Ambitious plans to develop Somerset’s community health services and create a clear framework for the long-term development of the county’s 13 community hospitals were approved today (16-7-15).
At a meeting of Somerset’s Clinical Commissioning Group’s (CCG) Governing Body, members discussed and agreed to take forward nine key proposals set out in the CCG’s community health service review, known as ‘Making the Most of Community Services.
Amongst the proposals included in the review was a recommendation to permanently close 40 community hospital beds. These beds have been temporarily closed for the last 12 months, and monitoring of bed usage over that time indicates they were surplus to requirements. (See temporarily closed bed chart)
A further 17 beds, temporarily closed for the last 12 months, would be kept in reserve by Somerset Partnership NHS Foundation Trust, should they be needed during peaks of demand this winter.
The review also expresses an expectation that as more patients, such as those who have experienced a stroke, benefit from early discharge from district hospital and have their rehabilitation and social care delivered in their own home, so demand upon community hospital beds might also be expected to reduce still further. Service modelling suggests that over a five year period the number of beds might reduce by 40 more community hospital beds.
Commenting upon the important role community hospitals play, both now and in the future, Dr Matthew Dolman, Chairman of Somerset CCG said: “There is no question of the CCG proposing the closure of any community hospital. However, people are living longer and living with more long-term illness, like diabetes, heart disease, dementia and chronic lung disease. We must plan now if we are going to prepare our community hospitals to meet this rapid rise in demand for health services and achieve this within existing financial resources."
Dr Dolman went onto explain that any change to community services would have to be in a phased and integrated way over the next three to five years.
The timescale for developing services will be dependent upon a number of factors such as enhancing existing provision for community based care, altering the choice of patients and referral patterns of family doctors and continuing to support hospitals to work flexibly in order to manage peaks of demand, such as those experienced last winter.
Services would also need to be aligned with Somerset County Council’s Adult Social Services and the services provided by local voluntary and community sector organisations.
The nine recommendations within Somerset CCG’s community service review are:
1. Urgent Care Centres: An upgrading of five of the county’s Minor Injury Units into Urgent Care Centres. These would offer a wider range of diagnostic investigations and treatments for patients with a range of minor injury and illness and reduce demand upon the County’s two Accident and Emergency Departments
2. Outpatient Services: More community hospital outpatient clinics will be provided thereby reducing the need for so many patients travel to district hospital appointments
3. Blood Transfusions and Chemotherapy: There are many patients who currently have to travel to a district hospital to have treatments like blood transfusions, intravenous antibiotics and chemotherapy. Such treatments could be delivered within a community hospital in what is known as ‘ambulatory care’, this would bring treatment closer to home and avoid length journeys to district hospital.
4. Community Stroke Services: In September a service is expanding that will support more stroke patients to be discharged straight from district hospital to home where they are given the rehabilitation they need. However, patients most severely affected by stroke (or head injury) will continue to benefit from having their rehabilitation within a community hospital, with their care overseen by a hospital consultant and specialist rehabilitation staff being available to provide intensive rehabilitation. The review suggests such a specialist service should be located within a single community hospital. A preferred location should be a matter for further consideration, public discussion and engagement.
5. Dementia Services: Community hospitals need to have the staff and environment to support patients with dementia and their carers. Somerset Partnership NHS Foundation Trust is working to better integrate older peoples’ mental health services and ensure dementia patients and carers have a better experience of support.
6. Palliative Care: Community hospitals need to provide excellent palliative and end of life care. Further collaborative work is being carried out by local hospices and Somerset Partnership NHS Foundation Trust. They are also strengthening hospital services and community teams are supporting palliative care patients with a view to helping more patients fulfil their wish to die at home or in a place of their choice.
7. Health and Wellbeing: Somerset CCG would like to improve the health and wellbeing of communities. This includes planning and funding more services with charitable and voluntary sector organisations fully embedded within mainstream health and social care services.
