Agenda item

The Chairman introduced the Director of Integrated Community Services, Lesley Jeavons and asked her to present an update report on Community Hospitals (for copy see file of minutes).

The Director of Integrated Community Services reminded Members that she had attended Committee in May this year with a report on Community Hospitals and now had a further update in that respect.  She reminded Members that back in April 2017 that Senior Officers from the County Durham and Darlington Foundation Trust (CDDFT) and North Durham and Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Groups (CCGs) had met and requested that consideration be given to the role and function of part of the Community Hospitals offer across County Durham, with a view to recommending options for service delivery over a medium to long term.

Members were referred to a table at Paragraph 3 within the report, setting out the complex tenure and mix within the Community Hospital estate in the County.  The Committee noted previous reviews and the funding arrangements in terms of those via block contract and those via a payment by admission. 

The Director of Integrated Community Services referred Members to Appendix 2 to the report which set out the current position in terms of bed use at the Community Hospitals.  It was added that work undertaken had shown that some patients had experienced two discharges prior to returning home, with patients coming from acute sites to intermediate care where it may have been possible for them to return home in the first instance.  Members noted that the ethos in Durham was “home first” and that this would be possible more as community services developed.

Members were referred to the types of staffing and medical cover provided at the Community Hospitals across the County and of important service development opportunities as the emphasis shifted away from acute hospital environments and to a service closer to a patient’s home.

The Committee learned as regards issues in relation to therapy, day hospital functions, delayed transfers of care and other services delivered from Community Hospitals.  Members were reminded of the Teams Around Patients (TAPs) initiative and how this was linked to more services being provided in local communities.

The Director of Integrated Community Services noted that since reducing the bed base in September 2017 across three of the hospitals, the remaining beds were operating at an effective level and there was a flexibility to be able to open additional beds in times of surge and increased activity. 

She added there was the link to TAPs and that the recommendation from the previous Director of Integration had been for no change, noting the ongoing work in terms of Shotley Bridge Hospital, which was subject to a separate report for consideration by Members at today’s meeting.  It was noted that there would be additional work undertaken in terms of looking at internal efficiencies and that there would be continued monitoring in terms of the bed use within Community Hospitals to inform whether the bed base was being utilised effectively.

The Chairman thanked the Director of Integrated Community Services and asked Members for their questions and comments on the report.

Councillor R Bell asked as regards those elements of the estate that were subject to Private Finance Initiatives (PFI) and whether once the period of payments had completed was the building owned by the Foundation Trust.  Councillor R Bell noted that the strategic direction seemed to be to look to discharge straight from acute care to the home wherever possible and asked how local communities would “know” as regards those patients and how local people would know that the relevant community services were in place, what safeguards were in place.

Councillor R Crute noted that the table at Paragraph 3 referred to bed compliment, however, the report in the agenda pack in connection to Shotley Bridge Hospital stated that less than 24 beds was “not effective” and asked as regards the differing statements.

The Chief Executive Officer, CDDFT, Sue Jacques noted that in respect of PFI, once the payments had been made the property would transfer to the NHS, with significant savings from that point.

The Director of Integrated Community Services noted in terms of local communities knowing about the role of Community Inpatient Beds and the new “Teams around Patients” model, there was a job to be done in terms of the publicity of services as part of the mobilisation and transformation process, and this had been identified.  She added that this was an area the Committee may wish to monitor and noted she would be happy to come back to update Members in relation to progress, uptake and outcomes.  She noted that from surveys and interviews it would be possible to add information in terms of peoples’ actual experiences of community services.  The Chief Clinical Officer, DDES CCG, Dr S Findlay noted that access to the TAPs was not direct, rather there would be referral via GPs and District Nurses and therefore there would be a coordinated flow overseen by the relevant professionals. 

The Director of Integrated Community Services noted that in terms of bed compliment that how beds were used in the future would be reviewed at that time.  Councillor R Crute noted that Members needed some definitive advice in terms of numbers that were cost effective and that there were concerns that the inpatient beds numbers within Community Hospitals could be linked to their long term sustainability. 

Councillor R Bell supported Councillor R Crute in terms of being able to understand what “critical mass” was required and that this was an issue to be watched very carefully.  Mr D Taylor-Gooby noted all involved “wanted it to work”, however, there was a need for information on how it would work, as there had been an aspiration in terms of this for a long time and there was a need to have the public’s confidence.

Resolved:

(i)        That the update report be received for information.

(ii)        That the work underway to utilise space across the estate be noted.

(iii)       That a further report be brought back to the Committee which sets out the performance management framework which was to be established around the Teams around Patients model and how this was delivering improved healthcare outcomes for patients.

The Chairman noted that Item 7 on the agenda, in relation to the Review of Specialised Vascular Services, would be taken as the next item, Item 6, with the Shotley Bridge report to be taken after as Item 7.