Agenda item

The Committee received a report from the Director of Transformation and Partnerships and a report from the Deputy Chief Executive of the County Durham and Darlington NHS Foundation Trust (CDDFT) that provided information following recent press articles concerning the future of ward six at Bishop Auckland Hospital (for copy see file of Minutes).

 

The Principal Overview and Scrutiny Officer appraised Members of the background to this report and reminded them of the meeting on 7 September 2018 whereby they considered a report from the Director of Integration about the community hospital offer and bed compliment at each facility. As Members were aware there had been media coverage around ward six at Bishop Auckland Hospital and further to a letter from the Chairman the consultation had been halted.

 

The Deputy Chief Executive of CDDFT extended an apology on behalf of the Trust to the Chairman and committee members.  She said that it had been right to talk to staff first but did recognise that Bishop Auckland Hospital was close to everyone’s heart and she recognised that discussions should have been had with the Adults, Wellbeing and Health Overview and Scrutiny Committee.

 

She went on to assure the committee that the Trust’s overarching commitment was to deliver safe and effective care for all patients.  There had been a change in demand for ward six, in particular, the need to look at the service model going forward.  She wanted to assure members about the dialogue with staff on the model of care for the patients using ward six and would bring back any future proposals here and to any other stakeholders when discussions had been finalised.   She went on to say that Bishop Auckland Hospital had a vibrant future with improved facilities providing a wide range of services with a great level of investment in radiology equipment. There were five inpatient wards.

 

Moving on to ward six, the Deputy Chief Executive reported that this provided nurse led care and was step down care provided around 24 beds by Advanced Nurse Practitioners.  It did not have rehabilitation support.  Work had been ongoing to look at the patients transferred to ward six to ensure that this was the right place for them for receive the right care.  She highlighted the evidence drawn up from these conclusions, the quality improvements carried out on the ward, implementation of discharge to assess and Teams Around the Patients (TAPs).  The Deputy Chief Executive reported that the average length of stay had reduced from 28.41 days in 2016/17 to 13.10 days at the end of October 2018/19.

 

Members were informed that ward six had also recently been used to help support the deep cleanse de-cant programme from the University of North Durham site due to work already carried out on ward six.  This prompted the consideration of different models of care with the engagement of staff and this had been used as part of the dialogue with staff as part of the HR process.

 

The Deputy Chief Executive acknowledged on behalf of the Trust that this had not been managed as well as it could have been and language used had been loose which was not good content to have for staff dialogue and had caused a level of concern.  She assured the committee that lessons had been learnt and actions put into practice to remedy that.  The issues had been addressed directly with those staff affected in one to one sessions and the period of dialogue had been extended.  The formal HR process had ended but the Trust would continue the dialogue.  It was also acknowledged that documentation was not as it should have been and feedback sessions had been held with union representatives and staff.

 

With regards to the staff consultation, lots of ideas and suggestions had been put forward and assurances had been given to staff to set up a series of mini short rapid improvement workshops whereby scenarios would be used for staff and patients on ward six and how those needs could be met.  Work would be ongoing with staff to pull proposals together and early in the New Year the conclusions and options would be presented to scrutiny and other stakeholders in terms of wider engagement.

 

The Chairman accepted the assurance from the Trust that there would be no closure until all options had been considered and presented.  He thanked the Trust for the report and invited questions from committee members, other members and members of the public.

 

Councillor Patterson thanked the Chairman for halting the proposal to close and thanked the Trust for coming along to the meeting today.  She made reference to the 24 beds being reported at the meeting on 7 September 2018 when plans had already been made for the closure.  She said that the proposal had caused unnecessary stress to staff and patients.  She appreciated that patients mattered but asked what about the staff, and did they not matter too.  She welcomed the apology and defended the power of scrutiny to call this decision in to the Secretary of State.  Councillor Patterson felt that the report did not set out the public consultation options and did not contain any future proposals about what would happen to staff and patients.  She asked for an explanation on the rationale used behind the decision making process.  She would like to see that the public consultation was meaningful and would like to see a full report to scrutiny showing the rationale behind any options put forward.

 

Councillor Smith believed this to be a damaged limitation exercise and that engagement should have been carried out with staff before an announcement was made.  She understood from speaking to staff in the ward that this had de-stabilised the team on ward six that was a fully staffed ward, with some staff members looking for employment elsewhere.  The patients looked after on this ward often had complex needs, could be homeless or awaiting a place in a care home or some whose families were not willing to take them home.  She re-iterated the point that this was a step down nurse led ward and putting patients in acute care would be bed blocking.  She found the timing of this announcement strange due to winter pressures being around the corner and the fact that the ward was heavily used.  She felt that this was an opportunity for the Trust to use this ward to plug gaps elsewhere and reported that this was how staff also felt.  Councillor Smith commented that it was strange to choose this ward for closure when it had no clinicians or consultants to stand up for it.  In her opinion it was an easy target but she was glad that the ward had a reprieve.  She said that the staff on this ward, including student nurses did a very good and valuable job.

