report 01.14.008 (6) trust board 30...report 01.14.008 (6) trust board 30th january 2014 subject...

REPORT 01.14.008 (6)

TRUST BOARD 30th January 2014

Subject RCHT Response to Poltair Consultation

Prepared by Paul Buller (Service Lead) & Stella Ellis (Divisional General Manager for Medicine, ED & WCH)

Approved by Ethna McCarthy (Director of Strategy & Business Development)

Presented by Ethna McCarthy (Director of Strategy & Business Development)

Purpose

The objective of this report is to recommend to the Board, a response to the options presented to stakeholders for future of Poltair Community Hospital, Penzance.

Receive

Approve

Trust Objectives

Quality Preferred Provider

Partnership Workforce Sustainability Finance

Executive Summary

The consultation about the future of Poltair Hospital is being led by NHS Kernow (NHSK) and Peninsula Community Health (PCH). As part of the consultation process an option development workshop was held with stakeholders, including RCHT, on the 25th September 2013. On the basis of this, and other communication events, the, options were formed and some then discounted due to either safety or financial constraints. The options are fully described in the consultation document, which is attached with this report. The Royal Cornwall Hospitals NHS Trust, as a stakeholder, is therefore responding to the five options presented in the published consultation document “Have Your Say, A Review of the Future Use of Poltair Community Hospital”. There are 2 options which include the use of West Cornwall Hospital.

Option 4 - Relocation of outpatient clinics and staff base to West Cornwall Hospital Option 5 - Relocation of outpatient clinics and staff base to WCH and alternative existing

sites in the Penzance area

The strategic direction for West Cornwall Hospital is that it should be a modern, intensively used hub for services in the West. This is keeping with the wider Health community strategy, of integrated care, delivered as close to home as possible. Any proposals regarding WCH, must therefore be in line with these strategies, and also be viable in terms of our own predicted use of the facilities and capacity. The Division of Medicine has led the work to formulate our response, but in doing so has engaged with stakeholders within and outside the Division, the West Cornwall Forum, and has also sought views from the 2 Governors for the West Constituency.

Next Steps

Subject to approval by the Board, RCHT will provide a formal response to NHSK and PCH on 31st

January, when the Consultation closes. On 5th March 2014, a stakeholder workshop will be held to review findings from the public consultation. The public report will be published on 31st May.

RCHT will continue to work with partners to refine the options and look at implementation plans, and specifically.

1. Prepare the capital planning / costing for any conversion of the premises as required in WCH.

2. Provide and agree detailed revenue costs for clinics that need to be accommodated.

3. Incorporate the above within a formal contract.

Corporate Impact Assessment

CQC Regulations Covers all CQC outcomes.

Financial Implications None.

Legal Implications None.

Equality & Diversity None.

Performance Management None.

Communication None.

In essence, the Trust considers that the continued utilisation of very small Community hospitals, does not represent a high quality, affordable model going forward and that, where ever possible, and subject to appropriate pathways being in place, hospital services should be provided in fewer, better supported units. The resource released should be redeployed to invest in preventative services, acute care out of hospital and social care support. A further stipulation would be that all relevant financial implications are addressed so that RCHT has, as a minimum, a neutral position.

Key Recommendations

The Trust Board is asked to support Option 5, and agree to the use of West Cornwall Hospital:

• Accommodate the specific outpatient clinics identified above,

• Provide a staff base for the Peninsula Community Health Staff from both Poltair and Bellair, subject to agreement of the financials and supporting contract.

Further, the Board should seek assurance that work will be accelerated, led by NHSK, to develop a clear Strategic Direction for Community Hospital Services to support early discharge and admission avoidance, with relevant supporting social care support services.

Assurance Framework

Assurance provided relevant to delivery of the Partnership objective, and in part mitigating system risks arising due to divergence of commissioner/ provider plans.

Acronyms / Terms used in Report

NHSK NHS Kernow

PCH Peninsula Community Health

WCH West Cornwall Hospital

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Contents

Introduction Page 3 Background and Context Page 3-6 RCHT: Strategic Director for West Cornwall Hospital in the West Page 6 Response to Poltair Consultation Pack Viable Options Page 6-7 Options for Relocation of Services to West Cornwall Hospital Page 7-10 Conclusion Page 10 Recommendations Page 10

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2.6 The average length of stay did rise after October 2012. This trend has continued through 2013, and will be related to a number of factors. Length of stay has also increased at RCHT for a similar cohort of patients.

2.7 The graph below shows the number of patients that have a length of stay over 10 days

at WCH.

2.8 This has risen dramatically from October 2012 and has remained high. As stated above this is due to a range of factors, most significant of which has been delays in the provision of social care packages and access to nursing home placements.

