Integrated Impact Assessment Tool

Transcription

1 1 Integrated Impact Assessment Tool Hywel Dda University Health Board and its Committees are asked to consider many proposals and to apply effective governance and scrutiny to their decision-making process. To do this, they must take into account a variety of impacts that Board and Committee level decisions may have. Certain proposals or decisions will require a wider consideration of potential impacts, particularly those relating to service change or potential major investment. It is therefore suggested that where strategic or higher level decision-making is required, these papers or proposals are subject to an integrated impact assessment to accompany SBAR in use for all reports submitted to the Board and its Committees. Integrated impact assessments are used to support the Board and Committees scrutiny process by identifying the impacts of key areas of action before any strategic or higher level decisions or recommendations are made The impact headings included within the integrated impact assessment tool are as follows: Financial/Service Impacts Quality/Patient Care Impacts Workforce Impacts Risk Impacts Legal Impacts Reputational Impacts A more equal Wales is one of the 7 goals of the Well-being of Future Generations (Wales) Act 2015 and we recognise that equality underpins all 7 of the goals. An equality impact assessment of the proposals is being undertaken in line with public sector equality duties in Wales. The results of findings to date are published along with this integrated impact assessment. Findings of the equality impact assessment will be considered together with the integrated impact assessment to help inform decisions made on Transforming Mental Health Services. *SBAR is an acronym for Situation, Background, Assessment, Recommendation; a technique that can be used to facilitate prompt and appropriate communication. This communication model has gained popularity in healthcare settings, especially amongst professions such as physicians and nursing.

2 2 Transforming Mental Health Project Integrated Impact Assessment Tool /N Evidence & Further Information Financial/Service Impacts 1. Has the new proposal/service model been costed? The proposed model has been fully costed in conjunction with the finance and modernisation department (please see our technical document on our website 2. Is the new proposal/service model affordable? The proposed service model will not cost more than the existing budget 3. Is there an impact on pay or non pay e.g. drugs, equipment, etc? 4. What is the financial or efficiency payback (prudency), if any? 5. Are there risks if the new proposal/service model is not put into effect? y y y There will be additional pay enhancement as we accommodate increased 24/7 work place practices in our proposed CMHC s and increased out of hours working for senior staff within our central assessment and central treatment units (see technical documents). Transport costs have also been accounted for (see technical document transport). It is anticipated that these costs will be made from efficiency savings of old to new proposed model. The new model will avoid duplication, reduce silo and unsafe working and provide care closer to home. It will also provide more efficient use of statutory and voluntary sector services and better use of specialist skills within multi disciplinary teams The following risks have been identified should the proposed co designed model not be put into effect: Continued wastage and duplication Services won t be fit for purpose for the 21 st century We risk sustaining inadequate services We reduce service user choice

3 3 We will fail with our plans for co production as per Together for Mental Health 2012 We will not be able to recruit and retain an appropriately skilled multi-disciplinary workforce to meet current and future needs of population equitably We will not attract an appropriately skilled workforce We won t meet goals/visions/aspirations of national strategy. We will not meet current demands and needs of service. Risk of continued gaps in current service provision 6. Are there any recognised or unintended consequences of changes on other parts of the system (i.e. impact on current service, impact of changes in secondary care provision on primary care services and capacity or vice versa, or other statutory services e.g. Local Authorities?) The current model of services is not sustainable or acceptable (see technical documentation on workforce challenges and the case for change). A system that is easier to access and more streamlined will have a positive impact for all statutory services. Research and past experience show that staff and service users can have a negative response to significant change. Strong and continuing engagement and involvement with key stakeholders through the options development process would have mitigated this but there may still be some unknowns. Staff and service user s response to the significant change and maintenance of business continuity will be managed through the transition and change process. Staff will be supported through the change process in line with the All Wales Organisational Change Policy. Although not a direct consequence of the proposed new model currently anti ligature legislation can impact on those with mobility issues in terms of safe transfers.

