Community Care services for people living in Craven 24...

Community care services for people living in Craven

Public consultation

(including the future of Castleberg Hospital)

Your views count!

Consultation: 14 November 2017 – 27 February 2018

Airedale, Wharfedaleand Craven

Clinical Commissioning Group

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How do I give my feedback?

We want to ensure that our future discussions take your views into account. You can tell us what you think about these proposals in a number of ways:

Complete the online survey at bit.ly/careincraven

Reply by email to [email protected]

Write a letter to us and return it to Care in Craven Consultation, Freepost RTEK-UHKG-UBEK, Douglas Mill, Bowling Old Lane, Bradford BD5 7JR (no stamp is needed)

Fill in the form at the end of this leaflet (page 23) and return it to the above address

Please also take time to complete and return the attached equality questionnaire.

Where can I hear more about these proposals?

You can also attend one of our drop-in sessions, at the following locations:

At our drop-in sessions you will be able to have one-to-one or small group discussions with representatives from the NHS organisations involved in this consultation.

This document is available in large print and as a summary (including EasyRead format). If you would like a copy please use the contact details above.

Please tell us your views no later than Tuesday 27 February 2018.

Victoria Hall, Kirkgate, Settle BD24 9DZ

The Town Hall, High Street, Skipton BD23 1AH

Gargrave Village Hall, West Street, Gargrave BD23 3RD

Devonshire Institute, 48 Main Street, Grassington BD23 5AA

Bentham Town Hall, Station Road, Bentham LA2 7LH

Dates and times

Monday 11 December 201710.00 am – 12.00 noon

Friday 12 January 20182.00 pm – 4.00 pm

Thursday 11 January 20186.00 pm – 8.00 pm

Friday 19 January 20188.30 am – 11.30 am

Monday 29 January 20182.00 pm – 4.00 pm

Thursday 22 February 20186.00 pm – 8.00 pm

Tuesday 6 February 201810.00 am – 12.00 noon

Venue

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Foreword

I am James Thomas, a local GP and chair of the Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG).

As a GP I know how much the NHS matters to us all. We rely on it to help us stay well and to make us better when we're not.

So it's no surprise that every year in Craven, thousands of people use NHS services at home, in their local communities or in hospital.

I want those services to be the best they can be: fit for the 21st century and something in which people can continue to take pride.

Personalising care to meet people's own health needs and their family circumstances is an important part of ensuring that our services are fit for the future.

Sometimes people don't need to be admitted into acute hospitals, like Airedale General Hospital (AGH), but need a greater level of care than can be offered at home. As a family doctor working in Craven, I have admitted people to Castleberg Hospital knowing that they received an excellent quality of care and that they were more often than not able to return home to live independently.

This consultation considers the future of the services until recently offered at the hospital, offering two options for you to consider. I am confident that both of these options are viable, both in terms of quality of care and financial sustainability.

As a resident of Craven, I understand the challenges that people can face when living in isolated communities, sometimes a long way away from hospitals and other mainstream services. These include travel, being close to families and friends, loneliness and isolation from familiar surroundings. I know how important it is to have high quality services within easy reach and choice to support people's individual needs.

Over the years, as well as offering services at Castleberg Hospital, we have responded to these challenges by providing more services in the home and other community settings, and by the use of technology to bring people face-to-face more easily.

The proposals in this document help to address the full range of people's needs, as well as promoting our vision of people who are healthy and happy at home with support from a diversity of care services as and when they are needed.

This document describes two different ways that we could offer the services that, until recently, were based at Castleberg Hospital and in the community. It builds on the engagement that we did earlier in the year.

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I would like to thank everyone who contributed their thoughts when we talked to local people about what matters most about the NHS services they use. We asked them about intermediate, end-of-life and palliative care services – delivered in the community and at Castleberg Hospital – and about how we should conduct this consultation.

A full report about what people told us can be found on our website at . We have bit.ly/AWCconsultationsused this information to help us develop the future options for the services outlined in this leaflet and to plan the consultation itself.

Finally, I'd like to reassure you that we will once again be working closely with Healthwatch North Yorkshire to ensure that your voices are heard. Your views matter to us and will help us to make our decision, so please do attend one of our drop-in sessions and/or fill in and return the questionnaire on page 23.

Dr James ThomasClinical ChairNHS Airedale, Wharfedale and Craven Clinical Commissioning Group

Introduction

The NHS cares for people throughout their lives, through family doctors (GPs), local and specialist hospitals and community teams, and a range of services in between.

This consultation is about some of the services that help people to stay out of hospital, or help them leave hospital sooner with extra support (intermediate care services). It is also about care for people who are drawing near to the end of their lives.

