Continue to provide 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; 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 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.
Overall, there were 284 admissions during the last 2 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 3 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 6 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 6 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.
- 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”.