 

Mrs Hassoon commented that there was no anecdotal evidence about the people discharged to home or the additional cost to send them home.  With regard to winter pressures she asked how many people would be bed blocking in acute care as a result of the closure of the ward.

 

The Deputy Chief Executive re-iterated her point that the option would be worked up and reported back to committee when the engagement exercise had concluded.  She agreed that nothing would change until the way forward was agreed.  She had already acknowledged that the engagement would be followed by HR consultation and would be the right way forward in future.  With regards to the destabilisation of staff she confirmed that the Trust were aware of this and were aware that some staff had secured job offers elsewhere. The Trust were in discussions with staff about their willingness to stay and that their contribution would help to shape the future of the service.  She agreed that the point made about winter pressures was well made.  She advised that beds were flexed across all hospital sites on a continual basis and that this was based on demand and would continue.  Referring to patients with complex needs the Deputy Chief Executive explained that the level of care was about ensuring that people were in the right place to receive it.  Acute beds were not always the right place and step down beds were in a hospital setting.

 

Councillor Bell concurred with Councillor Smith’s comments in that the ward provided a great service.  He found that the announcement of the closure was an effective use of mismanagement as this caused destabilisation of staff who would then leave and the ward would not be able to take on as many patients.  This in turn would show that the numbers on the ward were declining, deliberately running it down.  He had found nothing in the report to justify a closure.

 

Councillor Darkes commented that he had heard nothing from the report today that demonstrated the standardised working practice.

 

Referring to the statistics around complex discharges Councillor Savory was concerned about homeless people being released and the increased role for the already overstretched District Nurses.  She was also concerned that people living in a rural community would not get the same 24/7 level of care.  She urged the Trust to retain ward six.

 

Councillor Crathorne appreciated the fact that it was better for patients to be in their own homes but asked how the Trust could guarantee the care would be available with people on the ground to deliver it in the community.  She added that the community nurses were already stretched.  She also asked that ward six be retained.

 

Responding to these comments, the Deputy Chief Executive said that she noted the comments about her report and had explained that she would be working up a proposal with options to bring back to committee.  In respect to the comment made about deliberately running the ward down, she confirmed that the ward was very well used with high occupancy and that there was no intention not use the facility when it was still available.  Referring to the decant issue, she advised that the Trust would like to have this facility and that it was linked to being able to use bed stop on a flexible basis.  This would be drawn together as part of the proposals.  She had already acknowledged that the Trust did not handle the staff consultation very well and that they were addressing those points.  With regards to supported discharge she confirmed that this would not happen unless the patient was ready to leave.  Discussions would always take place to ensure that the right care was available at the right place.  In practice the Trust did not want people staying in hospital beds for longer than was necessary and that this would be supported through community services and Teams Around the Patients. 

 

The Director of Integration referred to her report to this committee on 7 September 2019 where she highlighted the compliment of community beds across the county but that the main focus of the report was about DDES hospitals.  She reported on activity in those settings and that beds would continue to be utilised, being fit for future use and providing a valuable community resource.  The Trust would continue to monitor take up and patients would be assessed effectively with the correct assessment and discharge arrangements in place.

 

Councillor Henderson asked what the Trust were trying to do, as all he had heard was that they were trying to close a ward of 24 beds.  He expressed concern as it had already been addressed about the shortage of GPs in the County and that if people were not in hospital this would impact and increase their workload further.

 

Councillor Temple commented page 2 of the report provided to the Committee by County Durham and Darlington Foundation Trust and to the evidence showing that “longer stays in hospital can lead to worse health outcomes and can increase long-term care needs. Research has identified that 10 days in a hospital bed leads to 10 years’ worth of lost muscle mass in people over the age of 80 and reconditioning takes twice as long as this deconditioning. Councillor Temple commented that J Gerontol in this research had used 12 subjects and none of them were over the age of 80.  He therefore queried the use of these statements as facts and said that he would like to see genuine evidence being used to reassure us.

 

Councillor Kay referred to the public meeting held on 18 October 2018 whereby the Trust were informed that this closure would lead to dire and severe consequences for patients.  He added that the transition of services to social care was already broken and could not take any more.  There was a recognition that the Council needed further funding for social care.  He said that the matter would be referred to the Secretary of State should the final proposal be to close the ward.

 

The Chairman invited questions from the other councillors in attendance.

 

Councillor Manchester referred to the duty on the Trust to consult with the local authority over any substantial changes.  He appreciated the apology given however commented that it if had not been for the letter from the Chairman the ward would now be closed.  He asked the Trust to ensure that a full consultation was carried out and concerns addressed.

