PLANS to extend intermediate care into the community have been given the green light by Shetland’s Integration Joint Board (IJB), paving the way for the eventual closure of Gilbert Bain Hospital’s Ronas Ward.
NHS Shetland now have the authority to shut down the rehabilitation ward and chief executive Ralph Roberts confirmed after the IJB meeting on Friday that a formal decision should be made by early June.
The ward, which contains six beds and is used for patient rehabilitation and recuperation, is currently mothballed to allow staff to fill vacancies elsewhere in the Lerwick hospital.
IJB members were asked on Friday to support NHS Shetland’s wish to move more rehab into the community, such as at home and in care homes.
Closing Ronas Ward is expected to create annual savings of around £500,000 during a time when NHS Shetland is facing a significant funding gap exacerbated by rising costs.
All patients who require hospital based treatment will continue to receive care in the Gilbert Bain, while the oncology and haematology services currently provided within the Ronas Ward are expected to continue, as well as ambulatory care.
Roberts admitted that, as is experienced elsewhere across the health board, recruiting staff to expand intermediate care through the community will be “difficult”.
“The IJB in my mind have agreed today that the shift in the balance of care is the right thing to do, the future of providing rehab services in the community is the right thing to do and the sustaining of the acute rehab in the hospital is the right thing to do,” he said.
“As part of that shift in the balance of care, they would expect us to disinvest a proportion of money which they will then use within the IJB to support all of their IJB services,” he said.
When asked if the closure of the Ronas Ward is a foregone closure, Roberts said officials and staff believe it would be the next “logical” step.
“It would be wrong of me to sit here and prejudge what the board will decide, but I think we’re all clear what we think the answer should be.”
The number of patients needing beds in the hospital has decreased, with last week having an occupancy rate of around 60 per cent, despite the Ronas Ward out of action.
Shetland’s intermediate care team was established in 2014 in an effort to reduce the number of people needing to go to hospital and to assist the discharge process.
During the IJB meeting on Friday, which lasted around four hours, director of community health and social care Simon Bokor-Ingram tried to allay concerns over capacity for patients and said there was a “change in the nature of the usage of beds” in the likes of the Montfield care home as fewer people have long stays.
Voting member Tom Morton questioned what would happen if recruitment for an augmented intermediate care service failed, with Bokor-Ingram saying employing locums could be an option, albeit an unpreferable one.
There is about the equivalent of four to five empty posts just for physiotherapists, it was said.
Councillor Billy Fox then sought assurances over the morale of the staff is who are currently relocated from the Ronas Ward.
Director of nursing Kathleen Carolan said employees have “all been able to take a temporary placement of their choice” in areas such as outpatients and theatre and are “happy” with the move.
She added that there had been no change in the terms of their contract.
Morton questioned Jim Unsworth on whether he felt confident in the plans, with the consultant physician suggesting it was the “least bad alternative”.
Hillswick GP Susan Bowie, appearing via video link, agreed that there needs to be regular “evaluation” of the service.
Roberts said after the meeting that he was “absolutely clear” that the quality of patient care will remain high.
“I think over time it will continue to develop,” he said.
“It is worth saying that I think some of the success of this is building on the stuff that Ronas developed, [such as] some of the lessons around how they did slightly longer term rehab.
“None of this is about saying what Ronas were doing wasn’t good and wasn’t valuable.”