HERTFORDSHIRE COMMUNITY NHS TRUST INTERMEDIATE CARE SERVICE UPDATE WINDMILL HOUSE MAY 2011 1. Purpose This paper provides an update on the outcome of the consultation to re-provide Intermediate Care Services currently based at Windmill House. It summarises the engagement and consultation processes, highlights the feedback received and outlines the proposed next stage of implementation. 2. Glossary of Terms HCC - Hertfordshire County Council HCT - Hertfordshire Community NHS Trust IC - Intermediate Care LINk - Local Involvement Network PCT - Primary Care Trust WHHT- West Hertfordshire Hospitals Trust 3. Recommendations The Board is asked to:- Note the outcome of the engagement process and implications for Windmill House Agree the implementation of the transfer of Windmill to Langley pending confirmation from the PCT Board Note the broader implications on estate and intermediate care strategy development 4. Background NHS Hertfordshire s Intermediate Care Strategy outlines their intention to re-provide intermediate care inpatient beds across Hertfordshire, utilising care home and nursing home beds. The first phase of implementation targeted intermediate care bed provision in the Bushey, Watford & Rickmansworth locality, specifically looking at the future provision of beds at Windmill House. In response to these proposals and in order to continue to meet care needs locally in terms of demand for complex rehabilitation services, step down care from the acute hospital (WHHT) and stroke rehabilitation service requirements, the HCT Board approved a business case to consolidate beds at Langley House. This proposal also provides value for money, in terms of achieving full utilisation of the Langley site, whilst securing income for the ongoing provision of services. During the engagement period, HCT has consulted with staff on these proposed changes.
Between 3 February 2011 and 26 April 2011, NHS Hertfordshire (PCT) undertook a 12 week period of public engagement on the intermediate care strategy for the county which also set out specific proposals for public consultation on intermediate care services for residents of Watford, Bushey and Rickmansworth as follows: Promote the integration and development of community intermediate /enablement care so that more people can be looked after in their own home to avoid unnecessary admission to hospital or following an acute hospital stay Transfer the majority of NHS intermediate care beds to Langley House, Watford and close Windmill House Purchase additional beds from independent sector care homes close to where people live if health and social care services assess that bed-based community care and support is needed 5. Engagement and Consultation The PCT have led discussions with local GP commissioning groups and community and patient representatives including Hertfordshire LINk. An update was presented to Hertfordshire County Council Health Scrutiny Committee at its October 2011 meeting. In November 2010, a conversation cafe was held bringing together a wide range of local agencies including patient, carer and voluntary sector representatives, local county councillors as well as provider and commissioner organisations. This event provided the foundation for the development of specific proposals for Watford, Bushey and Rickmansworth. 6. Public consultation for Watford, Bushey & Rickmansworth Public consultation on the specific proposals for Watford, Bushey and Rickmansworth started on the 3 February 2011 and during the consultation period, the views of local people, community representatives and NHS staff were sought. The PCT & HCT presented and discussed the proposals at meetings with:- Watford and Three Rivers Carers Network, Watford Senior Citizens Forum, Patient Groups linked to WatCom and Hertsmere GP Commissioning Groups Hertfordshire LINk GP Commissioning Groups (part of the Herts Valley GP Commissioning Consortium) Hertsmere Strategic Health Overview Group (chaired by Hertsmere Borough Council) A conversation café was held in Bushey which was independently hosted and facilitated. Senior representatives of the three partner consulting organisations participated with local patient and voluntary sector organisations. The PCT and HCT attended a public meeting organised by the Save Windmill House Campaign Group attended by 60 people. Page 2 of 8
7. Consultation Findings key themes Appendix 1 provides an extract from the PCT Board Report (being presented to the PCT Board on 25 May 2011. In addition to the specific responses the PCT has provided, NHS Hertfordshire has also provided a number of overall assurances regarding the issues raised:- Providing Care Closer to Home The PCT has stated that more patients from Watford, Rickmansworth could be cared for in Langley House which is closer for them. Bed based care will be commissioned when needed in the Bushey /Bushey Heath area thus retaining IC services locally. Reprovision for Bushey/Bushey Health Following a review and visits to care homes and nursing homes in the area, the PCT believes there are homes locally that can provide the quality of care, have the capacity and provide better value for money for IC services. Should the PCT board conclude that it will proceed with the closure of the intermediate care beds in Windmill House, they will proceed to purchase 5 beds for a 6 month period to test the use of care home provision, negotiating a vacancy reduction. Blocks of 5 beds will be purchased in one facility. Care will be of equal if not better quality The PCT has developed a detailed specification for the services that they wish to commission. All homes have been visited and have to be registered with the Care Quality Commission and all those that have been visited have a current contractual relationship with either the NHS or HCC. 8. Outcome of the Consultation PCT proposal Following the engagement process and having taken account of the views and comments received the PCT believe that the intermediate care strategy is supported. Although concerns have been raised regarding the loss of services in Bushey/Bushey Heath the PCT has concluded that this has been mitigated through the plans to commission intermediate care beds from local independent care home providers and the retention and development of community based intermediate care and enablement services. The PCT are recommending to their Board that the proposals to close Windmill House and re-provide inpatient beds at Langley House and via independent care homes are approved. 9. Next Steps for HCT Pending formal confirmation from the PCT following their Board meeting on the 24 May that they wish to proceed there are a number of actions HCT will need to take:- Page 3 of 8
