“An integrated acute care recovery service is planned for all adults with functional mental health difficulties who require either an emergency or urgent response to safeguard them and/or others from the likelihood of significant harm.”
“The proposed changes are based on a phased programme of bed closures and complementary investment in locality based services. This would involve the reduction in the number of functional inpatient beds from the current establishment of 58 to 38 beds which equates to a 35% reduction.”
“The Project would be managed carefully so that patients were not put at risk and a phased approach to implementation had been adopted to ensure this. The Project would be carried out in three phases to ensure that service improvement was aligned with bed reductions and the outcome of one phase would be reviewed before the next phase started.”
“A question was asked as to why funding had not been mentioned and that the public’s perception of this would be that the Trust were saving money by closing beds because no detail of the plans for home treatment and more flexible service provision were known. It was felt that the Trust should be open with the public about the costs, savings and benefits of the proposals as people were less likely to object if they understood the rationale behind the changes. The Deputy Director of Joint Commissioning and Partnerships explained that on balance it had been decided not to include figures, although they were available and could be shared with the public. The engagement process would give people, including those who might oppose the proposals, an opportunity to discuss and influence them.”
“One member drew attention to the fact that the proposed changes were cost neutral and that this wasn’t evident to the public. The Deputy Director of Joint Commissioning and Partnerships confirmed that overall the budget was neutral. The cost of the crisis house would be over and above the existing budget so would be a real increase in overall spending. The number of staff for locality services were being increased by 231 due to changing the skill mix, with some of this increase improving staffing levels in the adult inpatient units.”
“We have consulted widely with many interested parties including patients, health professionals, carers, support groups, social services staff and local councillors. Their views have been taken on board and a final proposal for new Mental Health Urgent Care Services for people aged over 18 has now been developed. … Before it is adopted formally, we would like to hear your final comments. We enclose a response form and we would be grateful if you would take a few minutes to jot down your views and return it to us by30 May 2012 .”
“Care for people may also be provided in ‘recovery accommodation’ (sometimes called crisis housing). This will be a home in either Weymouth or Dorchester, where people can stay for short periods. It will be for patients who have been in a mental health unit and recovered enough to be discharged but who still need some support before going home. It will also be used for people who may avoid going into a mental health unit if they are given extra support in the recovery accommodation for a short period.”
“As a result, inpatient units must: • develop a wide range of therapeutic activities and psychological help to enable a patient to gain control over their general recovery • have enough suitably-qualified and experienced staff to care safely for patients who are in crisis. The small community units such as the Hughes Unit and Stewart Lodge are not able to do this but they will continue to provide outpatient and day treatment services. Staff will be redeployed in the community and 10 additional people will be employed. Inpatient care will be provided at the Linden Unit in Weymouth and the Minterne Unit in Dorchester for the intensive care of younger adults. Both units will have more staff.” “As a result, inpatient units must: • develop a wide range of therapeutic activities and psychological help to enable a patient to gain control over their general recovery • have enough suitably-qualified and experienced staff to care safely for patients who are in crisis. The small community units such as the Hughes Unit and Stewart Lodge are not able to do this but they will continue to provide outpatient and day treatment services. Staff will be redeployed in the community and 10 additional people will be employed. Inpatient care will be provided at the Linden Unit in Weymouth and the Minterne Unit in Dorchester for the intensive care of younger adults. Both units will have more staff.”
“We know that getting around Dorset is not easy for people without cars, so we are also investing money to support the development of community transport schemes that will be of benefit to patients.”
“We are however convinced this is a more clinically appropriate model, and believe we have done all we reasonably can to provide reassurance, including the dual running of inpatient facilities and community services for a period of 6 months.”
“Summary of analysis: Taking current service provision as the benchmark against which the potential for differential impact is measured, it is anticipated that the proposed service would be better placed to meet the needs of people with protected characteristics; through the delivery of a proactive and integrated community based response to urgent need in a variety of different settings, that provides people with the greatest choice and control over their own lives through the adoption of recovery principles, that are focussed about the delivery of personalised care.” “What is the overall impact?: Overall the proposed model for urgent care mental health services with its focus on the delivery of recovery[-]focussed, person-centred care to people experiencing a mental health crisis would have a beneficial impact on the care received by people with protected characteristics, being better able to meet their particular care requirements.” “Addressing the impact on equalities: Where transport issues may be of a concern either for a service user, their carer or family, to and from inpatient facilities, this would be identified through the initial assessment, and supportive measures put in place. A review is taking place of community transport schemes, which seek to support the transport requirements of people accessing services across the Dorset health network, and will focus on the needs mental health users and their carers accessing this urgent care services. NHS Dorset will be supporting the infrastructure development of organisations providing community transport schemes.”
