saltash area and st barnabas community hospital workshop 4 · 2020-03-12 · austell/ falmouth)...
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Saltash area and St Barnabas
Community Hospital workshop 4
26 February 2020
About today
10.00am
• Registration and refreshments
10.15am
• Welcome and recap from workshop three
• Feedback from public drop ins
• Learning from other areas
• Large group session-some service
updates, allowing Q&As, reviewing
options
11.30: Comfort break/refreshments
11.45am
• Continuing to review options
12.30pm
• Conclusions and next steps
12.45pm
• End and evaluation forms
Aims for the day:
1. To review the long list of options to
understand and agree which should
be short listed
2. To review and agree the short listed
options for evaluation
3. To explain the next steps
Countywide
North and east Integrated Care Area
Saltash area
St Barnabas community
hospital
Principles and themes
Local need and local services
Long term vision-including
accommodation with care
Local investment
Modern, fit for future services
Ageless approach
Maximise existing resources
Enhance community resources
Make a decision on St
Barnabas
Recap from workshop three
The flow of our conversations
Plymouth
services
•Broad context
•Identifying themes
24 April
Workshop one
Exploring ideas
Reviewing data and services
29 May
Workshop two
•Evaluation
•Review of ideas
•Neighbourhood Development Plan
15 August
Workshop three
•Review long listed options
•Agree short listed options
•Next steps
26 February
Workshop four
What has happened since
the last workshop?
•Broad context
•Identifying themes
24 April
Workshop one
Exploring ideas
Reviewing data and services
29 May
Workshop two
•Evaluation
•Review of ideas
•Neighbourhood Development Plan
15 August
Workshop three
•Review long listed options
•Agree short listed options
•Next steps
26 February
Workshop four
• Collating more evidence on long listed proposals
• Clinical Senate recommendations review
• Reviewing documents on St Barnabas building state
• Purdah due to general election
• Implementing evaluation process for Edward Hain community
hospital project
• Reviewing learning from evaluation of Edward Hain project
Current
assumption:
The system
is not
functioning
adequately
to provide
the best
outcomes for
people
New model of care co-
development: Optimise resources, data on
need/provision
We need a
new
model of
care
Decision
needed on
St
Barnabas Options co-development
Long term
planning
Decision
on
St Barnabas
Countywide &
local strategy
Continual model of care development /long term service planning already
in progress
A recap on the process
• Greatest gap is rehabilitation and reablement at home-work is underway to
address this via the Embrace programme.
• Our current transfer of people from an acute hospital to a community
hospital or care home achieves the ideal outcome for only half of people.
• The default position should be home straight from an acute hospital-we
need to resource community services to do this.
• St Barnabas community hospital is not fit for modern inpatient provision.
• More local beds is not necessarily the answer.
• Local ambition to develop a 5-10 year plan for health and care services.
• We have four local ‘hubs’ and don’t need to replicate any activity there.
Recap of key messages from
workshop three
Key themes raised:19 attendees in total.
• Transport – attending Plymouth and Liskeard services remains a challenge for some.
• Promote integration of services on the same site such as GP services, minor injury services, voluntary sector and pharmacy.
• Preference for more modern facilities.
• Healthcare funding is limited and needs to be spent wisely.
• Some views that the hospital was not fit for purpose or needed.
• Some disappointment that the hospital was still closed.
• Desire to explore the possibility of the community using parts of the building if it was not re-instated as a community hospital.
• Importance (if possible) of retaining some money from disposal of the building.
• Wheelchair access for parking and building access is a challenge.
• Need to consider how this feeds into the local development plans and the impact of new housing developments.
Feedback on the public drop
in sessions: 8 and 17
October
Progress and learning from
the other areas
Yes
o
Project group to establish evidence and supplementary information for
long listed options
Information gathered on long listed options shared with the community
Full evaluation of short listed options to confirm viability
Long listed options co-developed with the community
Community and project group appraise long listed options and agree
which ones are viable to be short listed and to proceed to full evaluation.
Fowey
hospital
Edward
Hain
hospital
St
Barnabas
hospital
The three sites have progressed at different rates as expected.
Conversations at all three community stakeholder work shops have identified potential
for non viability of inpatient provision. Edward Hain community hospital evaluation will
confirm/deny viability for inpatient provision there.
In particular, through the option appraisal process the constraints raised for Edward
Hain community hospital included:
• Misalignment to long term strategy (e.g. home based/community care
enhancement, optimising estate, buildings as enabler not driver).
