saltash area and st barnabas community hospital workshop 4 · 2020-03-12 · austell/ falmouth)...

Saltash area and St Barnabas

Community Hospital workshop 4

26 February 2020

About today

10.00am

• Registration and refreshments

10.15am

• Welcome and recap from workshop three

• Feedback from public drop ins

• Learning from other areas

• Large group session-some service

updates, allowing Q&As, reviewing

options

11.30: Comfort break/refreshments

11.45am

• Continuing to review options

12.30pm

• Conclusions and next steps

12.45pm

• End and evaluation forms

Aims for the day:

1. To review the long list of options to

understand and agree which should

be short listed

2. To review and agree the short listed

options for evaluation

3. To explain the next steps

Countywide

North and east Integrated Care Area

Saltash area

St Barnabas community

hospital

Principles and themes

Local need and local services

Long term vision-including

accommodation with care

Local investment

Modern, fit for future services

Ageless approach

Maximise existing resources

Enhance community resources

Make a decision on St

Barnabas

Recap from workshop three

The flow of our conversations

Plymouth

services

•Broad context

•Identifying themes

24 April

Workshop one

Exploring ideas

Reviewing data and services

29 May

Workshop two

•Evaluation

•Review of ideas

•Neighbourhood Development Plan

15 August

Workshop three

•Review long listed options

•Agree short listed options

•Next steps

26 February

Workshop four

What has happened since

the last workshop?

•Broad context

•Identifying themes

24 April

Workshop one

Exploring ideas

Reviewing data and services

29 May

Workshop two

•Evaluation

•Review of ideas

•Neighbourhood Development Plan

15 August

Workshop three

•Review long listed options

•Agree short listed options

•Next steps

26 February

Workshop four

• Collating more evidence on long listed proposals

• Clinical Senate recommendations review

• Reviewing documents on St Barnabas building state

• Purdah due to general election

• Implementing evaluation process for Edward Hain community

hospital project

• Reviewing learning from evaluation of Edward Hain project

Current

assumption:

The system

is not

functioning

adequately

to provide

the best

outcomes for

people

New model of care co-

development: Optimise resources, data on

need/provision

We need a

new

model of

care

Decision

needed on

St

Barnabas Options co-development

Long term

planning

Decision

on

St Barnabas

Countywide &

local strategy

Continual model of care development /long term service planning already

in progress

A recap on the process

• Greatest gap is rehabilitation and reablement at home-work is underway to

address this via the Embrace programme.

• Our current transfer of people from an acute hospital to a community

hospital or care home achieves the ideal outcome for only half of people.

• The default position should be home straight from an acute hospital-we

need to resource community services to do this.

• St Barnabas community hospital is not fit for modern inpatient provision.

• More local beds is not necessarily the answer.

• Local ambition to develop a 5-10 year plan for health and care services.

• We have four local ‘hubs’ and don’t need to replicate any activity there.

Recap of key messages from

workshop three

Key themes raised:19 attendees in total.

• Transport – attending Plymouth and Liskeard services remains a challenge for some.

• Promote integration of services on the same site such as GP services, minor injury services, voluntary sector and pharmacy.

• Preference for more modern facilities.

• Healthcare funding is limited and needs to be spent wisely.

• Some views that the hospital was not fit for purpose or needed.

• Some disappointment that the hospital was still closed.

• Desire to explore the possibility of the community using parts of the building if it was not re-instated as a community hospital.

• Importance (if possible) of retaining some money from disposal of the building.

• Wheelchair access for parking and building access is a challenge.

• Need to consider how this feeds into the local development plans and the impact of new housing developments.

Feedback on the public drop

in sessions: 8 and 17

October

Progress and learning from

the other areas

Yes

o

Project group to establish evidence and supplementary information for

long listed options

Information gathered on long listed options shared with the community

Full evaluation of short listed options to confirm viability

Long listed options co-developed with the community

Community and project group appraise long listed options and agree

which ones are viable to be short listed and to proceed to full evaluation.

Fowey

hospital

Edward

Hain

hospital

St

Barnabas

hospital

The three sites have progressed at different rates as expected.

Conversations at all three community stakeholder work shops have identified potential

for non viability of inpatient provision. Edward Hain community hospital evaluation will

confirm/deny viability for inpatient provision there.

