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Location of Single Acute Mental Health

In-patient Unit for the South Eastern Trust

Consultation Document

January 2013

2

Contents

1. Introduction and Background 4

2. Strategic Context 6

3. Services we currently provide 9

4. Option Consideration and Appraisal 10

5. Pre-consultation 16

6. Recommendations and Conclusion 16

7. How to respond to the consultation 16

Appendix A Equality Impact Assessment 18

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How to receive a copy of this document

If you want to receive a copy of this consultation document please contact:

Tania Gibson

Strategic & Capital Development Department

South Eastern Health and Social Care Trust

Kelly House

Ulster Hospital

Phone: 028 9055 0434

Or, you can email: [email protected]

If you ask, we can provide any of our official documents in a choice of languages or

a range of other formats, including:

in large print;

on audio cassette;

in Braille;

on computer disc;

in ethnic-minority languages;

in easy-read form;

in DAISY; and

an electronic version.

(This is not a full list.)

You can also find this document on our website, www.setrust.hscni.net

mailto:[email protected]

http://www.setrust.hscni.net/

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1.0 Introduction and Background

1.1 Introduction

The South Eastern Health and Social Care Trust‟s vision is to be a leading

provider of health and social care. We will deliver, in partnership with key

stakeholders, a wide range of health and social care services that will make

demonstrable improvements in the health and wellbeing of the population. In

doing so, we will constantly review our services to ensure that they are

modern and fit for purpose. In delivering services, the Trust will ensure that it

provides person centred, safe and effective care that offers value for money.

This document is concerned with the future of hospital in-patient adult mental

health services within the South Eastern Trust. These are the mental health

services we provide in hospitals to people aged between 18 and 65 years of

age and those over 65 who have a functional mental illness. Acute Mental

Health In-patient facilities are currently provided from the Ulster, Lagan Valley

and Downe Hospitals. In November 2008, the Trust publicly consulted on the

proposal to rationalise the provision of Acute Mental Health In-patient units

from 3 -1. On 4 June 2010 the Trust commenced a further consultation

process which included the Mental Health proposal. One of the key

recommendations was the provision of hospital in-patient care in a single unit

instead of the three units currently used and where this will be located.

A Strategic Outline Case to take forward the recommendation to relocate

acute in-patient care from three current locations to a single facility in the

Trust area was submitted to DHSSPSNI and approval to develop a business

case was given on 24 August 2011.

In this consultation document, the Trust is seeking views on where a single acute mental health in-patient unit will be located.

The appendix of this document provides details of the Equality Impact

Assessment undertaken in relation to the proposed service changes. Very

importantly, this document also tells you how you can have your say on the

Trust‟s preferred option. This document will explain our plans and then

outlines how you can put forward your views on the preferred choice for the

location of the service.

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1.2 Background to this consultation

In September 2008, the Eastern Health and Social Services Board (EHSSB)

commissioned an independent body of experts (ATM Consulting) to undertake

a review of the acute mental health model within the Board‟s area.

In its report (The Future Provision of Acute Psychiatric In-patient Beds) ATM

Consulting advised that there would be an excessive number of beds within

the area once new community options had been developed. Investment

during that period, and since, has been focused on the development of a

range of community services including the extension of home treatment,

strengthening community teams and the planned development of out-of-hours

services.

In November 2008 the South Eastern Trust publicly consulted on a document

entitled “Our Mental Health Services – the Future”, which stated that “in the

medium to longer term the Trust would seek to reduce the number of units

from 3 to 1.” This was based on the premise that an increasing number of

people are, and would be, receiving support and treatment in their own

homes. Referrals to Home Treatment services have been increasing and in

June 2009 the Trust reduced its bed complement by 15 beds. Since then, the

Trust has been able to invest an additional £1m in developing its community

services. The impact of this recent level of investment in Home Treatment and

crisis beds has enabled the Trust to further reduce its hospital bed provision

from 79 to 76 beds (June 2012.)

On 4 June 2010 the Trust commenced a further review and consulted on the

proposed changes being considered to its services. An appraisal was

included within the consultation document which set out potential options for

the future location of the proposed single unit. Overall, there was an

acceptance of the Consultation‟s proposed “Centre of excellence” model.

However, some concerns were raised regarding the proposal to locate the

Unit in Lisburn on the Lagan Valley Hospital site. Following the consultation

period, a number of recommendations were made to Trust Board in

November 2010. These included:

• The relocation of acute in-patient care from the three current locations

(Downe, Lagan Valley and Ulster Hospitals) to a single facility.

• Closure of acute in-patient services at other Trust sites, following the

relocation to a single site

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• Continue to provide Psychiatric Intensive Care (PICU) and Low Secure

Services; and relocate these services to more appropriate environments.

The Trust commenced the development of the business case, based on the

findings of the 2008 and 2010 consultations. However, DHSSPSNI / Health

Estates Investment Group colleagues advised that the option to refurbish

accommodation at Lagan Valley Hospital will not meet required building

standards, good practice or provide equity when compared to the other options

within the business case, or other single acute mental health in-patient units in

Northern Ireland.

The Trust engaged with clinicians to review where the service would be best

located. The clinical team advised that the Ulster Hospital would be the

preferable site as the unit would be located on acute hospital site (providing close

access to the Emergency Department and other clinical services). The

DHSSPSNI advised the Trust that Tor Bank School was due to become available

for sale within the project timescales, and should be considered as an option in

the business case. An Ulster Hospital site option had previously been rejected

from the shortlist as the existing site did not have the physical capacity to

facilitate the development of mental health services.

The unsuitability of the Lagan Valley Hospital facility and the inclusion of Tor

Bank within the option shortlist fundamentally changed the outcome of the

appraisal. Engagement with key stakeholders, including staff, users, carers has

contributed to the development of the business case and the option appraisal.

Concerns have been raised from those in Lisburn regarding difficulties of

distance, travel time, cost and public transport to Dundonald from the Lisburn

area. For the majority of the population, transport links are better to the Ulster

Hospital than to Lagan Valley Hospital. Accessibility to Trust services remains a

key priority of the Trust. The Trust continues to engage with key stakeholders to

address access difficulties and develop appropriate solutions where possible.

2.0 Strategic Context

This proposal is a further stage in the rationalisation of Acute In-patient Mental

Health Services, which is significant in determining how mental health services

will be delivered in the future.

The Trust‟s strategic direction has largely been influenced by a number of drivers

for change. These include the commissioning intentions as indicated by the

Eastern Health and Social Services Board Strategy for Adult Mental Health

Services (2004); and the Future Provision of Acute Psychiatric Services (2007);

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Transforming Your Care, December 2011, Commissioning Plan 2012/13,

Commissioning Specifications 2012/13, Developing a future model for acute

psychiatric in-patient bed provision for NI (HSCB 2012) and Low Secure Reports

June 2010/May 2011.

2.1 Transforming Your Care (TYC) (December 2011)

The Review of the Provision of Health and Social Care Services in Northern

Ireland announced by the Minister for Health, Social Services and Public Safety,

in June 2011, has produced a report which offers an assessment of all aspects of

health and social care, and includes 99 recommendations.

The Review identifies and addresses the challenges that lie ahead and sets in

place a framework for future changes in Health and Social Care. The Review has

presented a methodology to implement change over the next five years.

