2. If community hospitals are the answer, what was the question?
Ben Bennett
Programme Director
NHS South West Commissioning Support

4. A long history

5. Substantial investment in the last 10 years
[Insert map]
Date opened
Community Hospital
Approximate capital cost
£ million
2005               
West Mendip 25
2008         
Frome 33
2009         
Newton Abbot
2010
Yate 10
2011        
Dursley
2011         
Minehead
2012          
North Cotswold 12
2012    
South Petherton 18
2012
South Bristol 45
2013     
Tewkesbury
2013
Cossham 20
2014         
Bridgwater
TOTAL
266

7. A bit about me A bit about NHS South West Commissioning Support

9. Local experience – Bristol, North Somerset & South Gloucestershire
Bristol Health Services Plan
10 year strategy
Replace outdated acute infrastructure
Rationalise acute services; 3 sites to 2
Care closer to home
Supported by a network of community facilities

10. Local experience – Bristol, North Somerset & South Gloucestershire
7 community facilities originally consulted on
3 for Bristol
1 for North Somerset
3 for South Gloucestershire

11. Local experience – Bristol, North Somerset & South Gloucestershire
5 delivered to date
2 as planned
+1 added in response to local ‘save our hospital’ campaign
+1 added by national ISTC programme
1 done differently
2 still to do but on a reduced basis
2 formally withdrawn (a long and challenging process)

12. Expected benefits
Replace outdated facilities with modern and adaptable environments
Improve access and choice
Make services more responsive and convenient
Reduce reliance on acute hospitals
Transform the way health care is provided locally
Provide a platform for a dynamic new community health system
Help address health inequalities

13. Local experience – Bristol, North Somerset & South Gloucestershire
Full realisation of benefits is proving elusive
Over reliance on transfer of existing services from acute hospitals
Affordability is challenging for non-PbR services
Technical and policy barriers to community provider entry
Limited innovation and few examples of wholly new models of care
Stakeholders suspicious of changes to plans

14. What next? Embrace community facilities as an opportunity not a burden
Re-brand as diagnosis and treatment centres – busy, productive, thriving
Consider opportunities for specialist ‘anchor’ services to improve affordability
Move beyond ‘like for like’ transfers - use community hospitals as a platform for innovative approaches
Put stakeholders in the driving seat – local GPs, public and patients

15. Re-commissioning South Gloucestershire Community Services
5 year contract - annual value £13 million
Over 20 individual services in scope of procurement including
Adult community, specialist and out-of-hours nursing;
Community therapy services
Minor injury services
20 bed inpatient services at Thornbury Hospital
Provider invited to design an innovative solution to deliver a high quality, integrated service
July 19
South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health

16. Re-commissioning Community Services for South Gloucestershire
Strategic Objectives
Improve Health and Wellbeing in South Gloucestershire
Work in partnership to achieve improvements across the whole health and social care system
Older patients and those with long term conditions are our priority
July 19
South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health 16 16

17. Effective Communication
Focus on Quality
Flexible & Responsive
Integrated
Working
Independence & self-care
Patient Centred
7 day working
Coordinated care
Maximising Technology
Value for Money

18. Procurement Approach Specification informed by
Joint Strategic Needs Assessment
Public and Patient engagement
Involvement of lay representation throughout the process
Strong clinical leadership
July 19
South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health

19. Timeline Planning commenced September 2011
1st Stakeholder event held November 2011
Development of specification 12 months
Procurement advert October 2012
Preferred bidder announced August 2013
Services commenced April 2014
July 19
South Gloucestershire Clinical Commissioning Group - Leading you to Better Health

20. Procurement Approach Pre-procurement events with prospective bidders
Shortlist of 6 following pre-qualifications stage
Non-competitive dialogue process including multiple meetings with each bidder
This ensured good understanding of commissioner requirements
High quality of final tenders as result of this process
July 19
South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health 20 20

21. Service outcomes specified in contract
Appropriate and timely services
Accessible locations
Improved patient experience
Improved health outcomes
Increase in numbers who die in their place of choice
Increase in numbers living independently & safely
Reduction in unnecessary admissions to hospital
Reduction in delays in leaving hospital 21

22. Example KPI Outcome: Reduction in unnecessary admissions to hospital
Indicator
Threshold
A reduction in the number of emergency admissions for individual Long Term Condition patients in the top 0.5% higher risk category compared to the previous two years
A reducing trend of 10% year on year improvement in the reduction of numbers of admissions from a 2013/14 baseline 22

23. Lessons Learned Dialogue stage was extremely valuable
Essential to have good procurement support
Timescale and workload should not be underestimated
July 19
South Gloucestershire Clinical Commissioning Group - Leading you to Better Health