Review into Community Rehabilitation Beds

Update on 18th September 2024

Update on the South Warwickshire Community Rehabilitation Bed Review: Options Appraisal

The ICB has reviewed all the potential options for delivering community bedded rehabilitation across South Warwickshire to understand what is viable.

When assessing the options, a wide range of factors were taken in account, including the current financial position for the NHS, both nationally and locally, and the changes in both the health profiles and health needs of local populations following the pandemic.

All options which have been considered are judged against the need to provide the right capacity for South Warwickshire, alignment with strategic direction of travel, affordability and if they are clinically appropriate for the cohort of patients that require inpatient community rehabilitation support.

In addition, the options have also been assessed in the context of the Coventry and Warwickshire Integrated Care Strategy, which outlines our ambitions as an Integrated Care System and how we will work together as system partners to improve health, care and wellbeing for the people of Coventry and Warwickshire.

One of the key areas of focus within the Integrated Care Strategy is supporting people at home where clinically appropriate, which aligns to the national strategic approach of ‘Home First’, and this has been factored in when considering the viability of the various options.

In relation to the use of community bedded rehabilitation, whilst patients generally have a good experience of using community hospitals, there is clear evidence that many patients should have been supported to continue their recovery and rehabilitation at home or in a care home, rather than within the community hospital inpatient setting.

Furthermore, during times of increased pressure on the health system there can be limited flexibility in terms of the capacity within current inpatient units. The learning from periods of extremely high demand, such as winter and the Covid pandemic, has highlighted the importance of the ability to repurpose beds for acute patients where possible. Rehabilitation beds have played an important role in offering temporary increases in capacity and therefore it is important they are located alongside acute services wherever possible.

 

Assessing viable options

The following two proposed options were confirmed as viable on 3^rd September 2024, in line with the approved timescales:

• Option A: Provision of 35 community beds across three sites (Ellen Badger Hospital, Nicol Ward and Campion Ward) and continue to improve care at home. This would see a maximum of 12 beds at Ellen Badger Hospital and would involve the refurbishment of the current building at the Ellen Badger Hospital in order to bring it up to standard.
• Option B: Provision of 35 community beds across two sites (Nicol Ward and Campion Ward) and continue to improve care at home.

Neither of these options would lead to a reduction of the number of community rehabilitation beds available for South Warwickshire patients.

One of the options that has been considered is the construction of a new building in Shipston to house community rehabilitation beds – known as ‘Phase Two’ Ellen Badger development. This option is not currently viable due to affordability and value for money, access to care for all, and patient need - especially in light of additional community rehabilitation funding supporting the national strategic approach of ‘Home First’. The significant financial support needed to fund Phase Two is not available at this present time.

As well as affordability, the panels considered 5 years’ worth of data highlighting the geographical location of patients admitted and discharged across South Warwickshire and this has informed our options appraisal. During that time, approximately 93% of patients are transferred to community rehabilitation beds from acute settings, with only 15-16% of patients being discharged to a postcode within the Shipston, Wellesbourne and Kineton areas. The majority of patients are discharged to postcodes within the Leamington, Kenilworth and Stratford areas.

This does not impact the building work currently taking place as part of Phase One.

 

Next steps

Now the viable options have been assessed, the ICB will now begin to develop a Pre-Consultation Business Case (PCBC), which is a necessary requirement prior to any major service change and must be completed before any public consultation can begin.

After listening to key stakeholders and receiving advice from NHS England, the consultation period will be shortened from 12 weeks to 6 weeks, thereby accelerating the decision making to March 2025 rather than May 2025.

The ICB acknowledges the potential negative implications of a shorter consultation period but will manage these risks with the support of specialist advice and close collaboration with key stakeholders, ensuring that we address frustrations over timescales and delays while still demonstrating that we have actively listened and responded to concerns.

We remain committed to ensuring that all local stakeholders have the opportunity to feed into the consultation process and we will provide regular updates to ensure stakeholders are kept informed as things develop.

