A Complete
Draft Business Case
BD183 - Rationalisation of Newcastle
Dementia Pathway
Document Control
Purpose of this document
The purpose of this document is to present the Business Case for the rationalisation
of the dementia Pathway in Newcastle.
Version Control
Date
Version
Status
Author
Update
Comments
29/04/2013
14/05/2013
1
2
Draft
Draft
Initial draft for team
Further information
added to support
clinical need
16/05/2013
3
Draft
Steve Brooks
Steve
Brooks/Christine
Lowthian/Carron
Yeouart
Steve Brooks
22/05/2013
4
Draft
Steve Brooks
24/05/2013
5
Draft
30/05/2013
6
Draft
05/06/2013
7
Draft
Steve
Brooks/Christine
Lowthian
Steve
Brooks/Lesley
Willoughby
Steve
Brooks/Christine
Lowthian
07/06/2013
8
Draft
Steve Brooks/
Carron Yeouart
13/06/2013
9
Draft
Steve
Brooks/Lesley
Willoughby/Lee
Turner
19/06/2013
10
Draft
Steve Brooks
21/08/2013
11
Draft
Steve
Further information
added re Equality
and Diversity
Assessment
Text amendments/
items required for
clarification
Text amendments,
activity and costs
Addition of
commissioner
baseline figures
Text amendments,
cost
clarification/revised
commissioner
baseline figures
Clarification of
service user status/
revised
commissioner
baseline figures
Amendment of
investment
costs/commissioner
baseline
figures/business
case format
Feedback from
June 2013 FIBD
Feedback from
2
22/08/2013
12
Draft
09/09/2013
13
Draft
Brooks/Caroline
Wild/Tim Docking
Steve
Brooks/Claire
Vesey
Steve Brooks
19/09/2013
14
Draft
Steve Brooks
Public Consultation
Feedback from
Staff Consultation
Feedback from
Commissioner
Consultation
Commissioner
Support
Document Approval
Version
Review Committee
Date of
Assurance/Approval
13
14
FIBD
Board of Directors
18/09/2013
3
Contents
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Introduction
Context
Case for change
The proposal
Improved service pathway, quality and outcomes
Affordability
Consultation
Project management arrangements
Recommendation
Approval
Appendices
Appendix 1 - Draft Transfer PGN
Appendix 2 - Equality & Diversity Impact Assessment
Appendix 3 – Support from Commissioners
4
1.
Introduction
The objective of this business case is to continue to rationalise the dementia pathway
in Newcastle, ensuring that the focus of the inpatient service provided by NTW is for
those requiring the highest level of care, provided by specialist dementia services.
Dementia inpatient facilities in Newcastle provide, inter alia, long term care / end of
life care. The Planned Care Group believes that people with predominately physical
care needs can be more appropriately provided in local general nursing homes. This
element of the pathway is an area that can be effectively provided by other providers
allowing the Trust to focus its resources on those at an earlier stage of the illness
who may exhibit challenging behaviour.
This will lead to a reduction in the number of dementia beds in Newcastle which are
currently used for caring for long term elderly frail patients. The proposal will allow for
some reinvestment opportunity into other Newcastle dementia services and will also
contribute to the Trusts financial delivery plan.
This development forms an integral part of the future plans for the rationalisation of
dementia care resources in line with the Planned Care Group service delivery plan
and the proposals are consistent with the Trust’s Transforming Services Programme
and its Service Model Review and will support any changes to the pathways currently
under development.
2.
Context
2.1 Local Context
The local context is viewed from the perspective of the Trust, the Service, and
Commissioners.
2.1.1 The Trust
The business case is written in the context of the Service Model Review (SMR) which
was undertaken by the Trust in 2010 and which has been broadly supported by
stakeholders including Commissioners, GP’s, Service Users, Carers and partner
agencies including the former Strategic Health Authority, and Local Authorities. The
SMR is based on a whole system service redesign approach and it shapes the
strategic direction of the Trust over the next 5 years and it is integral to the Trust’s
Integrated Business Plan (IBP) for the period up to 2017/18.
The SMR supports the Trust as it faces and responds to the Quality, Innovation,
Productivity and Prevention (QIPP) challenge of continuing to improve quality whilst
substantially reducing its cost base by 20% over 5 years. A key element of the SMR
in the context of this business case is a recommendation that the Trust should have
fewer but better resourced inpatient facilities as part of an integrated whole system
approach to service provision. This recommendation is being taken forward as part of
the Trusts Transforming Inpatient Services initiative and includes the proposal
covered by this business case.
The principal driver for change is to improve the quality of the services being
provided whilst meeting the QIPP challenge faced by the Trust. The Trust will broadly
do this in line with recommendations for service redesign proposed in the SMR. If the
5
Trust is to make improvements to the dementia pathway in Newcastle it is vital that it
identifies those areas where it can rationalise its services and facilities and reinvest in
areas which can improve service user outcomes. Services should also be delivered
from sites which offer the best physical environment.
The service redesign is also centred around Care Pathways and Packages. This
approach is mandated by the Department of Health and is endorsed by the Trust. It is
designed to ensure that service users consistently receive the right service, at the
right time and in the right place: depending on the nature of the problem, the level of
complexity, the urgency and the risk.
2.1.2 The Dementia Service
In the context of the IBP, the development of the dementia care pathway in
Newcastle focuses on the intention to provide an improved patient experience and
improved outcomes by increasing staffing ratios in the remaining dementia services,
and access to a better range of clinical support.
In Newcastle the Trust currently provides Dementia Inpatient services at Castleside
Ward (acute assessment) and Ashgrove Ward (challenging behaviour on the lower
floor and long term care / end of life care on the upper floor). Evidence and
experience of operating the new service pathway shows that long term care/end of
life care can be more appropriately and safely provided in local nursing homes. This
element of the pathway is an area that can be effectively provided by other providers
allowing the Trust to focus its resources on those at an earlier stage of the illness
who may exhibit challenging behaviour.
As part of its dementia pathway work (introduced in 2009) the Trust has been able to
successfully close long term care facilities for dementia across the Trust in recent
years, and service users have been safely moved on to other provision within the
overall capacity of beds available.
In line with implementing the Newcastle model, Dene Lodge (18 beds) closed in
2007/08, and this was followed during 2009/10 by the closure of Silverdale (22 beds).
This reflects the change in the patient profile within the Trust in recent years, and this
trend continues. In both instances service users were safely moved and
accommodated within the reduced bed capacity without any adverse impact on
access to admissions to meet clinical need. The implementation of the Challenging
Behaviour model, delivered by the Community Challenging Behaviour Team across
Newcastle, has successfully supported the discharge of people whose challenging
behaviour has resolved or can be more appropriately managed in another care
setting.
Following the reduction of the capacity of the Dementia inpatient services in
Newcastle, dementia beds are currently provided across two wards; Castleside (20
beds), and Ashgrove (36 beds of which 18 are long term care beds (on the upper
floor) and 18 are challenging behaviour beds (on the lower floor)).