The way that these NHS services are offered in the future may also affect the future of Castleberg Hospital in the heart of the Yorkshire Dales, at Giggleswick.

The NHS services described in this document serve people living all over the Craven district, from Crosshills and Skipton in the south to Bentham in the north, and all locations in

between. Away from the bigger towns of Skipton and Settle, the vast majority of the district is rural in nature with some isolated

communities and limited access to public transport. There are higher than average numbers of older people living in the area.

Caring for local people

Six NHS organisations are involved in the care of people living in Craven:

NHS Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG) is leading this consultation. Working with NHS Morecambe Bay CCG, the CCG plans, funds and monitors the quality of services. CCGs are membership organisations, comprising the GP practices within their areas.

Morecambe Bay CCG – which plans and buys services for people living in Bentham - came into being on 1 April 2017 and encompasses the boundaries of the former Lancashire North CCG and the southern region of Cumbria CCG.

Through its community teams and hospitals, Airedale NHS Foundation Trust cares for people living in Craven.

Similarly, the University Hospitals of Morecambe Bay NHS Foundation Trust cares for people living in the northern part of the district.

NHS Property Services Limited is the landlord/owner of Castleberg Hospital and some other NHS community buildings such as health centres.

Bradford District Care NHS Foundation Trust provides podiatry, mental health and some specialist nursing services.

North Yorkshire County Council (NYCC) works closely with NHS services to provide care.

There are also some care organisations that are not part of the NHS but have contracts with, or work alongside, it. These include the Sue Ryder Manorlands Hospice in Oxenhope and St John's Hospice in Lancaster, as well as a range of voluntary and community services. Family doctors (GPs) also have contracts with the NHS.

The services described in this document can be used by anyone living in Craven, from the age of 18 years onwards.

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Results of engagement

In August and September 2017 we engaged with people in Craven about what options we should consider when consulting about the future of services at Castleberg Hospital. We asked about how we should consult with people once final options had been identified.

Overall, 294 questionnaires and 51 emails/letters were returned and 254 people attended one of our seven drop-in sessions.

From the engagement, it was abundantly clear that there was a high degree of interest and emotion regarding the future of Castleberg Hospital. Residents of the Craven area – particularly those who live in Settle and the surrounding areas – were most concerned about continuing to have access to local, good quality care. They said that the consultation should ideally focus on having clear, accessible information regarding potential plans, with a range of opportunities for feedback, and evidence of having taken views of service users into account.

A copy of the full report is available online at , or by emailing – or writing to – the bit.ly/AWCconsultationsaddress on page 2 of this document.

Services for people living in Craven

In this section we describe the services that are provided now in Craven, as well as those at Castleberg Hospital prior to its temporary closure.

A wide range of services are available to people over the age of 18 years who need intermediate care, rehabilitation, symptom control, palliative care and end-of-life care. NHS services have a strong history of working with North Yorkshire County Council (NYCC) and the voluntary and independent sectors to deliver personalised services to individuals and their carers at home, and in other places where people live (such as in care homes). These include:

Services for people at home (or other places where they live)

Primary care – general medical care provided by family doctors at their surgeries and in people's homes.

Craven community nursing – the 24-hour/seven-day district nursing service cares for people in their own homes and plays a key role in supporting independence, managing long-term conditions and preventing and treating acute illness. Mainly, it supports adults with disabilities, older people living with frailty and long-term conditions, and those nearing the end of their lives.

Craven Collaborative Care Team (CCCT) – a 24-hour/seven-day team offering intermediate care in people's own homes, helping to prevent them being admitted to hospital or as a response to a crisis.

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This team includes advanced nurse practitioners, general and mental health nurses, social workers, occupational therapists, physiotherapists, community support workers and carers' support.

Community specialist services – such as tissue viability (wound care), continence services (bladder), neurology (for people with Parkinson's Disease, Multiple Sclerosis, stroke, etc), cardiac (for heart failure) and respiratory (breathing conditions).

Community rehabilitation team – this is a dedicated therapy team (including physiotherapy and occupational therapy) that offers rehabilitation programmes to people with lung and heart conditions, or who have had a stroke, to help them return to independence. This takes place over a few weeks – in people's homes or community venues – and involves education, support, advice and exercise.

Integrated community equipment service – this joint NHS and local authority service provides equipment to help people be more independent, such as simple aids to daily living or more specialist equipment (eg beds and hoists). This service works closely with the CCCT's occupational therapists and physiotherapists.

Goldline – offers 24-hour telephone support to people with a serious illness who are in their last year of life, and to their carers. This award-winning end-of-life service is run by senior nurses based at AGH.

