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Workshop 5

Minutes for the virtual Saltash integrated community services stakeholder event on Wednesday 9 September 2020.
Minutes

Workshop attendees

Workshop attendees

Sarah Martin, Saltash town councillor
Mary Shears, secretary, St Barnabas Hospital League of Friends
Barbara May, St Barnabas Hospital League of Friends
David Yates, member of Port View patient participation group (PPG), Saltash town councillor
Angela Andrews, community safety partnership and health commissioning, Cornwall Council
Vicky Wright, head of patient flow (north and east), Cornwall Partnership NHS Foundation Trust (CFT)
Laura Chapman, community maker, south and east Cornwall
Sharon Savigar, community hospital matron (Liskeard and St Barnabas), CFT
James Page, regional partnership director south west, NHS Property Services
Neil Parsons, primary care strategic development manager, Kernow Health CIC
David Wilson, area director (north and east Cornwall), CFT
Hilary Frank, Saltash town councillor
Catherine Thomson, community link officer, Cornwall Gateway, Cornwall Council
Fiona Hegarty, integrated community manager, CFT
Peter Thistlethwaite, member of PPG Port View and chair, Saltash Gateway CIC
Ann-Marie Perry, interim integrated community manager, CFT

NHS Kernow team

NHS Kernow team

Andrew Abbott, director of primary care
Kate Mitchell, programme lead
Hollie Bone, engagement manager
Paula Bland, head of localities
Ben Mitchell, engagement support
Michelle Smith, team support assistant

View the workshop slides for this meeting (PDF, 2 MB).

Introduction and recap from workshop 4

Kate Mitchell welcomed everyone to the virtual meeting. She explained to attendees how they could indicate if they wanted to speak, how to mute microphones and use the chat box to make comments. Kate gave apologies from Steve Day, Sarah Fisher, Sheila Lennox-Boyd, Steve Helley and Colin Martin.

Kate expressed her thanks to the attendees for their understanding for postponing the last planned workshop in March. This was due to COVID-19 and government guidance about holding public meetings. She then reviewed where we are in the process. Kate outlined the 3 primary aims for the meeting.

Primary aims for the meeting

  1. Complete reviewing the long list of options to understand and agree which should be short listed.
  2. Spend time considering the health and wellbeing hub option.
  3. Explain the next steps.

Kate then shared the outcomes from the evaluation of Edward Hain community hospital’s short-listed option. This is the re-provision of 12 inpatient reablement beds and maintaining current community clinics in a fire safety compliant and refurbished environment). The agreed score for this short listed option from the evaluation panel was 13 out of 84. The evaluation panel (13 individuals including 2 local representatives) decided that the option did not meet the minimum scores required for safety, financial affordability and sustainability. This means it is not a viable option. Kate explained that no decision has yet been made about the future of Edward Hain Community Hospital. This will be made later by NHS Kernow’s Governing Body.

Kate then discussed the new ways of providing care and support since the start of COVID-19. She explained that cooperation across the system has enabled quick decision making. This has speeded up our ambitions for improvements in coordination and communication across teams and organisations. Examples of what was discussed can be found on the presentation slides.

These included:

  • an increase in remote access to care
  • a single electronic referral process
  • community co-ordination centres (CCC): health and social care teams, linked to primary care
  • community bed bureaus: multi-agency staff who have an overview of all beds in the system (including residential, nursing care, extra care housing, community hospital) to match the person’s needs to the right care
  • clinical assessment and treatment units (CATUs)
  • use of St Barnabas community hospital for the provision of Port View surgery flu clinics

Questions

An attendee asked if there is a CCC in Saltash. The response was that there are 3 centres across Cornwall. The 1 for north and east Cornwall is based in Bodmin. This is the administration centre. There is a Saltash team which continues to work across Saltash and Launceston. The role of the CCC is to organise team visits in the most efficient way. The bed bureau based in New County Hall manages the county-wide bed stock.

The discharge to assess team spot-purchase care home beds from the bureau so people can be discharged from hospital to a care home if they need further short term support. This model is working well. The change since the start of COVID-19 in trying to keep people out of hospital to reduce their risk of infection has led to more use of community resources and integration across health and social care and the voluntary sector.

An attendee queried if there has been a drop in the number of Saltash residents going to Liskeard community hospital. Kate explained that reliance on bed-based care is less than it has been prior to COVID-19. She noted that even when St Barnabas hospital beds were open, some Saltash residents would have to go to Liskeard hospital in order to have their clinical needs met.

