FOR APPROVAL

BOARD MEETING 21 OCTOBER 2015 AGENDA ITEM 5.1 ADULT MENTAL HEALTH SERVICES NHS MANAGEMENT ARRANGEMENTS Report of

Executive Lead for Mental Health

Paper prepared by

Strategic Lead Mental Health & Project Manager

Purpose of Paper

To update Board Members about the NHS management arrangements for staff providing adult mental health services in Powys

Action/Decision required

For information

Link to ‘Health and Care Standards’

Governance, Leadership and Accountability

Link to Health Board’s Annual Plan

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Acronyms and abbreviations

Adult MHS NHS Management Arrangements

Striving for Excellence Always with our Staff Promotes Health & Wellbeing Continuously improves Safety, Effectiveness & Patient Experience Captures the Benefit of Integration

PCC – Powys County Council HBs - Health Boards LTAs – Long Term Agreements OD – Organisational Development MHSAC – Mental Health Services Assurance Committee SRO – Senior Responsible Officer OT – Occupational Therapy ESR – Electronic Staff Record LTA – Long Term Agreement CCIS – Community Care Information Solution TUPE – Transfer of Undertaking (Protection of Employment) CHC – Community Health Council Page 1 of 11

Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL

ADULT MENTAL HEALTH SERVICES NHS MANAGEMENT ARRANGEMENTS PROJECT Introduction This paper updates Board Members on progress with the project addressing the NHS management arrangements of staff providing adult mental health services within Powys. Background The Board of Powys Teaching Health Board (PTHB) approved a recommendation in February 2015 to seek to directly manage NHS adult mental health service staff in:     

Local Primary Mental Health Support Services within Powys Community Mental Health Teams within Powys Crisis Resolution Home Treatment Teams within Powys Mental health wards within Powys hospitals (for adults of all ages) Associated clinical psychologists and occupational therapists within Powys.

The proposed recommendation was not about changes to the location or range of existing patient services. The aim is to ensure the safety and continuity of existing services. PTHB has unusual and complex arrangements where four health boards are providing mental health services within one county. A strategy to improve the mental health of the people of Powys was published by PTHB and Powys County Council (PCC) in January 2013. A service model was developed with stakeholders and approved by PTHB at its meeting on the 16th October 2013. The Board initiated work to identify the best delivery arrangements for the model, including re-consideration of arrangements involving three neighbouring health boards as well PTHB as the responsible Health Board. An advisory option appraisal involving partners was undertaken in December 2013 and reported to the Board in February 2014. In response to this and subsequent Board discussions a Project Board was established, in September 2014, chaired by the then Deputy Chief Executive, to focus on NHS management arrangements (involving the employing health boards working in Powys), PTHB directors, PCC and GP representatives). The recommendation about the future NHS management arrangements of existing services was made by a Project Board with membership of all provider health boards and was endorsed by the Transformation Programme Board. The February 2015 Board paper also set out the services which would remain commissioned. The initial transfer of services in December 2009 (psychology transferred later) was based upon co-operation between integrated health boards in Wales. A Governance Framework was approved at Board level in 2010 setting out respective responsibilities, which was later reflected in Long Term Agreements (LTAs).

Adult MHS NHS Management Arrangements

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL The fragmented NHS management arrangements for adult mental health services in Powys have been difficult to navigate for patients, providers and partners. Whilst there have been successes, the system has been onerous and has resulted in uneven improvement. In Phase 1 a detailed assessment was undertaken, against essential standards, of the scope for further deterioration and for improvement. It set the context of the platform needed for closer working with the local authority to deliver the agreed strategy and statutory requirements within the county. This paper provides a summary of the progress of the Adult Mental Health Services NHS Management Arrangements Project; the current position in line with the Phase 2 Project Plan and; an outline of the work streams, their activity and key risks. Governance Arrangements The Project Board involving the four health boards, including Powys, is working to a detailed Phase 2 Plan with a transfer date of the 1st December 2015 (Appendix A). Although project timescales are challenging, the project is on track with key posts in place. (Please see the Leadership and Governance section.) The governance arrangements for the project are delivered under the Transformation Programme structure as set out below:

The Project Board chaired by the CEO (Executive Sponsor) includes representation at Director Level of the neighbouring health boards currently employing staff. The Board provides leadership and direction for the project, agrees and manages activities, sets priorities, manages risks and issues, monitors progress and allocates resource against agreed plans. The reporting line for assurance is to the Mental Health Services Assurance Committee (MHSAC). The MHSAC is chaired by the Vice Chair of PTHB. It will continue to play a vital role post transfer in ensuring there is assurance spanning the delivery of the strategy; risk management; quality and safety; and compliance with legislation. Adult MHS NHS Management Arrangements

