To consider a joint report from Morecambe Bay Clinical Commissioning Group and University Hospital Morecambe Bay NHS Foundation Trust (copy enclosed).
The Committee considered a report which provided a progress update of Morecambe Bay CCG’s and University Hospitals of Morecambe Bay Trust’s engagement activities for the Community Hospitals Bed Base Review in South Cumbria which took place across the South Cumbria footprint from 2 September to 13 December 2019.
Members were informed, as way of background, that in 2017, Morecambe Bay Clinical Commissioning Group commissioned the North West Utilisation Management (NWUM) Unit to undertake a Community Bed Based Service Review which included Langdale North Unit, Westmorland General Hospital, Langdale South Unit, Westmorland General Hospital, Abbey View, co-located at Furness General Hospital and Millom Community Hospital.
The Committee noted that the review had highlighted a number of issues on the units and a subsequent review of intermediate care across Lancashire and South Cumbria undertaken in 2019 indicated that outcomes for intermediate care delivered in people’s own homes was better than those who experienced intermediate care in another setting. It was explained that this further compelled a review of the current provision with the intention to re?design and modernise services.
Officers explained that after taking this into account, a project was initiated to review the community beds and develop ideas for effective use and future proofing in South Cumbria. Members noted that the first step had been to engage with a wide range of stakeholders, including the wider public and staff, to generate ideas in response to the question ‘Where would you like to be cared for?’
The Committee was informed that to?date stakeholder and staff engagement had taken place during the period September 20190January 2020. It was explained the survey confirmed that for some communities there would be a need for some bed?base, offering 24 hour care for people whose home circumstances were not suitable and for whom it would not be safe to provide sessional support at home. It was also acknowledged that, in some communities, the community beds provided good quality end of life care that was highly valued and an important offer for people who were at that stage in life.
The Committee was informed of the current position; over the past year, the community beds at Abbey View and Millom had continued to operate as close to normal as possible albeit with the restrictions imposed in terms of managing infection risk. It was explained that all attempts were made to implement Infection Prevention and Control processes which included a decision to directly discharge patients home wherever this was possible. Members emphasised the immense value of community hospitals in remote areas highlighting the need for such facilities to continue.
The Committee noted that in the initial stage of the COVID pandemic the beds on the Langdale Unit in Kendal continued to function for step down. However, by the beginning of July 2020, there were just 4 beds in use and, because of mounting pressure to manage the backlog of surgical patients and other elective care procedures, a decision was made by the Incident Management Group at UHMBT to temporarily close it and enable use of all of Westmorland General as a COVID-free site in as far as this would be possible.
The Committee was informed that the temporary closure of the Langdale Unit provided an opportunity to test some new ways of working which included deploying the majority of staff into community roles that supported those same patients who were now at home.
The Committee was informed of the next steps which would be subject to a formal consultation exercise, noting that because of the differing needs of the three different areas of South Lakes, Furness and Millom there was potential to adopt a phased approach to planning, with South Lakes leading the process.
During the course of discussion officers confirmed they were committed to simultaneously working on a plan to re-open the Langdale Unit in accordance with planned restoration of services that had experienced changes because of the pandemic. It was explained that should the proposed options indicate a reduction in bed?base, then reinvestment would be seen to community services to respond to the need and enable care be delivered closer to home.
A discussion took place regarding the geographical position of Central Lakes and members were informed that referrals were usually made to the site closest with an option to go elsewhere. It was explained that currently patients in Kendal and Grasmere were receiving care from community teams due to the closure of the Langdale Unit.
Members drew attention to GP feedback which included the UHMBT ward staff accessing community generated Care Plans to inform any acute admission. It was noted that despite efforts to date it had not been possible to change practices to ensure that any community generated care plan was accessed in Lorenzo to inform in?patient care in hospital and discharge planning. Officers confirmed the need to streamline the system.
The Committee was informed of the identified timescales to take the programme of work forward and it was agreed that the Cumbria Health Scrutiny Committee would be kept informed.
RESOLVED, that the report be noted.