The number of beds in use in Liskeard hasn’t increased. This indicates that more people have been going straight from acute hospitals to their home. It’s been agreed in previous workshops that the best pathway is for people to go straight from acute hospital to home where possible. Community hospital beds are no longer used for convalescence. The aim is that people get active rehabilitation and reablement at home to maximise their independence.

Key messages from workshop 4

Kate summarised the key messages from workshop 4:

  • St Barnabas community hospital is not fit for modern inpatient provision
  • we may need some alternative provision of local beds
  • local ambition to develop a 5 to 10 year plan for health and care services
  • enhancing local provision (for example transfusion or infusion that may not be appropriate on St Barnabas site but could be elsewhere)
  • interest in the development of Saltash Health Centre
  • ambition to plan for more activity from Plymouth to be delivered in Saltash
  • local test and learn service changes to continue
  • concept of a local health and wellbeing hub
  • planning for a modern healthcare facility

Attendees felt these key messages are still valid. It was agreed that there are 2 remaining options from the long listed options previously discussed. The first is the need for hub activities and the potential for St Barnabas community hospital to be re-purposed as a community health and wellbeing hub, should there be a clearly identified need for those activities. The second was to consider a longer term view around a new build or enhanced healthcare facility on an alternative site (inpatient and extra care, care home and enhanced delivery at primary care).

Attendees agreed with both as the remaining options. They did not identify any additional options. Other options have previously been discussed and discounted. Attendees recognised that the development of the local model of care remains in progress. It therefore doesn’t need to be put through the formal evaluation process.

Derriford

An attendee asked if there has been much response from Derriford (University Hospitals Plymouth NHS Trust (UHP)) in terms of people staying in the community, for example for transfusions. Kate explained that there isn’t a firm plan in place. However, all parties recognise the potential for further conversations to consider what activities currently at UHP could take place in Saltash and the surrounding area. We’ve discussed at previous workshops that a transfusion day case unit in St Barnabas isn’t feasible from the point of view of building safety, staffing and clinical environment. However, UHP continue to be interested in discussing provision of services in Cornwall.

Model of care development

An attendee asked if the model of care development is progressing. Kate explained that the Embrace work discussed in previous workshops is helping to design the model of care. It has fast-tracked some of the initiatives such as the CCCs and multi-disciplinary teams based in the primary care networks (PCNs). As we discussed in previous workshops, the current system is over-reliant on bed based care. People are therefore not always looked after in the best place for their needs. This is an ongoing focus to ensure the right community services are in place.

Hub function

Kate then explained that we are aware the community want to consider what hub function is required in Saltash. Slides were sent out ahead of the meeting to give people time to talk about what they feel is missing from existing hubs. Kate also noted that we need to be clear what activities Saltash needed, as the term hub has different meanings. Hub functions include meeting space, information and advice, services, social and activity groups and staff co-location. The activity should be based on need. It will then allow us to consider the most appropriate location and environment for that activity.

Other ideas were discussed such as children’s and mental health services and hearing aid clinics. These are already provided for. St Barnabas community hospital staff provide hearing aid batteries.

Hospital space and use

Kate presented diagrams showing how the current hospital space is used by staff, storage and clinic areas. There is unused space across the hospital. She pointed out that for a hub function to be considered as a short listed option to formally evaluate against agreed criteria, we would need to demonstrate that it was based on need. The need for provision of hub activities is not clear although the group has considered some ideas in the past.

The library hub will be closed shortly for refurbishments. The community hub is limited in space but is a better option than the school. This is a long way away. Kate thanked attendees for their local knowledge. We need to focus on what the population need is, as opposed to what use that we can find for an existing building.

Andrew Abbott advised that it is important to look at where local clinicians and practitioners find the gaps. Kate said that the Embrace diagnostics provided information which has been shared with the group. There is also a local public health assessment available. Kate also felt that if Dr Birte Morris was here, she would say that general health and wellbeing support will help relieve the pressure felt at primary care. This would support a more person and family based approach.

James Page from NHS Property Services advised that a building shouldn’t guide the service solution. The development of any service should be based on clinical need. St Barnabas community hospital is next to Port View surgery. James stated that if Port View wish for additional space, then this can be discussed as part of the options. However, ongoing funding will be a consideration.