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL

Overview of Progress Against Phase 2 Plan The detailed Phase 2 Plan is attached. In September 2015 77% of activity was on track, 22% was complete and only 1% was at risk of delay. A high level summary of key events is given below: March 2015

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  April 2015

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May 2015

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Stakeholders informed of Board decision Phase 2 Project Board and Team meetings initiated (monthly) Detailed Phase 2 Plan developed with work streams for:  Leadership and Governance  Quality & Safety  Workforce and OD  Enabling (including Information and Information Technology)  Finance Work initiated to establish a Mental Health Services Assurance Committee Recruitment to key posts initiated Schedule confirmed with Workforce and OD leads within four health boards Recruitment to key posts underway Equality Impact Assessment (1st Draft) Work streams on-going

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Staff engagement meetings held with affected staff Project Board considers feedback from initial staff engagement exercise Phase 2 Project Manager confirmed Dedicated HR Manager for Mental Health Services appointed Interviews held for Interim Operational Manager Work streams on-going

June 2015

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Interviews for Clinical Director (involving people using services) Question and Answer Portal live Continuing work on staffing list by provider HBs Surgeries/drop in sessions with affected staff (on-going) Work streams on-going

July 2015

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Interim Clinical Director in post 2nd Letter to CEOs setting out commissioning intentions 1st round of profession specific meetings held (OT and psychology) Mental Health Services Assurance Committee established On-going work on staff lists by provider health boards, including vacancies, to ensure comprehensive engagement; to assist

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL

August 2015

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September 2015

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October 2015

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with detailed decisions about services which will continue to be commissioned; to ensure service continuity; and to assess detailed financial implications Surgeries/drop in sessions with affected staff (on-going) On-going work up-dating stakeholders including WG Final staff lists received (slippage from July completion date) Interim Operational Manager in post (3 weeks slippage from planned July completion date) Ongoing work stream preparations 2nd round of engagement meetings held with staff (3x events) Profession specific meetings held (including medical staff) PTHB takes over responsibility for ensuring recruitment to vacancies (‘initiatives’ where there have been some longstanding vacancies) Mental Health Services Assurance Committee Work streams on-going including preparation of Legacy Statement and detailed work on IT, finance & commissioning in response to staff lists. CHC and other stakeholders up-dated

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Pilot of strengthened out of hours psychiatry arrangements North Powys (required whether services are commissioned or directly managed) Interviews for Permanent Assistant Director for Mental Health Services Work streams on-going

November 2015

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Final checks Reconfirm details with affected staff Update Director and Operational on-call folders Confirm PTHB organisational readiness to transfer staff Mental Health Services Assurance Committee

December 2015

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Transfer affected staff– Management arrangements in place for 1st December Celebration of staff returning Corporate induction Workforce systems support Payroll support IT support

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Phase 2 work streams The Project Team is chaired by the Senior Responsible Officer (SRO) - the Assistant Lead Director for Children/Strategic Lead for Mental Health. The Phase 2 Plan has been divided into 5 work streams. Each work stream is led at Assistant Director level Adult MHS NHS Management Arrangements

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL or the equivalent and involves the four health boards. The Work Stream Leads are accountable for developing, leading and delivering their respective work stream tasks; contributing to the development and updating of the Phase 2 Project plan; highlighting critical success factors; being an active member of the Project Team (reporting progress); ensuring timely escalation of exceptions and concerns to the Project Team; and updating the Director Member of the Project Board regularly. There are interdependencies between the work streams:     

Leadership & Governance (L&G); Quality & Safety (Q&S); Workforce and Organisational Development (WOD); Enabling (Information and IT); Finance

The activity and progress of each work stream is set out in Appendix A. Risks and mitigation are set out in Appendix B. Work stream 1 – Leadership & Governance The SRO is also the lead for the work stream. As set out in the Governance section a permanent MHSAC has been established (with two subcommittees in relation to legislation and powers of discharge) chaired by the Vice Chair of PTHB and consisting of Independent Board Members. Each meeting receives assurance reports including progress with the Phase 2 Plan, with a subsequent report to the Board. The MHSAC will be central to the on-going assurance arrangements for directly managed and commissioned mental health services after the 1st December 2015. Key posts to ensure a successful transfer, in addition to the Project Manager, and to ensure the safe management of services post transfer have been appointed including:    

HR Manager for Mental Health Services Interim Operational Manager Interim Clinical Director Interviews are being held for a permanent Assistant Director for Mental Health Services on the 23rd October, 2015.

