Agenda Item No. 5 Appendix B Service Redesign for Quality

Response to the Public Consultation – May 2011

1 Introduction The joint Service Redesign for Quality (SRfQ) programme has been under development for the last two years. The programme has involved Coastal healthcare commissioners and providers, together with the local authority social care departments who are responsible for the development and provision of community care. The programme’s overall aim is to ensure that local people receive safe and high quality care in the most appropriate setting, and particularly to improve safety for people currently treated as inpatients at Southlands Hospital.

The programme follows the direction that NHS policy has set – to implement models of care that meet the needs of an ageing population in which chronic medical conditions are becoming increasingly prevalent. In practice, these models of care will focus more on preventing ill health, on supporting self-care and on providing more care at home and in the community. To be successful and effective they will require health and social care specialists from all areas to work more closely together to coordinate services so that patients’ needs are met.

The SRfQ programme will enable Western Sussex Hospitals to move the inpatient services that are currently at Southlands Hospital, to the safer environment of Hospital, next to vital services such as critical care, theatres, and complex imaging equipment. They will also enable the provision of better facilities for the Trust’s Ophthalmology (Eye) Services by creating a new department at St.Richard’s Hospital and by moving the Worthing service to new premises at Southlands.

The wider SRfQ programme will support an overall shift of care from the acute hospital setting to alternative models of care in the community, for some people with acute medical conditions.

On 7th February this year the organisations involved launched a programme to consult with the public and with all local stakeholders on the changes that are being proposed. The aim of the consultation was to listen to the views of as many people and organisations as possible and to then address, in the plans, the key issues that arose.

The feedback from the consultation has now been independently collated and evaluated and the themes that have emerged have been considered by the programme Steering Group – The Western Sussex Coastal Cabinet - which comprises the lead directors of all health and social care organisations in the area.

This paper summarises our response to the issues that have been raised and our proposals for the way forward.

2 The Consultation Programme – facts and figures

2.1 The consultation lasted for 12 weeks – from 7th February to 29th April 2011.

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• Over 5000 documents describing the proposals were distributed – 4500 in print form, 180 downloaded online, 483 downloaded by hospital staff and more than 500 given out at public meetings and information stands • Over 700 organisations, including GP surgeries, opticians, libraries, local authorities and community groups, were sent information about the consultation • 3692 people viewed information about the consultation online • 1765 hospital staff viewed the information online on the hospital intranet • 361 people took part in public meetings • 176 people took part in staff meetings • 5 press releases were provided to the media and stakeholders

• 12 meetings were held for the public or for specific interest groups

• 3 information stands were manned in the Shoreham area

• 503 individual responses were received to the proposals – 73% were paper or online responses, 19% were in the form of letters or emails, and 8% were notes from meetings or telephone calls • 91% of the responses came from individuals • 27% of the responses came from Shoreham; 40% came from Worthing; 4% came from Chichester; the remainder came from other areas or the area was not stated

2.2 What did people think about the way we conducted the consultation?

The feedback Some people felt that we should have held the public meetings at different times, provided more publicity and made materials more widely available in different formats.

Our response– We held 7 public meetings in total and, in response to concerns expressed about the scheduling of these meetings, we offered to meet separately with any specific groups of people at a time and venue of their choosing - four groups took up this offer.

The consultation was publicised multiple times on local radio and televisions, in local newspapers, in the hospitals and on our websites. However, we accept the point that some people made that we need to keep pace with modern methods of communication and are planning to set up a Western Sussex Hospitals Trust Facebook page in the near future. NHS West Sussex established its Facebook page some time ago and updates about the meetings were added to the page during the consultation period.

We made it clear that the consultation document was available in different formats on request. We provided the document in large font, Braille and in an audio version in response to the only requests that were made for different formats.

Key stakeholders such as LINk acknowledged the amount of work that had been put into the consultation process and thought that the public meetings

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3 What did the feedback say overall?

The aim of our consultation was to be inclusive – to gain as wide a range of views as possible - and we were pleased to receive feedback from a large span of organisations and individuals.

Three key organisations in West Sussex – the Health Overview and Scrutiny Committee (HOSC), the Local Involvement Network (LINk), and the Patient and Public Council (PPC) – expressed broad support for the proposals although all asked for further reassurance around the shift of care from the acute to the community setting.

