Introduction and Context
This document has been developed by South Warwickshire NHS Foundation Trust to feedback on Warwick District Council's (WDC) Local Plan and Preferred Options in relation to the impact of any developments on Community and Acute Health Services' infrastructure.
South Warwickshire NHS Foundation Trust is the major provider of acute and community health services to the population of South Warwickshire and delivers services to patients from sites across the district;
* Warwick Hospital - This site houses the majority of the Trust's Acute Services including; Accident and Emergency services, Diagnostic and Pathology departments, Maternity and SCBU (Special Care Baby Unit), Main and Day Surgery Theatres together with an Intensive Care Unit and Coronary Care Unit.
* Stratford-upon-Avon Hospital - This is one of the Trust's community hospitals and it includes a minor injuries unit, outpatients department, radiology department and an intermediate care ward.
* Royal Leamington Spa Rehabilitation Hospital - This site offers rehabilitation services to adults and includes a Neuro-rehabilitation Unit together with a number of outpatient services.
* Ellen Badger Hospital - This community hospital has a 26 bedded ward which offers rehabilitation to patients to enable them to return to the community. In addition, a Day Hospital operates, which offers continuing rehabilitation and help with medicines management and reduced mobility. Due to its rural location, some out-patient appointments are also offered.
* Our community services teams operate out of a number of clinics, some of the larger ones include Saltisford House, Cape Road Clinic and the Orchard Centre.
In April 2011 the Trust acquired Warwickshire Community services as part of the Transforming Community Services initiative and, as a vertically integrated organisation, has already made good progress in establishing out-of-hospital services and pathways to deliver care closer to patients' homes. However, South Warwickshire's demographic growth and the ageing population have resulted in demand for Acute and Community health services increasing, creating capacity pressures for the Trust and challenging commissioner aspirations to reduce hospital beds on the back of increased disability free life expectancy assumptions.
Current Capacity and Infrastructure Requirements to meet Population Demand
During 2011/12, South Warwickshire NHS Foundation Trust's acute services saw in excess of 300,000 outpatient appointments and 55,000 patient admissions. 26,000 of the patients admitted during the year were registered to GPs within Warwick District, occupying an average of 216 acute hospital beds. The highest user group of hospital beds from the Warwick District were the over 80 year old patients, occupying nearly 100 beds as a result of an emergency admission. It is evident from increased demand from this patient cohort that, whilst our growing elderly population are living longer, they are not necessarily living well for longer. The Trust has been working with health and social partners to develop and implement new pathways and services for the elderly population. These are already being delivered in the Stratford District and have resulted in reduced admission rates per head of population. It is expected that these pathways and services are transferable to Warwick District to achieve the same benefits.
Vision for Acute and Community Health Services in Warwick District
Our vision is "to provide high quality, clinically and cost effective NHS healthcare services that meet the needs of our patients and the communities that we serve" which we aim to deliver through service underpinned by the following values;
1. We place the care and safety of patients and users as our first priority.
2. We will provide the best possible patient and user experience in every aspect of service delivery and aspire to deliver excellent outcomes.
3. The facilities that we run will be comfortable and clean and we will use effective techniques and technologies delivered by senior experienced and capable staff.
4. We are committed to the highest standards of honesty, openness and accountability in the way we carry out our public duties.
5. We want our staff to feel pride and satisfaction from their work, to work in a safe environment in an open and supportive team working culture that enables them to perform at their best, innovate and develop.
6. We will engage constructively with General Practice and other partner organisations and stakeholders to develop seamless, efficient services that respond to public priorities.
Scenario Modelling
Following on from work initiated by the Arden Cluster to understand acute hospital capacity requirements for the future, we have further developed the Cluster's capacity modelling tool to support impact assessment of different population and service delivery scenarios. Our capacity requirements are predominantly driven by age specific admission rates and age specific hospital length of stay and these will vary by different admission type (i.e. emergency or planned care). We have applied each of the three population projections considered by WDC's Strategic Housing Market Assessment to our modelling tool over the plan period (2011-2031) to forecast future hospital bed requirements based on the expected age profile of the population and 2011/12 admission rates and length of stay.
The results of these three projections are as follows;
Table 1 Summary of Projections 2011-2031
Table here

The implication of the three projections on acute capacity requirements over the plan period ranges from an additional 70 to 113 hospital beds.
Infrastructure Proposals
As a result of our modelling, we have considered our infrastructure requirements to deliver Acute and Community health services to match the health needs of the population growth associated with the three projections. Assuming we are able to accommodate 23 beds in a ward, we will require an additional 3 to 5 wards. Current Health Building Note (HBN) regulations require a 1395 m2 footprint per ward and current HBN compliant build costs, as detailed in the 2010 Healthcare Premises Cost Guides are in the region of £3,820,00 per ward.
We have also considered our infrastructure requirements if the new pathways and services we are developing in our Community Services successfully mitigate some of the impact of population growth on hospital beds. Based on Healthcare Premises Best Practice Guidance, we will require assessment, treatment and therapy rooms, office accommodation and storage equivalent to 1327 m2 for each ward we do not need to build.