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Health, Social Care and Wellbeing Scrutiny Committee – 12Th May 2009

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Health, Social Care and Wellbeing Scrutiny Committee – 12Th May 2009 AGENDA ITEM NO. 5(05) HEALTH, SOCIAL CARE AND WELLBEING SCRUTINY COMMITTEE – 12TH MAY 2009 SUBJECT: CLOSURE OF OAKDALE HOSPITAL REPORT BY: CHIEF EXECUTIVE CAERPHILLY TEACHING LOCAL HEALTH BOARD 1. PURPOSE OF REPORT 1.1 The purpose of the report is to inform the HSCWB Scrutiny Committee of the closure of Oakdale Hospital which was agreed by Caerphilly Teaching Local Health Board, Gwent Healthcare NHS Trust and Gwent Community Health Council in April 2009. 2. SUMMARY 2.1 The outcome of public consultation on Ysbyty Ystrad Fawr Local General Hospital (YYF) was agreement to develop the new hospital and close all other hospitals in the borough, with the exception of Redwood Memorial Hospital in the north of the borough, noting proposals for the development of an integrated health and social care Resource Centre in this part of the borough to address local needs. 2.2 While, in principle, closure of the borough hospital facilities was planned to coincide with the opening of YYF, it was acknowledged that planned ongoing changes to the delivery of hospital and community based health and social care services within the borough could provide a case for bringing forward some of the planned hospital closures. 3. LINKS TO STRATEGY 3.1 The context and case for change which underpin the planned closure of Oakdale Hospital support Theme 3 of the Health, Social Care and Well Being Strategy – ‘To expand and develop community based health and social care services to enable people to live safe, fulfilled lives, that are as active as possible, specifically 3.1 Expanding the range of services available in the community, through GP surgeries, enhancing the role of pharmacists, Local Resource Centres and palliative care and 3.4 Improving joint working between the NHS and the Local Authority through the development of integrated teams and services to improve health outcomes and continuity of care for vulnerable children and adults. 3.2 The proposed service change also reflects the requirements of the following Healthcare Standards: Standard 1: The views of patients, service users, their carers and the public are sought and taken into account in the design, planning, delivery, review and improvement of healthcare services and their integration with social services. Standard 2: The planning and delivery of healthcare: a) reflects the experiences, views and preferences of patients and service users; b) reflects the health needs of the population served; c) is based on nationally agreed evidence and best practices; and d) ensures equity of access to services. Standard 24: Healthcare organisations work together with social care and other partners to meet the health needs of their population by: a) having an appropriately constituted workforce with appropriate skill mix across the community; and b) ensuring the continuous improvement of services through better ways of working. 4. THE REPORT SERVICES CURRENTLY PROVIDED IN OAKDALE HOSPITAL 4.1 Oakdale community hospital currently has 14 inpatient beds, providing support care for those patients awaiting discharge home or long term care. 2 of the beds are dedicated to provide palliative care. Medical support for patients is provided by two GP's acting as Clinical Practitioners. 4.2 Oakdale Hospital originally had 20 inpatient beds but over the past 2 years it has been necessary to close 6 beds for health and safety reasons, primarily associated with manual handling issues and space constraints between beds and the use of profiling and other medical equipment in an environment that is not conducive to providing modern healthcare. The loss of the 6 beds has not impacted upon patient activity within the hospital. Patient throughput has actually improved over this time due to a reduction in the length of stay of patients 4.3 Oakdale Hospital, unlike other community hospitals in the borough, does not provide any other services such as minor injury, outpatient or rehabilitation services. Inpatient Activity 4.4 Patients admitted to Oakdale Hospital are transferred from acute hospitals, which include the Royal Gwent Hospital, Prince Charles Hospital, University Hospital of Wales, Caerphilly District Miners Hospital and Ystrad Mynach Hospital, following a period of rehabilitation and where they require support care. Patients admitted to Oakdale Hospital are generally awaiting a Residential or Nursing Home placement or a home care package. No patients are admitted directly from the community into Oakdale Hospital. Those patients that are admitted come from residential areas across the whole of Caerphilly County Borough and not just Oakdale. Current Workforce Profile 4.5 The current workforce is made up of 16 nurses, 2 catering and 6 domestic staff. The table overleaf identifies the skill mix and whole time equivalents (WTE) for the groups of staff. Table 1: Oakdale