“1. What was the reason for the decision to move from the original proposal to have three crisis houses to the proposal to have a single crisis house? During the consultation process, and in response to demographic and performance data, it was decided that a seven-bedded house would provide sufficient crisis accommodation within the west of Dorset. Prior to the opening of any additional facilities performance would be reviewed by NHS Dorset to establish future service requirements. 7. Is it proposed that any patients will be transferred directly from the Hughes Unit and Stewart Lodge to the Crisis House? No, it is felt that it would not be appropriate for the Recovery House to operate as a step-down facility in this instance. 33. What steps have been taken to date by the Trust, NHS Dorset and/or Dorset County Council to address the concerns raised during the consultation about the transport problems in the county? NHS Dorset made a commitment to work with appropriate partner organisations to strengthen the community transport infrastructure. The anticipated outcome will be easier access to health related appointments for people who have difficulty in travelling. Currently a working group is meeting regularly under the Chairmanship of a Dorset County Councillor, to review the current provision of volunteer car driver schemes, identify where there are gaps and then implement plans to fill the gaps and provide better coordination. Improved coordination is likely to be provided by a single point of access on both sides of the County. There is great enthusiasm within the group and good progress is being made. 34. In light of the steps that have been taken, please explain how patients will be expected to travel from the available in-patient facilities or the Crisis House to their homes during the day and how carers, relatives and friends will be expected to travel to the available in-patient facilities or the Crisis House to visit service users (i.e. please indicate whether people without cars will be expected to use public transport, the ambulance service or some form of ‘community transport’). Volunteer transport schemes have and are being developed to support the needs of patients, service users and carers from across Dorset. These services are open to all people who wish to access health services.”
“108. It is common ground that, whether or not consultation of interested parties and the public is a legal requirement, if it is embarked upon it must be carried out properly. To be proper, consultation must be undertaken at a time when proposals are still at a formative stage; it must include sufficient reasons for particular proposals to allow those consulted to give intelligent consideration and an intelligent response; adequate time must be given for this purpose; and the product of consultation must be conscientiously taken into account when the ultimate decision is taken (R v Brent London Borough Council, ex parte Gunning(1985) 84 LGR 168 ) …. 112 ... It has to be remembered that consultation is not litigation: the consulting authority is not required to publicise every submission it receives or (absent statutory obligation) to disclose all its advice. Its obligation is to let those who have a potential interest in the subject matter know in clear terms what the proposal is and exactly why it is under positive consideration, telling them enough (which may be a good deal) to enable them to make an intelligent response. The obligation, although it might be quite onerous, goes no further than this.”
“9. There remains an issue between the parties as to the extent of the consultation that discharge of the duty to notify and consult required. The underlying principles are not in dispute. They were identified by Mr Stephen Sedley Q.C. in argument in R v Brent LBC ex p Gunning(1985) 84 LGR 168 and were adopted by Hodgson J in his judgment in that case at p 189. They are: “First, that the consultation must be at a time when proposals are still at a formative stage. Second, that the proposer must give sufficient reasons for any proposal to permit of intelligent consideration and response. Third, that adequate time must be given for consideration and response, and finally, fourth that the product of consultation must be conscientiously taken into account in finalising any statutory proposals.” 10. Those principles were elaborated in this way by McCullough J in ex p Cran at p 38 as follows: “What kind and amount of consultation is required in a particular case must depend on the circumstances. A few general principles can however, be stated. The process of consultation must be effective; looked at as a whole, it must be fair. This requires that: consultation must take place while the proposals are still at a formative stage; those consulted must be provided with information which is accurate and sufficient to enable them to make a meaningful response; they must be given adequate time in which to do so; there must be adequate time for their responses to be considered; the consulting party must consider responses with a receptive mind and a conscientious manner when reaching its decision.” 11. So far as they go, those passages in my judgment correctly state the relevant principles. They do not, however, provide a complete answer to the question which arises for decision in this case. Thus, they do not address the question what is the necessary extent of the notification or consultation required in order to discharge the duty. As McCullough J pointed out, all will depend upon the circumstances. For example, a national project with wide implications for society as a whole will require far more extensive consultation than the installation of a pedestrian and cycle crossing. Provided that the notification and consultation satisfy the principles set out above, it appears to me that council must have a comparatively wide discretion as to how the process is carried out. The council cannot be in breach of duty unless the extent of the consultation process was such as to be outside the ordinary ambit of its discretion. In short, in order to be unlawful the nature and extent of the process must be so narrow that no reasonable council, complying with the principles set out above, would have adopted it.” “First, that the consultation must be at a time when proposals are still at a formative stage. Second, that the proposer must give sufficient reasons for any proposal to permit of intelligent consideration and response. Third, that adequate time must be given for consideration and response, and finally, fourth that the product of consultation must be conscientiously taken into account in finalising any statutory proposals.” “What kind and amount of consultation is required in a particular case must depend on the circumstances. A few general principles can however, be stated. The process of consultation must be effective; looked at as a whole, it must be fair. This requires that: consultation must take place while the proposals are still at a formative stage; those consulted must be provided with information which is accurate and sufficient to enable them to make a meaningful response; they must be given adequate time in which to do so; there must be adequate time for their responses to be considered; the consulting party must consider responses with a receptive mind and a conscientious manner when reaching its decision.”
