Your Driffield Councillors

Response to Consultation on the Commissioning Strategy for

Community Health Services for East Riding of Yorkshire PCT

Introduction

This is a joint response to the public consultation on the proposed Commissioning Strategy for Community Health Services for the residents within the East Riding of Yorkshire PCT from both Bridge Street and Cranwell Road Doctors’ Practices and East Riding of Yorkshire Council Ward Councillors for Driffield and Rural and the Driffield Hospital Defence League and the Hospital League of Friends who were fully involved in its formulation.

It is recognised that there is need for sustainable change to the way in which modern community health services are provided locally, and that the services must be affordable and flexible to respond to changes in the way in which they may be provided in the future.

Proposed Strategic Direction

It should be noted that the future sustainability and role of community hospitals has been supported by NHS policy in recent years (ref “Our Health, Our Care, Our Say” and the Wanless report).  However it would appear that national policy has been somewhat uncertain, and this has not been helped by the split between provision and commissioning. There are signs nationally that some investment is being made in community based hospitals and services, and that the advent of practice based commissioning will support the shift of services from secondary care to the community with appropriate funding.

We also understand the significant cost control pressures which the ERoY PCT faces in order to achieve financial balance, and that the turnaround process has led the PCT to question the affordability of the current configuration of community hospitals within the East Riding of Yorkshire.

We support the proposal for a two level service for community health services which would appear to be a logical approach; we also support the proposed “Level 1” services being provided in an accessible, local and flexible way. The most important objectives from community services changes, is that they should be well integrated, sustainable, of high quality, and without risk of being undermined every so often as at present. We would however challenge some important elements of the nature and siting of those services.

The Case for Three Community Hospitals (Option C)

The Local priorities which emerged in 2005 from the local public events, remain relevant, and are addressed within the proposed strategic direction, providing the case for three community hospitals is supported.

If there must be a reduction of the hospital sites which will provide “Level 2” services, then we would argue that this should be from three sites (Option C), which should be Bridlington, Goole and Driffield.  We would also argue that two sites, set on the extreme periphery of the East Riding of Yorkshire would not help to address the objective to provide locally based “Level 2” services. Accessibility of services in the central rural areas is not good, but the wider Driffield community has good links with villages, good main road, bus and rail access. The public particularly request, and value, the opportunity for them and their relatives to be nearer to home, with reduced and easier travel times.

We are concerned that Options A and B would lead to over reliance on non-NHS beds commissioned to be established in various unknown and possibly changing localities across the PCT, and that this would lead to reduced standards of care.  Whilst accepting that the commissioning of these beds should provide adequate standards, the fragmentation of beds (non NHS) would lead to concerns about retaining staff, training them, and standards. We would also express concerns about the ability to offer facilities offered such as physiotherapy and occupational therapy in such diverse locations for rehabilitation patients. We feel that this would not address the need to provide high quality local access to NHS rehabilitation.

We have great concern regarding the possible loss of local palliative care beds, which currently form a highly valued and extensively used function of some beds at Driffield’s Alfred Bean Hospital (ABH).  The patients are only admitted to these beds if it has become impossible to manage them in their own homes, and this requires a high level of nursing expertise and continuity.  The beds are best provided with the high level of integrated and collaborative care available in the community hospital setting. Historically GPs in the Driffield area have a very good record of providing as much palliative care at home as is feasible. This supports the case for three community hospitals with in-patient palliative care beds spread geographically in the East Riding.

The Case specifically for Alfred Bean Hospital

The Alfred Bean Hospital in Driffield is “purpose built” and has for a long time provided a high level of well developed community hospital bed services, with dedicated nursing and medical cover. It has for many years shown huge commitment of all staff to provide responsive and innovative services for the local population, with excellent teamwork which has been highly valued by local residents. Indeed Tom Hunter’s review of the Community Hospitals recognised that it provided an excellent model of care to the community. 

The ward at Alfred Bean Hospital has also very recently enjoyed an expensive up-grading, to ensure that it is fit for purpose, and already has all of the minimum support requirements e.g. X-ray, therapy areas, and visiting other support clinicians. We do feel that there is scope to increase further the efficiency of the ward as it is currently used, by increasing the beds to the maximum permitted by infection control (18), and being able to accept patients more readily (many have had to be turned away in recent months).

