Agenda item

Committee Members will hear from Buckinghamshire Healthcare Trust’s representatives on the Trust’s proposal to continue to operate Marlow and Thame as community hubs on a permanent basis, as part of the Trust’s strategy to develop care closer to home.

Presenters

Ms K Bonner, Chief Nurse

Mr D Williams, Director of Strategy

Papers

Report attached

Equality Impact Assessment Community Hubs, April 2018

Early Supported Discharge Orthopaedic Service (ESDOS)

Patient leaflet (ESDOS)

Stroke Patient Pathway

The Chairman welcomed Mr N Macdonald, Chief Executive, Mr D Williams, Director of Strategy, and Ms K Bonner, Chief Nurse from Buckinghamshire Healthcare NHS Trust (BHT).

The Chairman started by reiterating that one of the main roles of the HASC Select Committee was to be a critical friend to the health and social care system and to independently review and challenge health and social care service developments.  The Chairman requested that future reports were clear about this.

During their presentation, the following main points were made:

·       Community hubs were established, as a pilot, in Thame and Marlow in 2017 as part of BHT’s strategy of developing care closer to home.  The inpatient community beds were closed to enable the new model of care to be delivered.

·       The report outlined BHT’s proposal to permanently remove the inpatient beds at Thame and Marlow Community Hospital and to continue investing in the community hubs model.

·       The inpatient community wards at Thame and Marlow were no longer suitable to provide high quality care, due to challenges around sustainable staffing, the age of the facilities and enhanced infection control standards.

·       The report provided evidence of additional services introduced as part of the community hubs, as well as the support of the home first model of care. It also outlined plans to further develop this model.

·       A community assessment treatment service to provide multidisciplinary assessments, especially for frail adults, had been implemented which had led to a reduction in Hospital admissions.

·       Patients had responded positively to this service and support from some key stakeholders had been included in the paperwork.

·       Some services provided at the community hubs had had to be suspended during the pandemic but were restarted in March 2021.

·       The number of outpatient services, diagnostic services and x-ray services had increased.

·       The community hubs do not work in isolation and a number of other services had been developed to support the system.  For example, the Home First model had been developed since 2017 which was safer and more effective for patients who were medically fit to be discharged from the Hospital.  Investments had been made in the Ageing Well service and the patient stroke pathways had been strengthened. 

·       The evidence showed that the number of patients maintaining their independence had improved since 2017.

·       It was acknowledged that challenges were still being faced due to Covid-19, particularly staffing pressures (8% of the workforce was currently off sick).

·       A full demand and capacity model was being developed for discharge pathways into community beds, which was forming the basis of a business case to develop a single integrated pathway for Buckinghamshire residents. A proposal had been made for further provision of bedded capacity on all sites.

During discussion, Members made the following comments and asked the following questions:

·       In response to a Member’s concern about the lack of feedback following a public meeting in Buckingham in 2017 to discuss the roll-out of community hubs, Mr Macdonald explained that no decisions had been made in relation to Buckingham.  BHT were in discussions with the Swan Practice around the proposals for the Lace Hill development but nothing had been finalised.

·       It was noted that the Equality Impact Assessment included in the paperwork was from 2018 and the landscape had significantly changed.  Mr Williams acknowledged this but explained that the EIA had been included to reassure Members that this process had been undertaken at the start of the pilots at Marlow and Thame.

·       A Member expressed concern about how well the voices of people who are difficult to reach had been reflected in the Hospital Trust’s plans.  Mr Williams reassured the Committee that the Trust works closely with the voluntary sector. For example, work was currently being carried out with Heart of Bucks on cancer screening awareness amongst certain vulnerable groups. There were also projects around cardiology, cardiovascular prevention schemes which supported vulnerable people.

·       A Member raised concerns that some services, which were originally offered at both Thame and Marlow community hubs, were not now being offered – for example, rheumatology and diabetes.  Mr Macdonald responded by explaining that there was a systematic process in place to determine which services were in most need.   Some service changes had taken place due to the pandemic. 

·       There would be long-term investment in digital care to improve access to patient services.

·       A Member expressed concerns about people who do not necessarily require hospital care but need some additional support to get their confidence back.  For example, hip replacement patients who require physiotherapy following surgery. Mr Macdonald advised that there were patient pathways available for patient who required additional support following their discharge from Hospital.  He mentioned the Home First model and the work of community teams to provide this additional support.

·       Mr Williams mentioned the work of the Thame and Marlow stakeholder group which meets on a regular basis to help shape the development of the hubs.  The group consisted of councillors, patients and advocates in the local community. He went on to say that the public had been engaged on the changes made to the hubs, via surveys and other methods.

·       Mr Macdonald explained that there would be a move away from a GP referral system for the hubs as this relied heavily on the GPs being aware of the services available at the hubs. The development of the Bucks shared record allowed for a patient’s data to be accessed by the health and social care system which helped to identify those people most at risk.

·       In response to a question about whether the Trust had access to voluntary services as areas of support, Mr Williams advised that all voluntary organisations were accessible via a database held by the Council and regular communication was made to groups on engaging on service change and communicating issues of joint interest through this route.

·       A Member asked whether there was engagement with the Primary Care Networks so that GPs were made aware of the services being undertaken in Thame and Marlow. Mr Macdonald gave an example of a multidisciplinary team which meets across the ARC PCN, which includes the Marlow GP surgery.  These meetings include the community nurses and mental health workers.

·       A Member asked whether services for patients suffering with dementia would be made available across the hubs.  Mr Macdonald said that he would take this back for further consideration as to how this could be delivered through the hubs.  The Chairman agreed that access to dementia services needed to be improved. 

·       In response to a question about what services were available at Amersham Hospital and the current status on Chartridge Ward, Mr Macdonald confirmed that there was a community assessment and treatment service available at Amersham alongside other services.  He confirmed that Chartridge Ward was open for patients requiring rehabilitation.

·       A Member asked how Buckinghamshire compared to the other component parts of the Integrated Care System, in terms of the number of community beds.  Mr Macdonald confirmed that Buckinghamshire had fewer beds than the other parts of the ICS but the business case for the Intermediate Care model would look at this deficit.

In summing-up, the Chairman made the following statement.

The Committee were generally supportive of the Thame and Marlow community hubs model of care and understood the reasons for no longer using these facilities for providing community inpatient beds.  However, the Committee remained concerned about the removal of these beds, in terms of the alternative provision available for patients who would have used these community beds.  The patient pathways for those requiring additional support, following discharge from Hospital, were noted by the Committee but Members felt that information on timeliness of the assessment process, length of treatment and information on the community teams was needed in order to seek reassurance.

At a future meeting, the Committee would be looking for the following.

·       Evidence of developing links with voluntary and community organisations at the hubs to further enhance the services, to include services for dementia patients and carers;

·       Evidence of investment in IT and equipment at the hubs so that more diagnostics could take place leading to better patient outcomes;

·       More clarity and explanation around the impact on the whole system by providing alternative pathways for patients requiring additional support after being discharged from Hospital;    

·       As part of the development of the business case for the Intermediate Care model of care in Buckinghamshire, present evidence on the deficit in community beds and the plans to meet this deficit through alternative provision and the funding associated with this.

The Chairman concluded that the Committee would be reviewing the draft business case for supporting sustainable intermediate care model of care.  BHT to confirm the timeframes for when this would be available.

Action: Buckinghamshire NHS Healthcare Trust