2.9 The Royal Cornwall Hospitals NHS Trust, prior to inpatient beds being closed,

deployed an Eldercare Consultant to Poltair once a week to review patients.

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3. RCHT: Strategic Direction for West Cornwall Hospital 3.1 The Royal Cornwall Hospitals NHS Trust believes West Cornwall Hospital is an ideal

position to be the hub for community services. The hospital has received on going investment specifically from the Friends of West Cornwall Hospital and continued to increase the services available with public support through the well-attended Community Forum. There are also provisional plans to develop the site so that the needs of the population can be met. The hospital team, are very much engaged in the Pioneer pilot work, and actively working with Partners to develop more integrated models of care, particularly with regard to services for the frail and the elderly.

4. Response to Poltair Consultation Viable Options as Listed in “Have Your Say, a

review of the future use of Poltair Community Hospital” Document. 4.1 Option 1 Poltair Site: Outpatient & Outreach services only (closure of inpatient

beds on site and needs met by Helston and Edward Hain).

It is felt that this option is not practical given the cost of maintaining the estate for the size of the services provided.

4.2 Option 2 Poltair Site: Outpatient, Outreach and Inpatient services (5 inpatient

beds only).

This option is also not considered to be viable as the cost of capital funding and then ongoing costs for the support for 5 beds do not meet value for money criteria. The data supplied has shown that the majority of the previous bed base was occupied by people who could have had their care delivered at home with appropriate support after discharge from the acute hospital.

4.3 Option 3 Poltair Site: Outpatient and Outreach services only (increased

capacity), (closure of inpatient beds and needs met by Helston and Edward Hain)

As per option 1 this is not practical given the conversion costs and maintenance costs involved with older estates.

4.4 Option 4: Relocation of all outpatient clinics and outreach staff to West Cornwall

Hospital, beds to be within Helston, Edward Hain Community Hospitals and other settings - closure of Poltair.

This option is in keeping with the strategic direction for WCH, however, whilst some capital and revenue investment would allow the provision of a staff base for outreach services there is not enough capacity to accommodate all the clinics.

4.5 Option 5: Relocation of outpatient clinics and outreach staff both to WCH and

alternative existing sites in the Penzance area and beds, as option 4 - (Poltair closes).

In line with our strategy of integration, the Royal Cornwall Hospitals NHS Trust supports the benefits to patient care by co-location of services. We could offer, with considerations (see below), the relocation of most services and possibly rebasing staff at West Cornwall Hospital. In addition to this consultation option, the Royal Cornwall Hospitals NHS Trust could also support the provision of a base for staff from Bellair, which is another PCH base providing therapy, dental and other services. This will be dependent on a full appraisal,

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and assessment of risk to any other of the Trust’s other strategic initiatives and operational requirements. This would facilitate the ability to deliver care closer to home with the possibility of service integration. Some clinics that could not be accommodated may have to provided at other local sites.

5. Supporting Information – Option 5 (Relocation of some services to West Cornwall

Hospital 5.1 Outpatient clinics to relocate to WCH – Clinic total picture and capacity

Clinics that currently run at Poltair are:

Team/Service Days Frequency Leg Ulcer clinic

Tues, Thursday & Friday (all day)

weekly

Continence clinic

Tuesday (all day)

alternate weeks

Diabetic clinic

Thursday (all day)

twice monthly

Falls Clinic

Thursday (all day) monthly

Stroke clinic

Tuesday (all day)

weekly

ME/fatigue Group

Wednesday (all day)

weekly

Chronic fatigue (Psychologist 1:1)

Friday (all day)

weekly

Pulmonary rehab

Wednesday afternoon

weekly

Therapy team

Monday morning Tuesday morning Wednesday morning Thursday morning Friday morning

Clean clinic

Groups

8

West Cornwall Hospital could accommodate the following clinics in the Treatment Centre or in West Cornwall Hospital outpatients with some adjustments:

Team/Service Days Frequency Adjustments Sessions

weekly after adjustment

Leg Ulcer clinic

Tues, Thursday & Friday (all day)

Weekly

Thursday would have to move to Monday

6

Continence clinic

Tuesday (all day)

Alternate weeks

No adjustment needed to clinic times

1

Diabetic clinic

Thursday (all day)

Twice monthly

Would have to move to alternate weeks on a Friday

1

Stroke clinic

Tuesday (all day)

Weekly

No adjustment needed to clinic times

2

We propose to offer space for these clinics so that these services can still be provided centrally for Penwith area residents. Other available sites to provide the facilities for these clinics locally are limited. It also increases the use of our resources (Treatment Centre) and generates revenue.

