Fareham Community Hospital Taskforce: Future Vision

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Fareham Community Hospital Future Vision Leading the way for healthcare in Fareham

Presented by the Fareham Community Hospital Taskforce Fareham Community Hospital Future Vision | 1

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Foreword As Chairman of the Fareham Community Hospital Taskforce, I’m delighted to present this report which discusses how Fareham Community Hospital (FCH) can be further utilised to provide greater and more effective health services for the people of Fareham. When I was first elected as Fareham’s Member of Parliament in 2015, it was made clear that one the greatest concerns amongst local people wasand still is- the way in which FCH is used. In particular, there is frustration that a relatively modern facility is under-used, often resembling a ‘ghost clinic’ with empty waiting areas, very little day-to-day activity and a lack of understanding about which services are actually on offer. Moreover, with mounting pressure on other local hospitals such as QA and Southampton General, many Fareham residents have felt puzzled as to why FCH is not put to greater use as a way of alleviating that pressure. I therefore set up the Taskforce in 2015 to enable collaboration between NHS service providers, commissioners and decision-makers who are responsible for local health services. This report marks a new chapter for FCH as we work to expand services for patients. I carried out a survey in 2018 seeking views from local residents, patients, health professionals and groups on what they want from FCH, and I would like to thank all those who responded to the consultation. Our growing communities need a health service which keeps up with demand and provides first-class services. I’m confident that this report can help achieve that by unearthing the needs of patients and health professionals as well as highlighting what we can do to meet today’s demands.

Suella Braverman MP Chairman, Fareham Community Hospital Taskforce Member of Parliament for Fareham Spring 2019

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Who we are Launched in 2015, the Fareham Community Hospital Taskforce brings together senior decision-makers from local health organisations, patient groups and service-providers. There is a clear understanding that more and better use of FCH is needed, and one key goal of the Taskforce is to determine how FCH can be further utilised to serve the local community. The members of the group are:

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Adults Health and Care Team, Hampshire County Council Community Health Partnerships Fareham and Gosport Clinical Commissioning Group Fareham Primary Care Services Friends of Fareham Community Hospital Portsmouth Hospitals NHS Trust Solent Estates Partnerships Ltd Solent NHS Trust Southern Health NHS Foundation Trust One Community University Hospital Southampton NHS Foundation Trust

n Suella Braverman MP. Chairman, Fareham Community Hospital Taskforce

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Consultation The Fareham Community Hospital Taskforce has consulted a wide range of stakeholders involved in the provision of healthcare at Fareham Community Hospital, wider practitioners in the Fareham area, patient groups and the general public. Through this process the Taskforce has developed a vision and identified the services that reflect the needs of local people and will meet the changing needs for the area. Since it was launched, the delivery a high quality of care and ensuring the right services are available for patients is at the heart of what the Taskforce does. The Taskforce wants patients and practitioners to determine the future direction of healthcare in Fareham. The recommendations set out in the following pages are drawn from the consultation responses that were submitted by local GPS, Patient Participation Groups, health providers, Fareham Borough Council and members of the public in 2018. The consultation included nine broad questions on different aspects of healthcare provision. The questions are listed in the Appendix. We want Fareham Community Hospital to lead the way for healthcare in Fareham. This means responding to local health need with the right services in a way that is sustainable. Therefore, underpinning the Taskforce’s reflection of the consultation recommendations are three core principles:

n Need – meeting local demand for services in Fareham and serving the community

n Deliverability – ensuring we get the services that we need fully implemented and delivered

n Sustainability – ensuring services are sustainable and affordable.

