Warwickshire County Council: Senior clinician delivers verdict on South Warwickshire hospital beds review

Dr Martin Sandler is the clinical lead for frailty across the Midlands and the associate managing director of South Warwickshire University NHS Foundation Trust (SWFT) among other roles.

He joined colleagues at a two-hour meeting to discuss the consultation on the South Warwickshire Community Beds Review, the process by which the NHS will decide how to distribute 35 rehabilitation beds for the area.

At the heart of the debate is the future of Ellen Badger Hospital, Shipston, which has recently been redeveloped but is earmarked to have in-patient services removed, much to the ire of locals.

The NHS favours keeping the 35 beds in bigger settings and says its data shows that a chunk of the 12 beds that could go to Shipston as part of a “viable” alternative option would likely see patients from Stratford and Warwick transferred down out of their own areas.

Warwick district councillor Pam Redford (Con, Cubbington & Leek Wootton) serves on the adult social care and health overview and scrutiny panel, a body of county, district and borough councillors who question such decisions.

She had doubts over whether 35 beds is enough – campaigners in Shipston have called for Ellen Badger to have additional beds, not taking away any from the other two sites – with more than 54,000 extra homes set to be built in the area between now and 2050.

Dr Sandler said it was not simply a case of looking at the raw numbers.

“The year 2050 is roundabout where our rise in older adults starts to tail off as the baby boomers depart this planet,” he said.

“In some respects, it is almost the right sort of time to be planning more homes and they will potentially be largely for younger people.

“The number of frail older people will increase over the next 20 years, roughly speaking.

The question in many respects is how many of them will need bedded rehabilitation, which is very focused and available when required for a small proportion of people, probably even fewer than have it at present.

“Nationally and locally, the present services are become much more focused on service at home rather than a hospital setting.

“In all likelihood, the elderly population is increasing but will plateau and then dip. Our requirement for bedded rehab, because of the at-home service, particularly around rehabilitation, is already starting to dip significantly.

“It is really difficult to do precise modelling but as far as one can tell, the projections we are talking about will result in less and less requirement for in-patient rehabilitation beds.”

Cllr Redford suggested the prospect of another baby boom could not reasonably be ruled out and asked about the younger people who need rehabilitation.

“The number of younger people who need rehabilitation is relatively small and relatively specific,” replied Dr Sandler.

“Leamington has two existing rehabilitation wards aside from the community hospital beds. One is for stroke rehabilitation specifically, which can affect younger people unfortunately, and the Central England Rehabilitation Unit which is much more focused on things like head and spinal cord injuries, post-trauma.

“Those are very tiny numbers of very specialist beds. There is no obvious reason to expect that to increase."

He then addressed the benefits of home rehabilitation.

"It operates everywhere and that has the benefit of people not having to be in a hospital setting," he continued.

“We know being in a hospital setting for rehabilitation carries its own risks of falls, fractures, inflections, disorientation and dislocation from their own usual lives.

“The ability to rehabilitate at home actually allows people to rehabilitate in an environment that they are used to and even the smallest of things that people do – making a cup of tea, for example – is rehabilitation in itself.

“In many respects home-based rehabilitation is more attractive and it appears more effective. There is certainly much greater satisfaction for patients if we are to believe the feedback.”

Dr Sandler concluded with his opinion that those accessing the 35 beds would get better outcomes by being in settings with wider health services.

“The specialist physiotherapists in musculoskeletal work can talk to the specialist neuro physiotherapist and get a bit of advice about an awkward presentation,” he said.

“You find that the therapy services and the individual rehabilitation services actually fuel each other – expertise rises and the benefit the patient gets is substantially greater.”