Health Fit Strategy for Community Hospitals in
Cornwall
Purpose of Health Fit Exercise To define the role of CH’s and 5 year direction
of travel for their development in Central & West Cornwall (including Bodmin)
Identify the values and design principles that should underpin CH’s development thro’ analysis of forces & drivers for change impacting on the whole health & social care system
Scope9 Community Hospitals relating to the catchment area of RCHT- Total of 338 beds - MIU attendances (70,000 + per year) account for 50% of
emergency care contacts in Cornwall- Size of CH’s range from 14-76 beds- Mix of GP bed fund or Specialist Eldercare
West Cornwall PCT 4 CH’s – Penzance, Helston, St Ives, Camborne Central Cornwall PCT 4 CH’s – Falmouth, Newquay, St Austell, Fowey North & East PCT- 1 CH at Bodmin relates to RCHT, Other 4 CH’s relating to
Plymouth & North Devon not included
Process
Consultation with stakeholders through focus groups and facilitated workshops (over 50 held)
Patient Activity and financial analysis Stakeholder 1 day event facilitated by
OPM Development of design specifications
for each CH
What the Public Want from their
Community Hospitals CH’s well loved, fiercely protected by their communities & fundamental
to provision of local inpatient and outpatient health care;
people want to receive as much care and treatment in their own home, admission to hospital should be a last resort;
history of under investment in community services to maintain people in their own home e.g. district nursing and therapy;
CH’s vary widely in size and capacity;
nurse led MIU’s highly valued & effective vehicles for delivery of local emergency services to large numbers of local residents and visitors; fabric and design of a significant number of CH’s not fit for the purpose
of delivering modern health care;
What the Public Want from their
Community Hospitals variation in the skills and services on offer to local populations
from their CH; inadequate and limited primary care direct access to CH beds
as an alternative to acute hospital admission Ideal care setting for delivery of chronic disease management
and specialist neuro-rehabilitation (e.g. stroke) lack of access to basic diagnostic services to support direct
admission e.g. X-ray, and ultrasound in smaller hospitals; variability in the responsiveness and quantity of medical cover
and supervision variability in the skills and quantity of nursing and therapy to
support needs more complex than intermediate and slow stream rehabilitation
questions around the logic of investment in an independently provided DTC at the expense of developing CH’s
Background Financial pressures +++ more services than
income and growth money can absorb Dobson decision 1998 Unprecedented growth in emergency referrals to
RCH & A&E activity 334 CH beds classed as acute bed stock History of little significant investment in CH
services and community provider services, workforce redesign and performance management
Growing problem of delayed transfers of care
Cornwall Profile Rural and maritime county Population circa 500,000 Scattered villages and small towns Areas of high deprivation with objective
1 funding and Health Action Zone status Pockets of wealth and retired money Low salaries Fastest growth in country in property
prices on par with outer London suburbs
2001 Census Data ResultsGrowth Age 75 and over- England – 7.54%- South West – 9.25%- Cornwall – 9.77%
Households with one pensioner living alone- England – 14.37%- South West – 15.46%- Cornwall – 16.59%
People with a Limiting Long Term Illness- England – 17.93%- South West – 18.10%- Cornwall – 21.21%
2001 Census Data Results Health ‘not good’- England – 9.03%- South West – 8.51%- Cornwall – 10.25% Persons providing unpaid care- England – 9.93%- South West – 10.05%- Cornwall – 11.13% Carers who Provide Care 50+ hours per week- England – 20.48%- South West – 19.74%- Cornwall – 23.57%
Influences on CH Design Specification
Nursing Home Quality and Capacity
Community Hospital Workforce
Reimbursement fund investment in:- Rapid Response Assessment Teams in each district council
are- 4 EPIC nurses in each PCT based in GP practices with the
highest repeat emergency admission rates for the over 75’s. - Increased therapy in the acute trust to facilitate home
assessments and direct discharge.
Influences on CH Design Specification
Acute Care at Home
Increased focus on training, monitoring and support to ward teams to proactively manage discharge planning from the time of admission or before. (SHA, MA & CAT support)
OSPREY project and ‘Improvement Programme for Hospitals’ outcomes will facilitate improved patient flows and rapid access to diagnostics
Increased day surgery procedures will release bed capacity & commissioning strategies to shorten length of stay for elective orthopaedic patients through increased community post operative support
New Out of Hours services
Opportunity Most of influencing factors will impact on the acute trust
and community hospital bed days
Bed capacity will be released in the CH’s and a change in patient flow
Opportunity to develop more direct primary care access and local chronic disease management expertise with the CH as a focal point for it’s delivery and a wider range of community services and rehabilitation to maintain people in their own homes.
