Paignton and Brixham Locality Development

Paignton and Brixham Locality Development

Contents Population Pressures Slide 2 Current Use of Services Slide 11 Financial Pressures Slide 15 The Case for Change Slide 20 Into the Future Slide 23 How to Take Part in the Consultation Slide 31

Population Pressures

Local Population Challenges South Devon and Torbay has more than the average number of people aged over 65 years and over 85 years. We face a growth in the number of people with a long term condition and with more than one long term condition We have some areas of deprivation which reflect a younger population with different health needs We also have significant challenges in staff recruitment and retention

Current Population Resident population (2013) (population that live in the area) Registered population (2015) (population that are registered to a GP) 69,600 72,500 Registered Population Projections Average age (Years) Paignton & Brixham South Devon and Torbay England 2015 46.5 45.3 40.3 2020 47.3 46.0 41.0 2025 48.4 46.9 41.7 2030 49.1 47.6 42.4 Source: local registered population modelled against Sub National Population Projections (ONS)

Registered Population Projections Estimated registered population Change in estimated registered population 2015 2020 2025 2030 2015 to 2020 2015 to 2025 2015 to 2030 0 to 14 10,300 10,928 11,107 11,000 6.1% 7.8% 6.8% 15 to 29 11,242 10,646 10,545 10,736-5.3% -6.2% -4.5% 30 to 44 10,505 10,393 11,006 11,060-1.1% 4.8% 5.3% 45 to 64 20,270 20,293 19,665 18,635 0.1% -3.0% -8.1% 65 to 84 17,309 18,506 19,862 21,361 6.9% 14.7% 23.4% 85+ 2,856 3,214 3,837 4,723 12.6% 34.3% 65.4% Total 72,482 73,979 76,021 77,515 2.1% 4.9% 6.9% Source: local registered population modelled against Sub National Population Projections (ONS)

Estimated Burden of Disease Estimated burden of disease Number of patients with disease; known or not known to primary care 2015 2020 2025 2015 to 2020 change 2015 to 2025 change Coronary heart disease 4,872 5,275 5,762 8.3% 18.3% Chronic kidney disease 7,764 8,395 9,274 8.1% 19.4% People aged 65 and over predicted to have: Type 1 or Type 2 diabetes 2,507 2,700 2,936 7.7% 17.1% A longstanding health condition caused by a stroke 466 509 569 9.4% 22.1% Dementia 1,440 1,613 1,882 12.0% 30.7% Depression 1,737 1,862 2,032 7.2% 17.0% Severe depression 552 594 672 7.5% 21.7% A longstanding health condition caused by bronchitis and emphysema 340 368 403 8.2% 18.5% A moderate or severe visual impairment 1,768 1,940 2,209 9.8% 24.9% A moderate or severe, or profound, hearing impairment 6,230 6,852 7,848 10.0% 26.0% Source: Registered populations applied to: CHD, London Health Observatory. CKD prevalence, Public Health England. People aged 65 and over, POPPI

Deprivation in Paignton and Brixham Locality Most deprived area is in Paignton Part of Roundham with Hyde Electoral Ward Least deprived area is in Paignton Part of the Churston with Galmpton Electoral Ward Source: 2015 English Indices of Multiple Deprivation, ONS.

Resident Profile: Least vs Most Deprived Areas Measure Least deprived small area (Churston with Galmpton) Most deprived small area (Roundham with Hyde) Life expectancy at birth (2011-2013) 85.1yrs 74.8yrs Life expectancy at 65 (2011-2013) 21.1yrs 16.1yrs Population under 16 (2013) 12.9% 18.6% Population 85 and over (2013) 5.5% 4.5% Index of Multiple Deprivation score (2015) 7.0 71.3 % income deprived (2015) 6.6% 40.5% % employment deprived (2015) 7.6% 37.3% Jobseekers Allowance Claimant rate (2011-2013) 1.2% 8.6% Emergency admission rate per 10,000 (2011/12-2013/14) 672 1,470 General fertility rate per 1,000 (2009-2012) 52.4 78.6 Source: 2015 English Indices of multiple deprivation, Births data, ONS. PCMD, SUS, HSCIC.

