation Local Authority commissioner/ partner support Overview and Scrutiny Workforce consultation Use of estate