The purpose of this paper is to update the East Sussex Health Overview and Scrutiny Committee (HOSC) on the programme to reconfigure mental health inpatient services in East Sussex following formal public consultation and inform them that the Sussex Partnership Trust Board of Directors and the Joint Committee of Sussex NHS Commissioners have agreed the following final proposal which is to:

· reprovide the inpatient services at the Department of Psychiatry, Eastbourne, to a new facility in Bexhill.

This paper describes the work of the programme to date and provides assurance that the appropriate process and governance has been followed to ensure the case represents a robust proposal to improve the quality and outcomes for our local populations in relation to inpatient mental health services.

The paper provides the committee with:

· A progress update on the development of the decision-making business case for East Sussex mental health inpatient services following public consultation

· A summary of the case for change, pre-consultation business case proposals, summary consultation outputs and final proposal for implementation

· Information about how we have responded to the East Sussex Health Overview and Scrutiny Committee’s recommendations

· Key health inequality and equality impacts and action

· Assurance on the process of the consultation and the process of the development of the case

The full Decision Making Business Case and appendices will be made available on the CCG Website and the executive summary of this is provided as Appendix 1 to this report.

2.0 Context

Case for change

In January 2020, a Case for Change to the way that inpatient mental health services in

East Sussex are delivered was developed. This has informed our engagement to date.

The Case for Change provided a baseline assessment of the current state of adult

inpatient mental health services in East Sussex, examined current and future demand for

services and how this fits in with national, regional and local priorities.

It did not seek to identify any proposals or solutions at this stage but simply to confirm the need for change. This concluded that current adult inpatient provision is no longer fit-for-purpose, does not meet the objectives of Sussex Partnership Foundation Trust’s (SPFT) Clinical and Estates Strategies, is a barrier to staff recruitment and retention and does not enable 'People to feel valued, supported and cared for', a key tenet of the trust’s organisational strategy.

In addition, the Care Quality Commission has reported that, while staff continue to provide high-quality care despite the limitations placed on services, steps should be taken to improve, or remove, outdated dormitory-style wards. The work aligned with wider Sussex developments to eradicate dormitories such as the work that has taken place in West Sussex following consultation on proposals for that area.

National eradicating dormitories programme

In response to an invitation to bid, SPFT, supported by the CCG, applied for Department

of Health and Social Care (DHSC) capital funding in December 2020 to remove its

dormitory style beds and re-provide these in modern, high-quality, safe and compliant

accommodation. This followed a government announcement, on World Mental Health Day in October 2020, of additional funding to further support mental health trusts to eradicate out of date dormitory accommodation. This new funding followed the government’s commitment to accelerate investment in health infrastructure, and to level up access to mental health services, so that every inpatient can receive treatment in an appropriate setting. Capital funding has been allocated that allows for a like for like replacement of dormitory accommodation in order to:

• enhance the safety, privacy and dignity of patients suffering with mental illness;

• improve the individual care that can be given to patients;

• enable a reduced length of patient stay in a facility;

• improve patient safety, including better infection control;

• reduce the risk of incidents involving patients or staff; and

• provide a better environment for patients and staff to support improved outcome.

This re-provision must be complete by March 2024 to meet national timescales for the

eradication of dormitories. Following approval of the case the programme will continue its progression through the national capital programme process for a new build. Significant work has been undertaken and a plan in place to ensure completion of the programme to timescale.

The Trust has also been awarded capital funding to eradicate dormitories to support a refurbishment of Raphael Ward at the St Anne’s Centre at Conquest Hospital, St

Leonards on Sea. This does not require a change in location and does not form part of this business case.

3.0 Addressing Health Inequalities

Reducing health inequalities remains a key focus for our system and closing the gap that is still present is a priority. The Sussex Health and Care Partnership’s draft strategic framework to address health inequalities is structured around six areas of focus including early years, children and young people and mental health and learning disabilities.

Specific areas to note within this programme include:

· A comprehensive Equality and Health Inequality Impact Assessment was published with the pre-consultation business case and informed the proposals for consultation.

