Cranleigh Village Health Trust recently spoke with Giles Mahoney, Director of Integrated Care Partnership Guildford, about their support for our proposals.
The interview was played in full on Cranleigh Community Radio, and you can listen to the conversation here:
You can find a full transcript of the conversation below.
Robin:
Hello, I’m Robin Fawkner-Corbett, chairman of the Cranleigh Village Health Trust. A very warm welcome to CVHT’s first-ever podcast. And before introducing you to the other participants, I’m going to mention how history has played a part in the naming of CVHT and its subsequent recent name change. Twenty years ago, Cranleigh’s inpatient beds were coming under increasing threat of closure, and to counter the concerns of the community, I and several months like-minded individuals set up the Cranleigh Village Hospital Trust, a charity formed with the mission of securing the beds in the village hospital for the future. However, despite our best efforts, the authorities decided that with the age of the old hospital, it would not be clinically safe to continue inpatient care there. The only way forward would be to build a standalone hospital with an adjacent new medical center, together with outpatient and diagnostic facilities, all on the proposed Knowle Lane site. The resulting plan was endorsed by the PCT, the medical practice, and Cranleigh Parish Council and a subsequent successful planning application was made by CVHT.
Robin:
This news was greeted with significant enthusiasm by the community and it was followed by subsequent encouraging fundraising campaign. But then, with the change in financial properties of the NHS, the exciting plan was doomed and the CVH beds closed in 2006, and brought an end to active fundraising. Since then, the possibility of a standalone hospital facility has again been raised by members of the community, but in the present day, it would be not only totally unaffordable, but would also raise concerns over clinical governance. It was concluded that the only way we will be able to reinstate the community beds on financially-secure grounds will be through having a community beds wing within a care home. Now, this is the challenging group that CVHT has been negotiating ever since.
Robin:
Five years ago, the charity formed a stakeholder group that included both the Royal Surrey and social services, and only with their enthusiasm and commitment and the part HC One has played have we been able to drive this project further forwards. However, the original name, Cranleigh Village Hospital Trust, has not only become redundant, but also has been a cause of misunderstanding about the purpose of the charity. And hence, in the last six months, the name has been changed to the Cranleigh Village Health Trust, but the initials remain the same.
Robin:
Now, moving on, I’m delighted that John Bainbridge, treasurer and company secretary of CVHT, and Giles Mahoney, a previous director at the Royal Surrey, and now director of the Integrated Care Partnership and representing the NHS and Surrey County council, are able to join us for this Cranleigh Community Radio podcast.
Robin:
Let me now introduce Giles Mahoney. Giles is a previous director of the Royal Surrey and now a director of the Integrated Care Partnership, representing the NHS and Surrey County council, and I’m delighted he is able to join this radio podcast. Giles, could you tell me about the Integrated Care Partnership, its responsibility and your present role?
Giles:
Sure. Hello, Robin. Yes, so the NHS and social care and other parts of the health and social care system, the mental health team, the Ambulance Service, Surrey County Council in particular, and the borough councils, both Guildford and Waverley Borough Council, have all decided to come together with the voluntary sector as well, and community and faith sectors, to consider how best to develop programs of work and transform the services that we provide to local people in a much more integrated way. Often, the things that block us moving forwards, and as we’ve seen with the recent response to the pandemic, there’s a significant, amazing progress going forwards in all of the integration work. And it’s that foundation that we’ve created over the last year or two, where we’ve built some really fantastic relationships and begun to change services, and we’ve just seen recently an acceleration of that integrated way of working. And it’s absolutely fantastic for patients and local people to have that joint response locally.
Robin:
You’ve been involved with CVHT for over the last four years, four to five years. Could you describe your initial enormous enthusiasm for step-down beds from the Royal Surrey, and how this need has subsequently become of less importance as the growth in our elderly population requiring social care nursing has ballooned?
Giles:
Sure. So as director of strategy and the Royal Surrey since 2013 and getting a little bit more involved specifically in the Cranleigh program a few years after that, I’ve seen an enormous change in the way in which care is delivered to local people after they’ve had an admission to the acute hospital, the Royal Surrey obviously being our main local hospital. The real importance of developing a public-private voluntary sector partnership felt really important to me, but also the Trust and colleagues, as I said, in the Integrated Care Partnership. And particularly we’ve seen a change in the technology and the development of much more home-based models of care.
