Consulting theCommunity
A New and Vibrant Future for Benjamin Court Healthcare Unit -
A Resource for Everyone in North Norfolk and rural Broadland
Public Consultation and Engagement
Consultation and Public EngagementExercise
June 19th to September 11th 2017
FEEDBACK REPORT
Prepared for the
NHS North Norfolk Clinical Commissioning Group (NNCCG)
Dr StevenWilkinson onsulting theCommunity September2017
Contents
Background
Responses
Method and Methodology
Feedback Overview
Summary of Themes
Services (18%)
Hospital Beds - 15%
Community Based Care - 13%
Staffing - 11%
Funding - 9%
Planning - 9%
Care Quality - 7%
Location - 6%
Consultation - 6%
Logistics - 6%
Questions
Conclusion
Consultation & Public Engagement Feedback SummaryReport
Background
NHS North Norfolk Clinical Commissioning Group (NN CCG) in conjunction with the Benjamin Court Steering Groupproposed a vision for the future use of Benjamin Court in Cromer and the development of a new Supported Care Service. Full details of this proposal can be found at
(accessed September 2017)
A Consultation &EngagementExerciseincluded public meetings and an invitation to make submissions on line and/or in writing. NNCCG were interested to learn;
How these proposed changes impact people?
What else the CCG shouldconsider in making this decision?
Responses
All Reponses to this exercise were provided to Dr Steven Wilkinson – an independent consultant, who analysed the feedback and produced this report.
In total 84 Reponses were collected. These included submissions from;
North Norfolk District Council (Letter)
Cromer Town Council (Letter and email)
Kelling Hospital Friends (email)
Cromer Group Practice (Letter and email)
Norfolk County Council (email & minutes)
Opening Doors - a charity for people with learning disabilities (email)
A public meeting held on the 29th August in Cromer also invited written responses either on a form, or as ‘post–it’ note responses. Further correspondence was received in the form of letters and emails.
All responses from individuals were redacted and/or anonymised and returned to the CCG after this report had been constructed..
Method and Methodology
1st Stage Analysis
Responses received are entered into the central database. The free text is then coded. Questions raisedare included at the end of the analysis to help facilitate the CCG response to the consultation.
2ndStage analysis
The Second Stage analysis combined the coded free text into themes.
Report
Thisreporthasbeenwrittenusing(asfaraspossible)thewordsandphrasesusedinthefree text.Nocorrectionsoffact,grammarorsyntaxhavebeenmade.
This report summarises the themes. The themes with the most responses are discussedfirstfollowed by the next in descending order. This provides a relative indication of theweightingof each theme.
Noneoftheviewsexpressedinthisreportarethoseoftheauthororanyorganisationforwhom the author maywork.
Feedback Overview
The following ‘Word Cloud’ ( has been developed from the free text.
The following table shows the themes developed from the feedback showing % weighting and summarizing the key points raised.
Theme / % Response / ContextServices / 18% / Satisfied with existing services. Satisfied with proposals. Services are needed in this region – particularly palliative care.
Hospital Beds / 15% / Beds are needed. No reduction. Flexibility in bed usage required. Retain beds until Supported Care model is in place and proven.
Community Based Care / 13% / Care in the community and joined up care are needed. The Hub will provide benefit.
Staffing / 11% / The Staff are appreciated. Staff need to be informed of changes. Staff training is needed. Staffing numbers are important.
Funding / 9% / This is a cost saving exercise. Patients should be the priority.
Planning / 9% / Consider the demographics of the area and patients. Local services are needed. Confirmations have been requested (sequence, bed numbers, resources, timescales)
Care Quality / 7% / Concerns about Supported Care, safety, staffing and funding.
Location / 6% / Difficulties with accessing services. Care closer to home is needed.
Consultation / 6% / Concerns regarding the consultation document and Communication process. Conclusions drawn by the CCG are disputed and more information is requested. The consultation is also praised.
Logistics / 6% / Parking concerns. And public petition to retain BC has been raised.
Summary of Themes
Services (18%)
The unit is a good central Cromer unit and was a successful unit which when it had one ward to stabilise and one to prepare for discharge, sent patients home ready to be home - this prevented re admission. A small close knit (fantastic) team at Benjamin Court - a high (invaluable)level of professionalism and compassion has been provided by the staff to both patients and their families.
NNDC recognises that Benjamin Court currently provides a range of excellent inpatient and outpatient intermediate care services. It is highly valued by residents across North Norfolk and in particular by people living in Cromer and the surrounding area.
