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CYFARFOD BWRDD PRIFYSGOL IECHYD UNIVERSITY HEALTH BOARD MEETING

DYDDIAD Y CYFARFOD: DATE OF MEETING:

25 January 2018

TEITL YR ADRODDIAD: TITLE OF REPORT:

Transforming Mental Health Services

CYFARWYDDWR ARWEINIOL: LEAD DIRECTOR:

Joe Teape, Director of Operations / Deputy Chief Executive

SWYDDOG ADRODD: REPORTING OFFICER:

Libby Ryan-Davies, Transformation Director

Pwrpas yr Adroddiad (dewiswch fel yn addas)

Purpose of the Report (select as appropriate) Ar Gyfer Penderfyniad/For Decision

ADRODDIAD SCAA SBAR REPORT Sefyllfa / Situation Hywel Dda University Health Board (HDdUHB) set out openly and transparently with the public the issues facing existing mental health services in 2015. It made a commitment to work collaboratively with service users, staff, carers and key stakeholders to co-design a future model for mental health services, where people are supported to recover from mental health difficulties and live full and meaningful lives through services that inspire hope, confidence and understanding. Over the following two and a half years the ‘Transforming Mental Health’ programme has worked collaboratively with service users, staff, partners and the Community Health Council (CHC) to co-produce a future model for mental health services, built from learning from engagement, co-design, international collaboration and public consultation. The more recent development of the ‘Transforming Clinical Services’ programme also now generates opportunities to align with wider services where appropriate throughout implementation. This paper describes the process to date and provides supporting documentation to give assurance through:

Providing an assessment of compliance with stage 2 of the consultation process (public consultation)

Providing a closing report to give assurance that the process: o Has remained inclusive through a process of continuous engagement and co-

production o Meets the guidance as issued by the Welsh Government in relation to stage 2 of

the consultation process o Adopts ‘Best Practice’ through quality assurance by the Consultation Institute o Demonstrates that conscious consideration has been given to all feedback

against the proposals

Providing an implementation plan detailing the proposed implementation of the co-produced model

The consultation plan, consultation analysis and closing report were subjected to robust and extensive quality assurance by the Consultation Institute which has been awarded ‘Best Practice’ status. The Consultation Institute will ensure that HDdUHB receive a formal certificate

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of ‘Best Practice’ following an evidence review on 15 January 2018. The Board is asked to consider the consultation closing report and approve the proposal for the implementation of the co-produced service model for adult mental health services in HDdUHB.

Cefndir / Background The national strategic direction for mental health is to move services to more community focused delivery wherever it is appropriate and safe to do so. Welsh Government policy has clearly and consistently indicated the changes needed in the way community based care in Wales is delivered. The focus on delivering community based models within mental health services has been the strategic direction for many years following the closure of the historical large institutions. The range of community mental health services has extended significantly in recent years and the core values and drivers remain focussed on delivering services within and alongside local community infrastructures. However, there remains significant opportunity to deliver more services in the community. The mental health needs of society have changed significantly over the past decade and are well documented. Treatment advances have to some extent tracked these changes with delivery altering from a reliance on hospital care towards favouring community provision. These changes have seen people who previously required hospital care remaining in their communities, supported primarily by families and friends or, when required, by services delivered by health, social care and third sector professionals. The Mental Health (Wales) Measure 2010 has provided a great opportunity for services to be delivered differently, and enabled a more flexible and targeted use of resources ensuring that people receive the most appropriate support at the right time by the most appropriate service. The recovery model defines the philosophy of our mental health service in HDdUHB. This means that the individual is supported to ‘recover’ their life so that it feels worthwhile; so that they are working towards aspirations and goals that give value and meaning to their lives. Although they may not ‘recover’ fully from their illness, they find themselves living in and contributing to the community. The ‘Together for Mental Health Strategy and Delivery Plan’ in conjunction with the local Mental Health and Wellbeing Strategy 2012-2017 have given a clear focus for the Hywel Dda community to work in partnership to improve the health and wellbeing gains for people who are, or have potential to experience mental health problems. The overarching imperative and emphasis of the strategy is the promotion of mental wellbeing, mental illness prevention, appropriate and easy access, early interventions and timely treatment, with effective and evidence based treatments and interventions available at the most appropriate stage and consistently across services. The vision for the redesign of Mental Health services within HDdUHB is set out within the Mental Health & Learning Disabilities (MHLD) Directorate’s integrated medium term plan, developed in 2014 and updated in 2017. This vision has the Welsh Government’s strategy for mental health and wellbeing in Wales, Together for Mental Health (2012), at its centre with a commitment to build a well-produced and fully integrated network of care that responds promptly and holistically to contemporary health and social care needs. A Mental Health Programme Group (MHPG) was formed in April 2015 to oversee the co-production of the Transforming Mental Health Services programme. The MHPG agreed that the following principles should be at the core of any new service model:

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to have 24hr/7 day a week service

to not have to wait for a response

to move away from hospital admission and treatment to hospitality and timeout

to provide meaningful day time opportunities for our service users The MHPG committed to co-designing a future vision where services work actively with their communities to minimise, as far as reasonably possible, the development of mental health problems and to work together with individuals, communities and partner organisations to provide services that support when it is most needed. The work has followed an ethos of continuous engagement and co-production, working collaboratively with staff, service users, the CHC and other key partners. In recognition of current challenges with existing models of care, and the continuing need for improvement and innovation, the MHPG were tasked by the then HDdUHB Strategy and Planning Committee in April 2015 to engage with the public, staff and stakeholders to review current practice alongside alternative models of care for future mental health services, to better meet the needs of our population. The programme began with a period of pre-engagement from April to September 2015 which aimed to engage staff, service users, carers and key stakeholders in early conversations to set out the issues facing the service that any potential new service models would need to address. The resulting issues paper formed the focus of the wider conversation with the public and partners during the period of formal engagement which ran from October 2015 to January 2016. An external evaluation of the formal engagement period was undertaken by the University of Wales, Trinity St. David to define the key areas to inform the development of options for future service models This was presented to the Board in June 2016. An extensive period of options development and testing with our service users, staff and partners was undertaken through the remainder of 2016, resulting in the development of a proposed co-produced new service model on which to receive wider public consultation. During this period, HDdUHB and Trieste Mental Health Services in Italy signed the first Mental Health International Twinning Agreement in Wales. The Trieste mental health model of care is proven to deliver excellent outcomes for both service users and staff, and one which continues to attract international recognition for innovative and outstanding practice (World Health Organisation). Core to the Trieste Twinning agreement are a staff exchange programme and the exchange of learning. This learning has provided a wide range of staff and stakeholders the opportunity to reflect on current practices, explore new ways of working and have contributed to the evidence base that supports the development of the Transforming Mental Health programme. There are certain responsibilities that HDdUHB needs to consider and comply with when undertaking consultations of this nature. These are set out in the Welsh Government guidance document The Guidance for Engagement and Consultation on Changes to Health Services EH/ML/0161/11. The engagement and consultation process and timeline adopted is shown overleaf:

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Stage 1 – Engagement and options development The MHPG agreed an engagement plan to provide a structured approach to the management of engagement with key stakeholders, with the following core objectives:

Ensure a robust stakeholder mapping and analysis is undertaken and regularly

considered and updated

Ensure timely and accurate information is shared with internal and external stakeholders

regarding change

Ensure information is provided in an appropriate and accessible format

Provide opportunities for views to be expressed and shared into the organisation through

a range of engagement methods

Provide adequate time for proposals to be considered and commented upon

Consider the feedback during the decision making process

Over 100 activities were undertaken during the pre-engagement and formal engagement periods to ensure optimal participation and involvement from the public, service users, carers, staff and stakeholder groups. Throughout the engagement process HDdUHB worked closely with West Wales Action for Mental Health (WWAMH) to ensure that an independent service user and carer perspective on alternative models of care was used to inform any service transformation. The University of Wales Trinity Saint David were commissioned to analyse the engagement feedback. This engagement evaluation report was finalised following a stakeholder feedback event to test and confirm the emerging themes set out in the report. The draft and final reports were shared with the Community Health Council (CHC) and WWAMH. This was presented to HDdUHB on 2 June 2016. Building on the engagement analysis, between June and November 2016, a multi-stakeholder options development group was formed to distil and shortlist options. Representation included service users, carer representatives, the CHC, police, HDdUHB staff, WWAMH, Carmarthenshire, Ceredigion and Pembrokeshire County Councils. The group followed best