Night sitting service – supporting people in their preferred place of care, the Marie Curie night sitting service offers night-time care at home for people who are approaching the end of their life.

Telemedicine in nursing and residential homes – staff from care homes can call the telehealth hub at AGH, 24-hours a day, for information and advice from a senior nurse. This includes opportunities for assessment by video link. The nurse directs care home staff to other services as necessary.

Complex care – a health and social care team that supports people who are assessed as having complex care needs who may have had high use of NHS and other care services.

Independence team – this NYCC service helps people to look after themselves better in their own homes.

Domiciliary care – helps with personal care and household tasks for people who are frail or have long-term needs.

Voluntary and community services, including – for example – Home from Hospital and Carers' Resource.

Specialist palliative care team – an expert community team that offers a variety of services – including rehabilitation and day services – to people who have a life-limiting condition, either at home or in hospices.

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Fast-track provision – when someone's condition is deteriorating quickly and they are nearing the end of their life, the NHS continuing healthcare fast track pathway enables an appropriate care and support package to be put in place as soon as possible – usually within 48 hours.

Care homes, hospices and hospitals

Hospices – care for people with a life-limiting illness at Manorlands in Oxenhope or St John's Hospice in Lancaster.

Continuing healthcare within care homes – this is care arranged and funded by the NHS, following assessment of a patient's long-term care needs.

Craven care home quality improvement support service – supports continuous quality improvement of care, and develops personalised care plans, for people in care homes.

Residential and nursing homes – we have an agreement with NYCC to buy beds, as needed, for people to have short periods of care until able to return home. These are available at Ashfield in Skipton and Neville House in Gargrave, both of which are residential homes. These provide “step-up” and “step-down” care to help a person reach the stage where they can safely return home. We also buy beds through continuing healthcare and fast-track (as described earlier). Some nursing homes are “Gold Standard Framework” (GSF) accredited and care for people who have palliative or end-of-life care needs. This means that their staff have been specially trained to provide appropriate services. Other homes are dementia friendly, also having received specialist training. As well as being cared for on a day-to-day basis in nursing/residential homes, residents also receive the same additional care – such as the services of GPs – as those living in their own homes.

Inpatient intermediate care – ward 10 at AGH provides in-patient intermediate care. It is nurse and therapy led with input from a consultant for older people.

The people involved in these teams are multi-skilled. They assess people and gather lots of information – such as dietary needs, possibility of falling, risk of skin damage (pressure ulcers), carers' needs, etc – as well as their health conditions. They develop personalised plans of care which support patients and their carers.

Unlike the rest of Craven (whose services are commissioned by Airedale, Wharfedale and Craven CCG), Morecambe Bay CCG

commissions services for people registered with the GP practice in Bentham. The majority – but not all – of the services described above are available to people registered with the practice, as well as some others (for example, the University Hospitals of Morecambe Bay NHS Foundation Trust delivers specialist palliative care, acute hospital and some community services).

Castleberg Hospital

Castleberg Hospital was closed temporarily in April 2017 because of serious issues with the heating, electrics and drainage. Until then, the 10 beds at Castleberg Hospital were used by mostly older people needing rehabilitation for a short period of time to enable them to return home (“step-down” care). Whilst Castleberg Hospital was not a hospice, some people went there for short-term nursing care, pain relief and support as they neared the end of their life. Other people went there because their medical needs could not be met safely at home but they were not serious enough to be admitted to AGH or Lancaster Royal Infirmary (LRI). This is known as “step-up” care.

Staff at Castleberg Hospital gave care and support to people recovering from an illness or operation. They helped to improve people's mobility, speed up their recovery and get back to their daily lives as quickly as possible. The average length of stay was 20 days.

For people with a life-limiting illness, staff at Castleberg helped with their pain relief (“palliative care”), managing their pain and physical symptoms, as well as their psychological, social or spiritual needs. Most of these people returned home with daily support from community nurses and carers.

During the temporary closure, we have made arrangements for people to be cared for at home, in a community setting (such as a care home), or in an intermediate care ward.

Having described the services currently available, the following section looks at two potential options for the future of these services, and explains why we have discounted a third option.

The featured case studies illustrate a range of different patient journeys, involving some of these services.

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Option one: continue to provide inpatient care in the community and repair/restore Castleberg Hospital

The proposed service: In this option, both CCGs would continue to commission the same community services that were available prior to the temporary closure of the hospital (described on pages 6-9); we would also arrange for NHS Property Services to complete essential repairs to Castleberg Hospital, and then re-open it.

People living throughout the Craven area (including Bentham) would then – when needed – be able to continue to use Castleberg Hospital.