We have summarised below the major themes of feedback that we received overall as -

• The need for us to provide more clarity and detail around the reduction in the number of hospital beds, and about the plans for the community care that will reduce admissions to hospital and will reduce the overall length of stay in hospital beds • The public need for assurance that we are taking account of the growth in the local elderly population and their needs for the future • The problems that people with special needs – including people with visual impairment – will have in getting to Southlands for Eye Clinic appointments • Car parking at both Worthing and Southlands • The concerns that people have about the future of the Harness Block at Southlands Hospital

These key messages were made clear in the feedback from both individuals and from local organisations.

We have considered each of these themes carefully and our response is detailed in the following sections.

3.1 Our plans for hospital beds and alternative community care

The feedback By far the largest concern that people raised during the consultation was a lack of confidence in our plans to reduce the number of hospital beds in the area and to replace them with services that support people in their own homes.

Our response Our plans are founded in the expert knowledge of our clinicians – our GPs and hospital and community doctors – who believe that people should spend only the time they need to in hospital. Over the last few years we have admitted more and more people to hospital and many stay in longer than they need to. Doctors agree that this is not the best way to help people stay healthy and independent for as long as they can. We need to ensure that people receive the right level of care, at the right time, in the right place and for the right length of time and the SRfQ programme will make sure that there are credible alternatives in place to help us achieve this.

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What do our proposed bed reductions mean in terms of acute hospital capacity? Our plans to reduce the number of admissions and the length of hospital stay will affect our entire range of beds - apart from those ring-fenced for maternity and children’s services. The 60 beds that we are proposing to take out will come from all of the medical and surgical specialties and not just from Elderly Care. The 60 beds represent 12% of the total of Worthing & Southlands beds or 7% of all of the Trust beds at Worthing, Southlands and St.Richard’s.

How are we going to reduce our need for hospital beds? The consultation about moving services between Worthing and Southlands hospitals has come at a time when, as a local health economy, we have been working together to improve services for the large group of patients who need attention for sudden (acute) medical conditions. Our plans focus on three areas –

• Reducing the need for some people to be admitted to hospital • Improving the way that we treat people in hospital to make sure that they stay only as long as they need to • Making sure that there are good support services in the community so that people can go home from hospital as soon as they no longer need the day to day care of hospital doctors

The following sections detail some examples of the work that we are doing.

Reducing admissions Our medical teams have reviewed patients’ records over a period of time and have agreed that on average, around 260 patients a month are admitted to hospital when, with the right resources and expertise to hand in the community, they could be treated at home or in the care/nursing home where they live.

At the beginning of April this year we started to introduce our joint One Call/One Team scheme to provide the kind of support that is needed for this group of patients. The scheme consists of specialist doctors, nurses, paramedics and therapists all focused on assessing patients rapidly and making sure that the treatment that they need is provided as fast as possible. One Call/One Team will be up to speed fully in the next few weeks and we are confident that it will provide real improvements to the care that we give to patients and will release beds for those who really need to be cared for in hospital.

This scheme would allow us to reduce the number of hospital beds that we need by 15.

Reducing length of stay in hospital We are introducing a range of new ways of working in hospital that will eliminate many of the delays and hold-ups that currently extend length of stay.

For instance – • We have recently created a dedicated assessment area close to A&E where patients’ diagnostic tests and treatment plans are fast-tracked by a team of specialist doctors and nurses. This has resulted in a real

4 Item 5 - Appendix B WSHT & NHSWS response.doc Agenda Item No. 5 Appendix B reduction in the number of days that patients spend in hospital. • We are introducing changes in surgical techniques. For example our anaesthetists are pioneering a way of improving patients’ fluid balance during surgery. It has been proved that this will help patients to recover more quickly so that they are ready for discharge several days earlier. • We are planning to integrate all of our emergency admission beds at Worthing Hospital. These beds are currently spread around the hospital. Bringing them together to the same area will mean that our doctors will be able to see the patients more easily and so will be able to plan the treatment that they need more efficiently. • Patients who are transferred to Southlands experience at least a 1-2 day delay in recovery – with a day spent getting ready for the transfer and waiting for the ambulance, and a further day spent settling into new surroundings and routines at the other end. Bringing those beds to Worthing Hospital will eliminate those delays and shorten patients’ stay.

These new ways of working will reduce our bed requirement by about 26 beds.

Providing Continuing Care Assessment in the right place – step down beds There is a group of patients in our hospital beds who have recovered from a spell of illness and who are awaiting the long process of assessment of their future care needs.