Pre-engagement / establishing the

programme

April - September 2015

Formal

engagement

(Pre-consultation)

October 2015 -January 2016

Formal engagement evaluation

February - May 2016

Options development and

testing

May - November 2016

Building the proposed co-

designed model

December 2016 -April 2017

Formal public consultation

June - September 2017

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practice advice on developing options from the Consultation Institute and was guided by the Senior Equality and Diversity Officer for HDdUHB. The group worked to undertake the following core tasks:

Outline current services provided across the three counties

Provide an overview of the status quo including service mapping of current provision

and buildings utilised, and an overview of staffing and roles within the service.

Develop a scoring criteria and weighting for option appraisal

Develop options that take into account the themes identified from the engagement

period

Develop a clinical case for change

The group used what had been learned from stakeholders, service users and carers in the engagement process and the engagement analysis document to draw up a list of weighted scoring criteria. These were:

Transport and location

Service responsiveness

Information and understanding

Expertise (level of)

Service user and carer outcomes and experience

Ability to meet current or projected demand

Statutory requirements

Evidence-based practice/guidance

Crisis management

Equality and inclusivity

Protected characteristics and additional related considerations

Affordability

Workforce

Sustainability

Delivery – joint/integrated

Level of co-production/co-design

From September to November 2016 seven shortlisted options were tested and challenged by a range of stakeholders through focus groups, drop-ins and engagement events, and at two options scoring workshops. The outcome of this process was the development of a co-produced consensus model for public consultation due to the co-designed approach. This featured:

A Single Point of Contact for mental health support across the counties

24/7 Community Mental Health Centres in each county

Specialised assessment and treatment units

The Board gave their approval to commence public consultation at their Public Board meeting on 22 June 2017.

Asesiad / Assessment

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Stage 2 – Formal Consultation A formal consultation plan was developed and approved by HDdUHB on 22 June 2017. It set out to achieve the following objectives:

To ensure awareness and information about the consultation reaches the majority of key stakeholders by the close of the consultation exercise.

To target those most affected by the proposed service changes through engagement methods best suited to the key groups.

To provide a full range of opportunities, taking account of accessibility, for staff and key stakeholders to give their views by the close of the consultation exercise.

To raise awareness to the general public of the consultation and provide opportunities for feedback.

To maximise use of innovative engagement and communication tools, such as e-communications, social media and interactive events to effectively engage.

The public consultation was open for a period of 12 weeks, from 22 June to 15 September 2017. A number of elements of the model were not open to influence during the consultation as they had already been agreed through extensive and continuous engagement and co-design with partners. These were:

Community Mental Health Centres (CMHCs) to be delivered by a multi-disciplinary and multi sector team providing open door access and both outreach and in-reach to the community and inpatient facilities.

Pembrokeshire and Ceredigion to have one 24 hour CMHC and Carmarthenshire will have two CMHCs, one open 24 hours and the other open extended hours Monday–Sunday.

Each CMHC (excluding the second Carmarthenshire centre) to provide crisis and recovery beds to support their communities and the hospital inpatient services.

An Assessment Unit (based in Carmarthen) and a Treatment Unit (based in Llanelli).

A Single Point of Contact (SPoC) available 24 hours a day led by mental health professionals supported by a range of multi sector skills.

The following elements were undecided and were therefore open to influence throughout the consultation:

The SPoC model could be delivered from a single central point of contact, or from three, county-based, single points of contact.

Workforce - consultees were invited to respond to proposals for workforce development and new roles across sectors in the new model.

Services/activities – views on the types of activities and the level of responsibility that third sector (community and voluntary service organisations) might adopt in the new model / opportunities to work differently and include elements of social enterprise / the type of family provision offered within the CMHCs

Transport - the transport provision that will support service users and their families within the proposed model.

Outcome – designing the measures and indicators that will be used in order to ensure the new model is providing better care and support for service users and their families

Supporting and delivering care, treatment and support via a number of methods including face to face contact, phone, Skype, email, instant message, and any other opportunities.

