CNTW Estates Strategy - Where do we want to be?

• Poor condition of Monkwearmouth Hospital older buildings.
• Elements of the OPS for South Tyneside are based at Monkwearmouth.
• Uncertainty over long term future / sustainability of Rose Lodge in its current location.
• Poor medical staff accommodation and links to admin staff.
• Community teams in Sunderland - teams are suggesting a need to merge / co-locate, in order to provide a better service and cost benefits, however the team configuration has not been evolved.
• Community transformation model needs to be reviewed in order to address shortfalls.
• Poor accommodation for Psychiatric Liaison teams on acute hospital sites.
• Brooke House - could it be a consideration to move it to Meadow View.

Meadow View is not considered suitable for a wide ranging decant ward.

• Community provision in the West end of Gateshead is considered poor.
• Dryden Road needs to be upgraded.
• Need more bookable space for group work.
• Safe space for staff to see clients.
• Accessibility for clients to attend community facilities needs to be considered for future developments.
• Crisis team should be located on the SNH site.
• Poor facilities for staff across most sites.
• Poor accommodation for Psychiatric Liaison teams.
• Older peoples beds need to be resolved on the CAV site as a priority following sale to University and impending site development.
• Poor accommodation on the CAV site.
• Benton House generally does not meet team needs and car parking is poor.

• Trust is moving to a more specialist type of service in the Autism sector with increasing demand for bespoke packages of care.
• The need for flexible / adaptable estate.
• Future moves out of “main stream services” into specialist / challenging areas of care.
• Homeworking - how can this be supported.
• More robust accommodation will be required to cater for a challenging patient group.
• Druridge on the SGP site is underused.
• The client group on the SGP Village is becoming more challenging and consideration should be given to moving them to alternative accommodation - perhaps Druridge ward as it is empty.
• Major redevelopment for Northgate is welcomed.
• Not all services impacted by CEDAR have a plan to relocate the services.
• They need greater CCTV coverage.

• Future of Yewdale ward needs to be considered as it is in poor accommodation.
• Carleton Clinic accommodation is poor- lack of en-suites, poor layouts.
• Overuse of mixed sex accommodation.
• Layout of accommodation on the Carleton Clinic site is poor and issues with NCIC and shared space need to be resolved.
• 136 Suite not fit for purpose.
• Fragmented site at Carleton Clinic due to house building.
• PICU closure with.

• Lack of standardisation across the estate
• Provision of safe environments incorporating safety features varies between buildings, these safety features include:
  • CCTV
  • Seclusion room standards
  • Metal detection
  • En-suite doors
  • Bedroom door alarms
  • Nurse call
  • Standardised Staff Attack System
  • Patient monitoring

• Location of corporate services – on hospital sites or off site.
• Working from home model following COVID needs to be explored, and this may reduce need for space.
• Outside space for recreational use is not fully utilised.
• Ventilation in some areas is reliant on windows that have limited opening, and this problem has been magnified due to COVID.
• Need to focus on the environment.

With climate change labelled the greatest threat to health in the 21st century by medical journal The Lancet, in March 2020 CNTW’s Board joined a growing number of NHS organisations in declaring a ‘climate and ecological emergency’.

The Green Plan sets out a number of Estates related actions that CNTW will achieve. Initial targets were set for March 2022; however, the plan will be updated on an on-going basis to reflect a new set of actions for working towards the key goals. These actions cover a wide range of topics and include:

• Reducing our own carbon emissions to net zero by 2040.
• Making the most of our green spaces for service users, carers, staff and local communities to enjoy, encouraging biodiversity and connection with nature.
• Minimising waste and inefficiency as much as possible.
• Ensuring we consider the social and environmental impact of any decisions we make.
• Working with our partner organisations to ensure a co-ordinated regional response to the impact of climate change.
   

The government has published a draft Mental Health Bill for pre-legislative scrutiny, to modernise the Mental Health Act for the 21st century.

