An Exciting Future in Advance Clinical Practice
Emma Finlay (email@example.com).
Advance Nurse/ Clinical Practitioner.
Sussex Community NHS Foundation Trust.
There are approximately 94,000 people aged 65 to 74 years and a further 89,000, aged 75 and over in West Sussex and another 24,000 in East Sussex. Sussex Community NHS Foundation Trust (SCFT) provides both community and inpatient services to this population. Through-out the Costal West locality we have 111 beds (some flexibility in these numbers) over five Intermediate Care Units (ICU) based in Arundel, Bognor Regis, Rustington and Worthing that provides inpatient rehabilitation. The philosophy and model of care is built upon the multi-disciplinary approach to aid patient centred/ goal based care.
Historically the ICU medical model was based on local General Practice (GP’s) surgeries having medical responsibility for the patients and a few salaried doctors where they would visit for a short period daily to provide medical input. However, Advanced Nurse Practitioners (ANPs) were introduced into our Intermediate Care Unit medical teams in January 2016. This was in response to an increase in workload and a shortage of applicants for ward doctor roles.
The role of the Advanced Nurse Practitioner (ANP) has been recognised from the early noughties. The role has been developed in response to the shortage of doctors, with opportunities for nurses to expand upon their scope of clinical practice (which may have once been considered the role of the doctors) utilising expert knowledge to practice in a non-traditional manner. The Royal Collage of Nurses (RCN) in 2018 defined Advance Nurse Practice, as nurses that work at an advance level within the clinical, leadership, education and research pillars.
In December 2015, the Trust advertised a secondment role for an ANP at Arundel Hospital (a 19-bedded rehab unit) to help support the medical care at the unit, alongside a GP, employed by the Trust. The advert stated the candidate would ideally have advance skills in physical examination and be an independent prescriber. At the time I was employed at SCFT as Clinical Nurse Lead in Worthing. I meet the criteria and was interested in this role and saw it as an opportunity to further develop my clinical skills and professional development. My colleague and I proposed we were offered the chance to undertake a secondment job share; we both would do half our clinical nurse role and half as an ANP for a 6 month period.
The pilot was reviewed after 6 months and we were able to demonstrate through patient and staff feedback the benefits the role from a qualitative perspective. In 2016-2017 the ANP/GP model was rolled out across the organisation the West and Central areas following the success of the pilot.
From December 2016 I have been in a full time ANP. The past 4 years have been a massive, steep learning mountain (not hill!). Initially, with support of good GP’s we were feeling our way in the dark about how the role could impact on patient care, not just following the medical model and becoming “mini doctors”/”doctors assistant”. Over the years we have navigated through issues (which some are ongoing) around Governance/policies, support, supervision, professional development/ competences.
The organisation has recognised the growing need to foster new roles around Advance Clinical Practice and in 2017 funded me to complete the Masters in Advance Practice. The essential aspect of Advance Practice is that you never stop learning, exploring and developing your skills and knowledge to directly impact on patient care.
In 2017 Health Education England (HEE), in partnership with NHS Improvement and NHS England, recognised the growing educational needs for alternatives roles in nurses and allied health professionals. The National Framework for Multi-Professional Advanced Clinical Practice, included a national definition and standards to underpin the multi-professional advanced level of practice. HEE has helped to build the definition around 4 pillars of advanced practice. The Master programme that I am on is built on these principles.
The introduction of the National Framework for Advance Clinical Practice has helped clarify the role more clearly and given ANP’s/ ACPs ability to influence how organisations can develop these roles. What is important to remember about these roles, are we can offer more than just clinical skills. In SCFT we now have an Advance Practice Forum which is led by the Professional Head of Nursing and Education. This forum has helped developed policy and professional development of our service as well as providing support to colleagues.
My passion, alongside other passionate colleagues is the care we provide in the organisation to frail patients. We have a frailty steering group which is examining national and local drivers to improve the clinical pathway to this group, raising awareness in staff. On talking to the locality medical lead and later pharmacy colleagues, about my dissertation which will be exploring the ANP and frailty assessment, we devised a quality improvement pilot locally. What we explored through discussion was the lack of identifying, assessment and intervention within our frail population in our Intermediate Care Units.
On reviewing the literature, evidence suggested two most effective measures in frail medicine; comprehensive geriatric review and a medication optimisation review. With this in mind we conducted a two armed pilot; consisting of a Comprehensive Geriatric Assessment (CGA) and structured medical review. We recruited 10 patients over a 3 week period that were identified as being admitted with a frailty syndrome; fall, immobility, delirium, new incontinence and side effects to medication (British Geriatric Society, 2014). On reflection, undertaking a CGA and structured medication review, enhanced the holistic assessment of the patient, reduced dangerous medications in the frail, aided goal directed care and future care planning post hospital admission. The next step is to pilot the project in another locality to see if the results are replicable.
I am excited for the future in Advance Clinical Practice. This is a great time for nurses and other non-medical staff to remain clinical at a senior level, driving up clinical standards for the patients we serve.
COVID-19 - A Reflection
Steffi Bailey - Physiotherapy and Occupational Therapy Clinical Lead
Leslie Smith Ward, Bognor Regis War Memorial Hospital
Sussex Community NHS Foundation Trust
"As restrictions on all of our lives started to come into effect in late March due to COVID-19, it was evident that life on our Intermediate Care Units was also going to change significantly. Nearly all of the activities our patients and staff normally took for granted stopped overnight, and as a result we quickly realised we would have to increase our focus on supporting patients with their social and psychological wellbeing, in part due to the anxiety around the virus, but also because the restrictions were bound to have a big impact on patients' physical and mental health.
There were to be no exercise groups, no communal dining, no watching television in the dayroom, no visits out to the chapel garden, no visits from family and friends, no volunteers, no therapy dog visits, no hairdressers, and no chaplain to visit. Patients were not able to wear their own clothes, and at times they couldn’t even leave their rooms to access communal bathrooms. I’m sure that staff also felt less approachable to our patients in their face masks, face shields and all the other forms of PPE we have had to endure. From a staff perspective it felt like everything we valued about the quality of care and rehabilitation our service normally offered just stopped. For the patients I am sure it was terrifying, a feeling echoed by staff at times too.
