Agenda item

The Coventry and Warwickshire Integrated Care Board (C&W ICB) will provide an update to the Committee on the review of community bedded provision in South Warwickshire.

Laura Nelson, Chief Integration Officer for NHS Coventry and Warwickshire ICB provided an update, supported by Amy Danahay and Rose Uwins of the ICB. There had been previous engagement on the community hospital rehabilitation bed provision for South Warwickshire, dating back to February 2022.

Background was provided on the phased development aimed at modernising the Ellen Badger Hospital (EBH) in Shipston-on-Stour. The first phase comprised the construction of a new health and wellbeing hub, improved outpatient services, and expanded diagnostic capabilities. The sixteen in-patient beds were temporarily relocated. The inpatient area at EBH had been retained but due to changes in the building's footprint, the facility could now accommodate twelve beds. It did not comply with acute inpatient guidance and significant capital investment would be required to address a number of reported issues.

The report reminded of the review undertaken by South Warwickshire Foundation Trust (SWFT), and subsequent business case considered by the ICB in April 2023. The need for a wider review of rehabilitation services had been raised. The ICB had identified other areas to be addressed and had agreed to prioritise the rehabilitation beds in South Warwickshire.

The ICB recognised the legal and regulatory responsibilities associated with a service change. It considered that the potential changes flowing from the community bed review constituted a significant service change and consequently there was a need for further public involvement on the proposed options and their wider implications. Due to the time elapsed, the ICB needed assurance that all viable options for providing community rehabilitation beds, particularly in South Warwickshire, had been thoroughly explored, validated, and any critical new considerations identified. This reassessment, which included previous and new stakeholders, was conducted between June and August 2024. The options identified would serve as the foundation for any subsequent public consultation.

Progress was reported on the steps the ICB had taken in recent months, to assess if the clinical evidence supporting the options appraisal and subsequent Pre-Consultation Business Case (PCBC) were robust, to enable the ICB to proceed with a public consultation. Additional considerations were the submission of a system financial plan and a new estates infrastructure strategy and delivery plan. The following proposed options were confirmed as viable:

• Provide 35 community beds across three sites (EBH, Nicol Ward and Campion Ward) and continue to improve care at home (maximum of 12 beds at EBH).
• Continue to provide 35 community beds across two sites (Nicol Ward and Campion Ward) and continue to improve care at home.

With the ICB having completed all necessary steps, the Committee’s support was sought to move forward with the review through a formal consultation. It would involve the development of a PCBC and supporting documentation. Furthermore, it was proposed to shorten the consultation period from twelve to six weeks and the rationale for this was reported, thereby accelerating decision-making to March 2025 rather than May 2025.  The report included the proposed timeline. It acknowledged the potential implications from shortening the consultation period and how the ICB proposed to manage associated risks through close collaboration with key stakeholders, ensuring that the ICB addressed frustrations over timescales and delays whilst still demonstrating that it had listened actively and responded to those concerns. Regular engagement with the Committee would take place. The PCBC, the legal document on which the ICB would base its decision to consult, would be developed and ready for review by 31 October 2024.

The update was supplemented by a brief presentation highlighting the key points. The Committee submitted the following questions and comments:

