Today NHS Surrey Downs Clinical Commissioning Group (CCG) publishes a report summarising the outcome of a comprehensive clinically led review into services provided at the community hospitals in the local area.
The review, which launched back in March 2015, considered both inpatient (bedded care) and outpatient services across Cobham, Dorking, Molesey, Leatherhead and the New Epsom and Ewell Community Hospitals.
To gain a full insight, the comprehensive review process considered a wide range of areas including patient and activity data, the health needs of the local population and projected changes that will affect demand for healthcare in future, quality of care, national best practice and the condition of the current buildings. As part of the process, the CCG also heard the views of staff and local people through a series of workshops and staff drop-in sessions, which provided valuable feedback that has informed both the review process and the possible options that have emerged.
The report summarises the review process and includes detailed data analysis, as well as a summary of findings for each of the areas above. It also includes a number of recommendations and some emerging options for further consideration (see note to editors).
Dr Jill Evans, Governing Body member and clinical lead for the review explains: “The review process has been clinically led. We wanted to fully understand how services are delivered now, whether they will meet the needs of our changing population and whether there are opportunities to further improve, the already high, standards of care patients receive, both in the wards and through outpatient services.
“Over the last four months we have looked at the data, analysed local health needs and the changing needs of our ageing population, considered best practice and talked to patients and staff. We have also looked at the current buildings, both in terms of their condition and any un-used capacity that could enable services to be delivered in a different way.
“This has led to a series of recommendations that we believe will improve care, mainly by making the delivery of care even more efficient and streamlined for patients. For example, if we make some practical changes, we believe we can help patients who are staying in a community hospital return home more quickly, with the right support. There is evidence to show this is better for patients and it can also help their long-term recovery.
“The report also identifies a number of possible options on how services could be configured in future. I understand that local people may be concerned about some of the options that are included, particularly if they relate to their local hospital, and I would like to reassure people that we have carefully considered every option in getting to this stage. We do believe that changes to how some services are currently delivered will improve care.”
James Blythe, Director of Commissioning and Strategy at Surrey Downs Clinical Commissioning Group added: “We have published this draft report because we are committed to being open and transparent – and because we genuinely want to know what local people, local patients and our stakeholders think about the possible options that have emerged.
“We will use the next month to seek the views from as many people as possible. We will listen and we will take this feedback into account in any final options we put forward to our Governing Body.” James added.
If major changes are proposed, the Clinical Commissioning Group would seek the views of local people through a public consultation.
Mole Valley District Council’s Executive Member for Well-being, Councillor Lucy Botting, added: “Mole Valley District Council has been involved throughout this very open and transparent process and our residents are being provided with every opportunity for their views to be duly considered. It is very important that our local communities continue to engage with and contribute to the next step of this process, which is likely to be full consultation. This will help inform and shape future health care provision in Mole Valley.”
Local people and stakeholders can share their comments by emailing firstname.lastname@example.org or writing to Surrey Downs Clinical Commissioning Group, Cedar Court, Guildford Road, Leatherhead, Surrey KT22 9AE. People can also attend a series of public workshops to find out more and have their say:
Upcoming public workshops are as follows:
- Tuesday 1 September 2015, Main Hall, St Andrew’s Church, Downside Bridge Road, Cobham, KT11 3EJ, 6-8pm
- Wednesday 2 September 2015, Leatherhead Institute, 67 High Street, Leatherhead, Surrey, KT22 8AH, 2-4pm
- Wednesday 2 September 2015, United Reformed Church, 53 West Street, Dorking, Surrey, RH4 1BS, 6-8pm
- Thursday 3 September 2015, St Joseph’s Church, St Margaret Drive, Epsom, Surrey, KT18 7JQ, 2-4pm
Each event will give attendees a chance to provide any feedback to the draft paper, including how the process was undertaken, how options have been considered, and any final comments they would like the CCG to take forward. Workshops spaces are limited due to venue capacity and therefore individuals wishing to attend must book a space by emailing email@example.com or telephoning us on 01372 201500.
The full report is available on the CCG website at www.surreydownsccg.nhs.uk
Note to editors
1. Review process
The review objectives were to:
- Undertake a comprehensive review of current inpatient and outpatient services undertaken at the five community hospital sites with bedded care within NHS Surrey Downs CCG’s catchment (Molesey, New Epsom and Ewell Community Hospital, Dorking, Leatherhead and Cobham).