It outlines a clear direction of travel:

starting with the individual;

looking to a greater focus on prevention;

maintaining care close to home;

re-designing primary care and

re-shaping hospitals.

2.1.1 Transforming Your Care: Vision to Action (2012)

The consultation on the implementation of the recommendations from the health and

social care review proposes the following in relation to in-patient mental health:

Develop 6 in-patient acute mental health units for those aged 18+. There would

be one site in the Northern, Southern, South Eastern and Belfast areas, with two in

the Western area. In order to reduce stigma, and ensure there is good access to

acute care, it is necessary to locate mental health hospitals close to acute hospital

provision, recognising that this may not be possible in all circumstances.

2.1.2 South Eastern Trust Corporate Plan 2011-15

The South Eastern Trust‟s Corporate Plan covers the period 2011-15; under six key themes the following priorities are outlined:

To ensure that services are safe and effective and contribute towards

improving outcomes,

To develop new and innovative care, through new models of care,

To work with local communities to provide greater choice and enable

people to take more responsibility for their own care,

To reform services in line with the wider strategic agenda,

To deliver financial efficiencies through reform and modernisation.

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2.1.3 The Bamford Review (June 2005)

In 2002, the DHSSPS initiated an independent review of mental health and learning

disability law, policy and service provision, now referred to as the Bamford Review.

The report, published in June 2005, contained a number of recommendations aimed

at improving mental health services across Northern Ireland.

Key recommendations from Bamford, which have informed the proposals for service

modernisation within the South Eastern Trust, are outlined below.

Mental health services should be person-centred, seamless community-

based services, informed by the views of service users and their carers,

making early intervention a key priority and protecting and promoting

people‟s mental health.

Services should support people with mental illness to live as full a life as

possible and to promote recovery.

Care and support should be provided in such a way as to allow people to

remain in their own home or in a community setting.

Partnership working with the independent sector and with other public

agencies is vital in providing the support required.

Some people will need admission to hospital from time to time for

specialist assessment / treatment, however such admissions must be

short, therapeutic and focused on a speedy return to life in the community.

The Bamford Action Plan (2009-2011) referred to the expectation that continued

development of community mental health services should result in a 10% reduction

in admissions to acute psychiatric hospitals by 2011.

2.2 The Future of Trust Mental Health Services

The Trust has set out the direction of travel for mental health services, based on the

shape we want the service to take, as outlined in previous consultation documents

and the Trust‟s Delivery Plans:

Reduce the number of in-patient mental health units from three to a single

unit, to provide this service Trust-wide.

Further reduce in acute in-patient mental health beds from current 76 – 72.

This will require reinvestment in 24 Home Treatment Care packages.

Provision of 4 PICU beds co-located with the new single acute in-patient

mental health unit.

Relocate the low secure patients from a long stay institutional facility at

Downshire Hospital to a Trust 20 bed sub-regional facility at Downe Hospital.

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Further enhance home treatment and community mental health services.

Close the Downshire Hospital as a long stay institution.

The Trust is confident that these plans will enable sustained improvements to mental

health services, in a time when the prevalence of mental ill health will continue to

grow within the population. These changes will also improve the patient flow

throughout the mental health system reducing average length of stay, admission

rates, and the provision of hospital In-patient, PICU and Low Secure services only to

those who need them.

3.0 Services we currently provide

The Trust currently provides non-dementia in-patient mental health care in three

distinct ways:

1. Hospital based Mental Health Care

2. Low Secure Services

3. Psychiatric Intensive Care (PICU) Services

1. Hospital based Mental Health Care:

This is currently delivered across three sites:

Lagan Valley Hospital. This has 30 beds across two wards, catering for both

male and female patients. Of the 30 beds, 6 are dedicated to those aged 65

and over, who have a functional mental illness.

New Downe Hospital. This has the current capacity for 22 single rooms with

en-suite facilities. Of these, the Southern Health and Social Care Trust uses 1

-2 beds on a consistent basis throughout the year. The Southern Trust has

indicated it intends to withdraw from this arrangement.

Ulster Hospital. This service is located in Ward 27 of the hospital, offering 14

beds for female residents and 10 for males, aged over 18 years. On

occasions, when demand for male admissions exceeds that of female

admissions, the bed layout may be changed.

2. Low Secure Services:

There are a total of 43 beds provided across three wards on the Downshire Hospital

site. Of these, 12 beds are located in the Kilclief Ward, which is an outdated

environment that does not provide the optimum level of accommodation required to

aid recovery and rehabilitation.

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3. Psychiatric Intensive Care (PICU) Services:

There are four beds for this service, which are located in the Kilclief Ward of the

Downshire. As noted above the physical environment is not conducive to recovery,

but also the necessity to have a mixed unit of low secure and psychiatric intensive

care patients in the same location is far from ideal.

4.0 Option Consideration and Appraisal

In considering the proposed service model for the future provision of hospital in-

patient care for people with mental illness, the Trust has developed 8 options, which

are described below.

Option 1: Maintain the Status Quo

Continue to provide acute in-patient treatment at three locations across the Trust,

namely Ulster, Lagan Valley, and Downe. Maintain continuing care and PICU

provision on Downshire Hospital site.

Option 2: Do Minimum

Upgrade the existing four facilities, as required (Ulster, Downe, LVH and Downshire)

to meet Health and Safety and other statutory / legislative requirements. Existing

services within the building would require decant during construction works, which

would be completed on fully operational hospital sites. There would be no change to

the location and configuration of services in this option. The programme of works to

upgrade buildings would take 12 months, from submission to approval).

Option 3: Provide Acute Psychiatry and PICU services in refurbished

accommodation in Lagan Valley Hospital and Low Secure services in the Downe

Hospital

Provide acute in-patient care at a single location in refurbished accommodation at

Lagan Valley Hospital. Co-locate PICU with acute in-patient care at the new single

location. Provide low secure services at a single site in the Downe Hospital with

minor reconfiguration to provide social care / activity rooms in line with modern day

standards for low secure accommodation. Existing services within the LVH building

would require decant for the duration of construction works. The Hospital site would

be fully operational during these works. The timescale for the completion of works

would be 28 months (from OBC submission to HSCB for approval).

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Option 4: Provide Acute Psychiatry and PICU services in reconfigured

accommodation in the Ulster Hospital and Low Secure services at the Downe

Hospital

Provide acute in-patient care at a single location at the Ulster Hospital, Dundonald.

Co-locate PICU with acute in-patient care at the new single location. Provide low

secure services at a single site at Downe Hospital with minor reconfiguration to

provide social care / activity rooms in line with modern day standards for low secure

accommodation. The Ulster Hospital Care of the Elderly (CoE) building is currently

occupied and refurbishment cannot commence until at least December 2016 when

elderly services are scheduled to transfer to the new Generic Ward Block. The

timescale for the programme of refurbishment works would be 28 months (from OBC

submission to HSCB for approval). Therefore, it would be Spring 2019 at the earliest

before this option would be delivered.

Option 5: Provide Acute Psychiatry and PICU services in Downshire Hospital and

Low Secure services at the Downe Hospital

Provide acute in-patient care at a single location at Downshire Hospital. Co-locate

PICU with acute in-patient care at the new single location. Provide low secure

services at a single site at Downe Hospital with minor reconfiguration to provide

social care / activity rooms in line with modern day standards for low secure

accommodation. Existing services within the Downshire Hospital building would

require decant for the duration of construction works. The construction works would

be completed on a busy public sector campus. The timescale for the completion of

works would be 60 months (from OBC submission to HSCB for approval).

