NHS community care moves into the era of hubs and spokes: it'll be all change for Wiltshire's community hospitals
Radical changes are coming to Wiltshire's primary and community health care. A plan drawn up by Wiltshire Clinical Commissioning Group (CCG) and Capita (the outsourcing and management giant) for the buildings needed in northwest Wiltshire up to 2026, involves cutting two community hospitals and replacing them with other buildings and services.
The Marlborough area is not included in this scheme, but it sets a pattern that will be drawn on soon for community health buildings in south and east Wiltshire.
Instead of the three community hospitals at Chippenham, Trowbridge and Melksham, this plan relies on one community 'hub' hospital, one community 'spoke', three urgent treatment centres and extra space for primary care. Only Chippenham currently has inpatient beds and looks like a fully functioning hospital.
Called a Strategic Outline Case, this document only concerns buildings - no mention yet of the services to remain available at each site, of providers or of the ability to staff the plans. The plan - as outlined in a 112-page document - was approved by the CCG at their last board meeting.
This plan is based on two main considerations. First, many of the community health care buildings are in a poor state of repair and - in the words the CCG/Capita document - 'no longer fit for the delivery of modern healthcare'.
Secondly, the CCG has had, its Chief Finance Officer, Steve Perkins, who led the work on the document, writes: "...a strategy founded on commissioning health services which are based in our communities rather than in acute hospitals...This means that we anticipate, and seek, an increase in the use of our community buildings...so that we rely less on hospital facilities."
These three community hospitals in the north west of the county will reduce to: one 'community hospital hub for inpatient beds, outpatients and diagnostic services'. Plus services for 'outpatients & diagnostics at one community spoke site'. Plus three urgent treatment centres - each to include GP same-day access.
The scheme also includes the aim to 'develop primary care to provide additional space...' at local surgeries.
When this strategy covers all Wiltshire, will it include any reduction in the number of inpatient or intermediate ('step-down') care beds? Any loss of beds is bound to have an impact on the acute hospitals as they struggle to avoid delayed transfers of care that so clog up their care system and lead to delays in A&E.
What this sort of scheme will mean for Savernake Hospital when the CCG and Capita move on to plan for east Wiltshire's community buildings remains at this stage a matter for speculation.
However there are some questions over the policy. It is strange that the number and size of buildings is being decided on before the CCG's current review of its 'service delivery strategy and model of care for the provision of community based services across Wiltshire.'
This is almost certainly explained by the fact that the major part of the capital expenditure will come from the Department of Health's primary care 'Estates & Technology Transformation Funding' (ETTF) which is 'time limited' - that is, it has to be agreed and spent within a certain time.
It is also strange that this policy is being formulated in such detail before the integration of health and social care comes into effect with Wiltshire Council and the CCG working together. ETTF money has already been agreed for the Trowbridge Urgent Primary Care Centre - which will be part of Wiltshire Council's redevelopment of the former council buildings opposite County Hall.
The strategy document lists some of the risks to the policy that may also come to influence what happens in our area. The two high or red risks are: first, financial pressures on the CGG as falling NHS funding makes the plan untenable. And secondly that the plan may face "Local sensitivities, public resistance/opposition to [the] preferred way forward."
There is also a 'medium risk' that the policy could face 'judicial review on [the] process'.
They are also not sure they will be able to access Section 106 funds that have been levied on developers, to put towards the plan's building costs. For example, in our area, Redrow Homes' Salisbury Road development involves a £100,000 in Section 106 charges towards the necessary expansion of Marlborough's GP services.
Playing a central role in this strategy is the ownership of Wiltshire's NHS community estate. Strictly speaking it is no longer Wiltshire's as the buildings are now owned by NHS Property Services. (Savernake Hospital with its complex PFI contract is taking longer to make the move to NHS Property Services.)
The document also implies that acute hospitals - like the GWH in our area - are not part of the community they serve. This seems to be perpetuating the distinctly unhealthy battle of budgets and territory between primary and secondary or acute health care provision.
Below are the lists from the CCG/Capita document showing what services (and the service providers) the three community hospitals in the north west of Wiltshire currently offer: