February 2025

NHS Coventry and Warwickshire ICB Consultation on South Warwickshire Community Rehabilitation Beds

Response from League of Friends of the Shipston on Stour Hospitals

1 Introduction

Ellen Badger Hospital has been at the heart of the community in Shipston and surrounding villages since its foundation in 1896. It has served the health needs of the wider community and played a key role in the social and economic fabric of the area. The hospital has enjoyed strong support from the local community for over a century. Since 1973 when it was established the League of Friends has donated over £1.4 million to Ellen Badger Hospital, including £500k for the ‘Princess Diana’ building opened in 1994, and given many hours of voluntary service. In addition, substantial donations and bequests from local people have been made directly to SWFT charities for the benefit of Ellen Badger.

The League recognised the existing buildings were no longer fit for purpose, including Shipston Medical Centre. We therefore strongly supported the 2019 plans for a fully integrated development comprising inpatient beds, a health and well-being hub and new home for the GP surgery. League trustees worked with SWFT, including making joint visits to community hospitals such as the North Cotswold Hospital in Moreton in Marsh, to develop the proposal. The League even contributed £635k to purchase adjacent land to enable the whole scheme to be realised. The scheme was given wide publicity and received strong community support. Planning permission was granted in March 2022.

 The plan four years ago was to temporarily move the 16 inpatient beds to Leamington Rehabilitation Hospital while construction work was underway at the Ellen Badger site. But in 2020 during the Covid pandemic the NHS decided to undertake the development in two phases with inpatient beds relegated to phase 2. An internal Community Bed Review subsequently recommended that the temporary move of inpatient beds to Leamington be made permanent. Although it has not been separately published, we understand from the consultation supporting documents that it recommended an increase in community ‘rehabilitation’ beds from 35 to 41 to reflect the expected growth in population.

Having been promised an integrated health facility, the people of Shipston are angry and frustrated to see that promise broken. There is considerable strength of feeling about the proposal instead to permanently withdraw beds from Ellen Badger.

2 The Consultation

2.1 Scope

In the light of the above background, which was not referred to in the consultation document, we have serious concerns about the scope of the current consultation. Fundamentally it fails to address the impact resulting from the withdrawal of inpatient beds and other services from Ellen Badger. Historically alongside as many as 38 community beds, Ellen Badger Hospital provided Xray, a First Aid Centre and a range of diagnostic and outpatient services including consultant led clinics in ophthalmology. rheumatology, maternity, obstetrics and gynaecology, cardiology and paediatrics. The consultation documents are clear that under the preferred option the site will change from an inpatient and outpatient facility to an outpatient only facility. By any measure that is a ‘significant change of service’ and should have been the subject of a full consultation that took account of the full range of beds and their uses.

In the League’s view the building currently under construction does not constitute a ‘hospital’ in any meaningful or commonly understood sense of that term, as it will have no inpatient beds or essential services such as Xray. Rather we are told that the space in the new building will be used for a community-led wellbeing hub, offices for healthcare staff, physiotherapy and nurse led outpatient clinics. There is no firm commitment to consultant led clinics and no confirmation that Shipston GPs will take up space.

The consultation should have been into the whole range of services affected and their impact on the health needs of people in the Shipston area. Instead, it is limited to the distribution of the existing 35 community ’rehabilitation’ beds. The consultation document claims that unlike Stratford Hospital, Ellen Badger was only used for community rehabilitation beds. We strongly dispute this, historically Ellen Badger received some rehabilitation services, but this was not the primary role of the community hospital (services included minor accidents, infections, minor surgery, observations, respite and palliative care). Deliberately restricting the consultation to rehabilitation beds gives a false picture as it excludes other types of general community beds, flex beds and those for palliative or ‘discharge to assess’ care.

2.2 Need

It is not clear how the 35 community rehabilitation beds figure was arrived at, or why the Bed Review recommendation for 41 beds was rejected. We are told that there is no need for more than 35 rehabilitation beds, but the figures supplied alongside the consultation show that many more than 35 community beds are now being used routinely throughout the year. This includes the regular use of extra ‘flex’ beds. Now we believe as many as 51 beds are occupied, and more could be filled if they were available. The premise that there is no need for additional community beds flies in the face of common sense at a time when Warwick Hospital in January declared a ‘critical incident’ and patients are waiting many hours for beds There is an obvious need for more community beds and additional space to accommodate them to ease the pressure on acute hospitals.

The consultation document argues that recent discharge figures show that there were only a few patients from the Shipston area being cared for in Ellen Badger Hospital. But given the Ellen Badger’s recent role as a discharge ward from Warwick Hospital particularly during Covid it is not surprising that patients came from all over South Warwickshire. This does not mean that there is no need in the Shipston health economy for community beds. Even seven years ago SWFT agreed that a facility like the North Cotswold Hospital would address the needs of the exceptionally elderly population in rural south Warwickshire.

A growing and ageing population means that pressures are likely to increase but future needs do not seem to have been factored into the calculations. The population of Stratford District Council area (which includes Shipston) increased by 11% between 2011 and 2021  and the population over 65 by 25% .The proportion of over 65s is predicted to grow by 29.7% by 2043, which is a higher rate than other parts of Warwickshire, The emerging South Warwickshire Local Plan predicts a housing need of 54,700 additional homes in the south of the county over the next 25 years. A proposal for 1600 homes on the outskirts of Shipston is currently the subject of public consultation.