Now being able to reflect on this time of huge change to both our personal and working lives, I feel proud of how the team implemented ideas to make this awful time more positive for the patients. It is also worth noting here that lots of the staff involved were redeployed from other teams, but got stuck in and implemented ideas throughout.
|The therapists started a 'wellbeing hour' between 11 and 12 o’clock daily. In each bay staff would go in and carry out 30-40 minutes of group exercise, then for the last 20 minutes they would have been a quiz, or a word wheel put up on a flip chart. We also printed colouring and word search pages for patients. When we asked for donations of colouring pencils on Facebook we received so many that we were able to make up over 100 packs of pencils that patients could have to keep. The wellbeing hour also helped to ensure patients in the side rooms received some 1:1 time with a staff member, recognising that this was the only contact they would have.|
We went to the shops to buy newspapers for patients at their request to ensure they felt up to date with the ever changing news scene each day. We also asked for donations of books and magazines, which meant we could set up book trolleys to take around the wards with a huge variety of genres. Sage House Dementia Support gifted us lots of activity books, and SCFT volunteers kindly put together patient activity packs. Families of staff members donated wool and knitting needles, and playing cards and tissues; all brilliant ideas that we used to help improve the health of the patients.
|On the 75th anniversary of VE Day, patients had a cream tea and some units were decorated with bunting. The bunting in the picture was made at a local Bognor Regis school by all the key worker children and teachers, and it really brightened up the day!
Although it has been a tough few months for everyone, it’s been heart-warming to see how staff from different teams can work so positively in such a challenging environment, and also that volunteers and members of the public have supported the efforts of our NHS staff throughout. I feel that the focus we put into making the best out of a bad situation helped build morale and resilience throughout the team, so thank you to all involved."
LET’S NOT PANIC ABOUT TRAINING IN A PANDEMIC!
Sandra Speller Physiotherapist and Professional Head of Therapies Sussex Community NHS Foundation Trust
The role of community trusts at the height of the pandemic is perhaps a little under-appreciated, but this is probably understandable, given the high numbers of critically ill patients of all ages requiring intensive and complex healthcare at the time. We all watched the news each night as the crisis unfolded, and saw the numbers of patients being prone nursed, supported with CPAP - and for those most affected, ventilated as their lungs became unable to draw in enough oxygen to sustain life without mechanical help. We saw patients managed in ITUs, in operating theatres and in every nook and cranny in some acute hospitals, all requiring high level care. Releasing capacity to allow this space to be found meant moving other patients out – that phrase we all dread, particularly during winter pressures, of “maintaining patient flow” became the most important task across health and social care systems, driven nationally.
Ensuring we had the capacity to manage the expected patient numbers, and increased complexity of need meant stopping or significantly reducing much community provision, including MSK, podiatry, child development services and work by specialist teams such as community neurology and falls services. This allowed many AHP staff to be redeployed to support both our community hospital wards and community therapy provision - and ultimately maintain that absolutely essential movement of patients out of acute care. There have been many plaudits for the NHS on how it coped at the height of the pandemic, with no reports of overwhelmed hospitals, no reports of the sort of challenges faced by our counterparts in Italy – and we in community services can be very proud of the part we played in this response. Community hospitals were very important cogs in the NHS machine, without which the news reports may have looked very different.
So …. we had a supply of additional staff to support this increased and fast paced patient flow from acute to community – but how did we make sure they were able to be effective, safe and confident clinicians in what was, for many, a very different field of work? We had paediatric OTs who had not worked with anyone over the age of eighteen for 30 years, and MSK physios who were more used to managing complex spinal pain and rehabbing people back to county level sport - all suddenly expected to assess, treat and provide equipment to get the usual community hospital cohort of elderly, frail patients with complex co-morbidities home or into appropriate care placements. Training and skilling up such a diverse workforce at speed, to manage the therapy requirements for these patients was obviously a challenge – particularly in a large community trust, with a large number of community beds, spread over a large geographical area.
WHAT WE DID
The key important first step was identifying the essential skills that were needed, and asking those staff who were being redeployed to self-assess their current level of knowledge, competency and confidence with the skills identified – which included medical (recognising the deteriorating patient, taking basic observations), care (support with washing, dressing , toileting, eating and drinking and patient handling) as well as therapy tasks – which may have been rusty, but not fully forgotten!
Luckily we have recently developed clinical skills facilitator roles for our adult therapy teams; these staff are responsible for the training of our unregistered therapy workforce and supporting their competency development and sign off out in clinical practice. At the end of 2019 they had developed and delivered an extremely successful 3-day training programme for recently employed band 3 therapy assistants, receiving fantastic feedback. This training covered many basic therapy skills – mobility aids, managing stairs, strengthening and balance exercises, dressing and kitchen assessments and home equipment provision.
Helpfully these were exactly the therapy skills we were going to need quickly on our units, so it made absolute sense to use the expertise of our clinical skills facilitators to develop and deliver what was needed – and how fabulously did they rise to the challenge! I also pulled in one of our respiratory physiotherapists to develop a quick resource on Covid-19 and its impact, and some key advice on managing breathlessness. Together with the nursing practice development team and members of the project management team (who were redeployed to help) we commandeered the largest space in the Trust as our “Training HQ”. The plan was to develop training videos and run interactive training and Q&A sessions from here, which we did over a period of about 4 weeks – with so much to plan and deliver it certainly needed military style organisation to co-ordinate and manage!
HOW DID WE DO IT?