 

Councillor Allen felt that the plans had been ill judged and poorly implemented.  Staff had been informed that ward six was closing and had it not been for the intervention of the scrutiny it would have already closed.  She was extremely grateful for the actions from the Chairman.  She was concerned for the staff on the ward as morale was low and she hoped that they would not leave.  The ward was fully staffed and she said that we needed to do everything to keep them there.  She was concerned that the nurse practitioners who supported the staff had not been part of the consultation.  With regards to the length of stay she commented that this was sometimes caused by other delays in the system.  She appreciated that the Trust were experiencing financial problems but she asked that the staff of ward six be supported and that the ward be retained.

 

Councillor Zair thanked the Chair for his swift action and said that everyone was passionate about the hospital and the health service in general.  He asked that if the closure of ward six and its 24 beds took place were the Trust confident that this would not lead to pressures in acute services, leadings to delays in treatment and community resources.  He was also concerned about people being discharged too early and then having to be re-admitted for the same procedure.  He added that social workers and care agencies were also concerned as they had reported insufficient resources available within the community.  He said that it was important to take on their views as care in the community was a vital service.  Councillor Zair commented that people were living longer but still needed the health care that they deserved and a bed reduction programme would not guarantee that.  He reported that ward six was full to capacity which evidenced the need to retain it.  He asked the Trust to listen to the public, the staff and to take the consultation seriously.  He asked who knew about the plans for closure and were these discussions had taken place.

 

The Deputy Chief Executive said that she had already given her assurance that an options report would be brought back to committee.  With regards to beds being used, she advised that there were pressures elsewhere in the system and that they need to ensure that there was flexibility.  There was less demand on beds during the summer months however during the winter period these beds could be opened up to alleviate the pressure.  She reassured the committee that discharged planning for based on each individual and re-admissions occurred for a whole range of other issues.  She confirmed that the ward was full at present and as she had given an undertaking to the chair that nothing would change until a full consultation had been carried out, she took comfort that the ward was being fully utilised.

 

In response to a question from Councillor Zair who made the decision, it was confirmed that this was linked to the bed reduction programme and was discussed at the Foundation Trust executive meeting.

 

Councillor Quinn having declared an interest in this item, said that as she worked in a nursing home with six dedicated beds and the home had been told the week before this announcements that they had been commissioned for another three years.  She added that these beds were dedicated as step down beds with physio treatment offered.

 

Councillor Thompson said that this had been an excellent scrutiny meeting and expressed his concerns that this type of care would only increase as people lived longer, and therefore the bed provision would need to increase not decrease.

 

Referring to the consultation Councillor Shuttleworth asked if the Trust would listen to what people were saying as there was a lot of passion about this ward and the hospital itself.

 

Councillor Wilkes asked for confirmation of who knew what and when about this issue.

 

Councillor Hovvels said that this meeting had demonstrated the role of scrutiny and said that this was the correct way to deal with this issue.

 

Referring to a personal issue in relation to early discharge of patients Councillor Maddison asked if the Committee could look at acute medical conditions for the discharge process at some point.

 

The Deputy Chief Executive assured members that she did not know about the IC plus beds and therefore there was no conspiracy.  She did not have the details of who, what, why but that the details were discussed with the clinical leadership and executive leadership within the Trust.  She could not answer today if the ward would stay open but she confirmed that they would make a decision on what they had heard.  With regards to the discharge process she confirmed that the Trust were working with staff on a number of different scenarios.

 

In relation to the IC beds, the Director of Integration advised the committee that the beds were commissioned by the County Council as they hold the contracts for these beds.  The contracts vary in length however most were for a period of three years.  She confirmed that in this instance there was no other reason other than that the contracts were due for renewal.

 

The Healthwatch representative, Mr Shore, was dismayed at the way in which they had found out about the closely however he wanted to assure the committee that they were working very closely with the Trust.  They were grateful for the discussions held so far but had not received full disclosure.

 

The Chairman thanked the members for their questions and asked the members of the public in attendance for any questions.

 

Mr Neilson informed the committee that he had been campaigning for Bishop Auckland Hospital for many years and had worked with the current Chairman of the Trust and a number of local members on highlighting issues of concern.  He reminded the members of their right to call in this decision.  With regards to ward six and the 24 step down beds he said that there could not be a compromise and with people now living longer they needed further care, not less. He believed that community care was overstretched and in chaos and that bed blocking prevented people from receiving treatment and care.  He went on to say that this decision would not only affect Bishop Auckland, but Durham and Darlington.

 

The Deputy Chief Executive said that these were points well made in terms of bed blocking and life expectancy and she would be demonstrating the care that the Trust could provide.

 

The Chairman thanked everyone for attending and taking part in the discussion.  He asked that the Trust come back to the committee at the meeting arranged on 18 January 2019 with the results of the consultation exercise, providing a full options proposal.

 

Resolved:

(i)            That the reports be noted:

(ii)          That the data, actions taken and progress to date be noted; and

(iii)         That comments on the actions taken to date be noted.

(iv)         That a further detailed report on the options be reported back to the Adults, Wellbeing and Health OSC on 18 January 2019.