This option would not include the additional community services described in option two (see page 14) because the funding for this will be used instead to run Castleberg Hospital. However, it would continue to allow flexibility, when needed, to arrange some additional NHS-funded care at Neville House in Gargrave and Ashfield in Skipton.

The 10 beds at Castleberg Hospital would support short periods of rehabilitation. As part of their care, people would receive advice, support and encouragement to speed up their recovery from an illness or operation, improve their mobility and get back to their daily lives as quickly as possible. People nearing the end of their life would receive short-term nursing care and pain relief and be supported to return home.

For people with a life-limiting illness, the hospital's staff would help with pain relief, managing pain and physical symptoms, and with psychological, social or spiritual needs. Most of these people would return home with daily support from community nurses and carers.

During the engagement, we heard about the first class service offered at Castleberg Hospital and how its presence – including its staff and services – has helped, over the years, to reassure people living in remote rural communities that NHS services are close at hand. This option takes account of all of the positive comments we heard about the hospital but, because of limitations on funding, does not consider the additional services that people also told us that they would like to have in the Craven area.

People who use the services: People from north and south Craven have experienced services at Castleberg Hospital. In the two years to April 2017, 59% of admissions were from people registered with

a GP practice in south Craven and 41% were from north Craven.

In the same two years, we admitted 14 people who were nearing the end of their life, three-quarters of whom were admitted direct from home and the remainder from AGH.

People nearing the end of their life stayed at Castleberg for approximately five days and most of them chose to spend their last days at home. Those needing help with managing their

symptoms (palliative care) stayed for an average of 10 days and then returned home.

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Overall, there were 284 admissions during the last two years – that is, about 12 per month. On average, people stayed around 20 days. In 2015/16 there were 153 admissions and in 2016/17 there were 131.

Re-commencement of the service: Following our decision about the future of the hospital, it would take approximately three months to complete essential repairs to rectify previous issues with the electrical system, drainage and heating, as well as work to remove asbestos from the roof. It would take up to six months to fully re-establish the hospital in terms of staffing, equipment and supplies; this would run alongside repairs to the estate.

The costs of this option: NHS Property Services has assessed the cost of building works to keep the hospital operational into the future as £60,000 more than we currently spend for each of the next 20 years – bringing the total cost to £1.2 million. Within this sum, NHS Property Services has taken into account normal building maintenance such as the roof, other external finishes, internal pipework and electrics.

With a building of this age (Castleberg was built in 1834), it is possible that – even with normal maintenance – unanticipated, currently uncosted, and possibly major issues with the building or site will occur in the future.

The running costs of the service would continue unchanged at £600,000 per year, plus annual premises costs of £250,000.

Whilst overall this is an increased cost, it is affordable within our existing resources. However, there will be no additional money available for the development of additional community services.

Things to consider: When thinking about this option, you may want to consider the following:

A multi-disciplinary team will be on hand to care for people during the day, with nursing staff available at all times. The hospital will be open 24-hours, 365 days a year.

We know from engagement with local people that the care at Castleberg has been excellent and that people feel safe there.

The Care Quality Commission's 2016 inspection report rated Castleberg as good in all five domains.

It will take up to six months to repair and fully mobilise the hospital and its services, once a decision has been made about its future.

This option will cost the local NHS more money each year than is currently spent at Castleberg Hospital.

This option will not include the additional community services described in option two because the funding for this will be used instead to run Castleberg Hospital.

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Jenny “steps up” to Castleberg from home

Following deterioration in her long-term condition, Jenny is “stepped up” to Castleberg Hospital by her GP, where she is supported 24-hours a day by registered nurses and healthcare support workers. After assessment by physiotherapists and occupational therapists from the CCCT she is encouraged to be actively involved in her therapy plan and goals.

Jenny tells staff that she's anxious about going home to live independently, so they refer her to the mental health specialist nurse who teaches her some techniques to help with anxiety. Her progress is reviewed regularly by a GP and at the weekly multi-disciplinary team meeting, which involves social care and Jenny herself. At this meeting they agree a package of care that starts on the day of her discharge. When she gets home the CCCT therapist visits to make sure she is coping.

The hospital is large enough to provide care for more people than have used it in the past, so – in the unlikely event that considerable additional investment became available – could be expanded in the future, if necessary.

Whilst NHS Property Services has assessed and costed the work required to address known building issues and anticipated general maintenance, we cannot guarantee that a building of this age will not have further issues in future.

Airedale NHS Foundation Trust, the service provider at Castleberg, has reservations about whether – even when repaired – the building is fit for purpose. The Trust is concerned that the aged design and layout is not conducive to the delivery of the desired modern standards of care.