• Building constraints due to age and structure-limited longevity, facilities, flexibility.
• Bed capacity (12) under Clinical Senate recommendations (16) for a safe, efficient,
reliable workforce and expansion not possible.
• Workforce recruitment challenges to standalone units.
• Significant capital and revenue investment required and return on this investment
for the potential numbers supported is limited.
Previous workshops have raised similar issues with St Barnabas community hospital
(bed capacity 9).
Reflections and learning
from the other projects
Headline criteria Sub criteria
1. Quality 1a. Effectiveness
1b. Experience
1c. Responsiveness (based on need)
1d. Safety (there will be a minimum score required)
2. Access 2a. Impact on individual choice
2b. Distance, cost and time to access services
2c. Equity of access
2d. Extended access
2e. Equity of provision
3. Workforce 3a. Recruitment and retention-workforce supply
3b. Staff skills and training-workforce upskilling
3c. Staff capacity-new ways of working
4. Deliverability 4a. Timescales and ease to deliver
4b. Sustainability
5. Environmental 5a. Climate management
5b. Environment of service delivery
6. Financial 6a. Value for money
6b. Affordability (there will be a minimum score required)
6c. Financial sustainability (there will be a minimum score required)
7. Wider impact 7a. System impact
7b. Community impact
Reminder: final evaluation
criteria
(amends to wording in red)
Local updates
1. Community services-model of care development and Embrace
programme update.
2. NHS Property services-role within local service delivery,
buildings as enablers.
3. Saltash Health Centre developments
Saltash Health Centre
development:
Phase 1 development
• Development for additional consultancy
room capacity
• 5 consulting rooms in total
• Completed 2018
• Now used for Assessment Clinic
Saltash Health Centre
development: Phase 2 project
• ETTF funded project for additional
consultancy and treatment room
capacity
• 6 consulting rooms in total
• Due for completion April 2020
• Plan to use for both practice services,
but also for services for wider health
community eg. Diagnostic and
assessment services
Saltash Health Centre
development:
Front of practice re-development
• Plans developed to re-model front of building
• Improve patient access
• Part of NHS Kernow Minor Improvement Grant scheme
• Expression of interest submitted Feb 2020
• Awaiting outcome
Longlisted options Short listed options
1. Model of care development (in progress)
?
?
?
?
?
? Paperwork for shortlisted
options will need to cover
in detail:
1. Supplementary
evidence/information
2. Background reading
for evaluators
3. Complete options
appraisal
4. Equality and quality
impact assessments
2. Do nothing (discounted at 1st workshop)
3. Alternative care provision on existing site- extra care
housing
4. Alternative care provision on existing site- care home
5. Transfusion/ infusion day case unit
6. Re-instate 9 inpatient beds, MIU and continue existing
community clinics (original service)
7. Re-purpose : community health and wellbeing hub
8. New build healthcare facility on alternative site
(inpatient/ extra care, care home)
Anything else?
Current proposed long listed
options
• The minimum acreage for Extra Care Housing stated by Cornwall Council’s
Accommodation with Care Board as being required for a feasible site is a
minimum of 1.5acres, ideally 2 acres.
• St Barnabas community hospital and land is below this size at 0.66 acres.
• The site is too small for extra care housing.
(NB: Treledan site plans include 50 units).
Longlisted option: Alternative care
provision on existing sites for use
as extra care housing
Any questions/
concerns with these
statements?
• The Associate Director for Cornwall Partnerships NHS Foundation Trust’s
Estates and Facilities (and member of the system Estates Strategy Group)
has provided some market information on size requirements for a viable
care home (in excess of 50 beds). Three sources of information were
reviewed (Local Authority owned residential care building recommendations,
land acquisition company, specialist estate agent).
• The size required for a 50-60 bed viable care home is 3,000m2 to 3,500m2.
This equates to 0.74 acres to 1 acre at a minimum.
• St Barnabas community hospital and land is below this size at 0.66 acres.
• The site is too small for a care home.
(NB: Treledan site plans include 80 units).
Longlisted option: Alternative care
provision on existing sites for use
as care home
Any questions/
concerns with these
statements?
• Lack of on-site medical cover and diagnostics (x-ray/ultrasound).
• Environment a challenge for elderly and frail to attend and access.
• Relative low levels of activity: predicted activity is 5 per week.
• Additional staff required: two registered nurses, one healthcare assistant.
• Training required for additional staff.
• Refurbishment and equipment needed.
• Poor WIFI connectivity.