Least deprived area population profile Most deprived area population profile Source: 2015 English Indices of Multiple Deprivation, 2013 Population estimates, ONS.

Current Use of Services

Totality of Health Service Use in Paignton and Brixham GP Consultations: 506,380 Community Therapy and Nursing Services: 125,433 Secondary Care Outpatient Appointments: 106,614 Radiology events: 27,618 A&E and MIU Attendances: 23,482 Intermediate Care: 12, 300 Elective Acute Care: 11,335 Non Elective Acute Care: 6,624 Community Hospital Admissions: 1,154 Figures relate to activity not people and is based on available NHS data

Community Hospital Utilisation Paignton Hospital Admissions (Patients registered within locality) Total Admissions 723 Admissions (Patients registered outside locality) Of which, patients registered within the locality 380 47% 53% Of which, patients registered outside locality 343 Average LoS (days) 13 Total bed days 9,293 Brixham Hospital Admissions (Patients registered within locality) Admissions (Patients registered outside locality) Beds 28 Total Admissions 431 Of which, patients registered within the locality 287 33% 67% Of which, patients registered outside locality 144 Average LoS (days) 14 Total bed days 6,111 Beds 20

Activity Summary Activity Paignton and Brixham Locality Count of registered patients South Devon and Torbay DSR per 100,000 DSR per 100,000 A&E 19,485 26,658 24,032 MIU 6,790 9,349 12,883 Elective 20,207 12,678 11,101 Non-Elective 17,376 11,519 10,300 Outpatient - all activity Outpatient - single patients 97,666 121,456 107,547 50,379 32,566 29,403 Directly Age Standardised Rate (DSR) per 100,000 registered population 2013/14-2014/15 (annual average). DSR adjusts rates to take into account how many old or young people are in the population being looked at. Source: SUS activity data

Financial Pressures

Financial Projections As a CCG we are above our target resource allocation by 28m (c8%) Shortfall in budget against contract 15 million 2016/17 We have to close a significant potential funding gap in health and social care funding over the next 5 years For Torbay and South Devon this amounts to 142m in a do nothing scenario by 2020/21

Community Hospital Costs Hospital No of beds Bed Days No of Bed day Cost Admissions Avg. cost per Admission ASHBURTON HOSPITAL 10 3388 306.56 176 5,901 BOVEY TRACEY HOSPITAL 9 3088 326.22 235 4,287 BRIXHAM HOSPITAL 20 6253 261.81 431 3,798 DARTMOUTH HOSPITAL 16 4391 331.58 387 3,762 DAWLISH HOSPITAL 18 5278 362.28 440 4,346 NEWTON ABBOT HOSPITAL 20 7768 342.61 595 4,473 PAIGNTON HOSPITAL 28 9462 263.70 719 3,470 TEIGNMOUTH HOSPITAL 12 4476 267.80 261 4,593 TOTNES HOSPITAL 18 6016 285.04 364 4,711 Figures are based on 14/15 financial year

Minor Injury Unit Costs Cost Per Hospital Attendances Attendance Ashburton MIU 268 541.99 Brixham MIU 3081 93.56 Dartmouth MIU 3340 64.73 Dawlish MIU 3851 71.94 Newton Abbot MIU 16453 51.22 Paignton MIU 3274 71.45 Teignmouth MIU 3492 57.74 Totnes MIU 5665 85.78 Figures are based on 14/15 financial year

Community Nursing Costs Locality Activity (No. of Visits) Avg Cost Coastal 32,322 32 Moor to Sea 32,632 38 Newton Abbot 34,813 34 Paignton/Brixham 49,283 34 Torquay 43,228 32 Figures are based on 14/15 financial year

The Case for Change

In 2013 you told us you wanted: Accessible services convenient opening hours, transport and accessible buildings Better communication between clinician and patient, and between clinicians themselves Continuity of care to allow relationship-building with clinicians and carers Coordination of care including joined-up information systems Support to stay at home with a wide range of services and support.