6
Service
Beds
Description
Castleside, Centre
for Ageing and
Vitality, Newcastle
General Hospital
20
Castleside provides assessment, treatment and
rehabilitation by a multi disciplinary health and social
care team i.e. specialist doctors, nurses and
healthcare workers, for older people with mental health
problems arising from organic disorders such as
dementia.
Ashgrove Upper
Floor, St Nicholas
Hospital
18
Ashgrove Lower
Floor, St Nicholas
Hospital
18
Ashgrove is an inpatient unit focusing on the provision
of specialised long term care for people with complex
mental illness to ensure that seamless integrated care
pathways are provided for older people with mental
health NHS long term care needs.
2.1.3 Commissioners
Both Newcastle and North Tyneside Clinical Commissioning Groups (CCG’S) include
dementia issues within their commissioning strategies for 2013/14.
NHS Newcastle North and East, and Newcastle West Clinical Commissioning
Groups are continuing with the implementation of their Older Peoples’ review
proposals across inpatient, day care, continuing healthcare, dementia services and
carer support. Newcastle West Clinical Commissioning Group Support also intends
to improve support to those supporting people with dementia.
NHS North Tyneside Clinical Commissioning Group plans to improve diagnosis rates
and reduce the use of antipsychotic medicines in dementia and care of older people.
2.2 National context
National Dementia Strategy (2009) seeks to support people living well with dementia
in the community for as long as appropriate. The delivery of the Trust’s rationalisation
of the dementia pathway is working towards improving community services which
support people and their carers to continue to live at home for as long as possible.
The Department of Health Continuing Healthcare Guidance (2007) states that people
with long term healthcare needs should be regularly reassessed and care provided in
the most appropriate care setting to meet the person’s needs.
3. The Case for Change
3.1 Demographics and prevalence
It is recognised that the incidence of dementia rises with age and therefore demand
for all aspects of dementia services, including inpatient beds, is likely to rise
significantly by 2019. Increases of 19.1% in the 65+ age band for the Trust
catchment area are predicted, although for Newcastle the predicted increase is
10.1% by 2019.
7
The service believes however that this increase in potential activity is manageable
given the recent experience of safely reducing capacity in Newcastle. As referred to
above, the Community Challenging Behaviour Team has already enabled a safe
reduction in inpatient capacity in Newcastle in recent years by supporting patients at
home or in other settings outside the Trust. The development of the Memory
Services in Newcastle and North Tyneside will enable planning for future demand for
dementia services, and inpatient services in particular.
3.2 Clinical effectiveness and service delivery
The Trust’s dementia services are staffed by trained mental health nurses who have
developed enhanced skills to care for older people with mixed physical and mental
health needs. The clinical team is supported by a general nursing trained Nurse
Practitioner to ensure the safety of our patients whilst they require on-going mental
health treatment.
The Trusts dementia inpatient facilities in Newcastle provide, inter alia, long term
care / end of life care. However it is widely acknowledged that once a person has no
presenting challenging behaviour and their physical health needs outweigh their
mental health needs that their care can be more appropriately provided in local
nursing homes.
The Trusts dementia pathway was changed to reflect this in 2009 and new patients
entering the pathway have been successfully discharged from the dementia services
since it was implemented. The Planned Care Group considers that this element of
the pathway is an area that can be effectively and more appropriately provided by
other providers allowing the Trust to focus its resources on those at an earlier stage
of the illness who may exhibit challenging behaviour. When the patients challenging
behaviours reduce or rescind then their needs are assessed to support decision
making as to their suitability for transfer on to a general nursing home or other
provision outside the Trust.
To support this, the Dementia Service operates to a draft Practice Guidance Note
(PGN) based on Department of Health Guidance (see Appendix 1). The PGN is in
the process of being formally approved for use by the Trust. This PGN relates
specifically to patients who require transfer from the Trusts Older Persons services to
a long term, external care setting. The guidance relates to transfers mandated by
increased physical care requirements which are to be met in the external care
setting. The PGN aims to ensure the safe, appropriate and timely transfer of
patients with minimal risk to a more suitable care setting and provides a robust
framework of actions and requirements: inclusive of time frames, documentation,
consultation, transfer arrangements, care transfer and adjustment period. The
intention is to facilitate safe, collaborative and effective transfers of a vulnerable
patient group, to ensure patients are treated as individuals and to put measures in
place to minimise relocation stress for the patient and associated
family/friends/carers, and to handle the transfer process with sensitivity.
The rationale for this change is further supported by the Continuing Healthcare
Guidance issued by the Department of Health which requires the Trust to continually
assess the needs of patients and place them in the most appropriate care setting.
This means that patients are no longer entitled to a ‘home for life’ placement. The
8
Trust has however acknowledged that those patients who entered the pathway
before 2009 believed they had a ‘home for life’ placement and has to date continued,
if they choose so, to care for them within the Trust. Of this cohort of such patients the
remaining 4 are cared for on the first floor of Ashgrove which has a capacity of 18
beds.
Needs assessment work relating to the 6 patients in the upper floor of Ashgrove has
been carried out (over the past 6 months). This has provided information in relation
to discharge options. Two of these patients are on the discharge pathway. The
remaining four patients that are clinically fit for discharge, and their relatives, will be
given the choice to move to general nursing care with support or remain on
Ashgrove.
3.3 Capacity, activity and length of stay
The Trust currently (2013/14) provides 167 dementia beds, a reduction of nine since
2011/12. Average occupancy for the two years 2011/12 to 2012/13 was 133
occupied beds, representing 81% of the 167 bed capacity. The proposed closure of
the upper floor of Ashgrove will reduce total capacity to 149 beds therefore the
average activity would represent 91% of the revised total bed cohort.
However the serviced is confident that it will have options and flexibility to use beds
across the Trust if Newcastle beds are full, therefore any pressure can be shared.
In Newcastle the dementia pathway has been developing over recent years,
particularly in respect of reducing the capacity of the Long Term Care inpatient
services, and Silverdale was closed in October 2010, reducing capacity from 58 to 36
beds, with Ashgrove being left as the Long Term Care ward.
The reduction in Long Term Care inpatient capacity and activity in Newcastle has
been enabled through the development of the coordinated challenging behaviour
model including a Community Challenging Behaviour Team, and more effective
admission and discharge processes which have resulted in continued reduction in
demand on the current Long Term Care inpatient capacity within the dementia
pathway in Newcastle. In working into both care homes and in domestic settings the
Community Challenging Behaviour Team provides support and builds the skills of
staff in the community in managing challenging behaviour which has reduced the
need for hospital admissions.
Daily bed occupancy figures for 2012/13 for the two dementia wards in Newcastle,
Ashgrove and Castleside, are shown below.
9
Long term care actual activity has been managed within the overall capacity of
Ashgrove and Silverdale (which closed in October 2010) for the last three years, as
illustrated in the chart below.
