Agenda item

The Committee received a report of the Director of Transformation and Partnerships and report and presentation by representatives of County Durham and Darlington NHS Foundation Trust that provided an update on the proposals for consultation/engagement on the future of ward 6 at Bishop Auckland Hospital (for copy see file of Minutes).

The Director of Commissioning and Delivery gave a detailed presentation that highlighted:-

·        Background

·        Vision

·        Scope of Review

·        Current Service

·        Patient and Carer Feedback

·        Patient and Carer Themes

·        Case for Change

·        Options Appraisal

·        Preferred Option

·        What this means for patients in County Durham

·        Next Steps – ratify decision at executive and governing body, consultation planned 7 October for 10 weeks.

The Director of Commissioning and Delivery would welcome any suggestions to meet with groups in the community in addition to those already planned and would welcome any comments on the consultation.

The Chair reminded people to take part in the consultation process. He invited questions from members of the committee, other members and those members of the public who had requested to speak prior to the  meeting.

Referring to the report Councillor Bell picked up that the majority of patients did not receive therapy, however pointed out that 43% of patients did.  He went on to say that there was an implication that it was a waste of time being on the ward if it could not offer rehab or therapy, but he challenged that assumption.  Councillor Bell also said that with the vision of offering care closer to home should not exclude the Richardson Hospital.  He had not seen any evidence to show that community services were working and therefore could not support the proposal. 

The Director of Commissioning and Delivery confirmed that there was access to therapy at the Richardson Hospital.  She added that significant investment had been made to redesign and increase staffing levels in order to change the ways of working, together with the voluntary sector to maintain people’s health.  She agreed that there were really good services offered and that the proposal was to reduce the number of beds but to still have capacity at Bishop Auckland Hospital.

Dr Smith added that the majority of patients were at the older age of the spectrum and that they often required specialist therapy input.

Further to a question from Councillor Jopling about the length of time a patient could stay in ward 6 the Director of Commissioning said that all patients were treat as individual cases and the CCG were not saying that a patient could only stay on the ward a certain length of time.

Councillor Kay commented that the report was stating that ward 6 was not closing, and that the length of stay had reduced from 22 to 12 days.  He pointed out that the merger of two wards would affect the number of beds and therefore the overall time of stay would reduce.

With regards to the campaign by local people and members Councillor Smith said that this had had a positive effect on stopping the closure of ward 6 and she welcomed the prospect of better therapy input for patients on the ward.  She however was concerned that community services could only be effective if those services were in place and effective.  Councillor Smith referred to the stroke rehabilitation report whereby a clinician had said that one of the major causes for concern was in the provision of community services.  The Commissioning and Development Manager confirmed that this quote was not specifically about stroke rehabilitation but about the proposed changes and ensuring community provision.  The Director of Commissioning and Delivery added that it was important to get people to the right place and getting processes right.

Mrs Hassoon was also concerned about community services and that there seemed to be no continuity of care.  She was also concerned about the prescribing of medication and asked that care plans be looked and fit for purpose, especially as this was a lot of money coming from the County Council’s budget.  The Chair agreed that there was a potential impact on County Council services and the budget.

Councillor Allen welcomed the plans for the consultation and thanked those people who had signed the petition to keep the ward open.  She said that she would continue to fight for more beds and was disappointed to see that the proposals were looking at removing 8 beds and redeploying nursing staff.  She supported care closer to home but did have concerns about the ability to cover holidays, sickness and training.

Referring to the consultation Councillor Lethbridge asked how many people in Bishop Auckland knew about the proposals and the reduction in the number of beds.  He added that there were genuine fears within the community about the overall plans for reduction of services.

The Director of Commissioning and Delivery commented that the proposals had been formed on evidence of data and talking to staff and patients and that the point of the consultation was to consider everything before making a final decision.  She confirmed that the staffing ratios would be maintained and were always compliant with headroom to cover sickness and training.  She added that the guidance was changing and that the services also needed to evolve and change and that the this was about ensuring a better service on the ward, using the money available in the best way to get the best outcomes for the patient.

Mrs Evans was concerned about the actions of the CCG cutting services from the hospital and was baffled by the scrutiny process.  She found the documents produced impenetrable.  With regards to ward 6 she believed that the CCG were planning to close it and that despite the consultation it was a done deal.  She added that members of the public felt that the plan was to close ward 6 and open other wards as therapy wards.  She said that the lack of trust was increasing by the day with regards to the CCG as there were cuts to services in Bishop Auckland and the Dales.

The Chair reminded all that the consultation started in October and confirmed that Scrutiny would hold the CCG to account.  He encouraged people to respond to the public consultation and that the results would come back to this committee.

Mrs Burton referring to figure 4, page 11 said that there was a higher rate of admissions for 2018/19 and 81% of admissions were emergencies hence the need for escalation beds however page 10 stated that escalation beds were already included in the figures.  She asked how many escalation beds were being included and how much did that inflate the figures of bed occupancy.  She went on to comment that this proposal stated that patients would be referred to other community hospitals such as Shotley Bridge Hospital where current admissions stand at 2,471 and asked if it was under threat of bed closures or beds being moved to community care provider and if so how could this proposal work if that happens.  Mrs Burton continued and referred to page 19 of the document which stated preferred use of “home first” philosophy and Teams around Patients and stated “now they are supported by the local authorities and partner agencies”.  She asked if professionals were travelling to see individuals was this not more expensive than if they were on a ward, transferring the responsibility of cost from the NHS to the Local Authority.

Mrs Hackworth-Young commented that with an ageing population there was a need to increase the number of beds and she felt that the CCG were concerned with the financial implications rather than caring for the public.  She commented that the wards on the Richardson Hospital had been closed and that people had been told that they had been closed when trying to access services there.  She said that people living in and around Barnard Castle could not get to Bishop Auckland and that this issue has not been given consideration.

The Director of Commissioning and Delivery said that she had responded to these comments previously throughout the engagement process.  She assured the committee that significant changes had been made to the hubs and that the transport criteria had recently changed which also included an option for taxis.  With regard to the funding she added that this did not get in the way of being able to make the best decisions for patients and that it was managed in the best way.

The Head of Commissioning, Durham County Council explained that if a patient had been discharged funding would be provided from the local authority.  Should the patient need acute care they would be admitted to a hospital ward if that was the right place for them to be.  The Director of Commissioning and Delivery added that both the CCG and local authority were responsible for domiciliary care.

Councillor Zair referring to the length of stay on ward 6 being reduced from 22 days to 12 days and asked how many would be re-admitted within a couple of weeks of discharge.  He was concerned about the pressure being placed on A&E.  The Director of Commissioning and Delivery explained that they do look at re-admissions to hospital and learn from that.  She would make those figures available to the committee and Councillor Zair.

The Chair thanked everyone for the comments and reminded all to raise their concerns through the consultation.

Resolved:

That the report and presentation be received and the issues highlighted by the Committee be communicated back to the CCG.