Giles:
And there’s a significant investment. I led the work to bring the community services previously provided by Virgin Care in Surrey, into the Royal Surrey, for our area some years ago, with the direct intention of integrating staff teams and front line teams to work in a much more joined up way, but also to enable us to make new investments that particularly focused on people’s… Where they live and in their main home, their main residence. And the technologies that really enable us to do that, Robin, in a totally different way to perhaps where we were 10 years ago, certainly, and even five years ago, so that we can track the most vulnerable people in their own homes, support them in their own homes. And that’s resulted in less of a focus on community beds, NHS community beds, community hospitals, in the same way, and this is going on across the whole country.
Giles:
But what we have seen is a requirement for those who are particularly frail and unwell, perhaps after a visit to a hospital, and perhaps in the last two years of life. A number of people will visit hospital many, many times, multiple times, and as a previous local GP, you will have seen that trajectory. And as people become more frail, their ability to return to their own homes becomes more difficult. So providing a really great way of connecting people into a local care home setting, which is the substance of the proposals around, that we’re talking about today, enables the hospital to get people who are okay to come out of hospital, but aren’t okay to go into their own homes, that smaller group of people, actually getting them quickly into a care home is really important to us in the Integrated Care Partnership and in the hospital.
Robin:
That’s good. Okay. Why is the CVHT initiative so important to the NHS and Surrey County Council?
Giles:
There’s a real challenge around the quality of care home provision. We have, still, in Surrey, a number of requires improvement care homes, which have had that allocation provided by… Following an inspection by the Care Quality Commission, they’ve had that position. And Surrey County Council are very committed, as you can imagine, all of us are, that we have good quality care homes for local residents, local people. And so the development of good quality care home beds is a strategic priority for the County Council, alongside enabling people to be best supported in their own homes, which I was talking about earlier.
Giles:
So the importance of this particular program is that we need those good quality beds. The possibility that small numbers of publicly run and publicly funded beds, working in the less than 15 or so number of beds, is becoming more and more difficult. Would be very difficult for us to justify efficiency-wise, and already the community beds, hospital beds, we do have in Guildford and Waverley, both at Haslemere and at Milford Hospitals, the cost of those beds is about the same cost as an acute hospital bed. So it’s quite difficult to run community beds in a safe, efficient way. So partnering with the private sector who are already running a large facility, and we can add these beds alongside it, supported by yourselves, would be a significant opportunity to work together.
Robin:
Fantastic. And what local alternatives would be available to the stakeholders without this initiative?
Giles:
So there would be opportunities to go into other care homes. So that is a challenge around Cranleigh. There are other alternatives. But I think the opportunity to have this public partnership is really important to us and certainly colleagues within Surrey County Council, as you know, when we spoke at the planning meeting some months ago, Liz Uliasz, my colleague, who’s the deputy director of adult social care, the importance of having quick access to good quality care home beds in a specific part of Surrey, is really important to us. Because there’s a recognition that there are gaps in our care home provision across Surrey, at the moment.
Robin:
As you’re aware, the local population is keen to make sure the beds will be made available for the local population. I fully realized it when I was practicing as a GP, we had a flexible approach to this problem, very much relying on optimum bed usage, be it more for local or more distant problems. In those circumstances, he hospital was used for both local and more distant patients. Who, in terms of clinical need, is likely to be admitted to these beds, and can you reassure the audience that, where possible, that beds will be used for those from the Cranleigh locality?
Giles:
Sure. So the patients who would go into these ICP beds would be those who have probably been in and out of hospital. Frail and elderly patients who’ve been in and out of hospital, perhaps a number of times, as I mentioned earlier, who now are unable to go to their own home and need to be able to live in a residential and care home setting with that level of support that’s provided by that. And so those patients, at the moment, a number of them will be struggling to identify opportunities with their families and friends, social networks, about where best to go.
Giles:
But this provision would enable a quick conversation about that. And then we already now provide opportunities for people to get as close to either their family, so that sometimes means people do travel right away from where they were previously living to perhaps be nearer to children or other relatives. Others wants to be close to social networks and all the relationships and friendships they’ve got in a given geography. So it is always a mutual conversation and something around where the person has preferences to want to be, and we would naturally do that around the Cranleigh area, and Cranfold, to encourage people to be nearer those local networks, if they want to be. That is just the way it operates. We can’t guarantee that there won’t be someone from another part of Surrey or Guildford and Waverley in particular, but being in this area, the principle is people need to be close to their social networks, their friends, and family.