Deciding which video resources would be helpful to support staff was the easy part! How did we get over 26 videos made quickly, the content reviewed and checked for assurance and ready for staff consumption in about a week? Cue our knight in shining armour, the man who had an answer or solution for every question or problem, and certainly didn’t like to be beaten – our Digital Lead, who was a fantastic support with every stage of the process – and even didn’t mind being called via What’s App when he was out walking his dogs on a very blustery South Downs! After a couple of false starts we used a simple tablet set up – propped on a range of boxes and files to get the right height and angle. What we got was certainly not Oscar quality, but the videos were clear, with good sound quality and absolutely met the brief: quick, simple, bite size video clips demonstrating “how to” … walk a patient/ help them out of a chair/help a patient eat/get washed/get dressed/assess for walking frame/ hoist from chair to bed/ complete standing transfer etc; etc;
Our clinical skills facilitators became very adept at film direction and editing as they went, and by the 15th video were running through smoothly with minimal rehearsal and a good turn in ad-libbing! The videos were then reviewed for clinical content by senior clinicians, the AHP Lead and Chief Nurse and “editorial quality” (a couple got rejected for sound quality early on by the Digital Lead!) and uploaded very quickly onto an internal YouTube® platform. We developed a dedicated “Covid training” page on our intranet, which meant staff could access “any time, any place, anywhere” - and as we had broken down topics into bite sized pieces it made it much easier for staff to personalise their learning and updates – nothing worse than sitting through a whole 45 minute lecture or training package for the one small item you need!
Staff appetite for, and engagement with the videos was excellent; we monitored levels of uptake, which in turn helped us see in which areas staff were seeking support. For example, we had 431 views on slings and sling insertion, 260 on how to support sit to stand with a stand aid, 345 on toileting, 298 on washing and dressing, 204 on mobilising with a frame, 165 on techniques for managing breathlessness and 98 on basic home equipment.
We also sought feedback from staff when they had completed their learning to make sure we were meeting the needs of all the staff being redeployed, who were coming from a huge range of differing professions and years of experience. The staff reaction suggests the approach taken was more than adequate, as the feedback was very positive, with comments such as “I have seen the videos. Very Informative and helpful” and “feel much more confident to go back to the “adult world” now!”
The impact on staff confidence of using this approach is best explained by this health visitor:
“I just wanted to say thank you for taking the time & effort to put together the YouTube clips, especially the basic care clips. I am a health visitor about to be deployed to the adult rehab unit at ZM Hospital. I am an adult trained nurse but It's been almost 22 years since I last worked in a ward environment so I've found these really helpful. I'm going to be redeployed as an HCA for this reason. One of the reasons I left the acute environment was because I felt I didn't have the time to spend doing 'basic care' (I worked on CCU, emergency medical admissions units). Now I've watched these videos I am really looking forward to spending some time with patients, chatting & helping them with their activities of living & am no longer panicking about which way elbows bend!”
For many staff a quick view of a video was enough to reassure that the knowledge needed was still there; however, we also recognised that for some of our redeployed staff – such as our speech and language therapists and podiatrists, helping patients to wash, dress and use the toilet was not in their basic professional training, so would all be new skills, and they would have questions and concerns that a video alone would not be able to answer. Therefore, for a period of 4 weeks we set up camp in our large manual handling training room and ran a daily programme of interactive Skype sessions on:
This was done on a rolling rota, so different sessions were available at different times each day; this provided staff flexibility to fit in with their working and home lives, as we have many part-time staff. These sessions enabled staff to ask questions on anything they were not sure about after watching the video resources, or to ask the clinical skills facilitators to demonstrate a technique again. They also called on the help of some of our wonderful therapy practitioners and assistants to support and answer questions, which in turn was a great development opportunity for them! At this point different technical skills were called upon – we all got quite good at following the clinical skills facilitators running the session around with a laptop as they leapt up to demonstrate a certain technique on request, moving forwards and closer to zoom in close as required! Again, the feedback was great for these sessions, with staff really valuing the calm expertise from our staff, and the opportunity to learn directly from those who were doing such tasks on a daily basis. The patient handling equipment sessions were particularly popular, with over 140 staff joining at least one session (some staff did come back for more!) We found that as staff started to go out in their new roles they would often “dial in” for help with specific situations they had come across. Again, the staff feedback shows how much these sessions were important to staff confidence - “all your sessions have been really helpful.... wish you were all coming with us on deployment!!!!! Thank you so much”
WHAT HAVE WE LEARNT?
SUMMARY OF TRAINING PROCESS - INSTRUCTIONS FOR STAFF
Julia Fairhall Area Head of Nursing and Governance Sussex Community NHS Foundation Trust
My role as Area Head of Nursing is to lead on aspects of professional practice, patient safety, quality, ensuring both clinical and professional standards are in place to deliver safe, effective, responsive care and quality care across the Central Area that is covered by Sussex Community NHS Foundation Trust.
An important component of my role is about visibility and there's nothing I enjoy more than being on the community wards catching up with our fabulous teams and this has been so important through Covid, touching base with our teams. In the area I cover, our culture is important and one of openness and transparency. Listening and spending time with our teams plays an essential part in how we all develop and problem solve together. This was key to our team being able to effectively work through the challenges we faced with the COVID-19 pandemic.
Within our wards we had a number of patients with Covid and had to follow national guidance regarding ceasing any visitors (apart from exceptional circumstances such as our end of life care patients) onto our wards. As we know, family and friends play a significant role in hospital visiting in providing emotional support, encouragement and stability for our patients and this in turn supports a better recovery. Organisationally we recognised that the lack of visitors and familiarity could have detrimental impact on our patients’ health and hinder the speed of recovery and discharge plans.
With support from our patient experience, communication and IT teams, the organisation purchased a number of iPads. We contacted relatives to share the new communication links and highlighted through our intranet pages and social media sites the service. Families were given appointment times to dial in and our teams supported patients with the technology.
We had the most amazing staff redeployed to support our ward teams and three of the redeployed team, Mary, Sacha, and Helen led a project to support patients to use both iPads and or mobile telephones to make contact with family and friends as part of a wellbeing project. It wasn’t an easy project for the team as they faced teaching family (some of whom were elderly themselves) how to set up Skype on a variety of systems depending what technology families had.
