Frequently Asked Questions (FAQs)

NHS Coventry and Warwickshire ICB are inviting current and former patients, staff, stakeholders, local residents, and interested organisations to participate in a consultation about the future permanent locations of 35 community hospital rehabilitation beds in South Warwickshire.

These beds are a vital part of helping patients move from hospital care to recovery and we are consulting on two potential options to ensure they remain accessible, effective, and sustainable.

The two options being considered are:

• Option A – Three sites: Distribute all 35 beds across three sites: Ellen Badger Hospital, Leamington Spa Hospital, and Stratford Hospital. 
  
  This would reduce the number of beds currently at Stratford Hospital and Leamington Spa Hospital and return up to 12 beds to the Ellen Badger site 
• Option B – Two sites: Provide all 35 beds at two sites, Leamington Spa Hospital and Stratford Hospital. 

The wards would remain the same current size at Leamington Spa Hospital and Stratford Hospital and there would no longer be any beds at the Ellen Badger site.

This consultation seeks to understand the potential impacts of the proposed changes to the location of our 35 rehabilitation beds and gather feedback before any decisions are made.

We are asking people to tell us their views about:

• Where the community rehabilitation beds should be located.
• How these changes could make services better.
• What is most important to you when using these services.

We are not consulting on the total number of community rehabilitation beds because we have looked at the data for the past five years and we know that 35 beds are enough to provide rehabilitation support to our community. Nor are we consulting on the other services that make up community-based care or our approach to “Home First”.

The consultation will last for 6 weeks, beginning on 6th January 2025 and ending on 14th February 2025.

We want to ensure as many as people as possible can give their views on the proposed changes and so there are a variety of ways in which you can participate in the consultation process, which are:

• An online survey hosted on the NHS Coventry and Warwickshire ICB website
• At public events where you can share your thoughts in person
• Via a written submission

You can find out more about participating in the above ways here.

We will be holding four in-person consultation forums during the consultation period. These will be an opportunity for you to learn more about the changes that are being proposed and the wider context surrounding them, as well as tell us your views on the impact of the proposed changes.

If you are planning to attend an event, we would ask that you register using the registration link next to each of the events. 

The in-person events will take the form of a drop in exhibition which details the plans and the background to the potential changes. There will also be the opportunity to talk one on one with clinicians and other staff members who will be part of delivering the changes. There will not be specific presentation, so people are welcome to arrive at any point during the allotted time period. The details of the in-person events are:

We will also be hosting a series of online events for those who would either prefer this method or who are unable to attend in person. The online events will consist of a presentation and then a chance to ask questions directly to the presenters. These will be taking place:

The final decision on which of the two options will be chosen will be based on a range of factors, including:

• Clinical advice
• Travel and transport
• Workforce and sustainability
• Health inequalities
• Financial considerations

The feedback you provide will play a vital role in the final decision of the location of the beds and will help shape the future of rehabilitation services in South Warwickshire. Your ideas will help us decide whether to keep the proposed changes or think about other options.
 

The Ellen Badger Hospital site previously hosted 16 community rehabilitation beds. However, to accommodate the wider redevelopment of the Ellen Badger site, these community rehabilitation beds were temporarily relocated to Leamington Spa Hospital. Unlike other community hospitals in South Warwickshire, Ellen Badger Hospital was only used for community rehabilitation and there were no other bedded services delivered from the site.

Since October 2018, SWFT have been working to modernise the Ellen Badger Hospital. The new centre will support the health and wellbeing needs of the community in Shipston and the surrounding villages by delivering conventional healthcare alongside activities to address social factors. Construction on the site meant we needed to relocate 16 beds to Leamington Spa Hospital.

Out of the 35 beds, 19 are at Stratford Hospital and 16 are at Leamington Spa Hospital. The beds at Leamington Spa Hospital were previously located at Ellen Badger Hospital. However, when South Warwickshire University NHS Foundation Trust got funding to redevelop the Ellen Badger Hospital site, these beds were temporarily moved to the Leamington Spa Hospital to allow building works to take place.

The nature of the changes needed to Ellen Badger Hospital mean that now only a maximum number of 12 beds can be placed at that site. Therefore, any option that would see community rehabilitation beds returned to Ellen Badger would only involve 12 beds, with the other 4 having to be accommodated at another community hospital.

