Agenda item

Dr John, Clinical Director, Barking and Dagenham CCG presented a report on the trial of two new home based intermediate care community services and the case for change based upon evidence gathered through the trial, which had started in November 2013, of an expanded community treatment team (CTT) and the new intensive rehabilitation service (IRS).  The report and presentation provided details of the pre consultation business case and consultation period, which would end on 1 October 2013. 

Dr John stressed that both the CTT and IRS had been well utilised during the trial, with both services performing above expected activity rates.  Patients had been able to access IRS and community beds within an average of 2 days from referral, as opposed to 5 days before.  The service provides short-term support for people experiencing a short-term health care crisis and 34% of referrals to CTT are from the patients themselves or their carers and family.  90% of patients receiving care form CTT and IRS are supported at home and do not require admission to hospital and 94% of patients referred to IRS had improved outcomes.  Since the launch, the service had seen an increase from 2,100 to over 7,000 people being seen.  In addition, the admissions to acute care have been reduced, when compared to bed based services.  Dr John explained that services, such as physiotherapy were provided in people’s homes, and there was international evidence to suggest that patient outcomes are much improved when services are delivered in patients home environments.

The 12 week consultation period included on-line questionnaires and face-to-face events. The event for Barking and Dagenham would be held on 11 September at the Barking Learning Centre.

Dr John then advised that there was an issue with the empty bed rate, the details of which were set out in the report, and they were looking at a number of options but that any decision would be tempered by affordability and funding available, however, King George’s Hospital was the only site that could accommodate the bed numbers needed.

The Chair raised a number of concerns in regards to the differences between the three boroughs not being recognised, an increasing and ageing population in the borough and, if the service closed, what would happen to the clinics and Gray’s Court buildings.  The Chair also stressed that access to King George’s Hospital is a major issue for LBBD patients.  Dr John accepted that the points were valid but the proposal to remove beds from Gray’s Court was based on getting patients better quicker.  Dr John stressed that it was an issue of clinical safety as there is not enough clinical support at Gray’s Court, particularly overnight, and if people deteriorated they would have to be moved to another hospital: whereas if they are on a site with more clinicians it would remove the need for an emergency ambulance transfer and the need to go through processing on arrival at the A&E.  Clinicians were advising that the safest way to provide high quality care is by having bed services in one place, as running one unit would enable staff to be used more efficiently and flexibly.

Councillor Keller, Chair of Health and Adult Social Services Select Committee, commented that living space standards could be an issue and this had been discussed at an earlier Select Committee, for example Havering have larger and more modern housing, the smaller living areas in older LBBD properties could make it difficult to treat people well in their own homes.

Helen Jenner, Corporate Director of Children’s Services, stated that there had been research evidence in regards to the importance of visits from friends and relatives to patient’s wellbeing and she felt that option 3 might be the best option.

Anne Bristow, Corporate Director of Adult and Community Services, stated that at the end of July assurances were being given about sufficient cover, except for stroke care, at Gray’s Court that now seemed to have been misleading.  Anne Bristow added that even if you travel by car to King George’s Hospital the walk from the car park to the wards is considerable and could be prohibitive for elderly, frail or disabled visitors. 

The Chair and Anne Bristow raised concern about the comment on the safety level at Gray’s Court.  Their concerns were that if these plans were eventually agreed they will not come to fruition for some time and both wanted to know what was being done to ensure that Gray’s Court was safe now.  Dr John assured the Board that the facility was safe but that faster clinical care could be delivered if the beds were at King George’s Hospital.  Jacqui Van Rossum, NELFT, added that if a patient became acute overnight they would not need ‘a blue light’ move to a hospital, and that would reduce the stress on both the patient and family.

Steven Burgess, Interim Medical Director, BHRUT advised that of the 104 beds only half of them were regularly used.  King George’s site already had 60 beds, which would cover the demand and in his view it made clinical sense to amalgamate the beds on the King George’s Hospital site.

Martin Sheldon, Deputy Chief Officer, CCG, stressed that this trial had been a success, with more patients being seen and helped and that they had more positive outcomes: this was being reflected in the positive responses and by the referrals from carers and patients themselves. 

The Chair stressed that she was extremely disappointed that this is the second proposed closure of a local service in the Borough since the inception of the CCG.

Councillor Turner commented that it would be extremely helpful if the CCG and BHRUT dealt with the issue of recruitment of high calibre staff at all levels as a way of improving service provision across all services. 

Councillor Turner made a point about the broad brush statement about ‘some poor areas of care’ and the analysis that had been done needed to be reflected in the report.  Councillor Turner added that the lack of data or detailed information, was not conducive to understanding or in enabling informed discussions.

Christine Brand, a member of the public, commented on the need to ensure a better overlap in service provision and support between physical wellbeing and mental health services for the elderly, who by the nature of the services, were the majority of users of these services.

Having discussed the trial and proposals, including the transfer of care beds to King George’s, noted that the Board’s points will be taken back to the Programme and that a more formal response will come from the Council’s Health and Adult Social Services Select Committee.

 The Board commented:

(i)  There are three different boroughs, each of which had their own diverse and different needs, and that needs to be acknowledged.

(ii)  In the Council’s view, shutting the service at Gray’s Court at time of a growing population and an increasingly ageing population was short-sighted.

(iii)  Clarification was needed in regards to the future of the clinics that operate at Grays Court and the Gray’s Court building itself.

(iv)  LBBD residents find it difficult to get to King George’s Hospital.

(v)  The beneficial effect of visitors to a patient getting well could be lost if relatives, especially older residents, could not travel to visit patients. 

(vi)  The drive to provide more care in patient’s homes may be more difficult in LBBD, as the space in the older LBBD properties was not as generous as the 60s and 70s builds in Havering.

(vii)  There had been assurances that Gray’s Court service was safe and there had been categorical assurances of overnight clinical cover, with the exception of stroke cover, and now feel the Council feel it had been very misled.

(viii)  This was the second facility closure since the inception of the CCG and both facilities had been in LBBD.

(ix)  The recruitment of high calibre staff at all levels still needed to be resolved.

(x)  There was insufficient detailed data to enable discussions to be informed and meaningful.

(xi)  Based upon the evidence currently available the Board would prefer Option 3, which was provision on three sites.