Feedback from staff and families:
“It’s given everyone involved a massive boost and if only we could have captured the smiles of joy on both patients and families. It lifted everyone’s spirits”
We had feedback from a son who lives in France who was able to talk with his father before he passed away who just said:
“Thank you so much for making this happen”
We also utilised the iPads for patients to watch the VE Day activities and to mark the national silence. We also recognised that families who were trying to contact the ward by telephone for information about a loved one often had long waits due to staff carrying out care delivery which they found frustrating. Therefore, appointment times really relieved stresses and we utilised these also for medical /nursing updates with families too.
We recognise this project had a huge impact on patient’s mood and health and wellbeing. We had so much positive feedback from our families that we will continue to utilise. As we know not all families live locally in the same communities. Families felt anxious about their family members in hospital and this made a huge difference to keeping families informed and part of the care planning.
Learning in the time of Corona Virus
Sheila Doughty Area Therapy Lead, Horsham Hospital
During the corona virus pandemic I have been extremely lucky to have been working as a physiotherapist alongside a dynamic and innovative multi-disciplinary team on the Horizon Unit in Horsham. This is a 38 bedded Intermediate Care Unit with a predominantly frail, elderly caseload. At the beginning of April 2020, 4 therapists were redeployed to the unit to work alongside permanent staff - helping support new discharge pathways and ensure patients were discharged swiftly once medically fit. All of these staff had experience of working in a community hospital and were keen to refresh their skills in this area.
One of the Occupational therapists, who had recently been working in the wheelchair services, took onboard the complex discharge planning for a lady with a history of cervical myopathy leading to C3 laminectomy and T5 wedge fracture. She had been admitted with covid pneumonia. Her normal accommodation was not ideal for her level of ability, so it was essential that we had as much information about it as possible. The following is a reflection, written by her, of how she was able to embrace a new way of working, to enable the discharge to progress, at the height of the Covid 19 outbreak in our area.
“It usually takes me a while to get round to reading copies of OT News, but as a re-deployed staff member I thought there might be some helpful advice in this month’s edition focusing on Coronavirus. There was an article from an OT who had previously worked in New Zealand, explaining how she had started carrying out virtual access visits to avoid lengthy travel times. She wrote about using this experience to help with discharge planning during lockdown. I wondered if I could do the same thing in my current role on one of SCFT’s in-patient care units.
At work the following day there was an obvious candidate for trialing a virtual access visit - a patient who lived in a residential complex which was unwilling to accept NHS visitors in the current climate. With the client's consent, I spoke to her full time carer and talked through the option of using Skype to facilitate an access visit. Her carer was not very confident with new technologies, but had used Skype in the past and did have a smartphone. We agreed a time when she could visit the property.
The ward has iPads set up with Skype to allow patients to communicate with their families. I used one of these at my end. I checked in advance that the carers’ details were correct and was able to use a separate room to avoid distractions and ensure confidentiality.
I was not sure how well the call would work. Many people can now relate to how difficult it can be to try to help someone connect online when you are not with them in person! There were some issues for the carer as she kept losing the image from her phone screen, but she was able to point the camera where I guided, and I got a really clear picture of the home. Unfortunately, the carer had forgotten to find a tape measure before the call, but she took note of the measurements that were needed and called back later.
In addition to facilitating a visit we would otherwise have been unable to do, the call took less than fifteen minutes and I saved over one hour of travel time and expenses. Even once normal ways of working resume this method would help save time and resources when discharge planning.
This is something I am thinking about applying to my usual job in Wheelchair Services on my return. We cover a large geographic area and this could help us to identify environmental issues when we are planning to assess someone with a powered wheelchair. Powered chairs are very heavy, so sometimes even small steps and thresholds mean we can't take an assessment chair in to a property. We do lose clinical time going to visit properties that are not accessible. Hopefully, this new way of working will be of ongoing benefit.”
Embracing new technology has been key to the team working successfully over the last few weeks. The iPads, donated by NHS charities, arrived at a time when patients and staff alike were feeling isolated and missing contact with family, friends and colleagues. We have been able to facilitate patient / family conversations via skype on a regular basis including 3 way discussions about discharge plans, as well as using them to undertake mandatory training via skype, share rehab activities on Twitter and have virtual meetings with colleagues. Cross site MDT training sessions have taken place with laptops to view PowerPoint and iPads to run the meeting. Ipads have also been used to set reminders for patients to ensure adequate hydration and could be used to encourage increased activity levels in community hospitals and much more. I am confident that staff will continue to embrace new ways of working both on the ICU and when they return to their usual workplace and hope that more innovative ideas will develop for the benefit of patients and staff.
"At South Petherton community hospital we are working hard on keeping our patients as safe while maintaining the flow of admissions and discharges where possible. We are looking at new ways of communicating with patients and their families, for example by using skype to allow relatives to see their family members at this time, and conference calls/ zoom meeting as family meetings. Everybody is being very creative and thinking outside the box to make things as smooth as possible for our patients and their families and I am so impressed by the entire multidisciplinary team and their resilience through these unprecedented times.
We have had generous donations from members of staff of colouring pencils, pens, crayons and felt tip pens for the patients, and our activity co-ordinator has been busy making up bespoke patient specific activity packs for each patient. A local dentist and hair dresser have donated toothpaste and shampoo/ conditioner to our patients, which has been an incredible help when we do not have family members visiting to top up the patients supplies. Local children have also written cards for our patients to brighten their day at this time which the patients were so delighted with.
Staff are being supported across the Trust in various ways – for example the wellbeing team organised Easter eggs for everybody, and the Trust have organised meals each day from Somerset Larder to be delivered to each hospital for staff which is ever so kind.
We have also been up-skilling staff in clinical skills like verification of death, IV’s, PICC lines, cannulations, so that we can care for a wider range of patients in the community hospitals freeing up capacity in the acute and reducing transfers back if people deteriorate.
The team are incredible and I feel both proud and privileged to be their manager – my true NHS heroes in our small corner of the world."