Coventry and Warwickshire Integrated Care Board (ICB) commission 35 community rehabilitation beds. A thorough analysis of five years of data, demonstrates that this number is sufficient to meet the rehabilitation needs of South Warwickshire's population. The focus is on providing high-quality, targeted care that helps patients transition back to their homes or other appropriate settings.

You may have seen a higher number of beds quoted because at times of significant pressure on our hospitals, in order to improve flow through the hospital, all of our hospital trusts are able to “flex” the bed provision that they have, adding additional beds onto wards across their hospital sites.

Whilst ‘flex’ beds may be added to the same ward as community rehabilitation beds, the patients who are placed in them will not receive the rehabilitation support that comes with a community rehabilitation bed. Instead, those patients will receive general clinical support and observation from the ward staff, as well as more senior consultant led support from the wider hospital setting.

Not every bay can have additional beds as we need to be mindful of the maximum amount of patients each ward is able to add safely with the staff they have. In Nicol we can have up to 3 additional beds, and in Campion we can have up to 13.

When the pressure on the health system is at its highest level, the wards can be “flexed” to the maximum levels of 29 and 22 respectively, which would mean there are 51 beds in total on these two wards. However, only 35 of these would be community rehabilitation beds for patients to receive rehabilitation support.

Around 550 patients per year use community rehabilitation beds. 

However, it is important to note that the decision on whether a patient will be transferred or referred to a community rehabilitation bed will not be affected by the location of the beds. This decision is made by a clinician based on the need of the patient, and neither where the patient lives nor where the beds are based will impact this decision.
 

93.3% of all admissions to community rehabilitation beds are from South Warwickshire.

Data from the past five years shows that 15-16% of patients using community beds were discharged to addresses in Shipston, Kineton, or Wellesbourne. Whereas the majority of patients admitted to these beds come from the central and northern area of South Warwickshire.
 

The Needs Assessment that was carried out as part of the pre-consultation process showed the following about the people who were accessing community beds:

• Average Age: Patients accessing community beds average 83 years, with the largest group being 85-89 years.
• Gender: 62% of admissions are female.
• Ethnicity: 93% of admissions identify as ‘White’.
   

No, the location of the community rehabilitation beds will have no impact on a clinician’s decision to transfer someone to one or not. This decision is based purely on clinical need and every patient who needs a community rehabilitation bed will be recommended for a transfer to one.

Yes, the impact on visitors has been considered as part of the Travel Impact Assessment, which is a study to understand how a new development or project will affect traffic and travel in the area, including how people can get to services.

You can read the Travel Impact Assessment here.
 

In 23/24, 15 patients who were transferred to a community rehabilitation bed were from Shipston on Stour – 3% of all patients. Furthermore, the percentage of patients using community rehabilitation beds that are from Shipston has been steadily declining since 2019/20.

The number and percentage of patients from Shipston on Stour using community rehabilitation beds over the past 5 years is:

The 16 community rehabilitation beds that are currently located in the Campion Ward at Leamington Spa Hospital were moved there in January 2022. In the year’s 19/20, 20/21 and 21/22, the number and percentage of patients using community rehabilitation beds in Ellen Badger were as follows:

As you can see, the majority of patients who were occupying the beds when they were at Ellen Badger were from Stratford, Warwick, Kenilworth, Leamington and Southam.

There are several reasons the number of patients from Shipston has decreased.

First, we have significantly increased the community-based support available to patients who are being discharged from hospital. In Coventry and Warwickshire, we use a “Community Integrator Model” to bring together different community support services under one provider. This allows us to offer safe, effective, and high-quality care closer to where patients live, meaning fewer patients need community rehabilitation beds. With new services now available, many patients can recover better and more quickly at home or in the community.

In addition, the condition and severity of patients will also determine whether someone is transferred to a community rehabilitation bed or is supported to recover at home or in the community via a community support service. It is important to note that any patient who a clinician feels is in clinical need of a community rehabilitation bed will be recommended for a transfer to one. Also, due to the fact patients with less severe needs can often be treated by community-based services, those patients who are in clinical need of a community rehabilitation bed will typically those who require a higher or more intensive level of care. Therefore, this means that we are generally seeing less patients from Shipston who require a community rehabilitation bed and more who can be treated by a community support service.

Finally, all areas will have differing health needs and these needs will be constantly changing. One of the main drivers of the amount of demand placed on health and care services is deprivation. Those patients who come from areas that have a higher rate of deprivation on average need more regular and intensive care than those who come from communities with lower rates of deprivation. Shipston and the surrounding areas have a low level of deprivation, and this will be another reason there is less demand for community rehabilitation beds from these communities.

