Report of the Airedale, Whafedale and Clinical Commissioning Group to the meeting of the Health and Social Care Overview & Scrutiny Committee to be held on 12 December 2013

Subject: Coronation Hospital, S

Summary statement:

The ownership and management of Ilkley Coronation Hospital, and responsibility for commissioning services, changed on 1 April 2013 following the government’s changes to the NHS. This report summarises the current status of the hospital from the perspective of all the local NHS organisations, confirms partner commitment to expanding services in Ilkley and discusses the future direction of integrated care in the Aire and Wharfe Valleys.

Portfolio:

Adult Services and Health

Report Contact: Sue Pitkethly, Chief Operating Officer, Airedale, and Craven Clinical Commissioning Group Phone: (01274) 237317 E-mail: sue.pitkethly@.nhs.uk

Report to the Health and Social Care Overview & Scrutiny Committee

1. Summary

Until 1 st April 2013, Coronation Hospital in Ilkley was the responsibility of NHS Airedale, Bradford and . Following the government’s reorganisation of the NHS landscape, the buildings and land on which the hospital is built transferred to the ownership of NHS Property Services Ltd, whilst the majority of patient services continue to be provided by Airedale NHS Foundation Trust (ANHSFT) and Bradford District Care Trust (BDCT) - both trusts pay rent to NHS Property Services Ltd for the use of the building. From 1 April 2013 Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG) took on responsibility for commissioning the majority of the services provided at the hospital.

This report brings together the current status of the hospital from the perspective of these NHS organisations, confirms the commitment of the organisations to continue to develop services in Ilkley and discusses the future direction of integrated care in the Aire and Wharfe Valleys.

2. Background and Context

2.1 Ilkley Coronation Hospital

Built in 1904, Coronation Hospital has been a landmark in the local community ever since. However it has long since outlived its original purpose with parts of the hospital showing clear fatigue and some areas in need of significant improvement and investment.

In recent years there have been a number of proposals to develop the Coronation Hospital site. Most recently, in 2009, the former NHS Bradford and Airedale – the primary care trust (PCT) - conducted a formal public consultation on proposals for the expansion of community-based health and social care in Wharfedale including plans to invest in a new Coronation Community Hospital. A newly built Coronation Hospital - coupled with an increasingly important role supporting a bigger and better range of services in the community – was seen as a critical element of the PCT’s vision for modern, equitable, integrated health and social care services.

People who responded to the consultation said they would prefer the hospital to remain close to the centre of Ilkley and suggested the kinds of services they would like to see provided at the hospital. There was an acknowledgement that the current site presented a number of challenges including excessive traffic congestion, lack of parking, poor public transport links, and the unsuitability of the compact site to house the range of services being suggested or to provide for future expansion.

Four options were originally considered: redeveloping the existing site, re-providing the hospital on a new site, carrying out minor refurbishment of the existing hospital or complete closure. Whilst the preferred option was to rebuild on the existing site, an alternative site not previously consulted on became unexpectedly available. The PCT with the support of the Council’s Health Overview and Scrutiny Committee agreed to investigate the alternative site. Following investigation the PCT concluded that use of the existing site would be the most appropriate for any future developments in lIkley. This was confirmed at a meeting of the PCT’s Board in September 2010 where it agreed that a Wave 4 LIFT programme (value £3.3m) would be developed, incorporating Ilkley Coronation Hospital and two primary care premises, subject to assessment following publication of the government’s Comprehensive Spending Review that autumn. 2 Report to the Health and Social Care Overview and Scrutiny Committee

The deteriorating national financial position including that of the NHS and the abolition of PCTs as part of the Health and Social Care Act implementation meant that the funding identified was no longer available. As a result the plan for the redevelopment of the hospital could not be progressed as they could not be financed. The plans to expand community-based health and social care in Wharfedale were, however, implemented.

In June 2012 1 the Department of Health issued guidance to PCTs about the requirement to transfer property ownership by 31 March 2013 to successor bodies (either to NHS Property Services Ltd or to those NHS organisations who are the majority users of properties.)

Following rigorous due diligence, Airedale NHS Foundation Trust - the majority user of the hospital - decided not to accept ownership of the hospital due to the extensive maintenance and refurbishment investment required. The Trust remains committed to developing services in Ilkey but with an oversubscribed capital budget including a significant backlog maintenance requirement for the Airedale General Hospital facility (which is over 40 years old) coupled with the organisational requirement to make 5% year on year efficiencies, is not in a position to take on the financial responsibility of running and maintaining Ilkley Coronation Hospital.

On abolition of the PCT on the 31 st March 2013, Ilkley Coronation Hospital transferred to the ownership of NHS Property Services Ltd, where it remains today.

