Community Hospital Service Review – Outcomes Paper
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Title of paper: Community Hospital Service Review – Outcomes Paper Author: Tom Elrick, Urgent Care Programme Lead Exec Lead: James Blythe, Director of Commissioning and Strategy Date: 25 September 2015 Meeting: Governing Body Agenda item: 11 Attachment: 5 For: Decision Executive Summary: To present the final Outcome Report for the community hospital services review. The attached paper outlines the process undertaken in conducting the review of services delivered from the community hospital sites in Surrey Downs. The paper describes the current services commissioned by NHS Surrey Downs CCG, both for inpatient and outpatient care. The purpose of this paper is to present the final recommendations and options from the review for discussion and to seek the Governing Body’s approval to proceed to public consultation on the options presented. Compliance section Please identify any significant issues relating to the following Risk Register and Assurance No issues identified as yet. Framework Patient and Public Full communications and engagement plan adopted Engagement throughout the review, with appropriate stakeholder engagement. Engagement log presented as appendix. Ongoing engagement with Surrey’s Wellbeing and Health Scrutiny Board and Healthwatch Surrey throughout process. No issues identified – considered as part of EQIA. Patient Safety & Quality The emerging options have some financial Financial implications implications which will need to be developed and fully considered. A number require investment, however there are some potential cost savings in the long- term from better use of estates. A full financial evaluation will support the public consultation. No issues identified as yet. Conflicts of interest No issues identified as yet. Information Governance Equality and Diversity An EQIA has been completed as part of the project team and aligned to the Communications and Engagement plan. This document has been through the review Programme Board and agreed on 28 April 2015. Any other legal or Any substantial service changes would be subject to compliance issues public consultation. Accompanying papers (please list): Appendix 1: Community Hospital Services Review: Outcomes Paper Appendix 2: Engagement log Summary: What is the Governing Body being asked to do and why? To discuss the attached paper, including recommendation and options. To approve that the options proceed to public consultation in line with the arrangements specified. Community Hospital Services Review: Outcomes paper summary Introduction NHS Surrey Downs CCG (SDCCG) has undertaken a review of the services provided from the five community hospitals within its geographical boundaries. The review has focused predominantly on the future requirements for inpatient rehabilitation services, but has also included an examination of the volume and types of outpatient services delivered at each site. Background on current services Surrey Downs CCG has five community hospitals located within in geographical boundary. The table below provides details of the hospital locations, their inpatient bed numbers and the outpatient services provided. Table 1 – Community Hospital bed capacity Hospital Locality Beds available Beds open Leatherhead Epsom 18 0 Dorking Dorking 28 28 Molesey East 18 12 Elmbridge New Epsom Epsom 21 20 and Ewell Community Hospital (NEECH) Cobham East 18 0 Elmbridge Total 103 60 As the information above clearly demonstrates the CCG has significant unused community hospital bed capacity. Cobham Hospital has not had inpatient services for a number of years, although the ward space remains available for use. Leatherhead Hospital had the inpatient bed capacity transferred to the other hospital sites in November 2014 to allow CSH Surrey the ability to consolidate their clinical staffing resource on three locations. Review process The review process was split into three distinct phases: 1. Activity review (May-June 2015) This phase saw the review team spending time at each hospital site, working alongside the clinical delivery teams to understand what services were being delivered, how they were delivered and what factors were impacting on the care delivery. Inpatient care is currently delivered from three hospital sites; New Epsom and Ewell Community Hospital (NEECH), Dorking Hospital and Molesey Hospital. The quality of care delivered from the three inpatient units was found to be exceptionally good. Each hospital had similar types of patients, of similar age groups and common presenting conditions. The quality markers, infection rates and patient satisfaction surveys for each site were comparable and therefore did not act as a key differentiator in the assessment process. 2. Outcome review (June 2015) This involved an analysis of the key quality measures provided by the community hospitals and comparing them to national data. One of the difficulties with this phase has been the lack of nationally defined models of excellence in the Community Hospital Setting, with little research available for the UK. There are a number of case studies which detail community-based rehabilitation pathways, but these are not hospital based. The review team used data from the Community Hospitals Association to locate ten benchmark hospital sites, then contacted each and data gathered on their service structures and performance. The outcome review also examined the expected changes in patient population in Surrey Downs over the next ten years. For both inpatient and outpatient services it is essential to understand how the population groups aged 65 years and over will change, as these are the groups most likely to be accessing inpatient rehabilitation care from the community hospital facilities. 3. Recommendations preparation (July 2015) The outcomes paper covers the following areas: • A description of the current Community Hospital Services, including both inpatient and outpatient functions. • A detailed review of each hospital site, exploring current services • A summary of the expected changes in the patient population, particularly in the over-65 year age group. • An indication of the expected non-demographic population changes • A detailed list of the options explored and the recommendations for service improvement The paper also provides a series of five recommendations and four options for the overall provision of Community Rehabilitation Services based on the anticipated needs of the changing population. Each recommendation has come from observed issues in care delivery as well as benchmarking of best practice. If approved by the Governing Body, the development of these options will be assessed against criteria which have been developed with input from the public engagement groups. Engagement Extensive public and wider stakeholder engagement has been completed as part of this review, following the communications and engagement plan previously agreed at Governing Body. Between April and September 2015 the CCG has: • hosted four launch events (in Leatherhead, Dorking, East Elmbridge and Epsom) • held 20 public workshops (five in Leatherhead, Dorking, East Elmbridge and Epsom). Total workshop attendance was 111 individuals • facilitated 24 drop-in events with CSH Surrey staff, held at the community hospital sites • met with 271 members of local Residents Associations, League of Friends groups and local councillors Public workshops have been used to co-design key elements of the review. As well as commenting on the process and feeding in the views and experiences of local people, attendees have created the evaluation criteria that would be used to assess any potential options and contributed ideas for future engagement, including engagement channels that could be considered as part of a public consultation. A full engagement log, with details of engagement undertaken as part of the review is attached as an appendix with this document. The Communications and Engagement team have been represented on the Programme Board and have been fully engaged in the review process. Healthwatch Surrey and the Wellbeing and Health Scrutiny Board have been engaged throughout this process and two representatives from the Wellbeing and Health Scrutiny Board have been members of the Programme Board. The review team presented formally to the Board on 16 September 2015, who approved the review process. At the meeting it was agreed that a sub group comprising four committee members would continue to be involved in the process and would contribute to the CCG’s consultation planning. Outcomes of the review Following extensive public and stakeholder engagement, a comprehensive review of each hospital site and an examination of best practice models, the Programme Board identified a number of key service configuration proposals for the Community Hospital Services. These four principles underpin the final recommendations and options made within the outcome paper: Three Ward Model Key to the Surrey Downs-wide approach is the adoption of the three-ward model. Historically the community inpatient rehabilitation services have operated across four, small volume wards. The relocation of the Leatherhead beds in December 2014 demonstrated the potential for improvements in efficiency achieved through larger inpatient units. The benchmarking exercise identified the minimum number of eighteen beds to achieve long term efficiency in both length of stay and occupancy levels. The Programme Board recommends delivering inpatient care from three sites. Dorking Hospital The inpatient services provided from Dorking Hospital