Programme duration would be due to added planning pressures of historical building

consent.

Option 6: Provide all Acute Psychiatry, PICU and Low Secure services in a new

build extension at Downe Hospital

Provide acute in-patient care in a new-build extension at Downe Hospital. Co-locate

PICU with acute in-patient care and Low Secure Services at the new single location.

There would be no requirement for patient decant during construction works,

although the works would be completed on a fully operational Hospital site. The

timescale for completion of work would be 48 months (from OBC submission to

HSCB for approval).

Option 7: Provide Acute Psychiatry and PICU services in a new build facility on a

brownfield site on Tor Bank site, Dundonald and Low Secure services at the Downe

Hospital

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Provide acute in-patient care and PICU services at a single location in a new,

purpose-built facility on a brownfield site at Tor Bank School. Provide low secure



accommodation. There would be no requirement for patients to move during

construction works and no disruption of hospital services as the construction would

take place on a brownfield site. This option is subject to the pending acquisition of

the site (via licence, lease or purchase).The timescale for completion of works would

be 50 months (from OBC submission to HSCB for approval).

Option 8: Provide Acute Psychiatry and PICU services in a new build facility, on

Lagan Valley Hospital site and Low Secure services at the Downe Hospital

Provide acute in-patient care, co-located with PICU services in a new, purpose-built

facility on the Lagan Valley Hospital site. Provide low secure services at a single site

at Downe Hospital with minor reconfiguration to provide social care / activity rooms in

line with modern day standards for low secure accommodation. This option would

require decant of existing services currently operating from the building, followed by

the demolition of the existing facility and construction of the new Unit. Construction

works would be completed on a fully operational Hospital site. The timescale for the

completion of works would be 48 months (from OBC submission to HSCB for

approval).

The Trust has carried out an exercise to shortlist the options, which resulted in

options 4 and 5 being ruled out.

The remaining six options were then assessed and scored against the following

agreed benefit criteria, shown in the table overleaf:

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Following the completion of the scoring exercise, Option 7 emerged as the preferred

choice. Therefore the Trust‟s preferred option is a new build at the Tor Bank site.

Your views are sought on the suitability of the Tor Bank site adjacent to the

Ulster Hospital, Dundonald as the preferred location for the single hospital

based in-patient facility within the Trust.

CRITERION KEY FEATURES

1. Clinical

Quality

Enabling and maximising clinical safety

Supporting an improved model of care

Delivering improved patient experience/outcomes and promoting recovery for all patients within both hospital and community

Providing care in high-quality appropriate facilities that improve choice, privacy and dignity for patients

2. Accessibility &

Acceptability

Providing optimal access to psychiatric in-patient care and community services for the population served by South Eastern Trust.

Enabling the promotion of equality, empowerment, choice, good-relations and human rights considerations

3. Capacity &

Efficiency &

Sustainability

Providing high quality services that can be sustained in the medium to long term

Providing scope for staff recruitment, retention, training and development

Providing an efficient and seamless service to the patient

Providing flexibility to accommodate changing demand

4. Quality of the

physical

environment

Ability to meet accepted standards

Available space

Compliance with Health and Safety, HTM‟s, HBN‟s and DDA requirements

Efficient use of existing estate

5. Speed and

Ease of

Implementation

Potential speed of implementation

Ability to maintain service continuity

Disruption

Impact of any decanting of patients, staff and equipment

6. Compatibility

with Strategic

Vision

Compliance with relevant strategic direction ie Bamford, TYC, DBS, Mental Health Services – Our Future

Ability to fulfill strategic direction

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Although this option requires the greatest capital investment of £26.435m, and

additional recurrent revenue of 0.735m, it is the most beneficial option in qualitative

terms, enabling the Trust to deliver the future vision for Mental Health services.

This option clearly delivers the highest level of non-financial benefits as it scores

significantly higher than other “do something” options in terms of the ability to meet

project objectives. The option offers the opportunity for exemplary clinical care in a

fit for purpose environment, which will fully comply with strategic direction and was

awarded maximum score in these areas.

In summary, a new build on the Tor Bank site will enable the Trust to achieve its

vision for the rationalisation of acute in-patient mental health services and deliver an

equitable / sustainable model of care for the Trust population.

Details of how each of the options scored are outlined in the table overleaf.

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Benefit Criteria Weight

Option 1

Maintain Status Quo

Option 2

Do Minimum

Option 3

Provide Acute

Psychiatry and PICU

services in

refurbished

accommodation in

Lagan Valley

Hospital and Low

Secure services at

the Downe Hospital

Option 6

Provide all Acute

Psychiatry, PICU

and Low Secure

services in a new

build extension at

Downe Hospital

Option 7

Provide Acute

Psychiatry and PICU

services in a new

build facility on a

greenfield site at Tor

Bank School,

Dundonald and Low

Secure services at the

Downe Hospital

Option 8

Provide Acute

Psychiatry and PICU

services in a new

build facility, on

Lagan Valley Hospital

site and Low Secure

services at the Downe

Hospital

Score Weighted

Score Score

Weighted

Score Score

Weighted

Score Score

Weighted

Score Score

Weighted

Score Score

Weighted

Score

Clinical Quality 30 4 120 5 150 7 210 7 210 10 300 8

240

Accessibility & Acceptability 15 8 120 8 120 7 105 4 60 7 105 7 105

Capacity & Efficiency &

Sustainability 15 4 60 4 60 6 90 6 90 9 135 7 105

Quality of the Physical

Environment 20 4 80 5 100 6 120 8 160 10 200 7 140

Speed and Ease of

Implementation 15 10 50 6 30 6 30 5 25 8 40 5

25

Compatibility with Strategic

Vision 15 2 30 2 30 8 120 6 90 10 150 9 135

Total 100 460 490 675 635 930 750

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5.0 Pre-consultation

The Trust has engaged with key stakeholders on this proposal throughout the

development of the business case and in the preparation of this consultation

process. Discussions on the preferred location for the acute in-patient mental

health location have been held with carers and users, elected

representatives, staff and clinicians.

6.0 Recommendations and Conclusion

The Trust proposes that it should:


purpose-built facility on a brownfield site on the Tor Bank site. Provide low

secure services at a single site at Downe Hospital with minor reconfiguration

to provide social care / activity rooms in line with modern day standards for

low secure accommodation. The Trust is confident that this proposal outlines

the correct direction of travel to reform and modernise service delivery for

mental health.

Your views are sought on the suitability of the Tor Bank site adjacent to

the Ulster Hospital, Dundonald as the preferred location for the single

hospital based in-patient facility within the Trust.

This proposal is subject to on-going equality screening; the full impact

assessment is attached as an appendix to this document.

7.0 How to respond to the consultation

This document sets out the Trust plan to locate the single mental health in-

patient unit on the Tor Bank site adjacent to the Ulster Hospital, Dundonald.

Your views are sought on the suitability of this site for the single acute mental

health (hospital-based) in-patient facility within the Trust. Please let us know

whether you agree or disagree with this proposal. A summary of feedback will

be provided to all respondents.

