1. Commissioning future clinical services at Clevedon Community Hospital

2. The North Somerset Clinical Commissioning Group (CCG) is looking ahead to the future of Clevedon Community Hospital… This new project has been undertaken to identify and develop options for the provision of future healthcare services at Clevedon Community Hospital. The CCG will use its expertise, knowledge and evidence to develop and understand these options. The CCG wants to engage with all its stakeholders to inform them about and hear their views on the future provision of services at Clevedon Community Hospital so that the best option for the population of North Somerset is taken forward… No changes to services will be made in this phase of the project.

3. The challenge… The North Somerset population is growing and ageing. The number of people over 85 is expected to increase by 45.7% by 2021 There will also be a big increase in numbers of children and young people, with 5-14 year olds growing by 24.9% by 2021. There are already a growing number of children with complex needs

4. The challenge… Increasing number of patients with multiple long-term health conditions and dementia. Increasingly demanding standards and accreditation required for all hospitals & services delivered there. North Somerset CCG needs to save around £27m over the next 5 years in order to fund the increasing cost of delivering healthcare to a growing population as well as providing new medicines and technologies.

5. But we also have opportunities… A new integrated care service involving health and social care workers working more closely together has recently begun. New ‘enablement’ and ‘reablement’ care packages which enable people to move back into their own homes from residential or nursing homes as well as staying in their own homes for longer. We continue to work with community care providers to seek new opportunities to improve care and deliver it closer to home where possible.

6. But we also have opportunities… Opportunity to work with acute hospital providers to deliver care closer to home. New opportunities to improve both patient’s and carer’s experience of healthcare. A recent audit of the rehabilitation needs of all North Somerset patients in an acute hospital bed shows that more patients could be cared for in a community setting.

7. Scenarios An overview

8. Development of Options – What criteria will be used to come to a decision? The following information will be provided for each option; 1.Description of how the new service will look 2.Pros and Cons of this option 3.Description of the patient journey 4.Evidence base 5.Interdependencies in relation to other local healthcare services Each option will be scored against the following criteria; 1.Clinical need for this service in North Somerset 2.Value for money 3.Financial contribution to CCG challenge 4.Quality of care for the patient 5.Equality Impact Assessment The options appraisal will take into account the Department of Health’s Four Tests for Service Change (2010) as follows; Clinical commissioner support ? Good public and patient engagement ? A robust clinical evidence base? The impact on patient choice?

9. Background Information The Minor Injuries Unit has recently been refurbished and developed to offer a wider range of services and is open 365 days a year. As such, this project is not considering any changes to the MIU. Out of Hours GP clinics run from the outpatient building every evening 7 days a week and all day on Saturdays and Sundays. These will continue. The recent conditions survey of inpatient unit noted that whilst both the outpatient and inpatient facilities are fit for purpose, in terms of long-term viability the inpatient facilities in the old wing of the building are not in line with modern standards and cannot be refurbished. The options are not being drawn up on a blank sheet of paper – the long list of possible options are based on what is possible within the existing building, the needs of the North Somerset population and the healthcare budget.

10. 1.Do Minimum 2.Inpatients remains as is and outpatient and diagnostic (x-ray, ultrasound and other tests) services are further developed using the existing outpatient space. 3.Inpatient provision is delivered elsewhere and outpatients/diagnostics/day care is further developed in its place. 4.Something else.

11. 1.Do Minimum Inpatients today…. 18 beds - 3 GP beds & 15 rehabilitation beds where patients discharged from Weston or the BRI receive care from nurses & therapists Medical cover from local GPs 2 wards; one ground floor, one first floor & two single rooms on the first floor Outpatients today…. Community services - audiology, podiatry, musculoskeletal services Outpatient clinics – e.g. surgery, orthopaedics, psychiatry, sexual health and cardiology 21 clinics per week Most activity on Wednesdays - scope to develop further services in the week Diagnostics today….. One partially functioning ultrasound scanner One digital x-ray machine

12. 2. Inpatients remains as is and outpatients and diagnostics are further developed Examples of further outpatient clinics that could be provided within existing space include: A.New ultrasound machine to develop other clinics B.Extra outpatient clinics such as urology, orthopaedics, ophthalmology or dermatology If further outpatient space was available, the following are examples of further outpatient and diagnostic developments that could be made (if inpatient beds remain as per this option the extent to which other services can develop will be limited); C.Day case blood transfusions D.Ambulatory care (same day treatment for emergency care patients to prevent a hospital admission) E.Further community diagnostics F.Day case rehabilitation

13. 3. Inpatient provision is delivered elsewhere and outpatients/diagnostics/day care is further developed. The removal of beds will deliver greater space opportunities for developing day services as described in option 2. There are various options to explore for the provision of inpatient beds elsewhere; A.A specialist residential rehabilitation facility in the independent sector B.Nursing home provider(s) with therapy and GP cover overlaid C.A model that includes provision of all North Somerset Rehabilitation beds (including 18 at Weston Hospital) elsewhere D.A mixed model using existing acute hospitals and sub-acute hospitals E.Reduced number of beds at Clevedon Hospital to allow more space for existing beds and an improved environment. F.Reduced number of beds at Clevedon Hospital to allow space for ambulatory care chairs.

14. Timeline for this project Project documentation available at www.northsomersetccg.nhs.ukwww.northsomersetccg.nhs.uk Work completed so far: Project Mandate to undertake options appraisal approved by North Somerset Governing Body Project staff established and stakeholder groups contacted Started to gather information, intelligence and data about possible scenarios Long-list of options drafted Scenarios discussed and advice sought from stakeholder and clinical reference groups Work to be done Continue to contact stakeholders to share information about project and offer to attend local meetings Options to be comprehensively developed and scored against criteria Present at local stakeholder meetings to share information about project Stakeholder workshops to be held(September and October) Final draft of options appraisal North Somerset Governing Body reviews options Health Overview and Scrutiny Panel reviews options

15. To get more information: www.northsomersetccg.nhs.uk enquiries@northsomersetccg.nhs.uk North Somerset Clinical Commissioning Group, PO Box 247, Castlewood, Tickenham Road, Clevedon, BS21 9BH Tel: 01275 546770