Review of the Alignment of Services Between The

Ymddiriedolaeth GIG Hywel Dda NHS Trust Review of the Alignment of Services between the Proposals for the Development of new Community Health facilities at Aberaeron, Cardigan and Tregaron and services provided from Bronglais Hospital, Aberystwyth May 2008 Contents Page 1. Terms of Reference 3 2. Introduction and Background 3 3. Aberaeron Hospital 3 4. Tregaron Hospital 7 5. Cardigan Hospital 8 6. Ceredigion Local Health Board - Consultation on Community Services 10 7. What can appropriately be undertaken or devolved to these community hospitals? 10 8. Supporting Early Discharge 11 9. Governance Arrangements 11 10. Benefits of a Nurse-led Service 12 11. Shared Care Model for Continuing Care 12 12. Sustainability 12 13. Conclusion and Recommendations 13 Appendix A Models of Care in Wales and Elsewhere 17 2 Ymddiriedolaeth GIG Hywel Dda NHS Trust Review of the Alignment of Services between the Proposals for the Development of new Community Health facilities at Aberaeron, Cardigan and Tregaron and Services provided from Bronglais Hospital, Aberystwyth Terms of Reference 1. In the light of services currently provided at Bronglais Hospital, Aberystwyth and proposals for the development of new community health facilities at Aberaeron, Cardigan and Tregaron, to assess and report on: i) What can appropriately be undertaken or devolved to these community hospitals from Bronglais Hospital, in a cost effective and sustainable way, across the spectrum of care of diagnostics, therapies, inpatients and outpatients; ii) What model should be used, with reference to the models in place and being developed in other parts of Wales and further afield (South Pembrokeshire Hospital, Tenby and the emerging model in Builth Wells). 2. In relation to the model, to take into account work already undertaken in relation to the role of the three facilities and the intentions of the local authority, with regard to the development of local community services and consider: i) How could these facilities be used to support early discharge from Bronglais Hospital; ii) If there are to be beds, what should the governance arrangements be; iii) The potential benefits of a nurse-led service/unit; and iv) The most appropriate shared care model for Continuing Health Care. 1. Introduction and Background The purpose of this paper is to consider the current proposals for the development of new community health facilities in Ceredigion and to assess what services can appropriately be undertaken or devolved to these hospitals from Bronglais, in a cost effective and sustainable way, across the spectrum of care of diagnostics, therapies, inpatients and outpatients. Details of the three Community Hospitals within Ceredigion, situated in Aberaeron, Tregaron and Cardigan, are shown in sections 2, 3 and 4 below. 2. Aberaeron Hospital • 17 Miles from Aberystwyth. • Outpatient facility only (no inpatient beds). • Base for health and social care staff. • Contract let for 3rd party developer to create integrated community resource centre. Aberaeron Hospital was established in 1916, funded from public subscriptions. Until 1999, it operated as an inpatient community hospital for local residents, but because of clinical governance and cost effectiveness issues, the beds closed and the site became a base for the provision of outpatient and community health services, as well as providing accommodation for multi-agency and multi-professional teams. The fabric of the current hospital building is dilapidated and whilst the in-patient beds have been closed for some time, the existing hospital building has since remained open and the use of the 3 hospital as a base for community health and social services staff has been maintained since that time, with additional clinics provided on site. When the inpatient beds were closed, the Health Authority announced a review of provision and gave a commitment to the development of a multi-agency integrated centre to replace the old building. A Project Management Board was set up and it was agreed that the project should proceed as a primary care development via the primary care funding route, led by Ceredigion LHB. The principles underpinning the model of care were that: • People should be able to access care as safely and as locally as possible utilising both primary care services and secondary care services based in community settings. • The provision of appropriate care in local settings maximises the ability of people to remain in their own homes rather than relying on inpatient, residential or nursing home services. • By working together, service providers can ensure that appropriate care is delivered by appropriate people at the appropriate time. • Modern service provision is not about one service working in isolation, but about all services which an individual needs including services offered for health, social care, housing, education, recreation, benefits and the wide range of services offered by voluntary organisations. • The strategic goals of Designed for Life and the Wanless Report would be incorporated into future service provision. The proposed model of care in the original business case documentation (1998) was to provide an integrated response service as first contact point for new clients and a support and resource centre for patients with chronic and complex needs. The objective was to draw on available services within Ceredigion health, social and voluntary services, to provide a rapid, holistic response to keep clients safe in their own homes. The final model of care was developed by the Clinical Services Operational Development Group and adopted by the Project Management Board. The focus is the principle of local care delivered at a local level and has identified the following enablers as the basis for the development of successful and sustainable health services: • Access – this refers to better access to services that are currently oversubscribed or under- resourced which typically results in long waiting lists, along with improving access to advice and information and to services by extending the hours that they are available, and creating access to multi-functional space within the new facility. • Communication – better communication and information sharing is envisaged to ensure that everyone involved with the care and treatment of an individual will have timely access to relevant information. This will come about through a range of developments such as co- location, multi-disciplinary team meetings, video conferencing, and improved/compatible IT systems fully acknowledging the requirements of the data protection act. • Skills-sharing – co-location, improved integration and information sharing will provide an environment for increased learning and skills sharing within and across teams and disciplines. • Flexibility – the design of the facility must include multi-functional space and as many shared facilities as possible, plus must have the capacity to accommodate evolving patterns of health and social care delivery into the future. Flexibility also refers to the willingness to explore and commit to different ways of working to make the best use of resources in the area. • Integration – this is more than simply co-locating services within the new facility and refers to the changes in work practice that will bring services and information together to provide improved holistic, user-centred services. Mental health services is an area where improved integration between primary and secondary health care, social care and voluntary sector providers can result in significant improvements in the speed and quality of the services provided to users. • Prevention – this crucial element to healthy living and avoiding crisis health and social care intervention is manifested through encouraging and harnessing the enterprising expertise of the voluntary sector, recognising the importance of early, low level health and social care 4 interventions, providing joined up advice and information, and exploiting the benefits of new technologies in video conferencing, streaming diagnostic test results, telecare and telemedicine services. The role of primary health care providers is central to the success of the prevention strategies and long term health improvement of the population to reduce some avoidable causes of ill health. • Maintaining independence – by providing services as close to people’s homes as possible, integrating the care provided across disciplines and promoting preventative health and social care measures, people will be able to maintain their independence for as long as possible. • Sustainability - an environmentally sensitive approach to building design, materials, construction and management constitutes one aspect of sustainability, but this also refers to the flexibility agenda of creating spaces that retain their viability as service provision changes over time as well as acknowledging the need to ensure effective use of the resources allocated to the area. The preferred site for the integrated facility is adjacent to the Local Authority offices in Aberaeron. One of the local GP practices will be accommodated within the building and the other GP practice in the town wishes to develop links with the facility for training, telemedicine and intermediate chronic disease management purposes. In addition members of the adult social care team and the Sure Start team will be relocating and community mental health services intend to use the facility on a sessional basis. It is also envisaged that a dental practice and pharmacy

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