Appendix 1 Impact assessment 060112 , item 72. PDF 62 KB

critical damage being caused to B&NES HDU this is already in place onthe acute in-patient unit.d) Continued provision of an upgraded inpatient unit model to includemore integration with other aspects of the service and with enhancedtherapeutic delivery as part of the service redesign. This will improve thequality of the in-patient episode. Already started and will continue.e) Ensure active risk and quality management and monitoring tounderstand and act on service user experience and outcomes as well asbe assured that all aspects of medical, nursing and therapeutic caredelivery (including the use of medication) are robustly monitored andmeasured. In place and ongoing locally and via the NHS contract.6. TimescalesOnce agreement has been reached regarding the closure of Cherries HDU,the team will plan the permanent closure. As there are no service userscurrently using the service there will be no impact upon existing service usersor their families.7. Additional informationIn the current financial year there has been no external (external to AWP )usage of PICU beds despite the temporary non availability of the Cherries.There is provision for Banes of 1.6 PICU beds for both males and femalesand this has been accessed according to need.8. Does the NHS consider this proposal to be a substantialvariation or development?No. There is no reduction in service in relation to the bed base but ratherimproved efficiency and a releasing of monies for reinvestment into servicedevelopment that meets both strategic, patient and operational aspirations.PART TWO – Patients, carers and public representative views– summary of the potential impact of proposed servicechangesPatients, carers and public representatives are asked to comment on thefollowing areas, in relation to the proposed service changes detailed inSection 2:Benefits of the proposed servicechanges• Increase in staff numbers +20% onSycamore• More interaction with staff• Increase in opportunities forservice users to engage• More Occupational Therapists staffavailable / no split of provision• PICU has its own dedicated

therapists• Increased training for staff withassociated supervision –supervision rates improving – withassociated improvement in skill setof staff on sycamore• Increase in local communityservices – crisis services and earlyintervention + more plannedprimary care liaison• The needs of each individual willbe better addressed using arecovery focused approach.Any disbenefits, including howyou think these could bemanagedAny issues forpatients/carers/families inaccessing the new serviceparticularly if a change of locationhas been suggestedHow do you think the proposedchanges will affect the quality ofthe service• Wider range of acuity – nationaltrend. This can be challenging forstaff – training being implementedand individual staff needs will besupported.• Potentially more people will go to aPICU and this will be outside ofB&NES. Monitor numbers andassess if HDU would have beenused.• Some people liked the smallenvironment of PICU especiallywhen they were agitated.Therefore essential to progressde-escalation unit.• No change in location of PICU oracute beds suggested so accessto services unchanged.• It was acknowledged that for somepeople based in Bath the mainPICU being in Brislington cancause travelling problems. More soif in Salisbury• In general information needs to begood for families about theprocess.• Carer feedback via carers leadwas that the HDU was oppressive(so change may improveexperience).• Improvement in skill set of staff onsycamore• Increased number of staff +20%• Developments with somepsychiatry (medics + drugs) will

support improvement –• More use of drugs?• Evidence that there is noescalation in violence andaggression so not impacting onnegatively• It was mixed sex and smallenvironment – PICU is neither ofthese.• Quality has increased immenselyover the past few yearsImpact of the proposed changeson health inequalitiesAny other commentsIf you are a representative of anorganisation, such as LINKs,please indicate how you havedrawn on the views of others fromyour groupThis was felt to be generally positiveor no effect. It was noted that there is20% less bed capacity overall.• More access to care in thecommunity.• PICU have better facilities/environment• Pregnant women go to ElizabethCasson House which is aspecialist female PICU.• Rates of admission for youngpeople are very low for 16 to 18year olds. Discuss with oxfordhealthcare (for younger people).• Faiths individually focused so noeffect.• Gender- it will improve situation forpeople needing PICU because itssingle sex accommodation - HDUwas mixed.• Staff considered that the deescalationarea was very importantbecause without this some olderadults could become frightenedwhen younger adults were veryagitated. Therefore they, as group,rated health inequalities as amber.Mitigating action prioritised.LINKs were involved in both the firststakeholder engagement session inOctober and the impact assessmentmeeting.LINKs have fed back that they felt theimpact assessment had been verysuccessful and the information

provided was clear and helpful.PART THREE – Impacts at a glanceImpacts NHS Staff View Patient/carer/publicrepresentatives’viewImpact on patientsI x red; 3xorange; 3x greenImpact on carersImpact on healthinequalitiesImpact on local healthcommunity1xred; 3x amber; 3x green3x amber; 4x green1x red; 2 x amber; 4 x green = significant negative impact = negative impact for some = positive impactGLOSSARY- list definitions of any technical terms, acronyms etc