Summary Paper Previous Rehabilitation Work Undertaken

Transcription

1 Rehabilitation, Enablement and Reablement Review Summary Paper Previous Rehabilitation Work Undertaken Version no. 0.1 Status Draft Author Luke Culverwell Circulation BNSSG PCT Cluster Version Date Reviewer Comment /01/2013 Luke Culverwell Initial Draft 1 Purpose of paper The purpose of this paper is to: 1. provide a summary of work undertaken in relation to the redesign of rehabilitation services prior to the current ongoing review as part of the Frenchay community hospital project 2. highlight recommendations or outputs which resulted from that work 3. Identify key differences between the prior rehabilitation project and the current ongoing review 2 Background In 2004, extensive consultation resulted in the creation of the Bristol Health Services Plan (BHSP) which recommended the centralisation of NBTs acute service at Southmead Hospital, and anticipated a substantial transfer of activity from an acute to a community setting across Bristol and South Gloucestershire. In 2005, South Gloucestershire PCT Board, Bristol PCT Board and NBT Board approved proposals to move forward with the development of a business case for the centralisation of acute services at Southmead hospital and the creation of a community hospital at the existing Frenchay site. The BHSP identified a need for 48 intermediate care beds to remain at Frenchay after the transfer of acute services. An outline business case was produced in 2006, describing future provision at the Southmead and Frenchay sites. The business case built on the recommendations of the BHSP, but suggested a substantial increase in bed capacity at the future Frenchay community hospital to 112, made up of 54 general rehabilitation beds, 30 stroke rehabilitation beds to be shared between Bristol, North Somerset and South Gloucestershire PCTs and 28 older peoples mental health beds. In 2008 the Frenchay Project Board was established to oversee the development of proposals for the community hospital. The project board created 3 work streams to obtain the information necessary to inform the creation of a plan for future service provision at Frenchay. Page 1 of 8

2 health needs assessment Service mapping Review of rehabilitation services The needs assessment and service mapping exercise were limited to Frenchay hospital and its catchment area, but the rehabilitation review was tasked with considering rehabilitation provision across the whole of South Gloucestershire. A proposal for a new model of care resulted from this work stream. A paper presented to South Gloucestershire Health Scrutiny Select Committee in January 2010 outlined emerging themes from the work being undertaken by the Frenchay project board. In light of the model of care developed by the Rehabilitation work stream and changes within the local health economy, the paper put forward a revised proposal for service provision on the Frenchay hospital site with between 50 and 60 community rehabilitation beds. Information on further developments since the presentation of Emerging Themes was not available when writing this report. 3 Public and patient engagement The rehabilitation review work stream engagement strategy envisioned two consultation phases. Phase One During 2008 and 2009 the project team used consultation events and questionnaires to obtain the views of members of the public on how rehabilitation services could be improved. The major needs identified were for: A clear point of contact A simplified process for assessment Coherent information on the range of services available and how to access these Better communication and coordination between health and social care professionals Rehabilitation services to be provided at home or in the community wherever possible More information and education around specific conditions and self-management This feedback was used to inform the development of the model of care. Page 2 of 8

3 Phase Two Following the development of a model of care, the project team planned to seek feedback from key stakeholders on the adequacy and viability of this model. Specific constituencies including clinicians, commissioners, providers, patients and carers, the general public, and third sector organisation were identified. No information on the outcome of this second phase of consultation has been made available. 4 The model of care Further to initial patient consultation events and clinical engagement work a draft model of care was developed. The key elements of the model were: A single point of access to the service Comprehensive assessment of patient needs Better coordination and communication between different services and providers Formalised communication between the service provider and the patient Delivery of rehabilitation through multidisciplinary teams A focus on care planning and the proactive management of patient cases Use of community beds as a venue for service delivery The model envisioned access through a single point of entry, with a one stop comprehensive assessment. A single community rehabilitation service would deliver care in all locations outside of the acute setting (patients homes, community rehabilitation beds, nursing or residential homes) with nurses, therapists, generic rehabilitation workers/assistants and CPNs would work in a matrix structure, providing input to individual patients where required. The rehabilitation service would link with social workers to coordinate case management and care planning, and with aligned services such as continence management, tissue viability and reablement to draw on expertise. No information on the clinical engagement process which led to the development of the model of care has been provided. 5 Demand and activity modelling In 2008 the project team looked at levels of rehabilitation bed provision in several different areas with different rehabilitation service models. Work was undertaken to calculate the number of beds required per thousand heads of population under each of the models and this data was used along with information on South Gloucestershire s current activity and demographic composition to estimate rehabilitation bed requirements in South Gloucestershire: Sheffield BaNES 49 beds 74 beds Page 3 of 8

