Better Care Closer to Home s1

Consulting the Community

Better Care Closer to Home

Public Consultation

North Derbyshire Clinical Commissioning Group and

Hardwick Clinical Commissioning Group

Feedback REPORT

29th June – 5th October 2016

Dr Steven Wilkinson

Consulting the Community

October 2016 (final version 7th December 2016)

Executive Summaries

Proposal 1

There was support for the Care at Home teams. The Beds with Care proposal raised concerns about the quality of care and the availability of nursing or care homes. There was disagreement with moving Dementia Day Units out of community hospitals. The Dementia Rapid Response Team proposal had broad agreement. There was acceptance of the Community Hubs proposal, however the locations of these hubs raised concern. Common themes across all of these proposals included care quality, staffing (levels and skills) the use of community and acute hospitals and hospital beds, costs and funding, management and organisation, location, carers and respite, travel, transport and access. In every case there were requests for further detailed information and a range of questions about the proposals.

Proposal 2 –

There was broad disagreement with the proposal to close beds in any of the 5 nominated community hospitals. It was thought these beds would be needed to serve the local (and remote) communities. The introduction of Specialist Rehabilitation beds in both suggested locations was considered a good idea, however the locations raised travel and transport concerns. The number of proposed beds was also considered to be low. There was broad disagreement with the proposal to close OPMH community beds at the two nominated sites. The establishment of a Centre of Excellence at Walton Hospital met with broad approval, however the location was an issue for some. In each case there was discussion around the themes of the use of hospitals and hospital beds, management and organization of services, locations travel and transport, nursing and care homes (capacity and care quality), carers and respite, estates (building use) staff (levels and qualifications). In every case there were requests for further detailed information and a range of questions about the proposals.

Proposal 3 –

There was broad disagreement with the proposal to close either hospital. These hospitals were considered to be needed by the local communities. Common themes in both cases included, patient care and quality concerns, management and organisational issues including a timetable for the proposed changes, issues around costs and funding, the location of alternative services and the inherent issues around travel and transport. The use of community hospitals including the range of services provided through these hospitals. Concerns about staff, carers and respite and access to services were also raised. The use of the estates (buildings) was discussed. In every case there were requests for further detailed information and a range of questions about the proposals.

Dr Steven Wilkinson

Consulting the Community

October 2016 (final version 7th December 2016)

Contents

Executive Summaries 2

1 Background 5

2 Process 5

3 Proposal One – Executive Summary 7

3.1 Proposal One 8

Care at Home Teams 8

3.2 Care at home teams summary 8

3.3 Beds With Care Summary 17

3.4 Dementia day units – Walton Summary 24

3.5 Dementia day units – Newholme Summary 27

3.6 Dementia day units – Bolsover Summary 30

3.7 Dementia Rapid Response Teams Summary 33

3.8 Community Hubs Summary 40

4 Proposal 2 - Executive Summary 47

Proposal 2 48

4.1 Community Hospitals Bolsover Summary 48

4.2 Community Hospitals Clay Cross Summary 52

4.3 Community Hospitals Newholme Summary 56

4.4 Community Hospitals Whitworth Summary. 60

4.5 Community Hospitals Cavendish Summary 65

4.6 Specialist Rehabilitation Hospital Beds Cavendish Hospital Summary 69

4.7 Specialist Rehabilitation Hospital Beds Chesterfield Royal Hospital Summary 72

4.8 OPMH Community Hospital Beds Cavendish Summary 76

4.9 OPMH Community Hospital Beds Newholme Summary 80

4.10 Centre of Excellence at Walton Community Hospital Summary 84

5 Proposal 3 - Executive Summary 89

5 Proposal 3 89

Bolsover Community Hospital and Newholme Community Hospital 90

5.1 The closure of Bolsover Community Hospital Summary 90

5.2 The closure of Newholme Community Hospital Summary 94

6 Consultation Clarification 98

7 Report Outcomes 100

1 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 closing16 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)

2 Process

A database of feedback was developed. A First Stage Analysis was then undertaken, which coded responses. A Second Stage Analysis was then developed which organised the codes into themes. The first and second stage analysis documents are working documents and were used in the construction of this report.

This Consultation had three key ‘proposals’, which were explained in a consultation document accompanied by a feedback questionnaire. Further feedback to these proposals was collected via written and email correspondence and recordings and notes from public meetings. All feedback was included into the analysis and has been represented in this report.

This report has been written using (as far as possible) the words and phrases used in the responses. No corrections of fact, grammar or syntax have been made.

This report summarises the themes. The themes with the most responses are discussed first followed by the next in descending order. This provides a relative indication of the weighting of each theme. Every attempt has been made to report the feedback provided for each of the respective questions, therefore there is some repetition within this report.

Questions raised by respondents have been summarized and are reported at the end of each element of each proposal.

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

The following table indicates the number of responses received (rounded up);

Table 1 – Response count

Questionnaires 2,260

Correspondence (email & hard copy) c.100

Public meetings 18 x 2 hour meetings

+ Additional information including petitions, on-line comments, & media.