Care for the Carers
There is concern about how best to support those staff who are caring for others during covid-19, and that includes all staff in the health and social care sectors. These are examples of the way that carers are being shown how they may access support. We know from talking to staff in community hospitals that there are particular challenges to staff working in remote and rural areas. Please share with us what has been helpful to you.
Gloucestershire - Caring for those who care
This is helpful in terms of supporting those who are caring for others.
Accessing Support During Covid-19
This has been issued by the NHS, summarising support to staff.
Patient Safety Stories
The Patient Safety Learning website has launched its #safetystories
"How is the coronavirus impacting other areas of your care or treatment? Share your #safetystories"
Covid-19 Community Hospitals Meeting the Challenge
There are particular challenges in supporting local communities in remote and rural areas. Small local hospitals are contributing in a variety of ways.
Covid-19 Units - becoming dedicated units to support patients who have Covid-19 such as Tewkesbury in Gloc. and Ottery St Mary in Devon
Rehabilitation and Step down care - continuing to provide a service to patients (non-Covid-19) who can be safely transferred out of acute hospitals
Palliative care for all patients
Ambulatory care such as hosting a chemotherapy unit moved from an acute hospital such as Shotley Bridge in Durham
Nursing Resources - Redirecting community staffing, and closing facilities such as minor injuries - such as in Holywell, Wales; Johnson Hospital in Lincs.
Please let us know how your community hospital is being utilised to support patients and families during this crisis.
Thank you for all that you do. Thank you for your generosity in sharing what you are able to achieve within your communities. Within minutes of sending out our latest CHA newsletter, we had many emails telling us what was happening and thanking us for support. This is a selection. Many of these could only be achieved through the work over the years to create strong relationships across the community. Lets keep connected.
Honiton Coronavirus Support Network
“The League of Friends have redirected our time and energy to setting up the Honiton Coronavirus Support Network. We are well placed to have input with these networks as we have good links with our Health and Care teams and GP surgeries. We now attend a daily Community Team virtual meeting so we are all in this together. We got this together in 48 hours which is outstanding and down to the commitment and kindness from many people. As the statutory services get busier we are more and more in the front line and making pretty major decisions on a daily basis. Good working relationships across the organisations is crucial.”
Heather Penwarden Chair of Honiton Hospital and Community League of Friends
Bishops Castle - GP Initiatives
“Thanks all good here. No PPE yet promised for next week. We have put forward plan with community hospitals as hot hubs for the community and with 7 day cover by GPs. Our equipment fund have come up with immediate grant to allow us to work remotely ; i.e. pay for 6 enabled laptops support with equipment PPE and staff in addition to linking closer with local undertaker ( who has been left out of planning cycle entirely)”
Adrian Penney GP Bishops Castle
Fleetwood - Staying Connected
“If you could keep me in the loop please. Stay healthy and more importantly stay happy during this uncertain time and thank you for considering me.”
Kelly Garrick Fundraising Manager Fleetwood Trust
Rye Hospital Charity - Community Support
“Everyone is pulling together quite remarkably.”
Barry Nealon Chairman of Rye Health and Care, Rye Hospital
Please share your experiences with us, to help others.
This is a very good time to be within the CHA. I am so encouraged by the enthusiasm and commitment of committee members. It is a great team to be part of, full of ideas and keen to share experiences. I am delighted to report that we have new members volunteering to join us as co-opted members, which can only add to our strength and our offering. If any member has a query for us, we now have the expertise and experience of 4 GPs, 5 nurses and 6 managers to respond. Our committee continues to grow, demonstrating how important the CHA is seen to be in promoting community hospitals, their staff and services.
I am particularly pleased that we now have National Leads for all 4 countries of the UK – England (Chris Humphris), Wales (Tom Brooks), Scotland (Alastair Noble) and Northern Ireland (Shauna Fannin). These are very skilled and talented individuals who offer a great deal across the UK. I believe we all benefit from being UK-wide, and we are already learning much, such as from the Welsh rural emergency care initiatives, and the Scotland work on strategy and standards.
We are more than open to talking to anyone who wants to work with us either on a national or local basis. I am delighted to say that we are working with staff in local areas to create events for learning and sharing. I am sure this will be very rewarding and the outcomes will be of interest locally and nationally.
As with other committee members, I monitor news on community hospitals daily, and although the situation is still fluctuating, there is a slowdown in the pace of change. There is evidence of in-depth consultations with communities taking place, and serious consideration given to options. In some areas there is investment in community hospitals and a recognition of their role of being a local rural hospital with beds. In other areas however, there are closures of beds and minor injuries units. The staffing of remote and rural hospitals continues to be a challenge. There is support in some areas for the development of the “hub” model, whereby community hospitals are redeveloped without beds, but with a wider remit for health, social care and wellbeing. I will be interested to learn more about how this is implemented and the impact of this model.
This is a highly unsettled time politically, socially and environmentally. This is true for the UK and globally. We will want to continue to offer appropriate, high quality, affordable and safe care to our populations. We have the tradition of 150 years of health care in rural communities with community hospitals. Where possible, we will want to continue to offer our community hospital services that are so highly valued by communities.
Dr Helen Tucker, President of the CHA
Other MPs including James Heappey MP for Wells, and Karen Smyth for Bristol South who asked if the Minister agreed that the health service must bear in mind that such hospitals are developed and fundamentally loved by their communities, and that those communities should have the ultimate say in what goes into them.
Caroline Dinenage, Minister of State for Dept Health and Social Care, said that she would also like to reiterate the important role that community hospitals play in local areas. "Community hospitals provide vital in-patient care for people who need it most." Caroline Dinenage confirmed that the NHS Long Term Plan was prioritising resources into primary and community care, although decision-making was now devolved to local CCGs. She stressed the importance of local community engagement and said: "These open conversations between health systems and the people they serve will, ultimately, allow us to continue building a sustainable future for the NHS."
The transcript of the debate can be read here
The CHA will continue to raise the profile of community hospitals, and promote ways in which communities can be genuinely involved in future of their valued local community hospitals.