In particular, through the option appraisal process the constraints raised for Edward

Hain community hospital included:

• Misalignment to long term strategy (e.g. home based/community care

enhancement, optimising estate, buildings as enabler not driver).

• Building constraints due to age and structure-limited longevity, facilities, flexibility.

• Bed capacity (12) under Clinical Senate recommendations (16) for a safe, efficient,

reliable workforce and expansion not possible.

• Workforce recruitment challenges to standalone units.

• Significant capital and revenue investment required and return on this investment

for the potential numbers supported is limited.

Previous workshops have raised similar issues with St Barnabas community hospital

(bed capacity 9).

Reflections and learning

from the other projects

Headline criteria Sub criteria

1. Quality 1a. Effectiveness

1b. Experience

1c. Responsiveness (based on need)

1d. Safety (there will be a minimum score required)

2. Access 2a. Impact on individual choice

2b. Distance, cost and time to access services

2c. Equity of access

2d. Extended access

2e. Equity of provision

3. Workforce 3a. Recruitment and retention-workforce supply

3b. Staff skills and training-workforce upskilling

3c. Staff capacity-new ways of working

4. Deliverability 4a. Timescales and ease to deliver

4b. Sustainability

5. Environmental 5a. Climate management

5b. Environment of service delivery

6. Financial 6a. Value for money

6b. Affordability (there will be a minimum score required)

6c. Financial sustainability (there will be a minimum score required)

7. Wider impact 7a. System impact

7b. Community impact

Reminder: final evaluation

criteria

(amends to wording in red)

Local updates

1. Community services-model of care development and Embrace

programme update.

2. NHS Property services-role within local service delivery,

buildings as enablers.

3. Saltash Health Centre developments

Saltash Health Centre

development:

Phase 1 development

• Development for additional consultancy

room capacity

• 5 consulting rooms in total

• Completed 2018

• Now used for Assessment Clinic


development: Phase 2 project

• ETTF funded project for additional

consultancy and treatment room

capacity

• 6 consulting rooms in total

• Due for completion April 2020

• Plan to use for both practice services,

but also for services for wider health

community eg. Diagnostic and

assessment services


development:

Front of practice re-development

• Plans developed to re-model front of building

• Improve patient access

• Part of NHS Kernow Minor Improvement Grant scheme

• Expression of interest submitted Feb 2020

• Awaiting outcome

Longlisted options Short listed options

1. Model of care development (in progress)

?

?

?

?

?

? Paperwork for shortlisted

options will need to cover

in detail:

1. Supplementary

evidence/information

2. Background reading

for evaluators

3. Complete options

appraisal

4. Equality and quality

impact assessments

2. Do nothing (discounted at 1st workshop)

3. Alternative care provision on existing site- extra care

housing

4. Alternative care provision on existing site- care home

5. Transfusion/ infusion day case unit

6. Re-instate 9 inpatient beds, MIU and continue existing

community clinics (original service)

7. Re-purpose : community health and wellbeing hub

8. New build healthcare facility on alternative site

(inpatient/ extra care, care home)

Anything else?

Current proposed long listed

options

• The minimum acreage for Extra Care Housing stated by Cornwall Council’s

Accommodation with Care Board as being required for a feasible site is a

minimum of 1.5acres, ideally 2 acres.

• St Barnabas community hospital and land is below this size at 0.66 acres.

• The site is too small for extra care housing.

(NB: Treledan site plans include 50 units).

Longlisted option: Alternative care

provision on existing sites for use

as extra care housing

Any questions/

concerns with these

statements?

• The Associate Director for Cornwall Partnerships NHS Foundation Trust’s

Estates and Facilities (and member of the system Estates Strategy Group)

has provided some market information on size requirements for a viable

care home (in excess of 50 beds). Three sources of information were

reviewed (Local Authority owned residential care building recommendations,

land acquisition company, specialist estate agent).

• The size required for a 50-60 bed viable care home is 3,000m2 to 3,500m2.

This equates to 0.74 acres to 1 acre at a minimum.

• St Barnabas community hospital and land is below this size at 0.66 acres.

• The site is too small for a care home.

(NB: Treledan site plans include 80 units).

Longlisted option: Alternative care

provision on existing sites for use

as care home

Any questions/

concerns with these

statements?

• Lack of on-site medical cover and diagnostics (x-ray/ultrasound).

• Environment a challenge for elderly and frail to attend and access.