Robin:
Perfectly logical. With regards to need, do you have figures for the growth of the South West Surrey elderly population, and how have these figures in particular changed in the last two years?
Giles:
So certainly the current population of over 75s, which is the group we’re particularly focused on in this program, in 2019, there were about 14,100 patients, sorry, citizens, in that group. By 2025, we expect that to go up to 16,900, which is an increase of 2,800, just to help with the maths. And by 2035, so another 10 years beyond, it would be up to around 19,800, which is again another 2,900 on top. So we’re talking over the next number of years an increase of well over 5,000 people. So that is one of the biggest challenges in healthcare at the moment in the NHS, and when we get over the pandemic, we’ll be looking again at how we best support older people, which is one of our main focuses.
Giles:
And particularly that’s a focus in Surrey, given the aging population and the fantastic developments in medicine and health and social care over the last few years, which mean people live a lot longer and healthier lives more, without being so unwell. And that’s a real success story, and we should celebrate that. But the population pressure that that creates, in terms of services that we need to provide, we definitely have to plan ahead for that. And there’s a whole series of, as I go back to my first comments around the changes in technology, the changes in the way in which we see supporting this group of brilliant older people in our society, there were a number of range of things, from extra care, which people would recognize listening to this, that would be retirement homes or retirement villages, where people still own the facility they live in, but they have other facilities added to that and social interactions opportunities around that.
Giles:
And then as people would perhaps get decline and unable to look after themselves, they move into residential care and then eventually nursing care. So all of those numbers I’ve talked about for the population, Robin, there’ll be a number of people within that who are going to be transitioning across as, they become frailer and older, into those different settings, and I think that’s the important thing. But the thrust of our strategic response to people is to try and keep people in their own homes as long as possible. And the technology, as I said earlier, enables us to do that. And the investment we’re putting into community teams, we’re investing a lot in NHS teams and social care teams to support people in their own homes, which is a fantastic thing, and something that’s probably been under-invested in, in previous years.
Robin:
Are you therefore confident there will be no problem in filling the community wing with appropriate nursing care patients?
Giles:
Absolutely confident. That’s been a very active part, as you know, of our planning conversations with yourself and colleagues within CVHT and the local area. And as I say, Liz Uliasz and myself have consistently looked at the numbers, looked at the situation and the demands, and having this opportunity to have good-quality nursing home beds that have some public value in them as well, these ICP beds that we’re talking about, then that’s really important as well. So, yeah, absolutely no worries about that level of demand.
Robin:
And are you also confident that at the end of the standard NHS five-year contract or contractual period, the need will be the same, if not greater, thereby ensuring renewal the contracts?
Giles:
Yeah. So the public sector contract term you talk about, both NHS and social care use that sort of time period, is really important to us to secure good value and negotiate good value from that. And you’d expect us to be wanting to do that, and also expecting us to want to keep contracts under review. It incentivizes providers, partners, to continue to provide really high standards of care. And I think the wisdom of a five-year period is about right. It’s long enough for providers to invest and respond, knowing with some certainty their future contract values, but equally enables us as, if you like, purchasers of the care to keep providers on their toes a little bit, and also adapt over a five-year period to any changes. But again, we’re confident that, given those numbers of population growth I mentioned earlier, the demand will be there for many, many years to come
Robin:
With the additional bed capacity to be provided in Cranleigh, albeit for social care nursing, will this ease the pressure on beds in the Royal Surrey directly or indirectly?
Giles:
Yeah, absolutely. And I think the NHS community beds, the ones I’ve mentioned before, the rehabilitation of patients, again, lots of that’s happening at home now. And so this area of, as I’ve described it, people coming out of hospital who now won’t be able to go home, I think, is really vital, and what we’ve… To the hospital functioning well, and what we’re seeing through the pandemic, actually, is a significant acceleration of people who were ready to come out of acute hospital beds into care home settings. But just the practicalities of assessing what their needs are, talking about the preferences patients have had around different care home options, as we talked about earlier, that ability to quickly move people out.
Giles:
Obviously, there’ll be a whole process of ensuring people can settle into a good long-term position for themselves following the pandemic, but the principle is that the hospital is able to work a lot more efficiently if a number of people who don’t need to be there were able to be looked after well in the community. And that’s one of the big drivers for this whole initiative from ourselves at the ICP, is that we want to see patients in the right settings of care at the right time in their illness, so that the capacity in secondary care, in particular, at the Royal Surrey, can be used for the most unwell, and those who are in recovery and returning to the community can get there as quickly as possible.