Initially the clinics would be have to be accommodated in the Treatment Centre as outpatients at West Cornwall Hospital is at 95% capacity and do not have the correct room size available for the clinic sessions requested.

Any clinics in the Treatment Centre could potentially move when WCH outpatients is improved with our site development plan. The impact for the Trust is that if new services are required, availability of certain types of room will be restricted (the Treatment Centre has different facilities available in different rooms). All the services that are currently planned to start can be accommodated (Cataract one stop shop and Pre-assessment clinic). We can also accommodate an increase in cardiology and ophthalmology services that are currently being discussed.

The community led patient groups could not be accommodated as the rooms are not suitable. PCH are looking at room availability in General Practice (GP) surgeries, local council buildings and leisure centres for these groups if relocation is chosen as an option. The table below shows our indicative costs of each clinic based on the information currently provided by Peninsular Community Health.

Clinic Name Frequency, Day, am/pm Total Clinic

Charge Pa (£)

Leg Ulcer Clinic Monday, Tuesday & Friday (all day) 28,865

Continence Tuesday All Day (Alt weeks) 4,811 Diabetic Friday All Day (Alt weeks) 4,811 Stroke clinic Tuesday All Day 9,622 48,109

9

Currently, the therapists at Poltair use their gym on an ad-hoc basis. This availability would not be possible from the gym at Therapies Outpatients, West Cornwall Hospital, due to capacity constraints. However we are keen to accelerate work to develop integrated therapy services. This is outside the scope of the consultation.

5.2 Provision for a Staff Base for Outreach services at West Cornwall Hospital

There are 17 therapists, a Respiratory Nurse, a Stroke Nurse, a Learning Disabilities Nurse and a Diabetic Nurse to relocate from Poltair requiring 10 office desks. There has also been an expression of interest to accommodate staff from Bellair on site requiring an estimated further 20 desks. These include District Nurses, Community Matrons, Macmillan, Speech and Language Therapists.

These staff could be accommodated in the no longer used Pathology Laboratory or the meeting room/library above the Therapy Unit. The Royal Cornwall Hospitals NHS Trust would need to consider the use of capital funding to facilitate changes required with an agreement that the revenue achieved through the lease arrangements provide us with payback over a 1-3 year period, and return thereafter. PCH could also explore alternative financing arrangements.

Relocation of these staff is in line with our strategic partnership goals with Peninsular Community Health, i.e. co-location of clinical services, which could result in better discharge planning through improved communication and mutual sharing of knowledge. It would also be in line with the principles of the Pioneer Status that Cornwall has just received. Staff morale and retention would be positively affected. In this context it should be noted that the Penwith Pioneer Project is a program based on the outcomes of the Newquay Pathfinder and delivering integrated care. It brings together the NHS, Age UK Cornwall, Peninsula Community Health, Cornwall Council, and volunteers to provide a combination of medical and non-medical help for people to remain independent and to stay out of hospital. The Pioneer project is a collaboration between providers, to co-produce a single ‘person journey’ across health, social care, voluntary and community sectors.

Parking on the West Cornwall Hospital site is limited and staff would have to park in surrounding residential areas. Discussion is underway with Cornwall Council to provide parking permits in the nearby car park to reduce the effect on the local community. Disabled access is also limited as it is situated on the 3rd floor with only stairs for access.

If the above proposal is acceptable it would require a building program and investment to convert the current facilities. An initial assessment of such costs indicates £150,000 this is based on costs from 2012 but would need to be revaluated against new requirements and current market conditions. To re-mobilise, adjust design to current requirements and re-tender we are looking in the least at an 8 week period followed by an 8 - 10 week programme of works.

6. Conclusion 6.1 The Royal Cornwall Hospitals NHS Trust believes that that they have a significant role

to play in providing alternative ways of delivering services for the West Penwith population. The Trust already provides excellent services form West Cornwall Hospital and in particular, for frail elderly patients and this has been recognised by the Care Quality Commission.

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6.2 The options have been considered and our response has been reached through consultation with the Division of Medicine, Governors, Trust Management Committee and partners.

6.3 It is widely recognized that acute hospital beds are not appropriate for medically fit for

discharge patients and those requiring further rehabilitation. This consultation is one step towards the creation of a more out of hospital, care model but it must be supported by the provision of outreach services, alongside a clear strategic direction from NHSK regarding the use of Community Hospital beds and model for community services to support early discharge and admission prevention.

6.4 After considering options for the different modalities, the Royal Cornwall Hospitals Trust

can offer to accommodate most outpatient clinics at West Cornwall Hospital as per option 5. These could be factored into the future development of outpatient services at West Cornwall Hospital.

