Better Care Closer to Home

Consulting the Community

Better Care Closer to Home

Public Consultation

North Derbyshire Clinical Commissioning Group and Hardwick Clinical Commissioning Group

STAKEHOLDER FEEDBACK REPORT

29th June – 5th October 2016

Dr Steven Wilkinson Consulting the Community

Louise Swain Head of Patient Engagement & Experience NHS North Derbyshire CCG

October 2016 v4

Executive Summary

Summary of Responses

Detailed responses to each of the elements of the 3 proposals have been provided by each of these groups – however, each group takes a specific and relative perspective on the proposals. There is a separate short summary for each of the groups outlining these perspectives.

In general, main points raised include; concerns about flaws in the proposals, closure of hospitals and loss of hospital wards and beds, staffing and general capacity issues; rejecting the beds with care model; the loss of a venue to provide services; the resources needed for the changes; distances to the newly proposed services; concerns about care quality; concerns about end of life care and support for carers. There was concern that these proposals were based on the need to save costs.

Inaccuracies in pre-consultation data were also pointed out (relating to community hospital staffing numbers and referral practices). GP’s had not been consulted. The consultation process (communication) was also criticised.

There was support for the intention of the proposals and recognition of the need for change and an ongoing need for existing community hospitals. There was support for the suggestion of Beds with Care and Community Hubs to be located in community hospitals. Local investment is acknowledged.

Reassurance that changes will not take place until alternative services are in place was sought.

Dr Steven Wilkinson Consulting the Community December 2016

Contents

Executive Summary 2

Summary of Responses 2

Contents 3

Background 4

Process 5

Summary of all Stakeholder responses 6

Summary of Government Responses 6

Summary of Healthcare Providers Responses 11

Summary of Public Groups Responses 21

Summary of Patient Groups Responses 24

Summary of Professional Bodies Responses 27

Summary of Parish Councils Responses 29

Appendix A - Stakeholders 35

Name of Group or Organisation 35

Appendix B - Carers 37

Appendix C – Small Groups 39

Background

The CCG’s of North Derbyshire and Hardwick embarked on a 14 week formal consultation process which closed on 5th October 2016 to help assess the views of service users, health and other care professionals and the wider public, on three broad proposals.

Proposal 1 –

a)  forming Integrated Care at Home Teams,

b)  establishing Beds with Care

c)  moving services out of Dementia Day Units

d)  introducing Dementia Rapid Response Teams, and

e)  setting up local Community Hubs

Proposal 2 –

a)  Permanently closing 16 beds at Bolsover, 16 beds at Clay Cross,16 beds at Newholme, 20 beds at Whitworth, 16 beds at Cavendish

b)  Providing 8 specialist rehabilitation beds in the west of North Derbyshire & 20 at Chesterfield Royal Hospital.

c)  Permanently closing older persons’ mental health community hospital beds; 10 beds at Cavendish, and 10 beds at Newholme,

d)  Establish a centre of excellence at Walton Hospital

Proposal 3 –

Closing Bolsover and Newholme community hospitals http://www.joinedupcare.org.uk/ (Accessed September 2016)

Process

From the feedback database the Stakeholder responses were extracted and these form the basis of this report. A Stakeholder in this instance is defined as a group or an individual who represents the views of a group, community, practice, professional body or constituency and who developed the consultation response through specific expertise, knowledge, discussion, consensus or through the collection of feedback.

This Consultation had three key ‘proposals’, which were explained in a consultation document accompanied by a feedback questionnaire. Stakeholders provided responses either through responding to the consultation questionnaire on-line or in hard copy or by writing to or emailing the CCG’s directly.

This report provides a ‘snap-shot’ of the Stakeholder responses. In all cases, it is advised that the original response be referred to for detail. A list of the stakeholders is at Appendix A. The Stakeholders have been arranged into ‘types’ as follows;

Government Healthcare Providers Public Groups Patient Groups

Professional Bodies & Parish Councils

Views collected from two additional ‘non-stakeholder’ groups (carers and small group meetings) have also been included into this report at appendix B and C.

None of the views expressed in this report are those of the author or any organisation for whom the author may work.