“68. What needs to be published about the proposal is very much a matter for the judgment of the person carrying out the consultation to whose decision the courts will accord a very broad discretion …. But, in my judgment, sufficient information to enable an intelligible response requires the consultee to know not just what the proposal is in whatever detail is necessary, but also the factors likely to be of substantial importance to the decision, or the basis on which the decision is likely to be taken …. 70 … a flawed consultation exercise is not always so procedurally unfair as to be unlawful; R (Greenpeace) v Secretary of State for Trade and Industry [2007] Env LR 29, Sullivan J … the true test is whether the consultation process was so unfair that it was unlawful ….”
“(1) A public authority must, in the exercise of its functions, have due regard to the need to— (a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; (b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; (c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it. (3) Having due regard to the need to advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it involves having due regard, in particular, to the need to— (a) remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic; (b) take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it; (c) encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low. (7) The relevant protected characteristics are— age; disability; gender reassignment; pregnancy and maternity; race; religion or belief; sex; sexual orientation.” (a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; (b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; (c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it. (a) remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic; (b) take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it; (c) encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low. age; disability; gender reassignment; pregnancy and maternity; race; religion or belief; sex; sexual orientation.”
“89. … [W]e do not accept that either section 49A(1) in general, or section 49A(1)(d) in particular, imposes a statutory duty on public authorities requiring them to carry out a formal Disability Equality Impact Assessment when carrying out their functions. At the most it imposes a duty on a public authority to consider undertaking a DEIA, along with other means of gathering information, and to consider whether it is appropriate to have one in relation to the function or policy at issue, when it will or might have an impact on disabled persons and disability. … 90. Subject to these qualifications, how, in practice, does the public authority fulfil its duty to have “due regard” to the identified goals that are set out in section 49A(1)? An examination of the cases to which we were referred suggests that the following general principles can be tentatively put forward. First, those in the public authority who have to take decisions that do or might affect disabled people must be made aware of their duty to have “due regard” to the identified goals …. Thus, an incomplete or erroneous appreciation of the duties will mean that “due regard” has not been given to them …. 91. Secondly, the “due regard” duty must be fulfilled before and at the time that a particular policy that will or might affect disabled people is being considered by the public authority in question. It involves a conscious approach and state of mind. … Attempts to justify a decision as being consistent with the exercise of the duty when it was not, in fact, considered before the decision, are not enough to discharge the duty …. 92. Thirdly, the duty must be exercised in substance, with rigour and with an open mind. The duty has to be integrated within the discharge of the public functions of the authority. It is not a question of “ticking boxes”. … 93. However, the fact that the public authority has not mentioned specifically section 49A(1) in carrying out the particular function where it has to have “due regard” to the needs set out in the section is not determinative of whether the duty under the statute has been performed: see the judgment of Dyson LJ in Baker [R (Baker) v Secretary of State for the Environment[2008] EWCA Civ 141 ] at paragraph 36. But it is good practice for the policy or decision maker to make reference to the provision and any code or other non-statutory guidance in all cases where section 49A(1) is in play. “In that way the [policy or] decision maker is more likely to ensure that the relevant factors are taken into account and the scope for argument as to whether the duty has been performed will be reduced”: Baker at paragraph 38. 94. Fourthly, the duty imposed on public authorities that are subject to the section 49A(1) duty is a non-delegable duty. … 95. Fifthly, (and obviously), the duty is a continuing one. 96. Sixthly, it is good practice for those exercising public functions in public authorities to keep an adequate record showing that they had actually considered their disability equality duties and pondered relevant questions. Proper record-keeping encourages transparency and will discipline those carrying out the relevant function to undertake their disability equality duties conscientiously. If records are not kept it may make it more difficult, evidentially, for a public authority to persuade a court that it has fulfilled the duty imposed by section 49A(1) ….”
“38. The question whether due regard has been had, has to be decided as a matter of substance, not form. In R (Greenwich Community Law Centre) v Greenwich LBC[2012] EWCA Civ 496 Elias LJ said at [30]: “I would emphasise the need for the court to ask whether as a matter of substance there has been compliance; it is not a tick box exercise. At the same time the courts must ensure that they do not micro-manage the exercise.”
“…In a case where the council was fully apprised of its duty under s.149 and had the benefit of a most careful Report and EIA, I consider that an air of unreality has descended over this particular line of attack. Councils cannot be expected to speculate on or to investigate or to explore such matters ad infinitum; nor can they be expected to apply, indeed they are to be discouraged from applying, the degree of forensic analysis for the purpose of an EIA and of consideration of their duties under s.149 which a QC might deploy in court. …” 39. In R (Baker) v Secretary of State for Communities and Local Government[2008] EWCA Civ 141 , which concerned the application of one of the preceding equality provisions,section 71 of the Race Relations Act 1976 , Dyson LJ said at [31]: “In my judgment, it is important to emphasise that the section 71(1) duty is not a duty to achieve a result, namely to eliminate unlawful racial discrimination or to promote equality of opportunity and good relations between persons of different racial groups. It is a duty to have due regard to the need to achieve these goals. The distinction is vital. … What is due regard? In my view, it is the regard that is appropriate in all the circumstances.”