Public meetings The Trust is planning to hold a series of public meetings across its locality to

ensure that the public have the opportunity to contribute to the consultation

process. The Trust will publish the locations and dates of these meetings and

the meetings which will be attended by clinical representation and senior

managers from the Trust.

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You can also send your comments to the Trust by a variety of means such as:

in writing

by email

by telephone

by text phone

by fax

via our website

Additional copies of this document are available from the South Eastern Health

and Social Care Trust website by clicking on Involving You. Please return your

response by 17 April 2013 to:

Hugh McCaughey

Chief Executive


Trust Headquarters

Ulster Hospital

Dundonald

BT16 1RH

Telephone: 028 90564733

Textphone: 02891510137

Email [email protected]

The consultation on the proposals will last for 13 weeks, from 16 January to 17

April 2013.

18

MENTAL HEALTH SERVICES:

THE FUTURE OF HOSPITAL IN-PATIENT CARE

IN THE SOUTH EASTERN TRUST

Appendix A

EQUALITY IMPACT ASSESSMENT

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1.0 SECTION 75 OF THE NORTHERN IRELAND ACT – SCREENING AND

EQUALITY IMPACT ASSESSMENT (EQIA)

1.1 Section 75 (1) of the Northern Ireland Act 1998 requires South Eastern Health

and Social Care Trust, in carrying out its work, to have due regard to the need to

promote the equality of opportunity:

Between persons of different religious belief, political opinion, racial group, age,

marital status or sexual orientation;

Between men and women generally;

Between persons with a disability and persons without;

Between persons with dependents and persons without.

In addition, Section 75(2) requires the Trust to have regard to the desirability of

promoting good relations between persons of different religious belief, political

opinion or racial group.

The Trust has carried out screening from a Section 75 and Human Rights

perspective on the proposals relating to the future of hospital in-patient care and the

decision was taken to carry out a full EQIA.

An Equality Impact Assessment (EQIA) is an in-depth study of a policy or decision or

proposal to assess the extent of the impact on the Equality of Opportunity for the

nine equality categories identified by Section 75 of the Northern Ireland Act 1998. It

requires the analysis of both quantitative and qualitative data.

In line with the Equality Commission, „Guidance for Implementing Section 75 of the

Northern Ireland Act 1998‟ on EQIAs, the Trust has followed the seven designated

key steps:

Defining the aims of the policy/proposal.

Consideration of available data and research.

Assessment of impacts.

Consideration of measures which might mitigate any adverse impact; and

alternative policies which might better achieve the promotion of equality of

opportunity.

Consultation.

Decision by Public Authority and publication of report on results of EQIA.

Monitoring for adverse impact in the future and publication of the results of

such monitoring.

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1.2 This consultation document sets out the Trust‟s assessment in regard to the

Equality and Human Rights considerations of the proposals.

The Trust would like to hear from service users, their relatives and advocates, staff

and their representatives and any voluntary or community organisation which has an

interest in these proposals. In particular, where you have a contrary view to our

assessments, we would like to know what that might be and if you have any further

suggestions as to how we might mitigate against any of the impacts on our patients,

clients or staff, please let us know.

In particular we would like to know if:

You agree with our assessments regarding the equality and human right

considerations of our proposals.

You agree with our proposed mitigating measures.

You have any alternatives to our proposals.

1.3 Consultation

This document if being sent to a wide range of organisations and is available in

alternative formats if required.

1.4 Next Steps

When the consultation process is concluded the submissions will be considered and

submitted to the Trust Board prior to any decisions being made. Each submission

arising from this consultation process will be acknowledged and responded to in full.

A full record of the consultation process will be placed on the Trust‟s website and the

final decisions of the Board will be communicated to all who made submissions as

part of the consultation process.

2.0 PROPOSALS RELATING TO THE FUTURE OF MENTAL HEALTH SERVICES

HOSPITAL IN-PATIENT CARE

The creation of the South Eastern Trust has provided the opportunity to review and

modernise hospital mental health services for the future. In September 2008, the

Eastern Health and Social Services Board (EHSSB) commissioned an independent

body of experts (ATM Consulting) to undertake a review of the acute mental health

model within the Board‟s area.

In its report (The Future Provision of Acute Psychiatric In-patient Beds) ATM

Consulting advised that there would be an excessive number of beds within the area

once new community options had been developed. Investment during that period,

and since, has been focused on the development of a range of community services

including the extension of home treatment, strengthening community teams and the

planned development of out-of-hours services.

21

In November 2008 the South Eastern Trust publicly consulted on a document

entitled “Our Mental Health Services – the Future”, which stated that “in the medium

to longer term the Trust would seek to reduce the number of units from 3 to 1.” This

was based on the premise that an increasing number of people are, and would be,

receiving support and treatment in their own homes. Referrals to Home Treatment

services have been increasing and in June 2009 the Trust reduced its bed

complement by 15 beds. Since then, the Trust has been able to invest an additional

£1m in developing its community services. The impact of this recent level of

investment in Home Treatment and crisis beds has enabled the Trust to further

reduce its hospital bed provision from 79 to 76 beds (June 2012.)

On 4 June 2010 the Trust commenced a further review and consulted on the

proposed changes being considered to its services. An appraisal was included within

the consultation document which set out potential options for the future location of

the proposed single unit. Overall, there was an acceptance of the Consultation‟s

proposed “Centre of excellence” model. However, some concerns were raised

regarding the proposal to locate the Unit in Lisburn on the Lagan Valley Hospital site.

Following the consultation period, a number of recommendations were made to Trust

Board in November 2010. These included:

• The relocation of acute in-patient care from the three current locations

(Downe, Lagan Valley and Ulster Hospitals) to a single facility.

• Closure of acute in-patient services at other Trust sites, following the

relocation to a single site

• Continue to provide Psychiatric Intensive Care (PICU) and Low Secure

Services; and relocate these services to more appropriate environments.

These recommendations were approved by Trust Board and the Health and Social

Care Board (HSCB) in November 2010 and the Department of Health Social

Services and Public Safety (DHSSPSNI) in January 2011. As a result, work was

commenced to take forward the recommendation to relocate acute in-patient care

from three current locations to a single facility in the Trust. This was submitted to

DHSSPSNI on 22 June 2011. Approval to develop a business case was given on 24

August 2011.

Trust has been developing the business case, based on the findings of the 2008 and

2010 consultations. However, DHSSPSNI / Health Estates Investment Group

colleagues have advised that the option to refurbish accommodation at Lagan Valley

Hospital will not meet required building standards, good practice or provide equity

when compared to the other options within the business case, or other single acute

mental health in-patient units in Northern Ireland.

22

The Trust has engaged with clinicians to review where the service would be best

located. The clinical team has advised that the Ulster Hospital would be the

preferable site clinically as the unit would be located on acute hospital (including

close access to the Emergency Department). The DHSSPSNI advised the Trust that

as Tor Bank School is due to be available for sale within the project timescales, it

should be included as an option in the business case.

An Ulster Hospital site option had previously been rejected from the shortlist as the

existing site did not have the physical capacity to facilitate the development of mental

health services.

