Community Hospitals and Care Homes Project

Background

The East Lothian Integration Joint Board (IJB) approved a paper on the Reprovision of Belhaven and Edington Hospitals and Eskgreen and Abbey Care Homes in December 2018. The paper reported the results of a year-long engagement with community representatives, staff, individual stakeholders, service-users, carers, providers and partners in East Lothian Council, NHS Lothian, and the Third Sector. Noting the results of the consultation, the IJB issued Direction 12d to initiate development work.

Work began in 2019 to better understand existing capacity and the wider impacts of providing the care models discussed with stakeholders, and how this might affect future service delivery across East Lothian.

In August 2022, we commenced our community engagement events..   The key themes and findings from these engagement events were presented to the IJB in October 2022.

The original IJB direction, has not been superseeded byt direction 12L : NHS Lothian and East Lothian Council to transform the service delivery to older people for the provision of Community Hospitals, Care Homes and the development of intermediate care services, involving full engagement and consultation with appropriate parties. This should take into account demographic factors, current use of services, the impacts of COVID-19, funding pressures, service remobilisation and redesign. It must also take note of the emerging outputs from the Independent Review of Adult Social Care and development of a National Care Service (previously direction 12d).

The Health and Social Care landscape has changed

Since the publication of the December 2018 paper, significant issues have arisen for East Lothian Health and Social Care Partnership (ELHSCP)

• coronavirus (COVID-19) has had a huge impact on health and social care nationally and locally. How will it be delivered? How will it be funded? It will also have impacts on the future design of and regulatory requirements for care accommodation, the delivery of care at home, and the role of technology in future health care delivery
• COVID-19 double vaccination programme is in operation for the people of East Lothian, including 12-15 year olds with booster vaccinations also being offered
• the Care Inspectorate recently announced a national consultation on the future design of care homes and how new approaches to design will influence regulation in the future
• the Scottish Government's response to the recommendations set out in the Independent Review of Adult Social Care published in January 2021 gives clear indications that there will be major changes to deal with when a new National Care Service (NCS) is formed. Consultation on the NCS runs from August 2021 to the end of October 2021
• we have had significant workforce and recruitment pressures from the start of the Covid-19 pandemic, and these pressures will continue - the impact of this is still emerging as we move out of the pandemic and our first year after Brexit

Next steps 

At the Joint Integration Board Business Meeting on 23 February 2023, East Lothian Health and Social Care Partnership (ELHSCP) presented its initial findings and recommendations regarding the future provision of care services in East Lothian.  This follows an in depth review and public consultation by the ELHSCP Community Hospitals and Care Homes Provision Change Board.

The report made four significant conclusions and recommendations:

1. Inpatient Community Hospital Beds
   Currently community hospital beds are being managed effectively and there is sufficient capacity in the system for the foreseeable future. There is unlikely to be a requirement for additional hospital beds in the medium to long term.  The recommendation is to consider the capital and revenue options proposed to sustain the current provision.
    
2. Care Home Beds
   Analysis identified that the development of capacity for care home beds in East Lothian is bounded at a maximum of 70 replacement beds and potentially 30 new beds. These figures will be influenced by external provision (private/independent), Intermediate Care, capital expenditure options (availability) and different models of care.Five options were presented to the IJB which would see an increase/ decrease in bed rates across the geographical regions of East Lothian.It was recommended that these options are explored in more detail with further proposals to follow, to allow for the development of new or replacement care home bed capacity across the county.
    
3. Intermediate Care
   The Intermediate Care report highlighted the breadth and depth of those services being provided in East Lothian and the benefit they provide (now) following previous investment.  The report recommended that there is a focus on extending Intermediate Care resources and develop new and more Intermediate Care provisions.  It further proposed that Intermediate Care is recognised as the key priority for further investment.
    
4. Finance and Capital
   The report identified that the focus of the Finance and Capital working group to date has been around inpatient community hospital beds and care home and hospital bed capacity.  It subsequently recommended further development and modelling of the financial implications around the options presented for inpatient community hospital beds, care home beds and Intermediate Care.   This work should also identify and where partner input would be required considering revenue and capital pressures.

Following presentation of the report and successful support of the conclusions and recommendations by the IJB, ELHSCP will now develop the range of capacity options and financial assessments for the proposed inpatient community hospital and care homes beds as well as Intermediate Care options.  Once prepared these refined proposals will be presented for further consultation.

The Community Hospitals and Care Homes Provision Change Board Final Report 2021/22 can be viewed in the link below.

Community Hospitals and Care Homes Project document library