4 Thornbury 50 beds Service provision in Sheffield was considered the closest fit to South Gloucestershire. However, these figures were based on an assumption of 100% occupancy which afforded no spare capacity in the system. The project team calculated the number of beds which would be required to achieve the same level of service with 80% occupancy (61) and 90% occupancy (54) and the latter figure was put forward as the suggested capacity requirement in South Gloucestershire. The project team also considered the level of community capacity which would be required under the proposed model of rehabilitation. This was calculated based on provision under the model of care in operation in Sheffield. Assuming an average patient stay of between 18 and 21 days, the community rehabilitation service would need to maintain a caseload of patients. However, these figures did not include an allowance for projected population growth or change in population demographics. A suggested alternative basis for calculating capacity requirements was to work from a 20% increase in community activity which resulted in a capacity requirement of 166. Background information on the rationale for selecting these regions for comparison was not available when writing this report, nor was rationale for selection of Sheffield as the closest fit comparator. 6 Review of the model of care requirements In September 2009 an evaluation was carried out to assess various options for the specific design of the community rehabilitation service. The evaluation concluded that: Assessment and diagnosis should be carried out as close to home as possible, but assessment in a central community facility, or in selected health centres and larger GP practices could be a viable model. Community rehabilitation bed provision was required in order to ensure that the service could accommodate a sufficiently wide range of patients needs to be viable. However, there was no clear advantage to any of the options considered (beds in a community hospital, dispersed beds in care homes, and a hub and spoke model of bed provision). Community services needed to provide rehabilitation both in patients own homes and in community facilities depending on the needs of the patient. Services provided solely in patients homes would be financially unviable, whilst services provided solely in community facilities would limit the range of patients who could benefit. 7 Emerging Themes proposed approach and consideration of options Page 4 of 8

5 The previously mentioned Emerging Themes paper was presented to South Gloucestershire Health Scrutiny Select Committee in January 2010 and provided an overview of changed circumstances which had necessitated a revision to proposals for Frenchay Community hospital: Cosham hospital redevelopment proposals now included additional services which were not anticipated when BHSP and the 2006 outline business case were written Outpatient mental health beds were no longer to be provided on the Frenchay site and would be located at Callington Road in Bristol Several services which had been planned for Frenchay hospital were no longer necessary as a result of changed circumstances or new evidence: o Treatment Suite the increased provision of minor procedures in primary care settings had superseded this model of care. o Minor Injuries Unit analyses covering the period 2005 to 2008 projected activity of between 14 and 24 cases per day which was too low for a viable MIU. Additionally, much of this demand could be met by a planned GP led health centre in Kingswood with a minor injuries service. o GP Out of Hours Service advantages to collocating this service with a minor injuries unit made Frenchay a less attractive option. o GP Primary Care Services analyses determined that GP provision was adequate and that the needs of a growing population would be better served by planning GP provision in the larger housing developments than by basing services at Frenchay. Development of South Gloucestershire s intermediate care service to dramatically increase the capacity of IC teams had resulted in a reduced need for rehabilitation beds. The paper also proposed that community hospital services should be provided from the Frenchay site with a strong focus on rehabilitation and reablement, co-locating aligned third sector, local authority and NBT services. The proposals included between 50 and 60 community rehabilitation beds. In June 2010 a workshop including representatives from commissioners, providers, third sector organisations, and patient groups considered the advantages and disadvantages to three options for the future of the Frenchay site: 1. Provision of a community hospital as proposed in 2004 by BHSP, including those services identified in Emerging Themes as no longer necessary (primary care, GP out of hours, minor injury unit, treatment suite). 2. Provision of a health and social care centre as outlined in Emerging Themes, with co-located 3 rd sector and local authority services, but without the services identified as no longer necessary due to changes in the health economy. 3. Provision of a community hospital without the services identified as no longer necessary due to changes in the health economy, and with no co-located local authority and 3 rd sector services. Page 5 of 8

