executive summaries - north derbyshire ccg · web viewthe beds with care proposal raised concerns...

Consulting the Community

Better Care Closer to HomePublic Consultation

North Derbyshire Clinical Commissioning Group and Hardwick Clinical Commissioning Group

FEEDBACK REPORT

29th June – 5th October 2016

Dr Steven Wilkinson Consulting the CommunityOctober 2016 (final version 7th December 2016)

Executive Summaries

Proposal 1There was support for the Care at Home teams. The Beds with Care proposal raised concerns about the quality of care and the availability of nursing or care homes. There was disagreement with moving Dementia Day Units out of community hospitals. The Dementia Rapid Response Team proposal had broad agreement. There was acceptance of the Community Hubs proposal, however the locations of these hubs raised concern. Common themes across all of these proposals included care quality, staffing (levels and skills) the use of community and acute hospitals and hospital beds, costs and funding, management and organisation, location, carers and respite, travel, transport and access. In every case there were requests for further detailed information and a range of questions about the proposals.

Proposal 2 – There was broad disagreement with the proposal to close beds in any of the 5 nominated community hospitals. It was thought these beds would be needed to serve the local (and remote) communities. The introduction of Specialist Rehabilitation beds in both suggested locations was considered a good idea, however the locations raised travel and transport concerns. The number of proposed beds was also considered to be low. There was broad disagreement with the proposal to close OPMH community beds at the two nominated sites. The establishment of a Centre of Excellence at Walton Hospital met with broad approval, however the location was an issue for some. In each case there was discussion around the themes of the use of hospitals and hospital beds, management and organization of services, locations travel and transport, nursing and care homes (capacity and care quality), carers and respite, estates (building use) staff (levels and qualifications). In every case there were requests for further detailed information and a range of questions about the proposals.

Proposal 3 – There was broad disagreement with the proposal to close either hospital. These hospitals were considered to be needed by the local communities. Common themes in both cases included, patient care and quality concerns, management and organisational issues including a timetable for the proposed changes, issues around costs and funding, the location of alternative services and the inherent issues around travel and transport. The use of community hospitals including the range of services provided through these hospitals. Concerns about staff, carers and respite and access to services were also raised. The use of the estates (buildings) was discussed. In every case there were requests for further detailed information and a range of questions about the proposals.

Dr Steven Wilkinson Consulting the CommunityOctober 2016 (final version 7th December 2016)

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ContentsExecutive Summaries........................................................................................2

1 Background....................................................................................................5

2 Process...........................................................................................................5

3 Proposal One – Executive Summary..............................................................7

3.1 Proposal One...............................................................................................8

Care at Home Teams........................................................................................83.2 Care at home teams summary................................................................................83.3 Beds With Care Summary.....................................................................................173.4 Dementia day units – Walton Summary................................................................243.5 Dementia day units – Newholme Summary..........................................................273.6 Dementia day units – Bolsover Summary.............................................................303.7 Dementia Rapid Response Teams Summary.......................................................333.8 Community Hubs Summary...................................................................................40

4 Proposal 2 - Executive Summary................................................................47

Proposal 2.......................................................................................................484.1 Community Hospitals Bolsover Summary.............................................................484.2 Community Hospitals Clay Cross Summary..........................................................524.3 Community Hospitals Newholme Summary..........................................................564.4 Community Hospitals Whitworth Summary...........................................................604.5 Community Hospitals Cavendish Summary..........................................................654.6 Specialist Rehabilitation Hospital Beds Cavendish Hospital Summary.................694.7 Specialist Rehabilitation Hospital Beds Chesterfield Royal Hospital Summary....724.8 OPMH Community Hospital Beds Cavendish Summary.......................................764.9 OPMH Community Hospital Beds Newholme Summary.......................................804.10 Centre of Excellence at Walton Community Hospital Summary..........................84

5 Proposal 3 - Executive Summary................................................................895 Proposal 3 ................................................................................................................89

Bolsover Community Hospital and Newholme Community Hospital................905.1 The closure of Bolsover Community Hospital Summary.......................................905.2 The closure of Newholme Community Hospital Summary....................................94

6 Consultation Clarification..............................................................................98

7 Report Outcomes.......................................................................................100

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1 Background

The CCG’s of North Derbyshire and Hardwick embarked on a 14 week formal consultation process which closed on 5th October 2016 to help assess the views of service users, health and other care professionals and the wider public, on three broad proposals.

Proposal 1 – a) forming Integrated Care at Home Teams, b) establishing Beds with Care c) moving services out of Dementia Day Units d) introducing Dementia Rapid Response Teams, and e) setting up local Community Hubs

Proposal 2 – a) Permanently closing 16 beds at Bolsover, 16 beds at Clay Cross,16 beds at Newholme, 20 beds at Whitworth, 16 beds at Cavendishb) Providing 8 specialist rehabilitation beds in the west of North Derbyshire & 20 at Chesterfield Royal Hospital.c) Permanently closing older persons’ mental health community hospital beds; 10 beds at Cavendish, and 10 beds at Newholme,d) Establish a centre of excellence at Walton Hospital

Proposal 3 – Closing Bolsover and Newholme community hospitals

http://www.joinedupcare.org.uk/ (Accessed September 2016)

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http://www.joinedupcare.org.uk/

2 Process

A database of feedback was developed. A First Stage Analysis was then undertaken, which coded responses. A Second Stage Analysis was then developed which organised the codes into themes. The first and second stage analysis documents are working documents and were used in the construction of this report.

This Consultation had three key ‘proposals’, which were explained in a consultation document accompanied by a feedback questionnaire. Further feedback to these proposals was collected via written and email correspondence and recordings and notes from public meetings. All feedback was included into the analysis and has been represented in this report.

This report has been written using (as far as possible) the words and phrases used in the responses. No corrections of fact, grammar or syntax have been made.

This report summarises the themes. The themes with the most responses are discussed first followed by the next in descending order. This provides a relative indication of the weighting of each theme. Every attempt has been made to report the feedback provided for each of the respective questions, therefore there is some repetition within this report.

Questions raised by respondents have been summarized and are reported at the end of each element of each proposal.

None of the views expressed in this report are those of the author or any organisation for whom the author may work.

The following table indicates the number of responses received (rounded up);

Table 1 – Response countQuestionnaires 2,260Correspondence (email & hard copy) c.100Public meetings 18 x 2 hour meetings+ Additional information including petitions, on-line comments, & media.

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3 Proposal One – Executive Summary

Proposal 1Proposal one is a combination of;a) forming Integrated Care at Home Teams, b) establishing Beds with Care c) moving services out of Dementia Day Units d) introducing Dementia Rapid Response Teams, and e) setting up local Community Hubs

The ‘word cloud’1 illustrates the 100 most often occurring words within the responses. The larger the word, the more often it occurred.

There was support for the Care at Home teams. The Beds with Care proposal raised concerns about the quality of care and the availability of nursing or care homes. There was disagreement with moving Dementia Day Units out of community hospitals. The Dementia Rapid Response Team proposal had broad agreement. There was acceptance of the Community Hubs proposal, however the locations of these hubs raised concern. Common themes across all of these proposals included care quality, staffing (levels and skills) the use of community and acute hospitals and hospital beds, costs and funding, management and organisation, location, carers and respite, travel, transport and access. In every case there were requests for further detailed information and a range of questions about the proposals.

1 http://www.wordle.net/ of 100

3.1 Proposal One

Care at Home TeamsThe proposed service changes would include significantly expanding 'care at home' teams. These are community-based teams of health and care staff who will work together locally, to care seamlessly for older people in or near their own homes.

What do you think about this proposal to expand community-based care teams?

3.2 Care at home teams summaryThere was broad agreement to this proposal. Concerns were expressed about the quality of patient care and staffing levels. Those who disagreed lacked confidence in community care. There were concerns that this proposal would be sufficiently funded and about the management and organisation of the service. A preference for locally provided care was expressed and carers should also be considered in this model – particularly with respect to respite. Travel concerns took account of distances and weather and road conditions. It was suggested the service be available on a 24 hr basis. Further information was requested.

3.2.1 Agree It sounds a good (excellent, much needed, lovely, fair enough, helpful, positive, pleasing, extremely good, welcome, nice, Fantastic, necessary, beneficial, ok, welcome, essential, adequate, long overdue, fine, great, useful, sensible, amazing, commendable, common sense, brilliant, positive) idea. It is a nice idea to be cared for in your own home. I hope integrated care teams at home will be a success. We support this change. The more actual carers the better. A very good idea in theory (in principle, if done properly, basically, generally, partly, on paper, in concept, has merit). It will be very good for some suitable patients. Will hopefully minimise length of hospital stay and associated complications and improve rehab outcomes.

Provided it is in addition. This should not be at the expense of beds in local hospitals. I think there needs to be a balance between community care and in-patient care.

If you even consider doing this it should be trialled for at least three financial years before any beds close.

3.2.2 Patient Care & Quality DRRT’s cannot be possible to give the same quality of care in home visits as that in a rehabilitation ward with 24hr cover. I am very concerned that the interventions by the Dementia Rapid Response Teams will not be able to meet the needs of the people with severe dementia. Care at home provides only a short-lived respite in the numbers game, because, after short a period of time, the 'patient' will again need a higher level of care.

In hospitals they have access to other services. Patients are also admitted directly from home via the GP for medical assessment for: deterioration of heart failure, exacerbation COPD, chest

infection, Palliative care, pain management, wound

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This is a positive proposal, meeting a clear need.

Need to ensure quality of provision.

management, blood transfusions, IV antibiotics, fluid balance / hydration. There is also the consideration that the elderly quite often feel happier and supported in the company of others. Very concerned as realistically and practically I don't think so many people will be seen, and people will have to wait longer to be seen.

A lot of patients are simply not safe to be home alone between care calls. Living on my own with no family near - I know how lonely a vulnerable older people can feel when poorly. Increase in falls, pressure sores, fire hazards, more vulnerable people walking streets leading to hypothermia, poor nutrition, taking on things before they are ready - mortality rates will rise as well as morbidity.

I have no criticism of the care she received from the district nurses; my point is that there are limits to what they are able to do in the allotted time they are given for home visits. It depends on time allowed to each person. I would not want to think that I was relying on short visits. Visits are not long enough. These care in the community schemes end up being flying visits that don't really benefit those in need.

People with Dementia find unfamiliar surroundings frightening - people recover better in their own surroundings. By bringing care to the home, familiarity can be maintained. The members of the team need to be consistent so that the patient knows the individuals. A dedicated worker could visit a specific client rather than a different one each day, as I feel this would be much better for the client.

There is a stigma surrounding the acceptance of 'help' at home: many elderly people perceive it as admitting that they are no longer living independently, even if that is in reality an illusion (they are being supported by an informal network of neighbours/friends/relatives). They pride themselves in being able to lead these 'independent' lives.

The proposals do not take account of the customer’s wishes. Services should be available on an ‘as needed’ basis and in a patient-centred choice model.

3.2.3 Community Hospitals and Hospital Beds I think that there will still need to be a community bed provision for those who need more intensive care or a half way stage between hospitalisation and return to home. This still needs to be provided at community hospitals including the Whitworth, Newholme and Cavendish hospitals. I'm sure people living in Derbyshire (the Dales, Hope Valley, Matlock, Calow, Buxton, Bakewell) - prefer their local hospital.

Special staff will be needed and this will mean a stay in a main hospital. A larger number of people can be cared for with a 24hour service by fewer staff in a local hospital. The therapeutic groups and activities that take place requires a base.

Manual handling risks increase in the patient’s own home, where equipment is not always readily available. Staff from the Community Hospitals have raised the point that they need equipment and space and sterile treatment areas to use it which a hospital setting provides but which may not be available in the community.

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I’m not keen to be looked after in my own home.

3.2.4 Staff Only if enough qualified (social care/ private agency /

voluntary / charitable sector) staff are available now and into the future. There are not enough staff currently to care for the patients who are already at home. Community teams are already struggling

to cope with demand. We need to recruit well trained, committed, loyal, quality, properly paid and

contracted staff with the right qualifications (at the right level). The organisation wide problem seems to be that DCHS are struggling to recruit good staff whilst other experienced staff are leaving or are wanting to leave. If staff are ill, there is more likelihood that a vulnerable person will slip through cracks.

Safe nurse: patient ratio guidelines for ward based nursing is 1: to 8 patients. Community currently does not have a safe nurse: patient ratio guidance.

A large amount of time will be spent travelling, trying to gain access etc. again due to the geography of the area.

Generic teams demean those with specialist skills. There are far more care staff without experience as almost anyone can get a job in care. Training for non clinical staff is a low priority. I have reservations that the quality and training of staff will not match that of the current situation. There is also a risk that newly qualified and/ or inexperienced staff will be taking on more responsibility beyond their capability and rapidly "burn out". Newly qualified/ Inexperienced staff will need adequate support and supervision to develop their skills and to cope with whatever they find in a community setting. They should also be trained not to be forever on their personal mobile phones & slipping outside for smokes/vaping. Not staffed with school leavers or poor English speaking staff.

The only concern is there is no mention for the staff's salaries or benefits working in the new model.

3.2.5 Disagree This proposal is (absolute rubbish, not acceptable, unconvincing, a big mistake, a poor substitute, impractical, a bad idea, disingenuous and dishonest, inefficient, totally irresponsible, disgraceful, totally unworkable, absolutely ridiculous, a disaster waiting to happen, basically flawed, nonsense, ineffective, silly, disgusting, terrible, hopeless, detrimental, unrealistic, madness, a step backwards, impossible to achieve, misguided, dangerous).

Community based care is not appropriate for sufferers from dementia or their carers. I do not believe that this will be practical in

a rural community such as this. As the community gets older more care homes will be required.

Once the units/hospitals/wards/centres are closed there is 'no going back'. I ask you to please reconsider this decision and to leave the wards as they are. Many GPs believe that this system will be unsustainable.

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There needs to be enough staff.

Inexperienced staff may miss or not address specific issues.

Think it would not work.

3.2.6 Costs & Funding We understand that there are cost cuttings to be had. This needs to be done carefully. As long as funding is provided and ensured in the future. In the high peak and dales we have three fully staffed wards for only 42 patients - that isn't cost effective. Further investment in care of this type is required. If necessary we have to pay more tax and get a bigger better service. A lot of the community hospital was built with the people’s money and looked after therein from donations received from grateful families.

This is a cost cutting exercise, centralising local NHS services in larger units and covering the loss of local service and facilities with beefed up community services. It will be more expensive. To do this properly is unaffordable. Once it is established - cuts will be introduced.

The cost of carer support is not only to individuals but to the wider economy as a whole. Being able to self-fund seemed a disadvantage. This is an exercise to save money by closing local facilities and pushing the patients who would have used those services out of the state funded NHS beds and into independent sector beds where the NHS will not have to pay.

3.2.7 Management and Organisation Health and local authority staff working together is a good idea. Partnership working needs to improve between acute / Beds with care / spec rehab hospital beds / GPs / social care - improved communication & sharing, IT systems - access to information available to all. Past experience indicates that such integrated care is difficult to achieve. Social care have highly trained carers who can work along side health and social care but are not being used to their potential.

Care is not "seamless" when there is tremendous difficulty providing care now as there are simply not enough social care/ private agency / voluntary / charitable sector staff available - again due to the geography of the area.

As long as its joined up care in your own home. There might well be less continuity of care, with different staff arriving, which could be upsetting for an elderly, possibly confused, patient.

The more different disciplines work together the better the service to the clients will be -

rehabilitation services, geriatric care, dementia provision podiatry,

physiotherapy, occupational therapy and a need to ensure the GP practice team will be part of the package.

It also relies on a very effective team of people to coordinate this on an hourly

basis and need to be very well supported by an admin team that has some clinical

background so that they can empathise with the teams issues. Furthermore reliance of mobile phone signals in upland areas with poor or non-existent signal also hinders community-based care effectiveness. Coordination with communications/ transport and other relevant bodies is needed. At the same time I hope that it does not involve an increase in bureaucracy and time spent on paperwork. Social Services take too long to assess patients before they are returned home.

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Critically strong leadership will be necessary to develop a culture that will include a radically different approach to the management of risk across the system.

This has not been trialled in this locality - people live in remote places and weather has to be taken into consideration. Adequate checks on a regular basis will be needed to ensure that the older people are receiving good quality care in their homes. I think this should be in place for at least 2 years before the hospitals are closed.

3.2.8 Location More community care is needed - as long as you can keep it local. . For most people rehab will be best in a person's own home. With modern technology and telecare more care can be provided in the home.

The project is called 'Better care closer to home' I would question Whether closing local hospitals fulfils this brief. These local hospitals provide care in the community.

3.2.9 Carers and Respite I was a carer at home for over twenty years and I know from experience how isolating and stressful the carer role can be. Few carers find it easy to admit to a breezy professional just how far they are from coping - you will find that the carers of the patients will become so ill that will also be needing carers.

From personal experience, I also find it quite extraordinarily offensive that throughout the

report there isn't a single mention of the day to day voluntary carers whose unsung heroic efforts already

prevent the systems that are in place from collapsing altogether. Its no good

pretending that the care of elderly people is not totally dependent on their efforts and insulting

not to even mention them! It is not always possible that elderly people can be looked after in their own homes, they might not have family who can care for them 24/7.

Carers could possibly be trained as rehab assistants supervised by OTs and Physios.

It is hard to see how the Integrated Care at Home teams can offer a 24/7 service that would mirror the kind of respite / support that families and carers may need when they are struggling to cope with significant deteriorations in conditions and behaviours at home. It is essential to keep respite care for these carers and patients.

3.2.10 Travel & Transport I would question how efficient a team would be spread out across a community travelling from home to home. People who do not understand the geographical problems caused by tourist traffic, winter weather, poor gritting (preventing access for days of the year) - fog, ice, snow, and distances between villages. A simple drive from south of Bakewell to the north can take two to three times as long as on quiet days. There is often no alternate route, and much time is spent sitting in traffic.

If there is an emergency and a hospital is needed the time it takes to get to there is too long. It is already difficult to reach general hospital facilities. Patients and relatives (also older individuals) would find transport and travel issues (including costs) if having to travel to central services located in hospitals such as Chesterfield or Derby.

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There's relatively little recognition of the needs of carers who have a very challenging job

3.2.11 Access The success of these depends on whether their services are going to be available overnight and at weekends. For example, there are many people who I visit who live on their own who may not be able to manage on their own if they are ill or have an accident. If someone is highly anxious they are likely to contact services frequently, it may impact on their progress or rehabilitation, or they might take longer to gain confidence. If someone has a dementia particularly one that affects their executive functioning they may find it hard to inhibit themselves (i.e. they may not be able to stop themselves or not think of the consequences or risks of doing something). The 'at risk groups of patients', include the frail and elderly, those with dementia and end of life care. Care at home is the best place if the support is available 24/7 - 'care' on demand.

Yes it is proposed that an on call psychiatrist will be available - but this is to cover the whole of Derbyshire. As I know from personal experience that it is almost impossible to access medical care after midnight, due to the out of hours service being based in Chesterfield!

Rapid response is 8 to 8pm after that time most patients go to ‘the acutes’. They are not medically ill but have to keep them in an acute bed. Rapid response will be beneficial but overnight teams should also be considered. A Local Authority not far away have night care service 10pm -7.00 am and make 2-3 calls per night. Does Derbyshire have budget left to help with this type of service?

3.2.12 Unsure I am (not so sure, don’t know, sceptical, concerned, have reservations, can see problems, distrusting, not confident). It depends on particular circumstances. These obviously differ for different areas. It may work in some cases.

I have seen this promised in the past. Care in the community does not always work. I have yet to see a community based scheme of any kind prove to be better than the services they replaced.

3.2.13 Information & consultation The following further information is requested;

The right number and staffing levels and their locations across North Derbyshire It is not clear from the proposal whether the individuals who will make up the care teams will be dedicated to those teams or whether they will be expected to fulfil other duties also. Detail of specific delivery is vital e.g. how many hours a day there will be someone in the persons home and how readily help will be available There is no mention of Care at Home teams for younger disabled and those with complex and specialist neurological needs. None of this has been backed up by evidence that it will work A cost efficiency exercise should be undertaken to estimate the increased cost of admission to general hospitals that are distant from the person's home and crucially distant from community team bases. I have not seen sufficient information that explains how it is planned to meet increased need in this area.

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When this group of patients need support its 24/7.

I would like to also know what consultation has been done with staff who currently work in community inpatient services that suggests that people in these posts would be willing to transfer to Care at Home teams. The really worrying thing is that there is no Plan B, not even any contingency plan, for instance if the programme is so short of funds that there is no scope for expansion, and it becomes swamped by an increase in demand then it is almost inevitable that elderly people and their voluntary carers may become even more sidelined and neglected than they are under the present system. The research that has been conducted to support these proposals didn't appear to be peer reviewed. You should incorporate ideas from the East Midlands Clinical Network publication Commissioning Guidance on Community Based Neurological Rehabilitation No Consultation with GP Practices Nursing Homes Voluntary sector

Concerns regarding the consultation included;

The word "if" appears to many times in the "consultation" document as to make the proposal meaningless The decision appears to have been pre judged before the consultation. This questionnaire is far too complicated and contradicted itself. I think the wording of the proposals is confusing and misleading to the older generation, which is who these changes will be predominantly effecting. I notice no consolation meetings in our area. Once again the Hope Valley is just being ignored!!! The consultation has been badly publicised if at all and only after news coverage was the wider public even aware of the proposals. The proposals were kept from staff at threatened sites till the last minute. The lack of openness and transparency is upsetting.

ResearchThe National Institute for Health Research : "Advancing community hospitals and services in the NHS - learning from international experience" (due for completion September 2016) Scotland is promoting the development of community hospitals and in Italy there is a legal requirement to provide 7beds/10,000 population for rehabilitation and long term care. "A study to understand and optimise community hospital ward care in the NHS" (completion January 2018) "A comprehensive profile and comparative analysis of the classic community hospital" (March 2018).

3.2.14 QuestionsCareWho will look after the patients in between care calls? How can the same level of care be provided in the community and care homes? Do social services have response time targets?How will care safety and performance be assessed?How long will the carers be allowed to care for the person at home? How does Community Based Care Teams provide the respite care?Who will monitor the quality of care provided? What about people who have no or very little family to help support them? Has the psychological impact of transferring someone from an acute hospital to a care home setting been considered? What about the people that won't accept a care package at home?How often will they visit? The support of the GP services is also required to monitor response to medication during rehabilitation - has this been considered?At what point would it be deemed necessary to admit the patient to a community bed?

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What will happen to the people who need 'end of life's care? How will the clients be allocated to specialists?If you are using all your staff to focus on older people and those with Dementia, then who is left to provide the care for the younger disabled?Will carers receive training?

