The Committee received a presentation from
Glen Burley, Chief Executive of South Warwickshire University NHS
Foundation Trust (SWFT). The presentation included slides and
additional comments on:
·
Background on the
strategic review involving the inpatient
facilities at Ellen Badger Hospital in Shipston on Stour and the
Nicol Unit at Stratford Hospital, a total of 35 beds.
·
Review to date –
a timeline of the key stages from May 2021 to present. Reference to
the engagement undertaken, including with the Committee. As a
result, two additional options were included in the review. There
were periodic briefings for the Council’s Portfolio Holder.
Reference to more recent stages, including the latest NHS planning
guidance which had been included in the review. The SWFT Board had
considered and approved recommendations, submitting them to the
Coventry and Warwickshire Integrated Care Board (ICB), of which he
was a member.
·
Options appraisal
– details of the five options appraised fully
1. Retain the community hospital bed base ‘as
is’
2. Increase the number of community hospital beds
3. Change the type of services provided at community
hospitals
4. Reduce beds and invest in community alternatives
5. Retain the community hospital offer but change the
location
·
Options appraisal
criteria, assessed in terms of effectiveness, efficiency and
feasibility.
·
Mr Burley reflected that next week would be the
75th anniversary of the NHS. Historically, bed rest was
seen as part of the treatment pathway, but this was no longer the
case. A ‘home first’ approach with ongoing support and
care was shown to be significantly better for patients. There would
always need to be some inpatient bedded services.
·
Projecting future need
– the future bed
requirements had been projected by combining usage data and three
clinical scenarios around End of Life,
Orthogeriatric and Discharge to Assess.
·
The Community Recovery
Service. This was part of a national pilot programme to provide
capacity and linked to discharge to assess, in the patient’s
home. This was going very well and evidenced that the home first
approach should drive the way that services were delivered in the
future.
·
He touched on the
improvements being made in patient flow, benefits for the patient
and the economics of this model. The modelling had included the
scenarios and the population demographics, with an increasing
population and more elderly people. It showed that there was an
ongoing need for 19 beds (in one ward), which was less than
presently, and he was uncomfortable with that.
·
Patient access and a
postcode analysis which had recently been refreshed. It showed that
patient numbers from the immediate locality was very small with
only 17 patients from Shipston in the last financial year,
comparing to 313 from the Warwick, Leamington and Kenilworth areas.
This led to the recommendation to locate the beds in the areas of
biggest population.
·
Recommendation. This
was to increase from 35 - 41 beds in two wards, one located at the
Leamington Spa site and one at the Nicol Unit at Stratford
Hospital. He considered this was an appropriate and safe
recommendation, which could be staffed with the required specialist
skills. He reiterated the home first objectives and the ongoing
work with a number of partners to provide services at home and
enable people to live independent lives. He reminded of the
positive feedback from patients and service users from the pilot
Community Recovery Service.
·
Benefits of the
recommendation. An increase in the number of beds and capacity
whilst pushing the home first model.
·
Next steps. The SWFT
recommendation had been submitted to the C&W ICB for
consideration at its next meeting.
Mr Burley then responded to
the points raised by the public speakers earlier in the meeting. He
was huge fan of the Ellen Badger Hospital, speaking of the aims to
improve this site and increase the numbers using it, to co-locate
services, including primary care. Redevelopment work would commence
in the next few weeks, with opening of the new centre anticipated
for June 2024. The review did not recommend bedded provision at
this site. The small number of people needing access to community
hospital beds would be significantly outweighed by those using the
new facility. This was the reason that a bid for capital funding
had not been made. The plans had to support all the South
Warwickshire communities.
Questions and comments were invited with
responses provided as indicated:
- Councillor Rolfe spoke of her
previous representations to secure different options for the
options appraisal, including an increase in bed capacity. At that
time there were concerns regarding the future of the Nicol Unit,
which was now being retained. She reminded of her comments earlier
in this meeting about those people who could not return home to
receive continuing care and support. The member found it ironic
that the minimum number of beds required matched that proposed for
the Nicol Unit. The key point was the lack of consultation
especially for those in Shipston-on-Stour and surrounding
areas.
- Mr Burley referred to the previous
consideration at this committee and the resultant increase in the
options appraised. The discussion at that point was, there was no
need for a public consultation if SWFT followed the process of
engagement. This was now a decision which rested with the ICB and
if it felt that a consultation was required, based on the process
which SWFT had undertaken. SWFT’s view was that such
consultation was not required as it had gone through
engagement.
- Discussion then took place on how
Shipston residents and those representing them could encourage the
ICB to undertake a consultation exercise. Mr Burley acknowledged
the strength of feeling with communications to both himself, and
the ICB Chair, Danielle Oum. The consideration of this matter by
the ICB would be in public, so people could attend that
meeting.
- The Chair added that the Committee
could write to the ICB too. If it was the wish of the Committee, it
could request the ICB to undertake a further consultation, in the
same way as members had previously requested appraisal of the
additional options. Councillor Rolfe proposed that the Committee
send such a letter requesting further consultation. This was
seconded by the Chair and approved by the Committee.
