Lincolnshire East Clinical Commissioning Group (LECCG) is currently reviewing the provision of inpatient services on Manby and Carlton wards at County Hospital, Louth. 

These nurse-led wards currently support patients who require nursing care, rehabilitation, assessment, and palliative and end of life care. This care is provided by Lincolnshire Community Health Services NHS Trust (LCHS). 

As the commissioner of services at County Hospital, Louth, Lincolnshire East CCG remains committed to the future of the hospital.  As part of the review of services, we have introduced a service which brings together the expertise of a wide range of clinical professions and reduces the average length of stay for patients, while allowing them to be treated close to home.  Working with LCHS, we have also introduced measures to ensure compliance with same sex accommodation requirements.  

Our vision is to provide lasting security for Louth as a centre for innovative healthcare for local people.  The current state of the hospital buildings means that the options we outline below for the wards are a cost-effective means of delivering services whilst we develop plans with local people for the long-term future of a Louth community hospital.

A review of clinical service provision has identified significant opportunities to integrate care pathways, and to improve both efficiency and quality at Louth Hospital.  Most of the current buildings on site date back approximately 100 years and have received little investment. Consequently, the majority of the buildings have severe condition and suitability issues in the context of delivering healthcare to modern standards. Despite this Louth Hospital is well used and liked by both local people and clinicians.

In 2015 the CCG produced a strategic outline case which described the clinical vision and strategy for the hospital, and considered possible future options and the associated costs. 

Considering the overall focus on estates as part of the Sustainability and Transformation Partnership (STP), we need to:

  • Support the Acute Services Review
  • Support the ongoing development of integrated health and care with enhanced access to primary care
  • Provide suitable space for other agencies to support the delivery of an holistic approach to patient management including community nursing teams, third sector agencies such as Age UK, MacMillan, British Heart Foundation as well as Social Services in the support of patients at home, not in hospital

One of our commitments is to carefully commission services – this means we take into account the needs of the local community together with the finances we have.  This is not always an easy task to undertake and sometimes difficult decisions have to be made.  We are now engaging with the public and other stakeholders to support us to make an informed decision about the services provided locally for patients.  It is important that we encourage as many people as possible to give their views on the options.

In June 2017, a health and safety review of Manby and Carlton wards carried out by LCHS identified a number of fire safety risks. This resulted in the number of beds being reduced to ensure that patients could be safely evacuated in the event of a fire, and identified a need for essential building works to take place. This fire safety work, along with additional improvements, has represented a significant investment by NHS Property Services.

Since this time, there have been many positive developments at County Hospital, Louth. This has included introducing a more proactive approach to rehabilitation on the ward, and taking a ‘home first’ approach to care, to ensure that people have the right support to stay safely at home and are not unnecessarily readmitted. There has been an increase in the number of patients receiving clinical assessment during the day, without the need to admit them into a bed, and ward and community staff are establishing closer working partnerships with the Urgent Care Centre, which sees approximately 20,000 attendances each year, and consistently meets the national four-hour wait target. 

Using this approach, the average length of stay for patients has reduced by about four-and-a-half days when comparing 2016/2017 to 2017/18. This reduction brings several benefits to patients, including promoting remaining well at home, independence, socialisation with friends and family, opportunities for self-care and a reduced risk of infection. National evidence shows that for patients over the age of 80, a week in bed can lead to ten years of muscle ageing and 1.5kg of muscle loss.

This different model of care was also used by LCHS on Digby Ward at Lincoln County Hospital during winter 2017, to provide intensive, short term support to patients transitioning between acute hospital services and returning home. This saw 123 discharges within 72 hours over a six week period.   

These successes have identified a number of opportunities to develop and refine the care model on offer at Louth.  Based on the needs analysis of patients and the ability to manage the needs of patients out of hospital the following two options are being considered by LECCG for future provision of services at County Hospital, Louth: 

Option 1: 16 beds plus six chairs on Carlton Ward

This option is in line with the current service model which has been delivered at Louth since June 2017. The 16 beds on Carlton Ward would continue to deliver the existing service specification, delivering “step-up” (admission from home for care), “step-down” (admission from a hospital ward for extra care to facilitate a safer return home), palliative and end of life care. 