The unsuitability of the Lagan Valley Hospital and the inclusion of Tor Bank within

the option shortlist changed the outcome of the appraisal. The Tor Bank options and

has been identified as the preferred option. Key stakeholders including staff, users,

carers and carer and user partnership (CUP) representatives have been advised of

this. Concerns have however been raised from those in Lisburn regarding difficulties

of distance, travel time, cost and public transport to Dundonald from the Lisburn

area. The Trust has confirmed that, for the majority of the population, transport links

are better to the Ulster Hospital than to Lagan Valley Hospital. The Trust continues

to engage with key stakeholders to address access difficulties and develop

appropriate solutions where possible.

The Trust has identified the Tor Bank site adjacent to the Ulster Hospital,

Dundonald as the preferred location for the single hospital-based mental

health in-patient facility within the Trust.

23

Consideration of Available Data and Research

Developing Better Services (DHSSPS 2002)

Comprehensive Spending Review Document (2008-2011)

Our Mental Health Services – The Future (November 2008)

The Bamford Review of Mental Health and Learning Disability (NI) A Strategic

Framework for Adult Mental Health Services (June 2005)

Eastern Health and Social Services Board – The Future Provision of Acute

Psychiatric In-patient Beds Report of the Review Team (ATM Consulting

September 2005)


Services (2004)

The Future Provision of Acute Psychiatric Services (2007)

Transforming Your Care, December 2011

Commissioning Plan 2012/13

Commissioning Specifications 2012/13

Developing a future model for acute psychiatric in-patient bed provision for NI

(HSCB 2012) and Low Secure Reports :June 2010/May 2011

Mental Health Services: The Future of Hospital In-patient Care in the South

Eastern Trust November 2010


Services 2004

24

3.0 POPULATION PROFILE

3.1 South Eastern Trust Population – Census 2001 by Gender and Religion

within South Eastern Trust Legacy Areas

UCHT DLT SET

Gender Male Female

48.5 51.5

49.1 50.9

48.8 51.2

Religion

Protestant Roman Catholic Not Known

81.5 12.6 5.9

49.1 47.7 3.2

65.3 30.1 4.6

3.2 Profile of Current Staffing in South Eastern Health and Social Care Trust

Workforce by Section 75 Groups with comparison as at 1 January 2011 and

2012

Section 75 Group Workforce

Profile as at 1 Jan 2011

Workforce Profile as at 1

Jan 2012 Differential

Gender Male Female

1955 8918

2129 8889

174 -29

Religion Protestant Roman Catholic Not Known

7066 2928 879

6492 3431 1095

-574 503 216

Age

16-20 21-30 31-40 41-50 51-60 61-65 66+

119 1992 2531 3222 2419 429 161

111 2101 2512 3127 2451 504 212

-8 109 -19 -95 32 75 51

Political Opinion

No direct information was gathered on these dates on political opinion

Marital Status

Married/Cohabiting/ Civil Partnership Single Other/Unknown

7045 3358 470

6987 3549 482

-58 191 12

Dependant Status

As the majority of staff are female and may work part time it is likely they may have caring responsibilities

Disability Disabled Not Disabled Unknown

30 486 10357

34 733 10251

4 247 -106

Racial Group

The Trust has a majority of staff who are white but recognises the ethnic background of its workforce

25

Section 75 Group Workforce

Profile as at 1 Jan 2011

Workforce Profile as at 1

Jan 2012 Differential

Sexual Orientation

No direct information is gathered on sexual orientation. Population trends of 10% are assumed for gay, lesbian and bisexual individuals – data source Rainbow Project

26

3.3 Profile of Current Staffing with regard to Mental Health In-patient Care

across Ulster Hospital, Downe Hospital and Lagan Valley Hospital

Section 75 Group

Ulster Hospital Ward 27

Downe Hospital

Lagan Valley Hospital

Gender Male Female

4 (11%) 32 (89%)

7 (25%) 21 (75%)

7 (25%) 20 (75%)

Religion Protestant Roman Catholic Unknown/Other

19 (53%) 12 (33%) 5 (14%)

2 (7%) 23 (82%) 3 (11%)

8 (30%) 12 (44%) 7 (26%)

Age

16-20 21-30 31-40 41-50 51-60 61-65 66 +

0 (0%) 5 (14%) 13 (36%) 10 (28%) 8 (22%) 0 (0%) 0 (0%)

0 (0%) 4 (14%) 9 (32%) 8 (28%) 7 (26%) 0 (0%) 0 (0%)

0 (0%) 5 (19%) 8 (30%) 10 (37%) 4 (14%) 0 (0%) 0 (0%)

Political Opinion

Unionist Nationalist Do Not Wish to Answer Other/Unknown

<5 (3%) 0 (0%) 7 (19%) 28 (78%)

2 (7%) 4 (14%) 2 (7%) 20 (72%)

2 (7%) 4 (14%) 5 (19%) 16 (60%)

Marital Status


20 (56%) 12 (33%) 4 (11%)

17 (61%) 10 (36%) <5 (3%)

12 (44%) 14 (52%) <5 (4%)

Dependent Status

Child/Children Older Person Person with Disabilities None Unknown

10 (28%) <5 (3%) <5 (3%) 4 (11%) 20 (55%)

3 (11%) 0 (0%) <5 (4%) 5 (18%) 19 (67%)

9 (33%) 0 (0%) 0 (0%) 2 (7%) 16 (60%)


3 (8%) 13 (36%) 20 (56%)

<5 (4%) 8 (28%) 19 (68%)

<5 (4%) 12 (45%) 14 (51%)

Racial Group

White BME Unknown

19 (53%) 0 (0%) 17 (47%)

9 (32%) 0 (0%) 19 (68%)

10 (37%) <5 (4%) 16 (59%)

Sexual Orientation

Opposite Sex Same Sex Same & Opposite Do Not Wish to Answer Unknown

15 (42%) <5 (3%) 0 (0%) 0 (0%) 20 (55%)

10 (36%) 0 (0%) 0 (0%) 0 (0%) 18 (64%)

11 (41%) <5 (4%) 0 (0%) <5 (4%) 14 (51%)

27

3.4 Profile of Current Staffing in Psychiatric Intensive Care (PICU) Services

Section 75 Group

PICU Ward 27 Kilclief Downshire Hospital

Gender Male Female

12 (65%) 7 (35%)


0 (0%) 18 (94%) <5 (6%)

Age

16-20 21-30 31-40 41-50 51-60 61-65 66+

0 (0%) <5 (5%) 3 (16%) 5 (26%) 10 (53%) 0 (0%) 0 (0%)

Political Opinion

Unionist Nationalist Do Not Wish to Answer Other/Unknown

0 (0%) 3 (16%) <5 (6%) 15 (78%)

Marital Status


10 (53%) 8 (42%) <5 (5%)

Dependent Status


3 (16%) <5 (5%) 0 (0%) 0 (0%) 15 (79%)


0 (0%) 4 (21%) 15 (79%)

Racial Group

White BME Unknown

4 (21%) 0 (0%) 15 (79%)

Sexual Orientation


4 (21%) 0 (0%) 0 (0%) 0 (0%) 15 (79%)

28

3.5 Profile of Low Secure and Continuing Care Services

Section 75 Group

Ward 28/29 Downshire

Gender Male Female

0 (0%) 19 (100%)


0 (0%) 18 (94%) <5 (6%)

