Meeting documents

1.

Situation

Devon Partnership NHS Trust is making some transformational changes over the next few years to ensure that it can continue to provide high quality services to people with mental health and learning disability needs and remain financially viable. Its change programme is called SMART Recovery and it has three underpinning objectives:

To design and deliver clear pathways of care for people

To enable mobile working and better use of technology

To make the best possible use of the Trust's estate (land and buildings).

The Trust has produced a staff guide which outlines the basic principles and aims of the programme and the Trust is in the process of producing stakeholder information for people using services.

A key area of the programme is to make better use of the Trust's estate. The organisation currently operates out of around 60 buildings across Devon and spends around 10% of its annual budget (around 12m) on estates and their upkeep. Many of these buildings are old, under-used and/or unfit for purpose.

One of the main proposals under SMART Recovery is to operate three major clinical hubs across the county (Exeter, Torbay and Barnstaple) supported by a network of satellite sites. The Exeter hub will be located at Wonford House, serving Exeter, East and Mid Devon. One of the key benefits of this approach is that full, multidisciplinary assessments can take place in an environment that brings together the full range of clinical disciplines including doctors, nurses, psychologists, occupational therapists and many others. This model mirrors that which exists in physical health services, where some services are available locally, but most specialist services are concentrated in larger acute general hospitals.

As well as the clinical benefit, co-locating core services on a smaller number of hub sites also brings important efficiency gains. Although the Trust currently has a balanced financial position, it has to achieve annual savings targets of around 6m
per year from its 133m budget. The Trust is striving to protect frontline services and jobs by making sure that its investment in bricks and mortar is no more than is absolutely necessary.

The clinic hub approach does mean that some of the current work, notably people's initial assessment following their referral, will be transferred from areas such as Exmouth and Honiton (where it is currently conducted) into Wonford House. However, much of their care will still remain local, meaning that people will still be supported in their own homes or a more local satellite clinic, as they are now.

The Trust has conducted a full quality and equality impact assessment. This concluded that the Trust could consider selling some of its estate, including St John's Court in Exmouth, with a plan to relocate to more affordable premises in the town. The Trust is exploring a range of alternative locations, including co-location with other health and social care providers and voluntary organisations.

The Trust has made it clear that it will not make any decision about the future of St John's Court until suitable alternative accommodation is found in the town. It has made it equally clear appropriate arrangements will be made for people who are unable to travel to Wonford House for their assessment or other treatment.

The announcement that the Trust intends to sell St John's Court has met with some understandable opposition from local people. The Trust readily acknowledges that it is a lovely site that is highly valued by people who use services and staff.

Local people, users of services and staff are already engaged in the project through:

A Local Implementation Team (LIT)

Network Action Groups (the Trust's routine public engagement meetings)

A public meeting on 10 July 2015 (attended by Hugo Squire MP)

A St John's Court engagement group (which met for the first time on 18 August 2015 and is due to meet again on 20 October 2015). This group includes
Cllr Eileen Wragg.

The Trust has already engaged with users of services on some aspects of the SMART Recovery Programme, for example what a single point of access for all services would look like and what people would value about it. The Trust is planning to engage more widely in the near future about the SMART Recovery programme as a whole for example to seek people's views about pathways of care, the development of clinic hubs and the use of mobile technology.

2.

Background

St John's Court is currently the base for around 55 staff working in the following teams:

Mental Health Assessment Team (MHAT)

Depression and Anxiety Team (DAS)

The Older Peoples team (OPMH)

The Non-Psychosis (MHAR) team

The Psychosis (PAR) team

Psychological and Psychological Therapy team

The majority of people supported by the Trust's teams in Exmouth are not seen at
St Johns Court but seen at another setting or in their own homes. The site's estimated operating costs are 150k per year and a capital receipt from the sale of the building would generate an estimated sum of 600-800k. The Trust is confident that far less expensive premises from which to deliver services could be secured in the town.

At the public meeting on 10 July, campaigners suggested that St John's Court be 'saved' and developed as a local health hub, along the same lines as Budleigh Salterton Community Hospital. The premise being that, if other services were
co-located on the site alongside mental health services, the site as a whole would be more economically viable and the Trust could continue to own it.

At the meeting on 18 August, the Trust reiterated its intention to sell the site, use the proceeds from the sale to develop other capital projects (including investment at the Wonford House clinic hub) and significantly reduce its annual operating costs by moving to more affordable premises in Exmouth. The Trust also offered to support the campaign group in any way it could to secure St John's Court as a community asset of some kind. It cited the recent example of Stowford Lodge in Sidmouth which, although sold, was bought by a group of GPs.

3.

Assessment

The proposed sale of St John's Court will support the Trust's strategic move to a clinic hub model across Exeter, East and Mid Devon to proceed. This will ensure we can continue to provide affordable, high quality, multidisciplinary clinical services for assessment and treatment. People will get a better service, but some people will have to travel to Exeter (or wherever their nearest clinic hub is located) for some of their treatment, particularly their initial assessment.

The capital receipt and revenue savings assigned to this property are in the Trust's financial plan for the current year.

A Quality Impact Assessment has been completed. The assessment shows that where possible the Trust is taking steps to mitigate any adverse impact of its actions, for example an agreement in principle that up to 20% of assessments and 40% of treatments will be carried out in a person's home or alternative community base.

There is no intention to stop seeing the people of Exmouth in Exmouth or to reduce the level or quality of service to people in and around the town. However, elements of their care may be provided out of a larger clinic hub to allow for a better clinical outcome and to make efficiency savings.

Some service user groups are generally very positive with the suggestions as they appreciate it will offer a better assessment and quicker access to information about what will happen next in their care.

4.

Recommendations

The Health Scrutiny Committee is asked to consider this briefing. A senior member of the Trust's leadership team will attend the committee's November 2015 meeting.