2.2 Changing nature of health care provision

NHS ’s “A call to action”, sets out the future pressures from the increasing numbers of older people and those with long term conditions that threaten to overwhelm health and social care services. The resulting increase in demand with rising costs threatens the financial stability and sustainability of services. This means we will have to make fundamental changes to how we deliver and use health and care services in the future, by harnessing technology, integrating more services and putting people in charge of their well being.

When Ilkley Coronation was built over a hundred years ago, the model of health and social care was very different to what can be provided today. Today there is a greater emphasis on self care, with people supported to better understand their long term conditions, and a shift to provide more care at home/closer to home wth services increasingly provided at home/in the community, enabled by technology.

In response, health care providers including Airedale NHS Foundation Trust and Bradford District Care Trust are increasing their investment in community based integrated teams to better support patients in their own homes (including in nursing homes and residential care homes) and are using technology to increase support such as using telemedicine to connect patients in their own homes with health care professionals remotely.

As a result providers are rethinking their use of and need for all buildings as they look to make the best use of physical and financial resources to meet increasing population demand.

1 DH Guidance on planning for property and estates transfers, June 2012, Gateway Reference 17722 3 Report to the Health and Social Care Overview and Scrutiny Committee

Health and social care partners, through the local Transformation and Integration Group, are continuing to discuss how best to bring services together in a way that is patient centred and co-ordinated, with a view to further engaging with the public once proposals are fully developed. Any future proposals for Coronation Hospital would be the subject of public consultation.

3. Current situation

3.1 The estate

Although it has been a landmark of the local community since it was built in 1904, Coronation Hospital has long since outlived its original purpose. At best, parts of the hospital show clear fatigue whilst some areas are in need of significant improvement. In its current state the hospital premises are not now suitable for providing health and social care in a modern environment and little can be done to reverse the situation. Ongoing maintenance to the estate is provided by the landlord, NHS Property Services Ltd who have plans to invest upwards of £300k in the next 18 months to keep the building operational.

3.2 Services currently provided at Coronation Hospital

A range of community and outpatient services are provided at Coronation Hospital by Airedale NHS Foundation Trust and Bradford District Care Trust. These include a range of diagnostic procedures, outpatient clinics, assessment and rehabilitation services. A list of the current clinics operated by each Trust is attached (Appendix 1).

Activity profiles for Airedale NHS Foundation Trust by service are attached (Appendix 2). These demonstrate that activity in 2012/13 is slightly more than the previous year. In addition to the activity delivered at Ilkley Coronation, both Trusts have also increased the provision of community based services in the Ilkley area.

Both Trusts are reviewing how they provide care in the future. There is no doubt that more services could be delivered closer to home. The challenge is how to make best use of resources to sustain and ideally improve the patient experience. Whilst new service models are being developed, both Trusts have confirmed their commitment to continue to deliver services from Ilkley Coronation Hospital.

3.3 Commissioning of services

Health services provided for people living in the Aire and Wharfe Valleys are commissioned by Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG) and NHS England 2. Those services provided at Coronation Hospital are commissioned by the CCG from BDCT and ANHSFT who pay ‘rent’ to NHS Property Services Ltd for the space they use. Whilst both Trusts would like to provide more services from community settings, this has to be balanced against the cost of providing such services.

Currently the rental costs for Ilkley Coronation are in excess of income generated. Having clinicians and other healthcare professionals working from community based services has

2 Services commissioned by NHS England include, for example, specialised services (for rare and complex conditions), primary care (GP, dental, pharmacy and optical services), health visitor and family nursing services, offender healthcare and services for members of the armed forces. 4 Report to the Health and Social Care Overview and Scrutiny Committee

to be balanced against the loss of that expertise at the central site. Making the best use of this resource for the whole community has to be considered. In future there will be other ways to access clinical expertise using technology to connect remotely which enables greater access to specialist opinion for everyone.

The CCG and both providers have confirmed that in n the medium-term, Coronation Hospital will remain an integral part of service provision in the Wharfe Valley and whilst not attracting any significant future investment, the property will continue to be maintained at its current levels. The programme of investment over the next 18 months is set out at appendix 3

In the longer-term health and social care partners are committed to working together to provide integrated services closer to people’s homes. This may mean that services provided at Coronation Hospital may need to change to meet the ever changing needs of our local population.

4. Recommendations

That the intended commissioning model in the Airedale, Wharfedale and Craven area and the current status of Coronation Hospital be noted.

5. Background documents

None.

6. Not for publication documents

None.