It would also be feasible to extend the criteria to enable a wider range of medical problems to be addressed, using these beds (e.g. rehabilitation from medical, orthopaedic and neurosurgical problems).  Additionally, medical and nursing problems could and should be admitted direct from the community to avoid admission to an acute hospital setting if they can be appropriately managed at a local level, according to locally agreed admissions criteria.  

The day hospital at ABH has been innovative locally in its approach to supporting palliative case and its use for IV infusions, thereby preventing admissions to the acute hospital. There is scope to expand this service, which is especially valued by patients who are ill/ old/ or frail and has the added advantage of relieving pressure at other locations.

There also needs to be a commitment from the PCT to make community admissions to a “level 2” hospital more readily achieved, thus allowing suitable financial reward to a community hospital ensuring sustainability( through split tariff payment by results). The Alfred Bean has a longstanding track record of working closely with Driffield’s Doctors Practices and would offer the PCT the ideal opportunity to develop this style of commissioning.

The hospital already has a wide range of out patient clinics and visiting consultants, and whilst these may require further development, the opportunity exists for enhancing these, but also they are able to offer support to inpatients too. Additionally the GP day-to-day care is supported by a Consultant in Elderly Medicine. ABH has an X-ray department open five days a week, access to ultrasound, a physiotherapy department and occupational therapy.   MacMillan nurses are also on site, as well as a range of other visiting nurse specialists and therapists.

In short, the infrastructure is in place to continue to provide excellent in-patient services for the future, not just for local residents, but also for the wider population of the East Riding of Yorkshire.

Driffield offers a central option for the PCT to further develop and enhance an existing successful community hospital site, which would be considerably less costly than a “New Build” in either Beverley or Market Weighton.

This option also has the additional advantage of offering the PCT the least risk, in that at this existing site it would not be difficult to, with modest investment, significantly increase the role.  This is the most deliverable third hospital option, a known quantity, which can be achieved NOW.

Land adjacent to the Alfred Bean Hospital is available to provide additional building and car parking, and the site is readily accessible.

The provision of a community hospital with beds sited at Driffield offers the unique advantage of being located in a settlement recognised as a “Principal Service Centre” with a very clear focus of serving the wider rural area of the East Riding. This makes its potential role distinct from the larger conurbations close to acute hospital provision.

The location of services at the Alfred Bean Hospital is in complete concord with the Regional Spatial Strategy. Driffield is one of only four “Principal Service Centres” in the East Riding, (as designated within this strategy) the others being Goole, Bridlington, and Beverley.  But Driffield is unique in specifically serving the rural hinterland more distant and more difficult to access from urban areas.  

The Regional Spatial Strategy is the core planning and development document of Government Office for Yorkshire and the Humber and the Regional Assembly for Yorkshire and The Humber.  It sets the framework for future development within the region.  Driffield’s status in this document, as a “Principal Service Centre” means that the PCT can be assured that Driffield will continue to grow and develop its service centre role into the future, for instance, rural transport links, training facilities etc.  This ensures its long-term sustainability as a vital service centre for the surrounding rural hinterland.

The continued provision of services from the ABH site also offers the additional advantage of enabling NHS staff to be based at a site and in a settlement which provides them with a more sustainable and affordable employment. Property prices in Driffield are in the region of 20% less than those in Beverley and there is a relatively plentiful supply of “affordable housing”. The continued use of the ABH as the third hospital site offers the PCT the opportunity to locate an important workplace in a town which, put bluntly, gives their key delivery staff a better deal.

Additional uncertainty exists over proposals for “level 2” provision from the neighbouring PCTs in Hull. It would be short sighted for the East Yorkshire PCT not to explore how “level 2” provision for the Beverley and Southern areas of the East Riding might be jointly and cost effectively provided through partnership working with the Hull PCT. This strengthens the justification for the retention of and development of services from the Alfred Bean site to serve the deep rural areas of the East Riding most remote from the Hull, Cottingham, Beverley conurbation. 

The potential for expanded services on the ABH site

The provision of a rapid response managed care service for patients in their homes and/or residential care homes, is to be welcomed, but must work as part of integrated community services.  These seek to integrate the Minor Injuries Unit (MIU), out of hours (OOH) services, “in hours” emergencies and be responsive, so that all users (including staff/GPs/carers) can fully trust it, ensuring successful delivery.  This should link to rapid access to local investigations, and their interpretation in order to reduce/avoid acute hospital admissions.