· The Equality and Health Inequality Impact Assessment was recognised by NHSE/I as comprehensive and of high quality; this informed the proposal and the consultation and has been iterated throughout the programme.

· This showed the improved proposed facility would have positive impacts from the new build structure and design in providing an improved environment that takes account of differential impact for people with protected characteristics and improves privacy and dignity.

· This showed the Bexhill site could support an improvement in health inequalities as the cost of travel is reduced for people from deprived areas.

· It considered needs of carers to inform design and implementation.

· It identified ongoing action to ensure inclusion of people who use these services in the detailed building design.

· It identified the need for a travel and transport group which will continue to work with local people as the programme is implemented.

· The full updated Equality and Health Inequality Impact Assessment will be published with the decision-making business case.

4.0 Background and consultation

Pre-consultation business case

In January 2021, the RIS:ES Programme Board agreed draft proposals for the redesign of mental health inpatient services in East Sussex.

The proposals set out the vision for acute adult inpatient services in East Sussex for new state-of-the-art facilities to cover all inpatient services, potentially provided on a single campus sufficient to serve all the mental health inpatient needs of the people of East Sussex, now and in the future.

It was agreed that:

· the preferred way forward is to deliver the campus in phases, addressing the most pressing issues in the current provision as a first step, and

· confirmed the re-provision of the Department of Psychiatry (currently on the site of Eastbourne District General Hospital) is a priority.

The phased approach enabled the programme to take advantage of funding available to eradicate dormitories and focuses on the reprovision of services from the Department of Psychiatry.

As part of the development of options, potential sites for the new provision had been assessed. The assessment concluded that two sites were viable: one in Hailsham and the other in northeast Bexhill. These sites were both sufficient in size to enable this first phase and incorporate potential future phases of the East Sussex inpatient redesign in the future.

The sites were also deemed to be deliverable in terms of likelihood of securing planning consent and technical feasibility.

The draft proposals were subsequently reviewed by the Sussex Partnership Foundation NHS Trust Board of Directors, East Sussex CCG Governing Body and East Sussex Health Overview and Scrutiny Committee (HOSC), and approval was given to develop a Pre-Consultation Business Case (PCBC).

The PCBC set out the rationale for the change, the clinical support and governance, equalities and health inequalities impact (including travel time analysis), funding requirements (both capital and revenue) and the plans for undertaking a public consultation.

The PCBC was subject to Stage 1 and 2 Assurance Check Points by NHS England and Improvement before progressing to Trust Board, CCG Governing Body and East Sussex Health Overview and Scrutiny Committee (HOSC) in June 2021. HOSC agreed that the proposals represented a substantial change requiring public consultation and that the HOSC would establish a separate Review Board to review the plans in detail.

Public consultation

A robust public consultation ran from 14 June to 14 September 2021 and focused on the first phase of the long-term programme; the reprovision of mental health inpatient services currently provided at the Department of Psychiatry in Eastbourne to new facilities to be built on a different site. The consultation has been supported by an independent organisation, Opinion Research Services.

Views were sought on the proposed reprovision and the best site for these new facilities. The Bexhill site was the preferred option as part of the consultation, although both sites were viable.

While the wider vision for mental health services in East Sussex was not the main subject for consultation, views were also sought about these long-term plans that could, over time, create a ‘campus’ which would address all mental health inpatient needs and become a centre of excellence to not only provide outstanding outcomes for patients but also offer excellent teaching and research opportunities.

Opinion Research Services (ORS) were commissioned to evaluate the feedback from the consultation. Key findings from Opinion Research Services showed:

· almost universal recognition of the need for change

· strong support from all stakeholder types across all geographic areas for moving inpatient services to a new hospital on a different site, with Bexhill being the preferred site, and

· strong agreement with the long-term vision for a single ‘campus’ model for inpatient mental health services.

· Travel and transport (public and private, including parking) are raised as issues to be addressed as part of implementation, with suggestions that transport infrastructure and public transport improvement should be considered to mitigate impacts of changes.