The aim of the public consultation was to:

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Inform and provide opportunities for people (staff, service users, carers, partners, stakeholders and the general public) to share their views about how the model has been developed

Describe and explain the co-produced proposed new model for future mental health services in HDdUHB

Seek people’s views on the model, including the range of services/activities and contact methods of services as set out in the proposals

Ensure that a diverse range of voices was heard which reflect the communities involved in the consultation

Understand the responses made in reply to the proposals and take them into account in decision-making

Ensure that the consultation process maximised community engagement and complied with legal requirements and duties

Ensure the consultation effectively captures views and feedback from local populations, in partnership with the CHC, local authorities and the voluntary sector. Ensuring a comprehensive stakeholder analysis process has been developed, identifying all individuals and groups potentially affected or interested in the development of mental health services provided by HDdUHB. These partners were contacted and their views sought during the consultation period. In addition all organisations and groups were asked to act as conduits and to actively help promote the consultation (via their communication channels) to any relevant stakeholders.

Consultation methods were designed to be as accessible as possible. They provided opportunities for communities and individuals served to share their views on the proposals. Opportunities included an open consultation questionnaire, available in hard copy, electronically and in easy read format, as well as a series of meetings and drop-in events. There was a commitment to meeting people where they felt most comfortable therefore meetings and drop-ins were arranged at a variety of existing groups and meetings. Hwylus Cyf and Mela, bilingual communications and consultancy agencies, were commissioned by HDdUHB to undertake the independent analysis of the consultation feedback. They also facilitated five workshops across the three counties to encapsulate the views of a wide range of key stakeholders. External assurance was provided by the Consultation Institute for the engagement, options development and consultation processes. The Consultation Institute is an independent not for profit body that was founded to promote best practice in public consultation and engagement. The Institute works with clients facing challenging exercises, providing advice and guidance through each step of the process. HDdUHB’s Transforming Mental Health Programme engaged the institute at an early stage, prior to formal consultation, to build a process that was fit for purpose and that met ‘Best Practice’ guidelines. Over the last 10 months the Institute has been working with the programme in its Quality Assurance (QA) role. Those who sign up to the Institutes QA process work to meet the Institute’s standards throughout and aim to achieve good or best practice recognition. QA has six stages, each requiring sign off from the Institute’s Assessor: • Scoping – the basics of the consultation are agreed • Project plan – when the consultation activities are set out and organised • Documentation – ensuring that all hard copy and electronic versions are fit for purpose • Mid-point review – to assess whether all relevant views are being collected • Closing date – to finalise plans for analysis, feedback and to influence outcomes

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• Final Report – to confirm the institutes endorsement of the consultation The Consultation Institute confirmed that HDdUHB has been awarded ‘Best Practice’ status for the Transforming Mental Health programme. HDdUHB will be issued with a certificate of ‘Best Practice’ following the formal review of evidence on 15 January 2018. The programme has also won the NHS Wales Awards 2017 in the “Citizens at the Centre of Service Re-Design and Delivery” category. There was a process in place throughout the consultation period to review the feedback and reflect on the proposals. In order to achieve this, senior members of the MHPG met on a weekly basis to review and analyse broad themes, concerns, or questions as they arose throughout consultation. A report on the emerging themes and actions taken to adapt the proposals in light of these remained live on the consultation web page during the consultation. A number of service users had developed an ‘Alternative Questionnaire’ in parallel with the formal consultation process. The HDdUHB are committed to continued engagement with this process to ensure that all views are heard. HDdUHB have given conscious consideration to this alongside a wide diversity of views that have been expressed throughout the consultation, and will continue to do so throughout the implementation phase. Every effort will be made to ensure that flexibility remains in any proposals and that people’s voices continue to be heard and reflected within all future developments. Feedback from the Independent Consultation Analysis provided by Hwylus Cyf There was a broad range of feedback responses received. It was recorded that at least 1171 people engaged directly with the consultation. A breakdown of the following formal responses received was recorded:

A brief summary of the independent consultation analysis is provided below. The Executive Summary of the Hwylus Cyf consultation analysis is included within appendix 2 of the closing report. The proposed model of care There was qualified support for the proposed model of care, with strong support for a 24/7 service. The questionnaire results highlighted that 61.2% of survey respondents either agreed or strongly agreed with the proposed co-designed model. 25.8% of respondents either disagreed or strongly disagreed with the proposed co-designed model. It is important to note that whilst there is positive support for the proposed co-designed model, there are many people who expressed concerns with different aspects of the model. HDdUHB is therefore committed to ongoing engagement and co-production throughout any implementation to ensure that all views continue to be heard and considered. Some