ServicesHow will patients be given rehabilitation therapy in inappropriate environments? What's wrong with what we already have? What research into this model has been done ? What does "closer to home" mean? Are the CCGs going to change the policies governing equipment provision for people in residential settings? How are acute hospitals going to coordinate complex discharges home safely? Fast Track teams to ascertain what level of support for people staying at home is available in the Derbyshire Dales/High Peak/Buxton? Will the community teams have access to both electronic patient record system ? Have the CCGs consulted with the Social Services Teams/ NHS Continuing Care &What are you going to do without all the efficiency these old hospitals provide if you close them? Sounds Good in theory will the beds be there? Are medequip prepared for the influx of orders? Will there be a peripheral store to access equipment required and where would this be located? How long will the services be provided for? Can enough provision be in places required? How long will the change take for training and any benefits will show though?Who will receive this service?

StaffingHow and where from will suitable staff be recruited from? What medical and social service staffing levels are the CCGs proposing? Will staff be qualified or will they be care staff or assistants? What about Catering, Domestic Staff, House keepers and Porters?How are you going ensure that they all know what each other is doing? Will staff have adequate time with each patient?What risks will this pose to staffing of CRHFT?Is my GP and the staff part of this integrated team? Where are the teams to be located if they are expected to "work together"? How will Inexperienced staff be supported? Will they receive adequate quality training? Have you considered risk to staff? What is planned to support these staff in transition so that valuable skills and knowledge are not lost to the organisation?

FundingHow is this going to be funded?Is there going to be (finally) a joined up budget? If all health and social care resources are put into supporting people following an acute admission, where does the money come from for supporting those with chronic needs? How does the cost of this proposal compare to keeping the status quo ?Will it be privatised in part or whole? Will staff receive appropriate pay ?Will the staff be paid petroleum costs? Is there sufficient funding to expand the system as this [population] increase occurs?

Travel + LocationWhat specific measures are in place to deal with more rural areas (particularly in poor weather)? Where are they to be based?How will the technology work in rural areas where sending a text message is impossible?

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Is this a good use of valuable staff time, trying to get from one call to another? Our bus services are dreadful so how would they visit daily? Do medequip they have enough vans? Why have the proposed locations been chosen?How will those who are recovering from an accident travel to the hubs?

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3.3 Beds With CareThe proposed changes would include providing local ‘beds with care’ in existing residential and nursing homes in communities throughout North Derbyshire for older people who need extra support for a short time to regain their independence after an illness or accident.

What do you think about this proposal to provide local ‘Beds with Care’ in existing residential and nursing homes in communities throughout North Derbyshire?

3.3 Beds With Care SummaryThe quality of patient care was of greatest concern. Those who agreed with this proposal felt it was a good idea. Sufficient qualified staff was a concern. It was thought that care homes did not have the capacity to take patients. Those who disagreed did not feel the model would work. They felt hospitals were a better option. There were concerns about the funding of this model. The services will need to be ‘joined up’. Carers needs and travel were also discussed. Further information was requested.

3.3.1 Patient Care & Quality This is fine but if they are Council run homes - some of the private ones do not give best care and are focussed solely on profit. They do not deliver the care needed – it is not the same standard of care. After looking at some care homes/residential for day care I am not sure that any have enough stimulating activates to encourage someone to return home. If they are not sufficiently engaged with the process then the patient/client/person will decompensate and then be unable to return home. The staff in care homes generally "do for" people rather then encourage independence - there is no kitchen for people to make their own drinks/meals and so they will not be able to work with OTs to increase their independence with domestic activities. We have concerns about a care home’s ability to recognise a deteriorating patient and fear that unwell patients will be missed.

The quality of care would no longer be the problem of DCHS. This is a stressful and time

consuming experience and in my experience rarely results in measurable improvements in care homes. In the recent months there are 3 homes within North Derbyshire closing or

closed to admissions due to poor care. With the rare exception, the private care staff are over worked and under

motivated. Inspection by CQC only is insufficient monitoring tool. Private care facilities will receive the benefit of knowledge and skills of publicly funded teams, without any cost to themselves, and without having to guarantee to provide the recommended interventions of that team. Hospital care is far superior and things are often overlooked or missed in a care home.

As many have high numbers of patients with dementia it could be a very distressing environment for those whose problems are purely physical.

Nursing and care homes vary, some are wonderful. Policies should include no-one being allowed to use a mobile phone on the premises & No Smoking on the premises/grounds. Also only offer home cooked food & there should be no microwaves on the premises. All Homes should adopt such policies.

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The staff entering the care homes to provide DCHS services will have a duty to prevent patient harm and to report concerns

Many do not want to go into a home! I think older people will see this proposal as a way of sending them into permanent care, not a step towards getting home again. Would much prefer to be in the local hospital. I feel this may be due to the setting and the stigma.

There would need to be a lot of PR done as some people, for example, may still be working and need such care temporarily. Having separate facilities helps persuade them. I have seen this work well in other counties as the care homes are going to be of a high standard and better regulated

Moving a patient from home to a hospital to a care home and back home again can be confusing for a patient when they are in need of stability and routine. A care or nursing home will be a death sentence; it will frighten people, they will give up.

Patients put on danger being discharged before they should be. Staff would also need education around risk management and outcomes for patients (e.g. pressure sores, dehydration, nutrition, wandering at night). More and more patients are not considered fit to return home. This can be either due to their future prognosis or just as importantly the level of care that can be given at home by their close relatives.

I am aware that there are often not beds available in the community for the Royal Calow Hospital to discharge to and that often people are transferred to Derby as there are not enough beds in North Derbyshire when people need hospital beds.

At the moment elderly people are stuck in hospital as there is no bed available in local care homes. Some patients are admitted from the residential and nursing homes to the community hospitals for assessment of medical deterioration or a change in medical condition. These patients would have to be admitted to the acute hospital if there are no community beds.

If this will mean elderly patients can be discharged from a district general hospital quicker I can see it as a saving to the NHS as well as a benefit to the patient and their relatives. This would release hospital beds for more urgent cases.

GP's need to be involved. I have witnessed first hand that concerns about patients in this setting have resulted in increased demand on GP services covering that residential home or the use of paramedic EMAS service which in turn results usually in re-admission back into the acute hospital. GP's seem to be already overstretched.

3.3.2 Agree The proposal is (very good, excellent, fine, beneficial, pleasing, ok, great, sensible, reasonable, preferable, ideal, much needed, helpful, positive, agreeable, brilliant,

acceptable, well thought out, likable, not bad, logical, welcome, obvious, useful, workable, efficient)

In principle, if it is sustainable and depending on particular

circumstances. Good in theory and a good use of resources. People in crisis need support and care but not necessarily fully

qualified clinically trained staff, often someone to just support, prompt and offer a safe environment. This has been done successfully in other areas,

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I don't see this relieving bed blocking.

It is worth exploring.

so in theory, can be successful here. My mother benefited from something like this and I would like to see it available for others.

Keep the hospital beds also.

3.3.4 Staff My experience is sadly that care staff in residential care/nursing homes are poorly paid, poorly trained and often ineffectively managed. Private residential homes have less qualified trained and experienced staff and variable leadership. The staff in these nursing homes would need extra training. In my experience the carers in the homes are not professional enough compared to NHS organisations and need the constant backup of District Nurses. Care staff have limited training or skills in (rehab, Physio / OT and SLT) or the ability to recognise signs of early deterioration in a patient. We observe many patients with 'heavy' care needs such as using full hoist transfer following a leg fracture, stroke patients, those who require a little more TLC or education on managing conditions such as diabetes as well as those who require intensive rehabilitation in an appropriate setting.

There is very often on one or two qualified nurses on the premises and local GP's are called out when needed. The rest of the staff are Care Assistants who have very little medical knowledge.

On the job training is to be provided and care to be monitored. Extra training will be needed, which will need to be continuous to keep their skills and knowledge up to date. The staff will need a lot of support and training around not transferring patients back to acute trusts.

It is proven that good patient outcomes are directly linked to numbers of trained nurses. Nursing/residential homes do not work on the same ratio of staff as hospitals. Ill vulnerable people need specialist care not zero hours contract minimum wage or agency staff. Most of these homes have difficulty finding good staff. More increasingly English isn't often spoken by all staff.

3.3.5 Nursing & Care Home Capacity There needs to be enough places to cope with demand. The CCG is struggling to find appropriate nursing home placements, not to mention choice. There still seems few for the area. Many nursing homes, especially the better ones, have long waiting lists to get a place at present and this will get worse in the future.

3.3.6 Disagree This proposal is (not acceptable, a bad idea, crazy, a nightmare, daft, not good, poor, rubbish, disagreeable, a recipe for disaster, ridiculous, lacks credibility, nonsense, disgusting, unfeasible, wrong, appalling, unworkable, flawed, ill thought out, terrible, a joke, unviable, hopeless, abysmal, impossible, terrifying, inappropriate).

Don't think it would work. Leave things alone, it works well as it is. This seems a scheme which has had little realistic analysis of the probable demand based on

actual statistics. It just seems like we're going backward 100 years. In an area where the population is increasingly

elderly, this may not be possible.

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Staffing levels must be adequate.

I would not support the proposal.

3.3.7 Community Hospitals and Hospital Beds I think they would be better cared for, and be more confident, treated by a nursing team in their community hospital. Patients need to be in a hospital not a care home. To close other hospitals to provide this care will leave a shortfall in the health service. Hospitals should be kept open.

Many of the homes do not have adequate space for specialist equipment and some have very poor layout generally. Care homes don't have access to other services, i.e. imaging, pathology, physio, COPD exacerbation, unstable diabetic, young in crisis and admissions from minor injuries and out of hours or clinical input 24/7.

3.3.8 Costs & Funding Care in private residential and nursing homes is poorly financed by the NHS & LAs and are subject to means testing. Health (NHS) and private beds will cause conflict as to who pays for care. Care Homes are independent business that are sustained by bed occupancy - there is an inherent conflict with a rehab function. I think that in the end it will be the patient that ends up paying for this kind of care. Not everyone can afford residential care. I believe Haddon Hall in Buxton now accepts advanced Alzheimer cases, but at a cost of over £1100 per week. Would have thought it more cost effective to retain Spencer ward.

Surely it would cost less in hospital that the cost of nursing care in a home. I believe numbers of such people will mean that the cost of both beds in care and combined support will exceed service budgets by miles – if you go on just costs then patient will not receive good enough care.

Once you start to reduce the local facilities at the hospital, what is left becomes increasingly unviable financially. Once the local services are closed they will never re-open and the local voluntary effort which has gone into developing them and the charitable funds which support them will be lost. Yet another local NHS asset sold off.

I think it is very dangerous for our public national health service to grow dependent on private residential care homes. This is privatisation by the back door and is unacceptable.

3.3.9 Location Care homes can be anywhere in North Derbyshire. So may not be in patients community. If the location of beds is not known how can it offer local provision. Local beds with care are better than more remote locations. But they must be close to towns and villages so that old people can easily visit their loved ones.

I think the key phrase is local beds. If there are several residential or nursing homes used in each area then most patients and their family / carers should be closer to their treatment centre, although there will always be some who are further.

3.3.10 Management and Organisation It would take time to become 'seamless' and would need a high level of co-operation between staffing teams. As long as the infrastructure is such that it will achieve all the objectives. This means much closer working together than at present. The smooth management of the whole service will be vital - especially the transition to the community team providing the 'at home' care. It would depend on excellent

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The budget for this proposal needs to be sufficient and the service sustainable.

communication between the care home staff, the 'expert team' and their GP's. I am worried that when you have to involve so many people, communication can break down and it will be the patient and family that suffer the consequences. A joined up approach for those on the boarder of North and South Derbyshire would be very helpful.

There appears to be no joined up thinking as we have Derbyshire County Council closing short term care beds to give respite to their carers when along comes #joinedupcare who are proposing closing or reducing long term beds for dementia care.

The standard of care will be infinitely more variable and harder to monitor. As long as the planning, implementation and monitoring of the performance of homes is sufficiently good. The existing homes used must be checked carefully for quality of care.

3.3.11 Travel & Transport Provision should take account of geography climate (including the winter months) and transport provision - A6 corridor is national transport route for patients, carers and relations - you must link with local transport options and neighbour regions.

Hospitals are usually on main bus routes and are often more accessible than care homes. Not

every one has or can afford a car - taxis would be financially crippling. Some of the family are

old and would find visiting a problem. Travel for relatives/friends is difficult and being

treated close to home is vital. Dementia patients get distressed at change and need

contact with friends and family.

3.3.12 Carers and Respite I would say this service is essential as not everyone will have access to carers at home. However, the patient’s needs and those of carers must be retained. We are talking elderly patients, who have elderly family members. Carers may need respite - only 2 out of 5 care homes provided respite care. Many of our patients go into to care homes for respite.


The location of the care/nursing homes Costs need to be explained Details are vague (i.e. It is unclear what the involvement of residential and nursing home staff and/or the community-based teams will be regarding the older people who need this type of short-term extra support for a short time.) No mention of how people might qualify for one. Not much evidence of similar ideas in the past having worked. I do not know what the current provision is for male patients in transition from major hospitals. Define care. It appears there are no actual plans as of yet. There has been no answer to questions asked about how quality standards are going to be monitored and measured by DCHS.

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Bus services in the area are not always adequate to meet the needs of elderly relatives.

There seems to be no contingency for emergency admissions.


I went to one of your consultations at the Bolsover school were your spokes person assured members of the public that this would not be happening as the public we're concerned that if the hospital were to close, that nursing homes would be used and or very expensive. The reply from the board was they had no intention of using nursing home and the idea was to re habilitate at home. They stood there and lied to the faces of the community.

3.3.14 Unsure I think it would be extremely difficult to implement / maintain. Nursing homes are not always the answer and as I have seen first hand do not always meet the needs of everyone (e.g. for younger disabled). I am extremely sceptical based on the current situation. Will it not be difficult to work with each care home and make specific individual arrangements. This is a proposal fraught with challenges. I fail to see how this will work.

3.3.15 Access Care in the local small hospitals is guaranteed to be 24 hours 7 days a week. The beds with care in nursing homes will have very limited access.

3.3.16 QuestionsBeds With CareWhere are these 'beds with care' going to come from? Are there going to be enough beds available at the right time? Which nursing residential homes would be used? What happens if all of the beds placed in/near the patients home are occupied ? Are the care homes ready for this new approach? What will happen to respite beds?Why can you not have a bit of both? Acute hospital beds – will they be taken up for acute care during winter? What about ‘end of life’ care?Will there be a mixture of nursing and residential beds?Will the residential home be expected to purchase profiling beds, pressure relieving mattresses, rehab equipment etc etc. for those with short term needs?

ServiceWhy do this if beds are currently available in the current hospitals anyway?Have you included carers and service users in the planning? What will happen for older people with greater nursing need when all the beds have gone? Would this provision mean the closing of hospitals or wards /departments in them? Aren’t you just moving the patient from one bed to another?What happens to DCC's Meadow View?How would this impact to the existing residents in the residential and nursing homes!! ?What feedback have you taken from the residents of existing homes and their families? How will we stop bed blocking?How will services work together to try and over come these concerns with patients, families and carers? What support net work will the care homes have?How can this claim to give adequate coverage when the location is unknown? What about the stigma involved with someone having to go and stay in a nursing home even if it is only short term?Younger adults too spend time in community hospital beds so what happens to them? Is there any reason you cannot investigate sharing resources with other organisations? Resource Centre Chapel-en-le-Frith run by Derbyshire County Council closes 6 short term respite beds - Why not utilise these for dementia care for clients who come out of hospital?

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How is this to be arranged? How will patients be treated if they refuse to go into a care home?

CareWill care be of the same standard as the NHS?Who will inspect and ensure standards are good enough? Are res homes aware how much support the person needs following d/chge? Also, where is the doctor input going to come from?How often would they have visits from O/T Physios to enable them to go home?When is someone regarded as old?Do we have any evidence to show interventions lead to sustained improvements in care?Will these areas have specified areas set out for rehab as well as the equipment required to provide successful rehab? Continuity of personnel very important - can it be guaranteed?How many of these people live alone?

FundingWho will run and fund the beds?Where is the money coming from? Won't this be more expensive? Are you going to pay the home for vacant beds and who is going to fund this? Would the care in these be guaranteed to be free at the point of care in perpetuity? Nursing assessment to be completed currently for every res bed only sorts funding out – can this be stopped / redesigned? Is there any other justification other than cost saving?Are the proposers of this plan share holders in said homes?They charge £1100 per week for nursing care - is this good value for money? Do we know how these privately run institutions will be integrated into the NHS system?

StaffingWho will make sure that staff have the proper training?Will the homes need more staffing? Would there be extra training for existing staff? More beds in community may require more GP visits - who will do those? Will this cause conflict between regular staff of the care home and the nhs staff? Will the teams simply "pop in" once daily to provide rehab in these settings?

Travel +What happens to family visits if there family are not able to drive? I would like to understand what local is?

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3.4 Dementia Day UnitsThe proposed service change would mean making it easier for people with early dementia to use some dementia services by moving these services out of Dementia Day Units (which are part of community hospitals) nearer to, or providing them in, their homes

What you think about the proposals to close Dementia Day Units at;

Walton

3.4 Dementia day units – Walton SummaryThere was disagreement with this proposal. Carers relied on this units, it is close to homes and provides social and respite outlets. Those who agreed with the proposal believed care was better provided in the home. The quality of care was a concern. Centres cannot be near all people and some have difficulty travelling. Funding is questioned, and more details have been requested. Staffing levels were questioned.

3.4.1 Disagree This proposal is (rubbish, not acceptable, bad, disgraceful, a great loss, unthinkable, wrong, disgusting, short sighted, bad move, poor, wrong, not good, wicked, rubbish, very sad, big mistake, poor decision, a shame, madness, unacceptable, appalling, demented, disappointing, awful, stupid, crazy, dreadful, grossly unfair, unnecessary, terrible, poorly conceived, damaging, sinful, dreadful, outrageous, irresponsible, shocking, ridiculous, devastating).

. This will have a negative impact on carers/relatives of people with dementia. We should be seeking

to strengthen such units. Such provision needs to remain to serve their area. A terrible blow for the community. This decision will only

serve to increase the loneliness and isolation experienced by people in this

category. If it's provided in homes people will not get the social interaction they need. With an ever increasing elderly community we need this care unit.

3.4.2 Carers and Respite These units are near to their own homes. Day units are not only a good place for patients, but also give their family or carer a few hours of much needed respite. This may be the only break that a carer gets.

Closure of Dementia Day Units will only increase strain on families. You are isolating carers who want to be able to go to a day unit. I think it will result in more carers giving up trying to manage the carer responsibilities so more people will end up in social care. Carers of those with dementia have such a hard time managing the house with caring at the same time.

3.4.3 Agree This proposal is (good, possible, advisable, fine, sensible, supported, agreeable, acceptable, useful)

Absolutely 'yes'. Walton is a cold, barren, ugly place to walk into; furnishings are uncomfortable and shabby; echoing rooms are scary and cold. The building is not fit

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I do not agree with closing dementia day units

for purpose with lots of blind spots so that patients could easily get hurt or hurt others. We never saw the same nursing staff twice whilst my Father was there.

Care at home has been shown to have benefits for the patient. Services need to be spread across the County not all in one place. The cost of running these day units could be definitely spent caring for dementia patients in their own homes.

The proposed services should be in addition to current hospitals. No services should be removed until a proven alternative is in place.

3.4.4 Patient Care & Quality Staff are warm and welcoming. The care provided is excellent and has benefited patients and carers and given hope and comfort to us all. Patients get an enormous benefit from the Day Units. What dementia patient needs is a social environment stimulus and we need to preserve some of the current functions of the day units such as crisis support, management of unusual behaviours, assessment of complex needs. And some of the other functions eg cognitive stimulation therapy, living well with dementia and activities.

I would want assurance that this alternative would be sage and provide quality care and not put patients at risk. This is a very unsafe idea. 3.4.5 Location Centres cannot be near to every person. Putting these services too far away is not a sensible idea at all. If services can be relocated within local communities, this will help with social integration generally.

3.4.6 Travel & Transport Could not get there as I can't drive and my walking to bus is impaired. This is preferable than transporting a vulnerable person to a day unit.

Often patients do not like to go out & cannot be ready for bus pick-up so home support / assessment as provided during Living well programme could be better for patients and relieve stress for their carers/families.

3.4.7 Costs & Funding The population is ageing and the cost of restructuring normally costs more for a less caring service. This is more about selling the land for housing. These are even more crucial and should have the funding to continue. Group therapy must be, more cost effective than individual therapy at home, except in particular circumstances


Again details vague. we need to really understand what this will mean to the patients and their families

3.4.9 Staff The staff in the community will be too stretched to provide an effective service as there won’t be enough. Providing they are well staffed the more convenient the better.

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I know this service has been much valued by patients / carers.

It is apparent that the communities in Derbyshire have a distinct lack of voluntary sector dementia services. These hold up enhance and support the services provided by the NHS or councils.

3.4.10 QuestionsWhere will alternative centres be? These units have been good for older people so why close them?How would carers get respite?What about giving people some socialization?How can there be a day service in a persons home? What day care will be offered for those with dementia that need a period assessment away form home? Who will care for the patients in their own homes, are they not scared, confused and lonely enough now?Where is the support for the unofficial carers? What about the people that currently use these units and for whatever reason care at home is not suitable for?When looking at the models have volunteers been taken into consideration?How many more staff needed? Would 24 hours care/365days care be available?

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3.5 Dementia day units – Newholme SummaryThere was disagreement with this proposal. The model of care was discussed as was concern for carers. Those who agreed with the proposal felt that it was a helpful change. Location is of concern and some have difficulty with travel. There was concern over funding and staffing levels. Further information was requested.

Newholme3.5.1 Disagree This proposal is (short sighted, Ill considered, terrible, not acceptable, disgraceful, dreadful, bad, absolutely wrong, ridiculous, wrong, disgusting, upsetting, cruel, rubbish, not good, extremely sad, nonsensical, very worrying, appalling, a shame, criminal, a false economy, unbelievable, the worst proposal possible, crazy, disappointing, unbelievable, blooming crackers, horrific, awful, a big mistake, totally unacceptable, grossly unfair, poor, a dangerous mistake, very depressing, a travesty, not on, lacks thought, a backward step, sinful, a tragic loss, a total miscarriage, madness, discriminating, outrageous, utterly pointless).

Please, please don’t close it. This service is essential for receiving diagnosed patients and

existing unit far exceeds patient expectations. Many dementia patients using these facilities live near this hospital so nothing will be gained. Day units give patients the opportunity

to meet other people and to get out of the house.

This will have a negative impact on carers/relatives of people with dementia. We should be seeking to strengthen such units. Such provision needs to remain to serve their area. The amount of people requiring help with this problem is growing at an alarming rate.