Robin:
Can you describe how the beds will be funded and the financial implications for patients and families?
Giles:
Sure. So the focus of the public beds, the Integrated Care Partnership beds, the ones we’re working with yourselves on, and HC One, obviously, the main care home provider, expected here would be that those beds are made available to those who aren’t able to fund that care level of provision themselves. So a number of people in Surrey, because of the cost of homes, are able to self-pay. And that’s part of this assessment process that occurs every time someone needs a care home, that is a means-tested process that’s nationally coordinated. And that would mean that there were still a number of people who aren’t able to self-pay, who need to be provided with these beds on a longer-term basis.
Giles:
And that’s what we’re talking as, you know, with HC One and yourselves about, and providing that partnership model to it. What might happen is that a number of people, during the assessment process, which could take up to six weeks, might be placed into these beds. And then once their financial position is reviewed and understood, they might be able to then become self-payers, either in the same home or in that home of their own choice. But having that flexibility of these, I think we’re talking, currently, 15 beds or so, could enable us to manage that really efficiently and not have that happening in the Royal Surrey, which clearly causes a problem there, which we’ve discussed a few minutes ago.
Robin:
Can you say something about clinical governance, its need, and who will be responsible to make sure it is delivered?
Giles:
Sure. So one of the really important things that has changed in health and social care over the last few years is a significant focus on quality and providing really safe environments for patients and citizens. The Care Quality Commission do a fantastic job at doing that and raising standards. And one of the attractions of doing this public-private partnership at scale, so having a larger facility, a care home facility, residential home facility, with additional beds, as we’ve talked about, the ICP beds, as part of that, is that their scale of operation enables them to be really efficient and really safe in the way they can provide teams and provide cover.
Giles:
The smaller the units that we create in the community, the more fragile those are, the less resilient they are to staff sickness or other issues around staffing when you have vacancies. But if you’re part of a bigger facility, potentially as big as 50 beds or more, then that creates a critical mass of operation that enables things to be managed really carefully under our clinical governance regimes. I can’t overemphasize this focus we have, strategically, on enabling good quality care home and residential beds in Surrey. It’s a really big issue, and we want to work with our partners to develop that.
Robin:
How important is it to the ICP that there’ll be adjacent health worker accommodation?
Giles:
As you know, you’ve focused on this issue for some time, certainly when I was director of strategy at the Royal Surrey, this was a massive issue for us in terms of attracting people to a high-cost area, a high cost of accommodation area. And now more so with Brexit, and post-Brexit, the challenges of attracting relatively low-paid workers into areas, particularly rural areas with difficult transport links and things like that, cheap transport links, creates real problems. So one of the options, as you know, we’ve talked about, for this proposal, is to have health and social worker accommodation, which is absolutely vital, we feel, to enabling that team to be resilient.
Giles:
To have staff who don’t have to travel far to get to work, which is great for the environment, but also that they are able to be living in an area where the cost of living would perhaps make it more difficult for them to live. We already find within the NHS community services that we run in Guildford and Waverley that a number of those staff travel from outside Surrey, just because of the cost of living being so high. And that’s why this accommodation block’s so important as part of this proposal.
Robin:
Royal Surrey recommended HC One to CVHT. Are you still as confident and supportive of this recommendation?
Giles:
Yes. The Integrated Care Partnership has debated the ongoing progress of the Cranleigh proposals, and there’s nothing to indicate, from social care colleagues or from others within the partnership, that HC One are anything but a very good partner. We’ve seen them working, and seen examples of them working, and our teams, as you know, over the years, from the Royal Surrey and local community teams have gone to visit other public-private partnerships that they’ve set up. And that’s one of their values, I believe, to work in partnership with private and public sectors and the community to develop proposals. So there’s nothing we’ve got to suggest anything other than a continuing confidence that they are good partners to work with.
Robin:
Excellent. And with regard to care home capacity, is the Cranleigh area at present under-supplied?
Giles:
It’s a really difficult question to answer you directly on. The numbers of, certainly, residential homes, there’s a definite increase in our demand profiles as an ICP and Surrey County Council lead this work for us. It would indicate a significant requirement for, across Waverley, of residential home beds. The nursing home beds, because of the development of extra care in these other facilities, there are some different numbers being talked about, but I think the overall position, from our partners across, is that currently it does need good-quality nursing and residential beds in its geography, and that this fits the bill for that.