10
Long Term Care in patient activity in Newcastle has continued to be managed within
the bed capacity to the extent where at the end of 2012/13, the in-patient activity
across both the acute assessment ward, Castleside and the ward on the ground floor
of Ashgrove suggests that there is the capacity to absorb the 4 patients from the
upper floor of Ashgrove within the service without any adverse impact on admissions
into the pathway, after allowing for patients who clinically fit for discharge being given
the choice to move to general nursing homes with support or stay with NTW services.
As at the end of May 2013 across Ashgrove and Castleside 30.3 beds were
occupied, representing 55.1% of the 56 bed capacity. The activity trend has
continued and, as at 12th June 2013, occupancy was 53.6% across the 56 beds (30
beds occupied). The chart below illustrates the how actual activity within Ashgrove
and Silverdale has been managed within the reducing Long Term Care capacity over
recent years.
In addition to the reduced activity on Ashgrove recent changes in practice on
Castleside have resulted in shorter lengths of stay and fewer delayed discharges for
patients who require assessment and treatment and as at 12th June 2013 activity on
Castleside had fallen to 10 occupied beds, from 17.4 at the end of April 2013.
11
Additionally the lower floor of Ashgrove includes a number of long term care patients
who, providing they are deemed suitable clinically, could be moved on to other
accommodation, and this will further reduce demand on capacity.
The Planned Care Group contends that dementia inpatient activity in Newcastle will
therefore be manageable within the proposed reduced bed complement of 38 (18 on
Ashgrove and 20 on Castleside). The 30 occupied beds as at mid June 2013 would
mean an occupancy level of 78.9% on this basis. This is illustrated in the chart below.
4. The proposal
In the light of the case for change and the strategic issues identified above the Trust
proposes to realign the and improve dementia services in Newcastle by closing the
upper floor of Ashgrove on the St Nicholas Hospital site and investing in other
dementia service in Newcastle.
This upper floor of Ashgrove is used to provide long term care/end of life care. The
number of people accommodated in the long term care/end of life service based on
the 1st floor of Ashgrove has been reducing and currently stands at 6. The continued
running of a unit with a decreasing number of people is no longer viable on either a
clinical or financial basis. The patients who are clinically fit for discharge and who are
on the discharge pathway will be moved on to accommodation more suited to meet
their needs. Those with a bed for life will be given the choice to move to general
nursing homes with support or stay with NTW services.
12
The Planned Care Group considers the proposed reduction will be manageable
within the current occupied bed levels (as referred to above in section 3) and also
based on experience of previous improvements within the dementia pathway across
the Trust and particularly those which have resulted in improved efficiency of use of
current provision in Newcastle.
The Community Challenging Behaviour Team, supported by more effective
admission and discharge processes has resulted in continued reduction in demand
on the current inpatient capacity within the dementia pathway in Newcastle. In
working into both care homes and in domestic settings the Challenging Behaviour
Team provides support and builds the skills of staff in the community in managing
challenging behaviour this has reduced the need for hospital admissions. The roles
of the three elements of the coordinated Challenging Behaviour model – unique
features of each service and the generic aspects are illustrated in the diagram below.
13
Assess for admission, coordinate planned admission if
required
Assess and treat people in
own homes
Assess and treat in care
facilities
Own
Home
Facilitate moves to
appropriate settings to
meet clients’ needs
Care
Home
Develop leadership
skills in homes
Signpost services
Support families, preventing
crisis admissions
Teaching/ training of
staff
Inpatient
Services
Develop person-centred inpatient
services
28 day discharge follow-up
Support families
Generic work of all CB Teams in all settings









To treat challenging behaviours in a competent and carer-centred, person-focused manner;
To provide a bio psycho-social model of care in which pharmacological and non-pharmacological interventions are given as part of a
rational treatment plan;
To treat CB in the setting in which they are exhibited because the settings are often linked to the behaviours;
To work collaboratively with staff, families and care facilities to improve the well-being of people in care;
To prevent unnecessary admissions to hospital;
Minimise use of antipsychotics in accordance with national guidelines;
To facilitate effective discharges from hospital to appropriate care settings;
To facilitate transfers of patients to appropriate care settings (from and between clients own-homes, wards, & care facilities);
To develop links with statutory, regulatory organizations & others (e.g. Care Quality Commission, social services, resources centres).
Although demographic information indicates that there is expected to be a growth in
the elderly population and an associated increase in demand for dementia services,
the development of the North of Tyne Memory Services will enable better planning
for future demand for dementia services, and inpatient services in particular.
Further development of Memory Services has been agreed with North of Tyne
Commissioners who are looking to improve the early diagnosis of people with
dementia to support people to live well with their dementia through developing
services which will help people develop strategies to better manage their memory
problems, plan for their future and create self resilience. Their focus is to maintain
people with dementia in the community with appropriate support for as long as
possible. This is reflected in the Service Development Plan agreed with North of
Tyne Commissioners during 2013/14, and work is on-going.
The proposed development includes a number of quality issues, and these are
summarised in the tables below.
Quality
metric
Safety
Clinical
Effectiveness
Positive Quality Issue
Proposal would need to move
forward on the understanding that
the number of beds available is
commensurate with demand.
Manageable occupied bed levels
within the reduced capacity
This is the delivery of the final
phase of the dementia pathway
implemented in 2009.
Future admissions are for those
people requiring access to our
specialised dementia services
Environments will be fit for purpose
Completion of required works on
Ashgrove
There should be a positive impact
for patients with a better
environment being made available
to suit their needs
Completion of required works on
Ashgrove
Patients whose primary needs are
in relation to their physical
healthcare will be care for by skilled
staff in an appropriate environment
Patient
Experience
Measure
There should be a positive impact
for patients with a better
environment being made available
to suit their needs
Patients whose primary needs are
in relation to their physical
healthcare will be care for by skilled
staff in an appropriate environment
A review of the environment is also to
be undertaken on Castleside to
ensure we deliver our services for
people with dementia in the best
environments
In care settings staffed by skilled
general nurse trained staff.
Patient and carer feedback
Quality
metric
Possible
Adverse Measures
Quality Issues
Mitigation
Safety
Delays to admissions
across dementia inpatient pathway due to
lack of capacity of beds.
Evidence from activity
information and
experience suggests this
is manageable.
Current activity levels
indicate that there is
enough capacity within
Newcastle. Across
Ashgrove and Castleside
there is 53.6% occupancy
as at mid June 2013.
Manageable
occupied bed levels
within the reduced
capacity
In addition, there is
capacity within the
dementia beds across the
Trust which can be utilised
if required.
Moving vulnerable older
people carries and
increased the risk of
mortality
Current and future
admissions are for
those people
requiring access to
our specialised
dementia services
Current service users that
are deemed clinically fit for
discharge will be given the
choice to move to general
nursing care with support
or stay within NTW
services.
Continuing to care for
them on the ground floor
of Ashgrove this reduces
such risk for those who
chose to remain
The service has an
excellent record of safely
managing such moves for
those patients who move
on to other service
provision.