Age 16-20 21-30 31-40 41-50 51-60 61-65 66+

0 (0%) 2 (10%) 3 (16%) 4 (21%) 10 (53%) 0 (0%) 0 (0%)

Political Opinion Unionist Nationalist Do Not Wish to Answer Other/Unknown

0 (0%) 3 (16%) 3 (16%) 13 (68%)

Marital Status Married/Cohabiting/ Civil Partnership Single Other/Unknown

16 (84%) 3 (16%) 0 (0%)

Dependent Status


4 (21%) <5 (6%) <5 (6%) <5 (6%) 12 (61%)

Disability Yes No and Not Known

0 (0%) 7 (37%) 12 (63%)

Racial Group White BME Unknown

7 (37%) 0 (0%) 12 (63%)

Sexual Orientation


7 (37%) 0 (0%) 0 (0%) 0 (0%) 12 (63%)

29

3.6 Profile of Users of In-patient Mental Health Services by Ward April –

June 2012

Section 75 Group Ulster

Hospital

Downe

Hospital

Lagan Valley

Hospital

Gender Male

Female

38 (53%)

34 (47%)

25 (54%)

21 (46%)

56 (56%)

44 (44%)


17 (24%)

6 (8%)

49 (68%)

4 (9%)

20 (43%)

22 (48%)

13 (13%)

23 (23%)

64 (64%)

Age

16-20

21-30

31-40

41-50

51-60

61-65

66+

4 (6%)

8 (11%)

23 (32%)

19 (26%)

9 (13%)

4 (6%)

5 (7%)

2 (4%)

7 (15%)

9 (20%)

13 (28%)

7 (15%)

3 (7%)

5 (11%)

6 (6%)

26 (26%)

13 (13%)

27 (27%)

19 (19%)

4 (4%)

5 (5%)

Political

Opinion

No direct information is gathered on political opinion. Council voting

patterns have been considered.

Marital

Status

Single

Married

Common Law

Separated

Unknown

Divorced

Widowed

26 (36%)

19 (26%)

2 (3%)

12 (17%)

8 (11%)

3 (4%)

2 (3%)

15 (33%)

15 (33%)

<5 (2%)

4 (9%)

9 (20%)

<5 (2%)

<5 (2%)

48 (48%)

23 (23%)

0 (0%)

9 (9%)

13 (13%)

5 (5%)

2 (2%)

Dependent

Status

The Trust does not routinely gather this information but is not aware of

any significant impact.

Disability The Trust does not routinely record this information. Patients are

identified as being disabled at least a period of time.

Ethnicity

White

Unable to Obtain

Not Divulged

Not Recorded

Other Group

55 (76%)

12 (17%)

4 (5%)

0 (0%)

<5 (1%)

30 (65%

10 (22%)

5 (11%)

<5 (2%)

0 (0%)

69 (69%)

22 (22%)

9 (9%)

0 (0%)

0 (0%)

Sexual

Orientation

No direct information is gathered on sexual information. Population

trends of 10% are assumed for gay, lesbian and bisexual individuals.

Data source: Rainbow Project.

30

3.7 Profile of Users in Psychiatric Intensive Care (PICU) Services

Section 75 Group

PICU Ward 27 Kilclief Downshire

Hospital

Gender Male

Female

9 (90%)

<5 (10%)


2 (20%)

<5 (10%)

7 (70%)

Age

16-20

21-30

31-40

41-50

51+

<5 (10%)

<5 (10%)

2 (20%)

3 (30%)

3 (30%)

Political

Opinion



Marital

Status

Single

Married

Common Law

Separated

Unknown

Divorced

Widowed

7 (70%)

3 (30%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

0 (0%)

Dependent

Status

The Trust does not routinely gather this information but is not aware

of any significant impact.


identified as being disabled at least a period of time.

Ethnicity

White

Unable to Obtain

Not Divulged

Not Recorded

Other Group

8 (80%)

2 (20%)

0 (0%)

0 (0%)

0 (0%)

Sexual

Orientation



Data source: Rainbow Project.

31

3.8 Profile of Users of Low Secure and Continuing Care Services

Section 75 Group

Ward 28/29 Downshire

Gender Male

Female

31(70%)

16 (30%)

Religion

Protestant

Roman Catholic

Not Known

20 (43%)

18 (38%)

9 (19%)

Age

15-20

21-30

31-40

41–50

51+

<5 (2%)

22 (47%)

10 (21%)

6 (13%)

8 (17%)

Political

Opinion



Marital Status

Married

Single

Divorced

Separated

Widowed

Other

<5 (2%)

42 (89%)

3 (6%)

<5 (2%)

0 (0%)

0 (0%)

Dependent

Status

The Trust does not routinely gather this information but the majority

of service users are single and the Trust is not aware of any

significant impact.


identified as being disabled for a period of time.

Ethnicity White

Unknown

26 (55%)

21 (45%)

Sexual

Orientation



32

3.9 Distances and Travel Times between Ulster Hospital, Downe Hospital, Lagan Valley Hospital

Distance Travel Time

Ulster Hospital –

Downe Hospital 21.9 miles 31 minutes

Ulster Hospital –

Lagan Valley Hospital 16.7 miles 27 minutes

Lagan Valley Hospital –


Source –mapquest.co.uk

33

4.0 CONSIDERATION OF IMPACT

4.1 Assessment of the Impact of the Proposal on Service Users by Section

75 Equality Groups

With regard to the information gathered above, in respect of the nine equality

categories the Trust has noted the following in relation to the current population of

the South Eastern Trust area and users of Mental Health In-patient Services. As the

proposal has not yet occurred some of the impacts are described as potential.

4.1.1 Between Men and Women Generally

The gender profile for the South Eastern Health and Social Care Trust‟s population

(in accordance with the 2001 Census) was 51.2% female compared with 48.8%

male. The gender profile of service users for the In-patient Mental Health Wards at

the Downe Hospital, Lagan Valley Hospital and the Ulster Hospital are broadly

similar. The gender profile for PICU at Downshire Hospital is 90% male and 10%

female. The gender profile for Wards 28 and 29 at Downshire Hospital is 70% male

and 30% female.

Therefore a proposal to move away from the Downshire Hospital setting may have a

low potential adverse impact on this category. The Trust commits to monitoring for

future adverse impact.

.

4.1.2 Persons of Different Age

The age profile of users in the three main Mental Health In-patient Wards shows that

approximately 50% of service users are aged between 31-50. However, there is a

broad spread of age ranges and the Trust has not identified that any particular age

range will experience a potential impact.

In the PICU the age range shows that the majority of patients fall in to the over 30

age range. A total of 68% of patients in Wards 28/29 in Downshire are aged

between 21 and 40 giving a younger age profile.

The Trust is aware of the ongoing Demographic trends and recognises that the over

65 population will continue to potentially need more care. The Trust is committed to

monitoring for any further impact in all age categories.

4.1.3 Persons with or without a Disability

All patients and service users are identified as being disabled for a period of time.

Any proposal should consider the potential for adverse impact on this group.

34

Research indicates that adults with a disability have a higher risk of experiencing

poverty and also highlights that disabled people may face particular difficulties when

accessing public and social services. The Trust is committed to monitoring for any

future impact.

4.1.4 Persons of Different Marital Status

The Trust has identified that the majority of Mental Health service users are single at

55% and 22% of patients are married. Therefore, any proposal may have a potential

adverse impact on this group. The Trust is committed to monitoring for any future

impact.