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The Challenge Fareham has a growing population with elderly people being the fastest growing demographic. According to the Office for National Statistics, between 2012 and 2017 the number of people aged 70 and over increased by 18.6% in the Fareham constituency, with those aged 80+ increasing by 15%. The number of people in Fareham aged under 50 has grown much slower, with a widening gap between younger and older people. Future housing developments planned in Fareham such as the strategic development area of Welborne (6,000 homes approx.) and those in Warsash and Whiteley will also put extra pressure on social care services, local GP surgeries and hospitals. We believe that FCH can help address these extra pressures by offering more services. Growing populations in Portsmouth, Southampton and their surrounding communities will inevitably put extra pressure on local hospitals and GP surgeries. We therefore need to make sure that FCH is being fully utilised to not only provide a better service to local residents, but also to help relieve pressure from other facilities. Since 2015 we have seen local GP surgeries in Titchfield, Whiteley and Highlands working together at FCH to offer a Same Day Access Service, and a weekend Southern Hampshire Primary Care Alliance GP Extended Access Service, where patients requiring an urgent appointment can see a nurse or GP at the hospital. By introducing more innovative schemes like this, we can better utilise FCH to ensure that services are more widespread across the community and local residents can access services easier and quicker. There are also barriers when it comes to public transport links to FCH. Many elderly people who rely on regular access to local NHS services are unable to drive or don’t have regular access to car transport, and therefore rely on public transport. Having reliable public transport links to FCH is also very important to make sure that patients get to hospital safely and on time. Many patients live in rural areas outside Fareham or don’t have access to a motor vehicle, which means public transport is essential to many people in getting to FCH.

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Executive Summary Set out below is an outline of the recommendations from this report. They summarise the key messages and themes which were presented in the consultation, with the following pages going into greater detail for each point. 1) There is a clear demand for other surgeries to join the Same Day Access Service (SDAS). The CCG and local practices should consider the potential cost and benefit of expanding the SDAS. 2) FCH needs improved public transport links. A bus-stop, with a regular bus service, would address concerns from patients and local practitioners. The Taskforce should seek greater involvement of community and voluntary sector services to address this need, which is acute for older patients. 3) Better signposting of support services for elderly patients and carers e.g. dementia support functions. 4) FCH should clarify what its clinical priorities are and provide an expanded range of clinical services, eg diagnostics/ scanning and support for long term conditions. 6) FCH should explore more sign-posting for Child and Adolescent Mental Health Services, as well as potentially expanding them. 6) Future public health functions, eg mental health facilities or social prescribing, should be considered at FCH if it remains under-utilised and these should be potentially co-located with nearby services. 7) Patients want stronger communication channels with FCH. The hospital should consider ways of improving how it communicates with the wider community and seek cost effective ways, such as social media and regular website updates, of promoting campaigns through community engagement.

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1) Walk-in and Same Day Access Service The introduction of the Same Day Access Service (SDAS) has been widely welcomed in Fareham, with FCH working alongside GP surgeries in Titchfield, Whiteley and Highlands so that patients who require an urgent appointment can see a nurse or GP at the hospital on the same day.

“All residents in the area should be allowed to use same day doctors at FCH along with same day blood tests and urine tests.”

In the consultation, we asked respondents whether they would support walkin services at FCH as we felt it important to gauge opinion by respondents. We can then determine whether an expansion of the SDAS would be effective and efficient, given that it has already been introduced. 1) Walk-in services The majority of respondents supported the principle of introducing walk-in services at FCH.

“A walk-in service would be essential for elderly patients who find a fixed appointment difficult to adhere to.”

Reasons cited included easing pressure on A&E at the Queen Alexandra Hospital, freeing up appointments at GP surgeries and enabling elderly people to access services who typically find it difficult to meet a fixed appointment at a GP surgery.

“We don’t want to discourage people from going to their usual GP, but a walk-in service would be beneficial, especially out-of-hours.”

2) Same Day Access Service Other respondents suggested a broader rollout of FCH’s Same Day Access Service to include all surgeries on top of those that already take part in Titchfield, Whiteley and Highlands. “We need more access to same day GP services, and more clinics, to avoid locals having to travel to the QA.”

The scheme so far has been effective. At the time of writing, over 19,000 patient calls have been conducted since its inception, with 3040% developed into face-to-face appointments. Approximately 600 home visits have also taken place since starting the scheme.

Feedback from NHS stakeholders suggests that the expansion of the SDAS would be more effective and more financially viable than introducing a walk-in service. Although a walk-in service is popular amongst respondents, the expansion of the SDAS could provide a greater level of service provision that would meet with the expectation of those who responded and patients in general. 8 | Fareham Community Hospital Future Vision

3) Other A new minor injuries unit was also welcomed by many respondents as it could ease congestion at neighboring hospitals. However, a sizable number of respondents also expressed concerns that such a service would become congested as it would be a swifter alternative to seeing a GP. Further, it was also suggested that patients be better educated on which services they should use.

“Walk-in services should be considered, but people need more education about which services to use and when.”

