Q+A with ICB health boss Laura Nelson on the south Warwickshire bed consultation
GIVEN the pressures on acute hospitals and the projected growing (and aging) population of the area, why is there consultation on only 35 beds? Will that increase in the future?
This consultation is about a specific type of bed, community rehabilitation beds. These are used for patients who need further rehabilitation support in a community hospital before they are able to go home, usually after a hospital stay.
We have looked at the data for the number of patients using community rehabilitation beds for the past five years, which has shown that approximately 550 patients per year use these beds. Based on these numbers, we are confident that 35 is the correct number.
Although the population is increasing we anticipate that the increase in community-based services, such as the Community Rehabilitation Service, as well as the development of same day emergency care and improved management of long-term conditions, will mean the number of community rehabilitation beds required will remain at the current level despite the projected population growth. However, we will continue to monitor the demand.
To tackle acute hospital pressures we need to focus on the services which get people who are able to go home to do so as quickly as possible. Moving patients from acute beds into other services they may not need, such as community rehabilitation, just to relieve pressures is not a good use of our resources as it only moves the problem around rather than tackling it, and it would mean that patients who do need bedded rehabilitation would not be able to access it. We want to make sure everyone is accessing the right services to meet their needs.
In June 2023 SWFT CEO Glen Burley outlined five options for beds, which then included increasing the number of community beds and leaving 16 at Shipston. Why have these options been whittled down to just two when presented to the public?
In order to decide which options were going to be consulted on, we had to understand which options were viable. At first, there were many different proposals and a long-list was developed. A panel of experts, NHS staff, and community members worked to combine similar ideas, improve them, and develop a short-list that could then be fully appraised.
The short-listed options were then assessed for their strengths and weaknesses and in February 2023 three final options were shared with the Warwickshire Health Overview and Scrutiny Committee for more feedback.
By September 2024, the two final options were agreed to be viable and these options were further appraised to ensure they met patient needs, aligned with NHS goals and priorities, and were affordable and sustainable.
Our consultation document outlines the other options that were considered and why they aren’t viable.
It seems quite divisive to say that for Shipston to get beds, Stratford and Leamington hospitals will have to lose beds – it encourages a territorial approach.
Based on the data we have on community rehabilitation beds, we know that 35 is the right number to meet the needs of the population of south Warwickshire. As there are currently 35 community rehabilitation beds distributed between Stratford and Leamington hospitals, should the decision be that beds need to be located elsewhere as well, then it is unavoidable that the number of beds located at Stratford or Leamington will be reduced.
It is important for us to clearly communicate the impact of both the options that are being consulted on and what choosing each option would mean, to enable people to make informed decisions. The intention is not to be divisive, but the NHS has finite resources and has to make difficult decisions as to how we best use public money to meet patient needs.
What will be the next steps after the consultation?
When the consultation ends, we will carefully look at all the feedback. Whilst we have made every effort to outline the impacts of the two options in the consultation document, we appreciate there may be other impacts that we have not considered and this is something that we are particularly looking at in the responses, although we will consider everything which is put forward to us.
Once we have collated all the feedback, the ICB board will consider a final consultation with all of the data. They will then meet on 19th March to formally decide on the future of community rehabilitation beds. This plan will include clear steps, timelines, and actions to make sure the decision can be implemented smoothly without causing problems.
We are committed to sharing the results and any decisions.
We understand the drive towards ‘home is best’, but given the pressure on GPs and the decline in district nurse numbers how will this be supported?
In south Warwickshire, there has been a significant increase in the community-based services available to support this approach, which has seen the number of patients treated by these services increase over recent years, a trend we expect to continue.
South Warwickshire University Hospital Foundation Trust, working with Warwickshire County Council have put in a new Community Recovery Service which offers care and support for patients leaving hospital who have a new or increased care need. This service takes place in the patient’s home and enables patients to return home confidently from hospital following treatment or an injury or illness. The team consists of a variety of healthcare and social care practitioners with support from home care agencies.
As a multi-disciplinary team, the service works together to assist individuals to get back to their previous level of independence. This reduces pressures on other services, including GPs for longer term care.
A typical journey by bus from Shipston to Warwick takes around two hours and two changes of buses. The journey to Stratford is just under an hour. How is this impact on a rural community justified?
We recognise that where our community rehabilitation beds are located will have an impact on communities such as Shipston, and other rural areas such as Alcester or Southam who may have difficulty accessing public transport. When making decisions about the delivery of services in south Warwickshire we need to look at the impact across the whole of our area.
We also understand that rural communities face barriers when accessing care and we’re committed to understanding how we can ensure we deliver the services these communities need. Separate from this consultation process, we are meeting with residents and councillors to look at how we can develop our services and integrated neighbourhood teams to reduce these barriers and provide equity in the care we deliver to rural areas.
It is important to note that it is primarily visitors who will see their travel impacted should the community rehabilitation beds be permanently relocated. Patients who are transferred to a community rehabilitation bed will generally be transported by the NHS.
What options would be open to people who want to die close to home, but are too ill (or for other reasons) and cannot remain in their home? The Ellen Badger Hospital used to be able to step into this role and help families in Shipston.
Ensuring patients have the ability to choose how and where they receive care wherever possible is really important to us. Palliative and end of life care is so important to get right for patients and their families and the way we deliver these services has recently been considered and brought together in a single strategy and delivery plan. We are also undertaking mapping work across the system to ensure our palliative and end of life care bed capacity can meet the needs of our ageing population.
Across south Warwickshire, we also have Myton Hospice in Warwick and the Nicol Unit in Stratford that can both provide palliative care in an in-patient unit, and a range of home care and community-based services to support end of life patients in their homes.
We also have 29 nursing homes across south Warwickshire which are able to provide palliative care, working with excellent teams such as Shipston Home Nursing to deliver care and support and allowing a home from home setting for people.
The ‘care home market’ (including residential and nursing) is mentioned in the consultation documentation as a ‘buy out’ option. Isn’t this a step towards the state paying for private care that it could itself provide? And doesn’t it further entice staff away from the NHS to the private sector?
Using beds in care home settings as part of our discharge pathway is a nationally recognised way of supporting people who can’t go home yet, but do not need the level of clinical supervision offered in a community hospital. It enables patients to be discharged to a less clinical setting, usually in a private room, where they can continue their recovery, or while we assess their needs so that we can get the right care for them to go home.
There is concern that the brief assessments and analysis of postcodes where community bed patients were from is misleading, in particular that non-CV postcodes from the Shipston area were not included. How would you address that?
When looking at who has been using community rehabilitation beds, we have looked at data from the past six years showing who has been discharged from these beds and where they live. In the consultation document you have all of the numbers on a year by year basis and you can find all of the detailed data in appendix 4 of the pre-consultation business case on our website.
We found that the majority of people generally come from either Cubbington, Lillington and Warwick District East, Leamington Whitnash and Bishop’s Tachbrook, Kenilworth or Stratford. This has remained consistent, even when the beds were located at the Ellen Badger Hospital.
No postcodes are excluded from our data. When we look at the postcodes which don’t start with a CV we see the most use from B49, B95 and B80.
