Subject:		Knoll House Resource Centre: Future Use
Date of Meeting:		16 October 2019
Report of:		Executive Director for Health & Adult Social Care
Contact Officer:	Name:	Giles Rossington	Tel: 01273 295514
	Email:	giles.rossington@brighton-hove.gov.uk
Ward(s) affected:		(All Wards);

FOR GENERAL RELEASE

Glossary:

· BHCC – Brighton & Hove City Council

· BSUH – Brighton & Sussex University Hospitals Trust

· CCG  – Clinical Commissioning Group

· HASC - Health and Adult Social Care directorate, Brighton & Hove City Council

· HWBB – Health and Wellbeing Board

· SCFT – Sussex Community Foundation Trust

· KH – Knoll House

· CV – Craven Vale

· Integrated Care 24 (IC24) – social enterprise providing health services across SE England

1.         PURPOSE OF REPORT AND POLICY CONTEXT

1.1       This report summarises for the HOSC the recent background to the service remodelling that impacts upon the current use of Craven Vale and Knoll House. It explains the rationale underpinning the proposal to merge the revised service to operate from one site, which has BHCC cross-party and CCG support. Consultation with all staff working across both sites has now been completed and the future delivery will operate from Craven Vale.

1.2       This will release Knoll House for an alternative use. An initial desk top study has identified a number of potential uses for Knoll House, with the preferred use being retaining the site within Health and Adult Social Care and repurposing it to meet identified gaps in provision of services for adults with support needs.

1.3       A report with a recommendation that officers be charged with developing a business case for the future use of Knoll House was agreed by the HWB at its September 2019 meeting. The business case will be further considered at the January 2020 HWB meeting.

2.         RECOMMENDATIONS:    

2.1 That the Committee notes the information included in this report.

3. CONTEXT/ BACKGROUND INFORMATION

3.1      Knoll House and Craven Vale are two council owned and operated residential homes.  Both are registered with the Care Quality Commission to provide residential care. In recent years both KH and CV have supported older people requiring ongoing therapy and rehabilitation following their discharge from hospital to enable as many people as possible to get back to their home. SCFT provide both nursing and therapy staff commissioned by Brighton & Hove CCG.

3.2    Feedback from staff and population health data shows that the health and social care needs of our local population are changing, with more patients now leaving hospital with complex and greater nursing needs.

3.3    This is evidenced by the increase in people being transferred to Knoll House and Craven Vale requiring increased levels of support and specialist nursing care. 

3.4 In 2016 the CCG and City Council ran a procurement process to identify appropriate providers to deliver this care as existing contracts were reaching their end, and commissioners are obligated by national and international law to undertake competitive procurement when awarding public service contracts. Unfortunately the procurement process outcomes were such that commissioners in the CCG and City Council were not able to identify appropriate providers who could supply the necessary level of high quality care with value for money for our residents.In place of this, the temporary arrangement was agreed that in addition to the care provided in NHS community wards run by SCFT, services would continue to be located in Knoll House and Craven Vale, run by the City Council and supported with healthcare provided by SCFT nursing and therapy and GP medical support provide by Integrated Care 24.

3.5      The arrangements described above have been in place since 2016 and have until recently been able to provide an excellent level of care and patient experience. However, there have been a number of recent factors that have necessitated a review of these arrangements:

· Emerging NHS and public health data showing that the health and care needs of our local population have increased over the last few years,

· A recent report from Healthwatch Brighton and Hove, published in February 2019, revealed that patient experience of discharge from the Royal Sussex County Hospital is being negatively impacted by delays in finding suitable community care resulting in them being stranded in hospital even if they are well enough to be discharged from an acute setting.

· The increasing health and care needs of patients was also noticed and reported by staff working at Craven Vale and Knoll House during the previous winter and a question was raised amongst local system health and care leaders as to the sustainability of the current residential, social care community beds model in Brighton and Hove.

· Further to this in April 2019, Sussex Community Foundation Trust confirmed it would not be able to continue to provide a sustainable and safe model of community nursing and therapy at Knoll House and Craven Vale and felt that nursing staff had been providing significantly higher levels of care than had been commissioned. It was felt that the model of care needed should be in a setting where there is nursing care 24/7, whereas at Knoll House and Craven Vale this is only provided from 8am to 8pm.

3.6    In April 2019 BHCC was informed by SCFT of their intention to reduce their nursing and therapy services to Knoll House and Craven Vale.

3.7    Following this notice and with full priority given to patient safety and our duty of care to staff, BHCC amended the registered admission criteria for Knoll House and Craven Vale.

3.8    The revised admission criteria resulted in a significant reduction in occupancy levels in both Craven Vale and Knoll House; both sites are regularly at 50% or less occupancy.

3.9    People requiring more intensive and specialist nursing care when following hospital discharge access this via other provision commissioned by Brighton and Hove Clinical Commissioning Group. The overall number of community beds provided for Brighton and Hove and surrounding area residents will increase from 161 to 174 and this change will also involve the CCG increasing its investment in community beds.  The detail concerning bed numbers and level of care is as follows:

· Between September and December 2019 the CCG has agreed with health and care partners an investment to mobilise 42 community rehabilitation beds (sometimes referred to as 'step-down beds') in sites in the East and West of Brighton and Hove. This is in addition to 12 nursing home beds in the city which the CCG commissioned as part of supporting hospital discharges.  These nursing home beds are supporting patients who are non-weight bearing or have a diagnosis of delirium. 