It is considered that the proposed changes to the use of the intermediate care beds or the other beds for palliative care and I.V therapy at Benjamin Court will have little impact on Council services. The rationale, need and benefit of each element of the preferred option is clearly identified and accepted. Overall, it is considered that the impact of the proposed changes at Benjamin Court on the resident population of North Norfolk should be benefit.
The suggested option would result in the loss of 2 intermediate care beds from 18 to 16 beds. Given that the beds are not always fully occupied and the anticipated reduction in demand following the introduction of Supported Care this is considered acceptable.
Cromer Town Council sees the merits of all of the different options put forward by North Norfolk Clinical Commissioning Group for the future of Benjamin Court and is not opposed to the principle of the ideas. The Town Council broadly supports the recommendations of the Benjamin Court Steering Group of a mixed use of the unit. Norfolk County Council made supportive comments about the Benjamin Court Steering Group’s preferred options for the future use of Benjamin Court.
As people age, they become more susceptible to disease, disability and experience multi, chronic or long terms health issues and are more likely to need physical, mental and social care services. This combined with the rural topography of North Norfolk and the issues residents in North Norfolk face in terms of travel, time and cost to access any of the 3 acute general hospitals in Norfolk makes it essential that as many specialist and generic inpatient and outpatient clinics are provided in North Norfolk as possible.
Wrap around care is fine if illness is diagnosed prior to hospital admittance, however sudden illness/fall cannot often be predicted. It is this eventuality that is not being addressed by these changes.
We recognize the need for intravenous therapy; voluntary services and outpatient services to be locally accommodated.Great idea to have Big C there. Carer support and respite services are needed. We welcome that the existing Outpatient Treatments provided at Benjamin Court, such as Speech Therapy and Podiatry, will be retained following this consultation.
Palliative care (end of life facilities) is already provided, at Benjamin Court, and this should continue (is ultra important, pleased to see more). Residents praised the Palliative Care provided. Support the argument for increasing, or formally commissioning such services there.
Hospital Beds - 15%
Please consider very carefully, changing the use of the building and the beds that are available now at Benjamin Court. Using all parts of the ward and Poppy Wing will enhance the building. My experience was that Benjamin Court had a shortage of beds in 2012 – and not underused beds.
I feel that it is misleading to say that North Norfolk currently have four sites of inpatient beds: North Walsham, Benjamin Court, Kelling Hospital and Cranmer House. Cranmer House is closing its health beds from beginning of August so this site should not be factored into the consultation as it misleads people to think there are more beds in North Norfolk than there will actually be.
Benjamin Court should not lose the current intermediate beds. While the options put forward appear innovative, the reality is that it will do little to relieve the problem of 'bed-blocking' in the acute hospital situation. An issue that has been compounded by the closure of so many of these so called intermediate beds. Clarity is sought on the total number of specialist care beds to be provided.
The inflexibility of providing a set number of beds(diverse services, beds are ear marked for specific issues) means this could lead to beds being unused. I strongly feel that Benjamin Court should retain the intermediate beds, at the same number, but utilise them with flexibility. The consultation identifies the provision of up to 8 palliative care beds, 6 Discharge to Assess beds and 2 IV chairs / beds. This implies there would be a maximum of 16 inpatient beds assuming there are 8 palliative care beds and the IV beds are able to be used for inpatients if required. Confirmation is specifically sought on the number of palliative care beds that will be provided and assurance is required that if the 8 beds are not needed for palliative care they will be used for other specialist or intermediate care services and will not be decommissioned.
As the Supported Care service only started recently and its success in reducing demand for intermediate care beds in North Norfolk is not likely to be evidenced for at least a year, the Council would not currently support any proposals to further reduce or decommission intermediate or specialist care beds at Benjamin Court or at any of the other three intermediate care facilities in North Norfolk. Rehab beds have been full all the time.
There is a major difference between this group of patients in theory being at home with care / OT / physio input and the reality of the major difficulties this often involves for this frail group of patients with multiple co-morbidities. The CCG is being naïve in making such a major decision largely on the basis of this audit. Supported care will involve care for a different group of patients than those currently at Benjamin court. It is thus unlikely to reduce the need for intermediate care beds. The audits of Intermediate Care carried out by NNCCG in partnership with NCH&C showed an 82% occupancy of beds across 4 units in North Norfolk, which indicates a significant demand of Rehabilitative Care across North Norfolk. Following any changes, there would still be patients in need of the ward based Rehabilitative Care Benjamin Court currently provides, despite a net reduction in this service area.
A change in use of the beds to palliative care will reduce the admissions to secondary care for palliative care. However there is also an unmet need for local palliative care beds, and so bed numbers cannot be solely based on current palliative care admissions to NNUH. We wished to register our disappointment that the palliative care beds at Kelling Hospital were not carried on.