Full details are set out in the final analysis report from Opinion Research Services that the CCG will publish.

Consultation with the East Sussex Health Overview and Scrutiny Committee

During the consultation period, the East Sussex Health Overview and Scrutiny Committee (HOSC) established a Review Board to explore the proposals. The Review Board submitted their report to the HOSC meeting on Thursday 23 September and subsequently submitted a final report to the CCG. This report supported the proposals and made recommendations to ensure the success of the programme. This included recommendations to:

· ensure that the travel and access needs of patients, staff, families and carers are addressed as far as is practicable via the Transport and Travel Review Group (this group is now established)

· ensure service users and their families and carers are involved in the more detailed design process, including ensuring that the new site has a range of digital communications available to enable patients to contact their families and carers

· produce a travel and transport strategy during the planning process that offers adequate parking for staff, families and carers, whilst being compliant with the local authority’s planning requirements and which includes charging points for electric vehicles.

All recommendations have been considered as part of the drafting of the final business case and will inform the implementation plan as the new build takes place. Recommendations also included measures to mitigate any building constraints and support the delivery of the timescale. Appendix 2 provides an Action Plan to address these recommendations.

5.0 Programme Assurance

When developing our final proposal:

· We have considered the outputs from public consultation and used these to inform the decision-making business case

· We have developed the business case with due regard to our duties to reduce inequalities and promote integration of health services where this will improve the quality of those services, in addition to ensuring compliance with all relevant equality duties

· We have assessed the impacts of our proposal by undertaking a Quality Impact Assessment and Equality and Health Inequality Impact Assessment to identify any potential negative impacts and identified appropriate mitigating actions; this has been updated post-consultation

· We have considered the feedback from the East Sussex HOSC and this has informed our business case and implementation plans.

ORS has considered the process of the consultation and confirmed the following:

· As an established specialist social research practice, with wide-ranging experience of public engagements and statutory consultations across the UK, ORS’ considered view is that the process undertaken by NHS East Sussex CCG and Sussex Partnership NHS Foundation Trust has met these standards. The consultation has been conscientious in eliciting the informed opinions of stakeholders and members of the general public; the engagement process was open and fair, and conformed with the principles of good practice. To ensure accessibility, a range of consultation activities and channels for feedback were employed. Finally, ORS is satisfied that the consultation was proportional to the scale of the changes to health service provision being proposed and challenges being addressed.

6.0 Decision Making Business Case

The case has been finalised drawing on feedback and further work undertaken during the consultation period. Due diligence and further appraisal on site selection have been completed and included: site suitability, ability to deliver longer term aims, deliverability and timescales, technical issues, planning consent, site acquisition and ownership. This confirmed Bexhill as the preferred site to propose for approval.

7.0 Conclusions

The DMBC was produced following a formal 12-week public consultation and details the process followed by the CCG and the Trust to take forward the proposals for the relocation of the Department of Psychiatry inpatient facility, currently located at Eastbourne District General Hospital.

Initial proposals were developed with staff and stakeholder participation and a shortlist of two locations identified. A site due-diligence process identified that both site proposals were viable in this context. This was detailed in the Pre-Consultation Business Case.

A formal public consultation was undertaken, supported by an independent organisation between June and September 2021 and a report detailed all feedback received.

Following the consultation consideration was given to how the feedback given would be addressed. A Travel and Transport Review was undertaken with stakeholder involvement and both the Quality Impact Assessment and the Equality Health Impact Assessment were reviewed and updated.

The conclusion of the CCG and Trust is that a new facility should be created, using NHSE/I Eradicating Dormitories funding on a site which is able to allow for further expansion of services at a later date.

The site in North East Bexhill has been determined to be the preferred site for the Redesign of Inpatient Services in East Sussex.

Appendix 1 - DMBC Executive Summary

Executive summary

1.1 Introduction

The purpose of this Decision Making Business Case (DMBC) is to demonstrate that the proposal to build a new facility to replace the Department of Psychiatry (DoP) at Eastbourne District General Hospital with a modern dormitory-free facility on a new site, is confirmed as the right strategic proposal to improve services for the local population and is supported by stakeholders across local communities.