3.5.2 Patient Care & Quality Newholme is unique - home from home and very accessible to local community. It's much more than a day unit. All facilities are there and staff are very skilled and approachable. The whole point was to mix with other residents at the centre. Facilities can't be replicated in local care homes. This decision will only serve to increase the loneliness and isolation experienced by people in this category.

Perhaps it would work if the older people don't get someone different, each time they tend to them at home. It confuses older people having different carers each time. It will make the vulnerable become more vulnerable. People with mental illness can get very frightened and depressed when alone, and some wonder. Dementia is very easily camouflaged at home especially when 2 people live together. Could potentially increase adult abuse for both stressed carers and frustrated patients. 3.5.3 Carers and Respite

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Newholme dementia day unit is an absolute lifesaver for carers and family.

The respite provided by just one day a week can make the difference between coping and failing to cope.

It would seem that you have forgotten the third party Husband/Wife in your plans. The Dementia Day Unit has been a lifesaver for many patients and especially their carers.

My concerns with providing services in a person's home would be lack of opportunity for respite for spouse / family carer which is an essential lifeline. Many carers are elderly themselves undermining their own health. Also giving to carers a time out to do other things e.g. shopping.

3.5.4 Agree This proposal is (good, agreed, good in principle, a helpful change, possible, maybe advisable, fine, a good use of resources, sounds sensible, supported).

Services need to be spread across the County not all in one place. It fits with the overall plan. I agree

that many dementia patients benefit from being at home in familiar surrounds and with family

members and carers who understand their needs.

The proposed services should be in addition to current hospitals.

New services are welcome but not at the expense of existing serves. Provided the new service covers the whole region and there are enough teams.

3.5.5 Location This hospital caters for a large catchment area, which is far removed from Chesterfield. Elderly people with dementia need to be near home, the nearer the better. Relatives are often elderly themselves.

Centres cannot be near to every person. Finding new secure premises could be very difficult. The idea of meeting in cafes is unbelievable. Move it to a main health centre in Bakewell. There are no other services near by.

A home setting is a good way to discuss dementia with patients. People should be cared for near to family and friends.

3.5.6 Travel & Transport Could lead to long journey in buses for day care – and the cost of travel. Bakewell is a rural area with limited transport, elderly, sick and disabled people would struggle to attend other hospitals. The day centre should remain as this has easy access by bus for many many local people.

3.5.7 Costs & Funding This is not in the interest of the patient and is only being introduced to save money. These units are even more crucial and should have the funding to continue. You have been systematically closing hospitals or wards within hospitals, saying that you can't afford to staff them.

Much charitable money has been raised to support this hospital - it is a complete disgrace to betray of the efforts of those who have contributed.

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No services should be removed until a proven alternative is in place.

3.5.8 Staff All staff want to or have the skills to work autonomously in the community. I question whether two teams in each area is adequate. Other care is difficult to staff with the correct calibre of people.

The Dales South community mental health team, who work with older adults with dementia, have only two staff and an enormous waiting lists. The Dales North community mental health team has only one occupational therapist covering three geographical areas. There is only one occupational therapist employed in dementia care at Newholme so to redeploy her would not meet the needs of the current dementia patients, let alone including those generated by closing a rural community hospital ward. The staff in the community will be too stretched to provide an effective service, as there won’t be enough. Puts more pressure on already stretched at home services.

It is apparent that the communities in Derbyshire have a distinct lack of voluntary sector dementia services. These hold up enhance and support the services provided by the NHS or councils.


There is no indication as to how many there will be, where they are to be located or how they will be staffed. I have not heard anything to explain what wrap around service is going to bridge this gap. I would like to see a detailed plan how this would be implemented

3.5.10 QuestionsWhere will these centres be located? Do we really want to take this service away?How will providing this care at home give the patient's partner/carer a break?How can this care be provided better and more cheaply and closer than a community hospital? What about the people that currently use these units and for whatever reason care at home is not suitable for?How is treating one person at home going to beneficial when the patients get more out of the socialising element of the day hospital? What day care will be offered for those with dementia that need a period assessment away form home? Is it short sighted to shut this at the same time as in patient beds?How could memory clinics, memory courses etc be provided in someone's own home? How are these carers going to be supported in the future?Have the people who have decided that the dementia day units to close ever worked with dementia patients?Who will care for the patients in their own homes, are they not scared, confused and lonely enough now? When looking at the models has this [volunteers] been taken into consideration?People with Dementia have trust issues they are used to going to these units and know the people there, if this all changes how is this going to affect them?Where is the money coming from?How would the home service work? Where does confidentiality come into this?

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Concerned for staff.


3.6 Dementia day units – Bolsover SummaryThere was disagreement with this model – it was not considered suitable. Those who agreed with the proposal felt it was good in principle. Care quality was discussed as was the needs of carers. Location, travel, funding and staff issues were raised. There was a request for further information.

Bolsover3.6.1 Disagree This proposal is (disgusting, terrible, unacceptable, disgraceful, a loss, pathetic, wrong, a bad idea, rubbish, disagreeable, stupid, appalling, a shame, impractical, the worse proposal possible, wrong, not acceptable, disappointing, awful, a big mistake, stupid, grossly unfair to patients, isolating, poor, retrograde, horrific, unnecessary, not viable, ridiculous, short sighted, potentially damaging, madness, sinful, very sad, outrageous, terrible, disastrous, shameful, pathetic, utterly pointless, unworkable, discriminatory).

I do not agree with closing dementia day units. Not suitable as the whole service would be disrupted and continuity would not be maintained losing patient trust. I would like all units at Bolsover to be kept open. The people of Bolsover are no push over’s and will not take this lying down, even if the dementia unit is closed the beds are absolutely needed and should be converted into a training centre or something similar. I fail to understand how moving dementia units will make it easier to get the necessary support. A wrong decision the services they provide could be built upon and improved. This is a growing problem.

Bolsover hospital serves is local community as well as over flow from CNDRH without these beds the royal hospital will be continually on black alert.

3.6.2 Agree This proposal is (good in principle, ok, possible, fine, unopposed, sensible, supported, acceptable, adequate).

It is quite close to facilities in place at Chesterfield Royal Hospital and Walton. Provided the new service covers the whole region and there are enough teams. Services need to be spread across the County not all in one place. It fits with the overall plan. No services should be removed until a proven alternative is in place.


3.6.3 Patient Care & Quality This service works closely with consultant psychiatrists and in

many cases helps them to clarify a memory impairment diagnosis. This services provided

specialist care and support and houses a staff team that are know their patients inside out, which allows thorough and true specialist

assessments to be completed.

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Please reconsider and do not close.

This is a wonderful caring hospital with hard working staff.

The care provided is excellent and has benefited patients and carers and given hope and comfort to us all. We all are friends and stay as a block and see each other socially which is very helpful. It wouldn't happen with home visits. This might be the only time that this patient leaves the house and has any real contact with other people and may be the only hot meal they have. This hospital appears to be doing good work in looking after patients. Early stage dementia can knock your confidence, being able to 'get out' and feel secure and safe somewhere other than home is essential.

I would want assurance that this alternative would be sage and provide quality care and not put patients at risk. You need to establish correct working teams for this to work correctly i.e. social services/ physios, District nurses / OTs / GPs they all need to work together for this to work. 3.6.4 Carers and Respite This service may have an impact on carers respite. Relatives need to have time on their own, i.e. day units. This type of constant supervision must be very valuable to exhausted families who can’t provide this care at home. This may be the only break that a carer gets. Bolsover has been a lifesaver for my dad to have a break from mum twice a week for just 2 and half hours.

This will have a negative impact on carers/relatives of people with dementia.

3.6.5 Location Centres cannot be near to every person. A shame but I suppose these services could take place at GP Surgeries or in patients' homes. Bolsover could merge with Walton & be located at Callow.

These units are near to their own homes. We should be seeking to strengthen such units. Such provision needs to remain to serve their area. 3.6.6 Travel & Transport Elderly, dementia sufferers should not have to travel greater distances as a result of these changes. Not all people are able to travel to a hospital out of their area. I would think it an inconvenience for visitors to have to travel. Far too far away for an ill person to travel.

3.6.7 Costs & Funding If Bolsover is under used if staying open will need to bring in more services. Expensive to run at the moment. Most carers would like to contribute money to this cause.


Information seems to be a bit sketchy. There are no figures I have not heard anything to explain what wrap around service is going to bridge this gap

3.6.9 Staff Not all staff want to or have the skills to work autonomously in the community. The staff in the community will be too stretched to provide an effective service as there

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Relatives are often elderly themselves.

won’t be enough. Derbyshire have a distinct lack of voluntary sector dementia services. These hold up enhance and support the services provided by the NHS or councils.

3.6.10 QuestionsWhat about the people that currently use these units and for whatever reason care at home is not suitable for?How will this benefit anyone?Where will alternative centres be? Where do long term dementia cases get support if this closes?Why is this all the North and not the south?Don't some dementia patients benefit from the social contact with others? Will all staff be relocated or will there be some job losses?Are there long term plans to utilise the empty premises?How will those providing the services be supported if they have no base?Will staff be trained nurses to identify health risks?When looking at the models have volunteer been taken into consideration?How would the home service work? How many more staff needed?

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3.7 Dementia Rapid Response TeamsThe proposed service change would include introducing Dementia Rapid Response Teams to intervene when an older person with severe dementia is having a crisis which would presently usually require hospital admission.

What do you think about this proposal of introducing Dementia Rapid Response Teams?

3.7 Dementia Rapid Response Teams SummaryThere was broad agreement with this proposal. Care quality and patient safety was discussed. Access was a concern with the view that this should be a 24-hour service. Those who disagreed with the proposal felt that it would not work in practice. There were questions about the staffing levels and qualifications. Carers needs and respite was raised. It was thought that community beds would still be needed. Further information was requested. Matters of costs and funding, travel and transport, location and management and organisation were also raised.

3.7.1 Agree This proposal is (a great introduction, good, excellent, ok, great, ideal, supported, welcomed, excellent, sensible, great, a much better way of dealing with a crisis, helpful, forward thinking, ok, effective, impressive, the way forward, much needed, sensible, brilliant, laudable, less traumatising for patients, a good way to prevent admissions, brilliant, well thought out and workable, worth trying).

Think the idea of someone qualified to help in their own home is initially good. To keep

someone at home is a good idea. I think it's wonderful that those with dementia may get additional years at home before

their symptoms get too severe. This might be especially useful as many Dementia patients

do reach crisis situations when family try to continue in a very difficult situation. Works well in other areas. See Hereford's provision in the Stonebow unit for an example of good practise. You have the staff, skills and expertise to do this tomorrow, you don't need this exercise to get this off the ground. Fine if they can actually responded and not another delay to services. It should be an additional provision rather than a replacement. I feel a trial period on several patients would be advisable before a total take over. Don't close any beds until they are in place.

3.7.2 Patient Care & Quality Cases like FDD can be a matter of safety, indeed life or death for some carers. A crisis can occur with slight dementia. I worry what will happen if dementia patients are not monitored at night, they may wander out of their homes and injure themselves.

If a Dementia Rapid Response team attendance is required by a patient I would say that patient is already in need of more intense psychiatric care. Hospital admission is needed for correct assessment. Loneliness of individuals or even for isolated couples is literally a killer leading to depression, cognitive deterioration and deterioration in the older person's physical

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If it would help prevent acute admission I see this as a good proposal.

Safeguarding plans for patients in their own homes are needed.

health. If these people are alone and have dementia they are not always capable of calling in a Dementia Rapid Response Team! Simply put, people will be put unnecessarily at risk.

'Community-based' emergency services have great difficulty in applying prioritisation rules nor will they be equipped enough to deal with the problems. At present even an ambulance based in Buxton takes 25-30 mins to arrive. I do not believe a 'rapid' response team would be rapid. Out in the Valley there is nothing "Rapid".

What is needed is a care pathway which responds to the state of dementia and the personal relationship care of the person concerned. This will vary and no one change will provide the answer. In a great many cases, dementia rapid response teams do not avert admissions, they only delay them.

Dementia patients need continuity with people they know, they can react badly to strangers. Rapid response teams bring uncertainty, different staff every time. Its not just the response I worry about but how long they stay with the patient. How long and how intense will the input be.

If these teams are able to give outstanding care. I use 101 phone often and find the team very good.

I would like to see robust KPIs that monitor response times and patient and career satisfaction. The skill mix, staffing and support will need at least 3 years to trial.

3.7.3 Access Not having a night service is short sighted. It

seems to me that there can only be crisis between 8am - 8pm. But somebody with severe dementia would

undoubtedly require 24-hour care provision. Access to an alternative care

home or bed space would need to be available around the clock. The team would need to be available 24 hours a day 7 days a week and be able to cover the vast area of North Derbyshire – including psychiatry cover.

Sundowning is another symptom of Alzheimer’s disease and other forms of dementia which means that confusion and agitation worsen in late afternoon and evening. Lewy Body Dementia and Parkinson’s disease dementia is also associated with disturbed sleep, and at nighttime visual hallucinations or misidentifying relatives can be common, which can be very challenging for carers to manage.

I believe other services of this nature are aimed at patients of all ages and not restricted to 'severe' dementia. These teams must include care for many other types of mental health problems other than dementia.

3.7.4 Disagree This proposal is (unacceptable, hilarious, not good enough, problematic, a waste of time, unworkable, rubbish, appalling, not good, inadequate, a crisis, complete nonsense, disgraceful, impractical, ill informed, a deterioration in the level of care, a very poor use of professional resources, floored, a poor decision, a crackpot idea, not the best idea, might fail catastrophically, a cartoon idea, unrealistic, ridiculous, unfair, scary, unbelievable, a joke).

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This would be good if it were a 24-hour service.

I don't think it would work.

In another part of the country this concept does not work in practise. This will put dementia patients at risk and more than likely result in 999 calls for ambulance and police, services that are already under great pressure. Dementia Rapid Preseason Teams are likely to spend most of their time dealing with problems that arise from the lack of regular day provision. You will end up with patients in hospital a lot earlier than needed - it needs a lot more thinking about. There is a danger that the current proposal will result in fragmentation and the establishing of similar boundaries that the current integration agenda is seeking to overcome.

There is an increasing number of the community being diagnosed/living with dementia symptoms in their own home this is increasing day by day. What is likely to result is a few qualified staff 'fire fighting' and exhausted. Loads of support workers working beyond their remit and becoming disenchanted. Private Companies will then set up 'wards' (this has happened in Derby in Younger adults) and the whole principle of care in the community becomes an expensive farce.

3.7.5 Staff Each case will take up a large amount of time by

the response team, you may need more teams then suggested as Derbyshire is such a large area. Staffing would be vital.

The teams need to be very specialised, confident and with a good skill mix to provide a

comprehensive assessment and support.

I feel you will have difficulty recruiting enough staff. Can we recruit enough therapists/doc/nurses when community staff/organisations are already experiencing recruitment difficulties and training budget cuts - no longer flexible LBR [Learning Beyond Registration] for this area and LBR is cut 40%. Dementia cases are not easy to care for if you have no experience or are not fully qualified (expert, skilled knowledgeable. specialised, trained, flexible, focused on hospital avoidance). It would be more useful to employ admiral nurses https://www.dementiauk.org/how-we-help/admiral-nursing/. Strongly believe the refocus should be within the Community Teams rather than parachuted in from specialist mental health.

This will be a very expensive service, unless it is under-staffed. Staff have holidays and go off sick and there is no cover. I also wonder what the union’s positions are as I imagine this may be a significant change to people’s contracts and working hours.

3.7.6 Carers and Respite I am concerned that many patients with dementia rely on relatives or friends who are themselves elderly, or have other family caring roles. The carers can cope very well initially, but as the demands made on them by the patient increase this can exceed the capacity of the carer to cope; often they themselves become ill.

In closing the dementia day units this would mean patients being at home which puts extra burdens on the families and carers who already take a lot of pressure off the

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This depends on having adequate teams to cope with the needs of patients.

Dementia has no concept of time - families need support 24/7.

https://www.dementiauk.org/how-we-help/admiral-nursing/

NHS. If carers cannot cope then limited support from a DRRT is unlikely to meet their needs. The carer/s need to feel confident that their needs will be met, and that they will receive the skilled support they require. We need support in the home and in dedicated day units.

This cannot be a substitute for good residential day care and respite care.

3.7.7 Community Hospitals and Hospital Beds There should be a hospital bed available if the person

concerned needs it even once the response teams have been. People with severe dementia need their local hospitals - they do not require

"teams". They need care which is already being provided in a way which is much more effective and

superior to your cost cutting suggestions. For some patients with dementia and complex mental health needs, being away from the home environment may be the right way forward to support an assessment and treatment approach and also a de-escalation approach. If patients become quite unwell medically i.e. UTI, CI etc. - these conditions are likely to have significant adverse effects on their dementia.

Some homes are not suitable for home support teams to access due to hoarding, fire risks etc. The number of beds you will still have, given your expected increase in demand in this area of 16.5% - the combined loss of 104 beds seems far too high. I have been running a similar crisis team in an adjoining area for 10 years and can state categorically that the need for dementia admission beds has never been higher.

From a care home point of view having a resident that is in crisis that people are not able to respond to will end with the home ringing emergency services for support. They will finish up at A&E – and therefore will have a knock on negative effect. If general hospital admission is to be avoided surely the community hospitals will be needed instead.

A rapid response service may be a valuable provision in reducing hospital admission risk and supporting carers from an early point. Anything that stops dementia patients being admitted to a general hospital.


2 teams proposed seems based on little evidence - no clear proof the teams will provide full cover No firm proposals as to who and how many will make up the teams. No suggestion as to location. This proposal lacks detail in regards to out of hours crisis. I do not know how many people would be better at home after a crisis. It is difficult to imagine how an on call consultant psychiatrist will prevent admission. I would need to know what these Rapid Response Teams are able/entitled to do I would want to be assured though that there has been robust process mapping to demonstrate that the community team are resourced sufficiently to meet demand; using the range of dementia prediction tools. I am yet to see evidence of the effectiveness of this service It totally depends on what their roles would be and how the staff are utilised.

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Hospital must be the best place.

What hours will they work A lot of education for families/carers/GPs needs to take place. I am not clear if this is being presented as either/or so am not sure what is threatened by such an approach


This sounds like a good idea from elsewhere - but without the evidence that these changes are appropriate being shared in the consultation. Interesting that you lave so little space for the previous question!

3.7.9 Costs & Funding I would need reassurance that there was enough money in the pot to ensure the response teams were adequately funded so resources weren't too thinly stretched. If funding is kept up - not cut after a few years when money is tight. As long as the response is not privately run.

Think this is a way to waste money. This is simply cost cutting, not improving care. Surely it would be more expensive running and training for this service (and paying transport costs, a GP out of hours and then ambulance staff), than using revised existing bases currently provided.

You will soon be receiving extra funding as a result of this country voting to leave the European Union. Some of this money should be spent on providing Dementia Rapid Response Teams.

I'm not sure what savings will be made at the end of all of this. But surely these should be in place now - people have paid into the NHS and should get the best possible service. I think this would be more cost effective.

3.7.10 Travel & Transport I feel the teams would struggle with the geography of the vast and varied areas of Derbyshire, especially in the winter with the problems of the road networks, (e.g. heavy rain, flooding, snow) - some roads get closed. Poor road networks - about the worst in the country for access and patchy mobile phone signals.

The lack of Ranger support and relying on volunteer groups does not solve the issue, a lot of employees have small economical cars due to the rising cost in motoring, these small cars will not cut it in the rural area that they will be expected to cover. Unless the wages are dramatically increased and vehicles are provided you cannot expect employees to travel the length and breadth of Derbyshire Dales. This service cannot give good cover to all due to distance to travel - such teams will spend more time in transit than providing active patient care. Working in the community myself I am aware of the miles I can cover on planned visits. If this was to include countywide this would incur a massive cost.

3.7.11 Location My only concern is where these would be based. I am assuming these would be based in local care centres and go out when required. Provided this service from the Community Hospitals. A rapid response team in the High Peak would need to be based here - it is easier to reach Stockport than Chesterfield.

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Very difficult in a rural area.

I agree with all the proposals as long as the infrastructure is such that it will achieve all the objectives. This means much closer working together. This service would be a useful link with the (community teams, out of hours service, community hospitals, present facilities, day care services, High Peak Borough Council Care Link, GPs, Community nurses, social workers, Adults Mental Health Social Worker, nurses, physios, occupational therapists, care assistants and inpatient services). There is already a service called first responders in the ambulance network.

This would be difficult to manage and needs to be forward planning. The services need to be joined up so that urgent can be co-ordinated.

3.7.13 Unsure Not sure about this. Not convinced it would meet the need. I will believe it when I see it.

3.7.14 QuestionsAccessIs this going to be 24/7? What are the response time-frames? What about patients who live on their own?How will the team be alerted? What happens if the crisis arose outside the hours offered by the rapid response team? Can they be called by anyone? Are they ready to respond immediately at 8 am?Dementia is generally in most cases a progressive illness where does the rapid requirement come in?

Quality of CareWill patients be safe?How long would members of the Rapid Response Team stay with the dementia patient?What is likely to be the nature of the crisis? Does this improve the current Hospital based service? Why are you targeting the most the most vulnerable sectors of our community?

Location & TravelWhere will the teams be based?How to you expect them to get to these villages quickly in the winter months particularly? How big an area would they cover? Will staff have to travel there from home to start their shifts?

Service, Organisation and ManagementHow would this work? What is your evidence base? Who decides which patient needs there support?What happens if many crises occur at the same time? What will the Rapid Response Team do? How bad would patient have to be before admission? How will their performance be assessed?Would the same team attend the same patient or would different people turn up? What happens to other patients who have other mental illness beside dementia? Where will he/she [psychiatrist] be based?How will the DRRT prioritise calls? Why not prevent the crisis which is often what day units do? Where will they operate in the home? Where does the person with severe end stage dementia want to die- link with community palliative care teams?

CarersWhat about the carer’s needs (e.g. sleep, respite)?

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Good perhaps in a crisis, but what about the rest of the time - the lower level everyday, which wears the carer out?How many carers would be too proud to access it? If the carer has a problem will the team respond to call for help?

StaffHow many staff will be required? Where is this team of highly skilled and qualified nurses going to come from? 1) how many would be in the teams? 2) how many teams would they be?How is it proposed to convert generalist skills to specialist mental health skills, when training places are under provided?How will existing staff be supported to develop appropriate skills when re-deployed?Will only 1 on call adult psychiatrist be enough? Do you anticipate that voluntary societies will play a larger role?

BedsBut would there still be back-up beds if things do not work out, or the family can no longer cope, or the patient has to be sectioned?