Environment and staffing
will need to be enhanced
to manage risk of patient
group with diverse care
needs
Clinical
Effectiveness
Patients whose primary
needs are in relation to
their physical healthcare
will be cared for by
skilled staff in an
appropriate environment
Completion of
required works
Investment in
remaining dementia
services
General trained
Nurse Practitioner
engaged to support
physical health
skills of mental
health nurses in
Ashgrove
16
Implementation of robust
care plans for all of the
patients to maintain safety
and appropriate
observation levels.
Development of staff skills
and additional resource of
£196k
Specialist community staff
are already in place to
support general nursing
care providers with the
care of people who also
have mental health needs
5. Improved service pathway, quality and outcomes.
Reducing the dementia inpatient capacity in Newcastle safely will present a number
of potential risks and challenges however the Trust is currently undertaking work on a
series of pathway improvement developments which, when implemented, will
mitigate against these risks and also contribute to improvements across the wider
service pathway for dementia service users.
These developments include;







Standardising service user pathways
Using Productive Ward approaches
Improving Transitions into other services
Improving transfers
Developing Community services
Reducing delayed discharges
Developing admission protocols
5.1 Development of a standard service user pathway
There is a need to ensure that all service users experience safe, efficient and
effective care whist receiving their care within an inpatient setting. Part of the
evidence base behind this proposal demonstrates that by ensuring service users
receive the appropriate clinical care from appropriately skilled staff service user
length of stay and reliance on inpatient services can be reduced.
The Trusts Principal Care Pathways work is being developed and this will support the
development of a robust pathway across all Trust services, including those for
dementia.
5.2 Productive Ward Approach
There is a national acceptance that historically inpatient services have not operated
efficiently hence the development of the ‘Productive Ward’ initiative and more latterly
the Productive Mental Health ward has been rolled out across acute care wards
within the Trust.
Re-investment of resources in clinical staff in other Newcastle dementia teams,
including the remaining wards, following the proposed closure will help to develop the
clinical pathway and support the delivery of safe and high quality services for service
users in the remaining facilities Newcastle.
5.3 Improving Transitions into other services
Service transitions can be very disruptive for a patient so they need to be kept to a
minimum and should occur only where there is an advantage to the patient. In order
to ensure that this occurs we must provide well-defined, coordinated and transparent
pathways so that everyone understands what types of services exist, where they are,
how to access them and what functions they serve.
The following are key risks of poor transitions and care-coordination:
o Ineffective care leading to increased patient safety risks and poor
outcomes
o Poor patient experience
17
o Unacceptable variation in quality of care delivery
o Increased length of stay
New working practices are being implemented which should ensure smooth and safe
transitions between services ensuring service users receive the correct level of
service in line with their individual needs. This in turn should reduce length of stay
and inpatient bed usage. Working practices to improve transitions from December
2012 include;
•
•
•
•
•
•
Flow chart for admission, this includes whether someone has a care
coordinator or not and how allocation takes place
Flow chart for discharge including standards for attendance at meetings,
communication with community professionals
Protocols for 72hr review meeting including agreed standards for frequency of
care coordinator contact throughout admission
Protocols for 7 day follow up
Introducing the role of discharge facilitator
The role of the community liaison nurse will be strengthened and one will be
allocated to each inpatient ward
The use of the draft Transfer PGN referred to in section 3 supports the transfer of
clinically suitable dementia patients out of the Trust and along the wider dementia
pathway in to general nursing homes.
5.5 Developing Community Challenging Behaviour services
The Community Challenging Behaviour Team has been developed in Newcastle and
has successfully supported the reduction in inpatient capacity since the dementia
pathway was developed in 2009. It is envisaged that this team will continue to
support service users in the community and the reduction of in-patient capacity
proposed in this business case.
5.6 Reducing lengths of stay and delayed discharges
Delayed discharges affect inpatient services across the Trust and this is
unacceptable to the individual service user and can be very detrimental to their
recovery when this occurs. Failing to address delayed discharge means that valuable
inpatient resources will continue to be used ineffectively. The delivery of the final
phase of the dementia pathway in Newcastle addresses this.
New protocols as described above in Section 3.2 have been introduced on
Castleside and length of stay and occupancy levels have reduced over recent
months. As at mid June 2013, only 10 out of 20 beds on Castleside were occupied.
5.7 Developing admission protocols
A key concern expressed by the Trust’s commissioners and service users and carers
is related to service users being placed out of locality when they require an inpatient
stay. If protocols are not implemented or followed length of stay is likely to increase
with a resultant increase in bed usage and inability to admit dementia patients into
Trust facilities will impact on service users and their families and carers, and it will
also be detrimental to the Trusts reputation. Admission Protocols will be
implemented as part of the ward reconfiguration.
18
By implementing the protocols the patient will be placed as near as possible to their
family and local services which should in turn impact on their length of stay and bed
usage. For Newcastle residents, inpatient care out-with Newcastle will normally be to
a named ward in Northumberland. However the recent activity levels in Newcastle
have meant that no one has been required to be placed out of area.
6. Affordability
6.1
Revenue impact
Estimated savings of £896k will be made, after allowing for reduction in direct costs
of £833k (predominately direct ward budget related) and savings of £63k on indirect
costs.
There are approximately 26.0 staff working out of Ashgrove that will be directly
affected by these proposals. Of these, 23.0 wte are Nursing Staff and 3.0 wte are
administrative and facilities staff.
The current Medical, Psychology and Allied Healthcare Professionals (AHP) input to
the first floor service will be used to enhance the support to patients receiving care on
the ground floor of Ashgrove and will not be freed up for efficiency. In total this
represents 2.0 wte (0.5 wte Medical Staff and 1.50 wte Psychology and AHP input).
There will be a reinvestment of £207k into other Newcastle Dementia Services
staffing to continue the enhancement of the Trusts Dementia Services. Posts will be
made available to Staff using the TED approach.
To support the closure some transitional support from nursing and social worker will
be needed to support the transfer of patients into nursing homes if they choose to
take this option.
After allowing for the re-investment in dementia staffing and travel of £207,226, and
maintenance of some indirect costs and all corporate overheads, the activity and
income streams for the service will remain as at present with the Trust realising
efficiencies of £896,057 as a contribution to QIPP which is already implied within the
annual contract adjustment.
Revenue
Consequences
Existing
wte
Direct Costs
£
Proposal
wte
£
Efficiencies
wte
£
33.00
1,130,932
7.00
298,245
26.00
832,687
0.00
810,101
0.00
746,731
0.00
63,370
Overheads
0.0
-416,345
0.00
0.00
-416,345
0.00
0.00
Capital Charges
0.0
56,608
56,608
0.00
0.00
29.00
1,581,296
685,239
-26.00
896,057
Indirect Costs
Total
7.00
19
The proposed investment in other dementia services is;
Reinvestment in Newcastle Dementia Services
Service
Ashgrove
Castleside
Community CB
Band 7
wte £’000
Band 6
wte £’000
Band 5
Total
wte £’000
wte £’000
1.00 43,230 1.00
43,230
1.00 43,230 1.00
43,230
2.00 73,279
2.00
73,279
Older
Peoples 1.00 43,487
inpatient NoT Nurse
Practitioner Band 6 Band 7
Non pay (travel)
Total
1.00
4,000
43,487
4,000
1.00 43,487 2.00 77,279 2.50 86,460 5.50 207,226
6.2
Capital consequences
The impact on the estate will be that the upper floor of Ashgrove will be vacated and
capacity will be reduced by 18 beds.