NHS guidance in Planning, assuring and delivering service change for patients, 2018 [1] requires that a project must be sustainable in service, economic and financial terms and can be delivered within the planned-for capital spend. The DMBC follows the approved Pre-Consultation Business Case (PCBC) and subsequent formal public consultation and shows how all available information and evidence has been taken into account, together with feedback captured by that consultation to inform the final proposal.

Developed by the NHS East Sussex Clinical Commissioning Group (ESCCG), in partnership with the Sussex Partnership NHS Foundation Trust (SPFT), approval will enable the scheme to be developed within the timeframe of the national Eradicating Dormitories Programme, i.e. by March 2024.

1.2 Context

Sussex Partnership NHS Foundation Trust (Sussex Partnership) provides mental health services to care for and treat people with conditions such as psychosis, depression, anxiety, dementia and personality disorder. The focus of this document is the reprovision of the 54-bedded Department of Psychiatry in a new facility.

The DMBC details how that the CCG has met its statutory duties and responsibilities in relation to the involvement of the public, local authority and other stakeholders and system partners in a proposed service change. That change has also been informed by the Joint Strategic Needs Assessment (JSNA) to ensure it addresses need and supports improved population health and well-being.

1.3 The case for change

The Case for Change was developed by a wide range of stakeholders including clinicians, operational staff and experts by experience. It was recognised that the current service is constrained by the facilities available at the DoP and that this inpatient facility was not able to provide the quality of service that patients, carers and families deserve.

Service users stay in dormitory wards, impacting on both privacy and dignity and the therapeutic benefits the service aims to provide. The current building provides limited and low-quality external areas. It is seen as a barrier to staff recruitment and retention and does not enable 'People to feel valued, supported and cared for', a key tenet of SPFT’s Organisational Strategy.

The main conclusion of the Case for Change was that current adult inpatient provision is no longer fit-for-purpose, does not meet the objectives of SPFT’s Clinical and Estates Strategies, and should be replaced.

1.4 Process to date

To address this, a programme structure and assurance system were set up and are described here. A number of stakeholder engagement workshops resulted in the development of a longlist and then a shortlist of options including sites where a new facility could be constructed. A Pre-Consultation Business Case (PCBC) was developed to make the case for change and set out the plans for a Public Consultation around the reprovision of the DoP. It was approved by SPFT, East Sussex CCG and submitted to the Health Oversight and Scrutiny Committee of East Sussex County Council in June 2021 prior to formal public consultation.

An independent report on the findings of the consultation has been produced and the report presented the feedback from those who participated in the consultation.

1.5 Consultation

The formal public consultation on the proposal to move inpatient services at DoP to new facilities on a new site began on 14 June and ended on 6 September 2021. It set out the improvements anticipated from a reprovision of the current facility, together with the strengths and weaknesses of site options at Amberstone Hospital and a site in north east Bexhill, while highlighting that Bexhill is the preferred option.

While the long-term vision for a ‘campus’-style approach to address all inpatient needs and create a leading centre for mental health services was not subject to formal consultation, views and suggestions about this proposed approach were still welcomed.

Opinion Research Services (ORS), was appointed to advise on, independently manage and report on the public consultation programme of engagement with service users, their families and carers, clinicians and other NHS staff, and other stakeholders. The full report is attached as an Appendix to the DMBC.

1.6 Common Themes

A number of common themes were identified during the consultation process. These included concerns regarding travel and transport, queries about workforce matters and positive support for the creation of a new facility to enable facilities to be created from which a high standard of patient care can be delivered.

Initial actions in response have included a review of the QIA, EQIA and the establishment of a Travel and Transport Review Group.