• Staff recruitment would be required- staff could be utilised from Liskeard hospital, but will then need backfill from other day case units (Bodmin/ St Austell/ Falmouth) -leading to workforce vulnerability at other larger sites.
• Investment required in staff (as above-either new staff on site or to backfill) and refurbishment of room and equipment (minimum of £20,000).
St Barnabas hospital therefore has site constraints that means it is not a suitable site for safe delivery of this intervention.
Longlisted option:
Transfusion/infusion day
case
Any questions/
concerns with these
statements?
Opportunities to consider: option component one: inpatient beds
• Local bed reablement and rehabilitation offer in addition to home based
services.
• Bed based care closer to home for some.
• Travel time benefits for local residents.
• Increased use of building.
• Provision of choice for end of life care in addition to home and hospice.
• Local asset retained.
Longlisted option: Reopening 9
inpatient reablement beds, re-instating
minor injuries unit, maintaining current
community clinics
Any questions/
concerns with these
statements?
Ground floor: location of 3 beds and
bathroom/toilets (none en-suite)
1 2
Location of
bathroom/toilet
(not en-suite)
Location and
number of beds Entrance
First floor: location of 6 beds and
bathrooms (one en-suite)
1 3 2
Location of bathroom/
toilet (not en-suite)
Location and
number of beds
Location of bathroom/
toilet (en-suite)
Issues to consider: option component one: inpatient beds
• Known inefficient use of existing beds (doesn’t reflect true need).
• New Clinical Senate recommendations on minimum bed size as 16
(building structure and fire safety bed evacuation requirements prohibit
bed size expansion).
• Known difficulties in recruitment (29 ward staff required) to small units.
• Site constraints to deliver new model of care: location, access, parking,
ward size, building age and structure, range of diagnostic facilities.
• Limited opportunity to ‘future proof’-building and service provision.
• High cost to invest in building and staff to provide level of service.
• Strategic direction is investment in community services.
Longlisted option: Reopening 9
inpatient reablement beds, re-instating
minor injuries unit, maintaining current
community clinics
Any questions/
concerns with these
statements?
Issues to consider: option component one: inpatient beds
• Site would remain underutilised.
• Neighbouring sites have greater level of facilities-people may still need to be
transferred to Liskeard as greater level of rehabilitation and reablement with
ward based therapy staff.
• Bed occupancy in Liskeard has been under the national recommendation
(85%)- a snapshot from April 2018-March 2019 for the two wards was 65%
and 83%-bed capacity is available.
• Safety-no identified medical cover.
• Ward therapy provision would need to come from existing community staff.
• Moving staff from St Barnabas to Liskeard community hospital provided
safe, sustainable staffing for the larger unit.
• Liskeard has capacity for temporary escalation beds (6) to ease winter
pressures Any questions/
concerns with these
statements?
Longlisted option: Reopening 9
inpatient reablement beds, re-instating
minor injuries unit, maintaining current
community clinics
Option component two: Minor Injury Unit supporting up to 455 people a year
• Provide additional MIU provision (Monday-Friday, 8am-3pm, no x-ray) to what is already been
provided at:
Cumberland centre, 24 hours a week, 7 day service with x-rays-6miles away, 25 minutes car drive.
University Hospital Plymouth, 24 hours a week, 7 days with x-rays-6miles away, 20 minutes drive.
Liskeard community hospital,-open 8am-10pm, 7 day service.14miles away, 30 minutes car/bus
drive.
Saltash Health Centre, weekdays, 8am to 6pm (no x-ray). (Interim arrangement currently).
Port View practice, weekdays, 8.30am to 6pm (no x-ray). (Interim arrangement currently).
• Low numbers (455 people per year-9 per week) so maintaining skills and competencies is a
challenge. (Liskeard community hospital sees 10,000+ per year-192 people per week).
• The 455 attendances were 6% of all MIU attendances (7,578) from residents registered with
Saltash and St Germans GP practices.
• Previous annual attendance (455) insufficient for
standalone staffing.
Any questions/
concerns with these
statements?
Longlisted option: Reopening 9
inpatient reablement beds, re-instating
minor injuries unit, maintaining current
community clinics
Option component three: Maintaining existing consultant clinics (582 attendances
supporting 273 people a year) and community clinics (2,800 attendances a year)
1. University Hospital Plymouth (was Derriford) Consultant clinics-for Cornish and Devon
residents.