Some minor improvements to the ground floor environment in Ashgrove to enable it
to better function as a challenging behaviour ward will be required to deliver this
business case, and the Estates Department have advised the costs of this amount to
£41k.
Following a review of the environment on Castleside it maybe that work will be
required to improve the environment from which such services are delivered and this
will therefore require further review and possible additional capital investment.
6.3
Impact on Commissioner Baselines
Impact on Commissioner Baselines
The current income levels for Ashgrove are shown in the table below.
Existing SLAs
PCT
Contract
Type
POD
Plan
Activity
Annual
Plan Price
Annual £
Newcastle N&E CCG
Block
OBD
3,623
968,402
Newcastle West CCG
Block
OBD
3,769
1,007,394
North Tyneside CCG
Block
OBD
4,380
1,169,803
Northumberland CCG
Block
OBD
53
14,130
11,825
3,159,729
Sub total SLA Ashgrove
20
The Trust as part of the national QIPP agenda has an implied efficiency expectation
within the annual contract adjustment. The service change proposed in this Business
case affects all North of Tyne CCGs. The expected QIPP savings for Newcastle
West CCG are £866,002, for Newcastle North & East CCG are £832,385 for North
Tyneside CCG are £759,132 and for Northumberland CCG are £1,917,186. The
proposed change would deliver a contribution of £285,854 towards Newcastle West
CCG’s target, £274,881 towards Newcastle North & East CCG’s target, £331,337
towards North Tyneside CCG’s target, and £3,984 towards Northumberland CCG’s
target.
The following tables show the total existing SLAs and the proposed SLAs.
Existing SLAs
Contract
Type
Plan Activity
Annual
POD
Plan Price Annual £
Newcastle N&E CCG
Ashgrove
Block
All other services
3,623
OBD
Various
Various
-
Unidentified QIPP
Total SLA
Newcastle West CCG
Ashgrove
3,623
Contract
Type
Block
All other services
Plan Activity
Annual
POD
Various
Ashgrove
Plan Price Annual £
1,007,394
Various
-
Total SLA
3,769
Contract
Type
Block
Plan Activity
Annual
POD
21,226,399
866,002
21,367,791
Plan Price Annual £
4,380
OBD
20,402,039
832,385
20,538,056
3,769
OBD
Unidentified QIPP
North Tyneside CCG
968,402
1,169,803
18,320,915
All other services
Various
Various
-
Unidentified QIPP
Total SLA
Northumberland CCG
4,380
Contract
Type
Plan Activity
Annual
POD
Ashgrove
Block
OBD
All other services
Block
OBD
18,731,586
Plan Price Annual £
53
14,130
-
Unidentified QIPP
Total SLA
53
21
759,132
49,209,621
1,917,186
47,306,565
Proposed SLAs
Contract
Type
Newcastle N&E CCG
Ashgrove
Block
All other services
Plan Activity
Annual
POD
1,811
OBD
Various
Plan Price Annual £
697,832
20,397,728
557,504
Various
-
Unidentified QIPP
Total SLA
1,811
Contract
Type
Newcastle West CCG
Ashgrove
Block
All other services
Plan Activity
Annual
POD
Plan Price Annual £
1,885
OBD
Various
20,538,056
726,025
21,221,914
580,148
Various
-
Unidentified QIPP
Total SLA
1,885
Contract
Type
North Tyneside CCG
Ashgrove
Block
All other services
Plan Activity
Annual
POD
Plan Price Annual £
2,190
OBD
Various
21,367,791
843,682
18,315,700
427,795
Various
-
Unidentified QIPP
Total SLA
2,190
Contract
Type
Northumberland CCG
Ashgrove
Block
All other services
Plan Activity
Annual
POD
Plan Price Annual £
27
OBD
Various
18,731,586
10,209
49,209,558
1,913,202
Various
-
Unidentified QIPP
Total SLA
27
47,306,565
The reduction in activity levels for Ashgrove, to reflect a move from 36 to 18 beds,
has been adjusted based on existing investment per CCG. Similarly, the savings
identified for QIPP have been apportioned based on existing investment levels for
Ashgrove. The table below identifies how the current income for Ashgrove will be
adjusted.
Proposed SLA
PCT
Contract
Type
POD
Plan Activity
Annual
Plan Price
Annual £
Newcastle N&E CCG
Block
OBD
1,811
697,832
Newcastle West CCG
Block
OBD
1,885
726,025
North Tyneside CCG
Block
OBD
2,190
843,682
Northumberland CCG
Block
OBD
27
10,209
Sub total SLA Ashgrove
5,913
22
2,277,748
Newcastle N&E CCG
274,881
Newcastle West CCG
285,854
North Tyneside CCG
331,337
Northumberland CCG
3,984
Sub total contribution to QIPP
-
Total SLA
5,913
896,056
3,173,804
7 Consultation
In May 2013 the Board of Directors gave its approval to proceed with the consultation
and public involvement work on a series of proposed developments in 2013/14 as a
part of the Transforming Services Programme. These developments include the
reconfiguration of the dementia pathway in Newcastle.
Early engagement with partners including service users and carers and
Commissioners will be required to facilitate this development.
The service will follow the Trusts communications and engagement timelines – it is
proposed that all necessary consultations would be complete by July 14th 2013.
7.1 Public Involvement
Public involvement regarding this proposal has included:
Service Users and Carers
Engagement with service users and carers was undertaken in line with the
engagement plan which included:
•
•
•
Involving service user and families in any moves which affect their personal
arrangements and care. This was done on an individual basis and was led by the
multidisciplinary team, and involving advocates where appropriate.
Informing referrers, service user and care representative groups and any other
interested parties.
Information to referrers, service users, and carer representatives being made
available to suit their needs
Additionally the issue was discussed at three meetings of the Ashgrove Carers
Group. These took place on 13th March, 17th July and 1st August. Senior managers
and clinicians from the trust attended the meetings in March and August and the July
meeting was attended by the ward manager.
Carers were concerned about any changes that may affect their relatives and sought
reassurance about the process for the service change, the individual arrangements
for their relatives and the future of other services. They were concerned that the
ground floor service of Ashgrove may be considered for closure in the future and
were assured that there were no current plans for this. There was discussion about
the future of Dementia inpatient services with an emphasis on ensuring that we
23
provide inpatient services from the best buildings we can. This could result in a
change of buildings for some services and in the near future this will focus around
Castleside. There was also a clear message that the Trust inpatient services must be
seen as part of a pathway and as people’s needs change they need to move through
the pathway to more appropriate accommodation
Carers were very concerned about how the first floor of Ashgrove may be reused in
future, particularly as the entrance was shared with the ground floor service. They
were assured that a separate entrance would be provided should the upstairs
become used.