Are you also aware that Derby has only recently started this type of scheme and there are still two OPMH Day hospitals functioning in the southern part of the county?If the number of people with dementia is expected to rise from 6000 to 7000 in five years does logic not suggest that we need more beds not less?

FundingCan our health authority be prepared to pay for a service with the commitment it deserves? Where will all the extra money & nurses come from to facilitate this idea?A lot of people have paid into the NHS through national insurance contribution since it's introduction - do you think you are letting anyone down in any way?

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3.8 Community Hubs.The proposed service change would include setting up local ‘Community Hubs’ to enable the teams to work closely together to provide support to older people near to or in their own homes in the eight natural communities of North Derbyshire. The Community Hubs may not be located within a building - they will be sufficiently flexible networks designed to serve the population.

What do you think about this proposal of setting up local ‘Community Hubs?

3.8 Community Hubs SummaryThere was broad acceptance of this proposal. Location is key. It was thought that a stable location would be necessary. Patient care and quality was discussed and the need for services to work together was raised. Management and organisation discussion emphasised the need to strengthen communication. Sufficient funding was a concern as was staffing levels. Further information was requested. Travel may also be of concern for some. It was thought that community hospitals already provide hubs. Issues over hours of access were raised as were concerns about carers and respite.

3.8.1 Agree This proposal is (fine, beneficial, excellent, good idea, great idea, necessary, possible, nothing wrong with it, useful, ok, essential, better for us, a step towards the joined up care ideal, could work, sensible, worth a try, a change for the better, important, plausible, fabulous, positive, favourable, agreeable, workable, helpful, an excellent resource, fair, wonderful). In these times of availability of rapid, detailed

communication this should work efficiently.

Hubs largely already exist. DCHS already works in community support teams with allocated District nursing teams base in GP surgeries, dedicated community Matron, Social worker, physio and OT.

The Community Support team works with the DCHS Care Coordinator who

runs and liaises with all areas to ensure the correct service/support is accessed and all

agencies are up to speed with patients on the virtual ward. There are great examples of where these have worked in the Netherlands and much to learn from their model - small teams where people get used to who they see etc. I suggest that you talk to district nurses, podiatrists and Health Visitors on this issue as they have to try to make it work a very day.

This is a fantastic opportunity to integrate wellbeing and health promotion services in order to educate the community and prevent hospital admissions. This should be happening now in the existing system. It has been successfully done in Trafford Manchester with the help of outsourcing to a 3rd party.

A good add on but not an alternative to hospitals or existing services.

3.8.2 Location No indication of location. It's difficult to see how these hubs will be organised and coordinate with each other if they are not based in a building. A virtual 'community hub' sounds like 'newspeak'! Not having a building associated with them will be inconvenient for nurses and carers which may lead to a loss in productivity and cooperation between members of the profession. They need to be in a building so that

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All meeting regularly and discussing patients and exchanging information and support.

shared resources and human interaction leading to team building can be fully utilised and it may reduce the risk of professionals feeling isolated at a time of great change. Hot-desking where too many people share a small space is not adequate. It needs to be central for all teams to access for this all to work.

The general public also need the base for collaboration. Moving staff to geographical working works for some specialities however not for Community nursing as the close relationship and knowledge base of the GP surgery team would be lost to the detriment of the patients and their families. Elderly don't have as much access to the internet etc and so it is harder for them to find out about things.

There is work to be done ensuring that the current sites are used to maximum capacity. We could call these GP surgeries, or if needed to be bigger, community hospitals.

Whatever you do nothing looks to be local. Older people need to be near home.

3.8.3 Patient Care & Quality The managers and CCG will need to work hard to ensure collaborative working is effective with cross boundary issues between organisations and management structures being a big obstacle. Health and social care need to work to the same policies and procedures and there needs to be one contact number for patients. IT systems must be linked to enable partnership working and excellent patient experience and safe care.

The scheme in Bolsover area for Community Matrons was the best example I ever saw of Social Services and NHS working together. We already have a hub style arrangement set up at Whitworth hospital with ward, community and social services staff working together. Community Hubs need to be provided in conjunction with Southern Derbyshire for the Derbyshire Dales area which bridges the two regions.

My concern is that with 8 neighbourhood hubs, there may be times when services are not operating safely and the specialist services for older people will become too depleted. They wont be flexible enough.

Support teams should be able to work closely together under the existing format.

I think in practice this will mean a fragmentation of service provision as services will only be available locally on certain days, this could

mean less provision as those in need may not get seen until the allocated day. Patients

aren't going to get the care they should be receiving. A lot of patient neglect comes to mind. I think we are at great risk of isolating people and their families within

their own homes. You must know that this cannot possibly be in their best Interest. It is bound to lead to a plethora of complaints and possible legal challenge on Human Rights grounds.

We see many patients within their homes, some in clinic at our hospital where specialist equipment is available for specific treatments, a few in other venues such as their workplace for work-based assessment as part of vocational rehab.

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Joined up care is vital.

I don't see why new hubs would work any better.

For some people where there are potential safeguarding issues it is often better to see them outside of their home and away from their family/carers. Many properties are unsafe/ inappropriate places for rehabilitation to take place. Manual handling risks increase in the patient’s own home, where equipment is not always readily available. However from personal experience within my family this will only work if the 'patient' will allow carers into their home.

3.8.4 Disagree This proposal is (a waste of time, not acceptable, not realistic, meaningless, unworkable, a waste of resources, rubbish, added expense and wasted effort, ridiculous, unacceptable, disgraceful, likely to fail miserably, crap, not a substitute for what we have in place now, airy fairy, poorly conceived, cheap, nonsense, a little convoluted, not likely to be successful, not good enough, not practical, disgusting, terrible, totally inadequate, misguided, bonkers, not brilliant, silly).

Fine words butter no parsnips. The community hubs will take time to run so impacting on time spent in the community likewise the time spent with each member of staff travelling between home's will also impact on working time even if you are able to recruit the right people to the right standard. Next to think of is the added cost of standard checks and managing staff resulting in the loss of more time in the field. Carrying equipment in their own vehicles invalidates their insurance and presents a potentially fatal risk to staff and their passengers.

May work in cities but not in a rural area. These proposals are likely to create a two-tier health service for the people of Derbyshire. This goes against the NHS constitution.

3.8.5 Management and Organisation Any measures for better communication between teams and greater flexibility are to be welcomed. The public sector has a very poor record of such teams communicating with each other effectively and consistently. But enabling teams to work closely together is only a tiny part of the problem. Staff attitudes and networking across services by committed professionals is the most important aspect of cross-service collaboration. Teams need encouragement and support to work together, and the time to establish personal as well as professional relationships. Whilst all professionals should accept they each have personal accountability the coordination of services locally will be 'hit and miss' without dedicated management alongside support for staff working within isolated and challenging environments. I think its is important to have a base for people to able to meet face to face and feel part of a team.

I am assuming the hub will be operated through computer contact. This relies too much on technology. Mobile phone signals

and broadband coverage, where available, can be patchy. In my experience it is very difficult

to contact the "hubs" - messages left on the answer phone are not returned.

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From a personal experience of working closely with hubs they do not work as well as traditional methods.

You will need good IT.

For healthcare to be distributed the population needs to be confident in how to get it, where to get it and when to get it. Changes need to be communicated delicately. More info needs to be circulated via Doctor's surgeries to raise awareness of what these ' flexible networks ' may be involve.

The left hand should know what the right hand is doing without an over inflated bureaucracy. Matrix management within boundaries has attendant communication and responsibility problems. The 'Hubs' are likely to experience these.

Try them out first (maybe in one area) to make sure it all works before closing other facilities.

3.8.6 Costs & Funding If funding is kept up - not cut after a few years when money is tight.

I have to work from home because my company closed my local office where I worked. This saved them money, but costs me more, in heating, travel, and car insurance. Logistics and transport costs of nurses will be a nightmare.

I think it sounds like an idea to save money. Surely it will be more expensive for hubs than existing NHS owned hospitals with beds.

This is obviously a cost cutting exercise. This is just shifting the cash from one place to another. We should be supporting carers who are already saving health and social care millions of pounds.

3.8.7 Staff Community hubs need to be staffed by sufficient numbers of experienced (qualified, well trained, value driven) staff with good admin and managerial support. Effective training for staff will be essential.

I am concerned that several staff have retired, changed jobs or are looking

to leave which has meant that the service has lost very experienced

staff. People that were once proud to say they worked within this

establishment now are thoroughly demoralised through wage cuts and de-grading. I am aware that a colleague who recently retired has already received a letter inviting them to consider returning to work due to shortages of community psychiatric nurses (community workers).

I am not clear on how this will impact on staff working arrangements and what consultation has taken place with staff. The proposal talks about the shortage of specialist doctors and nurses but part of the problem is that changes to services mean that they are not retaining staff. You have a workforce that is half the size it was ten years ago but still serving the same if not larger community that it did then. When there is sickness or difficulty recruiting, services fail.

Providing rehab to a number of people in one place by one or two therapists is far more time efficient than numerous therapists visiting individuals in their own homes.

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Enough money needs to be provided to make it work.

High Peak and Dales areas will need more staff due to travel time / rural area.

The presence of voluntary services is much needed. A volunteer services operated by my local doctors surgery has been halted by CQC. If there are to be services supplied by the volunteer sector, then CQC needs to recognises what is needed in the area.


I have no idea what this means – too vague. I don't understand what a "sufficiently flexible network" would be. Hub 8 is very big and a bit vague. It only mentions older people. I would like to see a report of the research that the CCGS have undertaken being made public - Evidence that modelling has been carried out to determine the size of the team to meet needs of predicted number of patients. A total lack of information re location, response times and type of staff. I am unclear what is meant by in 'or near' their own homes.

The word "if" appears as many times in the "consultation" document as to make the proposals meaningless.

3.8.9 Travel & Transport Have to think about transport, bearing in mind that frail elderly people are not up travelling long distances – however, some people without transport could find it easier.

You must already know that many older people will not tolerate the long journey the Hub model will necessitate for them. Your own Pre-Consolation Business Plan document admits that many older people will be travelling further. Transport would need to be provided as we are faced with further cuts in bus services next year. This means transporting people around in community vehicles. Takes too long - what about the person you pick up first, they will be so exhausted by the time you get everyone there.

The environmental impact of more miles doesn't seem to have been considered.

Parking availability for staff needs to be considered.

3.8.10 Community Hospitals and Hospital Beds

I am concerned that the hubs are described as ‘virtual hubs’ so they will not provide an adequate replacement for the day hospital units or community hospital beds.

There is no better decision to have the treatment needed than in a ward. Everything that is needed is on the ward.

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I notice that the eight communities on the map are not close to Matlock.

Local hospitals are already community hubs.

3.8.11 Unsure Not sure. This rarely works in practice. Very sceptical. All ideas should be looked at to provide for the growing need. This could only be judged on its' ultimate effectiveness.

3.8.12 Access So 2 sets of people 8am till 8pm, is just not serviceable, this needs 24 HR structure including rapid response teams. The most vulnerable time is during the night when the 'hub' is closed. I don't think there will be enough support out of the working hours of these Hubs. The concern is that each referral will be marked urgent as the "hubs" are not able to rapidly respond to non-urgent referrals.

3.8.13 Carers and Respite Sometimes the carers need to be taken into consideration. Carers can visit them easier. Could help the families. All of the proposals in this consultation put an added strain on relatives and carers who are already struggling to cope with their responsibilities.

3.8.14 QuestionsLocationWhere will these hubs be located? Why set up hubs when there are community hospitals already in place? If they are not located within a building, what does that mean? Will you keep them local? Are there suitable existing buildings? Where are the bed and places of safety going to be?Aren't GP surgeries 'community hubs' anyway?

Operation +How will the Hubs work in practice (practice, equipment, services, access)?How do you know it will work? How do they coordinate/communicate with each other GPs, District nursing teams etc? Who will monitor and take the lead?How will effectiveness be measured? Will it be run on a 24hr basis for emergency situations? Is this proposal based on other similar projects in the UK? How would patients/ carers contact these hubs?Will there be pilot areas? How much time will actually be with patients?Will depend on internet / phone access which is impossible in many rural areasHow can teams be coordinated, resources efficiently allocated and team spirit engendered?

ServicesWhat services will be provided through these hubs? How will they access equipment services if the internet system does not function? Would they need a base to log on to main systems eg for Results, xray reviewing etc? Additionally there are 3 different electronic patient record systems used in North Derbyshire which do not communicate with each other (+"Framework i" used by social services) - how will the teams access essential information and communicate "better"? Will "pool" vehicles be available to community teams?Will case reviews be via Skype?

StaffingWhere are all of the staff coming from to man this?What will be this ratio in these hubs because the community does not have a safe nurse : patient ratio guidance?

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How many miles will staff have to be on the road in queues?What if two nurses have to attend and they are many miles apart? What happens when team members are off work (illness/holidays)?Would they be working flexibly/ from home?How will staff safety be ensured?Will each hub have a Manager, Deputy Manager, Assistant Manager, Clerical Manager, Team Leader, Senior Coordinator?

FundingWill funds be made available to build them?Is this a money saving exercise? Will this not cost more to fund where the hubs are and more staff to be in it? Will staff received enhanced pay for using their own vehicles as their "base"? Will you make sure the voluntary sector are sufficiently funded?

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4 Proposal 2 - Executive Summary

Proposal 2 – a) Permanently closing 16 beds at Bolsover, 16 beds at Clay Cross,16 beds at Newholme, 20 beds at Whitworth, 16 beds at Cavendishb) Providing 8 specialist rehabilitation beds in the west of North Derbyshire & 20 at Chesterfield Royal Hospital.c) Permanently closing older persons’ mental health community hospital beds; 10 beds at Cavendish, and 10 beds at Newholme,d) Establish a centre of excellence at Walton Hospital


There was broad disagreement with the proposal to close beds in any of the 5 nominated community hospitals. It was thought these beds would be needed to serve the local (and remote) communities. The introduction of Specialist Rehabilitation beds in both suggested locations was considered a good idea, however the locations raised travel and transport concerns. The number of proposed beds was also considered to be low. There was broad disagreement with the proposal to close OPMH community beds at the two nominated sites. The establishment of a Centre of Excellence at Walton Hospital met with broad approval, however the location was an issue for some. In each case there was discussion around the themes of the use of hospitals and hospital beds, management and organization of services, locations travel and transport, nursing and care homes (capacity and care quality), carers and respite, estates (building use) staff (levels and qualifications). In every case there were requests for further detailed information and a range of questions about the proposals.


Proposal 2

4.1 Community hospitalsThis proposal is to permanently close community hospital beds and replace these with community-based care teams and local beds with care in nursing or residential homes as set out above. The proposed closures would include;

16 beds at Bolsover16 beds at Clay Cross16 beds at Newholme20 beds at Whitworth16 beds at Cavendish

With the introduction of community-based care teams and local beds with care, what do you think about this proposal to close beds at:

4.1 Community Hospitals Bolsover SummaryThere was strong disagreement with this proposal. 24-hour care is a priority. Those who agreed also felt that this proposal should be additional. The benefit of community hospital beds was discussed. There was concern that this was a cost saving exercise. No changes should be made until alternative services are proven. Local hospitals are preferred as people have difficulty with travel and transport. There was concern that care homes did not have capacity. Carers needs were raised. Further information was requested.

Bolsover4.1.1. Disagree This proposal is (appalling, short-sighted, disgusting, not appropriate, not good, not acceptable, disgraceful, wrong, ridiculous, in need of revisiting, a backward step, rubbish, dreadful, disastrous for the community, a bad idea, impractical, criminal, shocking, poor, blinkered, a big mistake, a shame, not an option, dangerous, daft, over ambitious, dodgy, Ill thought out, tragic, madness, unnecessary, a decision which DCHS will come to regret, sinful, terrible, undesirable, a crying shame, a disaster for the community, atrocious, poorly thought out, bonkers, shocking, a damning indictment on the community care system, devastating, madness, stupid).

Always a bad idea to shut hospitals. There is no good reason for removing local care. If closing the whole hospital it would have major consequences to the local population, holiday makers, acute trusts and primary care trust, east midlands services which are already overstretched - this would have a huge knock on effect. It will create a geographical and skills hole in the local community.

If the number of people with dementia is expected to rise from 6000 to 7000 in five years does logic not suggest that we need more beds not less.

You are simply transferring the problem from the public to the private sector.

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Bolsover should be kept open.

4.1.2 Patient Care & Quality Some patients require 24-hour nursing care, particularly end of life. Not everyone can be cared for at home. I know that some people need support and care and I feel concerned about the standard of care that will be delivered in care homes.

Bolsover have provided excellent care on a "halfway" house basis until permanent care home of our choice was found - location is important. It would also have an

impact on the minor injuries unit, which help to prevent admissions to acute trusts or

give patients on-door step treatment. You are taking away choice. I’m 62 and would not want to go into a home even for a short period, hospital would feel more safe and secure with well paid staff. What about people who are not suited to at home care, for whatever reason.

4.1.3 Agree This proposal is (good, agreed, ok, excellent, not concerning, sensible, a sound plan, acceptable, fits with the overall scheme, fine, needed, fair enough).


4.1.4 Community Hospitals and Hospital Beds Concerned that we will not have enough beds for all areas. Recently there were no beds available and Bolsover patients were admitted to Whitworth so it would appear beds are still required. People of Bolsover need their beds.

Health Service professionals can surely deal with more patients more efficiently in a hospital situation. I would imagine that there are patients/ carers who really need a prolonged rehab spell in a site near to home, with daily access to AHP staff, equipment and specialist skills of hospital based nurses. There may not be enough beds at Chesterfield Royal specialist rehab if they are required for acute patients e.g. during the winter.

There will be more acute admissions; there will be more bed blocking in acute Trusts. This will fail if social care response is not greatly improved. I think we do need community beds but I feel they are not used correctly anymore. They are seen as a dumping ground by CRH while waiting for carers to be put in place.

4.1.5 Costs & Funding The decisions on which beds to close where needs to be based on individual

populations, travel links for patients an carers and the cost of the individual upkeep on building - it

cant all be cost driven alone. This whole proposal seems to be more about saving money than improving care.

Lease out offices and property to community groups to create care villages on DCHS property. You could also set it up with respite care (people would pay).

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I think it will cause serious neglect for patients.

Bolsover provides a good service.

Money can be saved in other ways.

Not keen if any of these are put out to tender and private organisations take over.

4.1.6 Management and Organisation As long as Community Care is well provided and you can prove that they are no longer needed. No beds in any hospitals should be closed until proven replacements are in place and working. Any loss would need to be gradually implemented to ensure there is not a sudden shock across the system. It’s a lot of change for a number of communities.

Also the changeover period would need to be very carefully managed. The local beds with care need to be spread evenly e.g. 4 beds in 4 different homes allocated, then therapy can be better planned, links with the care home staff can be made. If the beds are constantly changing and spread across 6+ homes, it will be difficult to plan therapy and it will be too time-consuming and inefficient.

4.1.7 Location These small hospitals are nearer to people’s homes. There is a special need for end of life to be provided as close s possible to the various local communities. If your proposals are truly local, you cannot expect these to be all in Chesterfield.

Bolsover could merge with Walton & Clay Cross & have 24 beds, based at Callow.

4.1.8 Travel & Transport Closure of beds means that elderly people in hospital are a long way from home and family, making visiting almost impossible. It is very difficult to travel to Calow hospital using public transport. Not a good idea for an elderly person. Parking at Chesterfield is difficult and distance to wards is too far. Visiting a loved one at CRH can often mean 3-4 bus changes from most of our rural areas.

4.1.9 Nursing & Care Home Capacity Bed numbers have reduced in Derbyshire. The pressure on beds in residential homes is already very high. Would need to ensure sufficient capacity in "Beds with Care". Many patients already end up in Matlock and Bakewell even thought they are from Bolsover. We would need extra care homes.

4.1.10 Carers and Respite My concern is that less beds means less overnight support and respite for people with dementia and their carers when they are in a crisis situation.


I would need to have more information about how this proposal would affect this location and what the future is for other services located here. We have no assurance about numbers of beds with care. I would like to see a report of the research that the CCGS have undertaken being made public. I have not heard sufficient detail about what consultation has taken place with Social Care and other agencies to assure DCHS that there will be a sufficient supply of care staff in place to meet the increased need. Local communities will not understand why these beds are closing. 4.1.12 Estates

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It's not an old building. Once these properties are lost they cannot be rebuilt.

The patient should be at the centre of what we do - it doesn't have to be in an antiquated building.

4.1.13 Staff Not all patients can be cared for in the community; with poorly trained staff. If more patients are in nursing homes then more investment is needed for DNs both in and out of hours to support them.

4.1.14 QuestionsWhat are the arrangements for staffing community based teams (number, hours, capacity, travel, rising demand)? How do we know the community care model works? How will nursing/care home beds be funded?What about carers who require respite? What are the arrangements for local beds (back up, non dementia)? Who will care for the patients in their own homes, are they not scared, confused and lonely enough now?Will care/nursing homes have enough beds?What support will be available after 8pm?What investment will you be making into out of hours services? What are the staffing arrangements for care homes (number, qualification, pay)Why is all NE & Peaks? What about the south?Will there be any facilities for patients to meet as a group such as a day centre?

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4.2 Community Hospitals Clay Cross SummaryThere was broad disagreement with this proposal. Patient quality of care was of concern. Hospitals were preferred. Those who agreed felt that the proximity to Chesterfield was a factor. There were concerns that this was a funding driven decision. Carers needs and respite was discussed. Further information was requested. The location and transport links were discussed. Access to care should be for 24 hours. Care home capacity and staffing concerns were raised. Suggestions for the use of the building were made.

Clay Cross4.2.1 Disagree This proposal is (appalling, short sighted, not appropriate, disgraceful, very contentious locally, wrong, disgusting, ridiculous, in need of revisiting, a bad idea, rubbish, criminal, disagreed, not in the patients interests, shocking, poor, a big mistake, could be reviewed, shouldn't be an option, stupid, totally unacceptable, dreadful, unworkable, a mistake, not good, unfavourable, Ill thought out, terrible, rubbish, madness, unnecessary, criminally wrong, sinful, undesirable, terrible, awful, a crying shame, really stupid, a disaster for that community, really wrong headed, mad, shocking, a backward step in the all encompassing care, devastating, blinkered).

Closing beds and then to conclude that there are 'beds with care' somewhere else in the community seems redundant. Clay Cross has been stripped over the years and this is the final action - increases the insecurity of provision. Taking away vital services is never a good thing. It will create a geographical and skills hole in the local community.

Community Hospitals are often the place patients and their loved ones choose to die. It is a

place where they can be confident in the quality of care they will receive and where experienced staff are on hand to advise and support at a potentially traumatic time.

Many people choose not to be at home in their last days for various reasons and there

are not enough beds in hospices to provide this level of expertise. It is vital that through this process we continue to provide excellent end of life care.