6.5 West Cornwall Hospital could also offer a staff base for therapists and specialist nurses,

indicative of costs and income as per option 5. This would include capital or revenue investment by Peninsula Community Health to make the proposed areas suitable for offices and desk space. This could potentially stimulate integration between West Cornwall Hospital and Peninsular Community Health staff both of whom are already working with similar groups of patients.

6.6 There are critical business decisions to be made if services are to be moved to the

acute provider. There would need to be a degree of confidence that resources previously invested in providing inpatient care could be directed to funding outreach services, rehabilitation and supporting patients who continue live in the community.

6.7 The Royal Cornwall Hospitals NHS Trust supports option 5 for the future of Poltair

Community Hospital. 7. Recommendations 7.1 The Trust Board is asked to support Option 5, and agree to the use of West Cornwall

Hospital:

Accommodate the specific outpatient clinics identified above, Provide a staff base for the Peninsula Community Health staff from both Poltair

and Bellair, subject to agreement of the financials and supporting contract.

7.2 Further the Board should seek assurance that work will be accelerated, led by NHSK, to develop a clear strategic direction for Community Hospital Services to support early discharge and admission prevention, with relevant supporting Social Care support. Services.

HAVE YOUR SAYA review of the future use of Poltair Community Hospital

Poltair document FINALFINAL.indd 1 02/12/2013 12:55:33

A review of the future use of Poltair Community Hospital2

01726 627800 [email protected] www.kernowccg.nhs.uk

Contents

1 FOREWORD Page 3

Explains what we are doing and why.

2 WAYS TO GET INVOLVED Page 4Tells you about our consultation events and how to get involved in a number of ways. Our contact details are in this section.

3 OPTIONS GRID Page 5Gives you an ‘at a glance’ view of what options are being proposed and how well they meet the evaluation criteria.

4 THE OPTIONS Pages 6-10Each of the five options described in detail. Read this for a more in-depth view.

5 OPTIONS WE’RE NO LONGER CONSIDERING Page 11This section tells you about the five options that are not being considered and why.

6 WHAT HAPPENS NEXT Page 12 - 14This is about how the final decision will be made and when. It also contains information about what is not included and details of consultation events.

7 SURVEY Back page tear off

Jump to here if you have a good idea of your views on this issue already. You can also complete this survey online or ask us to help you complete it over the phone.


A review of the future use of Poltair Community Hospital 3


ForewordWe are looking at how to improve the quality of community services in west Cornwall and where those services are provided. We want to know what you think should happen to the services that are provided from Poltair Community Hospital in Penzance. In this document we set out some proposals for you to consider. What you tell us will help us decide what will happen to the services that are provided at or from the hospital.

Each year, around half a million people in Cornwall and the Isles of Scilly use community health services, of which 65,000 are in Penwith. This includes people who attend clinics and groups, receive treatment in their home, or need an overnight stay in one of the county’s 14 community hospitals.

NHS Kernow, which plans and pays for local health services, began a review of Penwith’s community services in May 2012. Patients, carers, health professionals and care home staff, were among those asked to consider how community services were provided and how they could be improved.

Along with many ideas, people told us that they want a decision on the future of Poltair Community Hospital and the use of its 10 inpatient beds, which have been closed since October 2012. You have asked us to consider either re-opening them or to agree alternative services to be provided to support patients.

To make sure we provide health care services that are safe, of a high quality, provide value for money and meet patients’ needs both now and in the future, we have strived to identify and consider all of the potential options.

We have involved the community all the way. In September 2013, over 50 people, including doctors, nurses, and groups that speak on behalf of patients and their families attended an event to identify priorities and criteria against which options would be evaluated.

This document describes the options identified. All are defined by a proposed location or service model needed to deliver each of the services that are provided at the hospital, including the inpatient beds.

Stakeholders agreed at the workshop that before any options were considered by the public, they must pass two key tests: safety and affordability. We have looked at all 10 options and have discounted five on the basis of either safety or affordability. You can find out about these five in section 5.

We are now asking you to consider the remaining five options and to tell us, in order of importance, which would best meet your needs if you were using Poltair Community Hospital. Each option is supported by a summary of its potential benefits and limitations to help you reach your decision.

Once the consultation has ended on 10 February 2014, the findings will be used to evaluate the options to identify the preferred option(s). This will be carried out in February in partnership with the doctors, nurses, councillors and patient representatives who helped to identify the options and priorities.

NHS Kernow and Peninsula Community Health will then complete further work to deliver a detailed analysis of the preferred option(s) to support the recommendations that will be made to NHS Kernow’s Governing Body. Only then will a final decision be made in public during a Governing Body meeting.