The poor transport links and remote location of the building mean that it is not easily accessible to people living in south Craven and Bentham.

Familiarity and attachment: we know that people sometimes become attached emotionally to NHS buildings, often because of their association with a very personal experience like the loss of a loved one.

The Yorkshire and Humber Clinical Senate, which externally evaluated the proposed options, “recognise that Castleberg is a centralised [resource] for patients that is known to the community, staff and local acute health settings and acts as a central focus of the out of hospital pathway for patients”.

Pauline goes to Castleberg for palliative care

Pauline has an advancing form of cancer and her consultant has explained that there is no further treatment available. She says that she would like to die at home but has some pain that her GP and palliative care nurse have been struggling to control.

She is admitted to Castleberg Hospital for a review, where a consultant from AGH assesses her. Pauline is cared for by registered nurses and healthcare support workers. After a short course of oral medicines, she begins to use pain patches that help with the pain and she is given some other medicines that help to prevent nausea. After a week Pauline is able to go home. Whilst at Castleberg, she was involved in all decisions about her care; she understands what medicines she is taking and who to contact if she has further problems. Before discharge, Pauline had a hospital bed delivered to her home to help her sleep more comfortably. Once at home, her district nurse, palliative care specialist nurse and GP do follow-up visits. They ensure that she has regular reviews and feels supported.

Peter manages his Parkinson's Disease

Peter has been struggling at home with mobility and daily living activities because of his Parkinson's Disease. His GP referred him to the AIRE Unit at AGH – a weekday centre for intermediate care that focusses on falls, patient education and assessment – where he had a multi-disciplinary assessment and started some new medicines. His consultant and staff at the AIRE Unit recommended to his GP that Peter might benefit from being admitted to Castleberg Hospital for a period of intense rehabilitation and support whilst his new medication controls his symptoms.

After he is admitted to Castleberg, a registered nurse, physiotherapist and occupational therapist assess Peter. He takes an active part in developing his rehabilitation goals and his care plan focusses on the issues that are important to him. An assistant practitioner sees him every day and encourages him through the rehabilitation programme. The nurses help him take his medicines and an advanced practitioner and consultant review him regularly. After two weeks, Peter's mobility is much improved and he returns home. With some minor adaptations to his house – organised by the therapy staff at Castleberg – he lives independently. At his follow-up with the community rehabilitation team, together they continue to develop therapy goals, including improving his mobility outdoors. Peter attends the AIRE Unit for some classes to help him feel confident about controlling his Parkinson's Disease; he enjoys these and is able to share his experiences and learn from other people.

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Option two: provide care in people's homes or in an alternative community setting (determined by need), and close Castleberg Hospital

The proposed service: In this option, we would provide an expanded range of services to people in their own homes or the places where they live (such as residential or nursing homes). Castleberg Hospital would close and we would have arrangements at three community locations – in Settle, Skipton and Gargrave – to provide support to people who need some additional care and support that cannot be provided at home. The full range of community services, such as a collaborative care and nursing teams will support them.

This option would include:

enabling more people to have palliative and end-of-life care at home, or in their chosen place

additional support for carers

an increased night sitting service

increased access to beds in community locations across Craven, supported by a range of health and care professionals

an expanded rapid response team to help people who are in crisis

an expansion of intermediate care at home or another chosen place.

During the engagement earlier this year, we heard about the need for additional night sitting services. Often, a family member or another carer provides support during the night to people who are very ill. But there are times that they need respite to catch up on sleep or reduce any other worries they may have. Other people may not have a network of support to support them at home during the night.

A night sitting service provides this help but, at the moment, it is a very small service that cannot provide all of the support that people need. This option would allow us to increase this service. For example, for someone with short-term confusion we would be able to provide assistance that would allow their carer to have a break.

In this option, to help avoid unnecessary admissions to hospital, we would strengthen the community teams' ability to respond rapidly to people's needs. For example, in relation to someone living with dementia, the team would provide short-term intensive input in a person's home, support with medicines, nursing care, counselling, coping strategies, a listening ear, and suggestions to carers about how to occupy a loved one to keep them calm.

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For those people who are not able to be safely supported at home and cared for by the community teams, this option would offer short-term placements in care homes in Settle, Gargrave and Skipton so that people are cared for as close to home and their local community as possible. It means that there will be shorter distances to travel for families and friends, and enable them to visit more often. The care homes offer people the opportunity to be cared for in a more home-

like environment, including activities, shops, libraries, access to hairdressers, etc.

