Short-listed option

We reviewed and considered all the options we developed with the community. We all agreed that there was just 1 option which we should fully evaluate.

How the Edward Hain Community Hospital short-listed option was agreed

Based on the evaluation criteria, some of the options we chose not to evaluate included:

  • putting alternative care on the site – for example buildings with multiple self-contained homes with care and support services available for people to live in. This is called extra care housing
  • providing a care home
  • using it as an office and clinical base for staff
  • using it as a place for family and children’s services
  • building on site to provide more beds
  • using it as a place where, during the day, people can be helped to be independent and healthy

What was our short listed option?

The only option we decided to fully evaluate was to re-open the hospital’s 12 inpatient beds; and continue with the existing podiatry and mental health community clinics in a fire safety compliant and refurbished hospital. We agreed together how this would be evaluated.

How did we evaluate the option?

The evaluation criteria (or ‘tests’) and scoring were developed with people from across Cornwall. We asked these people to help us because they were experts in key areas. These areas included clinical quality, patient views, staff and finance. This group also involved local people from Penwith.

The process, criteria and scoring were agreed by the people on our community stakeholder group.

There were 13 evaluators. 2 people were from Penwith and 11 people were experts in specific areas. Read more detail about this work.

Together, they considered our short-listed option against 21 criteria (or ‘tests’). These are set out below.

Each of the criteria was scored on a scale of 0 to 4. The scores were agreed as follows:

  • 0: no evidence
  • 1: limited evidence
  • 2: adequate evidence
  • 3: good evidence
  • 4: exceptional evidence

We gave the evaluators background information to help them decide the right score. The information told them about local services, national guidelines, the local population and how services are used. The evaluators also had a plan of the hospital and how the hospital could be used to deliver services which would respond to people’s needs. Evaluators also had the opportunity to visit the hospital.

The evaluators scored the criteria on their own, before meeting as a group to discuss their scores and the reason for this.

The evaluators considered the evidence against the criteria set out below.

Evaluation criteria

Quality

Quality was considered in terms of:

  • effectiveness (people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence)
  • experience of patients, staff and relatives
  • how the service could respond to individual and population need
  • safety of patients, staff and relatives

Access

Access was considered in terms of:

  • patient choice
  • distance, cost and time for patient, staff and relatives
  • equal access to services
  • ability of the service to provide extended hours

Workforce

Workforce was considered in terms of:

  • ability to recruit the right type and number of staff
  • ability to train staff to the right skill level
  • the potential to develop new roles and new ways of working

Deliverability

Deliverability was considered in terms of:

  • how easy it would be to deliver in an agreed timeframe
  • how sustainable the service is – that is, can it continue to function at the same level over time and support healthcare provision for the long term

Environment

Environment was considered in terms of:

  • contribution to climate management such as whether the building was efficient in terms of energy use
  • internal and external environment of hospital including the age, structure and suitability of healthcare provision

Finance

Finance was considered in terms of:

  • value for money such as how many people are supported and how they would benefit
  • affordability – what it would cost to set the service up and what it would continue to cost
  • financial sustainability – that is, would the service be affordable over a long period of time rather than just for 1 or 2 years

Wider impact

Wider impact was considered in terms of:

  • what impact (positive and negative) could there be on the community and the health and care system

Evaluation outcome

The scores for each of the criteria are below:

Criteria Final score
1. Quality
Effectiveness 1
Experience 1
Responsiveness (based on need) 0
Safety (there will be a minimum score of 2 required) 0
2. Access
Impact on individual choice 1
Distance, cost and time to access services 1
Equity of access 0
Extended access 1
Equity of provision 0
3. Workforce
Workforce supply 1
Workforce upskilling 1
New ways of working 1
4. Deliverability
Timescales and ease to deliver 1
Sustainability 1
5. Environmental
Climate management 1
Environment of service delivery 0
6. Financial
Value for money 1
Affordability (there will be a minimum score of 2 required) 0
Financial sustainability (there will be a minimum score of 2 required) 0
7. Wider impact
System impact 0
Community impact 1
Total score 13
The final score was 13 out of 84. The minimum score is not met for safety, financial, affordability or sustainability.

The evaluation process made the following recommendation:

The short-listed option to re-open 12 inpatient reablement beds and the continuation of existing podiatry and mental health community clinics in a fire safety compliant and refurbished hospital is not viable at Edward Hain Community Hospital.

The evaluators agreed the option was not viable or deliverable, because it did not meet the minimum scores in several areas. A minimum score of 2 out of 4 was agreed in advance.

The areas where the minimum scores were not met were safety, financial affordability (cost) and financial sustainability (our ability to continue to meet these costs in the future). Safety was considered in terms of whether the inside and outside of the hospital provided a safe place for people who were admitted or attending. It was also important to consider the safety of visitors and staff. Safety included reviewing the staff levels and numbers required to deliver safe care.

In addition, the option did not provide the requirements for access, workforce, deliverability, environment and wider system/community impact criteria. The information above describes what was considered in each of these areas. All scores for each of these criteria are low (either ‘0=no evidence’ or ‘1=limited evidence’). The option scored a total of 13 out of 84.

What does this mean for the community clinics that are running from the hospital?