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respondents from Pembrokeshire and Ceredigion raised concerns about centralisation of acute services in Carmarthenshire and the accessibility of these services via public transport. Further, the issue of bed numbers and service capacity at the new CMHCs and at the Central Assessment and Treatment Units is repeated across all strands of the consultation. CMHCs The development of the CMHCs was welcomed across all strands of the consultation. There was support for calling them ‘wellbeing centres’. The feedback called for them to be carefully sited within towns to ensure that they are easily accessible and embedded within local communities. There were concerns expressed about the number of hospitality beds contained within them with people asking for some flexibility to allow for a greater number of beds if demand increases. Assessment & Treatment Units There was an understanding of the need to provide high quality inpatient care within centralised units however people from Ceredigion and Pembrokeshire expressed their concerns about distance and travelling. The accessibility of Llanelli was a particular concern. Single Point of Contact The introduction of a 24/7 Single Point of Contact was welcomed. The feedback was that people wanted a combination of a single, easy to remember phone number that was staffed by professionals who would answer quickly, were empathetic and had good local knowledge in each county. Other means of contacting the Single Point of Contact were also welcomed, such as email, or text messaging. The need to accommodate individuals with hearing or sensory loss needs was also raised. Future ways of working The proposals to develop social enterprises as a part of the CMHCs was welcomed. There were recognised benefits for service users becoming actively involved in the running of them. A greater involvement of the voluntary sector within CMHCs was also welcomed provided any issues around management, finance, governance and confidentiality were addressed. Workforce Introducing people from the voluntary sector into the workforce was welcomed provided that there were clear governance arrangements in place. Transport Concerns around distance and travelling were clearly heard throughout the consultation. There was strong support for involving the voluntary sector in helping to provide transport solutions. Travel costs can be a barrier to those wishing to access centralised services, particularly for those in the more rural north and west of the HDdUHB area. The use of technology and digital health The use of technology to extend the range of options available with which to raise awareness of mental health problems was welcomed, particularly amongst the younger population, however it should not replace traditional face to face contact. It should also accommodate the needs of those with sensory loss, literacy problems or learning disabilities. Difficulties with access to reliable high-speed internet links, particularly in rural areas, were also noted. Formal response from Hywel Dda CHC The Hwylus independent consultation analysis was shared with the CHC in order that they could provide a formal response as part of their statutory duties around service change in their

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role as the patient / citizen voice. They welcomed the approach that HDdUHB adopted during engagement and consultation phases. They reported that they had not seen a more comprehensive attempt to gather views and co-produce a new NHS service model. They noted the ‘good quality dialogue and real positivity’ throughout the engagement process that demonstrated a substantial appetite for change amongst the public. The CHC noted that the response to the consultation had started to elicit some divided opinions as positive views held by some were met with concerns raised by others. They have therefore provided eight conclusions for HDdUHB to take into consideration as implementation progresses. These may be summarised as:

1. Retaining a commitment to continued inclusivity, co-production and flexibility throughout, and after, implementation

2. Not making any changes without agreement with stakeholders and ensuring it is safe to do so

3. Having flexibility in the SPoC to respond to need and learn quickly 4. Provide further clarity on how transport solutions will meet need 5. Demonstrate a commitment towards accessible support across communities, working

with GPs and others to link existing services into cohesive networks 6. Maintaining a co-production approach around developing new ways of working 7. Retaining a co-production approach in the development of CMHCs, including an open

options appraisal process for their location 8. Developing meaningful measures of success to evaluate the service change.

