FAQs for specialist hospital dementia care consultation

FAQs for specialist hospital dementia care consultation

What is advanced or severe dementia?

During the later stages of dementia most people will become increasingly frail due to the progression of the illness. They will also gradually become dependent on others for all of their care and often lose the ability to respond and to interact with their environment. In some cases people also experience further health complications which can mean that there is a requirement for additional community and clinical support.

What involvement do Wiltshire CCG, Wiltshire Council and Avon and Wiltshire Mental Health Partnership have in specialist dementia care in Wiltshire?

Wiltshire Clinical Commissioning Group (CCG) commissions dementia services including specialist dementia hospital care throughout Wiltshire. This means that the CCG are responsible for funding and making decisions about the current and future specialist dementia care and, in context of this consultation the commissioning of specialist hospital dementia care services.

Wiltshire Council is as a community leader in public consultations that affect the population and communities within Wiltshire. In addition, Wiltshire Council works alongside the CCG to commission and improve dementia care services as outlined in the Wiltshire Dementia Strategy. Wiltshire Council does not commission or make decisions about specialist dementia hospital care as that element is a health service and that responsibility lies with the CCG.

Avon and Wiltshire Mental Health Partnership (AWP) are supporting the consultation, as they provide the specialist dementia hospital care in Wiltshire.

Why is there a need for a specialist dementia care ward?

Sometimes people with advanced dementia can become severely distressed and require specialist support outside of their normal residential or care home environment. During these short periods of illness, people will need to be admitted to a specialist dementia hospital ward which is designed specifically to help support them. Often people also have complex physical and psychiatric needs which cannot be met in their residential, care, nursing or own home.

Where do people with advanced or severe dementia currently go for hospital treatment?

Of the estimated 7,300 people living in Wiltshire with dementia, only a small proportion, around 120 a year, will need specialist treatment and assessment within a hospital dementia care ward. The assessment, treatment and stabilisation of patients who have suffered a crisis is provided by healthcare professionals with specialist knowledge of dementia and the impact it can have on people’s lives. Specialist dementia care wards are there for people when they have a crisis and are only for short stays (up to a maximum of 84 days) and are not a long term care option.

Since February 2013, all specialist hospital dementia care (consisting of 20 specialist dementia beds) in Wiltshire has been provided on a temporary basis at Amblescroft South, Fountain Way, Salisbury. Before that, there were 24 specialist dementia beds in Charter House, Trowbridge and 10 specialist dementia beds in Amblescroft South, Salisbury.

Specialist dementia care beds for Wilshire patients are also available in St.Martin’s in Bath and the Victoria Centre in Swindon.

Why is there a need to change where the current provision for specialist hospital dementia care in Wiltshire is located?

Although the 20 specialist dementia care beds have been located in Amblescroft South in Salisbury for the past two years, this was a temporary solution following the closure of Charter House in Trowbridge in 2013. There is now a need to make a decision on where to permanently locate these beds.

What are the options available when considering where to locate a permanent specialist hospital dementia care ward?

Wiltshire CCG, Wiltshire Council and Avon and Wiltshire Mental Health Partnership have identified three potential locations in Wiltshire for the specialist hospital dementia services to be located:

  1. Charter House in Trowbridge
  2. Avebury Ward, Green Lane Hospital in Devizes
  3. Amblescroft South, Fountain Way in Salisbury

What are the pros and cons of locating the specialist hospital dementia care beds at each of these locations?

A detailed overview of the three locations, including pros, cons and associated financial costs can be found in the consultation document.

Has Wiltshire CCG considered any other locations for a specialist dementia care ward?

The three options put forward are the viable options utilising assets that are currently owned by Avon and Wiltshire Mental Health Partnership Trust.

How long is the consultation process?

The consultation on the provision of specialist hospital dementia care beds in Wiltshire will last for approximately three months, from 1 December 2014 to 10 March 2015. At the end of the consultation period, Healthwatch Wiltshire will produce a report which collates all of the views expressed by the people of Wiltshire. The report will then be presented to the CCG at the end of the consultation, at the same time as being made publicly available.

Will 20 specialist dementia care beds be enough to service the entire county?

Over the past few years, not all of the 20 inpatient beds commissioned by Wiltshire CCG from Avon and Wiltshire Mental Health Partnership have been in use for the purpose they were provided for and have, in the past, been occupied by patients who could be cared for in a community setting. Wiltshire’s seven year dementia strategy sets out the need for increased provision of community level dementia care within nursing and care home environments. By providing additional support at this level it is hoped that specialist dementia care beds in a hospital setting can be used only for those people who have suffered a crisis and require additional specialist clinical support.