 Older people are moving to rural areas in greater numbers (see the Chief Medical Officer’s Annual Report of 2023) resulting in those areas having a larger proportion of older people than urban areas. The report recommends that rural areas should be given priority in the provision of services including health and social care, but the recommended Option B does the opposite by reducing rather than improving them. The failure to increase the number of community beds in line with the predicted demographic changes amounts to a real terms reduction in the bed to population ratio.

2.3 Home First

We are told that one reason for only planning for 35 community beds is due to the success of alternative support, such as the Community Recovery Service, for people at home, reducing the proportion of those needing a bed. This is in line with national ‘Home First’ policy. The consultation document states that such support is ‘better and faster’ but no evidence is put forward to support the statement.

There will always be a need for a balance between supporting people at home and in bed-based settings. But in our view, one service should not exclude the other but should operate together in a joined-up way. Home First seems to depend on patients having live in carers at home. We are concerned that such carers are often elderly and may fall ill and need care themselves. A fully functioning community hospital could support such carers for example by offering respite care.  Home First is an unproven high-risk strategy with no guarantees that it will be effective or more cost efficient.

 It is unclear how community support would be organised if Option B is adopted. Given the remoteness and travel distances involved, there could be serious challenges in serving an ageing rural population from Warwick or Leamington. Option A on the other hand could include organising community recovery services from Ellen Badger and dovetailing them with hospital in-patient and out-patient services. Such an arrangement could create valuable learning and staff training opportunities.

2.4 Equality Impact

The Equality Impact Statement published with the consultation document records that a survey of community bed patients showed that accessibility was a top priority.  But the accessibility of friends and relatives from the Shipston area who wish to visit their loved ones has been largely disregarded. A League of Friends’ committee member recently undertook a journey by public transport to see how long it would take to travel from Shipston to the Leamington Rehabilitation Hospital. The one-way journey took 2 hours and involved 3 different buses. The journey would be longer and more time consuming from most of the villages. The reality is that unless they have access to a private car, friends and relatives will be unable to visit patients in Leamington, it will cause distress to patients and their families and reinforce rural isolation and inequality. In the supporting documentation it was stated that there was qualitative evidence that patients were already turning down offers of community beds due to their inaccessible location.

Although the consultation recognises that Option B would result in travel difficulties for Shipston people, it argues that greater needs in the northern part of South Warwickshire justify concentrating resources there and removing them from Shipston. Our view is that concentrating on the majority should not be at the expense of the minority.

The permanent removal of beds from Shipston is also likely to have an economic impact on the town with a loss of skilled jobs and a reduction in the town’s attractiveness as a place to live, work and invest. Private investment follows public investment and good quality jobs and services are a factor in the town’s prosperity.

2.5 Conduct of Consultation

The League considers that shortening the consultation from the standard 12 to 6 weeks is unreasonable as it gives insufficient time to conduct a full and meaningful exercise that engages a wide section of the community. There has not been enough time for example to hold public meetings and other face to face events. The consultation team only offered one public event in Shipston in the form of a ‘drop in’ session. As this took place during office hours some working people were excluded.

A major concern is that the consultation is primarily online and therefore does not address the issue of digital exclusion. It claims to engage ‘hard to reach’ groups, including over eighties, and has arranged facilitated meetings but these are on-line on ‘Teams’. How many over eighties have access to Teams?

Some of the key information such as the Community Bed Review is buried in supporting documentation that is difficult to access, such as in the 900+ pages of material submitted to the ICB Board for its’ meeting on 6^th January.

3 Conclusion

The League of Friends supports Option A as it is the only one on the table that reinstates inpatient beds in Shipston. But for the reasons set out above, we have serious concerns about the validity of the consultation.  The documentation makes it clear that the consultation is only about the distribution of 35 community rehabilitation beds and no other services. We think that this limitation is wrong and a completely inadequate basis on which to take an important decision on the future of Ellen Badger Hospital.

Before any decision is taken to permanently relocate in-patient beds from Ellen Badger, we would want to see a full review that properly addresses the future health and social care needs of the Shipston area. In line with recent NHS policy guidance on developing ‘neighbourhood plans’ (Neighbourhood health guidelines 2025/26, Jan 25) we need a joined up local plan that has beds for patients discharged from acute hospitals who need support before going home, ‘step up’ beds to keep people out of acute hospitals and local beds for end-of-life and respite care together with a range of out-patient services and home-based care. In other words, we want to see integrated health care focussed on the needs of the residents of our rural community rather than the needs of the NHS/ICB organisation.

We believe that there is evidence that is both possible and sensible to have beds at all three hospitals without reducing the number at Stratford and Leamington. This can be achieved if the ICB accept that as well as the proposed 35 ‘rehabilitation’ beds there is a need to strategically plan for the full range of community beds including flex beds, respite, general purpose and palliative care beds. (The NHS already purchase end of life beds in Shipston care homes.) And Shipston is a viable choice. Most of the revenue should already be in the system as staffing costs for current beds have already been met. The League of Friends and the local community have a strong record of fund raising for the Ellen Badger and if necessary, would do so again to contribute towards the capital costs of reinstating beds. We donated £635k to purchase land to enable the promised integrated health scheme with inpatient beds to go ahead. (It would be unfortunate if we had to take action to recover that donation if the beds are permanently withdrawn).

We want to work positively and constructively with the NHS to ensure that what emerges from this limited consultation includes a plan for local beds in Shipston, within a wider plan for local health and care that we can all support.

League of Friends of the Shipston on Stour Hospitals   

February 2025