Recommendation: Other surgeries should join the Same Day Access Service (SDAS) at FCH to provide expanded coverage of the locality. The CCG should also consider the potential cost and benefit of a walk-in service at FCH and evaluate whether an expanded SDAS would actually provide many of the services that would typically be available through a walk-in centre.

2) Accessibility We asked whether and how accessibility could be improved at FCH. Access to FCH was listed as a priority for most respondents to the public consultation. It is noted as a particular concern for patients without the means to drive, who depend on a reliable public transport links in order to access the hospital. “Transport is a key issue given the limitations of public transport access and the cost of taxis. Elderly and disabled patients may not have the capacity to use public transport. Ensuring that strong links are established between FCH and local community transport schemes will assist with accessibility.”

A new bus service and stronger public transport links is noted by respondents as a clear solution for patients who have trouble accessing FCH. Some respondents suggest that a slight deviation be made to the X4 and X5 routes which are operated by First Bus, enabling direct access to FCH.

Other respondents set out the role of the community and voluntary sector in aiding accessibility. For example, it was also noted that a bus service will become increasingly viable as more services are available at FCH with more patients.

“Emphasise to First Bus that their X4 bus service is, for many, the only way to access the hospital, and ensure that it is reliable and frequent.” Fareham Community Hospital Future Vision | 9

A volunteer-led community transport scheme, similar to the ‘Good Neighbours’ scheme, would be very welcome.

Recommendation: FCH needs improved public transport links. A new bus stop with a regular bus service would address concerns from patients and local practitioners. The Taskforce should also explore greater involvement of community and voluntary services for the elderly and their carers, as well as increased dementia.

3) Supporting the over 65s We asked how FCH can serve our senior citizen population. Two key priorities were identified in the consultation: 1) Better signposting and collaboration. Greater linkage with existing support services (such as Lockswood Day Centre and Hamilton Court) and existing Older People’s Mental Health/Dementia services to support vulnerable people. Stronger signposting for groups that prevent isolation/loneliness in the community would also be effective.

“Signposting to visiting schemes, clubs and other social events, along with transport services, would be of benefit to patients’ health and wellbeing.”

2) A bus service for FCH. Surveys have shown that over 65s in Fareham are more dependent upon public transport. The consultation showed that stronger public transport links, including bus services, that serve FCH were popular prospects for older patients.

“First Bus should provide a bus stop closer to FCH with easy phone and online booking systems.”

Recommendation: The Taskforce should consider ways of signposting support services for senior citizens and consider more dementia support functions. The Taskforce should also prioritise improvements to public transport and campaign for more bus services to FCH, including a new dedicated bus stop. 10 | Fareham Community Hospital Future Vision

4) Clinical Services Diagnostics There is general agreement from the consultation responses that diagnostic services should be enhanced at FCH. Endoscopy services and expansion of ultrasound services were suggested. The introduction of X-ray facilities and CT scanning was popular in the public consultation.

“Scanning facilities would be beneficial as these are invariably used to assist diagnosis before appointments with consultants. Even if you could get these done at FCH and then go to QA to see a consultant, this would save travel time and stress for many people.”

Long Term Conditions centre When asked if they would support FCH becoming a long term conditions centre to manage day-to-day illness, a number of respondents stated that such a function may not be achievable and that it may not be desirable to use FCH for acute presentations. Rather, patients seeing GPs at an expanded Same Day Access Service at FCH may receive better management and planning for their condition. Others also welcomed this proposal as it would ease pressure on Queen Alexandra Hospital.

“If a long term conditions centre and more diagnostics facilities were available at FCH and other community hospitals, larger hospitals could concentrate more on surgery.”

Minor operations and treatment When asked if they would welcome minor injuries and treatment services at FCH, most public respondents welcomed this option. One respondent, a local GP, stated that it might allow greater provision of Minor Surgery and Joint Injections currently commissioned from primary care - while facilities currently available at FCH may be more clinically appropriate than existing facilities within practices. A Patient Participation Group stated that such a move may have the effect of easing pressure on the Queen Alexandra Hospital and other neighbouring hospitals.

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Other suggestions When asked what other clinical services should be considered, a number of respondents including Patient Participation Groups suggested greater mental health and CAMHS provision, including mental health assessment and treatment. It was also suggested that expansion of ‘community clinics’ with certain specialties could be considered. Currently, work is ongoing with cardiology, dermatology and gastroenterology which might have potential for FCH to act as a ‘hub’ for future service delivery.