Population needs will change this year due to COVID-19. Primary care provision will also change over the next 5 to 10 years. There is also a significant shift towards more digital provision due to COVID-19. In 5 years’ time both building and workforce requirements are likely to look different.

Cancer support services

Attendees asked about provision of cancer support services in the area. Cornwall Hospice Care doesn’t have a hub nearby. It was noted that the Mustard Tree Centre in Plymouth is excellent. Marie Curie also provides very good support. St Luke’s Hospice in Plymouth has picked up some care packages in the area recently, but these are time limited. It was felt that there may be more need for dementia care. Carers are struggling to have respite now that care homes are not able to provide day care due to COVID-19 restrictions.

Health and care provision

Saltash Town Council will be happy to look at room requirements for community activity to see if any are feasible.

Kate summarised that a short listed option for a potential hub function has not been defined sufficiently for it to be formally evaluated against the agreed criteria. However, the group has progressed the work to discount the other suggested long listed options. It was suggested that the wider community need to be engaged again and asked what they feel is missing in health and care provision. Attendees felt that the community are likely to ask for a hospital with inpatient beds. Kate said that it may help to inform them of the work that we’ve done to date and the evidence collected around the Embrace diagnostics. Some attendees also noted that surveys aren’t usually helpful for feedback.

There are other pieces of local work to consider. These include the Cornwall College site, the new housing estate and potential extra care housing and care home provision at Treledan and the work the council is currently undertaking to review their use of buildings.

From a primary care perspective, it was explained that the hot hub introduced at Liskeard to respond to people with COVID-19 symptoms was to keep as many premises COVID free as possible. Ideally Saltash would provide more long-term local provision wrapped round current existing primary care premises (as opposed to St Barnabas community hospital).

Further discussion

Kate stated that the learning from Embrace diagnostic highlighted the system was over reliant on bed based care and people were in hospital beds unnecessarily. The diagnostic found this was 67% of people in existing community hospital beds. The provision of 9 beds in St Barnabas was based on the model of care present then. The strategic direction is to develop out of hospital care to support more people close to, or at home. Step down beds (discharges direct from the acute hospitals) are provided in care homes. People in Saltash would like to see more of this.

There was historically low occupancy in St Barnabas and Liskeard community hospitals. Losing the 9 beds that were in St Barnabas has not had an impact on the delays within UHP. Liskeard Hospital has the lowest length of stay in all community hospitals. It has got better with the introduction of local Home First teams. They support people in their homes to develop their independence and improve wellbeing.

It was agreed that the original data that the group has discussed around bed occupancy and use of community hospitals should be re-shared. It was also noted that community provision was different in the past. It is now not possible to compare like for like.

An attendee asked about the financial affordability for community hub work given the current economic picture. It is difficult to answer this as we have not yet defined what additional community hub activity is required.

COVID-19

Kate confirmed that COVID-19 has had an impact on the timeline for this project. All activity needed to be paused to allow resources to focus on the COVID response. We also had a delay due to purdah and the general election. There are elections in May next year for town and Cornwall councillors. That means purdah and a different team of councillors from May onwards. This could have an impact on NHS projects.

Services outside of Saltash

An attendee asked if feedback is captured from people travelling to services outside Saltash to see if they are happy about that. Kate explained that patient experience and Friends and Family forms capture this. Conversations are held directly with patients. So far, no issues around travel have been raised. Attendees said they would like to see the question forms. Data on the proportion of people going from UHP to home and the pattern in the last few years would also be useful. Local clinicians shared that for the last 3 weeks across the east, at least 50% of people are going home from UHP (the other 50% will be going to nursing or residential home placements or a community hospital bed).

Summary

Kate thanked everyone for attending today and throughout the process. She summarised that we are not able to clearly define a shortlisted option to evaluate. This may delay us in deciding on a future for St Barnabas community hospital. Those present acknowledged this. We need more conversations with UHP, CFT and the local PCN.

This process hasn’t yet revealed a specific need for the future of St Barnabas. We need to think about whether we make a recommendation for its future while looking at service improvements.

Andrew Abbott said that he was impressed with the level of challenge and open engagement during the meeting. He suggested it would be useful to circulate the information discussed in previous workshops about bed based need.

Kate apologised that the meeting had overrun. She asked people to contact her for an individual conversation if wished. Email Kate Mitchell with questions and observations.

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