4.1.5 Persons of Different Religious Belief

The population profile for South Eastern Health and Social Care Trust in the 2001

Census was a follows. Protestant 65.3%, Roman Catholic 30.1% and not known

4.6%.

The Trust has identified that service users in the Ulster Hospital Wards are 24%

Protestant and 8% Roman Catholic. In Downe, service users are 9% Protestant and

43% Roman Catholic and in Lagan Valley 13% Protestant and 23% Roman Catholic.

In Wards 29/29 43% of service users are Protestant and 38% Roman Catholic. In all

Wards a high percentage of service users fall into the Not Known or Other

categories. The Trust recognises that, due to the nature of the proposals and the

possible relocation of services, there may be a potential impact on local communities

although travel times and distances to relocated services with still be within

acceptable guidelines see Table 3.9. The Trust is committed to monitoring for any

future adverse impacts.

4.1.6 Persons with/without Dependents

The Trust does not routinely gather information with regard to service user‟s

dependents. The Trust is aware that patients in the Mental Health Wards are visited

by friends and family on a regular basis, travel times and distances to relocated

services have been taken into consideration, Table 3.9. The Trust is committed to

monitoring for any future adverse impact.

4.1.7 Persons of Different Political Opinion

This information is not routinely monitored by the Trust but data shows that 82.6% of

seats on Ards Borough Council are held by Unionist Parties, and 66% of seats of

North Down Borough Council are held by Unionist Parties.

35

A total of 20% of seats on Down District council are held by Unionist Parties and

60% by Nationalist Parties.

A majority of 66% of seats on Lisburn City Council are held by Unionist Parties and

23% by Nationalist Parties.

Therefore it can be assumed that a proposal to change services at the Ulster and

Lagan Valley may have a potential impact on the Unionist community and any

change to services at the Downe Hospital may have a potential impact on the

Nationalist community. The Trust is committed to monitoring for any future impact.

36

4.1.8 Persons of Different Racial Group

The Trust has identified that the majority of patients in the Mental Health In-patient

Wards are white and has not identified any potential impact on this group. However,

the Trust recognises the increasing diversity of its population and those using its

services and is committed to monitoring for any future potential impact.

The Trust spends significant resources in ensuring its services are accessible by the

whole community. When necessary, provision is made for telephone and face to

face interpreting services to be made available via the Northern Ireland Regional

Interpreting Service and approved providers. Similarly, the Trust translates

information into a range of formats for those whose first language is not English

4.1.9 Persons of Different Sexual Orientation

This information is not routinely monitored by the Trust but research indicates that

10% of the population may be lesbian, gay or bisexual. There is no evidence to

suggest that this proposal will have an adverse impact on persons of different sexual

orientation. The Trust is committed to monitoring for any future adverse impact.

37

5.0 ASSESSMENT OF IMPACT OF PROPOSAL ON STAFF BY SECTION 75

GROUPS

5.1 Between Men and Women Generally

The gender profile for the South Eastern Health and Social Care Trust workforce

was 82% female compared with 18% male. These percentages are broadly

reflected in all the in-patient wards with exception of Ward 27, Kilclief which has a

staffing ratio of 65% male, 35% female. The Trust acknowledges this may have a

potential adverse impact and undertakes to monitor this figure. However the number

is relatively small and measures will be in place to mitigate and monitor potential

impact.

5.2 Persons of Different Age

The age profile for Ward 12 LVH, MIPU Downe and Ward 27 Ulster Hospital is

reflected in the age profile of staff within the whole of the South Eastern Trust. The

age profile of staff within ward 28/29 Downshire and Ward 27 Kilclief is slightly older

with a majority of staff being aged over 41 years of age. Therefore any proposal

should consider the potential for adverse impact on this group.

5.3 Persons with or without a Disability

Within the South Eastern Trust 5% of staff have reported disability. Within the wards

identified, a small percentage have reported a disability and the Trust recognises

that there is an under-reporting of disability by staff and makes every attempt to

accommodate staff as required. The Trust does not anticipate that this proposal will

have an adverse impact on staff with a disability but undertakes to monitor this issue.

5.4 Persons of different Marital Status

Available figures indicate that 56% of staff in Ward 27 Ulster Hospital, 61% MIPU in

Downe and 44% of staff in Ward 12 LVH are married, cohabiting or in a civil

partnership. A total of 53% in Ward 27 Kilclief and 84% in Ward 27/28 Downshire

are married, cohabiting or in a civil partnership. Across the South Eastern Trust 63%

of staff are married, cohabiting or in a civil partnership. These figures suggest that

any changes to Mental Health In-patient provision may have a slightly bigger impact

on staff who are on married, cohabiting or in a civil partnership than those who are

single. The Trust is committed to monitoring for any future impact.

5.5 Persons of different Religious Belief

Staff within the South Eastern Trust are 63% Protestant, 26% Roman Catholic and

11% recorded as their religious belief being unknown. These figures indicate that

38

there may be a potential impact on staff who work in MIPU Downe who are recorded

as 82% Roman Catholic, Ward 27 Kilclief who are recorded as 94% Roman Catholic,

Downshire and Ward 27/28 Downshire where 94% of staff are Roman Catholic. The

Trust is committed to monitoring this impact as the proposal is consulted on.

5.6 Persons with or without Dependents

Figures gathered show that there are a number of staff within the mental health

services who have caring responsibilities which may be for children or older people.

The Trust is aware of possible caring obligations associated with part-time female

employees. As the majority of staff of the identified wards are female any proposal

should consider the potential for adverse impact on this group. The Trust is

committed to monitoring for any future impact.

5.7 Persons of Different Political Opinion

The Trust has been able to gather some information with regard to the political

opinion of staff within the mental health services. As the majority of information

gathered indicates that staff do not wish to answer or that political opinion is

unknown the Trust has relied on local Government information. Therefore it can be

assumed that a proposal to change services at the Ulster and Lagan Valley may

have potential impact on the Unionist community and any change to services at the

Downe Hospital may have a potential impact on the Nationalist Community. The

Trust undertakes to monitor this potential impact.

5.8 Persons of a Different Racial Group

Available figures for the South Eastern Trust show that 77% of the current workforce

is from an EU background, 3% from a non-EU background and 20% not known. Of

the wards identified only LVH has reported a small percentage of BME staff. There

is a high percentage of unknown with regard to ethnic background among the mental

health staff. The Trust recognises the changing make-up of its workforce and

commits to continuing to monitor this for potential impact.

5.9 Persons of Different Sexual Orientation

The Trust has been able to gather information on the sexual orientation of its mental

health staff. The majority of staff have identified as being in a relationship with a

person of the opposite sex or have not answered or their status is unknown.

Population trends of 10% are assumed for gay, lesbian and bisexual individuals.

There is no evidence to suggest that the proposed changes will have an adverse

impact on employees as a result of their sexual orientation. The Trust is committed

to monitoring for any future impact.

39

6.0 CONSIDERATION OF MEASURES TO MITIGATE ANY ADVERSE

IMPACTS

This is defined by the Equality Commission as measures which mitigate any adverse

impact and the introduction of alternative policies which might better adhere to the

promotion of equality of opportunity.

