Agenda item

This report advises the Committee of a proposal to relocate stroke community rehabilitation beds from St Bartholomew's Hospital.  In the view of NHS Medway CCG and Medway Community Healthcare this is not a substantial service reconfiguration.

The Director of Planned and Urgent Care at Medway Community Healthcare added that other sites had been looked at but Amherst Court was seen as the best option given it was a modern residential home with single en suite rooms, lounge and kitchen areas to help with rehabilitation, more parking spaces for visitors and available beds. The home had a very person centred attitude to care with an emphasis on social interaction. Drop in sessions were planned in the coming weeks for staff and patients to answer any queries they might have.

Several Members acknowledged the largely positive nature of the proposal but were critical that the Committee had not been informed of the proposals at a much earlier stage, particularly given the planned move would be taking place imminently in July/August. In response, the Company Secretary (CCG) apologised for any impression given that the Committee had not been involved. He assured Members he had presented the proposal at the earliest possible time given the formal agreement to use Amherst Court had only recently been secured. If the Committee decided the proposal was a substantial variation then the CCG had prepared for that situation and would adjust their timetable accordingly, albeit this would be an inconvenience. Once there was clarity about the wider review of stroke services in Kent and Medway, the CCG would be in a better position to consider the future of community stroke beds. The view of the CCG was that changes arising from this review would entail significant variations.

The fact that it was only a two year contract was a concern for some.  The Company Secretary commented that it was not unusual for NHS contracts to only last two years and in fact the previous contract had been for one year.

A Member expressed concern that, following a site visit by two Members of the Committee, patients with dementia currently at Amherst Court were having to move. An assurance was given that existing residents would not be disadvantaged and more detail on this was promised.

In response to a question from a Member, it was clarified that stroke patients would have a discrete area at Amherst Court but would be welcome to use communal areas such as the café. There were benefits for both organisations in co-location and opportunities to learn from each other.

A Member queried whether locating stroke patients in a residential home might send the wrong message.

The CCG’s vision was to provide care close to home and there was no suggestion at this point that this approach would change at the end of the contract. If the position were to change the Committee would be informed in good time.

A Member referred to the wider review and commented on the difficulty of assessing whether this proposal was a substantial variation in isolation given the interrelationship with the wider review. The CCG acknowledged that ideally the two would connect but there were other services at St Barts which needed to be relocated and other factors had driven the timescales. A pragmatic decision had been made to relocate now.

A Member asked what contingency plans were in place if Avante Care and Support experienced financial difficulties. Members were advised that if the site was to close, then the CCG would urgently secure additional beds elsewhere following discussions with the Council. If there were issues about the quality of care then the CCG would deal with these rigorously and care would continue. Significant due diligence had been carried out.

Members asked for an assurance that they would be kept better informed in future. Whilst they had concerns about the process followed by the CCG there was a consensus that the Committee should not delay the move by agreeing it was a substantial variation. It was pointed out that this was not the first time the Committee had not been informed of a significant change, as the same had happened with the closure of the personality disorder unit.

It was agreed that Members be given an opportunity to visit Amherst Court.

Decision:

The Committee agreed:

a)        that the proposed development or variation to the health service as set out in the report and Appendix A is not substantial;

b)        that a letter be sent to the CCG formally requiring that this Committee is informed, and regularly updated, on the CCG five year strategy and 2016/17 commissioning intentions (and annually the commissioning intentions) so that the Committee can plan the areas Members would like to scrutinise in more detail and liaise with the CCG about any forthcoming proposals for substantial variations or changes to the Health Service, so that there is a proper timeline for consultation with the Committee.

c)         to also advise the CCG that the above in no way detracts from the CCG’s responsibility to inform Members of areas of change regarding substantial variations or Regulation 23.