The beds will be at Limestone View in Settle, Neville House in Gargrave and Ashfield in Skipton. Ashfield specialises in dementia care and both Neville House and

Ashfield are experienced in providing intermediate care. As part of this option, NYCC is willing to create an extra three beds at Limestone View in Settle – an extra-care housing facility with 24-hour care and support - to offer an alternative to Castleberg. The care home staff – working with NHS community teams – will look after people who have intermediate care, symptom control, palliative care and end-of life care needs.

We know from engagement that some people are concerned about the availability of care home beds in Craven, and the sustainability of the sector overall. In October 2017, we conducted a survey of available beds in the 12 nursing and residential homes in Craven. Overall, there are 352 nursing home and 152 residential home beds across the district. In October, seven per cent of nursing home and 25% of residential home beds were vacant – that is, a 14% vacancy rate across the sector. Beds regularly purchased by the NHS would help to ensure the sustainability of the sector and, with the arrangement at Limestone View in Settle, a small increase in the overall number of beds available.

Also within this option, staff from Sue Ryder Hospice's community service would be able to expand their day service. Potentially, this could be based at Limestone View, with access to consultation rooms, space for groups and some gym facilities. Outpatient appointments could be offered there with a specialist palliative care consultant or nurse, supported by the use of video links to the telemedicine service. The rehabilitation team to support palliative needs would be expanded and would also offer complementary therapies. There is also potential to expand the Sue Ryder social work team to offer social support to family and carers.

In this option we would expand NHS intermediate care services to support people wherever they live. This would include an expansion of the workforce – for example, nurses, therapists, general assistants, pharmacists, social care, voluntary services. To help combat some of the issues of rurality, we could increase the use of assistive technology – such as video links – in patients' care.

Recognising the valuable job that carers do, we would increase the support available to them. To do this, we would work with our colleagues in the voluntary sector, such as Age UK and Carers' Resource.

Access to all of the services outlined in this option would be by referral by a health professional – such as a GP or nurse – through the intermediate care hub at AGH. This well-established hub operates 24-hours a day, seven days a week and is staffed by health and social care qualified assessors. They review referrals and, where appropriate, conduct further assessments to ensure that personalised services are offered. With a patient's consent, all of the health professionals involved can view a shared health record, updated in real time, when assessing or making decisions about care.


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Morecambe Bay CCG will work with people in Bentham – including clinicians – to ensure that the money currently spent on services at Castleberg is used to boost the services outlined in this option. They would use the money to reflect local needs in the context of the Better Care Together strategy in the Morecambe Bay area – see .www.bettercaretogether.co.uk

People who use the service: Any adult registered with a GP in Craven will be able to use these services, following assessment by a health professional.

Commencement of the service: Whilst the core services listed on pages 6-8 are already operational, the additional services outlined in this option would take at least six months to become operational.

The costs of this option: With the closure of Castleberg Hospital, the funding released from running, staffing and maintaining the hospital (around £850,000 per year) would enable us to buy more face-to-face care. We would continue to commit this level of funding to secure the services described in option two.

Prior to consulting, we have agreed that this option is affordable and viable.

Things to consider: When considering this option you might want to think about the following:

This option would provide a flexible way of offering choice, personalising care around an individual's needs.

It would take at least six months to mobilise the newly expanded services, taking account of the need to recruit staff, buy equipment, etc.

Services would be available right across the Craven footprint, and would be easily accessible to everyone there.

We would need to plan carefully to ensure that our buying of care home beds can meet different levels of need at different times.

This option would provide more services at home and other community settings and, by the use of technology, bring people face-to-face easily.

Airedale NHS Foundation Trust's community health services for adults were rated as good by the CQC in March 2016, with an outstanding rating for “well led”. The collaborative care team was highlighted as an example of outstanding practice for its multi-disciplinary teamwork.

Limestone View was rated as good overall, and outstanding for caring, by the CQC in October 2017. Similarly, Neville House and Ashfield were rated as good overall in September 2016 and June 2017, respectively.

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John is supported at home

John lives independently in his own home, supported by the community nursing team. He is a long-term catheter user. John's GP is called out and diagnoses him with a urinary tract infection; he prescribes an antibiotic. Unusually, John seems confused, is unable to manage his medicines independently and is unsteady on his feet. The GP refers John to the intermediate care hub (ICH) with delirium due to the infection. ICH staff contact the CCCT who visit John within two hours of receiving the referral; he is assessed by a registered nurse and a therapist.

John's GP has provided a prescription administration record so that the CCCT nurses are able to administer his antibiotics for him. John is supported on the delirium pathway; his blood pressure, pulse, temperature, respiratory rate and oxygen levels are recorded regularly. He has four visits a day from the team and has a night sitter for the first three nights. After that, John is showing a marked improvement; the CCCT supports him to take control of his own medicines again and the visits are reduced. The CCCT and John are supported by the community advanced practitioners (CAPs) that are co-located with the team; they attend their multi-disciplinary team meeting. On the fourth day with the CCCT, the CAP visits John and contacts the GP with an update.