The draft Bill establishes that its proposals are expected to bring significant benefits to patients interacting with the MHA through increasing patient choice and autonomy over their treatment, ensuring they are treated with dignity and respect, improving inpatient therapeutic environments and promoting equality throughout the process.

The draft Bill proposes that further limits to the extent to which the Act can be applied to people with learning disabilities and autistic people, most notably by not permitting detentions under Section 3 where the patient in question does not have a co-occurring mental health condition that requires hospital treatment. This may impact on the services provided by CNTW.
 

During 2015/16, work began to lay the foundations for better, more responsive and accessible mental health services. The Immediate priorities for service redesign are:

• To increase access to specialist perinatal care.
• To reduce the number of out of area placements for children, young people and adults through the provision of more care closer to and at home.
• To increase access to crisis, care liaison services in emergency departments and inpatient wards.
• Suicide prevention.

The NHS - Five Year Forward View (2016) sets out a vision for the future of the NHS Services and articulates why change is needed, what that change might look like and how it can be achieved. It acknowledges that “one size does not fit all” and describes various models of care which could be provided in the future, defining the actions at local and national level to support delivery.

The Forward View covers areas such as disease prevention; new flexible models of service delivery tailored to local populations and needs; integration between services; and consistent leadership across the health and care system. 

In terms of mental health, The Forward View recognises that physical and mental health are closely linked - people with severe and prolonged mental illness die on average 15 to 20 years earlier than other people. 

The strategy states that the NHS must drive towards an equal response to mental and physical health and towards the two being treated together the ambition being to achieve genuine parity of esteem between physical and mental health.

This implementation plan followed the NHS Long Term Plan. The implementation plan sets out a number of priorities aimed at transforming mental health services towards a more integrated, population-level health systems which will support more localised and personalised responses to health inequalities across the prevention and treatment spectrum.

The core ambitions set out in the Implementation Plan are summarised in the table below.

Specialist Community Perinatal Mental Health

• Greater access to community services
• Maternity outreach clinics

Children and Young People’s (CYP) Mental Health

• Increased services and access to community teams.
• 24/7 crisis provision.
• Comprehensive 0–25-year-old offer that reaches across mental health services for CYP and adults.
• Target of 95% CYP with eating disorders accessing treatment within 1-4 weeks depending on urgency.

Adult Common Mental Illnesses

• Increase access to IAPT services.
• Adult Severe Mental Illnesses (SMI) Community Care.
• New integrated community models for adults with SMI (including care for people with eating disorders, mental health rehabilitation needs and a ‘personality disorder’ diagnosis) spanning both core community provision and also dedicated services will ensure adults and older adults per year have greater choice and control over their care, and are supported to live well in their communities.

Mental Health Crisis Care and Liaison

• Provide crisis resolution and home treatment (CRHT) functions that are resourced to operate in line with recognised best practice, delivering a 24/7 community-based crisis response and intensive home treatment as an alternative to acute inpatient admission.

Therapeutic Acute Mental Health Inpatient Care

• Deliver against STP-level plans to eliminate all inappropriate adult acute out of area placements.
• The therapeutic offer from inpatient mental health services will be improved by increased investment in interventions and activities, resulting in better patient outcomes and experience in hospital. This will contribute to a reduction in length of stay for all services to the current national average of 32 days (or fewer) in adult acute inpatient mental health settings.

Suicide Reduction and Bereavement Support

• Deliver against multi-agency suicide prevention plans, working towards a national 10% reduction in suicides by 2020/21. This includes working closely with mental health providers to ensure plans are in place for a ‘zero suicide’ ambition for mental health inpatients.

Problem Gambling Mental Health Support

• There will be a total of 15 new clinics providing NHS specialist treatment for people with serious gambling problems. This will include piloting provision for under 18s.

Provider Collaboratives (formerly ‘New Care Models’) and Secure Care

• All appropriate specialised mental health services, and learning disability and autism services, will be managed through NHS-led provider collaboratives over the next five years.
• NHS-led Provider Collaboratives will become the vehicle for rolling-out specialist community forensic care.

