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.
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 homelike 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, 7% 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, 7 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.
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 in “Services For People Living in Crave” 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.
- 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.