Community Hospitals and Care Homes provision recommendations

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.

With a significantly growing older population there will be an increase in demand for care and support across the county. [1]   While planning and preparing for this increase, there is a need to take account of policy direction at a national and local level, to shift the balance of care from institutional care to care in the community.  The aim being, to enable people to live longer at home or in a homely setting.

The Community Hospitals and Care Homes Change Board was established in 2021 with the aim of identifying ways of delivering more care closer to home and addressing the variation of use and delivery of health and social care services across the county while tackling inequality.  With a focus on prevention and low level support, a further aim was to ensure best value for the public purse through effective partnership working. 

Understanding that public opinion of care services, both now and into the future, was vitally important, during the summer months of 2022 a working group of the Provision Change Board conducted a series of public engagement sessions, both online and in person.  Their aim was to gauge public opinion – across a range of age groups - regarding the current provision of older people’s services, and what preventative community-based activities and care support services they would like to see in the future.   

Meanwhile a further working group focused on analysing a wide range of data sets and population projections to review and assess the current and future provision of care beds in both hospital and care home settings.     This element of the project looked specifically at the provision of inpatient community hospital beds, care home beds, and the provision of ‘Intermediate Care’. 

At its simplest, Intermediate Care services are the health and social care services that prevent people needing to go into hospital, or provide support to individuals allowing them to return home from hospital more quickly.  Home First, reablement, and rehabilitation are terms also used and they all represent different aspects of intermediate care. These services offer a link between hospitals and where people normally live, and between different areas of the health and social care system – community services, hospitals, GP’s, and social care.

The Provision Change Board also gave significant consideration to the finance and capital investment required to support such demand; with a final working group preparing a range of financial models considering both revenue and capital funding investment, as well as cost streams in line with the recommended options put forward by the Capacity and Planning working group. 

The measures, actions and findings of each of these investigations, and subsequent recommendation for addressing future demand of care services were compiled into the Community Hospitals and Care Homes Provision Change Board Final Report 2021/22, which was presented to the IJB on 23 February.  This is available to view online at eastlothian.gov.uk/elhscp.

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.

Peter Murray, Chair of the Integration Joint Board comments, “On behalf of the IJB, I would like to acknowledge and thank all of the participants who were involved in the engagement process, be that online, in person or via the survey.  Your thoughts and views are invaluable to this project and we thank you for your time, consideration and contributions. 

This project is very much still in its infancy, however it is important to recognise the significant work that has already gone into this project by members of the ELHSCP team.  Collectively our aim is to improve the health, wellbeing and provision of care services for the adult population both now and into the future.  I firmly believe that by planning for, and identifying innovative means of delivering care services, we will be able to support East Lothian residents to live well longer at home or in a homely setting.”