Workforce Position Band WTE No of Heads Vacancies Ward Sister 7 1.0 1 Deputy ward 6 0.61 1 sister Registered 5 5.87 8 3.0 Nurses HCSW 3 8.2 10 HCSW 2 2.0 2 2.0 Catering 3 0.80 1 Assistant 2 0.32 1 Domestic 3 0.80 1 2 3.20 5 Porter 2 0.26 1 Total 23.06 31 5.0 4.6 Over the past 8 months, recruitment to Oakdale Hospital, for both registered and health care support workers, has become increasingly difficult, due in part to known future closure plans associated with the building of the new hospital. Table 1 above highlights the current level of vacancies which equates to 23% of the total nursing workforce within Oakdale Hospital. CASE FOR CHANGE 4.7 An increase in the range of health and social care services provided in the community and primary care, coupled with changes to the way in which hospital based services are now provided, has resulted in a significant reduction in lengths of stay for patients and the numbers of delayed transfers of care. Such changes have a consequent effect on the number of community hospital beds required now and in the future. Such changes are in line with the strategic direction for healthcare services with greater local access to services, more services provided in the community and reduced reliance on hospital based services. Delayed Transfers of Care (DTOCs) 4.8 DTOC numbers in Caerphilly county borough rose to 82 in June 2008 but have steadily reduced over the past 8 months to 10 in March 2009. This significant improvement has largely been achieved through the resourcing and implementation of a Joint Hospital Discharge Team (JHDT), comprising both nursing and social worker staff. The JHDT works closely with other community based services, including the Home Assessment and Reablement Team (HART) EMI Liaison and Home Treatment Team and district nursing teams, which include community advanced nurse practitioner roles. The reduction in DTOC numbers has meant that there are fewer patients now delaying in Oakdale Hospital than at any other time. Bed Occupancy and Patient Activity 4.9 Bed occupancy within Oakdale Hospital has reduced from 98% to 91% over the past 12 months. The number of patients admitted to and discharged from the hospital now averages 15 a month compared to 12 months ago when the average was 9 per month. The continued development of community based health and social care services, including reablement, telecare and rapid response services, has resulted in a significant reduction in the length of stay for patients admitted to Oakdale Hospital from an average of 54 days to 33 days, indicating the continued improvement in quality of care for patients as well as improved performance. New Service Models 4.10 Alongside the development of community based services, the new Frailty Model of Care has been developed and implemented in a specially adapted ward (Nantgarw Ward) at Caerphilly District Miners Hospital. Through this model of care, elderly patients, usually with multiple medical and social care needs, receive an indepth assessment resulting in the provision of a patient-specific community based care package and following a much reduced hospital length of stay (typically 5 days).The development of this new service has also been facilitated by the recruitment of a Community Consultant Physician to the borough who is focusing on the development of effective services for frail older people across the patient pathway. The Frailty service model was implemented on Nantgarw Ward in January 2009 and is already demonstrating significant improvements to the quality of care for patients as well as enabling significant reduction in hospital length of stay. As a consequence, there will be a further reduction in demand for patients needing transfer to Oakdale Hospital as their discharge back into the community is more effectively managed. 4.11 Implementation of the Frail Elderly Model of Care is taking place in 2 stages with stage 1 comprising the opening of Nantgarw ward and phase 2 enabling a greater focus on admission avoidance so reducing the need for patients from across the county borough to be admitted to hospital in the first place. The development and implementation of the Frail Elderly service model illustrates necessary changes to the way in which services are provided in future, across the patient pathway, with a greater emphasis on care in the community, avoidance of inappropriate admission to hospital and reduced lengths of stay in hospital for those patients who require hospital admission. Such changes also underpin the revised service models that need to be in place in readiness for the opening of Ysbyty Ystrad Fawr (YYF), noting in particular the target maximum number of DTOCs for YYF which is 10 per month. Estates problems 4.12 The lease on the hospital building and grounds is due to expire in January 2010. Gwent Healthcare NHS Trust is currently paying a ‘peppercorn’ lease of £1 per annum. Discussions with the site owner have indicated that renewal of the lease will result in an increase of the annual charge to £88k.
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