Agenda item

Community Hospitals


The Chief Executive of the CCG outlined the key themes that had emerged from the consultation feedback, which included:-


·        accessibility and patient safety;

·        resourcing and quality of care;

·        a clear case made for retaining the community hospitals, and

·        concerns of a financial, economic and social nature


He explained the overall consideration of the options in light of the consultation feedback and referred to the following:-


·        the major challenge in recruiting and retaining staff

·        the limited prospects for staff in small isolated units

·        the operational difficulties when trying to rota small numbers of staff, and

·        the challenge of meeting clinical standards as set out by the National Institute for Health and Care Excellence.


Therefore the Success regime considered it important to have in-patient units with at least 16 beds where possible.


The Chief Executive confirmed that although the primary focus of the communities had been to defend bed closures, there had been some very innovative proposals for the future roles of community hospitals and differing services they could provide.  These had been co-produced by Cumbria Partnership NHS Foundation Trust working with the public stakeholder groups such as the Hospital League of Friends and the local GP practices in each of Maryport, Wigton and Alston. 


Members reminded health colleagues of the need to be mindful that community hospitals were considered an integral part of their community and removing them would be seen as diminishing those communities. 


The Chief Executive made members aware that the workforce position in Community Hospitals, and especially in Alston, was very fragile and that it may become necessary for bed closures even in the shorter term due to difficulties in sustaining safe staffing levels. He also acknowledged that bed closures were likely to continue happening on an un-planned basis because of the on-going staff recruitment and retention challenges. 


The Deputy Chief Executive of Cumbria Partnership Foundation Trust said Cumbria County Council had been engaging and was keen to work with stakeholders on the development of business cases for the proposals from Alston, Maryport and Wigton. 


The Director of Service Improvement from NCUHT outlined the work that had been undertaken in Maryport.  He had facilitated the co-production work there and there were some really exciting and innovative ideas coming through. There were 3 main proposals that had come forward from this group and a business case for these had already been produced.  However, further work was still needed for Alston and Wigton.

Members referred to page 87 of the document pack where it stated that the conversation had moved from community hospital beds in Alston to finding a sustainable, affordable health and care model for the most remote town in England. This would imply that there were 2 equal partners in these discussions but members did not feel this was the case.  They asked for clarity of the evidence in recommendation for the community hospital bed base and how would the impact for the removal of the beds be assessed.


The Director of Strategy from NCUHT said although the removal of the beds did have an important impact the real issue was about how we could create a sustainable healthcare model for the future of Alston.


Members asked if the proposed solution would include a number of medical beds.


The Director said the medical model for beds in Alston, Wigton and Maryport would be removed but that alternative models of delivering would need to be developed.  


One of the members asked about dignified end of life care in Maryport, and how this would be delivered based on the fact that there were no nursing homes in Maryport.  She also had concerns abut respite medical care and asked what the proposals would be for this based on the reduced bed status.


Members felt there was a lack of alternative nursing care provision and a new model of increased home-care support may not be appropriate or safe for patients currently supported in community hospitals particularly for end of life care.


The Director said hospital beds should not generally be used for respite medical care.  In the past year 185 people had died in Maryport, but 86% of these did not die in hospital.  The preference of most people would be to stay at home for end of life care and wide consultation was being carried out currently on the options for this. 


Members asked about whether rural proofing had been applied to the proposals for community hospitals.  They felt there would need to be some imaginative solutions to resolve the issues in Alston, where the issues of economies of scale would need to be addressed.


The Director of Strategy said the 16 beds in Alston would not meet the criteria and that the situation with recruitment of staff in Alston was reaching a crisis point.  The model was extremely fragile and the NHS was working hard to try to find a solution to this.


Members asked why there was no Independent Review carried out for Alston, similar to the one carried out for maternity in West Cumbria, before the decision was made.


The Chief Operating Officer from the CCG said an external audit was carried out, which considered issues such as:-


  • Reducing the length of stays
  • Reducing admission numbers
  • Buildings – fit for purpose
  • Sustainable nursing levels
  • Recruitment
  • Geography


He also said that the majority of admissions to Alston hospital were not for people who lived in the area.  The average distance patients travelled was 12.5 miles.


Health colleagues felt that in the majority of cases the patients using the community hospital beds actually needed adult social care services rather than hospital services and that innovative thinking would be needed to resolve this issue.  However, he reassured members that none of the hospital beds would close until alternative forms of care were available and it was safe to do so.  Transition would need to be carefully managed.


The Deputy Chief Executive said in Maryport a Health Alliance had been established and had proposed a number of alternative models to resolve the issues including:-


  • Developing the community hospitals as a ‘hub’
  • Recycling the nursing teams
  • Closing the public health gap


Members felt there was no denying that changes were required to make services fit for purpose, and that innovative alternative solutions were needed. However, some of the solutions would require the expansion of adult social care services, in the current climate of austerity this would be very challenging. 


Members had concerns about the ability of members and also the public to scrutinise the decisions of the Success Regime going forward, and wondered if there were any plans for future scrutiny.


The Chief Executive of CCG explained that due to pre election period guidance some of the information had been restricted and could not yet be shared.   However, in relation to the development of the Integrated Care Community Programme the Success Regime would be interested in engaging, both the members of the public, and also scrutiny members on this.


The Chair of Healthwatch asked the Success Regime whether they would be willing to engage with Healthwatch on Integrated Care.  The Chief Executive confirmed they would be willing to engage with Healthwatch.


Members felt that one of the major issues to be addressed to ensure these services were improved going forward was around IT.  The Deputy Chief Executive agreed with this.  There were also plans in place for future and improved engagement with the third sector to take this forward.


On conclusion of the discussion members proposed that this be referred to Secretary of State for health.


This was PROPOSED by Ms Taylor and SECONDED by Mr Hughes. 


The meeting was then adjourned for 10 minutes.


The meeting reconvened and the proposer outlined why members should refer this to Secretary of State for health on the grounds that the changes proposed are not in the best interests of the health service in the area.  Particularly:


  • There is a lack of alternative nursing care provision a new model of increased home-care support may not be appropriate or safe for patients currently supported in community hospitals particularly for end of life care.
  • Insufficient consideration of the interdependencies of the community hospitals to the health and care services in the areas
  • Insufficient consideration of rural proofing issues.
  • Lack of an independent review of Community Hospitals to inform the proposals.
  • Decision of the CCG to close medical beds have limited the options for developing further proposals within the next twelve months, as part of the plans to implement Integrated Care Communities.
  • Details of how the further proposals might be funded are not clear, and until that can be clarified no medical beds should be closed
  • Potential negative impact on Delayed Transfer of Care.
  • The committee think that the community hospital travel impact assessment does not sufficiently reflect the geography of the area, particularly around public transport provision.


This was then put to a vote, the results of which were:-


FOR - 10