2. Clinics require health care assistant attendance from Liskeard hospital
3. Increase in physiotherapy activity.
Total investment to support provision of up to 9 beds for up to 209 people a year ,
455 MIU attendances and 2,800 community clinic attendances will initially be a
minimum of:
1. £4.04m (£2.4m building works, £1.64m staff/rental/on costs etc) and then
2. £1.64m ongoing every year.
Longlisted option: Reopening up to 9
inpatient reablement beds, re-instating
minor injuries unit, maintaining current
community clinics
Any questions/
concerns with these
statements?
We have four local hubs
and don’t need to replicate
any activity there
(last workshop comment)
• What do we mean by hub?
• What is the model of care requirements for a hub?
• Is St Barnabas community hospital the right site for that activity?
Existing Saltash hubs where people can go to access
information about local services, activities and support:
1. Family Hub, Saltash
2. Community Enterprises PL12
3. Saltash Library
4. Saltash Community School
Longlisted options: Re-
purpose as a community
health and wellbeing hub
Any questions/
concerns with these
statements?
Ideas raised so far Response/information
Provide more children’s services No need identified from Children and Family
Services. Saltash family hub already present
9am-5pm weekdays. Saltash school hub
development ongoing (working with the
council).
Mental health: especially working age
adults support
Mental Health Strategy engagement
complete. New strategy due to be released.
Local plans to be delivered against that.
Planned activities:
transfusions/infusions
Site suitability already covered.
More University Hospital Plymouth
(UHP) activity
Any location of activity will be based on
need and site suitability. No current plans
identified by UHP, but Cornwall strategy is
more local community clinics so potential for
further discussions.
Longlisted options: Re-
purpose as a community
health and wellbeing hub
Ideas raised so
far
Response/information
Hearing aid clinics
for hearing aid
tube and battery
replacement
Nearest audiology clinics : Derriford, Mount Gould, Liskeard,
Specsavers in Saltash. Specsavers is for routine age related
hearing loss only (ie nothing complex, people under 55 years) –
this is not a Saltash specific issue- acute trusts are the only
providers that offer more complex audiology services.
Consumables, aftercare, replacement tubes/batteries can be
posted free of charge direct to people’s home, and via local
supply points (e.g. Saltash Health Centre, Quay Lane, Tamar
Valley, Torpoint, Pentorr, Pensilva). Nine months of recent data
shows: monthly average of 19 attendances: 62% (12) at Saltash Specsavers, 32% (7) at Derriford.
Community
activities
Lots of existing hubs/community spaces.
Staff base Current use is variable and limited. No other teams identified to
move in. Potential for more work with the Council to review this.
Longlisted options: Re-
purpose as a community
health and wellbeing hub
Basement use: now
respiratory/cardiac rehab
outpatient
physio
community
rehab
teams
Stores/offices
Clinic use
Ground floor use: now
health
visitors
consultant
clinics
reception
children’s
storage
Stores/offices
Clinic use
Entrance
Mezzanine floor use: now
acute care at home
Stores/offices
First floor use: now
District Nurses
(8 staff)
District Nurse lead/
admin
Community matron/
palliative care
Stores/offices stores
• What is the model of care requirements for
a hub?
• Is St Barnabas community hospital the
right site for that activity?
Longlisted options: Re-
purpose as a community
health and wellbeing hub
Can we make a
decision on St
Barnabas hospital in
the meantime?
Model of care development and long term planning
Decision on future of St Barnabas
Considerations:
• Longer term view-’future proofing’.
• Insufficient capital or revenue funding currently identified .
• Treledan development progressing- (80 bed care home/50 unit extra
care)-associated health infrastructure funds.
• Refurbishment of additional space at Saltash Health Centre.
• Links to the Council’s local review of building assets
Longlisted options: New build
healthcare facility on alternative site
February 2020 March April 2020 June, July,
August 2020
November
2020
• Community
workshop to
review long
listed options.
• Co-development
of short listed
options.
• Decision on
next steps.
• Evaluation of
short listed
options
• Train option
evaluators
• Sign off of
viable short
listed options
• Development of
pre-consultation
business case
(including equality
and quality impact
assessments)-if
required
• Request stage
two assurance
meeting with NHS
England and
Clinical Senate
• Public
consultation
(if required)
once stage
two
assurance
meeting is
complete
• Decision
made
Ongoing development of the model of care and long term service planning
Next steps: dependent on
short listing and today’s
conversations
THANK YOU FOR ATTENDING.
DO YOU HAVE ANY
QUESTIONS?
Please complete an evaluation form before
you leave
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