- Determine the long term inpatient and outpatient care requirements of the patient population from community hospitals including the number of beds required across both acute and community sectors combined
- Propose what services should be provided in the future drawing on the CCG’s commissioning strategy and established best practice
- Link with a review of the community healthcare estate to determine the best fit of the future service model with the available estate and its suitability to meet future needs. This will inform options as to where services are provided
The review has been led by a programme board, which has seen representation from local providers - including CSH Surrey and a Clinical GP lead - Surrey County Council’s Well-being and Health Scrutiny Board and CCG representatives from linked areas of work, such as integration, estates and planned care.
2. Recommendations and emerging options
The outcome report includes a number of recommendations and some emerging options for further consideration.
The report identified a number of ways to improve care, including opportunities to improve efficiency by making some changes to how nursing teams operate.
- Applying a standard admission criteria for community hospital beds – work with providers to ensure this is applied across all community rehabilitation beds. This will ensure patients are referred more appropriately to the service (ie. because they require rehabilitation)
- Managing the community bed capacity Surrey Downs wide. Currently many patients stay in an acute hospital because they wait for a bed at their local community hospital. This delays the start of their rehabilitation and is very expensive for the NHS as these patients don’t need this level of care. By looking at the entire bed capacity and transferring patients to available beds, the local health system will be more efficient. It will also mean there are beds available in the acutes for the most sick patients.
- Further work to review specialist neuro-rehabilitation beds – There are currently four neuro-rehabilitation beds at the New Epsom and Ewell Community Hospital. These beds are located next to the general ward and managed by nurses, supported by local GPs. Due to limited capacity, waiting lists for beds is common, which can delay rehabilitation. The report recommends that we review demand for neuro-rehabilitation care, and best practice models, taking into account the current Surrey-wide review of stroke services.
- Further work to review in-patient care for patients who don’t require rehabilitation – The review has identified that not all patients who are admitted to a community hospital require rehabilitation. For example, some patients are waiting for a social care or continuing healthcare assessment. They do not need to stay in an acute hospital and if rehabilitation is not an option, it is not appropriate to transfer them to a community hospital. The review recommends we look at the needs of this patient group and where care is best provided (eg. buying short-term capacity in a nursing home).
- Exploring the viability of a day rehabilitation centre – If patients require a lower level of rehabilitation it may be possible to provide this as a ‘day service’. That way patients could return home, instead of staying in hospital overnight. This idea has arisen as part of the review. It is recommended that further work is done to explore this idea.
- Considering optimum ward size - The review has looked at how the different wards operate. It has found that larger wards offer advantages in terms of staffing (continuity and greater resilience if staff are unwell), greater flexibility in terms of ward space, increased social services input and reduced length of stay. It is recommended that any future model takes ward size into account
- Reviewing the level of in-patient physiotherapy services commissioned – It is also recommended that inpatient community hospital physiotherapy services are reviewed to ensure the right level of provision is in place.
Emerging configuration options
The report includes options put forward for further consideration, as well as options that have been rejected due to their inability to improve care or their viability.
The four emerging options that are being put forward for further discussion and consideration are as follows:
Option 1 - Maintain the current three-ward model with inpatient wards at Dorking, Molesey and New Epsom and Ewell Community Hospital (NEECH). Develop Leatherhead planned care services (Leatherhead in-patient services remain closed).
Option 2 - Transfer New Epsom and Ewell Community Hospital inpatient services to the Epsom Hospital site and transfer outpatient services elsewhere in the locality. Develop Leatherhead planned care services (Leatherhead in-patient services remain closed).
Option 3 – Transfer Molesey inpatient and outpatient services to Cobham Hospital. Develop Leatherhead planned care services (Leatherhead in-patient services remain closed).
Option 4 - Transfer New Epsom and Ewell Community Hospital inpatient services to the Epsom Hospital site and transfer outpatient services elsewhere in the locality. Close Molesey Hospital and relocate all inpatient and outpatient services to Cobham Hospital. Develop Leatherhead planned care services (Leatherhead in-patient services remain closed). (options 2 and 3 above).
For more information call the CCG Press Office.