4.2.2 Patient Care & Quality Clay Cross ward and service is an excellent local community hospital and would be hard to follow. Having had personal experience of this hospital through a relatives stay I only have praise for them. My concern is that less beds means less overnight support and respite for people with dementia and their carers when they are in a crisis situation.

Nursing homes are poor quality. The beds should stay open so patients have a choice. Some people would prefer to be in hospital and need to be in hospital without

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Clay Cross only has 1 ward open, surely it is a bad idea to close that ward.

having to travel to Chesterfield Royal. They would not get the same interaction with other people. It can also be very distressing for the person with dementia and their carers if they are inappropriately placed and have to move repeatedly. Some patients require 24-hour nursing care, particularly end of life.

4.2.3 Community Hospitals and Hospital Beds There will be more acute admissions. There is already difficulty in finding beds to transfer people to from the acute wards who are medically stable but require further rehab or assessment and discharge planning. It may well lead to additional bed blocking leading to a shortage of acute beds for those who really need them. There is a special need for end of life to be provided as close as possible to the various local communities. Could put more pressure on the Hospice for end of life care.

I feel Clay Cross should continue to provide services for the community such as Catering etc. Could they not be used as "the hubs". I have been using the podiatry dept. at Clay Cross for the last 4 years. Up skilling and increasing care facilities i.e. IV services would make better use of these beds. A minor injuries unit should have been built on this site.

Clay Cross, Bolsover, Walton could all merge for a 24 bed unit.

4.2.4 Agree This proposal is (ok, good, sensible, a sound plan, supported, fits in with the overall scheme, agreed).

This community is closer to the proposed beds in Chesterfield. The patient should be at the centre of what we do - it doesn't have to be in an antiquated building.

4.2.5 Costs & Funding Significant investment will be needed into out of hours District Nursing to support patients at home.

This whole proposal needs to be more about saving money than improving care. The decisions on which beds to close where needs to be based on individual populations, travel links for patients an carers and the cost of the individual upkeep on building it maybe better to invest in keeping certain beds open if needed which is safe and high quality it cant all be cost driven alone. Not keen if any of these are put out to tender and private organisations take over - could lead to more abuse from private company's that are money lead! You are simply transferring the problem from the public to the private sector.

4.2.6 Management and Organisation No beds in any hospitals should be closed until proven replacements are in place and working and you can prove that they are no longer needed. Once the beds have gone, there's no turning back and I am worried about what happens if the closure does not work very well.

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It took years to get this fantastic hospital.

4.2.7 Carers and Respite Need to look after (safeguard) carers and family who are taking all the strain. Respite services must still be available.


Proposals are reliant on previous proposals that are unclear and untested. I would need to have more information about how this proposal would affect this location and what the future is for other services located here. I don't know the population ratios of these areas. I have not heard sufficient detail about what consultation has taken place with Social Care and other agencies to assure DCHS that there will be a sufficient supply of care staff and nursing or residential home beds in place to meet the increased need. Unsure of current usage at this facility to form a valid opinion. I would like to see a report of the research that the CCGS have undertaken being made public.

4.2.9 Location Close to Chesterfield with good transport links for families to visit if patients admitted in a crisis. Serves an area 10 miles from Royal Hospital.

This hospital is well positioned for its community. There will still be people who need a rehab bed. If your proposals are truly local, you cannot expect these to be all in Chesterfield.

4.2.10 Access The loss of hospital beds means that there is less overnight support. The dementia rapid response team will only operate from 8am until 8pm. Sleep changes in dementia are common and people with Alzheimer’s disease often wake up more often and stay awake longer during the night. Sundowning is another symptom of Alzheimer’s disease and other forms of dementia which means that confusion and agitation worsen in late afternoon and evening. Lewy Body Dementia and Parkinson’s disease dementia is also associated with disturbed sleep, and at night time visual hallucinations or misidentifying relatives can be common which can be very challenging for carers to manage. Care needs to be 24/7.

4.2.11 Travel & Transport Closure of beds means that elderly

people in hospital are a long way from home and family, making visiting almost impossible (without a car) parking at

Chesterfield is difficult and distance to wards is too far.

4.2.12 Nursing & Care Home Capacity The pressure on beds in residential homes is already very high. Bed numbers have reduced in Derbyshire and Community teams have been struggling to cope with the current demand.

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Clay Cross is very nice to use and on a good bus route for surrounding areas.

4.2.13 Staff Not all patients can be cared for in the community; with poorly trained and qualified staff. If more patients are in nursing homes then more investment is needed for DNs both in and out of hours to support them.

4.2.14 Estates Change the building to a residential home as an attempt to provide some beds when needed if these proposals go ahead. NHS should change less rent on the buildings they have.

4.2.15 QuestionsHow do we know the community care model works?How can be sure a bed will be available when needed?What are the staffing arrangements (how many, who, sickness cover)?How can you consider closing wards in community hospitals with excellent reputations and rent a ward from CNDRH with the terrible reputation they have got?What happens at night?How will this work in practice (GP referrals)?What arrangements are there for respite care? If beds are closed what would be the role of Clay Cross hospital? Who will pay for beds with care?

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4.3 Community Hospitals Newholme SummaryThere was broad disagreement with this proposal. It was thought care homes did not provide the same level of care. Community hospitals were the preferred option. The isolation of the location raised issued around travel and access. Those who agreed felt this proposal may free up resources. There were costing concerns. Carers needs and management were also discussed. Further information was requested. The staffing of nursing homes was also discussed. The building was considered ‘old’. Nursing home capacity was an issue. Access to care needs to be 24 hours.

Newholme4.3.1 Disagree This proposal is (appalling, short sighted, not good, very bad, not acceptable, disagreeable, terrible, disgusting, should not be happening, a retrograde step, a great shame, ridiculous, wrong, should be revisited, rubbish, appalling, shocking, ill thought out, thoughtless, criminal, not thought out properly, detrimental to patients care and welfare, beyond belief, sad, a loss to local community, dreadful, a big mistake, disastrous, a shame, should be reviewed, should not be an option, crazy, a backward step, poor, will not work, a tragedy, absurd, should be rejected, horrific, madness, unnecessary, inappropriate, disgraceful, sinful, silly, beyond belief, really stupid, out of touch with local needs, out of the question, devastating). Our experience has proved how valuable these beds are and we have seen friends recover well with the services provided here. Closing Newholme beds and then to conclude that 'beds with care' somewhere else in the community seems redundant. I worked here for many years and know just how important Newholme is to all villages. It will create a geographical and skills hole in the local community.


4.3.2 Patient Care & Quality Some patients require 24-hour nursing care, particularly end of life – you are taking away their choice. Nursing homes are poor quality. We only have one Nursing Home. People need to know they are somewhere familiar, where visitors can easily visit, where they feel comfortable, not in an unfamiliar, impersonal environment, where people are overworked. This is leading to the fragmentation of care as opposed to the centralisation. It can also be very distressing for the person with dementia and their carers if they are inappropriately placed and have to move repeatedly. Nursing and residential homes would not have the same team ethos. It's a life-threatening proposal with no proper planning to support it. If a person is on their own, home is not the right place.

This is a caring hospital with local staff and easy access for visiting with excellent care on an all day and all night basis. The standard at Newholme is 100 times better than any local care home!! Newholme is a specialist dementia hospital - this hospital it is best in Derbyshire.

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Bakewell has such a national high proportion of elderly and is a 'remote' community.

As long as the rest of the services continue in Bakewell (so one can access them by bus), including outreach clinics, outpatient services, and Oker ward remained open.

4.3.3. Community Hospitals and Hospital Beds My concern is that less beds means less overnight support and respite for people with dementia and their carers when they are in a crisis situation. People will end up in Chesterfield Royal and admission rates will go up there due to lack of planning and structure regarding these ill thought out plans.

I think this would lead to care further away from home for people being transferred from Chesterfield Royal. There is already difficulty in finding beds to transfer people to from the acute wards who are medically stable but require further rehab or assessment and discharge planning. It may well lead to additional bed blocking leading to a shortage of acute beds for those who really need them. This hospital is appreciated by High Peak residents when the Cavendish is full.

To close beds at Newholme Hospital would be disastrous and probably

illegal. It will get extra funding once Regulation 50 is activated and should be expanded. Riverside is an excellent ward,

Stanton day hospital is also a brilliant facility that would be missed.

Newholme is very good for ophthalmic, podiatry etc.

Could be consolidated at Whitworth either for a 20/ 24 bed unit. Either Newholme or Whitworth beds should remain open. Could they not be used as "the hubs".

These beds are needed throughout the county to serve the people who have worked all their lives supporting these local hospitals.

4.3.4 Travel & Transport The people who have decided that Newholme is shutting obviously haven't experienced a Derbyshire winter. Locality is the key here and is crucial for relatives and friends (especially elderly ones) to be able to visit without lengthy journeys. Calow hospital is a nightmare to get to. The distance from Chesterfield, is too far and has poor transport links. With transport links being cut from county council 2 buses would be needed to get to CRH or Walton from Bakewell let alone from villages.

4.3.5 Agree This proposal is (good, ok, not concerning, agreed, worthwhile, makes sense, a sound plan, supported, fits in with the overall scheme)

The patient should be at the centre of what we do - it doesn't have to be in an antiquated building. Good idea to free-up redundant resources.

4.3.6 Costs & Funding Significant investment will be needed into out of hours District Nursing to support patients at home. There will

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The hospital site should be improved and new units should be built on the site.

I believe you are confusing creating a better and more integrated system, which is a good thing, with trying to cut costs to save money in the current financially difficult times.

not be enough money to do it properly. We (the country) must make more money available for this type of essential service. The decisions on which beds to close where needs to be based on individual populations, travel links for patients an carers and the cost of the individual upkeep on building it maybe better to invest in keeping certain beds open if needed which is safe and high quality it cant all be cost driven alone.

Not keen if any of these are put out to tender and private organisations take over. This will possibly lead to a private hospital being set up. You are simply transferring the problem from the public to the private sector.

Transforming massive public support for friends group for the hospital will not be transferable to facilities many miles away.

I can understand that this is a very expensive site to maintain.

4.3.7 Carers and Respite Need to look after (safeguard) carers. Carers will be looking after potentially very ill people or not able to visit. It will also place a great deal more pressure on the families. If care homes were able to provide enough respite along with new rapid response team it maybe sufficient.

4.3.8 Management and Organisation No beds in any hospitals should be closed until sufficient alternatives prove fully resourced & meet all patient, carer & clinical needs.

4.3.9 Location They are very much needed especially for the Hope Valley as all the others are inaccessible. So much handier for us in this area. Newholme serves an important role to people in the Hope Valley as well as to those living in the immediate vicinity of Bakewell. This community hospital is in the heart of the rural areas.


Proposals are reliant on previous proposals that are unclear and untested. I would need to have more information about how this proposal would affect this location and what the future is for other services located here. I would like to see a report of the research that the CCGS have undertaken being made public. I have not heard sufficient detail about what consultation has taken place with Social Care and other agencies to assure DCHS that there will be a sufficient supply of care staff and nursing or residential home beds in place to meet the increased need. Need to consider numbers and benefits. There is little clarity about who would have access to these beds and what would happen to people when no beds available.

4.3.11 Staff Not all patients can be cared for in the community; with poorly trained staff. If more patients are in nursing homes then more investment is needed for DNs both in and out of hours to support them. Will depend very much on numbers of staff appointed in each area, time of year and width of experience in dealing with both medical and social problems to be cared for. It seems to me that looking after a number of people in 1 place is a much more efficient use of staff.

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Bring back 'crossroads' in the Bakewell area.

4.3.12 Estates Lovely staff but a facility that has outlived its usefulness. Very old (inefficient) building which is listed in parts.

Change to a residential home as an attempt to provide some beds when needed if these proposals go ahead.

4.3.13 Nursing & Care Home Capacity Community teams have been struggling to cope with the current demand.

There is no local capacity in nursing/residential homes at present, and demand on these beds is already very high.

4.3.14 Access The loss of hospital beds means that there is less overnight support. The dementia rapid response team will only operate from 8am until 8pm. Sleep changes in dementia are common and people with Alzheimer’s disease often wake up more often and stay awake longer during the night. Sundowning is another symptom of Alzheimer’s disease and other forms of dementia which means that confusion and agitation worsen in late afternoon and evening. Lewy Body Dementia and Parkinson’s disease dementia is also associated with disturbed sleep, and at nighttime visual hallucinations or misidentifying relatives can be common which can be very challenging for carers to manage.

4.3.15 QuestionsHow do we know this model works (e.g. bed availability)? How and who will fund this? How will this model be staffed (sick leave, shortages)?Would homes be required to keep beds vacant just in case they are required? The current system works well, why change it?Where would the people go if they need hospital care? How are those without their own transport expected to keep in touch? Will they provide the same level of care?These beds in care won't be in Hope Valley will they? Closing Rowsley ward after only just refurbishing it - are you are saving money? Will patients have to pay for beds in private nursing homes? If it's not broke why change? Ill people fall when left alone with acute illnesses causing an increase on fractures, hypothermia, acute confessional states and potentially death, is this FAIR?There are so many services provided here do you realise? How can the safety of patients in the community be assured?Has the option of one central purpose built community hospital been considered?How long would these teams spend half an hour - 2 hours day and night? Will carers problems be monitored?

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4.4 Community Hospitals Whitworth Summary. There was broad disagreement with this proposal. Patient care was discussed. This was a hospital bequeathed to the community and the feeling was that it should not be closed on the basis of funding. Community hospitals were preferred. The remoteness of the location raises travel and transport issues. Some agreed with the proposal. This location is a long way from Chesterfield. Nursing home capacity was of concern. Carers needs were raised. No changes should take place until the new models of care are in place. Further information was requested. Access to care should be 24 hour. Staffing matters were discussed.

Whitworth4.4.1 Disagree This proposal is (appalling, short sighted, not appropriate, unworkable, very bad, disgusting, unacceptable, terrible, thoroughly wrong, a retrograde step, unconvincing, wrong, unbelievably stupid, disgusting, ridiculous, i'll thought out, disastrous, nonsense, criminal, detrimental to patients care and welfare, terrible, has not been worked out, beyond belief, risky, difficult to reverse, shocking, dreadful, devastating, disgraceful, a big mistake, unimpressive, criminal, poor, inappropriate, a major mistake, an absolute tragedy, inconsiderate, a great shame, sad, disadvantageous, taking vital services from local people, the thin end of the wedge, appalling, rubbish, should be rejected, unnecessary, mad, dramatically impacting on the community, sinful, totally out of order, unacceptable, stupid, defeatist, shocking, madness, devastating, crazy)

It must be kept open. It will create a geographical and skills hole in the local

community. The beds can be repurposed and do not have to be closed. Keep the Whitworth beds to make sure that as much as possible of the Whitworth site is used. The loss of Beds at the Whitworth Hospital would be catastrophic to the large population of the Matlock Area. This hospital was left to people in Darley Dale. Could this not be used as a " hub".

This plan is your way of insulting our intelligence by making out this will help the community by closing these essential beds. The beds should be kept and specialist hospital beds added to. This hospital is the next best thing to being at home as agreed by 98% of local population. If the number of people with dementia is expected to rise from 6000 to 7000 in five years does logic not suggest that we need more beds not less. Does not provide enough individual care for the growing number of elderly patients especially those with severe dementia and other acute problems.

4.4.2 Patient Care & Quality Some patients require 24-hour nursing care, particularly end of life. Nursing homes are poor quality. I

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This hospital is a very important part of the community.

Staff have won awards on the ward.

believe 'Beds with care' will not provide the high quality care and rehab that is currently provided at the Whitworth. Whitworth Hospital provides high quality of care including rehabilitation with good access to physio and OT. We have found the Accident/Emergency department at The Whitworth is invaluable. The help my father received was exceptional and as a carer I found it invaluable. It is state of the Art for those in need of professional input and pain relief.

There will be more acute admissions; there will be more bed blocking in acute Trusts. Not all patients want to be cared for "home alone" and many prefer the security and warm atmosphere of Oker Ward.

Patients that require 1:1 nursing care will be safer in Whitworth than in a 'bed with care'. It's to hope staff make the right decision as to where the patients are best treated and not leave a deteriorating person alone, at home.

4.4.3 Costs & Funding For 125 years the Whitworth Hospital, given to the community by Sir Joseph Whitworth has served a wide area of Derbyshire faithfully and efficiently. A lot of money is donated by families and from League of Friends. Matlock Hospital league of Friends has spent several million pounds on equipment and facilities. Oker Ward at Whitworth can accommodate 24 patients and has recently been refitted. This property is owned not rented.

The decisions on which beds to close where needs to be based on individual populations, travel links for patients an carers and the cost of the individual

upkeep on building. It maybe better to invest in keeping certain beds open if

needed which is safe and high quality it can’t all be cost driven alone. This proposal is clever but obvious rhetoric to disguise the fact that due to government cut backs the Health Authority has to save money.

As the hospital building with just the minor injuries unit, this would be expensive in running costs. Significant investment will be needed into out of hours District Nursing to support patients at home. Should we be having discussions about specific local taxes for local health provisions?

Not keen if any of these are put out to tender and private organisations take over.

4.4.4 Community Hospitals and Hospital Beds Community hospitals currently provide care close to home. The Whitworth is ideal for Matlock and its environment. It has everything the better care project requires. Surely with social care moving to Whitworth it makes more sense in keeping the ward open. Health Service professionals can surely deal with more patients more efficiently in a hospital situation. Oker ward rarely runs at the 16 said beds, it has the capacity to run at 26 beds. There will still be people who need a rehab bed. It is not just old people that attend this hospital - lots of children do too. There are Consultants, physiotherapists and Xray facilities on site. The beds here have been utilised by patients from all over Derbyshire and

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The Whitworth has been supported by lots of money from local people.

The Minor Injuries unit there is invaluable.

Sheffield and include facilities for terminal care. You have a fully staffed ward with strong relationships with the other community services, who have strong knowledge of the area and the services available when sign posting patients and carers and yet you're going to attempt to recreate this ward elsewhere. Relocating 24 Community Rehabilitation beds to Chesterfield Royal Hospital is wholly inappropriate. The maternity wing closed 4 years ago so local people finish up at Chesterfield.

Whitworth & Newholme could merge creating 20/24 rehab beds, & a Dementia unit programmed for 21st century care. We need another GP surgery in this area - why not use the space for a drop in centre.

4.4.5 Travel & Transport People of Matlock and Darley Dale need to be able to

visit a family member who is ill. The Whitworth is centrally situated on a main road with good local bus services.

The community are in such remote area from acute trusts and other services. To travel to Chesterfield involves 4 buses from Matlock and 6 from surrounding villages. Local buses are being cut from the county council. Places like Winster, Birchover and Elton would need to get 3 buses to CRH. Chesterfield and Buxton are difficult journeys for the elderly to make particularly in the winter months.

4.4.6 Agree This proposal is (good, worthwhile, ok, sensible, a sound plan, supported, fits in with the overall scheme, agreed, workable).

The patient should be at the centre of what we do.

4.4.7 Location Chesterfield beds are too far away. The Whitworth is near to home for most people locally. Use it to its capacity and keep the elderly near to their homes. This community hospital is in the heart of rural areas. Other remote areas ie Eckingron, Dronfield, have a number of ICT bed yet the Dales are being discrimated against and have nothing for miles and miles. We do not have equal access to health care services.

4.4.8 Nursing & Care Home Capacity There are ever fewer local care/nursing homes at present 2 in Darley are at threat with CQC. The idea that local Care Homes can at a moments notice take in those in need of care is rather wide of the mark, most have waiting lists of their own and struggle to find enough trained staff for their own needs. Community teams have been struggling to cope with the current demand. The logistics would be unworkable even if enough residential homes existed. A large volume of housing in this area is planned.

4.4.9 Carers and Respite Not everyone has family to care overnight for them at home. Need to look after (safeguard) carers. This support is vital to give carers at home a break or reassess needs. Respite services must still be available

4.4.10 Management and Organisation Beds should not be closed until the proposals have been trialled and found to be working. Try out your new scheme, if it works, i.e. bed use declines, close the beds.

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Will provide enormous transport issues.


Proposals are reliant on previous proposals that are unclear and untested. I would need to have more information about how this proposal would affect this location and what the future is for other services located here. I would like to see a report of the research that the CCGS have undertaken being made public. I have not heard sufficient detail about what consultation has taken place with Social Care and other agencies to assure DCHS that there will be a sufficient supply of care staff and nursing or residential home beds in place to meet the increased need.

I hear that the number of rehab beds has already been much reduced even before the conclusion of the consultation.

4.4.12 Access The loss of hospital beds means that there is less overnight support. The dementia rapid response team will only operate from 8am until 8pm. Sleep changes in dementia are common and people with Alzheimer’s disease often wake up more often and stay awake longer during the night. Sundowning is another symptom of Alzheimer’s disease and other forms of dementia which means that confusion and agitation worsen in late afternoon and evening. Lewy Body Dementia and Parkinson’s disease dementia is also associated with disturbed sleep, and at nighttime visual hallucinations or misidentifying relatives can be common which can be very challenging for carers to manage.

4.4.13 Staff Whitworth hospital staff are also all undertaking a course in dementia care. Whitworth Hospital is the preferred place for local GP's to have their patients admitted.

If more patients are in nursing homes then more investment is needed for DNs both in and out of hours to support them. Their load could be greater with extra incoming help.

Staff could be utilised for MIU in emergencies, also in Meadow Building next door (DCC owned for Dementia Care, etc.) if required, e.g. Fully Trained Nurses on call 24 hours a day.

4.4.14 Estates Change to a residential home as an attempt to provide some beds when needed if these proposals go ahead.

4.4.15 QuestionsHow do we know this model works (bed availability, location)?Whitworth Hospital has been here for 125 years providing just what the community need, why 'reinvent the wheel'?How will this model work in practice (lone patient, out of hours)?Could you not adapt the Whitworth to provide the different levels of beds? Why not use the Whitworth Hospital?2 years after refurbishment what are the CCG thinking?Why on earth cut provision? Can the same standard of care been guaranteed in a nursing home?How will this be funded?What happens when Chesterfield Royal goes on black alert in the winter, Oker ward had to increase it's capacity every winter. what will happen then?

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How can you take all dales beds?Who will care for the patients in their own homes, are they not scared, confused and lonely enough now?Again, what about people who are not suited to at home care, for whatever reason? What beds will remain for all the other patients with different needs to dementia? No how many beds already used now? I'd like to be informed about current bed usage at the Whitworth - how used is it and by what type of patient before being asked my opinion? What are the arrangements for respite care? What are the staffing arrangements (numbers, sick leave, location)?Will they have time to actually care? Will carers problems be monitored? What about Meadow View?

