Health
Our existing GP Surgery is not that old, why do we need a new one?
The GPs identified that there was insufficient room in their current building for all the demands faced, and the town has also seen the retirement of the local dentist. The LHB primary care estates strategy had highlighted the need to review all current buildings, population growth and patient flows to have suitable provision for the next 15 years or so, and the LHB recognised the opportunity to bring health and care services together as a part of this. Acceptance of the primary care estates strategy by the Welsh Assembly then provides the LHB with opportunity to make a case for new premises if older buildings are either in a poor state or there are increased demands.
Are the Doctors at Carreg Wen in agreement with your plans?
As noted above, the GPs had highlighted a need for a new or expanded premises. Their initial preference was to remain on their current site, but there is recognition that this option would mean some decant of services elsewhere for a period. They have indicated preparedness to move to a new site if this gives greater flexibility for them to meet forecast demands.
Where would you have put a new Resource Centre if the Leisure Centre had not been closed?
It is important to emphasise that developing a new resource centre was being planned well before the leisure centre was closed in January 2007. There had been some preliminary consideration of sites, including staying on the current site, before the Council introduced the opportunity for wider integration with a new school and leisure facilities. Workshops with stakeholders in December 2006 and March 2007 highlighted that full integration should be actively considered, and this in turn highlighted the need for a larger site.
Who are the stakeholder bodies who attended these workshops? Were any binding contracts agreed?
Representatives from the following bodies were invited:
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Local Health Board
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National Public Health Service
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Community Health Council
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Primary Care representatives
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Gwent Healthcare NHS Trust
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Blaenavon GPs and Practice Managers
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Torfaen County Borough Council Members and Officers
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Town Council Members
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Education representatives
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Voluntary Sector
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‘Future of Blaenavon’ representatives
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Police
This was a consultative workshop aimed at looking at the potential around integrated provision and did not consider any contractual issues.
What will happen to staff when the Health Care Unit closes, will they still have jobs?
Staff at the Unit are on NHS contracts and have already had preliminary discussions with management about re-deployment options, both locally and further afield. Regular joint staff meetings have been initiated on a bi-monthly basis.
Where will the money come from for a new Resource Centre?
In undertaking consultation on its primary care estates strategy across Torfaen, with very well attended public meetings in Blaenavon, the LHB had endorsement of a preferred way forward with a "hub and spoke" development of primary care, having integration where sensible to do so. The LHB’s strategy was accepted by the Welsh Assembly when the outcomes on consultation were reported. This means that they can then bid for ring fenced development funding for primary care, which will be needed to finance a new centre.
How long will a new centre take to build?
The LHB appointed a third party developer, Assura, in Spring 2007, and Assura have been working with GPs, the NHS Trust and others to assess the scope and size of a new resource centre. It is anticipated that planning and build will take 2 years from completion of public consultation.
Will there be other services in the Resource Centre?
Yes, it will include not just primary care but rooms for multi-agency and multi-functional use. Torfaen Voluntary Alliance has canvassed affiliated groups and organisations as to slots they may wish to take. Social care staff will also use the centre on occasion and on the integrated site will be customer services and community safety links – the aim is that this is a one stop shop for information and advice, either able to give you the information you need then and there, or signpost you to where this information can be obtained.
What will happen to the current GP practice and BHCU site?
The site will be purchased by Assura who in turn will be engaged with the Council and other land owners such as Housing Associations to plan best development use, including housing (different types), commercial or other use. The LHB’s aim is to work with the Council to take a holistic view of needs and develop all available sites for the long term and sustainable future of Blaenavon.
Will beds in the new model be supported by health professionals?
Yes, registration requirements for nursing homes stipulate the number and training levels of staff working there. The LHB also plan for the local community nursing team to be based at the new Resource centre providing outreach to people’s homes and to short stay care beds.
Are new services being made available?
The important baseline is to provide services at least at current levels, but also using multi-functional rooms in the new Resource centre to expand the types of provision available – from health promotion work to expert patient programmes, from testing to visiting consultancy. The key is to have facilities and resources in place that are clinically safe for the provider services.
