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Review of Community Hospital Services North East Wales Health Community 8 February 2005 Community Hospital Review Document Control Sheet Client North East Wales Health Community Document Title Review of Community Hospital Services Version 12 Secta Reference 12794 Author Susan Thomas, Ian Johnston and Elaine Bennett Date 8 February 2005 Further copies from Email: [email protected] quoting reference and author Quality Assurance Steve Smurthwaite By: Document History Version Date Author Comments 1 03 November 2004 Elaine Bennett Framework for the report 2 09 November 2004 Elaine Bennett Initial drafting of report 3 03 December 2004 Susan Thomas Redrafting of report 4 08 December 2004 Ian Johnston Further drafting and additions 5 09 December 2004 Susan Thomas Further drafting and additions 6 13 December 2004 Elaine Bennett QA of draft report Changes from Neil Bradshaw 7 05 December 2004 Elaine Bennett incorporated Changes from NE Wales Health 8 10 January 2005 Elaine Bennett Community incorporated 9 11 January 2005 Susan Thomas Additional revisions Incorporation of Executive agreed 10 18 January 2005 Elaine Bennett changes 11 31 January 2005 Elaine Bennett Incorporation of final agreed changes 12 8 February 2005 Elaine Bennett Incorporation of final agreed changes Version 12 a Community Hospital Review Contents 1 INTRODUCTION...................................................................................1 1.1 Background................................................................................................................... 1 1.2 Objectives of the Review .............................................................................................. 1 1.3 Scope of the Review..................................................................................................... 2 1.4 The Shape of this Report.............................................................................................. 2 2 CONTEXT .............................................................................................4 2.1 Introduction................................................................................................................... 4 2.2 National Strategic Drivers............................................................................................. 4 2.3 Local Strategic Drivers ................................................................................................. 6 3 FINDINGS .............................................................................................8 3.1 Introduction................................................................................................................... 8 3.2 Methodology ................................................................................................................. 8 3.3 Key Findings................................................................................................................. 8 3.4 Point Prevalence Study ................................................................................................ 9 3.5 Financial Position........................................................................................................ 18 3.6 Summary of Hospital Services and Estate ................................................................. 20 3.7 Hospital Specific Issues.............................................................................................. 20 3.8 Stakeholder Engagement........................................................................................... 22 4 RECOMMENDATIONS.......................................................................25 4.1 Introduction................................................................................................................. 25 4.2 Key Conclusions......................................................................................................... 25 4.3 Active Bed Management ............................................................................................ 25 4.4 Flint Hospital............................................................................................................... 27 4.5 Llangollen Hospital ..................................................................................................... 27 4.6 Priority Projects........................................................................................................... 27 5 NEXT STEPS......................................................................................35 APPENDIX A - Stakeholders Interviewed APPENDIX B - Attendees at Strategic Vision Workshop APPENDIX C - Attendees at ‘Think Tank’ Workshop APPENDIX D - Outputs from ‘Think Tank’ Workshop APPENDIX E - Attendees on Options Workshop APPENDIX F - References Version 12 i Community Hospital Review 1 INTRODUCTION 1.1 Background 1.1.1 Early in 2004 a decision was made by the North East Wales Health Community to undertake a review of its community hospitals and the services currently provided. Secta was appointed to undertake this work over a three-month period from September to December 2004. The North East Wales Health Community consists of the following organisations: ■ North East Wales NHS Trust ■ Flintshire Local Health Board ■ Wrexham Local Health Board 1.1.2 The review of community hospitals took place within the context of the Welsh Assembly Government review of Health and Social Care in Wales, during 2003 (commonly referred to as the “Wanless Review”). 1.2 Objectives of the Review 1.2.1 The objectives of the Review of Community Hospital Services were to: ■ Enhance understanding of current community hospital service strengths and inefficiencies ■ Increase system capacity by improving the current efficiency and effectiveness of community hospital services ■ Enhance understanding of alternative models of care ■ Consider future models of care that will make most effective use of community hospital facilities and reduce pressures on other parts of the health economy 1.2.2 Secta’s work programme consisted of the following: ■ Determining existing utilisation: current services, activity, admission and discharge patterns and catchment populations ■ Identifying existing capacity and how this may be utilised more effectively to support current pressures ■ Scoping alternative models of care: consideration of how the community hospitals may be utilised differently to support alternative models, identify the potential capacity and assess the impact upon the overall health and social care system (in accordance with the agreed criteria) ■ Estimating future demand and indicate the infrastructure required to support the identified models of care 1.2.3 It became apparent during the review that finalising the role and, therefore, estimating the future demand for community hospital services was dependent on the development of complementary strategies for the transfer of care from acute Version 12 1 Community Hospital Review hospital settings to community and primary care settings. As a consequence, the focus of the review was on the first three items above. 1.3 Scope of the Review 1.3.1 This review focused on improving current use and defining future models of care for the five community hospitals listed below: ■ Chirk ■ Deeside ■ Flint ■ Holywell ■ Mold 1.3.2 The review also considered Llangollen community hospital. 1.3.3 The focus of the review was on identification of areas for improvement, in the short and medium to long term. Hence the emphasis of this report is on areas for improvement, rather than on highlighting good practice, which exists. 1.3.4 In addition, the review also took account of the local acute, primary and social care sectors due to the strong interrelationship with the community hospital services. 1.3.5 Over the course of the work undertaken, it became increasingly apparent that this review was, in fact, just one part of a much larger piece of work; namely, the development of a coherent and organised strategy around the future of primary and community services in general. There is a wider set of reviews occurring concurrently, including the work of North Wales Planning Forum. This examination of the configuration of acute and tertiary services will potentially have an impact on community hospital services. 1.3.6 This review therefore contributes to a wider debate about the future configuration of health care delivery in North East Wales. 1.4 The Shape of this Report 1.4.1 This report takes the following form: ■ Context: This will explore the context within which this review sits, on both a national and local level; ■ Findings: This will outline the key findings of the diagnostic review, which is both quantitative and qualitative in nature. This section includes the diagnosis undertaken at visits to the six community hospitals and will also outline the key messages of the various workshops undertaken during this process; ■ Recommendations: This section will outline the recommendations drawn from the diagnostic phase and information from stakeholders. This part of the Version 12 2 Community Hospital Review review identified some short and medium term priorities that will require action; ■ Next steps: This section will outline how this discrete review of community hospitals should be viewed within the wider context of primary and community hospitals. In addition, it will help identify ways in which the health community can move towards developing an integrated strategy for its health care provision. Version 12 3 Community Hospital Review 2 CONTEXT 2.1 Introduction 2.1.1 Community hospitals

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