In April NHS West Sussex arranged to provide 20 beds in the community for these patients so that they can wait for their assessment in the right environment and closer to their own home. Nine of these beds will be in Lodge in Worthing and it is planned for the remaining 11 to be in place by the end of September 2011. These ‘step down’ beds will be used for patients who are awaiting an assessment of their future needs or for patients who need rehabilitation following a spell in hospital. On average we expect this group of patients to stay in these beds for about six weeks. The cost of their care during this period will be covered by the NHS.

Any beds commissioned by NHS West Sussex in local care homes will be subject to the PCT’s assessment and monitoring process which will ensure a high quality standard of care.

These step down beds will reduce our hospital bed requirement by 20

The work that we have described above – reducing admissions, reducing length of stay, and providing step down beds in care homes – is all well underway and is already achieving the changes that we need. Together these schemes will reduce the hospital bed requirement by over 60 (15 from reduced admissions, plus 26 from reduced length of stay, plus 20 from the step down beds) and, with the additional 60 beds that we are creating at Worthing, will make up the loss of the 120 Southlands beds.

On top of this work we are also planning projects to review and enhance community services such as -

5 Item 5 - Appendix B WSHT & NHSWS response.doc Agenda Item No. 5 Appendix B Earlier discharge from hospital There are specific groups of patients currently in hospital beds who don’t require a high level of medical or nursing care and who would recover well in their own homes with the support of therapist teams.

For example, we estimate that at any one time we have 8 stroke patients, 8-15 elderly patients recovering from fractured limbs, and 2-5 patients recovering from leg amputations who no longer need hospital care and who would all be able to go home to continue their recovery if the right level of support was available. To this end health commissioners will be reviewing the spread of resources across the local heathcare providers to ensure that services are provided where and when they are needed.

This will enable us to reduce our bed requirement by a further 18-28.

Review of community service capacity Community healthcare services are provided in a number of different ways. Patients can be supported in their own homes, they can be admitted to beds in community hospitals, or they can be looked after in nursing or care homes. NHS West Sussex is reviewing some of its community services to ensure that they are able to provide the right level of services in the medium to long term to support the growth in our elderly population.

Use of Community Beds – NHS West Sussex is reviewing the use of the 173 community beds (this figure excludes the beds in Crawley and Horsham hospitals) that are currently available in Coastal West Sussex. The aim of this review will be to –

• Ensure that admission criteria to the beds is consistent – that is to make sure that all of the beds are available to the patients who qualify for the care that they provide • Ensure that all of the community hospital beds can play their part in providing care in the right setting for patients with acute medical conditions • Ensure that the beds provide the best use of taxpayers’ money

As a start to the review NHS West Sussex has held Stakeholder Group meetings to talk with staff, patients, GPs, LINk and other healthcare providers about the opportunities to improve the way that the community beds are used. This first stage of the process will be completed by mid July and the GP commissioners expect to review the findings and recommendations of the review in September. Any changes to services which are agreed as a consequence of the review will be commissioned from April 2012 onwards.

What will happen in the end if any or all of these plans don’t work? We are confident that the plans that we’ve described here will provide the level and quality of care that local people are going to need in the future, and that that the care they need will be provided in the setting that is best for them.

The work that we are doing has already started and will continue for the next two years. Over that time we will reduce the need for hospital beds and we will achieve our target reduction by March 2013. Our plans will always include a level of flexibility in terms of hospital beds so that we are able to increase the beds we use to meet the peaks of demand that we see, particularly in the

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If, in 2013 when all of the changes have been put in place, the demand for hospital beds remains at its current high level, we will look to create more new beds at Worthing Hospital. We will be able to do this by using space in the existing buildings there.

3.2 What are we doing to ensure that we will have the right services in place for our growing elderly population?

The feedback West Sussex has a higher than national average number of people in the older age bands and the proportion in these bands is expected to increase over the next ten to fifteen years. During the consultation a number of people and organisations asked for reassurance that the changes that we are proposing will take account of the demands that this demographic shift will place on the healthcare system.

Our response The Service Redesign for Quality programme is an integral and essential part of our response to the challenges of the ageing population. These challenges were laid down by the Director of Public Health and Wellbeing in 20091 and were taken up by NHS West Sussex in their Strategic Commissioning Plan (SCP) for 2010-14. The SCP sets out a number of goals and objectives that will improve services for older people and will enable them to maintain their wellbeing and independence for as long as possible.