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4.5 Community Hospitals Cavendish SummaryThere was broad disagreement with this proposal. The quality of patient care was discussed. Community hospitals were preferred. The relative isolation of this area raises issues over travel and transport. Some agreed with the proposal. It was thought that costs and funding should not be the basis for making this decision. Carers needs were raised as was management and organisation. Nursing home capacity was of concern. Further information was requested. Staff matters were raised. Access to care needs to be 24 hour. Ideas for building use were raised.

Cavendish4.5.1 Disagree This proposal is (appalling, short sighted, wrong, very bad, not acceptable, very wrong, opposed, disgusting, ridiculous, should be revisited, disagreed, disastrous, not good, rubbish, criminal, detrimental to patients care and welfare, shocking, blinkered, poor, disgraceful, a big mistake, a retrograde step, scandalous, a tragedy, totally unacceptable, dreadful, terrible, a backward step, unnecessary, senseless, sinful, undesirable, a crying shame, absolutely ludicrous, stupid, awful, pathetic, madness, devastating, crazy, diabolical). These are extremely valued and much used services providing excellent care and support. If an excellent facility like the Spencer Ward closes this will be a huge problem to people in Buxton. I am concerned that a useful service is being introduced at the expense of another useful service. Serves too big and aging population that could be in need of a special care bed especially in wintertime. With life expectancy increasing, children of patients are themselves often elderly.

4.5.2 Patient Care & Quality Some patients require 24-hour nursing care, particularly end of life. Nursing homes are poor quality.

The Cavendish is a proven fantastic provider of good quality care services. The work on Spencer and Fenton have both won quality always awards which demonstrates the quality of the care on both wards. My husband received good care I was able to visit every day. The nurses are fantastic. The staff instils confidence in patients

Patients would become more irritable and vulnerable if there is nowhere for them to go in a crisis. The beds should stay open so patients have a choice. Spencer ward is also used for Older Adults with functional mental health problems.

4.5.3 Community Hospitals and Hospital Beds There will be more acute admissions; there will be more bed blocking in acute Trusts.

There is already difficulty in finding beds to transfer people to from the acute

wards who are medically stable but require further rehab or assessment and discharge

planning. Length of stay will massively increase for orthopaedic

patients as we rely heavily on rehab. The

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Do not close the Cavendish.

The community hospital beds in Buxton have been reduced repeatedly over many years.

danger is further reduction reduces the flexibility to cope at times of high pressure on acute services, in the winter etc. There may be a need to keep some as stand-by emergency back up. More beds required not less. Services include eyes Diabetes tests. This is an excellent hospital.

Closing 52 beds in A6 corridor disproportionate to the 32 in North East Derbyshire. Cavendish being in the high peak could merge with the cottage hospital at Buxton, a 16 /20 bed rehab unit with 8 beaded unit for dementia care, also all out clinics could be brought & based at the Cavendish. Keep beds to a number of 8-10 if need be. Incorporate minor injuries.

4.5.4 Travel & Transport A long way for people in High Peak and Dales to travel. In winter, Buxton can be snowed in very quickly making Cavendish an easier place for family to visit. Chesterfield is very difficult re public transport. No public transport is available after 7pm.

Closure of beds means that elderly people in hospital are a long way from home and family, making visiting almost impossible (without a car) parking at Chesterfield is difficult and distance to wards is too far. This does not suit dementia patients needing admission in a crisis.

4.5.5 Agree This proposal is (good, ok, sensible, agreed, sensible, a sound plan, fits in with the overall scheme, inevitable) Looking at the CQC report it was reported that this environment did not meet the needs of people with Dementia. The patient should be at the centre of what we do.

4.5.6 Costs & Funding Significant investment will be needed into out of hours District Nursing to support patients at home.

The decisions on which beds to close where needs to be based on individual populations, travel links for patients an carers and the cost of the individual upkeep on buildings. It maybe better to invest in keeping certain beds open if s needed which is safe and high quality. It is clear one of the main motivators behind this operation the money. If the 6th richest nation can't keep it's hospitals open then we aren't trying hard enough - given the amount of money recently spent on this fabulous facility.

No mention of cost to the individual. The price of a taxi or volunteers car is costly.

This will throw the aging Buxton population into the hands of the private sector.

I understand that to set up the new system, costs have to be saved elsewhere.

4.5.7 Carers and Respite Spencer ward offers support to carers too. The closure of the dementia ward will cause hardship and difficulties for carers and patients. Need to look after (safeguard) carers. The family have had support and enough respite. If you strip the family of that you'll destroy the family and their ability to cope the rest of the time.

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It can’t all be cost driven alone.

Nowhere in the report does it mention the removal of the two beds from Spencer ward. Presume the 2 beds on Spencer will be staying until an alternative is in place.

4.5.8 Management and Organisation

No closures should be considered until 'alternative' have been proven. And that means running the

'alternatives' alongside existing provision for at least a year. Prove that

they are no longer needed.

4.5.9 Location Cavendish i.e. Buxton is an exceptional case because it is a great distance from all large urban areas with hospital beds. This community hospital is in the heart of the high peak - miles away from CRH. Weather conditions in the high peak can be bad. The hospital alternatives will not be local - its 20 miles form here to Matlock. They serve a very large community.

4.5.10 Nursing & Care Home Capacity Bed numbers have reduced in Derbyshire. Community teams have been struggling to cope with the current demand. The pressure on beds in residential homes is already very high. I think you will struggle to find beds with care in the local community to replace the beds shutting.


Proposals are reliant on previous proposals that are unclear and untested. I would need to have more information about how this proposal would affect this location and what the future is for other services located here. I would like to see a report of the research that the CCGS have undertaken being made public. I have not heard sufficient detail about what consultation and communication has taken place with Social Care and other agencies to assure DCHS that there will be a sufficient supply of care staff and nursing or residential home beds in place to meet the increased need. The CCG has not even confirmed where these new beds are to be in care homes.

It does not specify which beds would close and this is misleading to the public.

4.5.12 Staff If more patients are in nursing homes then more investment is needed for DNs both in and out of hours to support them.

The training the staff receive is second to none. Staff in nursing and residential homes are not sufficiently qualified to care for these patients. I know people who work at this hospital and they are unsure of the implications for their job security.

4.5.13 Access The loss of hospital beds means that there is less overnight support. The dementia rapid response team will only operate from 8am until 8pm. Sleep changes in dementia

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Have a better management in place.

are common and people with Alzheimer’s disease often wake up more often and stay awake longer during the night. Sundowning is another symptom of Alzheimer’s disease and other forms of dementia, which means that confusion and agitation worsen in late afternoon and evening. Lewy Body Dementia and Parkinson’s disease dementia is also associated with disturbed sleep, and at nighttime visual hallucinations or misidentifying relatives can be common which can be very challenging for carers to manage. Unless 24/7 care was possible at home this would be worse care, not better.

4.5.14 Estates The proposal is to close 16 beds but then establish 8 rehab beds. So the building will only be working at 50% capacity. Could make an excellent base for a High Peak Community Hub. Change it into a residential home as an attempt to provide some beds when needed if these proposals go ahead.

4.5.15 QuestionsWhere will you find enough beds with care?How will other services be effected (ie anxiety and depression, end of life care)?How do we know this model of care will work?Have they given any thought to the problems of transport especially in the winter?What about the 2 respite beds available on Spencer ward? How will this model of care be funded?Why fix something that isn't broken?What population is to be served by the remaining 8 rehab beds?Leaving only 8 beds for the whole of the High Peak, where is the sense in this?How will a dementia patient who starts to hit their loved ones or damage property get to hospital? Has the option of one central purpose built community hospital been considered?How will this be staffed (sickness cover, poor weather)?Will they have time to actually care?

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4.6 Specialist Rehabilitation Hospital BedsThis proposal is to provide specialist rehabilitation hospital beds for older people who are not well enough to go home but are recovering from a spell in hospital following an accident or illness by:

o changing the use of Cavendish Hospital to provide specialist rehabilitation beds in the west of North Derbyshire, and

o opening specialist rehabilitation beds in the east of North Derbyshire at Chesterfield Royal Hospital

What you think about the proposal to provide specialist rehabilitation hospital beds at:

4.6 Specialist Rehabilitation Hospital Beds Cavendish Hospital SummaryThis was considered a very good idea. The number of available beds was discussed. The location was an issue as travel and transport was of concern. Those who disagreed with the proposal felt things should be left as they are. Costs and funding were discussed. Patient care, management and staff were also discussed.

Cavendish Hospital4.6.1 Agree This proposal is (a good idea, excellent, agreed, vital, wonderful, absolutely essential for High Peak residents, sensible, ok, favourable, needed, fine, great, supported, interesting, justified, should be standard policy, a good addition, possible, fab, not bad, workable, the best idea yet, fantastic).

Only losing 2 beds, so in theory should be a good idea. Fine for people who live close by. All rehabilitation beds needs to be at the Cavendish Hospital. Any expansion of valuable services would be welcome. In principle, rehabilitation services have to be more useful than general care. If this allows the hospital to continue to be open and provide for the community.

Wonderful as an extra - do not reduce those that are there. Buxton Needs the 16 beds they have now, with an ageing population 8 beds will soon not be enough. As long as it doesn't impinge on existing use of the wards – i.e. Spencer ward for dementia patients. Make the Cavendish a place of excellence.

4.6.2 Community Hospitals and Hospital Beds As a Matlock resident I believe Whitworth should retain inpatient beds. Wouldn't be needed if Newhome stayed open. It's Clay Cross / Bolsover that we struggle to get beds at. Don't we already have these facilities at Cavendish - just doesn't seem logical. I can assure you from experience that these beds in the community are extremely difficult to find when needed.

A total of 32 beds is woeful. Seems disproportionate for population and location. We need urgent care

beds for whatever reason and end of life beds. Though in the long run you

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Better of the two for Bakewell residents if one had to choose.

A totally inadequate number of beds.

may need more beds. More beds needed not just rehab, but to treat dementia. Patients who have UTI's, chest infection and constipation and not send them to Acute A&Es.

As long as that is what they are used for and not ending up filled with patients who have nowhere else to go. Perhaps use nursing/ care homes for that instead of closing a quality dementia care service.

I can't see how rehabilitation can help people (who are mentally ill, at the end of life, step down beds, treatment of chronic conditions, blood transfusions, iv therapy). The proposal is to close 16 beds but then establish 8 rehab beds. So the building will only be working at 50% capacity.

4.6.3 Travel & Transport Geographically this proposal is no viable. It is practically very challenging to travel to Chesterfield. Buxton can be isolated in winter. There is only 1 bus per week from Bradwell to Buxton. Buses to Chesterfield from Buxton run every two hours and sometimes require a bus change in Tideswell, once relatives arrive in Chesterfield they will then be required to get another bus to the hospital.

It’s a long way to travel for care and also visiting - many relatives who care and visit are elderly too. Older people are more likely to need public transport in these situations. People need to be able to visit their relatives without long journeys, particularly if the spouse is elderly this could mean recovering patients do not see their relative.

Ok providing they are easily accessible to patients families for visiting.

4.6.4 Disagree This proposal is (not acceptable, ridiculous, not supported, rubbish, disgusting, unacceptable, a big mistake, not good, a bad idea, terrible, totally wrong, not acceptable, insufficient for local needs, a pointless waste of resources, not appropriate, hopeless, inadequate, not enough, stupid,

Leave as is. Far more beds are being closed than are being opened and hospital words are being closed as they cannot afford to open them. The need will increase in the coming years

4.6.5 Location These beds are not "local" to people in other parts of Derbyshire. High Peak / Dales need this local service. Too far away from the community 14 miles (20 miles) from Bakewell and further from Matlock and many surrounding villages. There are no facilities for patients in the Buxton area to travel to the north for treatment.

Useful as patients referred from stepping Hill and local for Buxton.

The consultation reads that beds will close, then reopen in different

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County Council is proposing to pretty much do away with all rural bus services.

Rehabilitation beds can act as a home away from home.

geographical areas. I feel that Cavendish should be one of the sites at which specialist rehabilitation services are provided.

Don't think we need specialised rehabilitation - that can be done at home.

4.6.6 Costs & Funding Ok if funding is kept up - not cut after a few years when money is tight. If this cannot be guaranteed then am against the plan.

I am concerned that cost savings are being made at the expense of service users and their carers. Patients having to get to Chesterfield will be cost prohibitive. The wealth built up by previous generations is wasted.

The ward will need a ward manager, admin staff, domestic staff, therapy staff etc, therefore expensive for only 8 beds. I would suggest 12-14 beds to justify the expenditure. 32 beds replacing 84 - cost cutting. 4.6.7 Patient Care & Quality Communication and co-operation between different health trusts is poor. Rehab should be better planned for patients. There will be occasions when patients need specialist care and may possibly be replaced in a care home.

What ever is best for the patient.

4.6.8 Management and Organisation Proposals rely on successful implementation of previous proposals. No changes or closures until replacement services are proven to work. Keep the bed number, while developing services. Acceptable if there has been modelling carried out to demonstrate sufficient beds. There should be a review after 12 months.

4.6.9 Staff Staffing and cost means it will not happen successfully with the correct calibre of staff. Need to ensure good rehab staff here and in community to support patients to go home.

4.6.10 Information & consultation There are no figures to justify this proposal.

4.6.12 QuestionsWill sufficient beds be available when needed?How has the eight beds been calculated – will 8 be enough?Have you considered travel and transport?Will they be adequately funded?Don't they already have this?What's going to happen to those who live in between?What about the palliative care patients or neurological conditions? Chesterfield Hospital rather Sheffield and Stockport/Macclesfield respectively - how are these going to be provided for? So can people with dementia use these beds? What about current intermediate care provision in hospital? Where is the west of North Derbyshire? Please be specific? Why not follow this model in the other locations?How would it work?Why cant there be 2?Patients within the Hope Valley, Buxton, and Chapel-en-le-Frith do not as a rule go to Will the ambulance service be able to cope if necessary?

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What you think about the proposal to provide specialist rehabilitation hospital beds at;

4.7 Specialist Rehabilitation Hospital Beds Chesterfield Royal Hospital SummaryThere was broad agreement with this proposal. The number of beds was an issue. Concerns around travel and transport were raised. Patient care quality was thought to be less personal in a larger hospital. Those who disagreed felt a DGH was not the right place for these patients. The location was thought to be further from home. Costs and funding matters were discussed. Staffing numbers and care quality were also discussed. Management and organisation issues and carers needs were also discussed.

Chesterfield Royal Hospital4.7.1 Agree This proposal is (a good idea, vital, popular, excellent, sensible, more effective being attached to the acute hospital, great, interesting, ok, a notable advance, good addition, fine, agreed, necessary). This sounds like a sensible change to make sure the elderly are fit for full discharge while releasing "acute" beds - and better able to cope at home. With help to families and friends to meet the extra costs of visiting this makes sense. For some people this may meet their needs and that the proposed changes may help support them to move home more quickly.

Let's see this in addition to community support not instead of. You will still need extra beds because of increasing numbers of elderly and infirm in the population.

4.7.2 Community Hospitals and Hospital Beds Seems disproportionate for population and location. Only 8 beds to serve A6 - Matlock to New Mills, but 24 for North East Derbyshire - it seems illogical. Some of these beds should be provided at the existing community hospitals.

The beds should absolutely be protected and possibly refurbished. Though in the long run you may need more beds. As long as this does not mean people genuinely requiring hospital treatment have to be taken vast distances to find a bed.

I am concerned about inappropriate referrals to the rehab beds when there is a push to discharge patients from the acute; it has the potential to become a 'dumping ground' and may get filled with medical outliers, especially during winter.

I would have thought chesterfield has enough people in the hospitals now without increasing it. The hospital is often already full and lacking beds - staff already overloaded, ambulances can't cope.

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We need a halfway between hospital and home.

The environment needs to be suitable for rehabilitation - dementia friendly, assessment kitchen, bedroom and bathroom a physio gym, space on the ward for different moving and handling equipment.

4.7.3 Travel & Transport It is too far to travel. No trains, no parking (difficult to park). 2-3 buses (with limited timetables & proposed withdrawal of rural transport services), to get there. NE Derbyshire has a high proportion of elderly people who will be seriously affected by the distance to Calow and the long distance to walk to wards. Bad winter weather makes the routes to these hospitals difficult with snow, ice etc and elderly people should not have to have these journeys added to the stress they are already under. It is isolating for patients -I saw 5 people over 80 in my ward at Chesterfield receiving no visitors

Park and ride from somewhere close by.

4.7.4 Patient Care & Quality This hospital does not have the care, the good food or the time that our community hospitals have to look after patients that need a little extra help. A reduction in the social network = less likely to go home. Many elderly people will not go to Chesterfield Royal if given the choice.

They focus on rehab not care and they are not filled with patients needing care home placements – this should be therapy/nursing led. Chesterfield’s reputation for care is not good. I feel

that it would be important to address reputational differences between the community hospitals currently providing such services and Chesterfield Royal. DCHS have an excellent reputation for good quality care.

I worry that vulnerable people are being exposed to hospital bugs in an acute unit. As long as there are nil infections – then fine.

There will be occasions when patients need specialist care and may possibly be replaced in a care home. It will also depend on the quality of the care homes available and their reputations as to how patients will feel about being sent there for periods of their care. I also question the term 'rehabilitation' where dementia is concerned until there is a cure. It is unrealistic.

I am also concerned that many of the patients that currently use our community hospital wards would be unlikely to meet admission criteria to access these rehab beds. For those who are admitted, it will still cause bed blocking. At present some patients are discharged too soon and end up being re-admitted.

4.7.5 Disagree This proposal is (unworkable, not acceptable, inappropriate, confusing, not good, disagreeable, inadequate, a bad idea, sad, awful, impersonal, outrageous, ridiculous, unwanted, a pointless waste of resources, appalling, poor, not good enough, a nightmare waiting to happen, disgusting, nonsensical)

Care of dementia doesn't seem right in an DGH. Why not make use of what is available in community hospitals. If the idea

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Community hospitals have a different ethos.

Totally against this.

of the community hospitals was to take pressure off general hospitals I don't see how this arrangement achieves that.

The population is growing and getting more elderly and more people are getting dementia.

4.7.6 Location These beds are a long way from the beds which are being closed and too far away from the areas they are intended to serve. Excessive concentration of resources in one place for a widely scattered area. Worse than the current provision. Way too centralised. This is not care closer to home. "Better Care Closer To Home" would not be served by closing community hospitals and providing beds at Chesterfield.

4.7.7 Costs & Funding Is there enough funding - staying at Royal becomes very expensive when it's over 3 to 4 weeks. This will cost the trust money to refurb and equip CRH. This is not cost effective. The waste of public money is unacceptable.

I thought the Specialist beds were funded for the Whitworth by the League of Friends.

Relatives will have the cost of travelling and parking. For people on a pension or low income

visiting relatives at the new centre rather than at Whitworth or Newholme or Buxton would be prohibitive. 4.7.8 Staff Again staffing means it will not happen successfully with the correct calibre of (specialised qualified) staff. There are never enough nurses. I can't see how the existing work base of nurses would be able to transfer to the Community or CRH Community Ward - they work very differently. Much training will be required. If DCHS staff are going to be working on this ward it would be beneficial but if not then, not acceptable.

4.7.9 Management and Organisation Proposals rely on successful implementation of previous proposals. No changes or closures until replacement services are proven to work.

With less hospital beds and fewer wards this may impact on the management. You will have to have very strong admission criteria and make sure they know its rehab. Communication and co-operation between different health trusts is poor. This may improve communication between acute and community teams.

4.7.10 Carers and Respite Think of the whole family - Not just the patient. As the carers are usually elderly family members, it is a cruel burden to impose on them and adds to the expense of looking after their relatives.

4.7.11 Information & consultation I do not know what the current levels of demand are in Chesterfield.

4.7.12 Estates Another closed building in Bolsover - council offices that we did not want are now empty - no swimming baths - more and more eye sore in Bolsover.

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It sounds like a cost cutting of services.

4.7.13 QuestionsHave you considered travel and transport?Would it be better to have more local beds?Why not keep existing beds?How can so few beds be suffice?How would it work?Will there be a guarantee that these bed will be used for local people?It depends upon what you mean by specialist hospital beds and how they are staffed? Don’t they already have this in place? Can you guarantee patients will be safe?Who will staff these beds?What links are you making with the specialist dementia units the councils set up in their new care homes ie, the one in Staveley?Patients within the Hope Valley, Buxton, and Chapel-en-le-Frith do not as a rule go to Chesterfield Hospital rather Sheffield and Stockport/Macclesfield respectively - how are these going to be provided for? Specialist - what about neurological conditions?Patients staying in the specialist rehab beds would presumably have access to OT and Physio facilities (ADL suite, gym etc) at the hospital ...would patients in beds with care have access to similar facilities?The plan talks about aiming for people to only be there for 3 weeks but usually less -what about people who may need longer or who have more complex care needs?

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4.8 Older Persons' Mental Health Community Hospital BedsThe proposal is to permanently close older persons’ mental health community hospital beds and replace with a new Dementia Rapid Response Team who will support older people with severe dementia who are having a crisis or urgent care needs at home as set out above. The proposed bed closures would include;

10 beds at Cavendish,10 beds at Newholme,

With the introduction of Dementia Rapid Response Teams, what you think about this proposal to close beds at;

4.8 OPMH Community Hospital Beds Cavendish SummaryThere was broad disagreement with this proposal – it was considered that these beds were needed. Patient care and quality was of primary concern. Community hospitals also provide a range of services. Those who agreed with the proposal felt the rapid response team model was preferred. The needs of carers were raised. The area is considered to be remote raising concerns over access and travel and transport. No changes should be made before alternative services are in place. Staff shortages are of concern. More funding was thought to be an issue. Further information was requested.

Cavendish4.8.1 Disagree This proposal is (wrong, a bad idea, madness, not acceptable, not good, dreadful, stupid, rubbish, disgusting, unworkable, just a waste of time, terrible, not practical, ridiculous, beyond belief, shocking, not needed, disappointing, a huge mistake, a disaster, displeasing, appalling, criminal, a sad loss, a great pity, insufficiently considered, forward thinking while stepping back two paces, not right, short sighted, stupid, very poor, very dangerous, can’t happen, wrong thinking, detrimental to the community, disgraceful, morally wrong, madness, sinful, diabolical, catastrophic, the single worst suggestion in the consultation document, awful, in need of reconsideration, despicable, irresponsible, misguided, potentially dangerous).

These beds are needed for local people - it would hit the area badly. Mental health needs more support not less. It is a centre of excellence and serves the A6 corridor and meets transport provision and climate constraints. I have no faith that a rapid response team will be funded sufficiently to enable them to travel the geographic area and provide acceptable levels of care. This takes away a valuable safety net for ill patients. Not all patients want to be cared for home alone. Dementia is not the only mental health condition that can seriously affect older people. Other conditions cause crisis and 'urgent care needed'.