• Relative low levels of activity: predicted activity is 5 per week.

• Additional staff required: two registered nurses, one healthcare assistant.

• Training required for additional staff.

• Refurbishment and equipment needed.

• Poor WIFI connectivity.

• Staff recruitment would be required- staff could be utilised from Liskeard hospital, but will then need backfill from other day case units (Bodmin/ St Austell/ Falmouth) -leading to workforce vulnerability at other larger sites.

• Investment required in staff (as above-either new staff on site or to backfill) and refurbishment of room and equipment (minimum of £20,000).

St Barnabas hospital therefore has site constraints that means it is not a suitable site for safe delivery of this intervention.

Longlisted option:

Transfusion/infusion day

case

Any questions/

concerns with these

statements?

Opportunities to consider: option component one: inpatient beds

• Local bed reablement and rehabilitation offer in addition to home based

services.

• Bed based care closer to home for some.

• Travel time benefits for local residents.

• Increased use of building.

• Provision of choice for end of life care in addition to home and hospice.

• Local asset retained.

Longlisted option: Reopening 9

inpatient reablement beds, re-instating

minor injuries unit, maintaining current

community clinics

Any questions/

concerns with these

statements?

Ground floor: location of 3 beds and

bathroom/toilets (none en-suite)

1 2

Location of

bathroom/toilet

(not en-suite)

Location and

number of beds Entrance

First floor: location of 6 beds and

bathrooms (one en-suite)

1 3 2

Location of bathroom/

toilet (not en-suite)

Location and

number of beds

Location of bathroom/

toilet (en-suite)

Issues to consider: option component one: inpatient beds

• Known inefficient use of existing beds (doesn’t reflect true need).

• New Clinical Senate recommendations on minimum bed size as 16

(building structure and fire safety bed evacuation requirements prohibit

bed size expansion).

• Known difficulties in recruitment (29 ward staff required) to small units.

• Site constraints to deliver new model of care: location, access, parking,

ward size, building age and structure, range of diagnostic facilities.

• Limited opportunity to ‘future proof’-building and service provision.

• High cost to invest in building and staff to provide level of service.

• Strategic direction is investment in community services.




community clinics

Any questions/

concerns with these

statements?

Issues to consider: option component one: inpatient beds

• Site would remain underutilised.

• Neighbouring sites have greater level of facilities-people may still need to be

transferred to Liskeard as greater level of rehabilitation and reablement with

ward based therapy staff.

• Bed occupancy in Liskeard has been under the national recommendation

(85%)- a snapshot from April 2018-March 2019 for the two wards was 65%

and 83%-bed capacity is available.

• Safety-no identified medical cover.

• Ward therapy provision would need to come from existing community staff.

• Moving staff from St Barnabas to Liskeard community hospital provided

safe, sustainable staffing for the larger unit.

• Liskeard has capacity for temporary escalation beds (6) to ease winter

pressures Any questions/

concerns with these

statements?




community clinics

Option component two: Minor Injury Unit supporting up to 455 people a year

• Provide additional MIU provision (Monday-Friday, 8am-3pm, no x-ray) to what is already been

provided at:

Cumberland centre, 24 hours a week, 7 day service with x-rays-6miles away, 25 minutes car drive.

University Hospital Plymouth, 24 hours a week, 7 days with x-rays-6miles away, 20 minutes drive.

Liskeard community hospital,-open 8am-10pm, 7 day service.14miles away, 30 minutes car/bus

drive.

Saltash Health Centre, weekdays, 8am to 6pm (no x-ray). (Interim arrangement currently).

Port View practice, weekdays, 8.30am to 6pm (no x-ray). (Interim arrangement currently).

• Low numbers (455 people per year-9 per week) so maintaining skills and competencies is a

challenge. (Liskeard community hospital sees 10,000+ per year-192 people per week).

• The 455 attendances were 6% of all MIU attendances (7,578) from residents registered with

Saltash and St Germans GP practices.

• Previous annual attendance (455) insufficient for

standalone staffing.

Any questions/

concerns with these

statements?




community clinics

Option component three: Maintaining existing consultant clinics (582 attendances

supporting 273 people a year) and community clinics (2,800 attendances a year)

1. University Hospital Plymouth (was Derriford) Consultant clinics-for Cornish and Devon

residents.