Considering the Consultation Analysis Feedback The range and richness of views expressed throughout the consultation period was acknowledged, including those who provided support to the model and those who expressed reservations about aspects of the model. HDdUHB continued its commitment to ongoing co-production throughout the process. Continued compliance with ‘best practice’ standards for the Consultation Institute quality assurance process also required that careful consideration be given to the consultation analysis with staff and stakeholders throughout the process. The consultation analysis and formal CHC response were shared with members of the MHPG. A series of staff, stakeholder and public drop-in sessions were also held across the three counties in December 2017 to consider the feedback received. Youth groups and key equalities groups were asked for specific comments in relation to any impact on protected characteristics groups. A meeting was also held between senior members of the MHPG and a service user representative who had led the work on an alternative questionnaire on the proposed model. This was to ensure that all views were being heard and considered within the review of the consultation feedback and reflected accurately within the closing report. Feedback from all these groups, including the formal response from the CHC, were collated and discussed at a post consultation analysis meeting with multi-stakeholder attendance. A series of recommendations were made to amend the proposed co-designed model in line with these comments. These were further discussed at a meeting of the MHPG on 20 December 2017. The following recommendations were made to adapt the proposed co-designed model for Board consideration and approval. CMHCs The CMHCs will retain their original purpose as set out within the consultation as warm, welcoming non-clinical environments. Strong consideration will be given to naming them ‘Wellbeing Centres’. The sites of these centres will be selected through a transparent co-produced options appraisal process. They will be commissioned in such a way that there will be

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flexibility in the number of hospitality beds that they can accommodate in order to meet any future demand. Further financial and workforce modelling will be undertaken to determine whether the Carmarthen CMHC can provide services 24/7 in line with the other CMHCs. Assessment Unit and Treatment Unit Existing constraints around capital and estates availability demand that the Central Treatment Unit must first be commissioned in Llanelli however transport solutions explored as part of implementation will need to be flexible to address these specific concerns. A business case will be developed to explore the co-location of this with the Central Assessment Unit. This will include the necessary engagement to ensure continued co-production values throughout the process. Single Point of Contact A single, easy to remember number will be commissioned that can be used from anywhere within the HDdUHB footprint to contact mental health services. This will connect to a local service within each county aligned to existing local authority systems and NHS ‘111’. Transport A transport service will be commissioned with partners to allow people to more easily access the CMHCs and Central Assessment and Treatment units, reducing the need for dependence on public transport. The modelling work completed as part of the public consultation will be refreshed during the implementation phase to ensure population need is accurately reflected with particular focus on concerns raised in relation to the Central Treatment Unit in Llanelli. A closing report was prepared that describes the consultation process undertaken and sets out the delivery of the consultation plan that was approved by Board on 22 June 2017. This has been quality assured by the Consultation Institute and the Transforming Mental Health programme has received ‘Best Practice’ status from the Consultation Institute for the whole consultation. Proposals for Implementation of the Co-Designed Model A proposed implementation plan has been developed. The timescales require detailed work-up with service, finance, workforce, staff side representatives and estates teams. Timescales will also be influenced by a business case scoping meeting with the Welsh Government Capital Team to progress an agreement on the source and timing of any capital funding. A strategic outline business case (SOC) may need to be developed and agreed to overarch the proposed capital programme. This will be aligned with the Transforming Clinical Services programme as the final options for public consultation emerge. Throughout the engagement and consultation process co-production and co-development have remained at the core of the ethos of the programme. HDdUHB and the three local authorities have held a strong commitment towards working in an integrated way to develop and deliver the proposed model. This will continue to be built upon with all partners to ensure all stakeholders are working together throughout implementation to provide integrated services and the best possible mental health care for people. Implementation of the recommendations will be progressed together in order that everyone, including service user and carer representatives, have the opportunity to influence and contribute to planning the implementation of the proposed model of care. There is recognition that people have varied requirements for health, social and voluntary sector care and support, and want to address issues that can create health inequalities.