This consultation received 72 responses from Stakeholders.

Summary of all Stakeholder responses

Government

Andrew Bingham MP Bakewell Town Council Chesterfield Borough Council Derbyshire County Council

Derbyshire Dales District Council High Peak Borough Council Matlock Town Council

Natascha Engel MP

North East District Council - Labour Group

Patrick McLoughlin MP

Bolsover District Council

Summary of Government Responses

While detailed responses to each of the elements of the 3 proposals have been provided, this group also made specific reference to Cavendish, Buxton, Newholme and Clays Cross hospitals. Joint working and proposals for change were also discussed.

Main points raised include; concerns about flaws in the proposals, closure of hospitals and loss of hospital wards and beds, support for the intention of the proposals and recognition of the need for change. Reassurance that changes will not take place until alternative services are in place was sought. There was support for the suggestion of Beds with Care and Community Hubs to be located in community hospitals. Specific elements of the proposals were objected to.

Andrew Bingham MP

Type; Letter (Hard Copy) ( Ref 306)

Reference Group; Constituents

Main Points; High Peaks (Cavendish and Buxton Hospitals + Newholme) Proposals are flawed – and opposed. Plans should be shelved and revisited. Range of response; A detailed response to each of the proposals is provided.

Proposal 1

·  Reducing care to unacceptable level

·  Buxton’s unique remote locality is unlike other areas that have trialled this proposal

·  Reduction of services in the High Peak, for elderly patients who are often without home support networks

·  A lack of clarity in the proposals about location of beds with care and the community hubs

·  DRRT does not take account of the needs of elderly carers.

Proposal 2

·  High Peak patients and visitors would have much longer distances to travel often not possible in winter months

Proposal 3

·  Increase in age of the community will increase the demand for community hospital at a time when the bed numbers are being reduced

Bakewell Town Council

Type; Letter (Hard Copy)

Reference Group; Residents of Bakewell

Main Points; Closure of Newholme Hospital will be detrimental.

Range of response; A detailed response to each of the proposals is provided.

Bakewell Town Council

Type; Email outlining notes of Bakewell Town Council Meeting 19th September 2016(Ref 248)

Reference Group; View of the Council on behalf of Residents of Bakewell

Main Points; That the proposals would be detrimental to patient care in Bakewell where there is an elderly population.

Range of response; A detailed response to each of the individual proposals from the Council

·  Mobile proposal – costly and result in less time with patient

·  No guarantee that beds with care being available and if they are care homes cannot provide the same level of care

·  Closure of Day units would not benefit patient care in High Peak and Dales

·  DRRTs helpful only as supplementary care. Distances to be travelled between patients in this rural area and road conditions in winter would reduce time for care

·  Community hub could result in staff not appropriately skilled being sent to patient

·  Special case for retaining a community hospital in this rural area

·  Need for rehab beds in Newholme as well as Buxton and Chesterfield is too far for visitors to travel and there is higher risk of infection there

·  Need for OPMH beds at Newholme

·  Centre of Excellence needs to be developed for this area as Walton is not easily accessible to residents of High Peak and Dales

·  At a time when there is an increasingly aging population in the area the Community Hospital will be needed to reduce the risk and hardship for the most vulnerable

Chesterfield Borough Council

Type; Letter (Hard Copy)(Ref 293)

Reference Group; Residents of Chesterfield

Main Points; Support for intent of proposals (Joint working). Concern about loss of beds. No mention of local authorities role or Chesterfield local health and wellbeing partnership, lack of specific detail.

Range of response; 13 main points regarding the proposals are raised.

·  No mention of local authorities role

·  Chesterfield local health and wellbeing partnership should be recognized and integrated

·  PLACE needs to be clearly defined and how it will align the two Chesterfield Hubs

·  DRRT and on-call psychiatrist cover arrangements seem vague should be clear pathways

·  Two Community hubs for Chesterfield what is the rationale for having 2

·  Shared public estate should be looked at as part of the proposals as a cost saving

·  Lack of specific detail about availability of beds with care in care homes

·  Competition for Care home beds could lead to increased cost for those seeking private care.