8. Hospital inpatient beds: Somerset CCG’s community review recognises that there are currently too many community hospital beds and recommends that 40 beds, temporarily closed for almost 12 months, should be permanently closed. This could free up resources to deliver much more community / home based health services to patients.
Reserved beds - The review also recommends that 17 temporarily closed beds, be kept in reserve in order to manage peaks of demand, such as those experienced by district and community hospitals last Christmas and New Year.
Future bed demand - As more and more patients benefit from early discharge from district hospital and support with health and social care within their own home, Somerset CCG expects to see a further reduction in demand for community hospital beds. In time this could release as many as a further 40 inpatient beds from the county’s community hospitals.
9. Designating hospitals ‘Step up’ or ‘Step down’:
The County’s 13 community hospitals need to have a clearly defined purpose and role. Somerset CCG’s community service review proposed that each community hospital is designated principally as one of two categories:
A. ‘Step up’ hospitals - providing care to people admitted from home and who require 24 hour nursing care with medical review or medical treatment.
Such hospitals should be combined with an Urgent Care Centre and include medical assessment and inpatient beds.
The review suggests community hospitals in Minehead, Bridgwater, Frome, West Mendip and Chard should be given this designation.
B. ‘Step down’ hospitals providing care for people who have been discharged from a district hospital but who still need hospital based rehabilitation. Some inpatient beds would be available to help patients recover from ill health, but there would be a focus upon improving health and well-being and supporting patients with long-term conditions, like diabetes, chronic lung disease and dementia.
The review suggests that community hospitals in Williton, Dene Barton (Cotford St Luke), Wellington, Crewkerne, Wincanton, Burnham-on-Sea and South Petherton should be given this designation
The review proposes that Shepton Mallet Health Campus should be designated as a ‘specialist’ unit due to the presence of the Shepton Mallet Treatment Centre as an integral part of the site.
Somerset CCG members approved the recommendation to permanently close 40 community hospital beds. There will ongoing patient and public engagement regarding the recommendation and the designation of community hospitals as either ‘Step Up’ or Step Down’. This wider engagement will involve patients, carers, NHS staff and the public and get underway from early 2016.
Copies of the Somerset CCG Community Service Review can be viewed or downloaded from the CCG’s web site here: www.somersetccg.nhs.uk/about-us/governing-body/meetings-and-papers/governing-body-agenda-and-papers-16-july-2015/
Members of the public who would like to know more about Somerset Clinical Commissioning Group’s community health service review or share their views can email: firstname.lastname@example.org
or write to:
Somerset Clinical Commissioning Group
Making the Most of Community Services
Notes for Editors
There are 13 community hospitals in Somerset with a total of 309 hospital beds.
Community hospital services are managed by Somerset Partnership NHS Foundation Trust. Of these 13 community hospitals seven have Minor Injury Units. These are located within the community hospitals in Frome, West Mendip (Glastonbury), Shepton Mallet, Bridgwater, Chard, Minehead and Burnham-on-Sea.
Somerset Clinical Commissioning Group is the GP led organisation responsible for the planning and funding of local health services for 540,000.
It does this in collaboration with local NHS hospitals and community services Trusts, local authorities and their social care services, the voluntary sector as well as patient representatives, carers and the public. Somerset CCG’s budget for 2015/16 is £690 million.
Between 2010 and 2035, the Somerset population is expected to grow by 12%. The largest increase is in people over the age of 75, where it is expected there will be a doubling of the population from 55,000 to 107,800; an increase of 2.7% per year.
In line with population changes, the proportion of people living with a long-term condition will also increase.
These demographic factors are contributing to a steep rise in demand for health and social care services and comes at a time when the local health and social care system must manage within limited budgets encouraging them to find innovative ways to meet this demand within existing levels of funding.
Providing more care in people’s homes and at local clinics and less within district hospital and inpatient beds is part of the national vision and policy direction set out by the Chief Executive for NHS England in his ‘Five Year Forward View’.