7. Appendices Appendix 1: Services currently provided at Ilkley Coronation Hospital Appendix 2: Activity profiles 2011/12, 2012/13 Appendix 3: Maintenance programme

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Appendix 1 Services currently provided at Ilkely Coronation Hospital

1 Airedale NHS Foundation Trust Airedale NHS Foundation Trust currently provides the following services from Ilkley Coronation Hospital:

Day / Time Service Frequency where not weekly Monday am Urology Alternate weeks Speech and Language Therapy Radiology Therapies Phlebotomy Monday pm Endocrinology Week 1 each month General Surgery Week 3 each month Speech and Language Therapy Tuesday am Elderly Medicine Radiology Therapies Phlebotomy Tuesday pm Wednesday General Surgery Alternate weeks am Radiology Therapies Phlebotomy Wednesday Gynaecology Weeks 2 and 4 each month pm Thursday am Orthopaedics Alternate weeks Urology Alternate weeks Speech and Language Therapy Radiology Therapies Phlebotomy Thursday pm Dietetics Weeks 1, 3 and 5 each month General Surgery Week 4 each month Speech and Language Therapy Friday am Orthopaedics Alternate weeks Audiology Speech and Language Therapy Radiology Therapies Phlebotomy Friday pm Audiology Speech and Language Therapy In addition ANHSFT also provides the following services in Ilkley • Level 2 and level 3 diabetes clinics with the MDT in GP Practices • Diabetes education groups • Telemedicine to patients in their own homes and nursing and residential care home • Community services in patients own homes through ACCT

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2. Bradford District Care Trust

Bradford District Care Trust (BDCT) delivers community and mental health services to the Ilkley community, with some staff based at the Ilkley Coronation Hospital, and some clinical activity there.

Podiatry services : During 2013, monthly average for patients attending appointments at Ilkley Coronation Hospital = 234 patients. In addition, average monthly home visits for podiatry patients registered with the 2 Ilkley practices = 6 appointments.

School Nursing Ilkley School Nursing team are based at Coronation Hospital The team consists of 2.05 whole time equivalent staff covering 17 schools and 6,165 school children. Most of their work is school based but they do sometimes see children at Coronation.

District Nursing Ilkley Wharfe and Burley District Nursing Teams are based at Coronation Hospital. The team consist of 5.93 whole time equivalent staff; most of their work is based in clients’ homes or GP surgeries. Current caseload is 179 patients (as at 27-Nov-13)

Continence The Continence service holds a monthly clinic session in coronation hospital, seeing an average of four patients per session (two new patients, two follow-ups).

Mental Health Services for the people of Ilkley are delivered in a range of settings, including home, clinics, outpatient and inpatient; the table below provides a high level breakdown of the number of patients using BDCT MH services (snapshot at 27.11.13)

Adult Mental Health 151 Child and Adolescent Psychiatry 71 Learning Disability 51 Old Age Psychiatry 121 Substance Misuse 31

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Appendix 2

Activity profile, Ilkley Coronation Hospital – 2011/12 and 2012/13

1. Airedale NHS Foundation Trust

Table 1: Outpatient Attendances TYPE SPECIALTY 2011/12 2012/13 Attendances Attendances First attendances General Surgery 234 256 Urology 169 189 Orthopaedics 141 160 General Medicine 2 0 Endocrinology 14 16 Geriatrics 69 64 Gynaecology 17 72 Nurse led 0 17 Sub Total 646 774 Follow up General Surgery 135 158 Attendances Urology 507 435 Orthopaedics 198 194 General Medicine 26 1 Gastroenterology 0 1 Endocrinology 31 72 Geriatrics 85 93 Gynaecology 8 95 Nurse led 0 98 Sub Total 990 1147 Grand total 1636 1921

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Appendix 3

Coronation Hospital - Programmed Maintenance

The condition of NHS property is assessed every 5 years with 6 facets of the building being measured against NHS standards these facets are:

• Physical condition; • Functional suitability; • Space utilisation; • Quality; • Fire, Health and Safety requirements; and • Environmental management.

As well as providing the basis of information for a Trust’s overall Estates strategy the findings of the assessment are used to develop 5 year programmed maintenance plans for each building; the NHS calls this work ‘ Back-log maintenance’

A ‘6 Facet Condition Survey’ was carried out on Coronation Hospital in 2010; remedial work recommended in the report is now to be carried out over the next 12 to 18 months. A detailed specification is currently being prepared by NHS Property Services and will include the following elements of work:

• Internal and external decorations • Replacement of floor coverings • Replacement of outdated signage • Upgrade lighting • Upgrade sanitary fittings to clinical rooms and WC’s

Based on similar work carried out on other NHS PS properties the cost of this work is expected to be circa £300000. The work will visually improve the existing surroundings but will also ensure building elements remain compliant with Health, Safety and Fire regulations as well as meeting current standards around infection prevention.

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