Work to improve services for the elderly is going on throughout the local health economy. A dedicated multi-agency group consisting of representatives from NHS organisations, County Council services, voluntary sector organisations, and patient/public members is currently working on a ‘Frail Elderly Strategy’ to define ways to provide the best service in the future for this important, and growing, group of people.

The joint One Call/One Team project is an example of the type of scheme that will improve services for the elderly people who make up the majority of patients who are admitted to hospital with acute medical conditions.

As part of SRfQ Western Sussex Hospitals is introducing specific ways to improve the care pathway for elderly patients including –

• Improvements to the emergency admission areas to ensure that the right care is provided as fast as possible • A change in care pathway for elderly patients with fractured hips to ensure that they get fast access to specialist elderly care doctors • Integration of the stroke admission and rehab wards • Elimination of the need to transfer frail elderly patients backwards and forwards between Worthing and Southlands hospitals • Ring-fencing of wards for elderly patients to make sure that they get the specialist nursing and medical care that will aid their recovery

All of the local health economy organisations have recognised the need for

1 ‘A Fair Old Age – commissioning challenges in West Sussex’ 2009/10

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3.3 Getting to Southlands for people with special needs

The feedback The issue of travel to Southlands was raised by many people and particularly by people with visual impairment who need to attend the Eye Clinic regularly.

Our response We accept that some people in the Worthing area who have previously enjoyed short trips to Worthing Hospital for eye care will now have to travel the extra six miles to Shoreham.

To mitigate this we are –

• Working with the GP Commissioners to organise more convenient community based clinics so that people from all over the area who have long-term eye conditions such as glaucoma, can be monitored regularly without the need to travel too far from home • We have investigated the options to make travel between Worthing and Southlands easier and have had detailed discussions with local bus companies about changes to their routes and timetables to accommodate the needs of local people. We have decided that, in the first instance, we will reinstate the minibus that used to shuttle backwards and forwards between the hospitals. This service will restart as soon as the new Southlands Eye Department opens and will operate on weekdays between about 7.00am and 7.00pm. The service will be open to hospital staff, patients and their escorts and will be fully equipped for passengers with limited vision. We will continually review the use of the service so that we can adjust the frequency and capacity to meet the demand. • Working with the voluntary sector to ensure that people who need help in getting to hospital are aware of the transport schemes that are available to them.

3.4 Car parking at Worthing and Southlands

The feedback Many people commented on car parking both at Worthing and at Southlands Hospitals.

Our response To deal with Southlands first – the hospital sits on a very large site and there is sufficient space for us to ensure that there will be enough parking there for staff and for the increased number of patients that the move of the Eye Clinic, and the development of other ambulatory services will bring.

We will continue to develop Worthing Hospital – with all of its critical services like ITU, theatres, and complex imaging – as the focus for all emergency and acute services in the eastern half of our patch. To do this we need to make sure that the space that we have at Worthing is dedicated to these acute services.

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Like most town centre hospitals, car parking at Worthing remains a problem. Moving the Eye Department – which receives 20-30,000 visitors a year, most of whom come by car - to Southlands will ease the problem at Worthing in the short term. For the longer term we have started discussions with the Worthing Borough planners about building a multi-storey car park at the hospital and a formal feasibility study for this is now underway. We will also continue to watch for opportunities to provide more parking in areas close to the hospital site, and we will continue to develop schemes to make it easier for staff to use alternatives to the private car to travel to work.

3.5 The future of the Harness Block

The feedback A significant number of people – particularly those from the Shoreham area – have raised concerns about the future of the Harness Block (the inpatient ward block) at Southlands Hospital if inpatient services are moved to Worthing Hospital. The view was expressed that this is an important NHS asset that should be used to its full potential, and many suggestions were made as to its future use. The West Sussex Local Involvement Network (LINk) said that it ‘remains convinced that alternative NHS uses for the building should have been thoroughly explored.’

Our response Western Sussex Hospitals have made it clear that no decision will be made on the future of the Harness Block until the outcome of the consultation and the future of services at Southlands is decided. The Trust would be very happy to see the building’s retention although cannot currently envisage any viable clinical use for it. It is important to bear in mind that any future use would need to be able to generate the annual running cost of the building – which is currently around £2million – and would need to justify spending money on upgrading and converting the building to bring it up to the standards required today.

The Trust will welcome the opportunity to work with its health partners, local authorities and other interested parties in reviewing all possible options for the future of the building.

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