The Value of Community Hospitals Recognised by the Secretary of State for Health
Good news! An unexpected endorsement of the role of community hospitals, by Matt Hancock, the Secretary of State for Health at the Tory Party conference. He said that the era of blindly closing community hospitals is over and that there is an undertaking to stop the cull of community hospitals.
The CHA welcomes this very positive statement, and we are now very interested in how this will translate to practice. We will of course provide the Secretary of State with any information required on community hospitals that have closed, are threatened with closure, or have lost or are losing valuable services such as inpatient beds.
One of those cases is Rothbury Hospital in Northumberland. The Secretary of State is due to make an announcement on the loss of beds at the hospital. The Local Authority referred the case to the Secretary of State, and an initial assessment has been carried out by the Independent Reconfiguration Panel. Local people have campaigned vigorously to have the ward reinstated and the service resumed. This will be a test case, and will indicate the commitment being made.
The CHA hopes that the Secretary of State recognises the value of community hospitals retaining a wide range of services, including critically the inpatient beds., The role of community hospitals in providing intermediate care, rehabilitation and palliative care, as well as health promotion, diagnosis and urgent care is clear. These local hospitals have been supported by their communities for 150 years, and the loss of services in rural communities has been felt very keenly.
Matt Hancock has supported his local community hospital, Newmarket Community Hospital, so we hope that his local knowledge will translate to a national strategy that recognises the role, function and contribution of community hospitals to the whole community. We hope that he will give a steer to the 44 Footprints and their CCGs to integrate their local rural hospitals to contribute to fulfilling the policy of "care closer to home."
We will wait and see.
4th October 2018
The Community Hospitals Association response to the Gosport Memorial Hospital Enquiry.
In the light of the findings of the recent Gosport Memorial Hospital Enquiry, the CHA wishes to express agreement with the findings and recommendation of the report and offer sincere condolences for all the families affected by the events at Gosport Hospital.
The CHA provides a voice for the 340 community hospitals in England and has led the way in conducting audit, quality assurance programmes and research in these small, local hospitals.
Research into end of life and palliative care provided in community hospitals has shown that GPs and community hospital trust doctors have been providing exemplary care with adherence to opiate prescribing guidelines. The care provided has been greatly appreciated by carers of patients. Community hospital doctors do not work in isolation now; they are supported by nursing and pharmacy teams and also by specialist community palliative care teams who provide advice and oversight for inpatients requiring symptom control and end of life care.
Despite the shocking findings of the report relating to a period from 1989-2000, the public should have confidence that the care given now in community hospitals is in accordance with accepted practice and subject to suitable oversight and clinical audit.
Dr Dave Seamark 03.07.2018
30th April 2018
Today NHS leaders make the case that the NHS is at least 4,000 beds short for next winter. The BBC television programme, "Hospital" has highlighted the impact that this lack of beds has on individuals as well as hospitals overall. The programme shows in particular the challenges to arranging appropriate discharges particularly for older and more frail patients with complex care needs. Community hospitals have a role in intermediate care and rehabilitation, and this enables patients in acute hospitals to be transferred out of the acute bed when they no longer require acute and specialist medical care, and if they are unable to return home directly. At a time when community hospital beds and rehabilitation services are most needed, around 100 community hospitals have had their beds close, either on a permanent or a temporary basis.
However, there has been a shift in thinking recently in some areas. Some of these beds are now preparing to re-open. The CCG in Devon has required beds in Holsworthy Community Hospital to be re-opened. In Somerset, it is hoped that beds in Chard, Shepton Mallet and Dene Barton will re-open. The results of an appeals to the temporary closure of beds in Rothbury Hospital in Northumberland is due to be announced and there is hope that these valued beds will be restored.
Community Hospitals offer services that help communities to be cared for within their own local area, and saves local people having to travel unnecessarily to acute General Hospitals (unless there is no alternative). The range of services in community hospitals can be extensive, and the CHA is regularly updated on innovative services that can now be provided in remote and rural locations. Those community hospitals that offer a wide range of inpatient, day patient and outpatient services are in a strong position to contribute to the health and wellbeing of the population. And to also contribute to the effective working of the whole health and care system in their locality.
NHS leaders have alerted to the scale of the shortfall, and the media is highlighting individual experiences. When planning for local health care services, it is important to include community hospitals and recognise their actual and potential role in managing demand.
22nd January 2018
The CHA office has been very busy with calls recently. The overriding concern from members and callers is the pressure that the NHS is under with regard to A&E departments and acute hospital beds, and wanting to be reassured that there is an appreciation of the role that local community hospitals have in offering Minor Injuries Units and community intermediate care beds. Community hospitals, as small hospitals serving a typically rural population, are part of the local health and care system and contribute to the management of demand. Also, calls have been received from communities who are concerned that their community hospital beds which have been closed "temporarily" may not re-open. This includes Castleberg Hospital in Settle, Wantage Community Hospital in Oxfordshire and Rothbury Hospital in Northumberland. Another issue high on the agenda is the role and potential of "community hubs" – those community hospitals that are shifting their focus to increase their role in wellbeing and prevention, and hosting services associated with healthcare provided through partners. In some areas, local people are now working with their CCG to co-produce a re-design of services within the community hospital/hub that are appropriate for the local area.
At the heart of the community hospital is the ethos that it is a service that helps to maintain people at home, support their independence and wellbeing, and provide a locally accessible and high quality service. We will watch with interest to see how this is interpreted for community hospitals and hubs and how their services and facilities are re-designed accordingly. We know that community hospitals and hubs have contributed significantly to the health and wellbeing of their local population over many years, and have the potential to continue to do so. Local people continue to demonstrate how much they value their local hospitals. The CHA will continue to respond to members who contact us, and hope we can help with advice and information as well as through our networks.
For more comment, follow the link to the University of Birmingham Viewpoint: Community Hospitals - Discovering A New Model of Care
5th November 2017
There are many communities across England who are actively involved in trying to influence the future of their community hospital and its services. Recently, community groups from Devon, Dorset and elsewhere came together to discuss what is happening to their local NHS and their community hospitals, and to share ideas about how to represent their communities and give a clear message about how much their local hospitals are valued. We know that involving local people in the planning and delivery of local healthcare is a key element of the World Health Organisation Alma Ata agreement. So communities asking to be involved is in keeping with the international recognition that this way of working is much more likely to result in appropriate and sustainable local solutions.
