Agenda item

To receive a presentation from Betsi Cadwaladr University Health Board representatives regarding the future plans for the provision of services at Denbigh Infirmary following the closure of Fammau ward.

10.10 a.m. – 10.50 a.m.

The Chair welcomed Bethan Jones (Area Director: Centre), Gareth Evans (Director Clinical Services – Therapies) and Alison Kemp (Assistant Director Community Services) from Betsi Cadwaladr University Health Board (BCUHB) to the meeting for discussion on Health Service related business items.

Denbigh Infirmary – the Assistant Director Community Services, via a PowerPoint presentation, briefed the Committee on the background to the decision to close the upstairs Lleweni Ward at the Infirmary having undertaken fire safety checks in accordance with guidance received from the Welsh Government (WG) in the wake of the Grenfell Tower fire tragedy.  The fire safety checks had identified “poor compartmentation and the presence of a first floor …constructed from timber joists and lath and plaster” at the two hundred year old building.  On this basis the fire safety assessors had concluded that “considering the number of mobility impaired patients and the limited number of staff, even following the completion of the remedial works, [the] building [would] still present an extremely challenging situation to manage safely during a fire incident requiring vertical evacuation”.  Based on this information a decision was taken initially to suspend 10 of the 17 beds on Lleweni Ward in order to minimise any risks associated with an evacuation.  To compensate for the loss of community beds in Denbigh 5 additional inpatient beds were opened in Ruthin Hospital, and remedial work, i.e. fire alarm panel, zoning and compartmentation in ceiling void etc. was undertaken on the ground floor area of the Infirmary building.  Whilst this work was taking place a detailed survey of the hospital building was undertaken by a fire safety consultancy.  The consultancy’s brief was to determine the quality of compartmentation within the original hospital building and the level of fire resilience afforded by the building’s construction.  This survey found that there were significant defects within the compartmentation of the original hospital building at both first floor and roof level.  This meant that it did not comply with current fire safety regulations and therefore the current fire evacuation strategy for the first floor, which was based on horizontal evacuation and reliance on compartmentation, was compromised and therefore did not comply with the requirements of the Regulatory Reform (Fire Safety) Order 2005.  As a result a decision was taken to suspend the use of the remaining 7 inpatient beds on the upstairs ward and to suspend the use of the midwifery led delivery room.  She emphasised that whilst the first floor was deemed no longer suitable for inpatient beds, etc., it did not mean that it could not be used for other purposes.

In taking the above decision the Health Board engaged with a wide range of stakeholders, including local and national politicians, the Community Health Council (CHC), staff, trade unions, local authority staff and the hospital’s League of Friends.  It also agreed longer term arrangements with Ruthin GPs to cover the additional beds at Ruthin Community Hospital and redeployed a small number of staff mainly to Ruthin Hospital.  As a consequence of the loss of beds work was also commissioned to identify alternative inpatient capacity and explore alternative pathways to inpatient care.

NHS Specialist Estates Department was currently in the process of identifying high level costs required to make the first floor area compliant with health and safety regulations, including fire safety standards.  It was already known that major structural work would be required and that whilst this work was taking place it would impact on the ground floor accommodation.  Due to the need to meet modern health service standards it was already envisaged that not all of the 17 beds, lost following the closure of Lleweni Ward, would be able to be re-provided on the ground floor of the hospital.  It was anticipated that an additional four to six beds would eventually be opened on the ground floor of the hospital.  Two options had been shortlisted as potential solutions on how these additional beds could be provided.  One entailed the conversion of the current physiotherapy area into a beds bay/ward with the physiotherapy provision re-locating to another part of the hospital site.  The other option was the construction of an extension.  Both of these options would entail a bid to WG for capital funding in order for them to be realised.  Health Board officials emphasised their commitment for services to be provided at Denbigh Infirmary in future.  In recent months the Board had invested in a number of facilities related investment projects, i.e. installing a new boiler, upgrading external lighting and paving.  The facility currently provided an array of valuable community based services to the local area, including in-patient beds, outpatient clinics, x-ray services, a minor injuries unit (MIU), audiology, physiotherapy, an Intravenous (IV) Therapy Suite and various screening services.  In future Community Dental Services were looking to consolidate its services on the site, whilst x-ray services had recently increased its sessions by providing two additional sessions which had resulted in the hospital now having a full time X-ray Service.  The use of the IV Suite was increasing as were visits to the MIU, which had registered a 22% increase in the number of attendees during the period April to October 2018 compared to the previous six monthly period.  On average a total of 50 patients a month were cared for in in-patient beds at Denbigh Infirmary and Ruthin Hospital.  At present there were no staff vacancies in the Denbigh Infirmary.  Health Board officials had recently met with representatives from the hospital’s very proactive League of Friends to discuss their ideas for future services at the hospital.  They had identified a couple of schemes for the Health Board to explore further and had requested that the first floor area be utilised as soon as possible for the purpose of providing some kind of services rather than remain empty and prompt speculation and fears regarding the hospital’s long-term future.