The Trust has carried out an equality screening exercise and EQIA to assess the

impact of the proposals on the future of Mental Health In-patient Care.

Information was gathered and analysed with respect to the users and staff within the

relevant wards at Downe Hospital, Lagan Valley Hospital and the Ulster Hospital. As

the proposal has not yet occurred impacts can be described as potential. The Trust

has identified that, depending on the preferred option, there may be potential low

impact on staff and service users from some of the nine equality categories.

Option 1: Maintain the Status Quo

Continue to provide acute in-patient treatment at three locations across the Trust.

Maintain continuing care and PICU provision on Downshire Hospital site. This option

serves as a baseline against which the others can be assessed.

As this is the current provision there is no potential adverse impact on any of the

nine Equality Categories.

Option 2: Do Minimum

Upgrade the existing 4 facilities, as required (Ulster, Downe, LVH and Downshire) to

meet Health and Safety and other statutory / legislative requirements.

As this is the current provision there is no potential adverse impact on any of the

nine Equality Categories.

Option 3: Relocate Acute In-Patient Care and PICU to Lagan Valley Hospital

and Low Secure Services to Downe Hospital

Move acute in-patient care from the current three locations to a single location at

Lagan Valley Hospital. Co-locate PICU with acute in-patient care at the new single

location. Move low secure services to a single site at the Downe Hospital.

The Trust has identified that this option may have a potential impact on service users

and staff in the following categories: gender, religious belief and political opinion.

40

Option 6: Provide all Acute Psychiatry, PICU and Low Secure Services to a

new build extension at Downe Hospital

Move acute in-patient care from the current three locations to a single location at

Downe Hospital. Co-locate PICU and low secure services with acute in-patient care

at the new build extension at Downe Hospital.



Option 7: Provide Acute Psychiatry and PICU services in a new build facility

on a brownfield site on Tor Bank site, Dundonald and Low Secure services at

the Downe Hospital


purpose-built facility on a brownfield site at Tor Bank School. Provide low secure



accommodation. There would be no requirement for patients to move during

construction works and no disruption of hospital services as the construction would

take place on a brownfield site.



Option 8: Provide Acute Psychiatry and PICU services in a new build facility,

on Lagan Valley Hospital site and Low Secure services at the Downe Hospital

Provide acute in-patient care, co-located with PICU services in a new, purpose-built

facility on the Lagan Valley Hospital site. Provide low secure services at a single site

at Downe Hospital with minor reconfiguration to provide social care / activity rooms in

line with modern day standards for low secure accommodation.



6.1 Service Users

The Trust has identified a number of measures to mitigate these potential adverse

impacts for service users including:

The proposal will enable long stay patients to be given individual assessment

of their needs.

41

The proposals will impact on a fewer number of people due to the restructured

provision of in-patient care.

Due to increased provision of care in community setting there will be a

reduced number of admissions to the acute wards.

The proposals will enable the Trust to reduce the length of stay for acute

patients.

The reduction in length of stay will result in patients spending less time away

from home and less time in the hospital setting.

Patients will have better access to community mental health services.

The Trust will be able to access alternatives to in-patient admission including

community mental health services.

The Trust will consult with users, their families and carers to identify the best

possible resettlement arrangements.

6.2 Staff

The Trust has identified the following mitigating measures with regard to staff.

The Trust recognises that this proposal may impact on staff in terms of

relocation to a new work site, reduction in the overall numbers of posts and

redeployment to a different post and new role.

The Trust will carry out one to one discussions with staff members who may

experience impact.

The Trust will take into account staff preferences for possible redeployment.

The Trust has kept staff informed of the direction the proposals are taking.

The Trust has carried out initial conversations with staff side representatives

and will work in partnership with them to assess the potential impact.

Service users and carers representatives were an integral part of the option

appraisal process.

The Trust will discuss retraining opportunities with all affected staff.

The Trust will identify all vacancies which may be appropriate for affected

staff.

The Trust will monitor the rate at which it is able to meet deployment requests

from staff.

Staff transferring to new locations may be eligible for excess travel allowance

paid at public mileage rate for a period of 4 years from the date of transfer to

their new location. The eligibility for this will be reviewed on transfer.

6.3 Disability Discrimination

The Trust has not identified that any of the proposal will in any way discourage

disabled people from participating in public life.

42

The Trust will work towards encouraging and promoting positive attitudes towards

disabled people.

When the Trust is aware of a patient with a disability, services are put in place to

accommodate their needs and this will continue to be the case.

The Trust will collate and monitor future data including:

Number of admissions by Ward

Length of stay in hospital

Numbers of people who receive mental health services in the community

Complaints/Compliments

Discharge data

43

6.4 Human Rights

The Trust has identified that the options for this proposal will have either a positive or

a neutral human rights impact due to the modernised specialist service which will be

provided to users of the mental health service. The Trust will keep this under review

and ensure any interference is balanced and proportionate to the needs of the

general community which we serve.

The proposal in general will allow patients and clients who have mental health issues

to remain in their own home and their own communities for as long as possible

thereby supporting their Article 8 rights.

However, due to the reprovision of services some patients, relatives and carers and

staff may experience additional travel distances and timings as follows:

Distance Travel Time

Ulster Hospital –


Ulster Hospital –

Lagan Valley Hospital 16.7 miles 27 minutes

Lagan Valley Hospital –


Source –mapquest.co.uk

However this is not seen as a major impact. Patients and their relatives for whom

this may cause financial hardship may be able to make an application for support

with travelling expenses.

Staff transferring to new locations may be eligible for excess travel allowance paid at

public mileage rate for a period of 4 years from the date of transfer to their new

location. The eligibility for this will be reviewed on transfer.

44

Conclusion

The Trust will work with management, staff and staff side to mitigate any potential

adverse effects as a consequence of the implementation of this proposal. The

completion of and consultation on the EQIA is evidence of the Trust‟s commitment to

ensuring that it actively addresses its equality, human rights, good relations and

disability obligations.

7.0 CONSULTATION

7.1 What do you think?

This document sets out the Trust plans for optimising Mental Health In-patient Care

within the South Eastern Trust.

You can send your comments to the Trust by a variety of means such as:

in writing

by email

by telephone

by text phone

by fax

via our website

Additional copies of this document are available from the South Eastern Health and

Social Care Trust website by clicking on Involving You. Please return your response

by 17 April 2013 to:

Hugh McCaughey

Chief Executive


Trust Headquarters

Ulster Hospital

Dundonald

BT16 1RH

Telephone: 028 90564733

Textphone: 02891510137

Email [email protected]

The consultation on the proposals will last for 13 weeks, from 16 January to 17

April 2013.

45

Glossary of Terms

Adverse Impact

A group under Section 75 has been affected differently by a policy and the effect is

less favourable.

Differential Impact

A group under Section 75 has been affected differently by a policy. This affect could

either be favourable or unfavourable.

EQIA – Equality Impact Assessment

An assessment of equality implications carried out according to guidance issued by

the Equality Commission for Northern Ireland.

Policy Screening

A procedure carried out using the four screening questions issued by the Equality

Commission for Northern Ireland. The procedure informs the likelihood of a policy

being subject to an Equality Impact Assessment.

TSN – Targeting Social Need

A Government policy to ensure that resources are targeted at those most in need,

using objective data and criteria.

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