1.7 Implementation

Once the DMBC is formally approved, an Outline Business Case (OBC), followed by a Full Business Case (FBC), will be developed to enable NHS approvals of the capital funding from the Eradicating Dormitories Programme to be achieved. Construction will begin once the necessary business case approvals have been given. The Trust will also seek planning consent to implement the project. By using modern methods of construction, particularly off-site manufacture, the new facility can be delivered at the earliest opportunity. It is intended that the new facility will be occupied by March 2024.

1.8 Decision making

The purpose of the DMBC is to ensure that the proposals have been consulted upon, are clinically sound, financially viable and in line with the improved outcomes agreed in the PCBC.

This will be considered by the CCG, and following the decision by the CCG, the East Sussex Health Overview and Scrutiny Committee will meet to decide if the change is in the interests of the public.

The recommended decision has been determined in two parts. Firstly, confirmation that the case for change and proposals remain valid and have received support through the public consultation, and secondly, which of the two sites (Hailsham or Bexhill) provides the best location for the new services. This is arrived at by identifying the optimal combination of site suitability and preference from the Public Consultation, and site deliverability infrastructure cost and risk as determining factors.

1.9 Conclusion

The key decision following public consultation is that the Department of Psychiatry should be re-provided in a new building on the preferred greenfield site identified in North East Bexhill.

Appendix 2 - HOSC Recommendations Action Plan

Recommendation	Actions to address the Recommendations
- be prepared to work with NHS England for a solution to any funding constraints well in advance should prices appear to be increasing dramatically and risking the viability of the scheme.	The Programme is working closely with NHSEI teams both at National and Regional levels. There are monthly meetings and open lines of communication to ensure early identification and resolution of issues.
- develop a design that takes advantage of high levels of modern methods of construction in order to ensure speedier construction and improved carbon footprint	The use of MMC and modular construction will be built into the design from an early stage to maximise the use of off-site manufacture components.
- move forward with the construction of whichever site is chosen as soon as is reasonably practicable, for example, finalising the design of the building; pre-ordering as many prefabricated elements as possible, and submitting a planning application by Spring 2022	The Programme is working to accelerate the programme wherever possible. This will include: - continuing the development work while business cases are approved. - Seeking financial support from NHSEI for early enabling working and potential for pre-ordering of MMC components.
- ensure that the travel and access needs of patients, staff, families and carers are addressed as far as is practicable via the Transport and Travel Review Group	A Travel and Transport Review has been established and has met to review the Consultation findings and to identify potential solutions. These solutions will be investigated for deliverability and the group will continue to meet throughout the design and build phases.
- ensure service users and their families and carers are involved in the more detailed design process, including ensuring that the new site has a range of digital communications available to enable patients to contact their families and carers	A comprehensive stakeholder engagement strategy and plan will be put in place to ensure continue engagement with all stakeholder include service users and their families and carers. This will ensure that the outcome is co-designed and co-produced. A digital workstream will be established and will include ensuring digital communication is embedded form the outset.
- produce a travel and transport strategy during the planning process that offers adequate parking for staff, families and carers, whilst being compliant with the local authority’s planning requirements and which includes charging points for electric vehicles	A Travel Plan will be produced and will form part of the Planning Application. This will cover parking, accessibility, green travel to encourage cycling, walking and use of public transport and the installation of elective vehicle charging points.
- once a site has been agreed, investigate the possibility of new bus stops with the appropriate organisations, such as Stagecoach and East Sussex County Council	The programme will engage with Stagecoach and ESCC at the earliest opportunity to discuss and investigate opportunities.
- develop a clear inter facility transfer agreement with South East Coast Ambulance NHS Foundation Trust to ensure patients are transferred from acute sites to mental health inpatient wards in a timely manner as soon as is reasonably practicable.	Engagement with South East Coast Ambulance services will take place during the build phase.
- ensure the Urgent Care Lounge at the Department of Psychiatry is replaced on site at the EDGH once the Department of Psychiatry closes	It has been confirmed, with East Sussex Healthcare NHS Trust, that these facilities will remain at the EDGH
- continue to review demand for inpatient services and take steps to mitigate demand wherever possible	The programme will continue to work with the CCG and Trust to forecast demand and ensure plans to respond to this.