4 4 7. Is there a need for negotiation/lead in times i.e. short term, medium term, long term? There will be increased demand on services in the community. The proposed co designed model provides a seamless service to access mental health services regardless of primary or secondary care. We predict reduced burden on the police as people will be able to access a local Section 136 facility when in distress. There will be a centralised fully staffed 136 facility for individuals, who are more aggressive, intoxicated or seriously unwell this reduces a burden on police resources as they should no longer need to stay with distressed patients unnecessary. There will be predicted reduced burden on our accident and emergency departments as people will be able easily access a mental health assessment in their localities. Having 24 hour services in our localities should reduce dependence on our ambulance services as we commission new transport arrangements (see technical document transport). The proposed model will facilitate a quicker transition from hospital to community which could impact on providers of supporting accommodation e.g. housing associations, social services. There will be no need for individuals to first see their General Practitioner they will be able to access their local CMHC. A phased implementation plan will be developed. There is a business continuity work-stream and workforce work stream under pinning the process (see supporting document work streams). We recognise the need for an organisational change process in line with the All Wales Organisational Change Policy as some roles and responsibilities will change

5 5 due to 24 hours working arrangements in the community. There have been numerous staff engagement workshops across the 3 counties to engage our staff and prepare them for change and keep them appraised in the process. 8. Are capital requirements identified or funded? Capital requirements have been identified for the CMHCs within the three counties. This includes seeking new premises and refurbishing existing. The central assessment unit will require capital investment to either modernise existing building or commission a new build. Requirements for capital costs are dependent on the results of the formal consultation. 9. Will capital projects need to be completed in time to support any service change proposed? 10. Has a Project Board been identified to manage the implementation? 11. Is there an implementation plan with timescales to performance manage the process and risks? 12. Is there a post project evaluation planned for the new proposal/service model? 13. Is the UHB clear of any other constraints which would prevent progress to implementation? N Existing IT systems will be reviewed with the aim of progressing towards mobile solutions that mean our practitioners can more spend time within localities and with patients. The proposed CMHCs and Central Assessment Unit will require capital works to ensure they are fit for purpose for the vision being proposed. A phased implementation will be addressed through Business Continuity Workstream. The project will be managed by the Mental Health Programme Group made up of service users, carers, local authorities, police, ambulance and Community Health Council. This will be completed post-consultation as we cannot pre-empt the public s decision. The Data and Evaluation Workstream are developing qualitative and quantative methods of evaluating the outcome of this proposed service change. A judicial review could prevent progress however; we have made every effort to reduce this possibility through extensive engagement, co production and the involvement of the consultation institute to reduce

6 6 any likelihood of unanticipated challenges. We have worked closely with the Community Health Council who have been fully engaged from the outset. The public being adverse to the options would be a constraint but the proposed model has been co designed with our partners. The project will need to be aligned to the clinical services programme. We would ensure clinical staff availability with links to the communication and engagement plan. Quality/Patient Care Impacts 14. Could there be an impact on patient outcome/care? A care focus has led to the high expectation of improvement in care and outcomes. However it is recognised that within the transition phase there may be some minimal unanticipated disruptions to patient care. This will be monitored and addressed as needed by the lead for the business continuity work stream and the head of adult mental health services. 15. Is there are potential for inequity of provision? E.g. rurality, transport. In the early stages there may be some inequities which will be monitored through a robust unmet need process and service delivery adapted accordingly. We have considered transport arrangements within our proposed service model in order to deliver a more equitable service in particular for isolated people. (Please see Technical Document Transport, this includes revising our commissioning arrangements to provide third sector solutions) 16. Is there any potential for inconsistency in approach? The model proposes equitable service delivery across the three counties, any inconsistency that is identified will be rectified within the business continuity work stream and review of the model. There needs to be an explicit explanation of the model and guidance on how it will be delivered. Strong operational and clinical leadership is needed, underpinned by comprehensive, SMART guidance.

7 7 17. Is there are potential for postcode lottery/commissioning? 18. Is there a need to consider exceptional circumstances? 19. Are there clinical and other consequences of providing or delaying/denying treatment (i.e. improved patient outcomes, chronic pain, physical and mental deterioration, more intensive procedures eventually required? 20. Are there any Royal Colleges standards, etc, applicable? 21. Can clinical engagement be evidenced in the design of the new proposal/service model? Workforce Impact The model proposes equitable service delivery across the three counties, any inconsistency that is identified will be rectified within the business continuity work stream and review of the model. There will be a need to construct new operational guidance and policies and a multi-disciplinary governance procedure. Clinical pathways will be key to this. Extensive efforts have made to engage and consult with the stakeholders including service users and carers groups including minority and hard to reach groups including people with protected characteristics and travelling populations as well as veteran services. The needs of these groups have been incorporated in the aspirations of the service model. The proposed model is designed to improve patient care and outcomes through reduced silo working, more integrated working, increased accessibility to promote more timely care and treatment. The model is designed to address unmet need. In addition, it is designed to address service users specific requirements and needs rather than being dependent on clinical condition/age. This follows the principles of prudent healthcare. We have no evidence that the proposed service model impinges on any standards from professional statutory regulators. We have consulted with our professional leads within our organisation and have not identified any professional standards that would be breached. Staff have been involved in all stages from options development through planning, development and delivery. (See website for technical documents)