6 4. No new provision, but non-acute NBT services to remain onsite following centralisation of acute services at Southmead hospital. Feedback was largely in favour of the Emerging Themes proposal, focusing on the potential benefits from closer working between health and social care and provision of a one-stop health and social care hub to improve patient choice and ease of access. Concerns remained around the loss of MIU and out of hours services, and the impact of this on people who would instead have to use facilities at Thornbury or Southmead. Approach Positive Aspects Negative Aspects Bristol Health Services Plan Emerging Themes Health and Social Care Centre (Community hospital with colocated 3 rd sector and local authority services) Community hospital with no additional non-nhs services Provision of out of hours, treatment suite and minor injuries unit. Third sector involvement Rehab centre of excellence would provide a coordinated service and help with attracting and retaining high quality staff. Outreach will be easier from a central hub More patient choice Better coordination and communication between services and less delay. Transport to a central point for all services will be easier for the patient. Dispersal of some services may allow better local access. Community hospital services are isolated from aligned local authority reablement services. Insufficient activity to support a minor injuries unit. Where will acute and rehab stroke services be provided? Does this develop lower priority services over urgent services (e.g. minor injuries)? Loss of out of hours service. Loss of minor injuries unit which would service populations the other side of the A4174 ring road. Concern that beds may not be enough Centre of excellence would be lost Recruitment and training would be less cohesive Better for services to be provided together Backward step from Emerging Themes Page 6 of 8

7 8 Key differences between the reviews The current rehabilitation review must build on the work undertaken as part of the Frenchay Project rehabilitation work stream, but this project differs in several key ways. The previous rehabilitation review was: Limited in scope to rehabilitation services within South Gloucestershire, whilst the current review has a mandate to rationalise services across the whole Bristol, North Somerset and South Gloucestershire area. An NHS project with no local authority ownership. As such, the project had no remit to consider service redesign which bridged the divide between health and social care. The current review has a mandate for system-wide change. Reactive, seeking to mitigate displaced activity resulting from the closure of Frenchay hospital. Whilst reduction in the acute bed base remains a key driver for the current review, a more proactive approach to service redesign is also considering how reductions in length of stay and improvements in reablement outcomes can be achieved by a new model of care. Luke Culverwell 30/01/2013 Page 7 of 8

8 APPENDIX 1 Documents Reviewed Frenchay Project Service Mapping Report v.0.8 Frenchay Project Service Mapping Report v.0.13 Services work stream report paper to Frenchay Project board 20/04/2009 (dated 16/04/09) Appendix A Draft Stakeholder engagement paper Appendix B Stakeholder questionnaire report Appendix C Rehabilitation involvement table draft v.0.6 Appendix E Community rehabilitation service draft model of care v Appendix F - Community Rehabilitation Service Core Pathway Diagram v.0.4 Community Adult Rehabilitation Service Framework v.0.1 dated 20/05/09 Community Adult Rehab Service Engagement (short version) v.0.2 dated 22/05/09 Frenchay Project, the Emerging Themes report to South Gloucestershire Health Scrutiny Select Committee 06/01/2010 Community Rehabilitation Service and Rehabilitation Beds Comparison between the BHSP, OBC and Current South Gloucestershire Planning v.0.2 dated 03/12/09 Rehabilitation Beds Calculations - Overview of Methodology Used dated 27/10/2009 Rehabilitation Estimates for the Community Teams dated 27/10/2009 Frenchay Project Structure undated Feedback from the 8 Working Groups at the Frenchay Stakeholder Workshop 21/06/10 v.5 Appraisal of Rehabilitation Options as part of the Frenchay Project. Dated 15/09/09 Frenchay Project Health Status Needs Assessment Brief v.2 dated 10/07/08 Rehabilitation Service Development Group Terms of Reference undated Frenchay Project Rehabilitation Project Brief v.2 dated 30/07/08 Frenchay Project Service Mapping Brief v.2 dated 30/07/08 Frenchay Community Hospital and the Rehabilitation Project paper to South Gloucestershire PCT Professional Executive Committee 08/04/09 Rehabilitation where are the gaps? Discussion paper for consideration at South Gloucestershire PCT Professional Executive Committee 13/08/08 Page 8 of 8