Angus Care Model – Medicine for the Elderly inpatient beds

Engagement document

June 2022

This summary engagement document sets out planned proposals for the location of Medicine for the Elderly (MfE) inpatient beds for the population of Angus.   This work has been ongoing for the last two years.

Introduction

Community hospitals have been used for many years to provide a range of services, including inpatient beds, for people in their local community.

A clear message from our ongoing engagement with the public is that people want to remain in their own homes whenever possible. One of the core principles of health and social care integration is to provide seamless, integrated, quality health and social care services in order to care for people in their own homes, or a homely setting, where it is safe to do so.

Angus Health and Social Care Partnership (AHSCP) has made significant progress with regards to increasing the level of care being provided to people in their own homes.  The table below illustrates some of the progress.

Table 1. Details of care provided in people’s own home.

2016May 2022
Percentage of
people 65+ population living at home (supported and unsupported)
91.9%93.3%
Number of hours of personal care delivered to people who are over 65 +4,5009,278

From 2016, as a result of more care being provided in people’s own homes we have saved over 22,000 unplanned bed days and reduced the average length of stay in our Community Hospital beds from 11 days to 7.9 days.

The Angus Medicine for the Elderly Service

The MfE Service in Angus offers a range of day treatments which can be delivered in Arbroath Infirmary and WHCCC in Forfar. These include infusions of intravenous iron or bisphosphonate treatment in the outpatient setting, to predominantly (but not exclusively) older adults. Arbroath Infirmary also offers blood transfusions and a deep vein thrombosis (DVT) service. We have also developed a reliable model for the delivery of intravenous (IV) antibiotics to carefully identified patients attending Whitehills from home.

Remaining at home has been a cornerstone of how we deliver care to frail older adults in Angus. A key aspect of how the MfE service supports this is the arrangement of a named consultant geriatrician working in each of the four locality areas in Angus. Three of the four locality areas also benefit from the support of a named MfE Advanced Nurse Practitioner (ANP) and discussions remain ongoing regarding a fourth ANP appointment. The team work closely together across primary and secondary care, supporting community-based teams to keep patients at home, or when necessary, ensuring safe and appropriate admission to hospital. This might be direct to an Angus community hospital, but may also be in Ninewells Hospital.

Patients admitted to Ninewells Hospital are usually taken to the Acute Medical Unit (AMU) and are reviewed by senior medical staff from the Acute Frailty Team (AFT) within hours of arrival. Our four locality consultant geriatricians in Angus are active members of this team, and patients benefit from a truly multi-disciplinary review seven days a week. Following this initial review some patients will move through to the Acute Medicine for the Elderly Unit (AME) for ongoing specialist comprehensive geriatric assessment. From here patients might be go home or be transferred to the Angus community hospitals for ongoing assessment and rehabilitation. Patients can also go home directly from AMU if there is no need for them to remain in Ninewells.

The same named consultant geriatrician is responsible for a patient’s care, whether they are in Ninewells or the Angus community hospitals. This continuity of care follows patients on discharge from hospital and they will be seen by a consultant geriatrician and the team if required.

Recent changes to Medicine for the Elderly inpatient beds in Angus

In January 2018, as part of Phase 1 of the MfE inpatient bed review, the Angus Integration Joint Board (IJB), which is the decision-making governing bodies for Angus Health and Social Care Partnership (HSCP), approved the required number of Angus MfE inpatient beds as 54, plus 4 hospice beds in Whitehills Health and Community Care Centre (WHCCC) (58 beds in total). A phased approach was taken to reduce the number of beds as follows:

In May 2018 there were 56 MfE and 4 Hospice inpatient beds in Angus in the following facilities:

  • Isla/Clova Unit, Whitehills Health and Community Care Centre (WHCCC), Forfar : 20 MfE beds  – All single rooms with en-suite facilities plus 4 beds for Palliative/End of Life Care within the Strathmore Hospice (24 beds in total)
  • Medical Unit, Arbroath Infirmary: 22 MfE beds – 2 eight bedded wards and 6 single rooms (four with en-suite facilities)
  • Ward 2, A Block, Stracathro Hospital: 14 MfE beds – 2 five bedded wards and 4 single rooms (none with en-suite facilities)

In May 2019 as a result of a people getting more care at home, the requirement for the number of MfE beds in WHCCC reduced to 17. This change provided 53 MfE plus 4 Hospice beds in WHCCC (57 beds).

In March 2020, the number of MfE beds in the Medical Unit, Arbroath Infirmary reduced from 22 to 21. This was as a result of new Scottish Government National Guidance for bed spacing.

