FENLAND: Extra care beds for Doddington emerging as hot favourite in NHS review

NHS CAMBRIDGESHIRE is set to launch the public consultation on the future of community based health services in south Fenland. The preference for ten intermediate care beds within an extra care facility at Doddington has emerged as a possible outcome.

The public consultation will take place from 27 April until 31 July 2009 and follows a listening exercise that took place last autumn.

As part of the listening exercise many people attended the public meetings and other events that were held, giving their views and comments which helped to inform the consultation document, which is being used as part of the consultation process. People were also able to email, phone and write in with their comments.

At the beginning of the listening exercise four options were put forward for discussion. These have been revised in light of the comments made during the exercise. Travel times and interim improvements were key themes that came through the consultation.

From the responses that have been received, NHS Cambridgeshire has now been able to put forward a preferred option which is known as revised option 3.

This option would involve opening ten intermediate care beds within an extra care housing facility on the Doddington Hospital site. Intermediate care is the term used as the bridge between hospital and home care for patients who are medically stable. These beds would replace the four beds that are presently commissioned in the community.

The additional six beds would provide a combination of palliative care, step down care for patients following a stay in an acute hospital and short stay care for procedures that could be carried out at Doddington Hospital. If this option is supported, interim arrangements would be made while the new services and facilities are put in place.

In addition, the operating hours of the Minor Injuries Unit (MIJ) would be extended from 8am-8pm Monday to Friday, and 9am -5pm on Saturdays, Sundays and on public holidays. The operating hours of the radiology service that is currently based at Doddington Hospital would also be extended to match the opening hours of the Minor Injuries Unit.

As well as housing the 10 intermediate care beds to be used for NHS patients, the extra care facility would also provide social care for frail, elderly people too. The extra care facility could include public areas, such as a caf�, gymnasium, consulting rooms and some training facilities that would be available for NHS staff and the local community to use.

Under revised Option 3, consultant led outpatient services would also be developed for the treatment of complex symptoms and to offer support to carers. In order to support patients where it is appropriate to treat them locally, the current outpatient and diagnostic services at Doddington Hospital would also be enhanced. This would be in conjunction with the development of the inpatient unit and extensions to the operating hours of both the Minor Injuries Unit and Doddington's radiology facility.

Vinny Logan, Executive Nurse at NHS Cambridgeshire said: "We would like to thank again everyone who took the time to engage in our listening exercise last Autumn. We had a tremendous response which has really helped us to develop our thinking on the three options that have now been identified in our consultation document. In fact we have now been able to identify a preferred option (known as revised option 3) which we believe to be in the best interests of local people as it will ensure that Doddington Hospital will be used as effectively as possible.

"We look forward to discussing all the options with people at the various events and meetings that we have scheduled in the coming weeks as part of the consultation process. We would encourage anyone who has an interest in having their say on how their local NHS services are provided in South Fenland to take part in the consultation."

How to have your say

People can get involved in the consultation process in a number of different ways:

1. Attend one of the meetings that are taking place throughout the course of the consultation (dates and venues for those meetings that are already booked are at the bottom of this media release). Further meetings are due to be scheduled.

2. Call our freephone number on 0800 279 2535 to give your views.

3 Email comments to southfenlandconsultation@cambridgeshire.nhs.uk

Dates of events

Below are a list of the events that are currently planned as part of the consultation process:

Additional dates are due to be added to this schedule.

DateTime VenueMonday 11 May 200911.00am Salvation Army Chatteris, East Park Street, Chatteris, PE16 6LHWednesday 20 May 20097.00pmMarch Youth & Community Centre, 34 Station Road, March, PE15 8LEThursday 21 May 20097.00pmDoddington Village Hall, Benwick Road, Doddington, PE15 0TGTuesday 26 May 200911.00amDoddington Village Hall, Benwick Road, Doddington, PE15 0TG

Option Development for the Consultation 2009

After careful consideration of the responses to the Listening Exercise, the South Fenland Review Group has identified the following options in response to the service needs highlighted. The options that have been identified are as follows:

Option 1

Maintain the status quo. No inpatient beds on the Doddington site, with access instead to beds at the Princess of Wales Hospital, Ely or the North Cambridgeshire Hospital, Wisbech. The minor treatment centre would continue to operate, limited to its current hours of operation, which roughly match weekday business hours. Some essential maintenance would need to be done to buildings on the site, but there would be no development of expansion of the services provided at Doddington.

BenefitsChallengesNo new investment required-No improvements to access or range of services

-No additional clinical benefits

-Facility potentially unsustainable due to lack of willing providers. To date there is evidence that finding an organisation to run this facility could be difficult.

-Recruitment and retention of staff would remain poor due to no staff development opportunities and the lack of range of service availability in a single location

-Less choice for patients

-Local population would still need to travel to services that could be provided close to home.

-Likelihood that existing services would become unsustainable over time and increase acute hospital activity

Travel may will still be an issue

Option 2

Re-open 10 intermediate care beds within the Iceni unit at Doddington Community Hospital. These beds would replace the four beds presently commissioned within the community, so adding six beds to the locality overall. These beds would provide a combination of palliative care, step-down care for patients following a stay in an acute hospital, and short-stay care for procedures that could be carried out at Doddington.