Dr Neil Walden, GP and Penwith Locality Lead, NHS Kernow

Helen Newson, Director of Nursing and Professional Practice, Peninsula Community Health




How to get involvedPlease read this document and the options we’re asking you to consider to help us provide high quality community services in west Cornwall. Please complete the tear off survey at the back of this document and send it to the Freepost address by 10 February 2014.

FREEPOST RTES-UZXK-SHBGC/O LOUISE MOOREKERNOW CLINICAL COMMISSIONING GROUPSEDGEMOOR CENTREST AUSTELLPL25 5AS

We can make this document available in different formats and languages and we will be working closely with the community and voluntary groups to involve people whose views are not always heard.

Online www.surveymonkey.com/s/ZPQQ553

Phone Call 01726 627800 from 9am to 5pm, Monday to Friday

Email [email protected]

Post Engagement team, NHS Kernow, Sedgemoor Centre, Priory Road, St Austell. PL25 5AS

Face to face You can talk to someone about our plans, or ask any questions at:

Penzance: public meeting on Wednesday 11 December from 6 to 7.30pm, St John’s Hall, Alverton Street, Penzance, TR18 2QR.

St Just: drop in session on Monday, 16 December from 4 to 8pm, WI Hall, Church Street, St Just, TR19 7HA.

St Ives: drop in session on Wednesday 8 January from 4 to 8pm, Studio 2, St Ives Leisure Centre, Trenwith Burrows, TR26 1HB.

Penzance: drop in session on Wednesday 15 January from 4 to 8pm, Committee Room 1, Penzance One Stop Shop, St Clare, Penzance, TR18 3QW.

We can visit you If you are a local organisation holding an event from Monday 9 December 2013 to the end of January 2014 and you would like us to come and talk to you about the proposals in this document, please call our engagement team on 01726 627820.




Options at a glanceEach of the options for consideration within this consultation are summarised below. (To find out about the options that were discounted and not included in the consultation, go to section 5.)

Options Outpatients Outreach InpatientsOption 1Poltair Site: Outpatients and outreach only

Clinic appointments would be delivered at Poltair Hospital.

Outreach and rehabilitation services would be delivered in the patients’ home and at Poltair Hospital.

Inpatient beds would be provided at Edward Hain and Helston Community Hospitals. Patients would be cared for in their home when possible and appropriate.

Option 2Outpatients, outreach and inpatient beds (5)

Clinic appointments would be delivered at Poltair Hospital.


Five inpatient beds would be provided at Poltair Hospital. (An option to provide 10 beds was discounted on the grounds of patient safety.)

Option 3Poltair Site: Outpatient and outreach only (increased capacity)

More clinics would be delivered using both the existing facilities on the ground floor and the first floor where the inpatient beds are now.


Inpatients would be provided for in existing beds at Edward Hain and Helston Community Hospitals. Patients would be cared for in their home when possible and appropriate.

Option 4Relocation: West Cornwall Hospital

Clinic appointments would be delivered at West Cornwall Hospital.

Outreach and rehabilitation services would be delivered in patients’ home and at West Cornwall Hospital.

Inpatients would be provided for in existing beds at Edward Hain and Helston Community Hospitals. Patients would be cared for in their home when possible and appropriate.Poltair Hospital would close.

Option 5Relocation: Other local health or community sites

Clinic appointments would be delivered in clinic rooms at alternative sites, including West Cornwall Hospital, local GP Practices, pharmacies and local community sites.

Outreach and rehabilitation services would be delivered in patients’ homes and at alternative existing health and community sites.

Inpatients would be provided for in existing beds at Edward Hain and Helston Community Hospitals. Patients would be cared for in their home when possible and appropriate.Poltair Hospital would close.

The options are presented in more detail on the following pages, with a summary of the initial assessment that has been carried out by the project team. Please note that this is just a guide to help deliver a meaningful description of the options and their expected impact.




Option 1 presents the configuration of services closest to that which is currently provided at or from Poltair Community Hospital. Outpatient services: Clinic appointments would be delivered at Poltair Hospital. Outreach services: Outreach and rehabilitation services would be delivered in the patients’ home and at Poltair Hospital.

In-patient services: Inpatient beds would be provided at Edward Hain and Helston Community Hospitals. Patients would be cared for in their home when possible and appropriate.

How well does this option meet the primary criteria? Affordability: medium, significant funding required for backlog maintenance Safety: good, but not as good as a modern building

Having read the above and thinking about what would best meet your needs if you needed to use community health services, what are your thoughts about this option?