The Carers group meets regularly and further updates will continue to be provided.
Additionally the trust received a letter from one carer via their MP which asked about
the future provision of inpatient services. A response was provided which explained
the consultation process and no further correspondence has been received. We also
received a letter from a carer via Freedom of Information (FOI) when the discussion
first started about the closure. A full response was given to this request.
Local Authority
The Local Authorities were updated on the proposals, and discussions were held with
each local authority through existing regular meetings. The main focus of this
discussion was to confirm that arrangements were in place to support the individuals
affected.
Consultation with Overview and Scrutiny Committee (OSC)
At the beginning of the process, following approval by the Board of Directors, a
briefing on each scheme was produced, and electronic and hard copies of the
document were sent to the relevant local stakeholders including the Local Authorities,
PCTs, Clinical Commissioning Groups, Healthwatch and service user and carer
groups which would be affected by the proposals. Key stakeholders were asked to
advise us how they would like to be included in the public engagement work. The
Trust offered to attend meetings, provide presentations or respond to any other
requests for information.
Due to the relatively small scale of each of the changes, the small number of people
affected and the issues of stigma for mental health service users, it was agreed that
this work would not include pro active approaches to the media.
The two local Overview Scrutiny Committees (Newcastle and North Tyneside) were
updated on the proposals and received presentations at their committee meetings,
which were held in public. Both committees were happy to note the proposals and
raised no concerns.
A letter was sent to the local Healthwatch organisations. These are new
organisations which were established in April 2013. The trust received confirmation
from Newcastle Healthwatch that they would be unable to contribute comments as
they did not yet have the capacity within the organisation. No correspondence was
received from North Tyneside Healthwatch
24
7.2 Staff and Trade Unions
On the 31st of May, 2013 a formal 45 day consultation began with staff directly
affected by the proposal, their representatives and Trade Unions commenced, with
the consultation process being supported by the HR process and Transitional
Employment and Development (TED) Approach. A letter and consultation pack was
sent to all affected staff.
Staff and their Trade Union representatives were invited to formal communication
and engagement sessions in line with the Trusts central HR framework. Meetings
were arranged with staff directly affected for the 4th and 6th of June 2013 and these
meetings included;


An initial meeting with Trade Union representatives to open consultation;
An initial overview workshop with affected staff and trade union
representatives;
The meetings were followed by;
 One to one consultation meetings with staff members during the consultation
period;
 Engagement meeting with professional groups to get their views;
 An open forum with Staff Side;
 Meetings with Staff Side and HR to answer any questions and queries as the
consultation progressed;
 Development of a webpage containing information pertaining to the
consultation such as job descriptions, frequently asked questions and key
dates;
 Updates from project team members to staff via group business meetings.
The 45 day Consultation period ended on the 14th July, 2013 following which the
feedback has been collated and reviewed with recommendations being made on any
adjustments to current thinking regarding the future proposals. Issues raised at staff
engagement events held on the 4th and 6th of June 2013 and individual sessions and
their feedback have also been taken into account.
The key issue raised by staff side representatives, as part of this consultation is with
regard to the staff selection criteria, whereby staff side feel both Ashgrove Long Term
Care and Ashgrove Challenging Behaviour wards should jointly be affected and
in consultation as they believe they operate as one unit. The Planned Care Group
have taken time to listen and understand the issues which have been raised and
following thorough analysis and careful consideration it has been determined that
only Ashgrove Long Term Care Ward should be affected by the proposal.
7.3 Commissioners
The Business Case has been presented to commissioners with the aim of securing
their formal support, and a number of queries have been raised in which
Commissioners sought assurances on the following (NTW answers are in italics):
25
•
That NTW is committed to improving its current dementia services and
working with other health and social care partners to ensure improved alignment of
services and pathways.
This was answered in line with section 3 above.
•
That adequate support will be available in the community to support people
with dementia and associated challenging behaviour.
The process of rationalisation of the dementia pathway has been made possible by
the development of community challenging behaviour teams in Newcastle, working
into community homes. The NTW dementia service works closely with colleagues
elsewhere in the pathway, e.g. the Local Authority to support this process. The
proposal includes reinvestment of 2.0 wte challenging behaviour community staff
who will work into Newcastle City Council Resources Centres (Byker Lodge, Chirton
House and Connie Lewcock).
•
That frail elderly patients are moved sensitively and that both patients and
carers will be regularly updated regarding the move
At the time of the meeting with Commissioners there was currently only 1 patient left
on the upper floor of Ashgrove and patients have been moved on appropriately to
other settings. Ashgrove occupancy at the end of August 2013 was 52% (18.8 out of
36 beds).
This is the culmination of the dementia pathway work referred to above.
Detailed planning involving the service user, family and carer takes place before any
move. A detailed protocol is used to support the transfer so that the receiving
organisation is fully au fait with all relevant issues relating to the individual being
transferred.
•
That the Local Authority has been consulted with and that a partnership
approach has been agreed to ensure appropriate levels of support are in place
across the pathway (potential increase in placement of patients with challenging
behaviour to residential and nursing homes)
The service works closely with colleagues in Local Authorities via the North
Tyneside Governance Meeting (contact is Sue Wood), the Newcastle Governance
meeting (contact is Cathy Bull), and the Northumberland Partnership Steering
Group (contacts are Jane Bowie and Vanessa Bainbridge).
Additionally a number of issues requiring direct response were answered including;
•
Provision of a full cost breakdown for the remaining proposed service in
Ashgrove.
This was provided.
•
Whether or not there is an increased occupied bed day cost Ashgrove, and if
so whether or not this relates to retained overheads from the upper floor of Ashgrove
Yes, the OBD rises from £267 to £385. Only direct costs have been released whilst
further work is done to review the resources that are being used to provide other
dementia in-patient services, for example at Castleside on the NGH site. At the
same time the number of available bed days reduces therefore there is a
proportionately higher cost spread over a lower number of bed days. Once the
review work is complete further efficiencies will be released from costs tied up in
overheads and estates.
26
•
Provision of feedback from discussions with LAs including Health and
Wellbeing Boards including their support of the proposed changes.
As above under section 7.1.
The Trust’s responses to the issues above were discussed at a meeting between
Commissioners and the Trust on 4th September 2013, and commissioner support to
the direction of travel outlined in the Business Case has been received from
Northumberland and North Tyneside CCG’s (see appendix 3). Confirmation of
support from the Newcastle CCG’s is expected shortly. There are some further
clarification points to be explained that will lead to final agreement with
commissioners on the proposed closures.
7.4 Equality and Diversity Impact
An Equality and Diversity Impact assessment was carried out in May 2013 and this
can be found at Appendix 2 to this business case. No issues of concern have been
raised.