• Councillor Mrs Redford referred to the substantial housing development required through the Local Plan. Discussion took place on liaison between planning authorities and the ICB about the increase in population and need for services. The local plan requirement was for an additional 36,000 homes over the next 10 years. Laura Nelson confirmed the ICB was aware of expected population growth, also referring to a wider review of service delivery. This item concerned the rehabilitation beds, but there were other work areas across health and social care. There was now a collaborative approach, working with partners to shape commissioning decisions. It was not just about how many beds were needed, but also how to utilise them effectively. There were other transformation projects to deliver care services closer to home. The Chair urged local councils to keep this under review and suggested the OSC should keep this item on the agenda. 
• Councillor Holland also spoke of government targets for house building, which would impact significantly on all of Warwickshire, but especially on the southern half of the county. There was a need to improve many NHS services. He also touched on joining up services, poor public transport services, especially in the rural areas and the financial challenges facing the County Council. The Chair suggested a need to see how recent government announcements translated into policy and was sure the ICB had accurate population data. 
• Clarification was provided on rehabilitation services which could be delivered both at home or in one of the community bedded facilities.  The terminology used could be simplified too.
• Councillor Rolfe raised a number of points. She referred to option 1, seeking a breakdown of where beds would be located across the three sites. She did not understand why the ICB wanted to reduce the consultation period to six weeks, as a twelve-week consultation would give everyone a better opportunity to take part. Councillor Rolfe was concerned that the ICB had not consulted with the groups located near to the EBH. The application for the EBH site stated it would have sixteen beds. If this was reduced to twelve or no beds, she questioned if there would be a subsequent application to allow local people to comment. In response to the Chair, Councillor Rolfe confirmed she was referring to the planning application. For the second phase of development, it had been claimed that there was asbestos in the building, which was incorrect. The Friends of EBH had gifted a lot of money towards this project and unless the scheme included bedded provision it may want this money refunding. She was suspicious of the report which she viewed as delaying and procrastinating about whether EBH would have a unit for rehabilitation. Care at home was completely different to that in a unit like the Nicol unit and it could cause isolation. Many people needed care in units of this type. She did not agree with reducing the consultation period.
• The Chair asked for the timeline for this project, which had been ongoing for a very long time, and she thought prior to 2017. Rose Uwins offered to research when SWFT secured the original planning consent, which was before the Covid pandemic. The Chair noted that a lot had happened since that time. On the point about delaying tactics, she sought the timescale as context. There had been a lengthy consultation by SWFT too, which was required at that time. The ICB considered potentially this would be regarded as a major change and therefore the consultation would have to take place again. There had already been a lot of public consultation, with a lot of the same people. There had been a lot of delays and in her view was a need to progress this. The Chair reminded that consideration of community beds in the north of Warwickshire had been raised, which may have slowed this process still further.
• In response to Councillor Rolfe’s questions, Laura Nelson first referred to the PCBC which would add a lot of detail. It would go through a number of NHS forums to look at the clinical, operational and financial aspects, detailing the impacts for patients, communities and individual organisations. This item brought the proposal to the Committee to take this forward to the PCBC. She understood the length of time this process had taken. Laura outlined recent stages to seek legal advice regarding the wider review across Coventry and Warwickshire and the decision taken to focus on the review for the South. There was a tight timescale to move this forward whilst meeting the national governance and due diligence required. If the consultation was lengthened her challenge would be what value would be added, given the earlier SWFT consultation process. The ICB had engaged with Shipston Town Council and had a dialogue with a group of individuals in that area.
• The Chair asked Councillor Rolfe to provide her questions in writing to ensure that none of her points were missed.
• Laura Nelson then spoke about the phase two scheme, a proposal by SWFT submitted prior to Covid. Phase two would be detailed in the PCBC and was in the long list of options to be considered. It had significant financial challenges with a £15m capital programme required to deliver it. This would be challenging in the current financial constraints, with a corresponding saving needed from other services.
• The Chair said this was exceptionally complicated, had taken a very long time and there had been system changes too. She had previously represented Stratford-upon-Avon DC on SWFT. During that time, she had asked what would be done if people from Shipston needed bedded care provision rather than being supported at home. Assurance had been provided that the Trust could pay for such care at a local nursing home like Shipston Lodge. Rose Uwins confirmed that there were many options, based on need. Such an arrangement could be used, but this proposal concerned the two options reported, one of which included bedded provision at EBH in Shipston.   
• Discussion about the options and total number of beds which could be provided at the three sites. Potentially this could increase the number to 47 beds. It was confirmed that there would be 35 community funded beds. SWFT needed some flexibility to meet operational pressures and made more use of the existing sites periodically. The discussion moved to different types of bedded provision, funding aspects and levels of need. Other aspects were the transformation of services and collaborative working, to use existing funding, to deliver services differently.
• Councillor Rolfe was suspicious that this process would result in no bedded provision being made at EBH. There was a need for bedded provision in that area. The first option should be chosen and with an increased number of beds. She asked how the number of beds had been determined at 35. With the known population growth, there would not be enough in patient bedded provision for the south of the county.
• Laura Nelson replied that the current number of beds was 35, with the temporary transfer of beds from EBH to the Campion ward. The level of funding was for 35 beds, not 47. Points were repeated about the difference in need, capacity and levels of funding.
• The Chair asked if the provision of 35 beds was based on need.
• Amy Danahay provided that assurance, referring to the data gathered on rehabilitation patients of their normal place of residence and bed occupancy data. The 35 beds were sufficient to meet the level of need. Account also had to be taken of the Community Recovery Service (CRS) which supported some patients at home through the ‘home first’ approach. The data showed that the acuity of need for inpatients had increased significantly. This was linked to the CRS supporting people at home where this was appropriate. At this stage no judgement had been made regarding the location of the 35 beds. Further work would take place to assess the needs of each area. Independent advice had been sought from the Clinical Senate to ensure that patient quality of care and access for all was considered. Both options were seen as viable. In response to a question from the Chair, it was confirmed that the data from SWFTs earlier case for change had been taken into account. Updated data was constantly being sought, most recently within the last month for the two sites currently being used.
• Councillor Shenton summarised that this concerned whether beds would be located at EBH. He asked whether strong local representation for beds at this location would be sufficient or what would be required to persuade that EBH was the right place for bedded provision. Laura Nelson replied it was about how patients accessed services. There may be a ‘want’ for many aspects of NHS services, but they may not be feasible. The PCBC would take into consideration all factors and the consultation feedback would be taken on board. No decisions had been taken by the ICB. There may be differing views, but the ICB would need to consider the best way to deliver these services. There was data on usage of the previous locations and during the current temporary arrangements. The ICB would present its findings to a future meeting of the Committee.  
• The Chair sought comment on the impact of not having a doctors surgery located at the EBH site. This was an area for SWFT to respond to, not the ICB.
• A point that the ICB already had the costings and background data. The member asked whether the public consultation was meaningful, as this would be driven by the cost pressures, logistics and geographies, not public or patient feedback. He viewed that the decision would not have regard to such feedback.
• Rose Uwins confirmed that the ICB did have the data. There had been a long list of options, and some had been discounted as not being viable. The two options presented were both viable. She explained the purpose of the consultation. The ICB wanted to understand the implications of each option if current services were reduced or not located in an area. This feedback could have an impact on the final decision and was important that the ICB gathered the wider view.
• The councillor considered that only people living in the areas directly affected would engage with the consultation process. Other residents were less likely to respond. Rose agreed that the consultation would be focussed on the South of Warwickshire including both Stratford and Leamington, as well as Shipston. It was hoped that people in that wider area would engage with the consultation. The feedback would include postcode data to show where respondents lived. The outcome of this process would impact on where the beds were located. The points about poorer levels of feedback were noted, but best practice would be followed for the consultation with an outline given of the methods to be used. Councillors were asked to publicise the consultation too.
• A point that the outcome may result in reduced bedded provision at the other sites. It was important that people in Stratford made their views known too.
• A councillor reminded of the previous representations made to secure retention of the Nicol Unit in Stratford. Shipston was located in the most rural area, and travel into Stratford could be difficult. The option of just Stratford and Leamington was considered too parochial. A contrast was provided between care at home and rehabilitation in these hospitals.  

