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

Response from the Beds4Badger Group 

Ellen Badger Hospital – A Beacon for Future Health & Wellbeing Services 

1) Summary 

Our group was formed specifically to channel the strong view of the local community and argue that there should be beds ‘returned’ to Ellen Badger Hospital. We did so because this focus on the future of beds was the one chosen by the NHS, not by us! But we regard this Consultation, with its narrow focus on the future of 35 beds as the wrong one at the wrong time! 

We believe that what there should have been instead, prior to any decision being made about the bed-based element of local services, was a proper look at all the health and care needs of our local rural community. Such work would then have led to a Consultation, if necessary, that focused on the whole provision of primary care and community health services in our area. Local beds would have been seen in that context. 

We have had to deal with the Consultation as limited to a type of community beds only. Despite this we have sought to engage with the ICB team to better understand what is being proposed and the basis for this. We want to recognise the efforts made by the ICB team to respond to questions and to explain the information contained in the different documents. 

Perhaps more importantly we would like to acknowledge the efforts of the ICB to work with us and others, although outside the parameters set by the Consultation, to discuss how we might together develop a plan for addressing rural health issues and in particular focusing on the health and care needs of our local rural community. 

Whilst we have views on the Consultation itself, we hope that you will look in particular at the specific recommendations we make about how you might respond to the Consultation in a way that builds upon the ‘separate’ work on addressing rural issues. You have not linked these two things. We would like you to do so following the feedback that we know you will have received from the Consultation. Response to the Community rehabilitation beds Consultation from the Beds4Badger group – 14.2.25 

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2) Background 

For many years we have had local health care services in Shipston that serve the wider community and meet local needs; many of them based at Ellen Badger Hospital. This included local NHS run and funded in-patient beds providing ‘step up;’ ‘step down’ and ‘end of life’ provision. 

We recognise that whilst the services themselves were very good there were problems and challenges with the existing buildings, including that used by the Shipston Medical Practice. 

We were therefore delighted when the proposal was developed for a ‘modern integrated health and wellbeing Community Hub.’ We understood that this would contain the General Practice, outpatient and community clinics, Diagnostics, and In-patient beds. It would also provide space to ‘support general health and wellbeing activities.’ It would mean being able to continue to provide the whole range of health and care services within a modern setting. We believe that the local community fully support having all of the above services! This was then changed to a proposed two phased scheme, with in-patient beds in Phase 2. 

The League of Friends of the Shipston on Stour Hospitals even contributed a substantial sum of money in order to purchase adjacent land to enable this whole scheme to be built. 

In the last four years that plan has changed, and decisions have been taken regarding the provision of in-patient beds on the Ellen Badger Hospital site. The first decision made was to move the in-patient beds to Campion Ward at Leamington Hospital. By doing this on a ‘temporary’ basis it was possible for this to happen without any prior formal public consultation. The second decision was to knock down the accommodation in which the in-patient beds had previously been housed. The third decision was to submit an application for NHS capital funding for the building now being constructed and not to apply for funding at the same time for the whole planned building which would have enabled in-patient beds to be returned to EBH. We now have a building currently being constructed that does not have space allocated for in-patient beds. The fourth decision was for SWFT to conduct an internal review of future needs for Community beds in South Warwickshire which concluded that this should become the permanent arrangement. The final decision was that there should be a formal public consultation on a choice of two options for the permanent location of 35 ‘Community Rehabilitation’ Beds, only one of which included beds returning to EBH. Response to the Community rehabilitation beds Consultation from the Beds4Badger group – 14.2.25 

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3) The Consultation 

3.1) Scope and Recommended option 

We have faced up to a formal Consultation process, led by the Integrated Care Board, with two options for ‘Community Rehabilitation’ beds in South Warwickshire; one that has beds at Shipston (as well as Stratford and Leamington) and one that does not. It is clear that the ‘preferred option’ of 16 beds in Stratford and 19 in Leamington is favoured. The option with 12 beds at Shipston then only has 11 and 12 beds in Stratford and Leamington respectively. 

If you stick to the parameters within the Consultation, then we believe that the outcome of this is a fait accompli. It is clear to us that the recommended option without any beds at Shipston is likely to be supported by the ICB. Whilst the option that includes beds at Ellen Badger Hospital is described as ‘viable’ it is presented as more expensive (both in annual and one-off costs) and locating in-patient beds in a building not regarded as fit for this purpose by the NHS. It is also presented as a better matching of patients’ residential addresses to the location of the beds. 

3.2) Views of the local community 

Despite what we see as its clear limitations we have sought to engage positively with the Consultation, and to encourage our local community to do so. We believe that whilst you will have heard and seen the strength of feeling of the local community about local health services and the issues raised by this Consultation these will still have been under-represented in the total responses that you will receive. We would agree with the points made by Shipston Town Council on the practicalities of the way in which the Consultation has been handled. We hope, that despite this, the overwhelming feeling of the local community will have come across. 