Other criteria (option evaluation) Description

Clinical excellence (eg best practice, care closer to home, personalised care)

Outpatient services in line with best practice requirements. Inpatient services tailored to meet individual needs and clinical best practice.

Integration Outpatients: Limited as this reduces opportunity to co-locate health and social care services.Inpatients: Optimal as multi-disciplinary services working together to meet patient needs in usual place of residence (when appropriate).

Impact on other services Negligible detrimental impact on other services, as no change to current provision.

Fair and equal access (inc physical accessibility)

Accessibility to the Poltair site meets requirements, but it is not ideal (eg. public transport, driveway)

Sustainability (inc good use of all local resources)

Does not maximise use of spare capacity. Poltair utilisation - clinics 90%, gym 55%. Unnecessary costs to maintain closed ward.

Ease of implementation Easy to implement – current provision. Backlog maintenance would be required.

Value for money Funding required to pay for backlog maintenance (est £1.1m). Rent likely to stay the same. Building running costs will stay the same.

Option one - Outpatient and outreach services only






Outpatient services in line with best practice.Inpatient services would have higher staff:patient ratios (higher than optimum reducing efficiencies). More personalised care could be offered.

Integration Outpatients: Limited as this reduces opportunity to co-locate health and social care services.Inpatients: Use of resources limited to supporting five people in bed based care as opposed to more people in home-based care.

Impact on other services Negligible detrimental impact on other services, as minimal change to current provision.


Accessibility to the Poltair site meets requirements, but is not ideal. Staff:patient ratio not equitable with the rest of Penwith.


Does not maximise use of spare capacity. Poltair utilisation - clinics 90%, gym 55%. Large nursing team for small numbers of patients. Does not free resources for delivery of care in a home setting.

Ease of implementation Backlog maintenance, reinstatement of beds and recruitment of staff would be required.

Value for money Funding required to pay for backlog maintenance and remodelling (est £1.2m). Rent likely to stay the same. Building running costs will stay the same.Increased cost per patient (inpatients) because of higher staff ratios.

Option 2 presents the configuration of services closest to that which was provided in September 2012. However, the option for 10 beds has been discounted on the grounds of patient safety, see section 5. Outpatient services: Clinic appointments would be delivered at Poltair Hospital.

Outreach services: Outreach and rehabilitation services would be delivered in the patients’ home and at Poltair Hospital.In-patient services: Five inpatient beds would be provided at Poltair Hospital (in line with current requirements for infection control and privacy and dignity).

How well does this option meet the primary criteria?Affordability: medium, significant funding needed for backlog maintenance and remodelling Safety: good, but not as good as a modern building.


Option two - Outpatient, outreach, inpatient services - 5 beds




Outpatient services: More clinics would be delivered using both the existing facilities on the ground floor and the first floor where the inpatient beds are now.Outreach services: Outreach and rehabilitation services would be delivered in the patients’ home and at Poltair Hospital.


How well does this option meet the primary criteria?Affordability: medium, significant funding needed for backlog maintenance and remodellingSafety: good, but not as good as a modern building



Outpatient services in line with best practice plus more available closer to home. Inpatient services tailored to meet individual needs and clinical best practice.

Integration Outpatients: Provides opportunity to locate a mix of services together. Inpatients: Provides opportunity for multi-disciplinary teams working together to meet patient needs at home (when appropriate).

Impact on other services No detrimental impact on other services. If other services needed a site for outpatients, this option could be positive for other services.


Accessibility to the Poltair site meets requirements, but it is not ideal. Greater range of outpatient services potentially improves access to services for local people.


Better use of building if there is sufficient demand to utilise the space.

Ease of implementation Backlog maintenance and building works for change of use required.

Value for money Funding required to pay for backlog maintenance and remodelling (est £1.2m). Rent likely to stay the same. Building running costs will stay the same.

Option three - Outpatient and outreach services only (increased capacity)





This option would mean the closure of Poltair Community Hospital.Outpatient services: Clinic appointments would be delivered at West Cornwall Hospital.Outreach services: Outreach and rehabilitation services would be delivered in patients’ home and at West Cornwall Hospital.


How well does this option meet the primary criteria?Affordability: good, no capital investment requiredSafety: good, more clinical support services and staff on one site

Other criteria (option evaluation) Reason


Outpatient services in line with best practice and being on the same site as the urgent care centre means better access to a doctor-led service. Inpatient services tailored to meet individual needs and clinical best practice.

Integration Outpatients: Provides opportunity to locate services together. Inpatients: Provides opportunity for multi-disciplinary teams working together to meet patient needs at home (when appropriate).