The community campaigning to stop the beds being permanently closed in Rothbury hospital have had a breakthrough, and have managed to make a case to Northumberland County Council health scrutiny committee to refer the CCG decision on closure to the Secretary of State. The group have made a powerful video, which makes a strong case, supported by evidence and heartfelt patient stories. It is well worth a watch, and has already been viewed over 1000 times. - please follow the link to Youtube for the video. This video is very relevant for so many community hospitals and communities. The group are happy to share their report and also their speech to the Scrutiny committee. The community also has an active facebook page We are waiting to hear what the next steps may be. The group is hoping that this is referred to the Independent Reconfiguration Panel for an assessment and review.
There are many community hospitals with services such as inpatient beds and/or minor injuries unit under review. A number of already scheduled to be reduced or closed. We know that community hospitals provide a key role in helping patients stay out of acute hospitals, and also enable patients to e discharged from acute hospitals for further care and rehabilitation. This intermediate care role is vital, particularly in remote and rural areas. As we watch the whole health and social care system struggle to cope with demand, lets hope that decisions-makers listen to those using the service and think carefully before removing valued and trusted locally accessible services out of the system.
26th October 2017
The closure of community hospital beds is leading to some extraordinary arrangements for offering patients alternative intermediate inpatient care.
One of the most outlandish proposals for alternative step down care has been what is being called the "NHS AirB&B" model. In Southend Hospital in Essex, the public were given information about the CareRoom model, asking them to consider taking a patient from the acute hospital into their homes if they could offer a spare room with access to a private bathroom. The headline on the website promotes this as a money-making scheme, encouraging people with an income. It looks remarkably simple: just apply, have a quick security check, and then take your first patient and receive payment. Thankfully, support for this extraordinary model has now been withdrawn in Essex. The outcry about the lack of safeguards and governance has been loud and clear. But sadly this shows how desperate the situation is becoming.
In contrast, NHS community hospitals are highly regulated, with clinical governance and safeguard systems in place. Community hospitals have been offering step down care for patients coming out of acute hospitals for generations.
But now, over 70 community hospitals have lost their beds. This equates to 1 in 5 community hospitals. When you count those scheduled to lose their beds, and those whose beds are closed on a temporary basis this number increases to 100 community hospitals.
This means that we are looking at losing over 2,000 beds, predominantly from rural areas, with a potential loss of 672k bed days based on their average occupancy of 92%.
The rationale for bed closures has been to re-direct funding into increasing support to people in their own home. The enhancement of community teams for home care and rehabilitation is to be welcome, but not at the expense of these valued local inpatient services. There is particular concern about the cohort of patients whose complex care needs means that they are not able to go straight from an acute ward to their own home.
Commissioners' plans to purchase care home beds for intermediate care are being thwarted in some of the rural areas, due to limited capacity and closures, leaving no alternative locally for inpatient care.
The impact of the loss of community hospital bed capacity will need to be measured in terms of patient experience, cost and outcomes, as well as the impact on patient flow through acute hospitals and the impact on the whole health and care system.
We have to hope that careful consideration is given by commissioners before taking decisions to close any more local community hospital beds. We need to consider the evaluations of the service model in those rural areas where they have lost their community hospital beds, and share these widely. We also need time to apply the learning from the evidence from research studies into community hospitals, both in the UK and internationally.
There are many examples of local action being taken across England, as more and more people become actively engaged in having their say about plans to change health and social care services. There are active campaigns against cuts to services in many areas, and in particular against closures of community hospitals in rural areas. One example is Shaftesbury in Dorset.
The community served by Westminster Memorial Hospital, Shaftesbury in Dorset have been making sure that everyone who has a right to have a say in the future of the hospital can do so. The campaign group has run public meetings, run a shop in the middle of the town full of information and staffed by volunteers and have a website. This is a highly organised campaign.
Local people strongly oppose proposals for closing beds in their local hospital. They are proud of their local hospital, and value its full range of services. It is a credit to the staff and the local NHS that local people feel so passionately about their local service.
The group has submitted their response to the consultation. They handed in over 5,000 completed questionnaires from Shaftesbury alone - and this did not include those completed online or posted separately. The group also submitted a report which I wrote on their behalf, raising questions about the proposals and their potential impact.
The report begins with a quote from the World Health Organisation Alma Ata "People have a right and duty to participate individually and collectively in the planning and implementation of their health care."
The local community are certainly taking their"right and their duty" very seriously indeed, and we have to hope that the decision-makers are listening to their collective concern.
The Shaftesbury and District Task Force Response has given permission to share their response to the Dorset CCG consultation.
There are plans to close community hospitals and community beds throughout England. This will have a significant impact on the overall bed capacity, which is already at breaking point.
There is a major bed crisis this winter, and significant pressure on acute hospitals that are regularly on black alert and red alert. Community hospitals have always played a role in keeping patients out of acute hospitals through offering intermediate and rehabilitation as well as palliative and end of life care.
The plans published for the 44 footprints of the NHS in England will see community hospital beds reduce significantly. The plans propose closures of valued community hospitals, changing some into community hubs without beds, and others to have a reduction in their bed numbers.
So a community may be facing changes in their local health care, with a loss of access to their valued and trusted local community hospital.
The CHA has made a submission to the Health Select Committee, and asked for an Inquiry into community hospitals and their strategic role in the NHS is providing "care closer to home." The CHA has asked for a pause in the plans, whilst evidence from current community hospital research is published this year.
This overview of plans across the country show this pattern of reducing the number of community hospitals, and reducing community bed capacity.
* Hospitals already closed include Southwold in Suffolk, and Poltair in Cornwall.
* Hospitals scheduled for closure include Bovey Travey and Ashburton Buckfastleigh in South Devon.