2. Clinics require health care assistant attendance from Liskeard hospital

3. Increase in physiotherapy activity.

Total investment to support provision of up to 9 beds for up to 209 people a year ,

455 MIU attendances and 2,800 community clinic attendances will initially be a

minimum of:

1. £4.04m (£2.4m building works, £1.64m staff/rental/on costs etc) and then

2. £1.64m ongoing every year.

Longlisted option: Reopening up to 9



community clinics

Any questions/

concerns with these

statements?

We have four local hubs

and don’t need to replicate

any activity there

(last workshop comment)

• What do we mean by hub?

• What is the model of care requirements for a hub?

• Is St Barnabas community hospital the right site for that activity?

Existing Saltash hubs where people can go to access

information about local services, activities and support:

1. Family Hub, Saltash

2. Community Enterprises PL12

3. Saltash Library

4. Saltash Community School

Longlisted options: Re-

purpose as a community

health and wellbeing hub

Any questions/

concerns with these

statements?

Ideas raised so far Response/information

Provide more children’s services No need identified from Children and Family

Services. Saltash family hub already present

9am-5pm weekdays. Saltash school hub

development ongoing (working with the

council).

Mental health: especially working age

adults support

Mental Health Strategy engagement

complete. New strategy due to be released.

Local plans to be delivered against that.

Planned activities:

transfusions/infusions

Site suitability already covered.

More University Hospital Plymouth

(UHP) activity

Any location of activity will be based on

need and site suitability. No current plans

identified by UHP, but Cornwall strategy is

more local community clinics so potential for

further discussions.




Ideas raised so

far

Response/information

Hearing aid clinics

for hearing aid

tube and battery

replacement

Nearest audiology clinics : Derriford, Mount Gould, Liskeard,

Specsavers in Saltash. Specsavers is for routine age related

hearing loss only (ie nothing complex, people under 55 years) –

this is not a Saltash specific issue- acute trusts are the only

providers that offer more complex audiology services.

Consumables, aftercare, replacement tubes/batteries can be

posted free of charge direct to people’s home, and via local

supply points (e.g. Saltash Health Centre, Quay Lane, Tamar

Valley, Torpoint, Pentorr, Pensilva). Nine months of recent data

shows: monthly average of 19 attendances: 62% (12) at Saltash Specsavers, 32% (7) at Derriford.

Community

activities

Lots of existing hubs/community spaces.

Staff base Current use is variable and limited. No other teams identified to

move in. Potential for more work with the Council to review this.




Basement use: now

respiratory/cardiac rehab

outpatient

physio

community

rehab

teams

Stores/offices

Clinic use

Ground floor use: now

health

visitors

consultant

clinics

reception

children’s

storage

Stores/offices

Clinic use

Entrance

Mezzanine floor use: now

acute care at home

Stores/offices

First floor use: now

District Nurses

(8 staff)

District Nurse lead/

admin

Community matron/

palliative care

Stores/offices stores

• What is the model of care requirements for

a hub?

• Is St Barnabas community hospital the

right site for that activity?




Can we make a

decision on St

Barnabas hospital in

the meantime?

Model of care development and long term planning

Decision on future of St Barnabas

Considerations:

• Longer term view-’future proofing’.

• Insufficient capital or revenue funding currently identified .

• Treledan development progressing- (80 bed care home/50 unit extra

care)-associated health infrastructure funds.

• Refurbishment of additional space at Saltash Health Centre.

• Links to the Council’s local review of building assets

Longlisted options: New build

healthcare facility on alternative site

February 2020 March April 2020 June, July,

August 2020

November

2020

• Community

workshop to

review long

listed options.

• Co-development

of short listed

options.

• Decision on

next steps.

• Evaluation of

short listed

options

• Train option

evaluators

• Sign off of

viable short

listed options

• Development of

pre-consultation

business case

(including equality

and quality impact

assessments)-if

required

• Request stage

two assurance

meeting with NHS

England and

Clinical Senate

• Public

consultation

(if required)

once stage

two

assurance

meeting is

complete

• Decision

made

Ongoing development of the model of care and long term service planning

Next steps: dependent on

short listing and today’s

conversations

THANK YOU FOR ATTENDING.

DO YOU HAVE ANY

QUESTIONS?

Please complete an evaluation form before

you leave

saltash area and st barnabas community hospital workshop 4 · 2020-03-12 · austell/ falmouth)...

Documents