·  Reduced NHS funding over time for beds will impact those on personal health budgets

·  What has been put in place to assist families and carers to access transport

·  How are the changes to be communicated to this vulnerable group

·  What plans are in place to re-train staff appoint new staff to meet the demand in the timescale outlined

·  Need for more evidence to show this will be “better care”

Derbyshire County Council

Type; Letter (Hard Copy)(Ref 247)

Reference Group; Residents of Derbyshire

Main Points; Recognition for the need for change and support for broad direction of travel.

Range of response; Detailed comments are provided including a cabinet report of the chief executive.

·  Financial implications,

·  Lack of public confidence in ability to achieve ambitions

·  Location of beds at CRH increase transport difficulty and journey times,

·  Levels of respite support for care

·  Workforce retention, capacity, capability and recruitment.

Derbyshire Dales District Council

Type; On-line survey response

Reference Group; Residents of Derbyshire

Main Points; Cannot support the proposals. Closure of services, beds and hospitals are opposed. (in particular Newholme).

Range of response; A detailed response to each of the proposals is provided.

High Peak Borough Council

Type; Letter (Hard Copy) (Ref371)

Reference Group; Residents of the High Peak district.

Main Points; Cavendish Hospital. Concern over proposed closure of Fenton and Spencer wards.

Range of response; 9 key issues are identified.

·  Fenton and Spencer Ward have high occupancy illustrates the need for a Centre of Excellence and specialist inpatient dementia care is retained in Buxton

·  Concern at limited night time cover for dementia crises

·  Lack of respite care despite increasing reliance on carer support in the home

·  Location of services in Chesterfield will put additional costs and stress on families especially in winter

·  Need assurances that the services can deliver what is envisaged across all areas

·  What is the future of the 2 respite care beds on Spencer Ward

·  Proposals will require expansion of the workforce how can this be achieved given national difficulties at recruiting to OT and Physio posts

·  Pace of transition needs to take account and allow time for patients and families to understand the new systems of care

High Peak Borough Council(Ref 303)

Type : Note meeting took place, Corporate Select Committee – Steve Allinson and Beverley Smith attended.

Matlock Town Council

Type; On-line Survey response

Reference Group; residents of Matlock

Main Points; Oker Ward, Newholme Hospital. Objection to the proposal to close Oker Ward. A waste of local funding support, Travel and transport difficulties.

Range of response; Response limited to Oker Ward proposal.

Natascha Engel MP

Type; Letter (Hard Copy)(Ref 407)

Reference Group; Constituents

Main Points; Proposed changes to care provision. Welcomes reassurance that changes will not take place until care teams are in place. Support for Beds with Care in community hospitals. Would like to see revised proposals.

Range of response; Response limited to main points.

·  no closures until the multi-disciplinary teams are in place and have been evaluated

·  Consideration that the beds with care could be located in the community hospital

North East District Council - Labour Group

Type; Letter (Hard Copy)(Ref 292)

Reference Group; Residents of North East District

Main Points; Clay Cross Hospital – including specific reference to Clay Cross hospital. The age and use of the hospital makes it viable, the high achievement of staff is noted and the suggestion to locate Beds with Care and Community Hubs in the hospital is supported.

Range of response; 6 main points are raised including those specific to Clay Cross Hospital

·  Joined up care has failed in the past due to lack of resources and patients have ended up reliant on private care or that of family members

·  This should not be a cost cutting exercise at the expense of the vulnerable, frail elderly

·  investment is important but should not be private profit driven

·  Concern that there are insufficient good quality care home beds to meet the increased demand

·  Public Care home provision has reduced due to cuts to councils by central government

·  Clay Cross should be retained as it is accessible, has an excellent level of care, could be the Hub and centre for the beds with care

Patrick McLoughlin MP

Type; Letter and Copy correspondence from constituents(Hard Copy)(Ref 305)

Reference Group; Constituents

Main Points; Whilst supporting the principle of better care closer to home the proposed closures of Newholme and beds on Oker Ward at the Whitworth are of concern to constituents as winter weather may cut them off from services

Range of response; 33 Responses from constituents attached.