The concept of a minor injuries/ailments service at “Level 2” community hospitals as an “appointment” based service is suggested.  This concept has not been well explained as the public is struggling to understand how a minor injuries service (some of which will be emergencies) could be run by appointment.  Certainly the times of “attendance” of minor injuries can be triaged to ensure grouping of some patients, but clearly this will not and cannot by the nature of the patients, work for all.  

Emergencies or urgent problems usually managed within an MIU service should not be “diverted or postponed” by an insensitive appointments system.  A “walk-in” service provides an accessible, patient friendly facility with a proven track record in Driffield.  Telephone triage may be effective during the OOH period but not in hours apart from being able to group patients for staff efficiency and convenience if appropriate.

MIU at ABH is a success. The service provided is nurse-led to established protocols, and the transition from being GP-led has been relatively smooth, thanks to the nurse training and previous integrated working with the GPs. It is a service highly valued by both patients and local clinicians, and should remain in its present form and opening hours.

There are real opportunities for the expansion of local services at ABH by utilizing existing areas of the hospital. For example the use of digital imaging within the X-ray department, increased access to ultrasound, possible establishment of 24 hour ambulatory BP, and ECG monitoring, pre-op and post–op clinics.  Additionally the hospital could host mobile scanning etc within the car park.

Future expansion of the hospital site could be feasible, by negotiating purchase of the land behind the hospital.  The Landowner has indicated agreement in principle to make available this land.  There is also the possibility of putting a first floor development over the existing out-patients and clerical wing. (This provision was made within the original build).  Similarly, it would not be difficult within the present layout of the site to configure new or additional service capacity, e.g. extension of the ward into the adjoining walled garden providing for an additional six beds.

Overall support from clinicians and the public

GPs in Driffield are fully committed to supporting and enhancing the retention and further development of the scope of services provided at ABH. They would also wish to continue to provide those services to the in patient beds at ABH, and other services as they become further developed. The Bridge Street practice has provided medical input to the GP ward during the last year.  They have confirmed that they wish to continue to provide this service into the community hospital.  They are fully committed to this service for all residents of East Yorkshire who may be admitted to ABH, should it be chosen as the third “Level 2” hospital site.  

Local GPs and nurses have always shown dedication to developing and enhancing the standard of medical care by working closely together. This has historically ensured the undoubted reputation for quality integrated services.

There is strong dedicated support for the Alfred Bean Hospital from the public, and local hospital support groups.  They join us in wishing to see enhancement of local services, and also recognize the importance of Alfred Bean Hospital in providing services on behalf of the wider East Riding community, as part of the PCT’s overall service provision for “Level 2” services.

Conclusions

In conclusion we would support the principles of the Commissioning Strategy for Community Health Services with two levels of community services. We have expressed some concerns about certain areas of provision.

The only sensible option in this very rural PCT is for “Level 2” services to be provided from 3 sites, and that these should be at Bridlington, Goole, and Driffield.  The Alfred Bean Hospital is geographically set equidistant (over 25 miles) from the three DGH sites of Hull, Scarborough and York.

Driffield has good public transport links and accessible road network for surrounding areas to gain access. The Alfred Bean Hospital is in good condition following recent investment to upgrade the ward, and indeed it would be feasible to further enlarge the hospital and increase and enhance the range of services. Medical cover is well established, forward looking, and fully committed to continuing to provide rehabilitation and palliative care services to all East Riding residents.

This is a consensus view of the undersigned and includes the views of GPs, nurses, hospital staff, residents and a reflection of the views of our patients.

Signed by                     Dr D Wigglesworth                                      

On behalf of                 Bridge Street Practice                          

On behalf of                 Cranwell Road Practice

Signed by                     Cllr Symon Fraser  &  Cllr Felicity Temple

On behalf of                 ERYC Driffield & Rural                        

Signed by                     Mrs Barbara Hall                                  

On behalf of                 Driff Hosp Defence League                  

Signed by                     Mrs Judy Douglas 

On behalf of                 Driff Hosp League of Friends