· These additional beds replace the loss of capacity due to the limitations on accessing Knoll House and Craven Vale from hospital discharge, and account for the increase in community beds that are being provided to Brighton and Hove residents whilst we work in partnership to introduce more community services over the next two to three years. 

· These 54 beds in the city are in addition to the existing community hospital beds provided by Sussex Community Foundation Trust at sites in Lewes, Uckfield and Crowborough. In summary this means in 2019 we will benefit from a growth in community beds for Brighton and Hove resident from 161 to 174, with an enhanced health and care model to support the changing health needs of our residents. 

3.10  An initial demand study has indicated that supporting the revised operational pathway will require a total of 24 social care community beds. These will be used for planned and emergency respite and lower dependency hospital discharge. Craven Vale, with its proximity to the RSCH site and existing capacity is the preferred site to operate from.

4       Future use of Knoll House

4.1      Officers have carried out an initial options appraisal exercise to consider the possible future uses of the Knoll House site.

4.2      The planning use for the site is currently C2, provision of residential accommodation and care to people in need of care, and planning permission would be required for any change of use.

4.3       The options appraisal initially considered the following three high level options:

A    Disposal - The site could be sold for alternative use. This could include use as a nursing or residential home, conversion to flats or redevelopment for housing (subject to receiving planning permission).

B    Hand the property back to estates to be retained as part of the corporate property portfolio. - The site could then be made available for consideration of future uses including potentially meeting other housing based needs within the city.

C    Reuse the facility to provide mental health step-down supported accommodation or as mental health residential accommodation.

4.4      The option 3.3.3 was supported by HASC as both meeting an identified need in the city and supporting person-centred outcomes maximising future independence of people on a recovery journey from moderate and serious mental health issues.

4.5      Between the last two performance years 2017/18 and 2018/19 there was an 81% increase in admissions to long term residential care for younger adults with mental health needs indicating an urgent need for further development of alternative accommodation and support for this group .In 2018/19 50% of all long term care admissions for 18-64 year olds were for people with mental health support needs.

4.6      Best practice suggests that young people with mental health problems need support to maximise independence. Our aim is to deliver this, but to do this we need more supported and move-on accommodation as part of the pathway to independence. The Supported Accommodation option has been shown to be an effective model in improving people’s outcomes and supporting longer term independence.

4.7      Having decided on investigating the feasibility of retaining the site, a further three possible uses were identified:

1. Functional mental health residential accommodation

2. High level supported step-down accommodation

3. Lower level supported accommodation to enable independent living.

4.8      These three options were explored at a high level that included estimation of revenue and capital costs and the potential benefits, risks and opportunities associated with each.

4.9      The full options paper was then discussed with the chair of the Health and Wellbeing Board and the lead member for Adult Social Care and it was agreed that, given evidence base and best practice the functional residential care would not be explored as the outcomes for the service users were not optimised and that the following options should be explored in more depth:

a) High level supported step-down accommodation

b) Lower level supported accommodation to enable independent living

4.10    The high level options appraisals are included as Appendix 1.

           4.11    Part of the business planning and process will include engagement with local residents.

5          ANALYSIS & CONSIDERATION OF ANY ALTERNATIVE OPTIONS

5.1       Not relevant to this report to note.

6          COMMUNITY ENGAGEMENT & CONSULTATION

6.1       None in relation to this report

7          CONCLUSION

7.1       Members are asked to note plans to re-profile services currently provided from Knoll House and Craven Vale and to concentrate future operations at Craven Vale, with Knoll House re-purposed to meet other HASC needs.

8          FINANCIAL & OTHER IMPLICATIONS:

Financial Implications:

8.1      There is the potential for financial efficiencies to be obtained by improving the pathway for clients with mental health needs and supporting longer term independence. As per paragraph 4.5, the number of admissions for younger adults with mental health needs is increasing and the average cost of an accommodation placement in the independent sector is £820 per week.

The high level calculations for the options outlined shows that there is a range of costs and potential net savings. Detailed modelling would need to be carried out to ascertain the likely financial impacts from the implementation of the different options.

Finance Officer consulted: Sophie Warburton                Date: 16/08/2019

Legal Implications:

8.2       The report highlights the need to review the use of Knoll House Resource Centre to improve performance and efficiency within Health and Adult Social Care. There are no legal implications arising immediately from this report. The business case may give rise to legal implications due to the level of capital expenditure and running costs, any building work or staff reorganisation that may be required in the adoption of identified options. These can be considered if and as they arise. 

Lawyer Consulted: Sandra O’Brien                                               Date: 03/10/19

Equalities Implications:

8.3      There will be equalities implications to consider for each of the options outlined above. An Assessment of equality impact will be completed to analyse areas of potential impact – and areas where negative impact might be mitigated. The findings of EIA will be reflected and articulated in the proposed business case and options appraisal that is brought back to Health and Wellbeing Board for approval in January 2020.

Sustainability Implications:

8.4       None identified

Any Other Significant Implications:

8.5       None identified

SUPPORTING DOCUMENTATION

Appendices:

1.         High level options appraisal for the future use of Knoll House

Documents in Members’ Rooms

None 

Background Documents

None