This option would expand services that help to tackle the issues caused by rurality and isolation by providing responsive services to people wherever they live, throughout the day and night, all year round.

Castleberg Hospital would be sold and proceeds from the sale returned to the Department of Health (DH). Because the DH retains money from the sale of NHS-owned buildings, it cannot be ring-fenced for local investment. However, the money currently used to staff, run and maintain the building (about £850,000) would continue to be available locally to invest in services.

The Yorkshire and Humber Clinical Senate, which externally evaluated the proposed options, says: “option 2 which sets out a model of caring for patients in their own home or a community setting, appropriately supported through community services, is in line with national best practice and has our support. The existing community integrated approach to healthcare has developed around the Castleberg facility with the success of the other approaches to intermediate care already reducing the need for the bed provision.”

In the engagement, some people were concerned about the availability of care home beds in the future. Experience tells us that we are able to arrange increasingly sophisticated packages of care that supports more people at home. However, we recognise the need to plan carefully the number of care home beds to support anticipated future demand, taking account of demographic profile changes.


Valerie receives palliative care at home

Forty-three year old Valerie is an adored wife and mother of three. She was diagnosed with cancer and, despite surgery and chemotherapy at AGH, was told that her cancer had spread and was now palliative. Valerie wants to go home and be with her family, and has previously told her family and GP that she would like to die at home. Members of the ward team refer Valerie to the palliative care team and Goldline. She returns home with support from the district nursing team and, together with her husband, is able to contact the experienced Goldline staff for advice and support. When Valerie's care needs increase, the community teams organise a package of care to support her to remain at home. On some nights, Marie Curie night sitters allow her husband to rest overnight and the CCCT supports Valerie with frequent visits.

Barbara “steps down” to Limestone View from hospital

Seventy-six year old Barbara has heart failure, rheumatoid arthritis and recently has been diagnosed with cancer. Until her husband – her main carer – passed away earlier in the year, she was coping well at home. Barbara loves living in her village but is becoming increasingly more anxious and lonely. She is having difficulty with walking and has had a couple of falls. After another fall, she is admitted to hospital and, although she receives excellent care, she wants to go home. She needs further rehabilitation and is not yet safe to be at home.

Barbara is “stepped down” to Limestone View where she can use all of the same services as she would have done at home – her own GP, the same district nurses and specialist palliative care team. Together with her healthcare team, the staff at Limestone View help Barbara improve her mobility and regain her independence. They support Barbara with everyday tasks, like making a cup of tea and managing personal care. She is able to join in with activities at Limestone View and, because she is staying close to her own village, her friends visit regularly. This improves Barbara's sense of wellbeing and, after three weeks, she is able to return home with a care package.

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Summary of options

In this option ….

Services will be provided by family doctors, dentists, pharmacists and opticians

Use of the intermediate care hub

Use of expanded intermediate care hub

Craven community nursing – district nursing service

Expanded Craven community nursing – district nursing service

Craven Collaborative Care Team (CCCT)

Expanded Craven Collaborative Care Team (CCCT)

Community specialist services eg tissue viability, continence, neurology, cardiac and respiratory practitioners, dietitians, speech and language therapists

Specialist palliative care team

Expanded specialist palliative care team

Community rehabilitation team

Expanded community rehabilitation team

Integrated community equipment service (health and local authority)

24-hour Goldline service

Intermediate care ward (Ward 10 at AGH)

10 beds at Castleberg Hospital

Beds at Ashfield (Skipton), Neville House (Gargrave)

Additional beds at Ashfield (Skipton), Neville House (Gargrave)

Beds at Limestone View, Settle

Fast track provision (continuing healthcare)

Hospice provision – Sue Ryder Manorlands in Oxenhope and St John's Hospice in Lancaster

Telemedicine in care homes

Complex care team

Independence team

Domiciliary (home) care

Home from hospital

Carer Support

Expanded carer support

Night sitting service

Expanded night sitting service

Option 1 Option 2

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Options that we have discounted

One of the options we put forward for engagement earlier this year was to provide inpatient care in the community by building something new.

Although this option was relatively popular with those who responded, we now know that it is not affordable or viable and, as a result, we are

not consulting on it.

Based on advice from NHS Property Services, the estimated cost of a newly built 10-bedded unit would be £4 million, including land costs.