The report highlights that people who use Mental Health Services, and those that care for them, continue to report gaps in provision and long waits for services. It also highlights that there is still insufficient support within communities and that there is as yet little impact on the enormous gap in physical health outcomes for those with mental health problems.

The report identifies 25 aspects of mental health care and support where government, along with health and social care leaders, academics and a range of representative organisations, expect to see tangible changes in the next few years. The impact of these changes is not fully understood, however as an organisation the Trust recognises the need for change and will react accordingly when service change is required.
 

The Government and leading organisations across health and social care are committed to transforming care for people with learning disabilities and / or autism who have a mental illness or whose behaviour challenges services. The report produced by Sir Stephen Bubb outlines how to accelerate the transformation of these services including developing a clearer model for health and care services, describing outcomes and associated performance indicators.

As the provider of a comprehensive range of services for people with learning disabilities and / or autism the Trust is working with stakeholders to review and, where appropriate, reshape services.

Guidelines reflect on the investigation into the abuse at Winterbourne View and other similar hospitals and the commitment to transform care and support for people with a learning disability and/or autism who display behaviour that challenges, including behaviour that can lead to contact with the criminal justice system. This is focused on building up community capacity and reducing inappropriate hospital admissions.
 

This guideline covers services for children, young people and adults with a learning disability (or autism and a learning disability) and behaviour that challenges. It aims to promote a lifelong approach to supporting people and their families and carers, focusing on prevention and early intervention and minimising inpatient admissions.

The guidance is clear that, children, young people and adults with a learning disability and behaviour should only be admitted to inpatient units if assessment and care planning show that their needs cannot be met safely in the community, and all possibilities for doing so have been considered and exhausted. This may therefore impact on the provision of services offered by CNTW.

This review followed a similar piece of work which looked at the acute care sector. The report made a number of findings relating to estates and facilities management:

• Of the £1.3 billion spend per year by mental health and community trusts there was significant variation in the running costs per square metre, from about £30 to over £230, and in the use of space.
• There is scope for trusts to rationalise their estate, building on good practice demonstrated by a number of trusts across the sectors, and in line with ongoing work in STPs. One trust found it could dispose of 14% of its properties.
• The review found that on average 3.7% of space in the community and mental health sectors is left empty, with a further 2.2% underused. In terms of leasing property, the report recommends that NHS Property Services and Community Health Partnerships arrangements should be reviewed.
• NHS Improvement will provide a more comprehensive set of benchmarks for the sectors, and trusts should review their estate to identify opportunities for consolidation and rationalisation.
• NHS Improvement will also review the current arrangements for estates leased from property companies.

The Estates Strategy for CNTW must therefore be mindful of the findings of the Carter review recognising the value of the Estate and the impact on positive patient outcomes along with the challenges of ensuring estate is efficiently operated and delivers value for money.

The Naylor report followed a high-level review considering the options open to the NHS to achieve best value, from NHS property, in alignment with the delivery of the vision set out in the 5YFV.

The Naylor report was clear that the “NHS estate is one of the key enablers to change in the health system and directly contributes to the delivery of high-quality healthcare to patients”. However, it also acknowledged the general consensus that the current NHS capital investment is insufficient to fund transformation and maintain the current estate. It was estimated that in England the capital requirements might total around £10bn, with a conservative estimate of backlog maintenance at £5bn and a similar sum likely to be required to deliver the 5YFV.  The view was that this could be funded through property disposals, private capital (for primary care) and from HM Treasury. However, the NHS needs to develop a robust capital strategy to determine the final investment requirements through the STP plans. This review was predicated on widely accepted assumptions that the NHS estate is not currently configured to maximise benefits for patients or taxpayers. It considered: 

• The size of the opportunity – building on the Carter Report on efficiency.
• The mix of incentives and sanctions required for delivery.
• How to strengthen capacity and capability across the system.

The Estates Strategy for CNTW must therefore be mindful of the findings of the Naylor Report, recognising the value of the Estate and the impact on positive patient outcomes along with the challenges of funding capital investment and the need to innovatively look to extract value out of the residual estate including the sale and disposal of surplus estate.