Impact on other services Opportunity for positive impact through joining up services at a single site. Other services may need to adapt and explore new ways of working.


Good access.


Utilises the capacity in existing site, to make it more sustainable in the long term.

Ease of implementation Physical space is available. Governance and contractual arrangements to be agreed.

Value for money No capital investment required. Running costs for Poltair could be spent on other community services

Option four - relocation to West Cornwall Hospital





This option would mean the closure of Poltair Community Hospital.Outpatient services: Clinic appointments would be delivered in clinic rooms at alternative sites, including West Cornwall Hospital, local GP Practices, pharmacies and local community sites.

Outreach services: Outreach and rehabilitation services would be delivered in patients’ homes and at alternative existing health and community sites. In-patient services: Inpatient beds would be provided at Edward Hain and Helston Community Hospitals. Patients would be cared for in their home when possible and appropriate.

How well does this option meet the primary criteria? Affordability: good, no capital investment requiredSafety: medium, CQC registration would be needed by all sites

Option five - relocation to other local health and or community sites



Outpatient services in line with best practice. Inpatient services tailored to meet individual needs and clinical best practice.

Integration Outpatients: Provides opportunity to locate services together using a range of community facilities. Inpatients: Provides opportunity for multi-disciplinary teams working together to meet patient needs through inpatient beds and home-based care.



Potential to increase patient choice in terms of location and times of access. Range of services provided in this way improves equity of access.


Utilises the capacity in existing sites to make them more sustainable in the long term.

Ease of implementation Further work required to agree suitable sites and implementation requirements.

Value for money No capital investment required. Running costs for Poltair could be spent on other community services.





Options we’re no longer consideringThe following have been discounted from the consultation as they did not meet the agreed criteria on safety and affordability. We have summarised the reasons for discounting but a detailed explanation is available from us.

Outpatient, outreach and inpatient services (10 beds)This is a return to the service provided in September 2012, before the inpatient beds closed, with 10 inpatient beds and outreach services provided at the hospital. It is not viable on the grounds of safety. Infection control and patient privacy and dignity policies set requirements that cannot be met with this option.

Inpatient services only (with increased capacity)To provide inpatient services only, with expanded capacity for more beds on the ground floor. The outpatient services and therapy team would be based at other sites in Penzance, including West Cornwall Hospital, GP practices and pharmacies.

This option is not viable owing to affordability. The cost of re-configuring the space, the associated increase in rent and the increase in nursing staff, as the two floors would need to be staffed as two separate wards, would significantly exceed available budgets.

New build - all servicesBuilding on a new site to combine services provided at Poltair Community Hospital and Bellair for outpatients; therapy; outreach services; offices and inpatient services. This option is not financially viable. The new build rental, facilities management and lifecycle costs would be in the range of £670,000 to £756,000 a year - significantly greater than currently paid for Poltair Community Hospital. Once staff and other costs

for delivering the services are added, the annual operating costs will be excessive.

New build - outpatients onlyThe provision of outpatients, rehabilitation outreach services and offices in a new build in the Penzance area. Inpatients would be provided for in a place to meet patient needs, including existing beds at Edward Hain and Helston Community Hospitals; intermediate care and long-term beds in care homes and the patient’s own home, with outreach nursing and therapy support.

This option is not financially viable. The building would be very small and uneconomic to run. The new build rental, facilities management and lifecycle costs would be in the region of £127,000 to £142,000 - significantly greater than currently paid for Poltair Community Hospital. Once staff and other costs for delivering the services are added, the annual operating costs will unviable.

Mobile community servicesA mobile service for outpatient and rehabilitation provided at West Cornwall Hospital. Poltair would close and the funding and resources to deliver services moved to alternative sites. The majority of outpatient; therapy; outreach services and offices would be delivered at West Cornwall Hospital and alternative sites. However, some clinics could be provided from a vehicle that would be parked at appropriate alternative health or community sites.

Beds would be in a facility to meet the patient’s specific needs, including Edward Hain and Helston Community Hospitals; intermediate care and long-term beds in care homes and the patient’s own home, with relevant outreach nursing and therapy support. This is not financially viable. The service is estimated to cost in the region of £100,000 per year, which is significantly higher than equivalent rental costs for the rent of permanent building facilities already available. Once staff and other costs for delivering the services are added, the annual operating costs will be excessive.



Outpatient services in line with best practice. Inpatient services tailored to meet individual needs and clinical best practice.

Integration Outpatients: Provides opportunity to locate services together using a range of community facilities. Inpatients: Provides opportunity for multi-disciplinary teams working together to meet patient needs through inpatient beds and home-based care.