A community rehabilitation bed is mainly used for patients who need extra rehabilitation support before going home after a hospital stay. They can also be used for patients who need more support than they can get at home, but who don’t need to be in hospital. They are not beds that are used in an emergency and they do not offer specialised rehabilitation support, such as the support you need after a stroke or brain injury.

In South Warwickshire, 90% of people who use our community beds are leaving acute hospitals, but these beds also have a role to play in supporting people to avoid being admitted to acute hospitals. 10% of people who use these beds are admitted from the community, usually referred by a GP or other healthcare provider.

Our rehabilitation beds in South Warwickshire are in a community setting, either at a community hospital or our specialist rehabilitation hospital. This means that they are not based in hospitals that provide emergency care. Instead, they are in specialist buildings that provide appropriate support. 

Rehabilitation services include physiotherapy, medicines management, and other services provided by doctors and nurses who look after patients in these beds.
 

When the NHS talks about beds, it doesn’t just mean the physical bed, but the services in place to support the patient who is in the bed. There are many different types of bed which are used in both our acute hospitals and our community hospitals. Some you may have heard of include intensive care beds for people who require critical medical attention and constant monitoring, day beds for people who need a bed for several hours following a procedure or minor operation but will be able to go home that day, or palliative care beds for people who need support at the very end of their life. 

All of these beds need different types and numbers of staff to ensure the patient in them receives the right level of support to make them better. This consultation is only about one type of bed, which are known as community rehabilitation beds.    
 

At times of significant pressure on our hospitals, in order to improve the flow of patients through the hospital, all of our hospital trusts are able to “flex” the bed provision they have, adding additional beds onto wards across their hospital sites. These beds are for people who no longer need acute care (short-term care for severe medical needs), but for many reasons are unable to return home. This ability to ‘flex’ bed provision has been vital during both COVID-19 and at times where the health system is under extreme pressure, which has become increasingly common in recent years, and has increased the usefulness of community hospitals that have multiple bedded services on the same site.

Both the Nicol Ward in Stratford Hospital and Leamington Spa Hospital offer the NHS the ability to ‘flex’ bed provision. This gives us a greater ability to ensure patients can receive the care they need and meet demand. These beds may be added to specialist wards, such as community rehabilitation wards, but they are not specialist beds and the patients on these additional beds do not receive rehabilitation support. This is not possible at the Ellen Badger site due to the distance from emergency clinical services and lack of consultant-led support. The footprint of the Ellen Badger site is now limited to 12 beds, which further prevents the ability to flex beds.
 

Community hospitals are small, bedded units that provide a range of services, including treatments, rehabilitation and end-of-life care. They play a crucial role in speeding up the process of patients leaving acute hospitals and they can also prevent people from having to go into hospital in the first place, albeit to a lesser extent. Medical cover is provided by local GPs, while nursing and therapy services are delivered by staff from South Warwickshire University NHS Foundation Trust (SWFT).

In South Warwickshire, there are two community hospitals with hospital beds for community rehabilitation purposes:

• Ellen Badger Hospital in Shipston on Stour. (Currently closed for redevelopment and beds temporarily relocated to Leamington Spa Hospital) 
• Nicol Unit at Stratford Hospital 

Over time, the identity and services of both community hospitals have evolved, shaped by patient needs, staff expertise, and local demand. However, recent redevelopment works have resulted in only one operational community hospital, Stratford upon Avon, while building work continues on the Ellen Badger site. The beds usually located at Ellen Badger were temporarily relocated in January 2022 to Leamington Spa Hospital.

In addition to these two community hospitals, South Warwickshire also benefits from a dedicated rehabilitation hospital, the Leamington Spa Hospital. This hospital provides rehabilitation support for patients recovering from complex conditions like neurological disorders, major trauma, and strokes. It is renowned for its Neuro Rehabilitation Centre, offering a mixture of different services tailored to improve patient independence and quality of life. As well as the temporarily relocated community hospital beds from Shipston, they also have beds for stroke rehabilitation and brain injury.

