Engagement: The Future of In-patient Non-Stroke Rehabilitation in Haringey

This consultation has now closed. Thank you to everyone who took the time to give us their views and to attend meetings during the consultation period.

The Chestnut Ward at St Ann's Hospital currently provides stroke and non-stroke in-patient rehabilitation.  The non-stroke unit is mainly for patients over 65 years, who require a minimum of an additional two weeks of in-patient rehabilitation following an acute hospital in-patient spell. Periods longer than this are generally provided for in an acute setting.

As part of our quality improvement programme, the NHS in Haringey undertook a market testing exercise and identified that stroke and non-stroke in-patient rehabilitation could be provided elsewhere in the acute and/or independent sector of a higher quality and at a lower cost than at Chestnut ward.  NHS North Central London therefore published an invitation to tender for the re-procurement of both services. The tenders were evaluated by a panel representing NHS North Central London, GPs, the Local Authority and Haringey LINks.

Following a successful procurement process, the Homerton University Hospital won the contract for the stroke beds.

However, the non-stroke procurement element was terminated as accessibility was not clearly highlighted or discussed within the initial consultation. We now want to address that gap and engage with all relevant parties to identify what travel times are acceptable in relation to accessing the proposed new service. This will then determine where the service could be relocated to.

What are we procuring?

NHS North Central London aims to improve the quality of the service by stipulating that patients need rehabilitation in an in-patient rehabilitation facility rather than in a less intense setting in the following circumstances:

• The individual requires 24 hour a day access to a registered nurse with specialised training in rehabilitation
• The individual requires frequent rehabilitation team assessment and intervention due to potential risk of significant change in physical or medical status
• The rehabilitation services require such an intensity, frequency and duration as to make it impractical for the individual to receive services in a less intense care setting
• Therapy is delivered at least six days per week
• The individual requires treatment from a multi-disciplinary team
• The individual is stable enough medically and is capable and willing to participate in intensive therapy for a minimum of three hours per day for at least five days per week
• The rehabilitation programme is expected to result in significant therapeutic improvement over a clearly defined period of time
• The rehabilitation programme is individualised, and documentation outlines quantifiable, attainable treatment goals.

The proposed new service would increase accessibility by accepting patients with:

• Nasogastric (NG) tubes - a medical process involving the insertion of a plastic tube (nasogastric tube or NG tube) through the nose, past the throat, and down into the stomach
• Tracheotomies

Next Steps

NHS North Central London will be talking and listening to a range of stakeholders between Friday 11 November 2011 and Friday 16 December 2011.  The purpose is to hear their views about the service we might receive. The decision to re-tender has been made, however we do want to make sure that the tender specification reflects the priorities and views of all those who are concerned with securing the best possible service for this group of patients.

We would like to hear your views on the following:

1. What percentage should be given to the two overarching priorities of cost and quality?
2. What are the key access issues should we consider, such as location, quality of build, travel time and so on?
3. Of the quality criteria which ones have greater importance?

For more information please contact Steve Beeho, Head of System Support at steve.beeho@haringey.nhs.uk