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, use the chat box to make comments etc. Kate gave apologies from Steve Day, Sarah Fisher, Sheila Lennox-Boyd, Steve Helley and Colin Martin (who initially joined the meeting to give his apologies in person).
Kate expressed her thanks to the attendees for their understanding for the pause in engagement and need to postpone the last planned workshop in March due to COVID-19 and government guidance about holding public meetings. She then reviewed where we are in the process and explained the 3 primary aims for the meeting as follows:
Kate then shared the outcomes from the evaluation of Edward Hain community hospital’s short-listed option (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) determined that the option did not meet the minimum scores required for safety, financial affordability and sustainability, which means the evaluation panel determined it is not a viable option. Kate explained that no decision has yet been made about the future of Edward Hain community hospital – this would be made by NHS Kernow’s Governing Body later in the year.
Kate then discussed some of the new ways of providing care and support since the start of COVID-19, explaining that cooperation across the system has enabled quick decision making and new ways of working. This has accelerated our ambitions for improvements in local coordination and communication across teams and organisations. Examples of what was discussed can be found on the presentation slides, but these included:
It was 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, Truro manages the bed stock across the county. The discharge to assess team ‘spot-purchases’ 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 very 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 virtual clinics and greater integration across health and social care and the voluntary sector. It was noted that voluntary sector staff have also been able to make even stronger links with health and social care colleagues during this time.
It was queried whether there has been a discernible drop in the number of Saltash residents going to Liskeard community hospital. It was explained that reliance on bed-based care is less than it has been prior to COVID-19. It was 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, which 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 wherever possible. Community hospital beds are no longer used for convalescence and the aim now is that people get active rehabilitation and reablement at home to maximise their independence.
Kate then summarised the key messages from workshop 4:
Attendees felt these key messages are still valid and when given the option to disagree or add to these no additional views were given. It was agreed that there are now 2 remaining options from the long listed options that have been previously discussed. The first is to consider 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/enhanced healthcare facility on an alternative site (inpatient/extra care, care home/ enhanced delivery at primary care.
Attendees agreed with both of these as the remaining options and when given the opportunity did not identify any additional options to consider. Other options have previously been discussed and discounted. It was recognised that the development of the local model of care remains in progress (and has been accelerated by changes since COVID-19) and therefore doesn’t need to be put through the formal evaluation process.
It was 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. It was explained that there isn’t a firm plan in place at present, but all parties recognise the potential for further planning conversations to consider what activities currently occurring at UHP could occur 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.
A query was raised regarding whether the model of care development is still progressing. It was explained that the Embrace work that has been discussed in previous workshops is helping to design the model of care, and 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 has an over reliance on bed based care and so people are not always looked after in the best place for their needs. This is an ongoing area of focus to ensure the right community services are in place.
Kate then explained that we are aware the community want to spend time considering what hub function is required in Saltash. This is why some slides were circulated ahead of the meeting to give people time to talk with their communities about what people feel is missing from what is already provided with the existing Saltash hubs. Kate also explained that we needed to be clear what activities Saltash needed as the term hub has different meanings to people. Possible hub functions include having meeting space, information and advice, services, social and activity groups and staff co-location. The activity should be based on need and then the activity will then allow us to consider the most appropriate location and environment for that activity to take place. Other ideas were discussed such as children’s and mental health services and hearing aid clinics which are already provided for in the area. It was confirmed that St Barnabas community hospital staff provide hearing aid batteries from reception.
Kate presented diagrams showing how the current hospital space is used by staff, storage and clinic areas. There is a lot of un-used space across the hospital. She pointed out that in order for a hub function to be considered as a short listed option to formally evaluate against the agreed 21 evaluation criteria we would need to clearly define what that was and demonstrate that it was based on need. The need for provision of hub activities is not yet clear although the group has considered some ideas in the past. Kate asked attendees for their thoughts. It was noted that the library hub will be closed shortly for refurbishments. The community hub is limited in space but is a much better option than the school which is a long way away. Kate thanked attendees for their local knowledge and reiterated that we need to focus on what the population need is, as opposed to thinking about the use that we can find for an existing building.