In November 2020, the inpatient accommodation at Ward 2, A Block, Stracathro, was made non-operational under Business Continuity Contingency arrangements. This was because the ward accommodation did not meet the requirements of the NHS Tayside patient placement pathways for COVID-19. At this time 10 beds (all single rooms with en-suite facilities) which were previously closed within the Isla Unit, WHCCC, were made operational. This arrangement enabled Angus patients to be cared for in accordance with the requirements of the NHS Tayside patient placement pathways for COVID-19.

This arrangement remains in place under the remit of Angus Community Hospitals Business Continuity Plan.

Proposed next steps?

We know that there is still a need for MfE inpatient hospital beds in Angus at this time. It is vital that the care provided within our Angus hospitals continues to be safe and person-centred.

As a service our aim is to ensure we provide care to our more elderly population in an environment most appropriate to meet their needs.

Since Ward 2 became non-operational, data has shown there has always been capacity within the remaining MfE inpatient units on a daily basis.

We are now recommending that the current MfE Business Continuity Contingency arrangements are made permanent. This will mean that:

  • Ward 2 will no longer be used by the MfE Inpatient Service in Angus.
  • The 10 MfE beds in Isla Unit in WHCCC, opened in November 2020, will remain open on a permanent basis. (This means there will be 27 MfE beds in total in WHCCC plus 4 hospice beds; 31 beds in total).
  • The number of beds in Arbroath Infirmary will reduce from 22 to 21 on a permanent basis.

The proposed changes within this bed configuration will mean that there will be 48 MfE and 4 Hospice bed for the population of Angus (52 beds in total) hence removing 5 beds.

Get involved and want to hear more?

We are hosting public engagement events to give people the chance to have their say.

  • Friday 24 June, 2pm – 3pm, Lintrathan Room, Whitehills Health and Community Care Centre, Forfar, DD8 3DY.
  • Wednesday 29 June, 11am – 12 noon, via Microsoft Teams

Please email tay.angushscp@nhs.scot or call 01307 491796 (by Thursday 23 June) to register your interest in attending, indicating your preferred choice. We will send you confirmation and a link to the event as appropriate.

For safety reasons we are required to limit the number of people who attend the meeting at WHCCC. Please do not attend without confirmation of registration.

In order to manage the meetings effectively, we ask for questions to be sent in advance. Please include any questions with your booking request.  

We have prepared some frequently asked questions which can be found at the bottom of this page.

Tell us your views

Email – You can email us with your views or send any questions to tay.angushscp@nhs.scot

If you are unable to attend one of the engagement events, you can phone us on 01307 491796 and we do our best to arrange a mutually convenient time for a member of the MfE Team to call you.

This engagement document is available in different formats and languages on request. Please contact us for further information on: 01307 491796

Arabic

وثيقة المشاركة هذه يمكن توافرها بصيغ ولغات مختلفة حسب الطلب،ولمزيد من المعلومات  برجاء الاتصال بنا علي01307 491796  او علي البريد الإلكتروني tay.angushscp@nhs.scot

Bulgarian

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Polish

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Romanian

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Russian

Данный документ-соглашение можно получить в различных форматах и на разных языках по вашему запросу. Если вам нужна дополнительная информация, пожалуйста свяжитесь с нами по телефону 01307 491796  или по электронной почте tay.angushscp@nhs.scot

Thank you for your contribution to the engagement activities around the proposed changes to Angus Medicine for the Elderly (MfE) inpatient bed reconfiguration.

We have developed a frequently asked questions document. This is an evolving document. Further questions and answers will be added during the ongoing staff and public engagement activities.

QWho makes the final decision about the reconfiguration of the Angus Medicine for the Elderly inpatient beds?
AThe Integration Joint Boards (IJB) which is the decision-making governing body for Angus Health and Social Care Partnership, will make the final decision.
QWhen would the changes happen?
AAugust 2022
QIf the decision is made to make Ward 2 non-operational on a permanent basis how does this impact on the future of the Stracathro site?
AStracathro Hospital is a vital part of health and social care services in Tayside now and into the future. It delivers important psychiatry of old age, surgical and diagnostics services both for Angus and for the wider population of Tayside, with people appointed to Stracathro from right across the region.

Stracathro is also an important regional site as it provides additional theatre sessions and surgical activity for NHS Grampian.
QIsn’t this all about saving money?
ANo.  This is a clinically driven decision which will ensure the care provided in a community hospital inpatient environment is safe and person-centred.
QSome people may have further to travel to visit family members/friends
AYes, this will be true for people who live in some parts of Angus, in particular the North East locality.

We will work with carers and families on an individual basis to seek solutions to any challenges that may arise regarding visiting.