Robin:
Well, Giles, that really completes the questions, and your responses have been very helpful, very full, and will be very useful to us. Thank you, Giles, for the detail and commitment that you have provided.
Robin:
Let me now introduce you to John Bainbridge. Could you say a few words about your involvement with Cranleigh Village Health Trust and your previous experience with Cranleigh Parish Council?
John:
Yeah, certainly. I became a trustee and treasurer of CVHT in late 2011. I was, at that time, a Cranleigh Parish councilor, where I’d served as chairman of finance, chairman of the recreation committee and [inaudible 00:23:26] planning.
Robin:
Can you share details of the land swap, and the concerns raised by some members of the public with regards to a ransom strip?
John:
Well, I’d be delighted to. I was a member of the Parish Council and the land swap was approved. We saw it then as a terrific win-win for the community, securing a large piece of land suitable for two football pitches in exchange for a disused paddock, which would become available to CVHT as a location for the new healthcare facilities. The transfer was completed in 2010, a while before I became a trustee of CVHT. In terms of the ransom strip, there is no such thing. At the time of the agreement, Parish Council did not want to own this strip of land edging Knowle Lane, as it contains a ditch and the Council would have had responsibility for it. The landowner accepted this and agreed to retain it, and is still maintaining the ditch, to the best of my knowledge. The Council has all the full access rights it needs across that strip of land.
Robin:
That’s great. Thank you. How much of the funds raised in the community are still held by CVHT for this project?
John:
The community raised some £950,000, net of all the associated costs of raising the money. Of that, an estimate something… the order of £150,000 is still held by the Trust. The other thing I wanted to add was that we have recently raised new funds that will cover the cost of any new application, if that should happen.
Robin:
Do you have a rough idea of the funds CVHT has expended to date on successive planning applications and associated professional advice?
John:
It would be some £630,000. This includes some very significant items of associated expenditure, including the Keep Beds Open campaign, the leveling and the laying of the new football pitch, and the traffic calming works that CVHT paid for at the junction of Knowle Lane and the High Street.
Robin:
Can you tell our audience how the health worker accommodation will be funded, and who will have ownership, and what does CVHT intend to do with the surplus rental income?
John:
Well, the cost of the building and fitting out of the accommodation block will be financed by the premium from the grant of the 125-year lease to the care home provider and the balance by local benefactors. The low-cost rents will be in accordance with local authority rates or lower, and they will be monitored by WBC under a section 106 agreement. Any surplus income, after maintenance costs, etc, will be donated to the League of Friends, possibly other healthcare charities locally.
Robin:
And the building will be owned by CVHT.
John:
Yeah. Although the operator will have a lease over that part of the land that it occupies, the ownership of the land will remain with CVHT in perpetuity.
Robin:
Thank you. CVHT expect to proceed in partnership with HC One, once planning permission has been achieved. Some critics claim that CVHT will be effectively donating its land to a commercial operator. Can you confirm that this is not the case?
John:
Yeah, absolutely. As I’ve said, the care home operator will have the benefit of 125-year lease, but the ownership of the entire site remains CVHT’s in perpetuity.
Robin:
After so much effort by the trustees and the generosity of the public, if CVHT were to fail in their efforts now, how do you see the future for the charity? In these circumstances, would there be any hope in the future for the return of community beds to Cranleigh?
John:
I believe this new application by the Trust is indeed the last chance for community beds to return to Cranleigh. And without the accommodation block for health workers, the facilities would be impossible to run. The NHS is providing wholehearted support to CVHT, but could not afford itself to build alternative facilities. If CVHT failed in its objectives, I believe this would be an absolute disaster for the community and the trustees would have to consider closing the charity down.
Robin:
Thank you, John. And thank you for your clarity. In addition, I would like to refer to the relationship between CVHT and the Cranleigh Hospital League of Friends. This has been a positive, ongoing relationship, very much helped by a member of the League of Friends, Caroline Norman, sitting in on our stakeholder meetings. In addition, the chairman of the League of Friends, Diane Davis, and I have been liaising over the health matters in Cranleigh for over 20 years, and continue to do so. And John Bainbridge has already mentioned that CVHT intends to donate some of its surplus profits from the health worker accommodation rental income to the League of Friends. So that brings the end to this inaugural CVHT podcast. But let me remind you that more information can be found on www.cranleighhealthtrust.org. Thank you.