3 Proposal One – Executive Summary

Proposal 1

Proposal one is a combination of;

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

The ‘word cloud’[1] illustrates the 100 most often occurring words within the responses. The larger the word, the more often it occurred.

3.1 Proposal One

Care at Home Teams

The proposed service changes would include significantly expanding 'care at home' teams. These are community-based teams of health and care staff who will work together locally, to care seamlessly for older people in or near their own homes.

What do you think about this proposal to expand community-based care teams?

3.2 Care at home teams summary

There was broad agreement to this proposal. Concerns were expressed about the quality of patient care and staffing levels. Those who disagreed lacked confidence in community care. There were concerns that this proposal would be sufficiently funded and about the management and organisation of the service. A preference for locally provided care was expressed and carers should also be considered in this model – particularly with respect to respite. Travel concerns took account of distances and weather and road conditions. It was suggested the service be available on a 24 hr basis. Further information was requested.

3.2.1 Agree

It sounds a good (excellent, much needed, lovely, fair enough, helpful, positive, pleasing, extremely good, welcome, nice, Fantastic, necessary, beneficial, ok, welcome, essential, adequate, long overdue, fine, great, useful, sensible, amazing, commendable, common sense, brilliant, positive) idea. It is a nice idea to be cared for in your own home. I hope integrated care teams at home will be a success. We support this change. The more actual carers the better. A very good idea in theory (in principle, if done properly, basically, generally, partly, on paper, in concept, has merit). It will be very good for some suitable patients. Will hopefully minimise length of hospital stay and associated complications and improve rehab outcomes.

Provided it is in addition. This should not be at the expense of beds in local hospitals. I think there needs to be a balance between community care and in-patient care.

If you even consider doing this it should be trialled for at least three financial years before any beds close.

3.2.2 Patient Care & Quality

DRRT’s cannot be possible to give the same quality of care in home visits as that in a rehabilitation ward with 24hr cover. I am very concerned that the interventions by the Dementia Rapid Response Teams will not be able to meet the needs of the people with severe dementia. Care at home provides only a short-lived respite in the numbers game, because, after short a period of time, the 'patient' will again need a higher level of care.

In hospitals they have access to other services. Patients are also admitted directly from home via the GP for medical assessment for: deterioration of heart failure, exacerbation COPD, chest infection, Palliative care, pain management, wound management, blood transfusions, IV antibiotics, fluid balance / hydration. There is also the consideration that the elderly quite often feel happier and supported in the company of others. Very concerned as realistically and practically I don't think so many people will be seen, and people will have to wait longer to be seen.

A lot of patients are simply not safe to be home alone between care calls. Living on my own with no family near - I know how lonely a vulnerable older people can feel when poorly. Increase in falls, pressure sores, fire hazards, more vulnerable people walking streets leading to hypothermia, poor nutrition, taking on things before they are ready - mortality rates will rise as well as morbidity.

I have no criticism of the care she received from the district nurses; my point is that there are limits to what they are able to do in the allotted time they are given for home visits. It depends on time allowed to each person. I would not want to think that I was relying on short visits. Visits are not long enough. These care in the community schemes end up being flying visits that don't really benefit those in need.

People with Dementia find unfamiliar surroundings frightening - people recover better in their own surroundings. By bringing care to the home, familiarity can be maintained. The members of the team need to be consistent so that the patient knows the individuals. A dedicated worker could visit a specific client rather than a different one each day, as I feel this would be much better for the client.

There is a stigma surrounding the acceptance of 'help' at home: many elderly people perceive it as admitting that they are no longer living independently, even if that is in reality an illusion (they are being supported by an informal network of neighbours/friends/relatives). They pride themselves in being able to lead these 'independent' lives.

The proposals do not take account of the customer’s wishes. Services should be available on an ‘as needed’ basis and in a patient-centred choice model.

3.2.3 Community Hospitals and Hospital Beds

I think that there will still need to be a community bed provision for those who need more intensive care or a half way stage between hospitalisation and return to home. This still needs to be provided at community hospitals including the Whitworth, Newholme and Cavendish hospitals. I'm sure people living in Derbyshire (the Dales, Hope Valley, Matlock, Calow, Buxton, Bakewell) - prefer their local hospital.

Special staff will be needed and this will mean a stay in a main hospital. A larger number of people can be cared for with a 24hour service by fewer staff in a local hospital. The therapeutic groups and activities that take place requires a base.

Manual handling risks increase in the patient’s own home, where equipment is not always readily available. Staff from the Community Hospitals have raised the point that they need equipment and space and sterile treatment areas to use it which a hospital setting provides but which may not be available in the community.

3.2.4 Staff

Only if enough qualified (social care/ private agency / voluntary / charitable sector) staff are available now and into the future. There are not enough staff currently to care for the patients who are already at home. Community teams are already struggling to cope with demand. We need to recruit well trained, committed, loyal, quality, properly paid and contracted staff with the right qualifications (at the right level). The organisation wide problem seems to be that DCHS are struggling to recruit good staff whilst other experienced staff are leaving or are wanting to leave. If staff are ill, there is more likelihood that a vulnerable person will slip through cracks.