Central Cornwall PCT CH Design Specification ‘More services and more patient care for the same level of investment’
programme for reform in Central Cornwall will be achieved through health and social care redesign that will reduce unnecessary hospitalisation, provide more care at home and improve chronic disease management.
Changes to existing services will be delivered through a proactive approach and radical approach to improve and widen the role of community hospitals and community services within localities within the current level of revenue funding.
This design specification will require:
fundamental changes to the traditional way of providing medical cover to community hospitals. Embracing new roles such as nurses with advanced skills and GP’s with a special interest.
Admission policies focused on patient needs allowing for direct primary care access to community hospital beds, diagnostics and specialist advice including domiciliary support to local care homes.
redesign of nursing and therapy roles to reflect the increased need for; patient education/expert patients, day assessment and treatment services, specialist inpatient, outpatient and home based chronic disease management programmes that include; stroke, diabetes, respiratory, dermatology, amputee care etc;
This design specification will require:
more community nurses and more community based rehabilitation therapists to facilitate early postoperative discharge of patient’s e.g. orthopaedic hips and knees at 5 days and planned increases in day surgery procedures.
New provision of a 24 hour 7 day a week Acute Care at Home Service to provide out of hours emergency care and to prevent unnecessary hospital admission.
Provision of an integrated maternity service offering more choice to women on place of birth and local access to midwife led care.
Provision of a new model of ‘Out of Hours’ care provision from October 1 2004 that maximises opportunity to develop new roles and builds on the existing skills of a wide range of health professionals.
Vision to Reality
Central Cornwall PCT’s proposals will be developed in the knowledge that there is limited opportunity for financial investment in community services now and in at least the next two years. They will require changes to the configuration of each of our CH’s and new ways of working.
maintenance of the current number of beds will prevent any other investment in community capacity designed to enable patients to receive more care in their own homes, & develop local CDM services.
Maintenance of the status quo within the current financial climate will perpetuate cycle of dependence on sub acute beds in the absence of home based and more patient focused alternative provision.
Vision to Reality
Our proposals require changes to the configuration of each of our CH’s.
In the next year we plan to make major redesign changes in
South Restormel at St Austell Community Hospital and the development of a mixed economy health and social care facility
to replace Fowey Hospital. Significant changes are proposed to Falmouth Hospital with
opportunity to establish integrated specialist stroke care beds. Capital Development to improve sexual health services for
young people in Newquay is underway
Health Fit Specification for St Austell Community Hospital
To be achieved through reduction of some beds and reinvestment to: - increase the therapeutic value of the remaining 46 inpatient beds and enhance the range of inpatient care - - enhance the range of diagnostic and day assessment and treatment
facilities enhance community rehabilitation capacity provide a 24 hour ACAH service to South Restormel establish specialist stroke beds establish a Falls Clinic establish a Nurse led dermatology service bring nursing and therapy establishments to national average
Health Fit Specification for St Austell Community Hospital
Estabish an EPIC nurse post in St Austell to support primary care chronic disease management
Increase medical capacity to enable: 1. Domicillary visits and support to care homes by Consultant/GPSI/Staff Grade doctors following GP referral 2. Chronic Disease Management Clinics in COPD, diabetes, neurological e.g. stroke etc 3. Increase direct primary care access to CH beds
Next Steps April 2004 - Seek endorsement from PCT Executive Committee to
proposed direction of travel April 2004 - Seek sign up from the PCT Board to proposed direction
of travel May 2004 - Discuss proposals with nursing and medical personnel May 2004 - Commence process of Public Consultation and
presentation of plans to the Overview and Scrutiny Committee May 2004 - Appoint Project Manager from within existing PCT
management resources May/June 2004 - Produce Detailed project plan & Board Paper June – September 2004 – Staff preparation, training and selection
for new roles October – December 2004 - Implement project and achieve service
reconfiguration.
Role of the Modernisation team in Cornwall to support Health & Social Care Redesign – Tracie North