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The programme will continue to operate transparently, enabling appropriate and professional scrutiny and challenge across the system by internal and external stakeholders. The risk that comes with a change programme of this size will be managed in a joined-up way, stakeholders supporting each other to ensure delivery, prevent failure and share benefits. The MHPG will develop into the Mental Health Implementation Group (MHIG) for the next stage of the programme once approval is received to progress to implementation of the proposed co-designed model. The Director of Operations / Deputy Chief Executive will take the lead for the programme as the Senior Responsible Officer as the programme moves into implementation. The multi-stakeholder members of the MHIG have agreed to follow a terms of reference and governance structure for the implementation phase (Annex 1). Both of these documents provide the necessary structure for the delivery and oversight of the next stage of work. This will enable better planning and design and a best practice approach to delivery with flexible and efficient management of the required work streams. The MHIG will provide governance and oversight of all aspects programme development. All stakeholders are committed to providing support and leadership in the development and implementation of the transformation necessary at all levels. They will hold each other to account for delivery, providing robust challenge and independent assurance. Throughout implementation, dedicated workstreams will have a nominated lead who will champion and be responsible for the planning and delivery of the work required to achieve the vision. These have been carefully considered to provide effective leadership and oversight of the delivery of a number of key areas. The consultation process has indicated qualified support for the proposed model however the remaining elements and features of the future service model are still to be co-produced as part of the detailed implementation phase. A number of focus groups will therefore be developed with key partners and other interested parties to ensure that there remains a strong commitment to co-production throughout the implementation phase. These are based on the feedback received throughout consultation. Service user, carer, community and stakeholder input will be integral to the delivery of the proposed implementation plan. Solutions to areas of concern identified as part of the consultation process will be co-designed with service users and stakeholders. The rationale for decision making will be explained to service users and stakeholders through clear communication and open dialogue. Opportunities to align with the emerging Transforming Clinical Services Programme will be maximised throughout the implementation stage where these can provide opportunities for integration, efficiencies and greater opportunities to progress early implementation. Links to micro-communities and to existing community support networks will be key to the success of the proposed new ways of working. Key Risks and Mitigation A Risk Register for the programme has been completed and is available on the Transforming Mental Health website here: www.hywelddahb.wales.nhs.uk/mentalhealth The MHIG workstreams will provide expert input into the development of a detailed risk log for the programme. Any risks identified outside of the scope of the MHIG will be added to the MHLD Directorate’s Risk Register for action. These will be monitored through the Directorate’s Business Planning and Performance Assurance Group and Quality and Safety structure.

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The following documents have been completed as part of the closing governance:

Integrated Impact Assessment

Equality Impact Assessment

Risk Register

Privacy Impact Assessment screening

Argymhelliad / Recommendation Taking into account the information presented, the Board must satisfy itself that the consultation process has been robust and comprehensive, and that the co-produced implementation plan reflects the outcome of the consultation feedback and analysis. The Board is requested to decide to:

Record and acknowledge the achievement of ‘Best Practice’ status through the quality assurance process undertaken by the Consultation Institute

Approve completion of Stage 2 of the consultation process (public consultation)

Approve the Transforming Mental Health proposed implementation plan

Approve the alignment of this programme with ‘Transforming Clinical Services’ as part of implementation to maximise opportunities to integrate and best meet the needs of the population

Amcanion: (rhaid cwblhau) Objectives: (must be completed) Cyfeirnod Cofrestr Risg Risk Register Reference:

New risk, awaiting approval on Risk Register

Safon(au) Gofal ac Iechyd: Health and Care Standard(s): Hyperlink to NHS Wales Health & Care Standards

All Health & Care Standards Apply

Choose an item. Choose an item. Choose an item.

Amcanion Strategol y BIP: UHB Strategic Objectives: Hyperlink to HDdUHB Strategic Objectives

1. To encourage and support people to make healthier choices for themselves and their children and reduce the number of people who engage in risk taking behaviours 7. To improve the mental health and wellbeing of our local population through improved promotion, prevention and timely access to appropriate interventions. 9. To improve the productivity and quality of our services using the principles of prudent health care and the opportunities to innovate and work with partners. 10. To deliver, as a minimum requirement, outcome and delivery framework work targets and specifically eliminate the need for unnecessary travel & waiting times, as well as return the organisation to a sound financial footing over the lifetime of this plan

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Amcanion Llesiant BIP: UHB Well-being Objectives: Hyperlink to HDdUHB Well-being Statement

Improve Population Health through prevention and early intervention Improve efficiency and quality of services through collaboration with people, communities and partners Develop a sustainable skilled workforce Choose an item.

Deddf Llesiant Cenedlaethau'r Dyfodol (Cymru) 2015 - Pum dull o weithio:

The Well-being of Future Generations (Wales) Act 2015 - 5 Ways of Working: Hyperlink to Well-being and Future Generations Act 2015 - The Essentials Guide

Please explain how each of the ‘5 Ways of Working’ will be demonstrated

Long term – can you evidence that the long term needs of the population and organisation have been considered in this work? The programme has been developed through extensive engagement and consultation with service users, carers, key stakeholders and the public and the co-designed model is based upon evidence of modern mental health services that can respond to the demands of the future needs of the population.