“Child mental health (CAMHS) is an area that is getting larger with significant problems. We need to address this urgently.”

Recommendation: The Taskforce should consider expanding the range of services provided at FCH. It should also determine what its clinical priorities are to best meet patient need.

5) Young People Public responses to how FCH can be utilised with Paediatrics were notably less detailed or considered when compared with the other topics in the consultation. However, a common response to the consultation was a need for greater Child and Adolescent Mental Health Services (CAMHS), particularly those that support young people dealing with stress. Child mental health is a growing concern and increased demand has been placed on services. This increased demand is causing long delays for patients who require access to support. A ‘Community Paediatrics Hub’ was also proposed by a local GP, who suggested that such a facility hub would be more of a ‘virtual’ clinic setting to allow integration between primary and secondary care clinicians to facilitate education and the sharing of best practice in managing common presentations. The ability to facilitate greater integration with existing Health Visitor, Community Paediatrics and CAMHS may enhance this process.

Recommendation: The Taskforce and FCH should look at more signposting for CAMHS services, as well as potentially expanding them. 12 | Fareham Community Hospital Future Vision

6) Public Health We asked whether FCH could be used as a public health hub, with services for those experiencing a range of health conditions. For instance, a hub could support patients with clinical obesity, depression, anxiety and other conditions.

“A hub would be a real benefit to the community. Mental health facilities and support services are often difficult to access and therefore a, ‘health hub’ would be helpful, especially to patients who are vulnerable and have yet to voice their fears and concerns.”

The response to the consultation was mixed, with nearly equal numbers of public respondents supporting and opposing the proposal of a health hub. Concerns largely centred on the use of FCH for non-clinical functions, or usages which could be provided at non-medical/health facilities such as leisure centres and clubs. Other “Anything exercise related respondents also suggested more support should be focused at the new at FCH for those suffering with mental leisure centre which is very health conditions and a joined-up approach close. Clubs should be using between dietitian consultations for weight the parish rooms and village management, exercise and fitness advice, halls. Keep the hospital for smoking cessation support and diabetes healthcare and develop this.” prevention. Of note were the proposals to develop FCH as a centre for social prescribing, promoting the use of landscaping within the grounds for vegetable growing as well as providing a venue for sports and art clubs and a volunteer-run coffee shop.

Recommendation: If the hospital remains under utilised, public health functions should be considered at FCH. It should also be considered if this type of service could be co-located with nearby facilities.

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7) Community Engagement When asked how FCH could engage better with the community, such as community groups and schools to advance public health and other campaigns including the promotion of positive lifestyle measures and improved patient activation/self-management, a significant number of public respondents contended that due to perceived time and resource constraints, the priority should be clinical services. Others suggested there should be a greater focus on the dissemination of information to the wider community. A common suggestion was the greater use of social media to highlight the work being done at the hospital and for reaching local children and young adults who could be targeted with relevant mental health related content. Other suggestions were a regular newsletter which could be implemented via online platforms to reduce costs. “Children’s mental health needs more support so I think the above suggestions are really good ideas. More Use of the centre in the evening and at weekends would be sensible.”

“More effective publicity and direct contact with Residents’ Associations, local sports and social clubs. Open Days and more effective use of Social Media would also be beneficial.”

It was also suggested that community engagement might require greater integration with Public Health/School Nursing services, while a ‘neighbourhood model’ with extension into larger populations that crossed the traditional GP boundaries was also suggested.

More support to work provided by the Friends of FCH—such as providing an Information Service which links current health and wellbeing promotion topics and issues in the local area—could also be explored.

Recommendation: FCH should improve how it communicates with the wider community and seek cost-effective ways of promoting campaigns through community engagement.

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Patient Viewpoint We asked the public what the priorities for FCH should be from a patient’s standpoint. The most frequent response to this question was, a desire for more walk-in and SDAS services at FCH, with public respondents often stating this would address difficulties in accessing GPs. “Access to transport, support groups and opportunities that will enhance the wellbeing of patients and complement their clinical treatment. ‘One Community’ would be delighted to help FCH to make connections with Voluntary and Community Sector organisations.”

Others suggested that access, transport links and mental health services should be considered a priority. A significant number of respondents stated that funding and resources were the biggest challenge to FCH, while population growth and new housing developments were cited as potential risks to service quality.