8 8 22. Has the impact on the existing staff/wte been determined? The Workforce Work stream has been profiling changes to staff roles. No staff will lose their posts or grade, it is anticipated that there may be opportunities for staff in terms of skill enhancements and potential career opportunities. It is also anticipated that the proposed new model will improve the current recruitment difficulties by offering enhanced opportunities, modernise services and more rewarding meaningful roles for staff who chose to work within mental health services 23. Is it deliverable without the need for premium workforce? 24. Is there the potential for staff disengagement if there is no clinical/ reasonable rationale for the action? 25. Is there potential for professional body/college/union involvement? 26. Could there be any perceived interference with clinical freedom? 27. Is there potential for front line staff conflict with the public? N N One of the aims of our proposed service transformation is to reduce our dependency on any locum or agency staff. The process started with consulting with our own staff who have contributed to the co-design of the proposed model. Numerous staff engagement events have been conducted in order to communicate the clinical and professional rationale for change, to reduce the potential for staff disengagement. Staff have contributed to the option development process and staff receive monthly briefings as part of our continued engagement. Staff drop in events have been continuing throughout the process. All relevant bodies have been involved and remain active in the development. The change being proposed will not interfere with clinical freedom. We do not anticipate that the proposed change increases any potential risk.

9 9 28. Could there be challenge from the industries involved? 29. Is there a communication plan to inform staff of the new arrangements? 30. Has the Organisational Change Policy been followed, including engagement/consultation in accordance with guidance? 31. Have training requirements been identified and will this be complete in time to support the new proposal/service model? There may be a challenge from centralising our inpatient services in Carmarthenshire. This is mitigated through offering a hospitality bed available in each county which provides more flexible access. We are also placing beds in Ceredigion where currently we do not have provision. This has been developed in collaboration with the Communication and PPE Department (see technical document communication and engagement plan) Extensive engagement with staff to date and we will continue to follow the organisational change process using the Workforce OD Workstream to address and highlight issues. The Workforce OD Workstream will address and highlight any training requirements prior to implementation and continue to review eg we are providing assurance that all staff including health, social care and third sector will receive the required training and supervision. Risk Impact 32. Has a risk assessment been completed? Risks are identified through consultation and engagement events and the consultation and engagement group overseen by the Mental Health Programme Group. Work streams identify and discuss risks, these report to the over arching MHPG. 33. Is there a plan to mitigate the risks identified? The programme group holds a risk register with records of all known risks and mitigating actions. These are reported through the mental health partnership board.

10 10 Legal Impact 34. Has legal compliance been considered e.g. Welsh All legislation guidance has been considered Language: is there any specific legislation or regulations that should be considered before a decision is made? 35. Is there a likelihood of legal challenge? This is a possibility, however extensive engagement has been undertaken and the MHPG have received advice from the Consultation Institute to ensure the risk of legal challenge is minimised. We have not had any indication that any groups are oppose to our proposed model. 36. Is there any existing legal guidance that could be perceived to be compromised i.e. Independent Provider Contracts, statutory guidance re: Continuing Healthcare, Welsh Government Policy etc? N We are not aware of any existing legal guidance that could perceived to be compromised. 37. Is there any existing contract and/or notice periods? We have a Commissioning and Partnership Workstream that was developed to advise on any potential concerns of contracts and notice periods. Reputational Impact 38. Is there a likelihood of public/patient opposition? Past experience of major service redesign within the UHB and external examples have demonstrated that it is likely to create public/patient opposition. It also attracts media interest. Work is ongoing with the Communication and Public and Patient Engagement teams to address this. 39. Is there a likelihood of political activity? An extensive stakeholder mapping exercise has been undertaken to include engagement with key partners including local government representatives. However, there may be unanticipated political activity at local level

11 11 See also response to Q Is there a likelihood of media interest? See Q Is there the potential for an adverse effect on recruitment? N The project aims to address the current challenges of recruitment, to create new innovative opportunities and diversify current job roles. It is anticipated that this will make the UHB a more attractive employer of choice. 42. Is there the likelihood of an adverse effect on staff morale? N The UHB is actively working to minimise this with communication and engagement planning, and through the business continuity Workstream. It is anticipated that staff moral will be enhanced through new ways of working, enhanced career opportunities and more rewarding roles. 43. Potential for judicial review? We have made every effort to reduce this possibility through extensive engagement, co production and the involvement of the consultation institute to reduce any likelihood of unanticipated challenges. Technical and supporting documents are on our website