Who is accountable for beds? Who places people and provides care responsibly?
Long stay bed placements are made either by the local authority social care department (if there is a predominantly social care need) or by the Local Health Board Complex Care team (if there is a predominantly health care need). Determination of whether social care or health care is the dominant need is made through a multi-disciplinary team approach involving medical, nursing, therapist, social work, etc assessments.
Short stay beds come under Intermediate Care, and again placements are made through a multi-disciplinary team assessment. Community nurses and social workers provide support alongside the care staff within the care home.
Who is responsible for the medical cover of the beds?
Medical cover lies within the community. Residents in whatever care setting remain registered with their own GP, who holds their medical records. This is the case for those in both short stay and long stay beds. Short stay beds – defined as stays of up to 6/8 weeks – also have support from Intermediate care clinicians. These work with Gwent NHS Trust, are able to provide community outreach and along with the Advanced Clinical Assessment Team (ACAT) nurses, are able to visit to give medical opinion and recommendation to GP’s.
Who do the queries go to regarding patients in Nursing Homes? What are the complaints procedures, inspections, etc?
Each nursing and residential care home within Torfaen (and across Wales) has to be registered and is subject to inspection/visit by both its local authority and the Care and Social Services Inspectorate Wales (CSSIW). Each has to have its own complaints procedure, available to residents and their families. The first instance then is for a resident or family member to approach the particular home with their query, and if not satisfied with the outcome of that query, to contact the local authority social care department. They can also contact CSSIW direct. Outcomes of inspections are held by both local authorities and CSSIW, and final reports are in the public domain. The CSSIW website is at www.cssiw.org.uk| and they can be contacted by e-mail at cssiw.se@wales.gsi.gov.uk|
Who will manage complaints?
Each care home has to have its own complaints procedure, and to make this available to residents and their families who may have issues to raise. Many complaints will be resolvable by the home itself – although these still need to be recorded and reported as part of monitoring and inspection. If not resolved at that level, then complaints go on to the local authority to investigate, with recourse to an independent investigator (not part of the local authority) if required. The social care complaints procedure is outlined in the leaflet Complaints: How to be heard and the Complaints Officer can be contacted in writing at:
Complaints Officer
Torfaen Social Care & Housing Services
County Hall
Cwmbran
NP44 2WN
E-mail: socialservices.complaints@torfaen.gov.uk|
How will Health buy beds?
It is envisaged that beds will be bought on a block contract basis, that is, the Local Health Board will contract with the care home provider to purchase a set number of beds at a set price for a defined period – usually 3 or 5 years. The care home provider then knows that irrespective of whether a bed is currently occupied or not, it is still paid for. Alternatively, beds are purchased on a spot basis, i.e. if a bed becomes available it is provided for a particular patient and paid for whilst that person needs it. Local authority social care departments have been using block purchasing arrangements for care home beds for some time, and are looking to share their expertise and experience with health colleagues to ensure this process can work in a similar way for health beds.
How will Delayed Transfers of Care be prevented?
Delayed transfers of care (known as DToC) have long been a problem within the SE Wales area, and there is no one single solution. The new model of care we are proposing in North Torfaen is very much geared to improving the situation, by having an increased number of beds available within the community, a mixture of both long stay and short stay – allied to a wider range of community support.
A majority of people want to stay living independently within their own home for as long as possible, but quite quickly lose some of their independent living skills whilst in hospital, where the focus, rightly, is on treating any medical condition or injury that they have. Intermediate care, focusing on individuals and their needs, and also focusing on a return to living as independently as possible, looks to address this, using a multi-disciplinary approach – occupational therapist, social care, nursing, physiotherapy, etc. Having short stay beds, but linked with kitchen facilities, bathroom, sitting room etc allows for active rehabilitation as part of the return to home process.
Preventing DToC is a big issue that no one agency can address, but developing greater community capacity, allied to greater levels of integration between agencies and individuals is a positive step in the right direction.