Important services we also wish to develop are the delivery of intra-venous antibiotic treatments, blood transfusions, and some simple types of chemotherapy. These could best be delivered by using the in-patient unit, however, it could be that patients are admitted on a day basis for treatment then return home or could stay overnight if further observation of their condition was necessary. We would support the development of these specialist services via the appointment of a project nurse skilled in delivering this type of care outside of hospital. This post would an additional post under option 2 and would be shared across other community hospital sites. The post would be part of the medicines management team and would mean more patients would get care locally.

The Minor Injuries Unit would also continue to be located within the Iceni building.

BenefitsChallenges- Improved access to services locally

- small increase in range of services available.

- intermediate care beds closer to

peoples homes

- environmental benefits due to reduced travel

- Limited increase in services available in area

- Sustainability in the medium to long term likely

to be challenging in terms of staff recruitment

and retention due to establishing a willing

provider. To date there is evidence that finding an organisation to run this facility could be difficult

- maintaining on a 24 hour, 7 day a week basis the appropriate skill mix and arrangements for clinical safety of patients in a stand alone unit, could be challenging

- Minimal increase in services available at

Doddington hospital site.

- Limited choice for patients

- Travel could still be an issue

- out of hours medical cover

- Finding a suitable provider could take

- 12 - 18 months to come into service.

Option 3 (Revised)

Open 10 intermediate care beds within an "extra care"* housing facility constructed on the Doddington site. As in Option 2, these beds would replace the four beds presently commissioned within the community, so adding six beds to the locality overall, and would provide a combination of palliative care, step-down care for patients following a stay in an acute hospital, and short-stay care for procedures that could be carried out at Doddington.

In addition, the operating hours of the Minor Injuries Unit (MIU) would be extended to 8am - 8pm Monday to Friday, and 9am - 5pm on Saturdays, Sundays and public holidays in accordance with recommendation 6 of the NCAT review carried out by Professor Alberti. The operating hours of the radiology service that already exists at Doddington would be extended to match the opening hours of the MIU. Should this be the preferred option these services could become effective quickly (allowing for staff to be recruited).

In addition to housing the 10 intermediate care beds to be used for NHS patients, the extra care facility would provide social care for frail elderly people. Fenland District Council will be developing a number of these facilities across Fenland, including South Fenland and specifically the village of Doddington. Discussions have established that the District Council are amenable to including an intermediate care unit within such a facility, and there are advantages to both sides in locating this unit on land, presently unused, on the Doddington Hospital site.

This extra care unit could include public areas, including a caf�, gymnasium, consulting rooms and some training facilities that will be available to NHS staff and the local community

Under revised Option 3 we acknowledge that it would take time to secure planning permission and to erect the extra care facility in which 10 intermediate care beds would be located. In order to offer some additional assurance to the south Fenland community, we propose to commence the recruitment process with immediate effect should this be the preferred option. These additional nursing and therapy staff in the interim could operate as both a defined 'hospital at home' team looking after patients in their own homes (and supplement existing community services) plus deliver some day treatments e.g. IV antibiotics, blood transfusions within the current Iceni building. This would start to improve services very quickly. Once the new building was ready, these staff would transfer to run the 10 bedded intermediate care ward within the extra care facility A big advantage of this approach is that the time could be used to help staff develop the new skills and competencies needed to run an intermediate care facility capable of looking after patients with palliative care needs, delivering goal focused rehabilitation and patients who currently go to an acute hospital for short interventions that could safely be managed in a community hospital setting.

The Iceni Unit would continue to accommodate the Minor Injuries Unit. Space within the remainder of the Iceni building is used at present, but not necessarily as efficiently as it could be. Various options are being considered for better use of this space, for example under this option there may be opportunities for the GP practice on-site at Doddington to integrate more closely with the proposed extended minor injuries service. This would be subject to agreement with the practice and our current provider of minor injuries services, Cambridgeshire Community Services.

As in Option 2 we would wish to develop the delivery of intra-venous antibiotic treatments, blood transfusions and some simple types of chemotherapy.

We have heard from the public and local clinicians about the need to improve end of care life services. Under revised Option 3 we plan to develop a consultant-led outpatient service so treatment of complex symptoms and support for carers can be addressed. By providing the service locally this development will bring considerable benefits to local people who are in need of this type of care. The consultant can also offer supervision and clinical advice to staff caring for end of life patients in the inpatient unit.

In order to support patients with treatment locally where it is appropriate to do so, current outpatient and diagnostic services at Doddington Hospital would be enhanced. This would be co-ordinated with the development of the inpatient unit and extensions to the operating hours of both the minor injuries unit and Doddington's radiology facility.

BenefitsChallenges-clinical benefits of services closer to home

- additional services and more availability of

services

- significantly more services available on the

Doddington site than have been for some time.

- value for money

- Long term sustainability possible due to

collaborative working

- enhanced range of services available- Will need investment in partnership with an

extra care sheltered organisation.

- Could take 18 months to happen

- recruiting and retention of staff would still exist

although there would be greater opportunities to share staff and the ability to offer staff development.

*The inpatient facilities identified in option 2 and 3 will be based on the same service specification. This means that will operate to the same nursing care standards but delivery will be in different buildings.