Clinical Drivers National NHS strategy promotes switching resources from hospital care to out of hospital care The longer someone remains in a hospital bed the less likely they are to regain their independence Many people in a community hospital bed in South Devon and Torbay are medically fit to leave Safe staffing standards for medical beds requires 1 nurse to 8 beds and a minimum of 2 nurses any time. For some people, hospital at home care is at least as safe and effective as care in a hospital setting MIU staff should see at least 7,000 contacts per year to maintain all their skills

Into the Future

The Proposed New Model of Care

Clinical Hubs In each locality there would be a clinical hub providing people with better access to medical, clinical and specialist services. These hubs would offer a broad range of services to people and, although one is proposed in each locality, they could be used by everybody irrespective of where they live. Services provided across the hubs would include: Multi long-term condition clinics Minor injuries unit (Newton Abbot and Totnes only) Specialist outpatient clinics Rehabilitation gym Inpatient care

Local Health and Wellbeing Centres Health and wellbeing centres would be delivered from Ashburton/Buckfastleigh, Bovey Tracey/Chudleigh, Brixham, Dartmouth, Newton Abbot, Paignton, Totnes and Torquay. These would see community staff (community nurses, physiotherapists, occupational therapists, social care staff, coordination and support staff ) based locally and working alongside GPs, pharmacists and voluntary-sector organisations to provide health and wellbeing services to the area. Within these centres, the clinical services most frequently used by local people would, wherever feasible, be provided by professionals based locally and who would work across community sites.

Intermediate Care Investment in community based staff Expansion of care home and community provision Stimulation of the Care Home Market Flexible number of beds in Brixham Community Hospital

Minor Injury Units Concentrate activity in 3 settings Consistent opening hours Access to diagnostics e.g. x-ray 7 days a week MIUs in Newton Abbot, Dawlish, Totnes Close MIUs in Ashburton (currently suspended), Dartmouth (currently suspended), Paignton and Brixham

Community Medical Beds Up to 16 beds 2 nurses covering at any one time Locality Provision in Brixham, Totnes, Newton Abbot and Dawlish Close beds in Paignton, Dartmouth, Bovey Tracey and Ashburton

What would this mean for Paignton and Brixham? Clinical hub in Brixham (currently Brixham hospital) providing: New multi long-term conditions clinic Specialist outpatient clinics Community beds (16 beds plus 4 flexible use) Rehabilitation gym Pharmacist Health and wellbeing centre in Brixham providing: Health and wellbeing team Community clinics Health and wellbeing centre in Paignton providing: Community clinics Pharmacist Enhanced primary care MIU services Health and wellbeing team

How to Take Part in the Consultation

Come to a public meeting We have arranged public meetings to discuss the proposals across South Devon and Torbay. Those in the Paignton and Brixham locality are as follows: Location Date Time Venue Paignton Wednesday 28 September Brixham Thursday 29 September 9am, 4pm and 7pm 6.30pm Cecil Road Catholic Church Scala Hall

Fill out our questionnaire Please complete the questionnaire at the end of the main consultation document or available here electronically: www.communityconsultation.co.uk Your responses will go direct to Healthwatch who are collating feedback from the consultation and will be producing a consultation report at the end of the consultation period.

Invite us to a meeting in your community We are very happy to attend as many meetings that happen routinely in your community as is practical. To arrange this please use one of the following methods to contact us with your request: Call us on 01803 652511 Write to us at South Devon and Torbay CCG, Pomona House, Torquay, TQ2 7FF Email us at sdtccg.consultation@nhs.net

Read up on the detail There are detailed papers, including our main consultation document, available on our website www.southdevonandtorbayccg.nhs.uk/community-healthservices Follow on Twitter or Facebook Throughout the consultation we will be holding question and answer sessions on Twitter and using our social media pages for presenting information Twitter.com/sdtccg Facebook.com/ccgpaigntonandbrixham

Ask to receive our regular briefing We will produce a regular consultation briefing throughout the consultation period. If you would like to receive electronic copies of this, please email sdtccg.consultation@nhs.net Ask us a question You can contact us with your questions about the consultation via any of the following methods: Call us on 01803 652511 Write to us at South Devon and Torbay CCG, Pomona House, Torquay, TQ2 7FF Email us at sdtccg.consultation@nhs.net