The transfer of an NHS community hospital to charitable ownership is helping provide key healthcare services to users closer to home, as Alison Moore discovers.
Wells Community Hospital in Norfolk had been a mainstay of the local area for nearly one hundred years when the NHS decided to close inpatient beds in the mid-2000s. With few services remaining its future seemed in doubt. Now, after a long campaign to raise funds and support, ownership has passed into the hands of a charitable trust, which has ambitious plans to develop more health and social care services.
At the moment the hospital is used by NHS outpatient clinics and independent practitioners, offering services such as audiology and counselling. An NHS dental practice – badly needed in the area – and NHS physiotherapy services lease some space, as does the childhood and parenting initiative SureStart. Community groups also meet there.
While this may seem relatively modest, it has ensured the hospital buildings remain in use and has helped some patients avoid a long journey to acute hospitals in either Norwich (37 miles away) or King’s Lynn (26 miles). As 36 per cent of the hospital’s catchment area are older people, travel can be a significant issue. Nor is the area uniformly affluent – there are areas of deprivation and many older people rely on public transport.
Earlier this year the freehold of the site was transferred to the Wells Community Hospital Trust charity, funded by a capital grant from NHS Norfolk. Since 2006 the trust had been operating the hospital under licence from the NHS. Support from the primary care trust for the new role of the hospital has been crucial.
But to become viable the hospital needs to acquire more services. Last month a dedicated dialysis unit opened at the hospital, initially serving holidaymakers. In the future, it may be possible for local people to receive their dialysis there year round.
The unit was set up after the local community raised £120,000 in a little more than six months. Any profits from the service will be ploughed back into the hospital.
Longer term, the trust wants to bring back inpatient beds with a plan for 12 intermediate care beds and 12 dementia beds. Dementia has been identified as an important issue, due to the elderly local population, and an Alzheimer’s support group already meets at the hospital; beds could provide respite and crisis care. So far, the trust has secured funding for seven intermediate care beds from NHS Norfolk and will now talk to adult social services and mental health commissioners about the dementia beds.
Beds have become a totem for a community hospital.
“The one thing that local people are very keen on is the re-establishment of beds. That’s something that we are very conscious of,” says chief executive Simon Atkinson.
He believes that 24 beds would be a minimum number. They would be developed and run by another organisation, most likely from the third sector – the trust has been in talks with two potential partners.
“We don’t know for certain at the moment how that would pan out. The partner might feel that a minimum of 40 beds would be needed for them to run it.”
Another plan is to increase the number of outpatient services offered at the hospital.
A final part of the jigsaw may be a 50-apartment “housing with care” complex, developed with a housing association. This will require planning permission and will need careful handling in the local community.
Examined for viability
The proposed expansions have all been carefully examined for viability and are in the organisation’s business plan.
“We have to think about what it is that the local population will actually benefit from,” says Mr Atkinson. But there is no doubting the appetite for more services, although some people’s expectations may be ambitious, especially in the present financial climate.
“Managing the community’s expectations can be quite challenging,” says Edward Hare, an adviser to the trust. “Although we can’t provide everything, what we do is better than nothing.”
But perhaps a seasonal minor injuries unit might not be out of the question, suggests Mr Atkinson. Holidaymakers undoubtedly put strain on services – both at GP surgeries and at accident and emergency – and a daytime minor injuries unit might help to cope with that at peak holiday times.
Why Wells is working
- Support from local NHS bodies – including willingness to commission services
- How the hospital could link into NHS priorities has been identified
- Strong backing from community
- Trustees with vision of a reshaped community hospital
- Taking on board learning from earlier projects
At the moment the trust runs on a shoestring with a minimum of paid employees (Mr Atkinson is part time) although this has been increased to staff the dialysis unit. Volunteers were used extensively in the first couple of years but as services have increased, so has the need for professional staff. Public support is high and local people are happy to fundraise for the hospital: but that cannot be a long term solution.
“The crucial thing is that we have to make sure that the core hospital unit is viable and is able to hold its own and cover its costs. If that’s not the case then we are going to run into difficulties down the line and it is not going to work,” says Mr Atkinson. He adds that if all goes to plan the trust could be in profit by 2013.
“We have to take a small hospital that has been closed by the NHS and turn it into a profitable business. That needs a lot of thinking outside the box.”
It has also meant the trust has needed high calibre trustees with business acumen to drive forward the vision and to act strategically.
“The crucial thing is to get key people in the local community on board… without local community support, frankly there’s no point,” he says. The trust’s chair, Jonathan Hazell, is a well respected retired hospital consultant. The board of trustees was extensively changed around 18 months ago and expertise from a similar project elsewhere in Norfolk brought in.
And, rather than just producing a wish list of local health services, the trust has had to pinpoint how its proposals can fit into the NHS in the area. Luckily, NHS Norfolk has been committed to moving care closer to home and a convincing case could be made for more facilities in North Norfolk.
“You have to be fleet of foot and understand what the strategy requires of you,” says trustee Jenny Manser. “You need to find solutions that tick the boxes.”
Trustees need a professional approach to inspire confidence when dealing with outside organisations, she says.
A business case was developed for Wells which was backed by NHS Norfolk, allowing the trust to shape its plans. And the dialysis plans have been supported by the renal unit at the Norfolk and Norwich Hospital, which will provide medical advice and take any transfers, if necessary. Working in partnership with NHS organisations that will commission and support services at the hospital is seen as the way ahead.
The establishment of clinical commissioning groups may also be a boost to the scheme: GPs in the area are likely to understand the difficulties many people have in accessing more distant services and two GPs sit on the trust’s management sub-committee.
But the last few years have shown how vulnerable the voluntary sector is to changes in government policy, which can blow plans for partnership off course.
The charity had originally drawn up plans for the hospital predicated on receiving money from the last government’s community hospitals fund – a £750m five-year pot to build new community hospitals and refurbish existing ones. It which disappeared when the global financial crisis hit.
More recently, plans for the holiday dialysis centre were well underway when many commissioners started insisting holiday dialysis should only be paid at national tariff rates, despite the preparation and planning needed for what may only be three sessions during a week’s holiday. This could seriously affect the unit’s income.
Once services are established, the project will need to be sustainable and retain support from local commissioners.
NHS Norfolk chair Sheila Childerhouse says it will continue to work with the Wells trust. The hospital’s approach of allowing wider use of the site for complementary therapies could help its sustainability.
“They can be creative and work across sectors. In some ways, they have less of a constraint than we have,” she says, adding that the model could be replicated elsewhere.
The social experiment
Experimenting with social ownership of health and social care facilities may be rare elsewhere but it looks normal in Norfolk.
The campaign to bring services back to Wells was able to draw on the experience of the Aylsham Care Trust, which was set up in 1985. For many years it provided various forms of support to elderly people – anything from transport to hospital, to social events and help for carers.
More recently, it has led an ambitious project to transform the St Michael’s Hospital site in the town. This site and adjoining land is now being redeveloped to provide housing – including some affordable housing and “housing with care” – a nursing home, a health centre and a community centre which the trust will run.
Although the hospital will close, some NHS funded beds have been kept in the new nursing home. Services have been kept in the local community and elderly people should find it easier to remain in housing in the town, rather than having to move away.
The expertise of the team behind the Aylsham Care Trust has been shared with Wells – chair Jenny Manser now sits on the Wells board of trustees.