Potential to increase patient choice in terms of location and times of access. Range of services provided in this way improves equity of access.


Utilises the capacity in existing sites to make them more sustainable in the long term.

Ease of implementation Further work required to agree suitable sites and implementation requirements.

Value for money No capital investment required. Running costs for Poltair could be spent on other community services.




Making a final decisionAt the end of the consultation, NHS Kernow’s Governing Body will consider all the views that have been gathered during this process alongside more detailed evaluation reports produced following a further stakeholder evaluation workshop to take place in February.

The Governing Body may be able to decide on one of the options described in this document, or it may amend the approach in light of comments and suggestions received in the consultation. This debate will take place in public at a Governing Body meeting.

At the time of writing, a decision is expected to be made in May 2014, with a view to implementing any changes during 2014.

What this consultation is not about

Although we are consulting on services provided at Poltair Community Hospital, and the outcome will clearly have an impact on the hospital itself, we do not own the hospital and are not responsible for making decisions about what will happen to the building.

Enquiries about the building need to be made to NHS Property Services at:

Email: [email protected] Post: NHS Property Services Ltd451C Skipton House80 London RoadLondonSE1 6LHPhone: 020 7972 5255

More information

More detailed information about the process followed in this consultation and the events held with stakeholders so far to decide on the options and evaluation criteria is available on request from:

Fiona ScottPoltair Project ManagerNHS KernowSedgemoor CentrePriory RoadSt AustellPL25 5AS




Still not sure?Why not come along to one of our pubic events? There’ll be plenty of people available to chat to, ask questions and find out more.

PenzancePublic meeting on Wednesday 11 December from 6 to 7.30pm, St John’s Hall, Alverton Street, Penzance, TR18 2QR.

St JustDrop in session on Monday, 16 December from 4 to 8pm, WI Hall, Church Street, St Just, TR19 7HA.

St IvesDrop in session on Wednesday 8 January from 4 to 8pm, Studio 2, St Ives Leisure Centre, Trenwith Burrows, TR26 1HB.

PenzanceDrop in session on Wednesday 15 January from 4 to 8pm, Committee Room 1, Penzance One Stop Shop, St Clare, Penzance, TR18 3QW.

For more information about these events please contact the Engagement Team at NHS Kernow on 01726 627800 or [email protected]


Describe the current situation

Workshop 1Agree evaluation criteria

Agree outline options

Detailed work on evaluation and optionsPlus testing options against primary

criteria

Public consultation

Summarise feedback

Workshop 2Evaluate the options

Full health impact analysis, equality impact analysis

Business case development

Option(s) recommendation

NHS Kernow Governing Body presentation and discussion

September 2013

NowDecember 2013-February 2014

February 2014

May 2014



What happens next?




SurveyThis section is where you get to tell us which of the options we have presented would best meet your needs if you were using community health services in Penwith.1. Where do you live?In Penzance In west Cornwall In the rest of Cornwall

On the Isles of Scilly Outside the region

2. Have you or a relative used community services in west Cornwall?Yes, me Yes, a relative/friend No

3. Are you answering for yourself or on behalf of an organisation or group?For myself On behalf of a group or organisation

If you said a group or organisation please specify here

4. Please rank the following optionsPlease tell us in order of importance which option would best meet your needs if you were using community health services. You must rank all of the options, with one being your favourite option and five being your least favourite option.

Most favourite 2 3 4 Least favourite1. Poltair: Outpatient and outreach services only.

2. Poltair: Outpatient, outreach and inpatient services (5 beds).3. Poltair: Outpatient and outreach services only (with increased capacity)4. Relocation: West Cornwall Hospital. 5. Relocation: Other local health and/or community sites.

5. Please add any other comments or suggestions here




6. If you would like to be contacted about this consultation or other opportunities to get involved, please give us your preferred contact information below.

Name Phone number

Organisation (if any)

Email address

Postal address

Equality and diversityThis part of the survey is optional but completing it can help us to get a fuller picture of the local community we serve.

Your gender: M F

Your age: 0-17 18-24 25-49 50-65 65+

Your ethnic background:

Do you have a disability: No Yes, physical Yes, non-physical

Your religion:

Your sexual orientation:

Your relationship status:

Are you pregnant? Yes No

Thank you for helping us make this important decision about the future use of Poltair Community Hospital. Tear off and post free to:

FREEPOST RTES-UZXK-SHBGC/O LOUISE MOOREKERNOW CLINICAL COMMISSIONING GROUPSEDGEMOOR CENTREST AUSTELLPL25 5AS


report 01.14.008 (6) trust board 30...report 01.14.008 (6) trust board 30th january 2014 subject...

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