 

 

 

Update on 31st July 2024

South Warwickshire Community Rehabilitation Beds: Progress and Future Plans

Background and Historical Context

Within Warwickshire, there are 2 community inpatient wards, both in South Warwickshire, provided by the Out of Hospital Care Collaborative within South Warwickshire University NHS Foundation Trust (SWFT).

The beds available at the Community Hospitals are broadly split into 2 areas:

• Acute Discharge beds for patients who have recently experienced an acute illness and require ongoing 24 hour medical and/or nursing input for a short period of time, and
• Admission Prevention beds for patients with a deteriorating health condition requiring medical or nursing intervention that doesn’t require acute admission but cannot be managed at home.

In both cases, the focus of the offer is rehabilitation. Therefore, moving forwards we will be referring to these inpatient community beds as "rehabilitation beds".

SWFT conducted a South Warwickshire Community Inpatient Review that was focused on inpatient facilities at:

• Ellen Badger Hospital in Shipston on Stour which has 16 inpatient beds; and
• The Nicol Unit at Stratford Hospital which has 19 inpatient beds.

The review was conducted to both assess the current community hospital use and demand and help inform the way services are delivered in the future to ensure the appropriate services are in place to meet the needs of local communities that align with local and national policy.

This review made several recommendations about the future of community beds in South Warwickshire. These recommendations were presented to the ICB Board who decided that the changes may constitute significant service change and, therefore, a pre-consultation business case should be developed to consider the options for community bed provision as well as the wider impact that making the proposed changes would have.

In addition, Ellen Badger Hospital is currently undergoing significant redevelopment. Therefore, due to the practical challenges of continuing inpatient services during construction, the inpatient beds have been temporarily relocated to Campion Ward at Leamington Spa Hospital.

Several key reports and reviews have informed the options being explored for the future provision of community rehabilitation beds, including:

• South Warwickshire Community Inpatient Review, conducted by SWFT, which made recommendations on the future of community beds in South Warwickshire.
• A Review of the South Warwickshire Community Inpatient Business Case and ICB Requirements and Duties, conducted by the ICB, that identified the need for a wider review of Rehabilitation Services for the whole of Coventry and Warwickshire.
• Generalist Specialist Rehabilitation Report which reviewed community hospital rehabilitation provision across the whole of the Integrated Care System (ICS) footprint including consideration to the wider impact of the SWFT proposed changes in conjunction with other transformation work.

 

Current Status

There are two distinct pieces of work taking place to assess the provision of community rehabilitation beds: one focusing on the rehabilitation beds in South Warwickshire and their impact on SWFT, and another addressing the broader rehabilitation bed provision across all of Coventry and Warwickshire.

The broader rehabilitation bed provision workstream is important to assess the system-wide position and will allow for specific, deliverable options for rehabilitation beds in South Warwickshire to be developed. Both workstreams will ensure we are providing the services that meet the health and care needs of the people of Coventry and Warwickshire, both now and in years to come.

With a comprehensive overview of our broader rehabilitation bed provision awaiting formal governance approval and sign off, we recognise that several essential improvements are required to enhance our services. However, we cannot address all of them simultaneously. Therefore, we have prioritised the rehabilitation beds in South Warwickshire.

 

Next Steps and Timeline

The Integrated Care Board (ICB) have legal and regulatory responsibilities to adhere to before implementing any service change, including the permanent geographical relocation of services.

The ICB requires assurance that all viable options concerning the provision of community rehabilitation beds across Coventry and Warwickshire, including the focus in South Warwickshire, have been thoroughly explored. These options will serve as the foundation for any subsequent public consultation regarding the future of community rehabilitation bed provision.

Should the options entail significant changes to current services, the business case will be subject to NHSE Strategic Change Oversight process and final approval by the ICB Board. This would include a transparent and inclusive public consultation process on the proposed options, which the ICB has committed to.

Our aim is to conduct a thorough, inclusive, and transparent public consultation process over approximately 11 months, allowing for comprehensive stakeholder engagement and informed decision-making. The aim is for it to be completed by May 2025.