Engagement and consultation with affected staff is subject to TUPE and is covered in detail in the Work Force and OD Work-stream. However, engagement activities and informing other stakeholders has been led by this work-stream. Two rounds of engagement meetings with affected staff have been held involving the Chair, Vice Chair, Chief Executive Officer (CEO) and senior managers in provider health boards. At these meetings the approved strategy and service model in Powys have been explained, together with the recommendations of the Project Board and the Phase 2 Plan.

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL No concerns have been raised which are not covered by the Phase 2 Plan. Issues raised have included ESR; pay dates; bank staff arrangements; e-rostering; and IT issues such as access to historic e-mails. Individual surgeries have been offered to all staff. Key documents and answers to questions raised have also been available on-line to affected staff. Profession specific meetings have taken place. There is already a professional lead for Occupational Therapy within PtHB who was involved in the discussions. OTs will be line managed within mental health teams, but there will be specific arrangements for their professional leadership, development and supervision. PtHB will appoint a professional lead within mental health services, supported by commissioned expertise from a neighbouring health board whilst the new arrangements are embedded. A “needs led” approach will be developed. A Band 5 rotation will take place within Powys and recruitment to posts has been initiated. There is no overarching designated lead professional for psychology within PTHB and a proposal will be considered by the Director of Therapies. Psychologists within the budget of the Mental Health Department will be line managed within mental health services, as is already the case in south Powys. However, specific arrangements for the professional leadership, supervision and development will be secured. It is recognised that such psychologists may contribute to other services. There is greater concern amongst some psychologists about services moving away from an age based approach for adults (i.e. a focus on adults above or below the age of 65) to a needs led model, which will need to be worked through. Other stakeholders have been kept informed in line with the Phase 2 Plan including the Community Health Council, the Powys Mental Health Planning and Delivery Partnership and Welsh Government. GPs are represented on the Project Board by the lead GPs for Mental Health. This work stream has also led work on service continuity:    

Work is underway to update major incident planning and Director and Operational on-call folders to go live on 1st December; High level “Service Transfer Principles” have been agreed by the four health boards involved through the terms of reference; Work is underway to ensure essential policies and procedures will be in place on the 1st December; Commissioning discussions are underway to ensure continued access to the services as set out in the February 2015 Board paper and subsequent correspondence between CEOs. The commissioning discussions inform the project, but are managed through the Long Term Agreement process. The issue is continuity of access to existing services which are already commissioned. At the last Project Board it was agreed that the commissioning arrangements with each provider should be risk rated separately. The piloting of a strengthened on-call psychiatric rota for Montgomeryshire is necessary regardless of whether services are directly managed by PtHB or commissioned. It is part of the work undertaken over the last two years to strengthen out of hours arrangements in north Powys, such as the

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL implementation of a successful Crisis Resolution Home Treatment Team. ABMUHB and PtHB are working together to ensure that no difficulties arise from complex geographical boundaries in the Ystradgynlais area. At the time of submission of this Board paper further information was awaited from ABUHB in response to discussions in the last commissioning meeting. Work stream 2 – Quality & Safety (Q&S) The Quality and Safety work stream is led by the Assistant Director for Quality and Safety. As set out in the Phase 2 plan this work stream includes Information Governance. A Legacy Statement template has been developed which will include input from all four health boards. Its purpose is to provide the history to the transfer, confirm key legacy issues and ongoing commitments and risks from ABMUHB, ABUHB, BCUHB when PTHB returns to directly managing staff. It will assist in clarifying residual actions in the controlled closure of Phase 2 of the Adult Mental Health NHS Management Arrangements Project. Along side the Legacy Statement, other critical success factors identified in this work stream include continued Datix access (which relied on the receipt of the staff lists to determine management levels) which is essential for the continuity of investigations of critical incidents and for responding to complaints and concerns. Although challenging, the Quality and Safety work stream is on track. Key risks have been identified, documented and mitigating actions agreed. Work stream 3 – Workforce and Organisational Development (WOD) The workforce work stream is led by the Assistant Director for Workforce and involves the Workforce and OD Departments of four health boards. The Workforce and OD work stream is ensuring appropriate compliance with the statutory engagement and consultation needed under the TUPE regulations. A large volume of activity is assigned to this work stream and as a result a dedicated full time HR Manager is in place. Vacancies are now being advertised by PtHB – and recruitment to some posts has already been successful. Medical staffing has historically been a challenge in south Powys and existing vacancies prior to transfer are being advertised or are being submitted for Royal College approval. Management plans are being put in place for other absences such as sick leave, disciplinary procedures, grievances and maternity leave. As part of the Transfer of Undertakings (Protection of Employment - TUPE) regulations, a Due Diligence Plan has been developed and sets out critical tasks and other activity (Appendix A -Annex 1). Staff surgeries/drop in sessions and individual meetings have been offered for those with any specific queries. A delay in receipt of the final staffing lists including vacancies, resulted in some delay to other work streams. Nevertheless, overall activity is still on track (1% activity is Adult MHS NHS Management Arrangements