The Chair referred members to the report recommendations and the first three of those listed below were agreed. Further debate took place on the final recommendation which concerned the consultation period.

·       Councillor Sinclair did not feel able to vote on the recommendation about whether the consultation period should be six or twelve weeks, as this aspect had not been covered enough. He would therefore have to abstain, unless there was further clarification.

·       Rose Uwins confirmed that the statutory minimum consultation period was two weeks and twelve weeks was the maximum. There had been a lot of information gathered already. The ICB would be clear in the consultation plan about how it would engage and in light of this six weeks would be sufficient to gather the vast majority of opinions.

·       The Chair referred to the previous consultation which had given people with a view the chance to submit it. She considered that consultation for six weeks would be sufficient.

·       Councillor Shenton was not comfortable with a six-week consultation. There was a need to ensure that everyone in south Warwickshire had the chance to submit their views. Rose Uwins said the consultation materials would be clear, setting out the merits of each option. It was about how the ICB communicated rather than just the length of time involved.

·       Councillor Holland advised that he was the Council’s representative on the SWFT Council of Governors and whilst there was no financial interest and that body was not the decision maker, he would abstain from voting.

• Councillor Sinclair referred to public perception and having a thorough process, asking why the consultation period could not be for twelve weeks. The ICB representatives confirmed it could be for twelve weeks, but this would prolong the process and a significant amount of engagement had already taken place. Feedback from other groups including Shipston Town Council had asked how the process could be completed more speedily. The period for the PCBC could not be reduced, but the consultation period could. The ICB had listened to the feedback and therefore proposed the six-week consultation. Councillor Barker declared that she was a member of Shipston Town Council and one of the people supportive of the six- week consultation period.
• Rose Uwins added that the twelve-week consultation period would take the timeline up to the pre-election period for the County Council elections. NHS pre-election guidance meant it could not do any form of consultation during that period, effectively delaying any decision making until May. If the decision was a for a twelve-week consultation, this could be undertaken. The ICB’s priority was to give people the opportunity to be heard.
• In response to a question from Councillor Drew assurance was provided that the consultation would be complete, presenting the two options.
• The Chair added that the new building was nearly finished, and costs would increase if there were further delays. The twelve-week consultation would take this process into the pre-election period and there had been extensive consultation previously.
• Due to the requirements for the PCBC, it was not possible to commence the consultation at an earlier date.
• Councillor Rolfe urged the longer consultation period. These were two new options and the division of the bed numbers across the three sites was a crucial aspect for the consultation. This was not just about Shipston but all south Warwickshire and therefore a longer period was required so everyone could be consulted.

In closing the debate, the Chair confirmed members had already supported the first three recommendations shown below. The final aspect on the consultation period being reduced to six weeks was put to a vote, there being four votes in favour, four votes against and two abstentions. The Chair exercised her casting vote in favour of the proposal.

Resolved

That the Committee agrees to:

1.     Note the contents of the report.

2.     Be assured in respect of the progress against the agreed approach to deliver the South Warwickshire Community Hospital Rehabilitation Bed project.

3.     Endorse the approach to formal consultation due to the service change proposed being considered substantial and therefore warranting public consultation. This would then enable the ICB to fulfil its duty to notify the Secretary of State.

Endorse the reduction of the public consultation from 12-weeks to 6-weeks enabling the future decisions about the 35 community hospital rehabilitation beds to be approved by the end of March 2025.