One correct comment mentioned that all the emphasis is on bed clearing and needs to concentrate on wrap around care. Inappropriate admissions from the NNUH have been a long standing issue - unrealistic discharge times due to patients condition and home situation all led to 'Bed Blocking', which though they were too unwell, or support in the community not available, was seen a failure on the part of Benjamin Court.
Palliative x 8 would be good. Keep some rehab beds.There are not sufficient numbers of Respite Care facilities to complement such changes.
Although it is not mentioned in the consultation, the Council are pleased that NNCCG have publicly stated that none of the facilities in North Norfolk where they commission inpatient beds and services namely Kelling Hospital, Cranmer House, North Walsham Memorial Hospital and Benjamin Court will close.
Community Based Care - 13%
The clinical audit further identified that 46% of the patients assessed as part of the audits either did not need to be admitted to hospital or could have been discharged home directly from the acute trust if access to appropriate Physiotherapy or Occupational Therapy assessment and a care package were available. Discharge to assess should be part of the Supported Care Service – in patient’s homes. The longer people stay in bed the more they loose of their independence. Increase people’s independence, enable them to stay in their homes and in turn reduce the number of people going into residential care. This will build on the success of our home-based reablement and it will of course benefit the whole system. The Town Council broadly supports the principle of care and treatment being administered to patients in their own homes where possible.
A health at home team was initiated some years ago, which was then dismantled - these are costly initiatives, which have led nowhere. We have concerns regarding supportingthe community locally if they are unable to be cared for in their own home but do not require a nursing home. Careful physical and mental checks are needed to ensure that patients are reasonably capable of self care plus assistance at home. We would like to see investment in district nursing.
I know Benjamin Court provided an 'Outreach service' - it provided after care on discharge. This service should continue. There is an opportunity to create a fantastic integrated community service in Cromer with Benjamin Court, Cromer Hospital – the new GP surgery with links to Keeling etc…
The Hub which forms part of the county wide, multi-agency early help service is a partnership of voluntary and statutory organisations that work collaboratively to offer help, advice and support services to children, families and adults of all ages. A key aim of early help is to reduce, delay or avoid the need for intense, intrusive, long term and costly interventions from statutory services. The location of additional voluntary / third sector provision at Benjamin Court will offer greater opportunities for partnership working and integration with the North Norfolk Help Hub located at the Council. This is joined up thinking (sounds good) - organizations should be prepared to work closely together (i.e. Age Concern, local centered Cromer Drop In, Cromer Hospital, Dementia UK or Alzheimer’s UK). Must involve everyone who has an interest in looking after loved ones.
Staffing - 11%
Benjamin Court is well sourced by excellent and loyal staff who are capable of adapting to any of the proposals and have continued to give 100% under the climate of uncertainty. Paramount is the respect for staff who in all this give their all to the service, rely on job security and in this age are hard to replace. All the staff there are exceptional – look after them.
The staff provide the best care they can, but everyone knows that palliative care is requiring of a higher staffing ratio, as in Pricilla Bacon Lodge. There is for example unlikely to be a resident daytime palliative care consultant. Any initiatives need to be staffed adequately.Thedelays to make clear decisions on what services are to be provided causes me difficulties to be able to manage the staff needs. More staff training will be needed.
Using the building as day care would underutilise the staff, result in job losses. The excellent district nursing team has been decimated spread too wide and has had its skill mix cut, due to funds.
Staff are exhausted from worry. Ensure staff are kept up to date with timely decision making - consider staff morale.
Encourage staff to join the home care team and maybe do shifts on wards as well. The Home Care team and Supporting Care at Home should team up.
The service will require around 50 extra health, social care and voluntary sector staff across NNCCG area. Confirmation as to whether these staff have been recruited and the proportion and numbers of health, social care and voluntary sector staff is sought.
The Town Council is concerned about fluctuations in the number of carers who are able to provide care to patients in their own homes. Volunteers are already overstretched.
Funding - 9%
The consultation document identifies the challenges faced by NNCCG and the need to make changes at Benjamin Court for financial reasons and more importantly to meet current and future intermediate healthcare needs in North Norfolk. Good to see the NHS investing as opposed to cutting (re Supported Care).
Benjamin Court has been overused by NNUH in its aim to save their costs. The building which was not rented back to itself initially now must have a cost incurred which it didn't before.
We need to have realistic ideas about seeing these issues as genuine needs, which can't be ignored and though undesirable, have to be funded. Patients who do not progress, or deteriorate can't be just a financial figure. From my experience physio at home subject to a few sessions – then stopped due to funding restrictions.