Transfer of Windmill to Langley HCT will need to proceed to implement the transfer of services from Windmill House to Langley Hospital. 16 beds will be opened at Langley House in the Pembroke wing. HCT has already completed consultation with staff, and their feedback will inform the way services are configured at Langley and staff transfers. The proposal will be for a fully integrated team at Langley, with staff rotating through the unit. The staff have raised a number of issues as part of the consultation regarding concerns about the integration in terms of clinical and administrative space, and the need to consider the gym space available at Langley House. These issues will need to be addressed and there may be some estates work required. Implementation is likely to take place in two phases over a period of two months. Peripatetic Support to Care Homes HCT needs to confirm the service model with the PCT to provide therapy and nursing support into the care homes. This will be based on the minimum of 5 beds, and will be a model that is likely to be rolled out across other areas of Hertfordshire as the Intermediate Care Strategy is taken forward. The PCT has indicated that it will take approximately 4 weeks following a decision to buy beds at an independent care home for these to be available. This will include staff training, protocols developed with the provider, HCT and the relevant acute trust and GP Practices. Medical Cover There is already a well established model of GP practice support for independent providers and the PCT will negotiate new arrangements with a local GP practice if this is needed to cover any increased independent care home provision. For HCT, the medical contract with WHHT is under review and will be adjusted accordingly to ensure adequate provision at Langley Hospital. HCT will need to give notice on this. Home Based Care development Given the stated PCT strategy to develop home based services to reduce the reliance on inpatient intermediate care bed, HCT will be working closely with the PCT/PBCs to identify the service model and to secure funding to implement an enhanced service. It is anticipated this will be done initially through access to the transformational funds and bids will be firmed up with the PCT in June to support this. This includes intermediate care home based services, but as importantly covers the full range of core adult home based service. This will be addressed within the overall HCT intermediate care strategy which is under development. Page 4 of 8
Estate ownership The Windmill House estate has previously been identified for transfer to HCT as part of the overall transfer of community estate. This is due to take place in September. However, the PCT have indicated that they may wish to reconsider the transfer of this estate given the proposed outcome of the consultation for Windmill House to be vacated prior to the September transfer. PBC groups have indicated they may wish to look at the future use of the site in conjunction with HCT, and may look to secure the site themselves. HCT need to conclude and secure the estates transfer with the PCT and agree the estates strategy for the Trust. 10. Conclusion This paper has provided an update to the Board on the outcome of the PCT consultation to re-provide Intermediate Care beds for the Bushey, Watford and Rickmansworth locality. The Board is asked to approve the transfer of services from Windmill House to Langley, pending formal confirmation from the PCT. It is also asked to note the broader implications of the outcome of the consultation which will need to be considered as part of HCT s estate and intermediate care strategy development. Karen Taylor Deputy Chief Executive 16 May 2011 Page 5 of 8
APPENDIX 1 Extract from PCT Board Report May 2011 Consultation Feedback Main Themes and PCT Response Vision & Strategy Local GPs and the acute hospital trust welcomed the development of integrated community teams and care in more local facilities with appropriately commissioned nursing and therapy support. Patient and carer representatives welcomed the intention to join up services. Some cynicism was expressed as to whether the NHS and HCC can deliver the necessary changes. Care & Support in people s own homes There is support for enabling more people to stay in their own homes, with GPs keen to see effective alternative services to prevent unnecessary hospital admissions and A&E attendances. GPs want to be involved in implementing the new arrangements. Concerns were raised regarding capacity of community teams and with regard to overnight/24 hour services and the burden on carers. Whilst supporting intermediate care and enablement at home for those who can manage, campaigners highlighted the needs of people living alone and elderly carers. PCT Response: The intention is to have bed-based intermediate care provision complementing well-developed community intermediate care services. A new specification for delivery sets out a 2 hour response time for teams to provide prompt care for patients and prevent unnecessary admissions. This is already happening on some parts of the county. In Welwyn & Hatfield a GP commissioning consortium pilot project involving primary, community and secondary clinicians is taking forward the