Funds from the sale of an NHS property, such as Castleberg Hospital, are retained by the Department of Health with no guarantee of them being returned to the area. The bidding process for capital funds for a new build would therefore depend on us securing support from the West Yorkshire and Harrogate Health and Care Partnership and submitting a business case to the Department of Health.

Based on the capital funding required for a new build and its running costs, NHS Property Services has estimated that the annual premises costs of a new 10-bedded facility would be £427,000, which is £177,000 a year more than we currently pay. Given the scale of this increase in annual costs, it is not considered to be affordable.

We have also considered whether there are any existing facilities that could be developed to accommodate a 10-bedded unit. NHS Property Services conducted a review of local NHS estate in Craven and identified no suitable options.

How will we make the final decision?

When making a decision of this kind, we consider a range of information. This includes:

the vision for Accountable Care Airedale, the fit with our strategic objectives and principles and the CCG outcomes framework

the NHS Forward View

West Yorkshire and Harrogate Health and Care Plan

views expressed by the public and other stakeholders during consultation

the duty to have regard to the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategies

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patient choice

the clinical evidence base

the views of service commissioners

intermediate care guidance issued by NICE in September 2017

NHS England has set a statutory duty for all CCGs to operate within their financial allocations and to commission services without overspending. In view of this, we must also take account of the financial implications of each option under consideration, whether it is affordable and demonstrates value for money. For clarity about the affordability of each of the options, we have considered this prior to writing this document.

Following consultation, our Clinical Executive Group – which includes GPs from Airedale, Wharfedale and Craven – will consider a business case and make a recommendation to the Governing Body, members of which will make the final decision. Prior to making our decision, NHS England will review and approve how the Clinical Executive Group came to recommend a preferred option.

We anticipate that the Governing Body – whose membership includes clinicians and lay people – will make its decision on the future of these services in May 2018.

Help with some of the terms used in this document

Accountable Care Airedale – our vision is to move beyond integrated services and truly transform the way we deliver health, care and support for our population now and into the future. Our strong and clear vision for the future is for people to be happy and healthy at home.

Carers' Resource – gives information, advice and support to carers, the people they care for and to the professionals that work with them.

CCG outcomes framework – comparative information shared by NHS England about the quality of services commissioned by the CCG and associated outcomes.

Commissioning services – CCGs plan and buy healthcare, and monitor the quality and outcomes of the care provided.

End-of-life care – supports people in the last months or years of their life, helping them live as well as possible until they die, and to die with dignity. Services also support family and other carers.


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Home from Hospital – provides short-term practical support to help people return home and be independent – for example, by ensuring that the home is safe, doing practical tasks such as shopping, prescription collection, light cleaning, dog walking, etc.

Intermediate care – provides short-term support to help people recover and increase their independence. For example, it may help them: remain at home when they start to find things more difficult; recover after a fall, an acute illness or an operation; avoid going into hospital unnecessarily; and return home more quickly after being in hospital. It can be provided at home, in a care home or in hospital.

Joint strategic needs assessment (JSNA) – looks at the current and future health and care needs of local populations to inform and guide the planning and commissioning (buying) of health, well-being and social care services within a local authority area.

Palliative care – services for people living with any kind of life-limiting illness for which there is no cure. The service also helps to control symptoms experienced by people with other complex illnesses. It aims to treat or manage pain and other physical symptoms, as well as help with psychological, social or spiritual needs.

Yorkshire and Humber Clinical Senate – a source of independent, strategic clinical advice and guidance to the CCG and other stakeholders to help us make the best decisions about healthcare for the population we represent.

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Tick one only

Our questions for you

If you need more space to write your answers, please include a separate sheet with your reply

1 Which is the option you prefer most?

Option 1 Continue to provide inpatient care in the community and repair/restore Castleberg Hospital

Option 2 Provide care in people's homes or in an alternative community setting (determined by need), and close Castleberg Hospital

I have no preference

Please tell us why you have made this choice:

2 What questions or concerns do you have about the option you have not chosen?


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3 Is there anything else you'd like to tell us about these proposals?

I give permission for Airedale, Wharfedale and Craven Clinical Commissioning Group to send me information about other health and care developments. The CCG will never share your details with any other organisation/third party.

Yes/No*

*delete as appropriate

If you would like to receive information about the outcome of this consultation or other health and care developments, please write your contact details below:

Name

Address

Postcode

Email

Please return this questionnaire by no later than Tuesday 27 February 2018 to Care in Craven Consultation, Freepost RTEK-UHKG-UBEK, Douglas Mill, Bowling Old Lane, Bradford BD5 7JR or complete it online at: bit.ly/careincraven

To help us understand who is responding to this consultation please also complete the attached equality questionnaire.

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