Prevention – can you evidence that this work will prevent issues or challenges within, for example, service delivery, finance, workforce, and/or population health? The programme has been developed to meet future challenges in service delivery through:

Providing a more efficient service

Reducing dependence on variable pay

Improving professional staff recruitment and retention

Reducing the burden of mental ill-health

Integration – can you evidence that this work

supports the objectives and goals of either internal

or external partners?

The programme has been extensively co-produced

with service users, carers, HDdUHB staff members,

and key stakeholders as a model that meets these

goals.

Collaboration – can you evidence working with

internal or external partners to produce and deliver

this piece of work?

The process has been extensively co-produced over a

period of two and half years with our key statutory

partners, including service users, carers, local

authorities and others. The CHC have had a key

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involvement throughout the process and, as part of

their statutory role, have provided a formal response.

Involvement – can you evidence involvement of people with an interest in the service change/development and that this reflects the diversity of our population? Co-production values have been at the core of the programme’s ethos since its inception. Significant attention has been given to the diversity of the population, including those with protected characteristics. The process has also received ‘Best Practice’ status to date from the Consultation Institute.

Gwybodaeth Ychwanegol: Further Information: Ar sail tystiolaeth: Evidence Base:

World Health Organisation – Trieste Mental Health Recovery Services Consultation Institute WG “Guidance on Engagement and Consultation for Changes to Health Services”

Rhestr Termau: Glossary of Terms:

Contained within the documents

Partïon / Pwyllgorau â ymgynhorwyd ymlaen llaw y Cyfarfod Bwrdd Iechyd Prifysgol: Parties / Committees consulted prior to University Health Board:

The Board (Public) Strategy & Planning Committee Business Planning, Performance & Assurance Committee Mental Health Legislation Assurance Committee Stakeholder Reference Group CHC Planning Committee CHC Executive Committee Partnership Forum Local Mental Health Partnership Board Professional Forums (including Medical Staff Committee) Integrated Services Board (WWHSCP) Mid Wales Healthcare Collaborative Board (MWHCC)

Effaith: (rhaid cwblhau) Impact: (must be completed) Ariannol / Gwerth am Arian: Financial / Service:

Please see Integrated Impact Assessment Tool (Annex 2) Financial modelling completed of proposed model and options – Technical document available on TMH webpage www.hywelddahb.wales.nhs.uk/mentalhealth

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Ansawdd / Gofal Claf: Quality / Patient Care:

Please see Integrated Impact Assessment Tool (Annex 2) Clinical case for change developed to support the consultation and proposed service model – available on the TMH webpage www.hywelddahb.wales.nhs.uk/mentalhealth

Gweithlu: Workforce:

Please see Integrated Impact Assessment Tool (Annex 2) Workforce technical document developed to support the consultation and proposed model – available on the TMH webpage www.hywelddahb.wales.nhs.uk/mentalhealth

Risg: Risk:

Please see Integrated Impact Assessment Tool (Annex 2) Please see Risk Register (Annex 3) Risk register developed as part of the Consultation Plan – available on TMH webpage www.hywelddahb.wales.nhs.uk/mentalhealth Compliance with WG Guidance The Guidance for Engagement and Consultation on Changes to Health Services EH/ML/0161/11 – Best practice awarded by the Consultation Institute for the Consultation Scope and Consultation documents.

Cyfreithiol: Legal:

Please see Integrated Impact Assessment Tool (Annex 2) Best practice awarded by the Consultation Institute for the Consultation process and closing document.

Enw Da: Reputational:

Please see Integrated Impact Assessment Tool (Annex 2) 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. An Integrated Impact Assessment has been completed and is available on the TMH webpage.

Gyfrinachedd: Privacy:

Please see Integrated Impact Assessment Tool (Annex 2) Please see Privacy Impact Assessment Initial screening document (Annex 4)

Cydraddoldeb: Equality:

Please see Integrated Impact Assessment Tool (Annex 2) EQIAs have been completed for the Programme, each of its work streams, the proposed model and the consultation plan – available on the TMH webpage www.hywelddahb.wales.nhs.uk/mentalhealth