development of an integrated single assessment process aimed at providing a rapid response service to care and support people in their own homes. Windmill House as an intermediate care location There is local opposition to the proposed closure of Windmill House and the loss of the site as a health facility; concern also regarding the potential loss of beds with a growing ageing population. A few respondents had been looked after in Windmill House and praised the care they had received. Some people raised the recent refurbishment and perceived waste of resources. GPs recognised that the provision of care in this environment was not ideal. A hard copy petition with over a 1000 signatures was delivered to the PCT by the Save Windmill House Campaign Group together with 150 signatures on line. The petition wording is as follows: We the undersigned are concerned about the proposed closure of Windmill House and the problems this will cause for the elderly in the community and for the potential negative impact on the local environment. We therefore urge NHS Hertfordshire to reconsider its proposals and to keep Windmill open as an NHS facility. Page 6 of 8
Response: The consultation was not about the future of Windmill House site and under NHS Estates guidelines alternative health and social care uses have to be explored thoroughly before it can be considered surplus to NHS requirements. This work has not been undertaken. Many respondents appeared not to realise that beds would be commissioned in Bushey/Bushey Heath for local people needing intermediate care. Whilst the strategy is to move away from reliance on bed based care and to further develop community health and social care services, buying beds when needed locally from a greater number of providers introduces greater flexibility and provides better value for money. 5 beds will need to be commissioned in the Bushey/Bushey Heath area to provide local bed based care. Discussions have taken place with a number of potential providers. Langley House as an intermediate care location Most of the concerns raised were from people living in Bushey / Bushey Heath regarding access to Langley House and their experiences of care that they felt was not as good as Windmill House. A few people raised environmental issues, citing the quality of the air in North Watford. People also questioned whether Langley House has sufficient capacity to cope with the proposed increase in its catchment. Response: The consultation document highlighted the fact that only 16% of patients who received care in Langley House during 2010 lived locally with over 60% living in Watford and Rickmansworth. The majority of visitors, therefore, have to travel now. Langley House has 32 beds and could open a further 16 beds to accommodate those patients from the Watford / Rickmansworth areas that are currently looked after in Windmill House. During 2010, a quality assurance review of Langley House was carried out by the PCT s Nursing and Quality team as part of its programme. The unit was commended for the improvements made in privacy and dignity and the strong leadership given it its senior nurses. Alternative provision, capacity and capability Respondents questioned the availability and capability of independent local providers of IC services and whether they could provide the level of nursing and therapy services needed. Response: The capacity and suitability of independent local providers has been investigated and a number of them would be able to provide the capacity for the Bushey / Bushey Heath area. If the Board approves the purchase of beds in alternative settings, then we would be able to put in place the necessary arrangements. Additional nursing and therapy care, if needed, would be commissioned from a number of providers including HCT. The specification for the intermediate care bed based services will be the same for all providers whether NHS or the independent sector. The specification has been discussed with Hertfordshire care and nursing home providers at a number of meetings. Since the start of the consultation, HCC enablement services have Page 7 of 8
been rolled out in west Hertfordshire. These provide social care support to maintain independence and should reduce the number of hospital admissions and premature placements into long-term care home provision. Other themes from discussions included discharge planning, medical cover at Langley House and environmental issues Response: The importance of discharge planning cannot be overestimated and is a high priority for all NHS, social care and voluntary sector organisations. A pilot project providing social care support at weekends has been running at both Hertfordshire acute trusts over the last few months. This has enabled more patients to be discharged safely at weekends. The specification for intermediate care for all providers includes the commissioning of appropriate GP/medical cover. Consultation issues Is this a done deal was asked by one or two people and was mentioned in the response by the newly formed Save Windmill House Campaign Committee. The Committee also mentioned that local councillors were not informed. Response The intermediate care strategy was agreed by NHS Hertfordshire in July 2010 following over two years of discussions between the NHS, county council and voluntary sector organisations. County and district councillors on the Health Scrutiny Committee were formally briefed in October 2010 on progress and invitations to the October conversation café were sent to all county councillors in the area as well as many local voluntary organisations supporting the elderly. Proposals for consultation were therefore developed following a lengthy preconsultation and engagement period and are supported by the partner organisations. The views/concerns of the campaign committee and individual signatories to the petition have been taken into account in the recommendations and will be considered by the NHS Hertfordshire Board. Page 8 of 8