In Coventry and Warwickshire, we use a "Community Integrator Model" to bring together different community support services under one provider. This allows us to offer safe, effective, and high-quality care closer to where patients live, meaning fewer patients need community rehabilitation beds. With new services now available, many patients can recover better and more quickly at home or in the community.
Before a patient is considered for a transfer to a community rehabilitation bed, they are first assessed as to whether one of these community-based services would be more suitable to deliver their care. The services available include:

• Community Recovery Service, providing short term care for patients who are leaving hospital in their own home.
• A care at home package that will provide more extensive care to a patient in their home after leaving hospital.
• Support by a Community Response Team or Virtual Ward.
• Specialist support via a Delirium pathway.
• A nursing or residential care home placement, also known as a Discharge to Assess (D2A) pathway.
• A hospice inpatient bed or hospice at home package of support.
• Outpatient Parenteral Antimicrobial Therapy to support any of the above services.
• Reablement service to help the patient gain skills and confidence to live independently at home.

It is important to emphasise that, despite the development and availability of these services, all patients who require a community rehabilitation bed will be transferred to one, no matter where they are live or receive treatment.
 

Stratford Hospital

The hospital is divided across two buildings with an Ophthalmology Unit, the Rigby Cancer Unit, an outpatient pharmacy and Health and Wellbeing hub spread across a three-storey building. Outpatient Services, a Minor Injuries Unit (MIU) and the Nicol Unit are housed at the original site.

The Nicol Unit is a ward of community rehabilitation beds which care for patients who require admission prevention rehabilitation. It can also provide palliative care when appropriate.

There is currently construction work to develop a dedicated Community Diagnostic Centre (CDC). The new unit will be a single-storey extension of the existing hospital building, which will house two MRI scanners and a CT scanner. The development will help to increase access to diagnostic services, supporting patients to get conditions diagnosed sooner and improve their treatment outcomes. The building is expected to open by spring 2025.

Leamington Spa Hospital

The hospital supports a number of inpatient, outpatient, community, and information technology services.

Campion Ward currently delivers a community hospital service supporting community referrals from GPs and trusts for rehabilitation needs.

The Central England Rehabilitation Unit (CERU) is also located at the hospital, which is a national centre of excellence for rehabilitation.

Specialist Neuro Rehabilitation is provided to patients with acquired brain injuries (ABI) as well as stroke rehabilitation. ABI services are offered across Allsopp and Chadwick Wards, and Stroke Rehabilitation is delivered across the Feldon Ward as part of the Integrated Care System (ICS) Stroke pathway.

CERU also hosts four outpatient services - Specialist Neuro Rehabilitation, Spasticity Toxin Services, the Community Neuro Rehabilitation Team (specialising in multiple sclerosis pathways of care), and a multidisciplinary Complex Neuro Rehabilitation Team (supporting the local community and regional major trauma pathway).

The Integrated Musculoskeletal Service is also based at the hospital site.

No, there was not a minor injuries unit prior to the redevelopment and, as per national guidance, new minor injuries units will not be established going forward.

As is common across the NHS, clinical staff work across multiple sites. This allows us to deliver more services locally. SWFT are currently working with clinical and operational teams to identify which clinics will run from Ellen Badger Hospital. This will be aligned to local demand and will develop over time.

SWFT secured £2.9m funding from national NHS monies to support the out of hospital/community model of care and allocated it to redevelop the Ellen Badger Hospital for these teams. The board signed off a business case for an integrated building with Shipston Medical Practice to support Integrated Neighbourhood teams using this national funding. The board acknowledged the plans enabled a future build for beds dependent on the bed review and funding.

When Shipston Medical Practice decided they were unable to proceed, it was at a point that SWFT would have had to return the national funding due to the time it had taken to start the development. The main delays associated with this programme were due to Covid, planning, highways and bats. On that basis, the Trust Board proceeded with the integrated building to ensure that there was health infrastructure in place for the future in Shipston.

The Trust often builds the shell of a building and then fits out the internals in line with availability of capital, this is the approach that was taken at Stratford Hospital and with the new elective hub at Warwick.

There has been £8.2m invested into a new, modern healthcare facility that will bring more specialities and clinics closer to the local communities in and around Shipston.

The new Ellen Badger Health and Wellbeing Centre will provide enhanced clinical spaces for outpatient services, including specialties like audiology, heart failure, Parkinson’s Disease clinics, antenatal clinics, and shared spaces for community nursing teams. The number of specialities running clinics is expected to grow in the future once the Health and Wellbeing Centre becomes established.

The focus is on delivering preventative and community-based healthcare, aligning with NHS priorities to promote independence and reduce hospital stays.

Furthermore, SWFT continue to work with Shipston Medical Centre with the ambition being to bring them on site when possible.