IMProVE Integrated management and proactive care for the vulnerable and elderly.

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1 IMProVE Integrated management and proactive care for the vulnerable and elderly. Questions and Answers How can I have my say? Come along to one of our drop-in sessions, or fill in a questionnaire. Full details are on the CCG website at Material has also been distributed via local community and voluntary organisations, to GP practices, library and hospital premises. In addition, we are working with community and voluntary groups who will be helping us to make sure that those who are housebound or with limited mobility are able to give their views. Why are you proposing to close Carter Bequest Primary Care Hospital? By putting more services into the community, we will not need as many community hospital beds. We have therefore looked at reducing the number of beds across the South Tees area. In putting together our proposal to close this particular hospital site we looked at a range of quality and other criteria including the state of the building, quality and safety standards, co-location with other supporting services, parking and accessibility. The building is in a poor state of repair and would require significant investment to bring it up to the required standard. We believe this money would be better invested in services rather than in buildings. As part of our wider proposal, we want to centralise stroke services in one location. Carter Bequest Primary Care Hospital is not a viable site for this service because of the reasons above. Closing this hospital will only affect a very small number of patients. Over the course of last year, only 37 people were admitted to this hospital (non-stroke patients).

2 What will happen to the services currently available at Carter Bequest? Stroke beds will re-locate to Redcar Primary Care Hospital. Why are you proposing to centralise stroke services in Redcar? NICE guidance recommends setting up an inpatient stroke unit to provide stroke rehabilitation for all those admitted to hospital. Currently we deliver services in three community hospital locations. Delivering stroke services on a number of sites is difficult to maintain. Staff are spread thinly, diluting the level of specialist input and it is difficult to sustain the required levels of therapy. We can deliver a better service by centralising support in one location. In putting together our proposal to base this service in Redcar we looked at a range of quality and other criteria including the state of the building, quality and safety standards, co-location with other supporting services, parking and accessibility. The building at Redcar is relatively new, is a high quality environment, and would not require significant additional investment. We need to ensure that we use the building to its full potential as it is currently under utilised. Redcar Primary Care Hospital was funded under a public finance initiative (PFI) and has 30 years left of its lease to run. Why are you not proposing to put stroke services into Guisborough Primary Care Hospital? See above for rationale for selection of Redcar. The buildings at Guisborough Primary Care Hospital are in a poor state of repair and would require significant investment to bring them up the required standard. We would prefer to invest in services rather than in the re-development of older buildings, especially when there is a more suitable location available. Closing hospital beds on this site will only affect a very small number of patients. Why are you proposing the closure of urgent care services? What will local people do if they need medical assistance? In proposing changes to community hospital buildings we have also considered the services that are currently being delivered there. The urgent care centres at Guisborough and East Cleveland Primary Care Hospitals are underused. Between 2 and 6 people attend these centres each day compared with around 60 daily attendances at other similar services in South Tees. The cost of maintaining safe services of the appropriate quality is very high for such small numbers of patients. Patients in these areas will continue to be able to access primary care through their GP practice and out-of-hours service in the usual way. Urgent care support is provided via the free NHS 111 telephone number.

3 We are currently developing an urgent care strategy for the South Tees area which is designed to improve the quality and safety of services. Plans will include new urgent care facilities as well as extended GP opening hours. What services will be available at East Cleveland Primary Care Hospital? We want to develop unused space on this site to provide a range of inpatient services as well as outpatient, diagnostic and therapy services. The 30 community beds and other associated services on this site will be retained. Have you considered transport issues? We carried out a transport survey to look at how accessible services were in terms of private and public transport. We also carried out surveys to find out how most people travelled to hospital locations. This showed that over 70% used private transport. Redcar Primary Care Hospital has good transport links during normal working hours and later in the day. We are maintaining the site in Brotton East Cleveland Primary Care Hospital because we know that for people living in East Cleveland there are issues with public transport. What about staff? Once the CCG has made its decision on the configuration of services, we will be carrying out a full workforce modelling exercise. In developing our proposals we have carried out an interim review and are confident that there are sufficient, suitably competent staff to meet any increase in demand. We do not anticipate any staff redundancies. The balance of hospital and community based staff will probably need to change and this will require appropriate training and development to be put in place. We may also have to recruit additional staff including different types of therapists. What is the timescale? Our proposal is to make changes over the next two years, with full implementation by Before making changes at community hospitals, we want to ensure that we have sufficient community support available. This means we will be taking a phased approach. Why are there no options to choose from? We spent a lot of time looking at a range of criteria including state of the building,

4 quality and safety standards, co-location with other supporting services, parking and accessibility. We also talked to patients, partners and stakeholders. In doing this we reached a decision to put forward the most viable solution, which is our preferred option. We could not legitimately put forward options for consultation which we felt were un-workable, for example for reasons of quality, safety or cost. You have already made a decision NHS South Tees CCG board of governors will not be taking a decision until they have received feedback from patients, carers and local people. In making the decision, the board will consider all comments made as well as a range of other criteria including quality and safety, sustainability, and cost issues. The consultation has been described as cutting NHS services The IMProVE consultation is not about cuts, it is about having the right services available to our population and we believe our proposals will improve care for the vulnerable and elderly in the South Tees area. As a resident of Guisborough, I feel that I am losing out with this consultation As part of our proposals, we are suggesting that all stroke services be centralised at Redcar Primary Care Hospital. By centralising services, we can ensure that we have the right level of clinical expertise and support available in the same place for every patient in the South Tees area. We would like to develop the space we have available at Guisborough Primary Care Hospital by redeveloping the Chaloner Building, retain existing services and provide a range of additional outpatient, diagnostic and therapy services from the site. By reducing the number of beds available, you are reducing the level of service Our proposals would see a reduction in the number of beds available. However, our main thrust with IMProVE is ensuring that people are treated in the most appropriate place for their needs; in many cases this is their home and is where most patients prefer to receive treatment. Our findings tell us that there are currently too many people being treated in our local hospitals, who do not need to be there. We believe that these patients will benefit from being treated in their own homes or as part of a community-based service. By investing in our local community-based services, we will be able to support people to better manage their health conditions at home, which means that they won t need to be admitted to hospital and can remain independent for as long as possible. By closing minor injuries units at Guisborough Hospital and East Cleveland Hospital, already busy A&E departments will be under further pressure