Podiatry clinics run 2 days a week and support over 300 people a year. 73% of the people who attend the clinics come from St Ives.

Mental health clinics run a morning a month and support almost 30 people. 93% of these people come from St Ives.

If the Governing Body decide it is not appropriate to run these clinics from Edward Hain Community Hospital in the future then we will need to find another suitable location. We have talked with clinic staff and other health and care colleagues to look at where else the clinics could be held locally. We considered locations within a 20 mile radius that have availability for clinics. We also wanted the sites to be easy to get to and to have good parking. Use of the sites also needed to be affordable.

This analysis has concluded that Stennack GP surgery in St Ives is a viable potential option. We are now asking for your feedback on this proposal. We are also writing a letter to people who attend the podiatry and mental health clinics to get their views.

How do we think this could affect Penwith residents?

Through this work we’ve spoken to a lot of people who live and work in Penwith and St Ives to ensure we are meeting local needs and understanding and responding to concerns.

In undertaking this assessment we have also recognised the different needs of people in local communities. We know it’s important to be able to respond to these needs.

We have described positive changes that have taken place to provide more care in or close to people’s homes that provide real alternatives should Edward Hain Community Hospital not provide healthcare anymore. We have also identified some concerns that people may have if Edward Hain Community Hospital does not provide healthcare in the future. We understand that there may also be other impacts that people will be worried about.

The purpose of involving you now is to make sure we have understood what these impacts are, and thought about what we can do to address these. We want you to have your say so we can feedback your views and shape the decisions to be taken by the Governing Body.

Through this engagement process, we can review and adjust our assessment of benefits and impacts to reflect the feedback of local people.

Positive impacts for Penwith residents

Frontline staff and those planning care can focus on improving community services to keep people at home where possible. We know people would rather be treated at home wherever possible. Being in a hospital bed is not always the right place for people.

Inpatient healthcare will be delivered from an environment that is safe and better able to meet people’s individual needs and improve their chances of returning to independence.

Community clinics will be delivered from an environment that is safe and appropriate.

Resources in the local area can focus on supporting people in the community.

We can make the best use of the support available to care for people at or closer to their home. The community therapy teams and the GPs will also be able to remain working in the community to support people at home. This means there will be more opportunities for the development of local teams to focus on prevention and planned services to support those individuals and families who are most at risk of ill health, and help avoid hospital admissions.

Concerns that Penwith residents may have

People who live in St Ives and close by may have to travel further if they need to be admitted for care to a community hospital.

There may not be enough community hospital beds to serve local people.

We understand the connection people have with their local health care facilities and the history they have in local communities. The League of Friends for Edward Hain has been working closely with us. We also feel passionately that people deserve to have their care delivered in buildings that can deliver 21st century care that best meet their needs.

What have we done to address these concerns?

We have looked at data to understand if Penwith residents need to travel further to access a hospital bed. Recent data shows that in the recent 12 months compared with the 12 months when the Edward Hain Community Hospital beds were open, Penwith residents were admitted to hospitals on average 5.36 miles further away than residents outside Penwith who were discharged from Royal Cornwall Hospitals NHS Trust (RCHT).

There is a local NHS funded transport scheme to help people attend care settings if transport is difficult.

We have provided more care in the community.

The local hospice in Hayle provides 2 additional end of life care beds – a total of 10. It also provides a neighbourhood ‘hub’ for people and their carers to have access to support, information and therapy. This hub helps people at the end of their life to manage their symptoms and feel confident to stay at home if they wish. This provides more specialist care for local people and their loved ones when they need it most.

Local GPs and community teams also provide more end of life care in their homes (if people wish) rather than a hospital or hospice bed.

West Cornwall hospital has developed its services and diagnostic equipment. More people can be seen here rather than attend Royal Cornwall Hospital Treliske. The changes at West Cornwall Hospital also means more Penwith residents can be diagnosed, treated and admitted there direct from the community rather than having to attend Truro or another hospital first.

NHS Kernow and Cornwall Council are working together to improve the way we provide care for people in their own home. We are doing this by recruiting more care workers. We have also improved our systems and the way services work together. This helps us use all staff time most effectively. This will mean we can see more people.

We have undertaken a review of how we use all hospital beds in Cornwall, which has shown we rely too much on hospital beds for care that could be provided in people’s local communities. This helps us to understand how we use hospital beds better. This will help ensure that people have access to a bed when they need it.

We have focussed on recruiting new staff in the hospitals and care sector in the west in September, 2020. 10 additional community care workers and 12 additional hospital healthcare assistants were recruited. This will help ensure we have enough staff to provide the right care.

We have provided more support to care homes. Each care home in the west has a designated GP to link with. All care homes have had a greater level of training and support through COVID. We know this is important in reducing avoidable admissions for people who often do not cope well in unfamiliar environments.

Development of new ways of working creating a new community geriatrician consultant role. This person works closely with local GPs to help people keep well and stay at home.

Local stakeholders will continue to be involved in conversations about local healthcare needs and services. There is a strong group already established (Penwith Integrated Care Forum) that includes local community representatives as well as health and care workers.

We will continue to work together to recruit more local carers to care for people at home.

The single bed for drug and alcohol detoxification based at Edward Hain Community Hospital that provided treatment for the county has now been relocated to Helston Community Hospital.