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL currently amber). Other critical tasks include the Mass Organisational Change Process (MOCP) readiness assessment 1 (complete) and readiness assessment 2 (dress rehearsal) which is planned to start at the beginning of November. An Equality Impact Assessment (EQIA) has been developed to ensure equality and human right principles are identified and acknowledged. The process enables the consideration of the effects of decisions and actions on different communities, individuals or groups. It includes anticipating or identifying consequences of the work on individuals or groups, making sure negative effects are eliminated or minimised, and maximising opportunities for promoting positive effects. The Workforce and OD section of the risk register is being updated as additional WOD risks have been recently identified. The descriptions, scores and mitigating factors are being confirmed. These additional risks include communications with affected staff on long term leave; complexity around E-Systems including Powys implementation of E-rostering; and the payment of enhancements and overtime. Work stream 4 – Enabling (Information and IT) Information: An Information Officer has been allocated to ensure there is no disruption to the provision of essential information, including that which must be reported to Welsh Government. Liaison is underway with provider health boards to ensure a safe transfer of information. Updates are being received by the Project Team. Many staff are already using PtHB systems such as Datix and the patient information system known as Myrddin (MIP). Meetings with provider health boards have taken place to identify any existing information that cannot be recorded within Myrddin, so an alternative way forward is developed by the end of October 2015. Reporting mechanisms will be built via a suite of reports on IFOR for internal and external reporting by end of November 2015. Any new staff that require Myrddin training are being identified, and the training needs of existing users will be assessed at a later date. Activity in this work stream is on schedule. The Interim Operational Manager is attending Community Care Information Service (CCIS) meetings as this will be a major vehicle for service improvement and the development of integrated working with social care services. IT: This work stream has been strengthened in the Phase 2 Plan and involves the four health boards. Activity is underway to provide the detail of the ICT changes required in order to migrate desktop devices, saved data and user accounts. Hardware details are being gathered from affected staff to ensure all IT equipment is accounted for in advance of the transfer. Adult MHS NHS Management Arrangements

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Board Meeting 21 October 2015 Agenda Item 5.1

FOR APPROVAL The Project Board is considering whether temporary additional IT support will be required in preparation for the transfer, and so there is dedicated support to deal with any issues that arise during the transfer.

Work stream 5 – Finance The Finance work stream is being led by the Finance Business Partner supporting mental health services and involves the four health boards. Just over £20M is spent on adult mental health services. The transfer of services affects approximately £10.3M. Work has been undertaken to map the resources initially provided at transfer; additional resources provided during transfer; and additional resources available during 2015/16 such new funding from WG. A financial assessment of staff lists has been undertaken and a project cost centre set up. Asset registers and balance sheet preparations are progressing. LTA meetings are attended by the Finance lead. The key risks that have been identified and mitigated to ensure there is sufficient funding for the transfer and no unexpected cost implications. Conclusion Whilst this Project is very challenging and wide ranging, overall it is on track. The delay in finalising the staff list has had an effect for some work streams. LTA meetings are addressing the continuation of services already commissioned where required. Recommendation Board Members are asked to note the progress of the Adult Mental Health Services NHS Management Arrangements Project. Report prepared by: Tanya Summerfield Project Manager & Clare Lines, Strategic Lead

Background Papers

Presented By: Clare Lines Assistant Lead Director for Children and Strategic Lead for Mental Health

Appendix A

Phase 2 Delivery Plan 150930 Phase 2 Plan v12 Sept 15 - Iss

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Board Meeting 21 October 2015 Agenda Item 5.1

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Appendix B

Project Risk Register

150930 Risk Register v12 Sept 15

PTHB Board paper 25th February 2015 Financial Consequences

Phase 2: Key appointments have been made ahead of transfer as set out in the paper approved by the Board in February 2015 (which identified additional costs of £77k). The potential full year impact was revised to £110k following the Board’s view that more sessions would be needed for the Interim Clinical Director.

Other Resource Implications

Approximately £20M is spent of adult mental health services. The transfer of services affects approximately £10.3M NA

Consultees

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Board Meeting 21 October 2015 Agenda Item 5.1