5 By centralising our minor injuries service at Redcar Primary Care Hospital, we can ensure that the services available are appropriate and safe for the local population. East Cleveland Minor Injury Unit has an average attendance rate of 8 patients per day, and Guisborough Minor Injury Unit has an average attendance rate of 6 patients per day, which is not effectively utilising the skills and or securing the clinical competencies of the staff working in these units. By dialing 111, South Tees residents will be directed to the most appropriate service for their needs, first time. The NHS 111 service was launched in the Tees area in April 2013, is available 24 hours a day and is free to call from landlines and mobile phones. I have used the minor injuries units at Guisborough and East Cleveland in the past. If they were to close, what are my options? In the first instance, we would always advise people to contact their GP practice and make an appointment. If your GP surgery is closed or you re not sure what to do, call 111. The NHS 111 service is available 24/7, 365 days a year and is free to call from landlines and mobile phones. 111 will signpost you to the most appropriate service for your needs, first time. What will the assessment hub look like? We are currently reviewing best practice to determine and develop our model for an assessment hub in the community. We are aware of the benefits of rapid assessment of the Frail Elderly, admission avoidance and care closer to home and are keen to other this preferred model of care to our patients. Will we have two assessment hubs? One in Middlesbrough and one in Redcar? This is something that is being considered in developing our model of care. We are reviewing the demand for such a service and identifying if there is a critical mass. We are conscious that Middlesbrough is in close proximity to James Cook University Hospital as opposed to Redcar and East Cleveland who have the furthest to travel currently for a medical assessment. If a GP in Middlesbrough wants a patient to be admitted to a community hospital for step up care, will this be possible and if so, who will look after that patient? The community bed base will be placed in Redcar and East Cleveland and will serve the entire population. Regardless of their locality all GPs will have the option to step their patients up to a community bed; this is about patients being in the most appropriate bed to meet their needs. In line with developing the model of care consideration is being given to who the named clinician will be for patients who are admitted to community beds. Why is it best practice to have an x-ray available for stroke patients? Whilst ph testing is the preferred way of confirming NG position it is not uncommon for an aspirate not to be obtained in which case the position has to be confirmed by

6 X-ray so there is not any doubt that X-ray screening of NG tubes needs to be available. Therefore in line with developing a high quality model of care and service for our patients the CCG have agreed that it is essential that an X-ray facility is available in our community hospital. Will providing more care in patient s homes result in more work for GPs and if so have we got enough GPs to take on this work? It is apparent that in the South Tees area that we have sufficient GPs to deal with our populations needs; and as a national comparative we have a slightly higher number. The aim of the model is to provide more care from a number of professionals in a patient s home, potentially reducing the demand on GPs. By keeping patients out of hospital, will this not put more strain on social care? In maintaining people in their own home there is the potential to increase the demand for social care services. The CCG are working very closely with the Local Authority to ensure that there is a robust re-ablement service available to meet any increased demand and we are further developing out integrated Rapid Response service which can address both Health and Social Care needs. The IMProVE programme places a large amount of emphasis on integration of services to meet the needs of the population and this is also recognised nationally as part of the Better Care Fund which the CCG and LA are working in partnership to deliver. Why, if Carters Bequest is currently the most utilised hospital would you want to close this? Whilst Carters Bequest appears to have the highest utilisation this is specifically in relation to bed numbers. This site is actually the smallest of all the estate and does not offer any possibility to expand our services i.e. Assessment Hub and Out Patient facilities. Additionally Carters Bequest is the oldest of the estates and will require a significant amount of reinvestment to make it fit for purpose now and into the future. What will happen to the General Practice located at Carters Bequest? The CCG is working with NHS Property Services, the Area Team and the Practice to develop and agree the most suitable options. There will be no disruption to the public and their ability to access the GP s in the surgery. Will it not cost more to deliver care in patient s homes rather than in hospital? In monetary terms it is cost neutral to deliver care in a patient s home opposed to a hospital facility. However from the perspective of patient experience, quality and safety we are aware that satisfaction levels are higher in the patients home and the risk of hospital acquired harms (infection, falls, blood clots, pressure damage) are dramatically reduced. Who receives the revenue for selling any of the vacant buildings/land? Any money made from the sale of estate is automatically returned to NHS England. However the money that can potentially be saved by reducing maintenance costs

7 and utilising void space could be reinvested into our community services enhancing the desired model of care. Is Guisborough likely to close before April 2016? This is something that will be reviewed at 6 monthly intervals or as required throughout the process of implementing/delivering our model of care. How will you assess whether your new model of care is working? Patient and carer experience Satisfaction surveys patients, staff and public Deliverable outcomes and measures. Where will I go if the Minor Injuries Units are closed? We know that the small amount of people who currently attend the MIUs could receive appropriate treatment in Primary Care via their own GP. The CCG is also currently reviewing all Urgent Care services in South Tees.