* Worcestershire plan to reduce community beds from 324 to 182 by 2020/21 which will affect community hospitals such as Malvern, Pershore, Evesham, Tenby and Bromsgrove. The plans are for a reduction of community beds across Hereford by 62% and Worcestershire by 44%.
* Oxfordshire describes its 9 community hospitals at risk
* Somerset states in its plan that they have 233 beds on 13 community hospital sites, and that they are planning a "significant reduction" in community beds.
* In Leicestershire, there are plans to reduce community hospital beds from 233 to 195 by 2020/21 in their 8 community hospitals.
* Staffordshire and Stoke on Trent have already closed 105 beds at hospitals such as Cheadle, Longton and Bradwell and are planning a further 99 bed closures.
* Eastern Devon had 244 beds in 2012, and now have 143. They are proposing to reduce these further to 72 beds.
* Derbyshire plans to lose 85 community beds from the system reducing from 210 to 125 beds. There are proposals that hospitals such as Bolsover and Bakewell Newholme close. "Some of the community hospitals will not be required. Others will play a key role within community hubs."
* In Cumbria, there will be a reduction in the number of community hospitals from 9 to 6, with threats of closures to community hospitals in Alston, Maryport and Wigton.
* Community hospital wards are already closed such hospitals as Shotley Bridge, Durham and Rothbury in Northumbria, and are subject to review.
The CHA will continue to monitor these plans and proposals, and we are working with local community groups and helping with responses to consultations.
15th January 2017
In order to be fit for the future the CHA committee is undertaking a review of the CHA.
The CHA is seeking views from stakeholders, members and potential members about what sort of service would be valued in the future.
The CHA is reviewing its role and function, and wanting to hear from you about your ideas of what is important and useful to you.
The survey takes just a few minutes to complete. The CHA will be discussing the learning from the survey in committee and at our Annual Conference.
7th January 2017
What happens when the data published by a CCG in their proposals in a consultation are found to be wrong?
It has been up to local people to find the inaccuracies.
In Devon,"access" was stressed as a key deciding factor when choosing which hospitals would keep beds, but 6 of the postcodes used were wrong in the tables published. A corrected document was added to the website but no further action to date.
In Derbyshire the costs of threatened community hospitals were overstated. A public apology was made, and time added to the consultation for clarification.
These fundamental errors reduce confidence of local people in their local NHS. Local people have said that they are concerned that these proposals are being put together in haste, without attention to critical detail, and without due regard for the impact on patients, families and communities.
The NEW Devon consultation proposes that only 3 of their 12 community hospitals have inpatient beds, and that the number of beds reduces from 143 to 72. Read the CHA Report responding to the consultation here. and the Executive Summary here.
6 of the community hospital postcodes used to calculate access were incorrect in the published papers. Examples of errors included Honiton hospital, where the postcode shown was 65 miles from the hospital. Honiton hospital and Okehampton hospital have been excluded from any possibility of retaining inpatient beds in the consultation , and yet their postcodes were both wrong. Read more on their website here.
2 of the 6 criteria used to consider which hospitals retained their beds were "Patient Access" and "Carer Access" so accuracy in this fundamental measure was critical. The future of local community hospitals and health services are at stake in this rural county.
"During the course of the consultation it has become apparent that incorrect postcodes were indicated on the original document. The document below is the corrected version. Please note that the correct version was used for detailed analysis." NEW Devon CCG
There is no date on the original document or the one that replaced it, so it is not clear at what point in the consultation this correction was made. It is not clear whether any further action will be taken to demonstrate that a robust process was carried out, and to reassure the public that there is evidence that inaccurate information was not used.
With respect to community hospitals, the proposals set out in the consultation were to permanently close 84 community hospital beds. These would be at the Bolsover; Clay Cross; Cavendish (in Buxton); Newholme (in Bakewell) and Whitworth (in Darley Dale).
Consultation papers issued by Derbyshire were found to have material inaccuracies in 3 financial tables, with errors such as overstating the baseline costs of 4 of the threatened community hospitals.
A formal apology was published, and a "clarification" period of one month was added to the consultation period, read more here.
A youtube video showing clearly the extent of the mistakes made was publicised.
Those being consulted had an opportunity to complete a clarification form to say whether the new accurate information had changed the previously submitted response. The CHA was contacted for advise on this, as many who opposed the closure of community hospitals said that it did not change their response, but that it strengthened their opposition to the proposals.
22nd November 2016
"People have a right and duty to participate individually and collectively in the planning and implementation of their health care."
Alma Ata 1978 World Health Organisation
Local people are trying to find ways of voicing their opposition to planned cuts to community hospitals across England. Campaign groups are making more use of social media to enable people to voice their support for their local hospitals. They are using actions such as petitions, marches, communications with MPs, and attendance at NHS meetings in order to voice their concerns. They are also preparing to contribute through the statutory consultation process when this takes place. Community groups and members of Leagues of Hospital Friends are becoming involved in campaigns to save their community hospitals from closure or loss of beds. Local people value their local community hospitals, and are clear about the role that they play in providing local accessible care.
In an article in the Telegraph, Chris Hopson, Chief Executive of NHS Providers said:"Street protests could halt hospital closures." He pointed out that MPs were joining in the opposition to plans in some areas, and that the architects of the plans had failed to engage local communities. Hopson believes that"Fundamentally you can't make big changes to service provision without taking local people with you."
This will be encouraging to the many campaign groups that are now highly active. The collective energy, passion, determination and skill within local communities is very impressive. Local people have much to contribute to the planning of their local health and social care. The campaigns listed below, with links to their sites, include those in Devon, Torbay, Cumbria, Oxfordshire, Durham, Derbyshire, Leicestershire and Staffordshire. As more NHS Sustainability and Transformation Plans are released we may expect further campaign groups to assemble.
Campaign groups are using social media such as facebook, 38 degrees and other public action websites to share their views and encourage support and action. These create powerful local news stories. I hope that by sharing links to local campaigns, we can create a supportive network and develop this into a national news story.