One GP suggested FCH has the ability to act as a ‘hub’ and facilitate greater integration of existing health care providers, including existing support services for specific patient groups. Another GP suggested more coordinated support from the CCG and Community Health Partnerships through using the facilities and the expansion of opening hours.

“More access to same-day GP services and more clinics so local residents don’t have to travel to the Queen Alexandra Hospital.”

Also of note is how the Queen Alexandra Hospital in Cosham is the acute hospital serving the city of Portsmouth and the surrounding area. FCH facilities could also be better utilised to address the additional pressures upon the Queen Alexandra hospital.

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Next steps The recommendations of this report will now shape the work of the Taskforce and its strategic direction in recommending how service provision at FCH can be expanded and improved. Of course, any specific changes in service provision at FCH must be decided and implemented by those organisations which own, manage and fund the hospital and local services, and it is important that FCH and its partners review the findings of this report and recommend how some or all of its recommendations can be moved forward so that the people of Fareham have a hospital which better suits their needs as well as one which better serves the wider network of NHS services. It’s imperative that the future of FCH is safeguarded and that it is better utilised for and by the people of Fareham and its surrounding communities. This report is an important evidence-base of local demand for FCH and should form the starting point for collaborative working between the FCH, key NHS stakeholders and patients.

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Appendix 1: Consultation questions 1) Accessibility – we want Fareham Community Hospital (FCH) to be accessible to all. With usage set to continue to increase with the additional footfall from same-day services, we want to hear from you on how we can make FCH more accessible. 2) Public Health - we want FCH to be a public health hub, with services for those suffering from a range of public health issues. Exercise classes and clubs led by health professionals have been shown to support the wellbeing of patients diagnosed as clinically depressed, or suffering from anxiety or clinical obesity. Such a function at FCH could also include strong links to local sports clubs (e.g. bowls) and community groups. Being mindful of the need for deliverability and cost effectiveness, how do you believe FCH can be utilised as a public health hub and what services should be prioritised? 3) Walk-in centre – given the success of the Same-Day-Access-Service which is now available to around 39,000 patients from 3 surgeries, with 8,510 calls having been triaged and 1,864 people receiving face to face consultations, should walk-in services now also be considered? If so, how? 4) Supporting senior and elderly patients – Fareham has a significant over 60s and elderly population. The last census revealed that most growth since 2001 has been in the oldest age groups, with the 65 and over’s increasing by 21.2%. How can FCH be utilised to meet the growing need to support our ageing population? 5) Clinical use of FCH – what clinical services would FCH benefit from? Some options include: 1) Minor operations theatre or treatment room. 2) Acute chronic illness centre to manage day-to-day chronic illness. 3) More diagnostics facilities (e.g. CT scan, biopsy facilities, endoscopy). 6) Paediatrics – we want Paediatrics services that meet the needs of children in Fareham. What services are deliverable or you believe to be of interest to FCH? 7) Community engagement – we want FCH to work with local groups and schools. This would involve local schools being invited to meet doctors and healthcare professionals, as part of their curriculum. This could cover areas of personal development, mental and physical health, possibly through having weekly lessons at FCH. Other community groups could benefit from public health related sessions. How do you see FCH engaging with the community and how would you advance community engagement? Fareham Community Hospital Future Vision | 17

8. Priority – what do you view as the prevalent health priorities in Fareham, and how do you see FCH’s role in addressing these? 9. Priority – we want to hear your thoughts, recommendations and proposals on what services you believe will best serve the people of Fareham and be best utilised at FCH. Or, alternatively, what the major obstacles to progress are. Please provide details below.

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Appendix 2: Consultees n n n n n n n n n n n n n n n n

Adults Health and Care Team, Hampshire County Council All Fareham GPs Community Health Partnerships Fareham and Gosport Clinical Commissioning Group Fareham Community Hospital Fareham Primary Care Services Friends of Fareham Community Hospital Members of the public NHS England Fareham Borough Council One Community Portsmouth Hospitals NHS Trust Solent Estates Partnerships Ltd Solent NHS Trust Southern Health NHS Foundation Trust University Hospital Southampton NHS Foundation Trust

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Fareham Community Hospital Future Vision Leading the way for healthcare in Fareham


A strong voice for Fareham S uella Braverman MP 14 East Street Fareham Hampshire PO16 0BN

t: 01329 233 573 w: suellabraverman.co.uk e: suella@suellabraverman.co.uk fb.com/SuellaBravermanOfficial

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