Current projections indicate by 2020, Wiltshire will see an additional 1,800 people being diagnosed with dementia. We are confident, however that the provision we are making now for specialist hospital dementia care beds will be able to meet the level of demand in Wiltshire now and into the future.

Are there enough specialist dementia care nurses in Wiltshire to care for the growing number of people with dementia?

If Amblescroft South in Salisbury is chosen as the preferred option there will be a £0.44m surplus of funds. These funds will be reinvested into community services, which will include dementia care.

What happens if all of the specialist dementia care beds in Wiltshire are full? Can Wiltshire patients be sent out of county for specialist dementia care treatment?

We commission 20 specialist beds from Avon and Wiltshire Mental Health Partnership, and this includes being able to use beds in Swindon and Bath where they may be better placed for Wiltshire patients taking into account where people live.

What will happen to the two premises that are not chosen as the location for the specialist hospital dementia beds?

Charter House is currently empty. If the dementia service moves to Charter House both Avebury Ward and Amblescroft South will be empty and available for other healthcare service developments.

Avebury Ward is currently empty. If the dementia services move to Avebury Ward the Charter House site will be offered for sale and the proceeds will contribute to the historical costs (impairment) associated with the building. Amblescroft South will become empty and available for other healthcare service developments.

Amblescroft South is the current temporary location of the dementia inpatient service. If the service remains at Amblescroft South on a permanent basis the Charter House site will be offered for sale and the proceeds will contribute to the historical costs (impairment) associated with the building. Avebury ward will remain empty and available for other healthcare service developments. 

What are the costs associated with locating the specialist dementia care beds in one permanent location?

Wiltshire CCG has £1.48m available to procure a permanent location for the specialist dementia care beds in Wiltshire. Charter House in Trowbridge will require a £5.37m capital investment, £0.25m to move the services to Charter House and an annual running cost of £2.24m. Averbury ward in Devizes will require a £3.12m investment, £0.25 to move the services to Devizes and annual running costs of £2.15m. Amblescroft South in Salisbury will require no capital investment or relocation costs but will incur costs of £1.04m to run annually.

The costs for refurbishing Charter House and Avebury ward are a lot of money, are these figures accurate?

Avon and Wiltshire Mental Health Partnership commissioned specialist consultants to look at how the buildings could be refurbished to meet the current standards and provide an environment suitable for people needing advanced dementia care. Significant work is needed on the Charter House site and Avebury Ward, Devizes because they were not designed, or built to meet the current requirements.

The consultation shows that there will be money left over in the budget if Amblescroft South in Salisbury is chosen as the preferred option, what will happen to this surplus?

If Amblescroft South in Salisbury is chosen as the preferred option for the permanent location of the 20 specialist hospital dementia care beds, it is our intention to reinvest the savings (£0.44m) into enhancing current community dementia support across the county, in line with Wiltshire’s seven year dementia strategy.

It appears that there is not enough money in the budget to afford either the Charter House or Avebury ward options, if however one of them is chosen as the preferred option how will it be funded?

If either Charter House in Trowbridge or Avebury ward in Devizes are chosen as the preferred option, the funding would need to be made available. This could impact on other services within the county. At this stage, which services would be impacted upon is not known.

How are you ensuring that the views and needs of patients and their carers are taken into account?

Wiltshire CCG is working closely with Healthwatch Wiltshire, the independent consumer champion for health service users in Wiltshire, to ensure as many people and organisations as possible are able to find out about the three options, to ask questions and to share their views.

As well as being made available on Healthwatch Wiltshire’s website, Healthwatch Wiltshire is also talking to people in several different ways to ensure that as many people as possible can have their say. This includes

  • 1:1 interviews
  • Meetings with stakeholders
  • Meetings with service users of community and voluntary service
  • A questionnaire which is available as a hard copy by calling 01225 434218 or it can be completed online
  • Public meetings

At the end of the three month consultation process, Healthwatch Wiltshire will produce a report which collates all of the views expressed by the people of Wiltshire. The report will be presented to the CCG at the end of the consultation and will also be made publicly available at the same time.

Is there any support (financial or other) for carers and family who could face long journeys to visit patients?

Wiltshire CCG currently commissions, and will continue to commission, specialist hospital dementia beds at the Victoria Centre in Swindon and St Martin’s in Bath for patients in north, east and west Wiltshire. We appreciate that travel across Wiltshire, especially without use of a car, can be challenging and as far as possible we look for bed availability close to home, however this is not always possible. In order for the best possible care to be provided it is necessary for there to be a single site for all 20 of the specialist hospital dementia beds. These beds will only be for patients suffering a crisis and it is the intention that people spend only a short amount of time on the ward before being well enough to return home or to a care or nursing home.