This option also includes a bay with six chairs for day case therapy, which would include intra-venous (IV) therapies, such as fluids and antibiotics. 

This option would mean Manby Ward would not re-open to beds but there may be opportunities for the space to be used differently.  Opportunities might include the ability to co-locate other services, such as those delivered by community staff, which would support Neighbourhood Working; a key programme within Lincolnshire’s Sustainability and Transformation Partnership (STP) which sees professionals from different organisations working together to deliver patient-centred care.  Hours of operation would remain the same, including Monday to Friday 9am – 5pm for the chairs.

Option 2: 20 beds on Carlton Ward, plus six chairs on Manby Ward

Carlton Ward would continue offer 16 beds in-line with the current service model, as described above in Option 1, with a further four “flexible” beds. This model of care builds on that which was delivered by LCHS on Digby Ward at Lincoln County Hospital.

These four beds could be used for those in need of assessment overnight or a more complex care package, aiming for a fast turnaround of up to 72 hours. This means patients will have access to a wider range of health professionals within the community, such as pharmacists, therapists, specialist nurses, advanced nurse practitioners or doctors, to quickly evaluate their needs. 

On Manby Ward, there would be six chairs for day case assessment, treatment and care planning, underpinned by a new Frailty Assessment, Stabilisation and Treatment (FAST) pathway - these chairs will be in operation seven days a week. A fully-equipped gym would support the assessment of patient mobility and development of personalised therapy plans. It is anticipated that Manby Ward could also host staff contributing to Neighbourhood Working, a key programme within Lincolnshire’s Sustainability and Transformation Partnership (STP) which sees professionals from different organisations working together to deliver patient-centred care. 

Patients should be better supported through this change in approach, which also promotes personalised care planning and the involvement of the wider integrated team of professionals. It would also enable those patients in need of supportive palliative care to be identified earlier and additional services, including IV therapy, to be offered for people requiring day intervention to return home following treatment. 

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* 1. Please tell us the first 5 digits of your postcode

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* 2. Are you:

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* 3. Have you or a family member received community care which has helped you stay at home and prevent you being admitted to Louth, Lincoln or Grimsby Hospitals?

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* 4. Please tell us your experiences of this community care below:

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* 5. Have you or a member of your family been admitted as an inpatient to Louth Hospital?

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* 6. If you or a member of your family have been an inpatient in Louth Hospital and required rehabilitation, where did you receive this? (if not, you do not need to complete this question)

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* 7. If you are a health professional, have you referred patients to inpatient services at Louth Hospital?

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* 8. To what extent do you understand the reasons why we need to change how inpatient services are delivered at Louth County Hospital?

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* 9. If you don’t understand, please tell us what additional information would help you to understand the need for this change?

Option 1: Single Ward model in line with current service.
(16 beds plus 6 chairs on Carlton Ward) 

Further details of this option are explained in the survey introduction.

This is the service that is currently being delivered. More services in the community have already been developed to safely care for people in their own homes and only be admitted to Louth Hospital when needed. 

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* 10. What do you think the benefits of this model would be for the people of Lincolnshire East?

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* 11. If you have any concerns about this option please tell us below and your suggestions for how we can overcome this:

Option 2: Inpatient Ward with flexible beds plus a Frailty Assessment Day Unit
(20 beds on Carlton Ward plus 6 chairs on Manby Ward)

Further details of this option are explained in the survey introduction

This alternative model is the same as option 1 but also recognizes the importance of getting packages of care in place for frail, older people before they become too poorly and also getting them back home sooner to keep people independent.

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* 12. What do you think the benefits of the frailty assessment unit would be for the people of Lincolnshire East?

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* 13. If you have any concerns about this option please tell us below and your suggestions for how we can overcome this:

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* 14. Which option do you think best meets the needs of the local population?

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* 15. Please tell us below if you think there are any additional services that would benefit the local population:

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* 16. Your opinion is important to us please use the space below for any other comments or suggestions