In response to members’ questions Health Board officials –

·         advised that North Wales Fire and Rescue Service had also undertaken a fire safety inspection at the hospital in recent months

·         confirmed that the existence of wooden joists to support the floor of the first-floor area would impede the ability of staff to be able to safely evacuate the upper floor ward using the approved horizontal evacuation procedure in the event of a fire. Compliance with regulations and safety procedures were therefore essential.  A recent fire in a care home in North Wales had highlighted this problem.  That incident was currently being investigated by the Health and Safety Executive (HSE)

·         confirmed that modern standards relating to the provision of space for in-patients on hospital wards would make it impossible for the Board to replace the number of beds lost at the Infirmary with a corresponding number of new beds.  Nevertheless the Health Board was committed to re-instating some of the ‘lost’ beds through the provision of potentially 4 to 6 additional beds on the downstairs ward (Famau Ward)

·         advised that to facilitate the provision of the additional beds on Famau Ward a business case would require to be compiled and costed for submission to WG to seek capital funding for the project, as the cost of remodelling and construction work would probably be in excess of £1m

·         informed the Committee that when costings were available and a draft business case had been compiled the Board would consult with residents, the Council and other stakeholders on the most appropriate facility to develop in order to meet community needs and demands.  The project would incorporate facilities to support effective partnership working and projected future community health service provision needs

·         confirmed that dignity and privacy requirements were now an integral part of the design process for new or refurbished healthcare facilities

·         advised that, despite BCUHB having circa 60 fewer community beds available in Denbighshire as a result of the closure of Prestatyn Community Hospital, the Royal Alexandra Hospital and Lleweni Ward at Denbigh Infirmary in recent years, there was not a shortage of community beds in the county to meet local need.  Through more effective bed management and the availability of an enhanced care package at home for patients the demand for in-patient beds had reduced.  It was now acknowledged that longer periods in hospital contributed towards the loss of muscle ability and led to greater levels of confusion amongst patients, this was often referred to as ‘Pyjama Paralysis’.  Through effective working with Social Services the Health Service was able to get patients home earlier and via the services of the Community Resource Team (CRT) was able to support them in their own homes

·         confirmed that, whilst the aim was to get people wherever possible back home as soon as possible, the Health Board acknowledged that community beds needed to be available for those who needed them and patients nearing the end of their lives would be able to choose where they wanted to be during their final days

·         advised that whilst the Conwy and Denbighshire council areas had the highest number of elderly residents in North Wales it had the lowest incidents of delayed transfer of care (DToC).  Nevertheless this was not a reason for having no community hospital beds at all.  Community hospital in-patient and other facilities had a pivotal role to play in convalescent care and rehabilitating people and getting them ready to return home.  It was envisaged that residential homes would in future have a role to play in convalescence care and rehabilitating patients

·         confirmed that the Home Enhanced Care Service (HECS) was developed following the closure of the Royal Alexandra Hospital as a method of providing in-patient type care, similar to what was being provided at community hospitals, to patients in their own homes

·         reaffirmed that the Health Board had no pre-determined plan for closing the community hospital in Denbigh.  It did however need to establish the type of health facility the town and its surrounding area would require for the future, including which services would need to be delivered from the site.  Once that had been determined proposals and plans would need to be drawn-up in order to deliver a fit for the future provision in the town.  It was important to remember that a ‘’community hospital’ was much more than in-patient beds, although in-patient beds were an important part of any such facility

·         advised that the NHS Wales’ Specialist Estates Department was expected to be in a position to provide the Health Board with indicative high level costs for the refurbishment work required on the ground floor area and Lleweni Ward by the end of November 2019.  Work would then commence on drawing up an outline business case for the proposed future development to submit to WG as part of the bid for capital funding for the project.  No firm timeframe could be given on the length of time it would take to secure the necessary funding, but it was anticipated that this would take a minimum of three years to secure before construction on site could start.  Nevertheless, in line with the League of Friends wishes, Health Board officials were keen to make use of the former Lleweni Ward area in the interim to avoid leaving it empty.  Consideration would be given to possibly locating the CRT there on a temporary basis, perhaps bring the Community Therapists there to help facilitate the ‘step down’ service (similar to what was currently happening in both Rhyl and Ruthin) whilst re-locating the District Nursing Team to the lodge building on the site.  Health board officials invited Committee members and local members to contact them with their ideas of which services could be provided on the site either on a temporary basis or as part of the planned future long-term provision for Denbigh, and

·         confirmed that the cost of re-providing some more in-patient beds, to replace the ones closed at the Infirmary, would be explored and considered before consideration was given to providing them elsewhere.

The Chair of the Denbigh Member Area Group (MAG), Councillor Rhys Thomas, advised the Committee that the local MAG was monitoring the situation at the hospital closely, particularly the number of in-patient beds available there as they had concerns that the Health Board had a tendency to remove bed provision at various hospitals prior to replacement services being established and operating at full capacity.  Health Board officials were due to attend the January 2019 meeting of the MAG to discuss progress in relation to the Infirmary.

At the conclusion of the discussion the Committee –

RESOLVED, subject to the above –

(a)       to receive the information on the current position with regards to Denbigh Infirmary, and

(b)       that a further report be presented to the Committee in the Spring of 2019 on the indicative costs identified for the purpose of providing additional beds at the hospital, outlining the progress made with developing a business case for the future provision of services at the site, and detailing future long-term plans for the facility.