3.3) The Consultation itself 

If you look at the figures supplied alongside the Consultation you can see that many more than 35 community beds are now being routinely used throughout the year at the two hospitals. The counter argument to this is that when these additional beds are being used this is done on a ‘flex’ or ‘surge’ capacity. We have also been told that these extra patients do not need, and do not receive any ‘rehabilitation’ through for example, access to therapy support. We are genuinely surprised and concerned if this is the case. The numbers suggest that this ‘flexible ‘use of the beds has become the norm. For example, we are aware that in January all 51 beds were occupied, and that more could be occupied if they were available. Of course there will be winter pressures, but we would suggest that such pressures are now the norm, not the exception. Response to the Community rehabilitation beds Consultation from the Beds4Badger group – 14.2.25 

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As described in the response from the League of Friends and others we all know that the population of older people in particular is going to grow substantially in the Stratford District area over future years. As they point out, the Chief Medical Officer has suggested that such increases in older people living, and requiring health services, in rural areas, will be a key issue for the NHS to address. As the population in our area grows and gets older, there will be more pressure. We were told that this increase will cease around 2050. That is of course a long way away. In any case, we believe that there will be a further shift as people move out of the more densely populated urban areas into the less crowded rural area in which Shipston sits. We can produce personal evidence that this happens! 

We have found the information about geographical distribution of patients rather confusing. This has been compounded by a substantial part of the analysis including the Covid period where community beds were used for rather different purposes. Our conclusion from these figures is that if you take the need for community beds as a whole (greater than 35), and then identify those for whom a bed in Stratford or in Shipston would be most convenient, it is possible to have both a substantial number of beds at Stratford (e.g.16 at least) and still have some beds in Shipston. Our difficulty is that the only option available within the Consultation with beds at Shipston immediately places them in competition with those at Stratford by having fewer there. 

We have been told that one reason for only planning for 35 Community beds is that the success of alternative support for people at home reduces the proportion of people needing a bed. When we go back to the Community Bed review, undertaken by SWFT, we can see that it was recommended that there should be 41 beds and an increase in home-based support for people in the community. 

We have not seen, or heard, any evidence that the current balance between bed-based and home-based support is right, or that there are firm plans to increase resources in this area to deal with known future demand. We know that there will always need to be such a balance for those people who need additional support for a period of time between receiving this at home, or in a bed-based setting. We are as keen as everybody to ensure that when people need support at home that is available, and we want to work with the Trust and other bodies to see this in our rural area. There are particular challenges for providing this in an area where travel time and distance can be substantial and where we are at some distance from acute health care. 

Local community beds should form an important part of a whole integrated service. We agree with our local GPs that such beds can, as they have done in the past, be used to enable them to support ‘step up’ admissions without requiring people to be admitted to Warwick Hospital. Similarly local beds can support ‘step down’ and end of life / palliative care with patients cared for by our local GPs and the wider team. Response to the Community rehabilitation beds Consultation from the Beds4Badger group – 14.2.25 

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We want to see a joined up local service that has beds for patients discharged from Warwick Hospital who need support before they are able to go home (or to a Care Home) permanently. Where someone needs a bed to provide end of life care, we want this to be local as well. This is so important to us that we are confident that if funds are needed to refurbish a building or even go beyond that, then these can be found. 

3.4) Our response to the choice available within the Consultation 

We cannot adequately respond to the choices presented by the two options as we do not accept the basis on which this has been done. Whilst we do, of course, want to see local community beds in Shipston, we do not wish to see this at the expense of having community beds available in our more urban areas of Stratford and Warwick / Leamington. We support Option A, as we expect many responses from our local community will do so, as it is the only one on the table that gives us local community beds. We certainly do not wish to see this as some kind of competition between different local populations. But we repeat, this is the wrong choice! We agree with the Town Council and League of Friends that neither option is fully acceptable. 

4) In Conclusion – what we would like to see happen 

We agree with our GPs and others that we should concentrate on addressing ‘rural inequality of care.’ We all signed up to the vision of an integrated service as laid out alongside the original buildings plans for a new Ellen Badger Hospital. This recognised that having a wide range of services, (including local beds), was the right vision for our rural community. The local community was completely behind this. This is still what we want to see achieved. 

We want there to be a positive outcome from this Consultation. We are very concerned that a simple decision made about which is the better of the two options will not produce this. 

We welcome the discussions that we have had with ICB colleagues to develop work with a focus on addressing local ‘rural health needs’ in our area. We can see that such work will allow us all to agree where local community beds could fit into such an integrated service model. Response to the Community rehabilitation beds Consultation from the Beds4Badger group – 14.2.25 

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We are committed to work with the ICB and all other local partners to develop a plan and a model for health care for our rural area. We are therefore asking the ICB and its member organisations to make the same commitment as part of your response to the Consultation. 

• that the ICB work with local community groups to undertake a review of all rural health and care services with a focus on our local area 

• that the ICB support the outcome of this review and indicate that they wish to see this lead to the development of a rural health model, in line with national and local policy. 

• that the ICB acknowledge that there is a case for having some community beds located in Shipston in addition to those at Stratford and Leamington Hospitals. 

• that the review will therefore be able to consider future plans for local community beds in Shipston as part of a wider integrated service if this is supported by all parties. 

• that whilst there will be a reasonable number of NHS run community beds located at Stratford and Leamington Hospitals (a minimum of 16 each for efficiency and effectiveness) any final decision on the exact number should be subject to the work above to allow for a wider look at future need for both bed and home based services. 

• that the final decision on the location of the 35 beds should therefore be paused until the review above has been completed.