8 Project management arrangements
8.1 Project Implementation Team
 Ken Wild
 Carron Yeouart
 Christine Lowthian
 Claire Vesey/Amanda Venner
 Brian Robertson
 Steve Brooks (business case)
8.2 Timetable
The current estimated timescale for the completion of the closure of the upper floor of
Ashgrove is October 2013. This is only achievable if it is agreed that capital works
can commence in time to allow for the adaptation of the lower floor to enable the safe
transfer and care of the remaining patients on the upper floor.
Key dates for the development are:
May 24th 2013 - Board consideration and approval to proceed with consultations
May 31st 2013 - Draft Business case completed
14th July 2013 – End of public involvement, commissioner and 45 day staff
consultation
22nd July 2013 – Final business case, subject to commissioner approval, to SMT and
Transforming Services Board
25th July 2013 – Final business case, subject to commissioner approval, to Board of
Directors
26th July 2013 – Implementation phase
27



It is proposed to close the upper floor of Ashgrove Ward for admissions from
June 2013
Remaining Service Users will then be transferred externally or to other
dementia services within NTW during Quarter 2 2013/14 if the proposal is
agreed.
If supported, the upper floor of Ashgrove Ward will be fully closed from
October 2013.
9 Recommendation
The Board is asked to consider the business case, and note the feedback from
consultation and engagement and support letters from commissioners.
The Board is asked to approve the business case and delegate the responsibility for
providing the additional assurances required to commissioners prior to
implementation of the proposed changes.
10 Approval
We will need to demonstrate Commissioner, CQC and Monitor approval as required
Appendices
Appendix 1 - Draft Transfer PGN
Appendix 2 - Equality & Diversity Impact Assessment
Appendix 3 – Support from Commissioners
28
Appendix 1 – Draft Transfer Practice Guidance Note
Transfer of Frail, Older NHS Patients to Other Long Stay Care Settings – Practice
Guidance Note: Version 1
Date issued
Planned review
Responsible officer
Issue 1 -
Insert First 2 letters
of policy -PGN-0
Part of - reference
associated policy
Contents
Section
Description
1
Introduction
2
Aims
3
Principles
4
Consultation
5
Actions
6
Best practice summary points
1
Appendices – listed separate to PGN
Appendix 1
Discharge Pack Checklist
Appendix 2
GP Notification Letter (copy to send and one to retain)
Appendix 3
Discharge Care Plan
Appendix 4
Transfer Planning: Timed Checklists
Appendix 5
Patient Profile
Appendix 6
Associated Documents
Appendix 7
Equality and Diversity Assessment
1
Page No
Introduction
29
1.1
This guidance relates specifically to patients who require transfer from
Northumberland Tyne and Wear Foundation Trust (NTW Trust) older persons
services to a long term, external care setting.
1.2
The guidance relates to transfers mandated by increased physical care
requirements which are to be met in the external care setting.
1.3
The majority of patients requiring transfer may be physically frail with some
form of mental health care need.
1.4
Such transfers must be planned, executed and reviewed in a robust fashion
to ensure patient care in not compromised at any point
1.5
Trust managers, nurses, doctors and therapists have collective responsibility
for patients leading up to, during and for an agreed period after transfer
1.6
It is a principle responsibility of all staff involved to maintain high levels of care
and patient wellbeing throughout the process.
1.7
The transfer process is inclusive of: planning and consultation, the transfer,
evaluation and learning.
2
Aims
2.1 To ensure the safe, appropriate and timely transfer of patients with minimal risk
t o a more suitable care setting
2.2 To provide a robust framework of actions and requirements: inclusive of time
frames, documentation, consultation, transfer arrangements, care transfer and
adjustment period
2.3
To facilitate safe, collaborative and effective transfers of a vulnerable patient
group
2.4 To ensure patients are treated as individuals
2.5
To put measures in place to minimise relocation stress for the patient and
associated family/friends/carers
To handle the transfer process with sensitivity
3 Principles
3.1
Transfer will only be considered if the required level of physical care required
mandates that an alternative care setting is required. I.E the physical needs of
the patient have surpassed that which can be provided within the mental health
nursing care setting or they have reached the end of their period of assessment
and treatment.
3.2
The mental health of the patient will be stable and has had a period of
assessment, continued individualised care planning and review.
30
3.3
In the absence of family or next of kin an Independent Mental Capacity
Advocate (IMCA) will be sought.
3.4
Relocation stress will be combated with an extended period of supported care
in the new care setting with release of key staff to support the patient, family
and new care providers
3.5
Transfers in or with the threat of adverse weather conditions will not be
sanctioned (snow/flood risk etc)
3.6
Out of hours (19:00- 09:00) will not be sanctioned except in exceptional
circumstances where the care need for transfer is crucial and can not be
delayed.
3.7
Winter transfers may occur if required but with extra attention paid to weather
conditions, appropriateness of transfer, mode of transport, extra precautions re
clothing/blankets, access to buildings or alternative routes.
3.8
A transfer may be halted and reviewed at any stage of the process by any
individual involved.
4
Consultation
4.1
Consultation with the patient/family/IMCA is paramount to the transfer process.
It allows all involved to have input into the decisions being made.
4.2
Discussions regarding the reasons for transfer should be undertaken from the
start to ensure clarity and understanding of rationale and requirement for
transfer.
4.3
A full disclosure of care choices, needs and associated risks should be
undertaken.
4.4
It should be made clear that the overarching aim of transfer is to maintain high
quality, appropriately delivered continuing health care in a more suitable
setting.
4.5
Discussions should at this stage focus on the needs of the individual, their
wishes and needs, those of the family and carers involved including external
agencies.
5
Actions
5.1
The family/IMCA will be central to the planning, undertaking and review of
transfers.
31
5.2
Site visits of potential new care setting will be encouraged: participants may be
family, Consultants, carers, ward managers, physical health nurses and the
patient if able.
5.3
A transfer pack and patient profile will be produced for each individual, ensuring
personalised care planning is undertaken along side consolidation of
information for robust care handover (Appendix 1)
5.4
The transfer pack will be used by the multidisciplinary team, updated as
required at set times (One week, forty eight hours pre and on day of transfer)
5.5
Handover will revolve around the transfer pack. All relevant information should
be found in the pack
5.6
The hand over process will be both verbal and written with information sharing
occurring pre, during and after the transfer has occurred.
5.7
The transfer pack will be handed over to and left in the keeping of the new care
setting
5.8
During the transfer, the patient will be cared for in such a way that safety,
dignity, privacy is maintained at all times
6
Best practice summary points
6.1
The mental health of the patient will be stable and has had a period of
assessment, continued individualised care planning and review.
6.2
Site visits of potential new care setting will be encouraged: participants may be
family, Consultants, carers, ward managers, physical health nurses and the
patient if able.
6.3
Family/IMCA will be central to the planning, undertaking and review of
transfers.
6.4
A comprehensive patient profile and transfer plan will be documented in the
patient transfer pack
6.5
The hand over process will be both verbal and written with information sharing
occurring pre, during and after the transfer has occurred.