Andrew Abbott advised that it is important to look at where local clinicians and practitioners consider the gaps to be. Kate said that the Embrace diagnostics provided information which has been shared with the group, and there is also a local public health assessment available. Kate also felt that if Dr Birte Morris was in attendance she would be likely to say that low level and general health and wellbeing support would help relieve the pressure felt at primary care and 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. It was pointed out that St Barnabas community hospital was adjacent to Port View surgery which may lend itself to options. James stated that if Port View wish for additional space then this can be discussed as part of the options, but the ongoing funding will be a consideration.
The point was made that population needs will change as we move through 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. In 5 years time both building and workforce requirements are likely to look very different.
The query was raised regarding provision of cancer support services in the area and whether there was additional need for that. Cornwall Hospice Care doesn’t have a hub nearby. It was advised that the Mustard Tree Centre in Plymouth is excellent and 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, as carers are struggling to have respite now that care homes are not able to provide day care due to COVID-19 restrictions.
It was noted that Saltash Town Council would be happy to look at any room requirements for community activity if people suggested them, and to see if any of them might be 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 21 agreed evaluation 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 particularly around the Embrace diagnostics. Some attendees also noted that surveys aren’t usually helpful way to receive feedback. There are other pieces of local work to consider: 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, and ideally Saltash would provide more long-term local provision wrapped round current existing primary care premises (as opposed to St Barnabas community hospital).
Kate stated that the learning from Embrace diagnostic previously discussed with the group highlighted the system was over relying 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 and people in Saltash would like to see more of this. It was pointed out that there was historically low occupancy in St Barnabas and Liskeard community hospitals. As shared previously it was stated that 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 within all the community hospitals. It has got better with the introduction of local Home First teams who support people in their own 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 shared again. It was also noted that community provision was different in the past so it is now not possible to compare like for like.
The question was asked around the financial affordability for community hub work and if it is affordable given the current economic picture. It was agreed that it is difficult to answer this as we have not yet defined what additional community hub activity is required for Saltash.
It was queried if COVID has had an impact on the timeline for this project. Kate confirmed that it has as 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. The point was also made that there are elections in May next year for town and Cornwall councillors. That means purdah and a different team of councillors from May onwards which could have an impact on NHS projects.
A question was asked if feedback is captured from people travelling to services outside Saltash to see if they are happy about that. It was explained that patient experience and Friends and Family forms capture this, and conversations are held directly with patients. So far no issues around travel have been raised. It was suggested that the questions asked should be sent out for the group to see what is discussed. It was also mentioned that data on the proportion of people going from UHP to home and the pattern in the last few years would be interesting to see. Local clinicians shared that for the last 3 weeks across the east, at least 50% of people are going straight home from UHP (the other 50% will be going to nursing or residential home placements or a community hospital bed).
Kate then thanked everyone for attending both today and throughout the process. She summarised that we are not in a position yet to clearly define a shortlisted option to evaluate. This may delay us in deciding on a future for St Barnabas community hospital. Those present agreed and acknowledged this. We need more conversations with UHP, Cornwall Partnership NHS Foundation Trust and the local Primary Care Network. This process hasn’t yet flagged up a specific need for the future of St Barnabas. We need to consider whether we make a recommendation for the future of the building whilst looking at service improvements.
Andrew Abbott concluded that he was impressed with the level of challenge and open engagement displayed during the meeting. He suggested it would be useful to summarise the information discussed over previous workshops about bed based need and circulating these for feedback. Kate then apologised that the meeting had slightly overrun, and asked people to feel free to contact her for an individual conversation should they have any specific questions or observations. Email firstname.lastname@example.org with questions and observations.