The answers to the questions you want answered

Based on 32 questions sent to the Success Regime on March 25, we asked 10 last month and put the regime on a clock to answer them.

It responded in 12 days, 18 hours and 55 minutes.

Here are the Success Regime's answers.

Q: Are specific costings available for the likely cost of “no-bed” hospitals, compared with the current hospitals with beds? What are they?

A: Using the out of hospital care model as a guide, by taking the same resource from the running of Reiver House in Carlisle to support 14 patients in hospital (£1.2million) we are now able to support more than double the number of patients in their own home with the same resource.

Q: How precisely will the integrated care proposal be funded, and in particular, what additional funds will come from the relevant local authorities?

A: Integrated care communities are not about transferring funds, they are about pooling existing resources and coming together locally to focus on using those effectively for the population needs, eradicating duplication.

The business cases have not yet been completed, however the first phase is looking at appointing local level experienced managers to lead across health, social care and third sector utilising public health data to plan services accordingly.

The initial focus will be on high risk patients and families but they will also look at preventing ill health.

Workforce planning is currently under way.

Q: Senior staff have stressed the value of visitors to patients in the recovery process, but the increased distance to visit patients and the lack of public transport after 6pm would seriously affect the ability of visitors to support their loved ones. How would the Success Regime suggest overcoming this problem?

A: It is precisely because people recover more quickly when in their own home environment - closer to

relatives who are able to visit them - that our emerging thinking is to provide more care in communities where people live and within people’s homes.

Our plans are designed not to INCREASE travelling distance but to REDUCE it.

Q: League of Friends believe the move to home-based patients would create increased demand on ambulance services, which would be the first port of call if a patient is taken ill. Has this been assessed by the Success Regime?

A: The North West Ambulance Service are active partners within the success regime and heavily involved in the transport workstream, which is evaluating the impact of options proposed.

Q: Can you confirm the additional number of community beds that will be made available as the result of the “expansion” of hospitals in Workington, Cockermouth and Penrith?

A: The information contained within the progress report is emerging thinking only.

The confirmed proposals for all of our local community hospitals will be published in our upcoming consultation

document.

Q:Are there meaningful statistics on how well the current city-based “hospital at home” scheme works in Carlisle?

A: Yes, the Out of Hospital Care Scheme in north Cumbria is now helping twice as many patients recover up to twice as fast as they would if they were admitted to hospital.

The scheme also means that patients are being treated where they want to be - in their own home.

We knew from feedback that patients wanted to stay at home rather than be admitted to a hospital and this scheme really does put the individual patient at the centre of things.

Their care is delivered by a multi-disciplinary team which is co-ordinated properly according to that patient’s needs.

There are no duplicate conversations because each service talks to each other on a regular basis to make sure that each patients is being cared for appropriately and effectively.

Plus it’s better for families and friends who don’t have to travel to hospital to visit.

The focus is not only on providing the same care as patients would receive in a hospital ward in their own home, but also includes developing self-care, prevention and support when needed, linking to the Carlisle

Healthy city work. We are working together to provide a full package of support and care with a wide range of organisations including voluntary and charitable groups.

For the 12 months - April 2015 to March 2016 - 652 people were assessed and 485 received their treatment at home.

This has saved stressful visits to the Cumberland Infirmary and helped improve pressures at the hospital.

Statistics also show that nearly 10,039 bed days have been saved in north Cumbria’s hospitals in the period April to March 2016.

The scheme has also shown that patients get better much quicker at home; the average length of stay for patients in Reiver House was 29 days where as the average ‘length of stay’ for a patient being looked after at home for period April to March 2016 was 16 days.

The Out of Hospital Care scheme has effectively replaced but also expanded the provision of Reiver House, which was a step-up-step-down unit on the grounds of the Cumberland Infirmary.

The former unit had 14 beds for patients however the same resources are now being used to treat up to 30 patients.

The multi-disciplinary team including nurses, physiotherapists, and GPs are working with Cumbria County Council adult social care to care for people aged 18 plus living within Carlisle, Longtown and Brampton, 24 hours a day, seven days a week.

The Out of Hospital Care services involved joint working between NHS Cumbria CCG, Cumbria County Council, Carlisle City Council, Cumbria Partnership NHS Foundation Trust, North Cumbria University Hospitals NHS Trust, Cumbria Health on Call, GPs and the third sector.

Q: What are the expected number of visits during the day and night that a patient can expect when being cared for in their own home?

A:It is not possible to answer this question as different patients have different needs.

Q: Can the Success Regime provide a list of specific conditions that can be successfully treated at home, compared to a community hospital?

A:

The top reasons for conditions treated at home from the out of hospital care model in Carlisle are:

1, Palliative care.

2, Infections eg urine and chest.

3, Awaiting care package.

4, Supported discharge from hospital.

5, Exacerbation of chronic conditions.

Q: Have Success Regime members visited all of the locations mentioned in the proposals to experience transport and operational issues?

A: Yes they have. We are collectively aware of the transport and operational difficulties.

Q: What is the cost comparison between a bed in an acute hospital, a bed in a community hospital, and 24-hour stay at home with 24-hour medical attention?

A: It is impossible to give a simple answer to this question.

There are many different types of “bed” in an acute hospital.

Supporting a “bed” in an intensive care unit would be more costly than a “bed” in, say, a recovery ward. The cost of supporting a bed in a community hospital depends in part on the cost of staff.

Permanent staff are clearly less costly per “bed shift” than locum staff.

In Cumbria the NHS faces a major recruitment challenge and therefore employs more locum staff than it would wish. The cost of supporting a patient at home over a 24-hour period depends on how many daily visits that patient needs.

However, it is not just about money. The real issue is the potential ‘cost’ to the patient.

We know that for older people, every day spent in a hospital bed compared to being at home is associated with loss of muscle tone and mobility and the potential for confusion and other complications.

It is almost invariably better to be cared for at home than in hospital wherever possible and there is a real need to build up integrated community services to allow this to happen.