- Councillor Holland reminded that the
Leamington Hospital was actually located in Heathcote, Warwick. He
recognised the value of local knowledge of the services required
for an area, considering that the decision just reached would take
this matter in the right direction. He spoke more generally about
patient choice on treatment, prevention work, medical advances,
including earlier diagnosis and technology improvements. He
advocated greater involvement of primary care, also speaking about
virtual hospitals where patients were monitored by technology in
their home. This also linked to integrated care. On this review he
considered it was well thought out and a positive step forward,
also stating the need to take account of local people’s ideas
and incorporate them where possible.
- The Chair outlined her local
knowledge of this review, noting the differing views of people and
the positive comments from Councillor Holland. She then explored
onward care provision for those unable to return home. Glen Burley
outlined the discharge to assess approach, the community hospital
bedded provision, but also the beds commissioned in care homes with
ongoing health support provided. These could be located even closer
to the patient’s home than a community hospital. For some
patients, community hospitals located in adjacent areas may provide
another option.
- The importance of providing adequate
onward care was stated, to reduce the likelihood of a readmission
to hospital. There was a national shortage of community care
workers, and it was asked how this would be addressed to ensure the
‘home first’ approach worked effectively. Mr Burley spoke of the review the hospital group
had undertaken, with one of the key outcomes being support for
domiciliary care capacity, working with the sector and possibly
delivering services itself. An aspect was commissioning capacity in
advance from the domiciliary care market, to ensure the timely
delivery of care packages. This had been very effective during the
current pilot. He reiterated the individual assessments and
personalised approach to ensure patients’ care needs were
met.
- The Councillor reiterated the
national shortage of community care staff. Becky Hale reminded
members of the ongoing support provided to the care market with
recruitment and retention of staff. The Community Recovery Service
had really helped, and an outline was given of the different ways
of working, and resultant improvements in care market
sustainability. Linking therapy to domiciliary care was a key
aspect, maximising peoples’ independence at home. The pilot
was in week nine and was continuing to develop, but the signs so
far were very positive. There would always be a need to monitor the
domiciliary care market. Becky referred to the Market
Sustainability Plan and the key aspect of care staff salaries.
- The Chair stated the importance of
Council staff integration in joining up services both in acute
settings and for patients’ onward care. The pilot work was
exciting, and it would be useful for the Committee to see the
results of how well this was working.
- Discussion took place about similar
services being provided in the north of Warwickshire, referring to
the closed Bramcote facility and it was questioned if such services
would be re-established. Mr Burley replied that this review was
specifically about South Warwickshire. He spoke of the discharge to
assess model and commissioning capacity in care homes, supported by
the NHS to provide rehabilitation and therapy. This could be
provided at various locations throughout this mainly rural area,
rather than in a single location. He also touched on increasing end
of life care capacity for this area. The services referred to
mainly provided for ‘step down’ care after discharge
from an acute hospital setting.
- The Portfolio Holder, Councillor
Bell, reminded of previous representations to the ICB to undertake
a similar review for the north of Warwickshire. Such a review would
be really helpful to understand how many beds were needed. She
congratulated Glen Burley and SWFT for the thorough review
undertaken in South Warwickshire. It was agreed to follow up the
request to the ICB for a similar review of bedded provision for the
north of Warwickshire.
- The Chair was concerned about the
pressure on GP doctors and the impact this had on acute hospitals.
Glen Burley spoke of the close work with primary care, the good
partnership arrangements, especially around the ‘front
door’ of A&E and admission pathways. There were
opportunities, including technology and making the best use of
clinical skills. However, demand for health services continued to
increase. He referred to a recent Kings Fund publication on the
challenges. There was a need for a workforce plan and there may be
some news shortly, linked to the 75th anniversary of the
NHS. Any increases in staffing, training and the required funding
would be welcome, but there would be a long lead time to train new
clinicians. Warwickshire had a good system and was better placed
than most areas to meet the demands faced. He thanked members for
their comments and questions.
The Chair brought this item to a conclusion.
After the meeting, she suggested a further conversation between the
two public speakers and Mr Burley. There was a clear need to
communicate with the ICB and the two letters proposed would be
sent. She was delighted with the positivity from the Committee.
There needed to be a careful balance between what people wanted and
what they actually needed. She was conscious of the points raised
on onward bedded care provision. The ICB would consider this matter
in July. The proposal was for more beds than currently. The Chair
hoped that some agreement could be reached regarding Shipston, also
speaking about the retention of the Nicol Unit and the arrangements
for onward care too. She thanked Glen Burley for his
attendance.
Resolved
- That the Committee receives the
presentation and update from South Warwickshire Foundation Trust on
the South Warwickshire Community Hospital Review.
2.
That a letter is sent from the Committee to the
Coventry and Warwickshire Integrated Care Board that were it to
proceed with adopting the recommendations of the SWFT bed review,
the Committee requests a further consultation.
- That a further letter is sent to the
ICB to reiterate the request for a similar review of community
bedded care provision for the north of Warwickshire.