6.6
The patient profile will be left with the new care setting to ensure a seamless
continuation of care
32
Appendix 2
Equality Analysis
Equality Analysis Screening Toolkit
Names of Individuals
involved in Review
Christopher Rowlands
Review Date
Date of Initial
Screening
May 2013
Service Area / Directorate
Planned
Policy to be analysed
Is this policy new or existing?
Draft Business Case
New
BD183 - Rationalisation of Newcastle Dementia
Pathway
What are the intended outcomes of this work? Include outline of objectives and function aims
The objective of this business case is to continue to rationalise the dementia pathway in
Newcastle, ensuring that the focus of the inpatient service provided by NTW is for those
requiring the highest level of care, provided by specialist dementia services.
Dementia inpatient facilities in Newcastle provide, inter alia, long term care / end of life care. It
is felt that this care can be more appropriately provided in local nursing homes. This element of
the pathway is an area that can be effectively provided by other providers allowing the Trust to
focus its resources on those at an earlier stage of the illness who may exhibit challenging
behaviour.
This will lead to a reduction in the number of dementia beds in Newcastle which are currently
used for caring for long term elderly frail patients. The proposal will allow for some
reinvestment opportunity into other Newcastle dementia services and will also contribute to the
Trusts financial delivery plan.
This development forms an integral part of the future plans for the rationalisation of dementia
care resources in line with the Planned Care Group service delivery plan and the proposals are
consistent with the Trust’s Transforming Services Programme and its Service Model Review
and will support any changes to the pathways currently under development.
Who will be affected? staff, service users, carers
It is proposed to close the upper floor of Ashgrove on the St Nicholas Hospital site. This part of
the building is used to provide long term care/end of life care. The number of people
accommodated in the long term care/end of life service based on the 1 st floor of Ashgrove has
been reducing and currently stands at 7. The continued running of a unit with a decreasing
number of people is no longer viable on either a clinical or financial basis. The patients who
clinically fit for discharge will be given the choice to move with support or stay with NTW
services.
33
Continuing to care for these patients on the ground floor of Ashgrove will mean that there will
need to be some environmental changes to ensure the safety of nursing patients with both end
of life and challenging behaviour needs. However the impact of moving very frail patients and
the associated increase in mortality risk is much reduced by maintaining continuity of care
within familiar surroundings and staff.
The Planned Care Group considers the proposed reduction will be manageable within the
current occupied bed levels and also based on experience of previous improvements within the
dementia pathway which have resulted in improved efficiency of use of current provision in
Newcastle.
Protected Characteristics under the Equality Act 2010. The following characteristics have protection
under the Act and therefore require further analysis of the potential impact that the policy may have
upon them
Disability
NA
Sex
NA
Race
NA
Age
Pathway improvement developments are imperative to the success of this and
to ensure that any potential negative impacts resulting from the move are
mitigated.
Gender reassignment
(including transgender)
NA
Sexual orientation.
NA
Religion or belief
NA
Marriage and Civil
Partnership
NA
Pregnancy and maternity
NA
Carers
Pathway improvement developments are imperative to the success of this and
to ensure that any potential negative impacts resulting from the move are
mitigated.
Other identified groups
NA
How have you engaged stakeholders in gathering evidence or testing the evidence available?
Early engagement with partners including service users and carers and Commissioners will be
required to facilitate this development.
Public involvement regarding this proposal will need to include:


Involving service user and families in any moves which affect their personal
arrangements and care. This will be done on an individual basis and led by the
multidisciplinary team, and will involve advocates where appropriate.
Informing referrers, service user and care representative groups and any other
interested parties.
The service will follow the Trusts communications and engagement timelines – it is proposed
that all necessary consultations would be complete by September 2013.
Staff and their Trade Union representatives will be consulted in line with the Trusts central HR
framework.
34
How have you engaged stakeholders in testing the policy or programme proposals?
Through consultation
For each engagement activity, please state who was involved, how and when they were
engaged, and the key outputs:
See above for proposal
Summary of Analysis Considering the evidence and engagement activity you listed above, please
summarise the impact of your work. Consider whether the evidence shows potential for differential
impact, if so state whether adverse or positive and for which groups. How you will mitigate any negative
impacts. How you will include certain protected groups in services or expand their participation in public
life.
Potential impact will need to be reassessed after public consultation.
Now consider and detail below how the proposals impact on elimination of discrimination,
harassment and victimisation, advance the equality of opportunity and promote good relations
between groups. Where there is evidence, address each protected characteristic
Eliminate discrimination, harassment and
victimisation
NA
Advance equality of opportunity
NA
Promote good relations between groups
NA
Has potential to allow for the delivery of
services by those best placed to provide and
to allow Northumberland Tyne and Wear NHS
Foundation Trust to concentrate its delivery in
those areas where the skills knowledge and
expertise of its staff can be best utilised.
What is the overall impact?
Addressing the impact on equalities
Pathway improvement developments are
imperative to the success of this and to
ensure that any potential negative impacts
resulting from the move are mitigated.
From the outcome of this Screening, have negative impacts been identified for any protected
characteristics as defined by the Equality Act 2010?
Potential negative impact if Pathway Improvement Developments are not put in place.
If yes, has a Full Impact Assessment been recommended? If not, why not?
It is recommended that we review this equality impact assessment upon completion of the
public consultation to the proposal.
Manager’s signature:
Christopher Rowlands
35
Date: May 2013
Appendix 3 – Support from Commissioners
Northumberland
Letter to Lisa Quinn 17-09-13.pdf
North Tyneside
From: Paradis Anya - North Tyneside CCG [mailto:Anya.Paradis@northtyneside-pct.nhs.uk]
Sent: 19 September 2013 12:02
To: Quinn, Lisa
Cc: Clow Philip - North Tyneside CCG; Evans Ruth - NHS Mail
Subject: Transformation Programme
Hello Lisa
Thank you for attending the Commissioning Development Group on Wednesday 18th September to
inform the meeting about Northumberland, Tyne & Wear NHS Foundation Trust’s Transformation
Programme.
Following the presentation and subsequent discussion, I would like to advise you that the
Commissioning Development Group has agreed to recommend to our Clinical Executive to support
the direction of travel of the Transformation Programme as presented by the Trust, and for the CCG
to work with the Trust to progress this. We are not yet in a position to agree the Business Cases but,
again, will work with the Trust to develop these to meet the needs of North Tyneside patients.
I would also like to let you know that the Commissioning Development Group will recommend to
Clinical Executive that North Tyneside CCG be considered for Tranche 2 of the roll-out programme.
I hope, Lisa, that this will help with your papers for your Board meeting next week but if you need me
to clarify anything or provide any more information, just let me know and I’ll sort it out.
Many thanks
Anya
PLEASE NOTE MY NEW CONTACT DETAILS:
Anya Paradis
Head of Commissioning
North Tyneside Clinical Commissioning Group
12 Hedley Court
Orion Business Park
North Shields
NE29 7ST
Tel: 0191 2931157
Fax: 0191 2931181
E-mail: anya.paradis@northtyneside-pct.nhs.uk
www.northtynesideccg.nhs.uk
Newcastle CCG’s
Confirmation of support to follow
36