Agenda item - Future use of Knoll House Resource Centre

Report of Executive Director, Health and Adult Social Care (copy attached)

RESOLVED – (1) That a business case and options appraisal be worked up for the use of Knoll House as; a) High level supported step-down accommodation for adults with mental health needs; or, b) Lower level supported accommodation for adults with a mental health condition to enable independent living c) Both of the above options will be considered within the business case ad options appraisal;

(2) That a recommendation based upon the business case and options appraisal is brought back to the Board for approval by January 2020;

(3) That in view of the proposals to close Knoll House as a council run rehabilitation service, that the Board agrees to receive a future report on:

 - an assessment of need for ongoing therapy and rehabilitation inn Brighton and Hove;

 - an understanding of how the above proposals for Knoll House, help the council and CCG to achieve agreed proposals for “Home Care” and community care;

(4) That the Board agrees to commission a further report for the November Health and Wellbeing Board meeting, detailing:

 - the capacity of the CCG to meet the needs of people who require more intensive and specialist nursing care following hospital discharge, including;

 - detail on where facilities for Brighton and Hove residents are based; and

 - information on the impact of new facilities being based outside of Brighton and Hove, and any need for, or support offered, to patients and carers who may incur associated transport costs resulting from the changes.

20.1    The Board considered a report of the Executive Director of Health and Adult Social Care summarising the recent background to the service remodelling which had impacted on the current use of Craven Vale and Knoll House. It explained the rationale underpinning the proposal to merge the revised service to operate from one site, which had BHCC cross-party and CCG support.

20.2    The Executive Director, of Health and Adult Social Care explained that the action taken would release Knoll House for an alternative use. An initial desk top study had identified a number of potential uses for Knoll House, although the preferred use would be to retain the site within Health and Adult Social Care and to repurpose it to meet identified gaps in the provision of services for adults with support needs. The Board were being asked to support the preparation of a fully costed business case to support the future use of Knoll House. This document would be brought back to the Board for approval and would identify how best to meet the accommodation needs which were a priority for the city and would support future demand and support the best possible outcomes for adults with support needs.

20.3    It was noted that the following amendments to the recommendations had been received from the Green Group proposed by Councillor Shanks and seconded by Councillor Nield:

1.1.3 That the Board agrees to note with concern that the planned changes did not allow sufficient time for public involvement or scrutiny by the Health and Wellbeing Board and HOSC;

1.1.4 That in view of the proposals to close Knoll House as a council run rehabilitation service, that the Board agrees to receive a future report on:

-       an assessment of need for ongoing therapy and rehabilitation in Brighton and Hove;

-       an understanding of how the above proposals for Knoll House help the council and CCG to achieve agreed proposals for ‘Home Care’ and community care;

1.1.5 That the Board agrees to commission a further report for the November Health and Wellbeing Board meeting, detailing:

-       the capacity of the CCG to meet the needs of people who require more intensive and specialist nursing care following hospital discharge, including:

-       detail on where facilities for Brighton and Hove residents are based
 

-       information on the impact of new facilities being based outside of Brighton and Hove, and any need for, or support offered, to patients and families/carers who may incur associated transport costs resulting from the changes”

20.4    Councillor Shanks whilst noting the rationale for the action taken had concerns that this issue had been concluded without being brought back before the Board for further discussion. Councillor Shanks considered that this would have been beneficial and would not want a similar approach used going forward, hence her request that a report be brought to the scheduled November meeting. Her concerns related to the process, rather than to the decision taken.

20.5    Councillor Nield who had seconded the amendments concurred with Councillor Shanks observations stating that additionally she had concerns at the potential practical impact on families if they were required to travel greater distances and on the environmental impact which could result from a higher level of emissions.

20.6    Dr Supple, CCG, stated that the current offer was not always the most appropriate setting for a number of adults who had support needs and going forward it was important to look at the bigger picture in terms of community based provision which was equipped to meet changing demands. Fundamental to that process was the need for capacity planning in the light of the current review. Currently a number of adults were receiving care outside of the city in Crowborough, Newhaven and Uckfield and the intention was to provide those spaces in or closer to the city.

20.7    The Executive Director stated that he fully understood the concerns raised but considered it important to stress that there had been unusual circumstances around the decision taken. Following notification by the Sussex Community Foundation Trust of their intention to reduce their nursing and therapy services to Knoll House and Craven Vale patient safety had been of paramount concern as had the need to provide assurance for the dedicated staff employed. The action taken had avoided the need for any compulsory redundancies whilst allowing the services required to be delivered in a different way. Whilst providing emergency respite care it would enable a more appropriate package of care to be provided for those with less complex needs.

20.8    David Liley, Healthwatch confirmed that although non-specific and anonymised they had been notified of concerns in the past that it was that the action plans devised for individuals had worked well in some cases but not in others. Measures that had been put in place to address that were welcomed and would form the subject of separate reports to HOSC.

20.9    Councillor Appich stated that she had visited the staff at Knoll House with the Chair. A number of them were long serving and had not taken holidays for example due to insecurities regarding their futures. The action taken had removed that uncertainty and had avoided the need for any compulsory redundancies. It was accepted that the criteria used for admissions needed to change.

20.10  The Chair stated that whilst discussions would usually take place within the usual budget round there had been particular circumstances which had guided the decision making process in this instance. The decision taken had been the right one and had been supported by staff. They were to be thanked for their co-operation and the service albeit a smaller one was being retained with an options appraisal report being brought forward for approval by the Board in January 2010.

20.11  Councillor Shanks re-iterated that whilst not critical of the decision taken she wanted to stress the point that procedurally such decisions should come to the Board for decision so that members were aware of the germane issues and had a voice.

20.12  As no further matters were raised in respect of the item the Chair then took a vote on each of the proposed Green Group amendments in turn.

            A vote was taken on 1.1.3 and it was lost on a vote of 5 to 1 and was therefore not carried;

            A vote was taken on 1.1.4 which was agreed unanimously and was therefore carried;

            A vote was taken on 1.1.5 which was agreed unanimously and was therefore carried;

20.13  The Chair then took a vote on the substantive amendments which were carried and are set out below:

20.14  RESOLVED – (1) That a business case and options appraisal be worked up for the use of Knoll House as; a) High level supported step-down accommodation for adults with mental health needs; or, b) Lower level supported accommodation for adults with a mental health condition to enable independent living c) Both of the above options will be considered within the business case and options appraisal;

(2) That a recommendation based upon the business case and options appraisal is brought back to the Board for approval by January 2020;

(3) That in view of the proposals to close Knoll House as a council run rehabilitation service, that the Board agrees to receive a future report on:

- an assessment of need for ongoing therapy and rehabilitation in Brighton and Hove;

- an understanding of how the above proposals for Knoll House help the council and CCG to achieve agreed proposals for “Home Care” and community care;

(4) That the Board agrees to commission a further report for the November Health and Wellbeing Board meeting, detailing:

- the capacity of the CCG to meet the needs of people who require more intensive and specialist nursing care following hospital discharge, including;

- detail on where facilities for Brighton and Hove residents are based; and

 - information on the impact of new facilities being based outside of Brighton and Hove, and any need for, or support offered, to patients and carers who may incur associated transport costs resulting from the changes.