I think the problem is getting worse - there are more older people each year - so is it short sighted to close beds.

4.8.2 Patient Care & Quality Vulnerable patients will require more support in a

specialist environment. Experience of home-based

care demonstrates massive problems – it will mean

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Do not close the beds.

I myself would not have coped without the help and support I was given.

shorter and poorer care for people with dementia. I think this will lead to increased loneliness, isolation and fear for a vulnerable group of people. 7 weeks attendance at the programmes planned is not sufficient for a life long condition. Rapid response can complement but not replace existing services.

I have visited this hospital many times it is (a good hospital, a happy one, excellent reputation, secure, warm atmosphere) don't spoil it. The ward just got a gold award for the service they render. Spencer ward has changed the lives of many carers and people experiencing dementia.

Dementia patients think they can do what they did when they were fit and healthy so most fall (catch infections, suffer delirium) in home or wander off - so they need to be in hospital. A lot of tragedies will occur (it’s risky, dangerous). There are accidents just waiting to happen. Risk management is not being considered. Unless you have a team who really know (and the patient trusts) I don't think it’s workable and will only delay admissions in many cases. You seem to have forgotten the real needs of the patients in all this.

4.8.3 Community Hospitals and Hospital Beds The High Peak has traditionally been out on a limb for mental health services, to close Spencer Ward at the Cavendish Hospital will leave a large area including New Mills, Whaley Bridge, Chapel, Buxton and Glossop with no acute Mental Health support. These beds are very important to the local people. Beds lost in the High Peak are too high as it stands. There will be more admissions to the acute hospital. We need more beds for carer and patient support/assessment.

Also, you are just talking about Dementia. Spencer Ward does not only serve patients with Dementia and does not only cater to older adults. We had patients with alcohol problems who couldn't manage to be looked after at home as they were a danger to themselves and to the community. We managed to help them at Spencer and now they are back to the community. We had patients with other mental health conditions (schizophrenia, severe depression).

Closing 10 more beds would mean this hospital is unsustainable. Cavendish could become the hub/ centre for Rapid Response / Integrated Care teams. Maintain the 10 beds for patients with functional mental health problems not dementia which can be dealt with an Fenton. I feel this should also become part of the centre of excellence.

4.8.4 Agree This proposal is (supported, a good idea, ok, sound, not concerning, will be beneficial, agreed, not bad, fits the overall plan, a good thing).

Very sorry indeed but I think the dementia rapid response team is better to support people in their own home. I go along with all you are trying to do. The rapid response team would hopefully enable patients to stay in their own home with the suitable support. Hope the team can be set up.

I doubt DRRT will work without bed option as well. Cannot be one or the other. Inpatient beds and home based crisis team.

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It should be as well as not instead of.

4.8.5 Carers and Respite Carers often cite sleep disturbance as a

reason for the person going into full-time care. My concern is that less

beds means less overnight support and respite for people with dementia and their carers when

they are in a crisis situation - family will suffer and problems multiply. This

proposal will only work if these teams see carers as their charges as much as the patient. Respite beds are needed to give the families a break from caring for their love ones. The breaks are most likely the reason why some patients are still being cared for in the community.

4.8.6 Location The North Derbyshire area has a population over a significant remote rural area. I am concerned that it has not been fully considered as to the length of time it will take to reach patients in a distressed and confused state. Hardly 'closer to home' if you have to travel to Chesterfield. Inpatient care needs should at least be geographically central. Those with dementia need to be kept in their own local community. Build Cavendish into a Dementia Centre of Excellence for West Derbyshire and a DRRT training centre.

4.8.7 Access No firm proposals for 24 hour care. Those affected by dementia may require round the clock supervision that a rapid response team would be simply unable to provide.

4.8.8 Travel & Transport Even if the claim that half of patients admitted with dementia could be cared for in the community is accurate the other 50% of patients who would still need inpatient care would have to be admitted to hospital necessitating long difficult journeys for relatives themselves often elderly. We cannot travel any further (No transport of own, Public transport limited, winter conditions). It is more harmful and cruel - it will cause more stress on patients and families.

There is a good bus service to Buxton especially for people who don't drive.

4.8.9 Management and Organisation Closures reliant on successful implementation of previous proposals, especially the DRRT's. DRRT's have not been proven to work. Should be no closures until the proposed replacement service is proven to be viable and robust. The impact on carers needs to be clearly thought through and closely monitored.

I am concerned that there will be too much of a divide between mental health and physical health services and that they may need to work more jointly.

4.8.10 Staff They are often short staffed and struggling to keep running with current funding. Demand for services will outstrip DRRT ability to cope. The DRR teams in the south

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Carers rely on local 'joined up' approaches which the Cavendish and other agencies currently provide.

People don’t want to travel - we want our family closer to home.

cannot cope with many of their referrals. It is likely to lead to a loss in a very experienced and competent team.

Closing beds will be lost forever and your teams will be tearing their hair out and going off sick because they will be unable to function.

Never enough (well trained, experienced) staff/nurses. Not enough experience will cause neglect. If these rapid response teams are fully trained OK, but I believe this wont be the case.

4.8.11 Costs & Funding Extra finance needed for this. It will cost more financially in the long run. Again, appears more to be about reducing cost than providing improved care. For all community bed closures, the questions will need considered analysis. Closure of a few beds at several hospitals will not deliver the economy of scale of closure of a single site. As long as you are saving money, you will have no qualms about this.


It depends really on what needs these wards were providing. No viable alternative yet proven nor proposed for many surrounding villages & towns Suggest talking to East Cheshire and Stockport re their plans.

4.8.13 Estates As long as the 'change of use' proposal is put in place.

4.8.14 QuestionsWill Rapid Response provided 24 hour care? What happens to patients when these beds are full?Is this the correct decision? Who calls for help for the severe dementia patient who needs urgent help? These teams on the surface seem like a good idea but what happens when urgent hospital care is needed will these people be admitted to hospitals miles away?Will there be adequate transport available?Will there be any beds in case of carer stress/breakdown? How will this work? How can a rapid response team provide care fit demented people in their own homes? What service is in place to look after other people who have other mental illness? Who will call out the team if someone lives alone?What if the rapid response team decide to admit the patient? If the hospital is staying open anyway, why remove these beds?At what point is a patient deemed to require hospitalisation, and where will this be? What risk assessments have been undertaken in respect of health professionals' safety?Presumably the new building next to the Whitworth will help with this?Bad idea what happens in bad weather? Are DRRTs proven to work?What about younger mental health? Shouldn’t they have the right to stay at home in Buxton?

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Depends how many staff are on the rapid response.

With the introduction of Dementia Rapid Response Teams, what you think about this proposal to close beds at;

4.9 OPMH Community Hospital Beds Newholme SummaryThere was broad disagreement with this proposal. There was concern over the model of treatment in the home and the quality of care. Community hospital beds are needed. Those who agreed with the proposal felt it was time to ‘move on’. The needs of carers were discussed. 24-hour access to care is needed. Travel to Chesterfield was considered to be problematic. No changes should be made before the new service is in place. It was thought this would cost more than anticipated. Staff skill issues were discussed. The age of the building was raised.

Newholme4.9.1 Disagree This proposal is (wrong, short sighted, very bad, not acceptable, dreadful, opposed, crazy, disgusting, unworkable, ridiculous, bad, not practical, a waste of care, nonsensical, not supported, beyond belief, shocking, disappointing, horrific, a big loss, dreadful, shameful (it makes me angry), impractical, a backward step, displeasing, a great pity, terrible, in need of further consideration, unfair, inconsiderate, rubbish, a terrible loss for the community, very worrying, saddening, crazy, detrimental to the community, sinful, bad news, silly, catastrophic, despicable, awful, a scandal, criminal, appallingly bad)

Beds are needed closer to the people of Bakewell. Will we end up with the same crisis as in mental health Care in the community, where the majority of ill people end up living on the streets. This would remove - for good- a facility which has been vital to the Bakewell and Matlock areas for many years.

The NHS does no care about people with dementia. Impossible to treat people in a crisis at home. There has been too many changes here, the hospital services have already been eroded. No more please. The ward has just been refurbished does not make sense to close it.

A full range of services is needed for the increasing number of people with dementia. Dementia is not the only mental health condition that can seriously affect older people. Other conditions cause crisis and 'urgent care needed'. With an ever ageing population we should be thinking of increasing community hospitals. Derbyshire has an older than average population.

4.9.2 Patient Care & Quality Care at home while preferable is not always practical. There will be more admissions to the acute hospital. Acute hospitals cannot appropriately cope with dementia patients. Experience of home-based care demonstrates massive problems. A full assessment would not be completed in the community. I think it would lead to poorer health outcomes. Dementia doesn't cease when the team leaves the home.

I am concerned that the dementia rapid response service will mean

shorter and poorer care for people with dementia. Do not think Rapid

Response Teams would be adequate in these isolated locations. A rapid response

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Waiting for a crisis to occur is not the answer.

Listen to what people prefer.

unit won't be able to care for 10 people spread out through the area as 10 people in one unit.

Where it is true patients with dementia recover well in familiar surroundings there is also a lot of evidence to show that this can also be achieved with familiar items, decoration of the wards etc. Patients are admitted to protect themselves and sometimes others. Staying at home may be too risky.

Newholme has provided wonderful (excellent) services to local people over many years. This ward has won awards for the care given to patients.

4.9.3 Community Hospitals and Hospital Beds Personal experience has proved the enormous value of community hospitals. Riverside was purpose built for MH patients. If Newholme has to close the services provided there should be transferred to the Whitworth Hospital. If closing Newholme, at least expand beds at Matlock.

This will lead to complete closure. Mental health beds need to increase not reduce! This will also impact on the High Peak area as Newholme has at times been an overflow/back-up service for Spencer Ward. Already older adults MH beds are oversubscribed. Older adults are inappropriately admitted to The Hartington unit due to lack of beds.

4.9.4 Agree This proposal is (agreed, feasible, good, ok, not concerning, not bad, supported, fits the overall plan).

Time to move on. My feeling is that a person in crisis is likely to respond more quickly to any intervention that takes place in familiar surroundings so I support the creation of a rapid response team. Acceptable as Cavendish and Walton are geographically split enough.

Local people need local care in addition to local rapid response teams.

4.9.5 Carers and Respite Caring for someone with mental illness is a huge strain on loved ones - sometimes we need the help and support; and need to know our loved ones are safe so we can sleep at night too. For many carers of those with dementia these local facilities provide a lifeline in terms of respite. Some old people can be very violent and their loved ones will suffer in silence.

4.9.6 Access The rapid response team should not only be an 8 till 8 affair since dementia affects people every minute of every day. Unless these response teams are fully manned and available 24 hours a day 7 days a week, the service will be far poorer.

4.9.7 Location Not convenient (or sometimes possible) for visitors to go to Chesterfield. Newholme serves the Peak District & with a population of 39.300 this service of Dementia care is a much needed & essential service to its people & remote out laying villages & it's

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I think this would work well.

I understand the response time will be 40 minutes.

prime locality is well situated. It is criminal to deprive the most vulnerable people in Derbyshire of existing local care.

On the whole encouraging a whole community approach to caring for those with dementia as locally as possible.

4.9.8 Management and Organisation The new dementia teams should have time to see if this new idea works before closing the existing hospital beds once closed - no going back.

You seem to have a miss match on number of beds to close (16 mentioned here earlier) and the resulting position of the beds left in use is questionable re the community.

4.9.9 Costs & Funding Would seem to be the best for the individual, is not the easiest or most cost effective for the NHS.

Again, appears more to be about reducing cost than providing improved care. A

lot of work and funding with the help of the Kings Fund has gone into these wards to benefit the

patients which can't be transferred to patients homes. There is going to be extra

funding coming from the sensible decision by this country to leave the European Union.

This is cost-effective.

4.9.10 Travel & Transport Newholme draws on a large area - travelling for relatives should be a major consideration. Too far away for elderly relatives to travel - and mean that when people are admitted that their significant others will have further to travel or not be able to visit them. Comments about bus services still apply, much easier for relative to get help in getting to Newhlme than Calow.

4.9.11 Staff Depends how many (well trained, experienced, specialised, qualified) staff are on the rapid response. Never enough nurses - staff already over worked.

Local GP's can stay involved if patients stay to local. Such teams will spend more time in transit than providing active patient care.

4.9.12 Estates Newholme is a dated old building but with some investment could be bang up to date (residentially) for mental health patients. I would be very worried about this proposal as I fear it might spell the end of NHS services on the site and lead to its sale.

4.9.13 Information & consultation This has already been decided.

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Will cost more than anticipated.

4.9.14 QuestionsAre these teams going to provide a 24 hour service? Will patients be safe?How would you provide any respite for careers if the local beds have gone?Where will the patients go? How is that an improvement? Have you considered transport (including in the winter)?At what point is a patient deemed to require hospitalisation, and where will this be? Who calls for help for the severe dementia patient who needs urgent help?What will the rapid response team do?Will there be adequate transport available?Dementia and mental health are not the same thing, are these beds not needed?Where are this team based? Why not have these beds at Clay Cross or Whitworth?So that would leave 6 beds at Newholme? How can this proposal provide continuity of care?What is the frequency of the visits?What risk assessments have been undertaken in respect of health professionals' safety?Are DRRTs proven to work?Bad decision how can mentally ill patients cope on their own?

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4.10 Centre of Excellence at Walton Community HospitalThe proposal is to establish a centre of excellence at Walton Community Hospital where older people with the severest dementia symptoms will be admitted as inpatients because they cannot be safely cared for in their homes.

What do you think about this proposal to establish a centre of excellence at Walton Hospital?

4.10 Centre of Excellence at Walton Community Hospital SummaryThis was considered to be a very good idea. However, the location did not suit all. Travel and transport issues were raised. Those who disagreed did so on the question of location and questioned if the model was necessary. Care quality issues were discussed. Local hospitals were also suggested as venues for this service. Costs and funding were matters of concern. Staffing levels and qualifications were also concerns. Further information about this model was requested. The needs of carers and respite were raised. Management issues included the need for joined up care. Questions of access were raised.

4.10.1 Agree This proposal is (a good idea, excellent, agreed, vital, long overdue, alright, fine, practical & necessary, sensible, definitely - big tick, much needed, favourable, ok, interesting, acceptable, great, timely, the best idea yet, is better than nothing, positive, brilliant, exciting, a blessing in disguise, long overdue, important, a great innovation, commendable).

Obviously good for Chesterfield residents. This would be a good site it would offer the ability to use other services if necessary. Enjoys a good reputation and easy to access.

Dementia at present is not curable and is an illness that continues with deterioration - once dementia patients reach a stage of crisis it is usually then that they can no longer be safely cared for at home so short term care would be appropriate. I think a centre of excellence may finally offer patients with dementia an opportunity to receive a greater standard of care. Centres of Excellence are to be welcomed as the ageing population puts greater strain on the Dementia Service.

This in itself is a good idea but not at the expense of reducing bed capacity elsewhere. The service cannot be cut back when the demands are rising. I feel that establishing a centre of excellence at Walton allows the Trust to build on the service provision and expertise it already has in place.

4.10.2 Location Distance is a problem. I'm not sure that Walton hospital is the right location. Sheffield is more local. Bakewell is more local to where the highest population of dementia

patients are. It isn't anywhere near North Derbyshire, certainly not High Peak or Hope Valley, Buxton and some of the High Peak - Whaley, Chapel, New Mills, Longnor,

Flagg, Tibshelf and surrounding areas.

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Seems best to centralise expertise in one place.

It is too far away.

Should be at Cavendish or have two centres - Newholme and Cavendish. The Bolsover site is much more suited to being a centre of excellence. Walton is fairly central I suppose in Derbyshire so as a base this is ideal. You would be better making use of The Whitworth hospital if you are to continue to push the issue of Better Care Closer to Home. I think patients should be based near their own homes for visits.

I accept that there cannot be one in every area.

4.10. 3 Travel & Transport This group of people are not mobile. They are mostly old and infirm with older carers. This would mean impossible transport problems for patient’s carers and relatives. The distance to Walton and the poor public transport services there make it a difficult place to get to for many - no train - taxis way too expensive. There is not enough parking.

4.10. 4 Disagree This proposal is (not a good idea, not acceptable, stupid, disagreed with, not good, ridiculous, not really thought out, not supported, not an option, terrible, appalling, perverse, just so badly thought out, poor, disgraceful, utter rubbish).

I do not think centres of excellence are needed - everywhere should be a centre of excellence. I am so angry that I am considering approaching the press. I think this proposal is all about serving the Chesterfield community not even thought of the high peaks and dales.

I don't think you can establish a 'centre of excellence' it has to become one following inspections and review, just be clear and call it a dementia support unit. Walton has a negative reputation. Given the whole thinking behind the rest of the proposal it is difficult envisage a centre of excellence at the pinnacle.

The implied insult to Riverside Ward and Spencer Ward that they are not centres of excellence is part of the hallmark arrogance of these proposals.

Demand is increasing; we have an aging population with increasing dementia.

4.10.5 Patient Care & Quality I've always heard good reports about the care at Walton. We have excellence at the Cavendish. Newholme hospital riverside ward has won awards for the care they provide to their patients.

I have very little confidence in Walton Hospital to manage 'excellence' in relation to mental health of older people. It is a cold and plastic environment. Staff cannot have sight of all patients at all times. Patients with severe dementia are very aware of their environment and need to feel safe and secure.

GPs will need to be retrained because they are not aware of the needs of older people. The response is to pack them off to A&E.

We have an increasing and ageing population, who are having their wishes overlooked to save money.

Patients should only be admitted of all other options have failed, hopefully the rapid response team will be at the heart of admission avoidance

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4.10.6 Community Hospitals and Hospital Beds Linacre and Melbourne wards at Walton hospital are already used as specialist dementia beds where people go when they cannot be safely cared for at home. Need to keep centre of excellence in west. As long as there are enough beds. There needs to be beds in a specialist ward for these patients.

4.10.7 Costs & Funding It wouldn't save money to establish a new centre. Sounds more expensive than the current option. Expanding to do the same for Cavendish would not be equal cost or effort as Walton as similar elements at Walton and Cavendish could be treated simultaneously, so should be looked at.

There needs to be enough money provided to make it work. It probably makes financial sense.

If this programme is basically a cost-cutting exercise then I would oppose it wholeheartedly.

4.10.8 Staff Need to ensure this unit is staffed appropriately by well trained staff who can problem solve. You describe it as a centre of excellence, but it will rob local areas of their expertise. Existing staff from other locations jobs are at risk to re-train to support at this location. However I suspect the reality is likely to be increased pressure on staff who already may well have considerable stress owing to recent changes and pressure on their services.

Never enough nurses - worse care. Staff still need up skilling on communication. If it brings with it research and pioneering work towards helping people.


No reason given or figures to back up why there will be only 1 centre of excellence and why it should be in Chesterfield. Also, the research that has been conducted to support these proposals didn't appear to be peer reviewed Would need a very strict criteria. It is difficult to imagine how an on call consultant psychiatrist will prevent admission. Would need more detailed information on this. Define centre of excellence. I presume this unit in Walton Hospital will be able to admit sectioned patients under the Mental Health Act but would be interested to learn more about the proposed unit. I think the Government and the NHS are not understanding that this is a ticking bomb situation.

Excellence is a meaningless phrase. All teams dealing with people with dementia should be trained to provide excellent care there is no need to concentrate this is one place, all the current local community hospitals should be centres of excellence.

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More inpatient beds may be needed.

This document is designed to only support the proposals for closure as any requests against the closure are limited to 1 line only and not a box like here.

The notion that you are consulting, we accessed this via our parish council and most of the dates have passed and the PC have not even been consulted.

4.10.10 Carers and Respite An organisation solution and not patient focused nor meets relatives and carers needs. Families need a lot of support. Travel costs for relatives, or some sort of accommodation for them on site would be needed. Many carers of such patients are themselves elderly and struggling. My concerns are that concentrating inpatient support for this client group in one geographical location may impact on carers and families being able to be part of the support mechanism.

4.10.11 Management and Organisation Staff may well need really good support, teamwork, management and training in order to be able to cope with the additional stress involved from cutting other local beds and day hospitals. This means much closer working together than at present. Good idea to rotate staff from hospital to community but in my experience this needs to be managed really well or it falls apart.

A much better alternative would be to combine the RR Teams with a number of localized beds even if these have to be reduced or amalgamated to some extent. Furthermore, liaison with community based professionals will be more complex, less frequent and more formalized.

If the other structure you propose is (monitored) effective.

Instead of cutting back on services, greater efficiency savings should be sought

by looking at staffing and bureaucracy.

Centre of excellence is a management descriptor. It is not often meaningful, every place should aspire to be a centre of excellence, and the PCT should be supporting everyone to be excellent through communication, training and management.

I do not believe that dementia patients go into 'crisis'. The word 'crisis' suggests a short term, if severe, problem. I believe, having worked with dementia patients, that dementia is a degenerative, ongoing condition, i.e. it gradually gets worse over time. So I don't think the terms you are using here are appropriate.

4.10.12 Access I am concerned that the dementia rapid response service only provides time limited input and will not be able to manage the risks of people with dementia who live on their own. Agree proposal with doctors available 24/7 and specifically at weekends. Establishing a centre of excellence is to be applauded if there is reasonable equality of access. A centre of excellence is always a good thing, but for constant care dementia patients will also need somewhere that is easily accessible.

4.10.13 Estates Bolsover is a newer building than Walton - Bolsover hospital is a lovely building.

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It needs to have a clear inclusion criteria.

4.10.14 QuestionsServiceIs Walton central for the areas that you propose?How will it work? What's wrong with the current services available? Is this 'better care closer to home'?What is the definition of 'a crisis'? How is this going to benefit relatives and carers of dementia suffers?I thought we already had a centre of excellence at Newholm hospital at Bakewell - or do you want to waste that building and experience? Why Walton that is a long way from Bakewell why not make Whitworth centre? Will it be staffed 24/7?Have you visited other services? What does this mean - what are the services? Why are you removing everything from the rural areas and placing them into the built up areas?Not sure whether closing beds elsewhere would cause bed blocking elsewhere though? What is going to really change in terms of service, skilled personal employed and treatment? What is it modelled on? Has the Iris Murdoch centre in Stirling been consulted? What do carers and service users want? Have you asked Earle's take dementia service users what their thoughts are?Would it not be worth considering as well as the wards being the centre of excellence keeping LeaHurst Day Hospital as part of that centre and using improving the service they already provide? A centre of excellence needs to provide support to the staff so they become excellent and remain so - could this not support the peripatetic teams?Do you need more buildings or more expertise? My only concern is that this keeps referring to older people and as we know young people get dementia to - who is going to offer services to them? What about those living the other side of Bakewell and the surrounding areas - how will their relatives view these proposals? Will there be psychogeriatrician cover? Can't this be on site at the Royal hospital with closer links and better access to the acute hospital? If this is the case then what is the purpose of Meadow View in Darley Dale?Is this proposal in addition to or instead of the proposal for crisis teams?In reality, are these crises much more likely to be precipitated by physical illness, and result in admission to acute Trusts? Would a better use of the resource be to support GP services and acute trusts to manage severe dementia symptoms whilst physical causes are treated?

BedsHow many beds will be available? Will there be enough beds for demand or will there be a constant waiting lists?

TravelWill patients with dementia cope with travelling all the way to Walton (including n poor weather)?How would non drivers get to the hospitals to see their relatives?How is a 90 year old husband/ wife supposed to do this? How do you expect family to visit with no bus service?

FundingWill it be the cheapest option?How will you prevent Walton hospital becoming a dumping ground when strapped for cash? What happens if the Hospital gets into financial difficulties?

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5. Proposal 3 - Executive Summary

Proposal 3 – Closing Bolsover and Newholme community hospitals


There was broad disagreement with the proposal to close either hospital. These hospitals were considered to be needed by the local communities. Common themes in both cases included, patient care and quality concerns, management and organisational issues including a timetable for the proposed changes, issues around costs and funding, the location of alternative services and the inherent issues around travel and transport. The use of community hospitals including the range of services provided through these hospitals. Concerns about staff, carers and respite and access to services were also raised. The use of the estates (buildings) was discussed. In every case there were requests for further detailed information and a range of questions about the proposals.


5. Proposal 3 Bolsover Community Hospital and Newholme Community HospitalBolsover Community Hospital and Newholme Community Hospital will over time no longer be needed for NHS services and will close when their inpatient services have been replaced by alternative services.

What you think about the proposal to close:

5.1 The closure of Bolsover Community Hospital SummaryThere was broad disagreement with this proposal – community hospitals are needed. Those who agreed with the proposal felt that the reality of financial constraints should be considered. The quality of care of alternative services was of concern. A timetable for change is requested. Concerns over costing were raised. Care closer to home was a priority. Bed numbers were considered too low. Further information was requested. Suggestions relating to the buildings were made. Staff redeployment was suggested. Matters concerning travel and transport and carers needs were also discussed.

Bolsover Community Hospital 5.1.1 Disagree This proposal is (absolutely disgusting, not reasonable, not acceptable, strongly opposed, wrong, a big mistake, very bad, short sighted, terrible, very sad, illogical, an uneducated decision by ill-informed management, in need of more thought, shocking, a loss to the local community, disrespectful to patients, shameful, doubtful, a pity, a backward step, narrow minded, scandalous, outrageous, rubbish, horrific, ill conceived, heart breaking, morally and criminally risky, an unmitigated disaster, purely insane, poor, a crying shame, detrimental, appalling, irresponsible, a grave mistake). We all need our community hospital. A community hospital is somewhere that everybody knows about; the new system could be confusing or poorly communicated and will impact the most on the elderly who are less likely to use technology.

In 10 years you will be looking to reopen it as it will be realised that it was a mistake. Bolsover is modern well run and with physio OT and Social services all in place - it is to rehabilitate as well as a good place to die. A vital community resource closing in an already deprived area where health problems are already neglected. Due to ageing population would have thought there would be a use for Bolsover hospital.

5.1.2 Agree This proposal is (ok, good, makes sense, fine, not a problem, not detrimental, a possibility, not objected to, logical, workable, the obvious thing to do, supported, great, fair).

One must accept the reality of financial constraints, but much reassurance is owed to Bolsover residents. Local people will see the benefits. It already has another hospital in the town of Chesterfield. This hospital is too far from Bolsover town centre. An important way of making best use of resources – we can see the need for economies - if other services are in place.

5.1.3 Patient Care & Quality

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It should be kept for the local and surrounding area patients.

I do not believe that there will be adequate services to replace inpatient beds. Community nursing is not the same as hospital nursing - they will diminish care for vulnerable people. The day hospitals actually support people to stay in their homes longer. I think this will lead to increased loneliness, isolation and fear. It will lead to an increase in mortality rate.

Bolsover has/is a very caring environment for patients - a homely feel, beautiful gardens, friendly supportive teams - on site facilities are first class.

Poor reputation recently with care concerns.

Old people don't like care homes they are everybody’s nightmare. Local people do not want to go to CRH.

5.1.4 Management and Organisation A clear timetable of change needs to be in place so local people know exactly what will close at a particular point. The public need to have used and approved the "alternative services" before closure takes place. Would have to be clearly communicated and CRH staff adequately educated as to the alternatives.

5.1.5 Costs & Funding Significant investment is required. It will be a loss but a good way to put money back in to the services - if the money gets but back in! There would be a huge cost I am sure to keep the premises open and yet lots of NHS services seem to struggle for space/and to be accommodated. It seems an inevitable result of the earlier changes, but you will need to find a convenient, lower cost building.

The government should give less money away and use it for the NHS. Previous

generations their tax have built up the resources and wealth that we enjoy. If this generation via the CCG throws it away, history will judge you harshly.

It is simply a way to remove things from the public to the private sector, and therefore is a political decision. Fear it will just be private nursing homes. Patients will end up being in a nursing home that they will fund themselves.

5.1.6 Location People need to be near their families not miles away. The NHS is trying to centralised services making it extremely difficult for many patients to get easy local access.

It is close to Chesterfield royal so clinics can be attended there and local health centre.

I thought you were moving services nearer home, you are if patients are at home not if they need to travel longer distances to hospital, many relatives will be older and may not drive.

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It seems to be only about money.

Patient care & day centres do not necessarily need to be in hospitals.

5.1.7 Community Hospitals and Hospital Beds Closing 104 beds and using only 32 beds - not enough to replace those closing. On a daily basis we have to wait for beds to become available - surely this means demand is high and we need these services. Will this not put pressure on A&E at the remaining general hospitals. Closures need to take account of impact on acute trusts.

It would seem to me that closing so many beds at Cavendish, that is the one for closure if any is necessary.

The service to the community in terms of physio, family care, and other general services is extremely important and removing from local centres will mean some will simply not bother to access help - less healthy population.


Your plans make no mention of what happens at the end of life or during the out of hours period. You have not demonstrated that we can do this without risking making worse an already desperately difficult bed shortage situation This may affect the economy of Bolsover as there will be less movement of people coming into the town - an economical impact assessment is needed. The proposals have not, to my mind, fully answered the questions about how sufficient care staff and nursing / residential home beds are going to be sourced to meet increased demand on these services, what additional support carers and families are going to be offered in order to enable them to continue in their roles in light of the increasingly complex and severe conditions that they will be assisting staff in caring for at home, and the impact on family / carer involvement and home visits of concentrating all inpatient services in specific geographical localities. I have raised my concern about arrangements for assurance of quality if DCHS contracts out to other providers of nursing / residential home beds.

Some of the proposals would appear to have been built on statistics that are misleading (since the physio musculoskeletal outpatients were moved out of this hospital within the past 3-4 years to Welbeck Health Centre their many thousands of attendances have not been included, although their admin is still run by our team and they are still regarded as part of our teams).

Looks like the decision has already been made & anything the public say or do will have no bearing. The last sentence should read 'if' having designed large scale consultations, I have an awareness of foregone conclusions. I think there should be a further consultation process to see if the hospital premises can be saved.

5.1.9 Estates It is the most recently built hospital in North Derbyshire apart from Clay Cross Hospital and has so much there. There are many rooms which could be bases for other local groups that combat social isolation. Can't it be used as a hub or community place.

I think a bonus once the facility has closed could be the sale of the land for housing providing income to the NHS and much needed local housing.

5.1.10 Staff Although you plan to re-deploy staff, this will not be enough to replace the existing service. Concerned about ability to double run services as we struggle to recruit to our

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current service so not sure we would be able to staff parallel services. All staff will need training and support.

You have already practically closed it by making services impossible to run safely and effectively (staffing) - hope all the staff are not made redundant.

5.1.11 Travel & Transport Most people that will be effected are elderly that cant drive so would have to get public transport. Using transport to get to Chesterfield is a nightmare.

5.1.12 Carers and Respite When this resource is gone it may mean that people are admitted into hospitals or care homes sooner because carers are not given the support or respite that the day hospitals provide. I think you could use these places more to help patients and carers cope with the demands of those suffering with dementia.

5.1.13 Access If you get rid of a 24/7 service, then the service to replace it also needs to be 24/7.

5.1.14 QuestionsHow can you say with such certainty that they'll "no longer be needed? What is the criteria for the decision?How can this suggestion comply with your stated aim of providing care nearer home? Disgusting who says nhs services will close at these hospitals?How will new services be funded before existing services are decommissioned?Will this be sold off as land to redevelop or used by social services / DCC provider for beds with care?How will good quality care be maintained whilst the hospital is run down? Do the existing staff team have the required skills and expertise to work in the community? Have the problems of winter pressures been factored in to these proposals?Will this work for people in Buxton considering its location and winter conditions?One vitally important point made in the meeting was that there is evidence to suggest that the dementia rapid response service only works with a day hospital as a hub - would it be possible to utilise the hospitals and use them as community hubs then have smaller outreach teams in the local communities? Where will the money come from?

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What you think about the proposal to close:

5.2 The closure of Newholme Community Hospital SummaryThere was broad disagreement with this proposal - local community hospitals are needed. The location of the hospital is important. Those who agreed with the proposal felt that the reality of the financial situation should be considered. The financial basis for this proposal was questioned. The quality of care was thought to be impacted by this proposal. The number of beds was thought to be too few. No closures should take place until alternative services are in place. Travel and transport to alternative services were discussed. Suggestions regarding the buildings were made. Further information was requested. Staffing concerns and carers needs were also discussed.

Newholme Community Hospital 5.2.1 Disagree This proposal is (short sighted, not reasonable, disgusting, not acceptable, dreadful, heavenly minded but no earthly use, strongly opposed, a bad move, wrong, ridiculous, very sad, stupid, absolute nonsense, i’ll thought out, smacks of hidden agenda, needs more thought, a false economy, unworkable, shocking, not acceptable, a loss to the community, effecting peoples lives, a crying shame, awful, disrespectful, a shame, doubtful, not good enough, disastrous, a pity, shameful, narrow minded, outrageous, deplorable, regrettable, frightening, ill conceived, concerning, morally and criminally risky, insane, a retrograde step, hard to bear, appalling, dismaying, a nightmare, a tragedy, irresponsible, misguided and dangerous)

Newholme is a marvellous hospital, serves a big area and needs to remain open - and investment

made. Please think of those of us who are getting older need to

be able to access our everyday needs such as hearing clinic's physio etc in easy reach of home. We use the hospital for Hearing aid batteries and very regular podiatry care. This would remove - for good - a facility which has been vital to the Bakewell and Matlock areas for many years. It seems to us that you are cutting down on services in spite of an expanding and increasingly elderly population.

5.2.2 Location Local care will always give a need for local hospitals - surely these local hospitals are what community care is about. No other facilities for miles around. It will have a huge impact on local people - not only patients but visitors and family as everything will be made harder e.g. visiting, travelling further distances, unfamiliar places.

All these depend exactly where you live. It is central for many people in this area. This community hospital is in the heart of the local community servicing local rural areas, Monyash, Winster, Elton, Birchover, these villages are too far away from Chesterfield. I would propose that a purpose built, centrally located community hospital covering all functions of the existing hospitals in the Darley Dale, Bakewell, Buxton, Chapel-en-le-Frith and Hope Valley is built.

5.2.3 Agree This proposal is (ok, a good idea, acceptable, agreed, necessary, will help finances, not problematic, not opposed, fine, seems logical, the obvious thing to do, supported).

One must accept the reality of financial constraints, but much reassurance is

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Totally disagree with this decision.

An important way of making best use of resources.

owed to local residents. As long as alternative space is available for staff to relocate to in Bakewell or nearby in the High Peak this reasonable. Good idea to get rid of old building, maybe replace with modern health centre. They have Whitworth close by, I suppose not so drastic. Patient care & day centres do not necessarily need to be in hospitals.

5.2.4 Costs & Funding Financial projections for 'new' services typically

prove to be inaccurate and understated - and will prove far greater than what the status quo would evolve to.

It has been supported by fundraising by several local organisations for many years, proof of its place in the hearts of this community. All the money being spent on 'alternative' services could surely keep the hospital (in some degree) open. Why not let some Areas and recoup some rent. Financial expediency vs patient loss is very sad.

I understand the economics of the situation. I understand a large amount of money needs to be saved and this is an expensive site. Rent has to be paid here so yes that is a drain on resources. The NHS cannot afford to keep this when in such a prime location and upkeep is so costly. It note the CCG is on a hiding, the Government has broken its promise re health services budgets, instead of £8.4 billion its 4.5 billion.

If one was cynical one could think you were heading towards privatisation – paying private nursing homes to replace some of the services. You have reviewed which sites are most valuable for selling and acted accordingly. Be sure this site is used for independent living - no sale to the million pound holiday maker brigade.

NHS property services was set up by the secretary of state. NHS property services charges in excess of £300,000 per annum to rent the site which then goes back to the Secretary of State. Yes the Government might increase funding to the NHS with one hand but it’s going back to the Government with the other hand.

5.2.5 Patient Care & Quality I do not believe that there will be adequate services to replace inpatient beds. Community nursing is not the same as hospital nursing - the day hospitals actually support people to stay in their homes longer. Alternative Services can only be inadequate at best; they will diminish care for vulnerable people and the people who are their carers.

Appointments are always on time - it is a peaceful well-run establishment with parking – and excellent care is given. This is such a lovely happy place for people to recover. Consultants’ clinics will stop so further difficulties for patients.

I think it will leave our most vulnerable elderly people more excluded, more vulnerable, less able, more ill. I've accessed mental health care here, myself. It was at a time when asking me to travel out of locality would have been too much and the care I received may literally have saved my life.

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Significant investment is required.

Such patients should not be left on their own to cope.

A cut of rehab beds from 84 to 32 is just not going to work 52 less beds. Newholme seems to be a busy hospital with departments that are well used. I was told there was always a waiting list for beds. There will always be beds needed as a bridge between acute hospital care and going home in the Bakewell and the Dales area. Don’t take our community beds, keep Oker ward and the wards at Clay Cross and Buxton open I would have thought we need either Newholme or Whitworth. It should be built up.

They do provide other services. Lots of outreach facilities are here such as the physio service and the hearing services, diabetic foot and eye tests, outpatients physiotherapy, podiatry, mental health services, school health, speech and language. This is the only place I want to die - in here or at home. We prefer to go there as it is closer than Calow and requires less time off work. 5.2.7 Management and Organisation No closures until the proposed replacement services are proven to be viable and robust. Depends on new care and time allowed and quality. You would need to wait and see if demand really does fall. Provided backup is readily available. There is not one reference in the consultation document from social care to indicate they are preparing for this change.

5.2.8 Travel & Transport There are good pubic transport links to it.

I for one do not feel confident to drive to Chesterfield, and I am one of the lucky ones with a car. This will negatively impact, ambulance services. Using public transport to get to Chesterfield is a nightmare. We are at risk from adverse weather conditions. Parking is restricted. Visiting will be so limited.

Chesterfield is on a good bus route and actually not too far away.

5.2.9 Estates Consider moving other services in such as the doctor’s surgery, opticians, age UK day unit, dentist, and a community hub. Suggest the Hospital could be used by an independent Nursing Home provider who might provide some rehab provision and thereby reassure local community regarding the value of a valued local asset.

This building was left in a legacy for the people of Bakewell. The Big Fat Lie is that Newholme is not fit for purpose. The Truth is that the wards and day hospital are new build.

A very old building - not fit for purpose. If the alternative building is cheaper to maintain and more accessible for patients and carers, then close the hospital.


Your plans make no mention of what happens at the end of life or during the out of hours period. Need to know exactly what the alternative services would be. You have not demonstrated that we can do this without risking making worse an already desperately difficult bed shortage situation. The proposals have not, to my mind, fully answered the questions about how sufficient care staff and nursing / residential home beds are going to be sourced to meet increased demand on these services, what additional support carers and families are going to be offered in order to enable them to continue in their roles in

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light of the increasingly complex and severe conditions that they will be assisting staff in caring for at home, and the impact on family / carer involvement and home visits of concentrating all inpatient services in specific geographical localities. There is no actual evidence of any local alternatives that will work. I question if implemented properly will save money, and I would be interested to see the detailed financial proposals rather than global figures.

I do believe that the people who are making the decision have not done any research into the demographics of this area and I strongly suggest they do this.

This has already been agreed for this site and the ordinary person in the street like myself will have no say in whatsoever. I think this is a completely dishonest proposal and consultation. This whole questionnaire does not allow you to put alternatives. Your questions are put in such away ie. 'easy for people' or 'better care' that you feel pressured to go along with it.

5.2.11 Staff Although you plan to re-deploy staff, this will not be enough to replace the existing service. Never enough nurses. Not sure how the double running will work, as if the ward staff keep it going until the community teams are working. All staff will need training and support.

The nursing homes around Bakewell all have waiting lists. Private care homes could be far away or not guaranteed to always be available. You are closing the council run residential homes as well, which is just compounding the problems.

5.2.12 Carers and Respite Moving everything to hospitals further away makes it harder for the patient and those trying to support the patient. When this resource is gone it may mean that people are admitted into hospitals or care homes sooner because carers are not given the support or respite that the day hospitals provide.

5.2.13 Access If you get rid of a 24/7 service, then the service to replace it also needs to be 24/7.

5.2.14 QuestionsThere are a number of other facilities provided at Newholme, clinics etc. What will happen to these, this proposal makes no reference to them, if they close as well where will residents have to go for these services?Why close a unit that has been doing such a good job especially when the alternative services are untested and will not provide the constant care that is available at the moment?What will happen to the buildings and site?Could these hospitals be used to provide other NHS services?What is the criteria for the decision?Where will the ward staff transfer their work to?Will there be respite beds in other local Homes?How are people expected to travel over 40 to an hour on public transport which cannot be relied upon in this area to be at the right time? How can this suggestion comply with your stated aim of providing care nearer home? Can 4X4 vehicles be provided for winter to ensure more teams can access remote locations in bad weather?

6 Consultation Clarification

When answering enquiries received during the consultation the consultation team

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became aware that incorrect figures were printed in two tables containing financial information in the pre-consultation business case (PCBC). As part of the commitment to a robust consultation process they also then asked independent auditors to check the entire PCBC and a third table was identified which included some errors. They therefore held a clarification exercise throughout November.

The aim of the clarification, starting on 31st October and ending on 28th November, was to provide corrected versions of the tables and to ask whether or not this impacted on the feedback provided during the consultation.

In total 62 responses to the clarification exercise were recorded. Of these 77% either did not feel that the corrected information impacted on their original response – or they were undecided. Of the 23% who felt this information had impacted on their response, in each case they indicated that it had strengthened their original position. In other words, they would not have taken an opposite view. We can therefore be assured that the feedback collected above represents the informed views of those who responded to this consultation.

The following feedback was also provided in this exercise.

Support for Community HospitalsBy far the greatest volume of comments were in support of community hospitals, the Oker ward at the Whitworth hospital in particular and the current arrangement of services in general. This feedback serves to amplify the discussion in the original consultation feedback.

Views UnchangedThose who provided free text indicated that in light of the corrected information, their views remain unchanged. E.g.;

My response carries more weight due to the 24% reduction in the costs of community beds. The new figures do not change my opinion. The error strengthens the existing opinion.

Information ConcernsThere was a range of information concerns. E.g.;

I think it is very poor that the figures were not correct in the original document or as presented at the meeting, as the majority of people did not have or read the full PCBC document but relied on those figures given out at the public meetings to be accurate. Figures and numbers can be manipulated to fit requirements! The very fact that the tables had to be amended is proof of that. My trust in the CCG organisation has gone. I have little confidence in the decisions being made by the 2 CCG's if the plans are based on figures that are incorrect to that extent. The figures are estimations to justify the CCG agenda, they're not real. It only leaves me to believe there are more mistakes that have been made and are being covered up.

Table 1 from page 60 shows oker/whitworth to be significantly more cost effective than originally estimated which undermines any plans to close Oker as a cost saving exercise. Table 1 from p60 contradicts table 2 from p81 which then shows Whitworth as being more expensive - option 3 is based on a 32 bedded model at Whitworth when the maximum numbers of beds on Oker is 26, the figures are deliberately misleading. Furthermore your existing costs lack a break-down as justification. To isolate the cost of a single unit is false economy to the NHS.

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I would be interested to see how figures for option 4 have been modelled - given that CRH includes rent as well as running costs - versus option 3; this cannot be factual or it is incorrect.

Once again I am left believing that there is no real financial grasp of the impact of all the different strategies put in place by accountants and are just number crunching to reach an aim.

Council considers the distress caused by ill thought out proposals to the residents of the rural communities and the fundamental errors and flaws now exposed an excellent reason to dismiss this consultation and seek to properly integrate the invaluable care wards into all future plans with no further talk of closure.

I have not ticked any of the boxes because once again you are not asking appropriate questions. It appears to be an attempt to further influence public opinion by publishing figures that the public would not necessarily have taken any notice of, in order to promote the outcome the CCG intend on forging ahead with.

This does further undermine confidence in the competence of Commissioning Bodies to make informed recommendations about such crucial decisions when some of the figures they have provided in the original consultation document are out by up to 54%. You assure us that “the identified errors do not affect the proposals we put forward for consultation” which brings into questions how many other unidentified errors there may still be in the original consultation paperwork. We therefore have no confidence in this consultation as it is based on potentially flawed data and we strongly urge that the whole consultation is re-run after independent verification of the data to enable the people of Derbyshire to have confidence in the decision making process.

QuestionsWhat are the CRH figures modelled on? Where is the evidence for these figures and how have they been calculated? What guarantee then, that the final figures shown are correct? How have you modelled a ward in Chesterfield that does not exist? What else are they going to get grossly wrong? What is the cost of a bed? Why the figure of 32 hospital beds for Bolsover? (Not had 32 beds for a long while, this figure of 32 puts our cost up double)

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7 Report Outcomes

This report has been developed independently using the feedback provide. All queries concerning this report can be forwarded to the author. All further correspondence should be forwarded to the respective CCG’s.

Final Report developed byDr Steven Wilkinson – Consulting the Community*[email protected] 2016 (final version 7th December 2016)

* Consulting the community is a research centre of academics from the social sciences. This method for analyzing feedback has been developed by colleagues from this centre. Enquiries can be made by contacting the CCG. Website – www.consultingthecommunity.co.uk

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http://www.consultingthecommunity.co.uk/

executive summaries - north derbyshire ccg · web viewthe beds with care proposal raised concerns...

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