Briefing: Community Beds, Care Home Provision, and Hospital at Home in the Bridgend County

Community First – Preventing Hospital Admission and Discharge Home 

- Cwm Taf Morgannwg University Health Board (CTM UHB) and Bridgend County Borough Council (BCBC) provide integrated services with the Community Resource team focusing avoiding hospital admission and supporting discharge and community network teams bringing together 15 different health and social care professions to provide seamless long-term care and support. 

- The aim of these integrated services is to bring the right team to the person to deliver the right care at the right time in the right place. Teams support patients in their own homes in the community. Teams successfully prevent long term care home admissions as well as hospital admissions for the frail and vulnerable, recognising most people experience the best quality of life and outcomes in their own environment, connected to their family, friends and community. 

- There are many teams part of Bridgend integrated service including the acute clinical team, telecare and assistive technology team, mobile response team, care and support at home reablement service, community occupational therapy, integrated network teams and Hospital@Home is part of the integrated team in Bridgend. Together Bridgend integrated services aim to avoid unnecessary admissions to hospital and support timely and effective discharge. 

- The home first approach is supported by international evidence that shows inappropriately admitting frail older people into hospital can lead to a decline in both their physical and cognitive ability. For those over 80, 10 days of bed rest in hospital can cause muscle aging and cognitive decline equivalent to 10 years1 

- When a person is admitted to hospital, there is a clear process to support them for discharge, with the priority always being home first. Welsh Government standards require that this is achieved a maximum of 2 days after they are clinically optimised. Within 24 hours of admission, a patient is put on a discharge pathway known as Discharge to Recover then Assess (D2RA). There are 4 discharge pathways outlined below: 

• 53% of hospital patients in CTM need a supported discharge pathway 1 – 3. The focus is always home first (D2RA Pathway 1) and 55% of patients return home on this pathway across all CTM UHB hospitals. In BCBC, the percentage of patients that go home on this pathway is the highest in region at 61%, demonstrating the success of the integrated operating model 

Community Hospital Bed Provision 

- Whilst the focus is always home first, some patients will need a period of bed-based recovery and assessment because they are not safe in-between care calls or overnight. This is provided by D2RA Pathway 2 and 3 beds. CTM UHB has 270 of these beds located in community hospitals 

- There are 10 D2RA community hospital beds located in Bridgend County Borough council at Angelton Ward 3, Glanrhyd Hospital and 6 Pathway 2 residential reablement beds based at Bryn-Y-Cae Care Home 

- Community hospital beds are available to any CTM UHB patient, which includes our 3 Local Authority areas (Bridgend, Rhondda Cynon Taf and Merthyr Tydfil), as well as out of area patients. Ysbyty Cwm Rhondda, for example, provides dedicated stroke rehabilitation for the whole region 

- Following the re-location of community beds originally based at Maesteg Community Hospital, a reduced number of beds were provided elsewhere in Bridgend and funding was re-invested in the service now known as Hospital@Home, including geriatricians for the Bridgend area supporting patients in their own home 

- On average, there are 33 admissions into community hospitals per week across CTM. Demand for D2RA beds varies across the 3 local authority areas 

- Demand for Pathway 2 beds (step-down/reablement and rehabilitation) across CTM, including Bridgend County Borough, has decreased. A yearly average, the demand for Pathway 2 beds within Bridgend County Borough stands at 3 per week 

- Pathway 2 beds were considered as part of the redevelopment of Maesteg Community Hospital. However, the demand for Pathway 2 beds across Bridgend County Borough is low and a dedicated Pathway 2 only ward is not required, particularly when considering the shift to supporting people in their own homes 

- The greatest demand for community beds is for Pathway 3. A patient requires this type of bed when they need time to recover in a community setting and then have a statutory assessment from a social worker and a nurse and often an Allied Health Professional 

- As Pathway 3 is for patients who are not safe in-between care calls or overnight at home, nor able to engage in rehabilitation or reablement, a large proportion have dementia or a cognitive impairment and data suggests that 68% of patients on Pathway 3 have this type of presentation 

Care Home Provision 

- Bridgend County Borough has a care home market comprising 1,066 registered beds for older adults, representing 335.78 beds per 10,000 population. This is higher than many comparator areas, including Rhondda Cynon Taf 

- Half of placements into Bridgend County care homes are made by Bridgend County Borough Council (BCBC), with a proportion of those placed receiving NHS-funded nursing care. The other 50% are funded by CTM UHB, private or cross-boundary placements, notably from Vale of Glamorgan and Rhondda Cynon Taf County Borough Councils 

- The expansion of Abergarw Manor Care Home in Brynmenyn, Bridgend from 12 to 60 beds, providing specialist Elderly Mentally Infirm (EMI) nursing care, has contributed to increased capacity, but at a higher cost to reflect the specialised needs of patients 

- An ongoing challenge for BCBC and CTM UHB within Bridgend County is ensuring the provision and types of beds across Bridgend County Borough is appropriate to meet patients’ needs, which fluctuates over time. There can also be quality concerns from time to time, which mean that work has been commissioned by BCBC funded by the Integrated Regional Commissioning Fund to support future market management and commissioning plans 

Next Steps 

- BCBC is currently undertaking an analysis to plan its future care home accommodation strategies, and is working closely with CTM UHB 

- CTM UHB is also continuing to develop its community hospital bed provision to meet patient need across the region, recognising not only the shift to at home provision, but also considering how to provide patients with a community bed, when required, as close to their home as possible whilst delivering exemplary care 

- BCBC and CTM UHB also share an understanding that future models must combine bedded (hospital or nursing care home) and home-based care, with long-term investment aimed at creating flexible, joint solutions to deliver high-quality, compassionate, person-centred services that reduce unnecessary stays in hospital and improve patient outcomes. Both organisations are committed to working together to plan and develop the high-quality services needed to meet future needs. 

- These plans will take into account the future demographics across Bridgend County Borough. In 2021, across Wales more than 1 in 5 were aged 65 years and over and since 2011, within Bridgend County there has been an increase of 21.5% in people aged 65 years and over (Bridgend population change, Census 2021 – ONS)

- Predictions of dementia is especially significant when planning future services and we know that dementia prevalence in Bridgend County Borough is rising, with projections indicating that more than 3,000 people will be living with the condition by 2030, nearly doubling the 2011 figure. This is important information when determining future care home and community bed needs 

- Bridgend faces a higher, faster-rising dementia caseload compared to some regional partners. Bridgend also has a high proportion of carers over 50 (estimated 17,000 total, with only 2,100 known to the authority), indicating high-demand for future support services that can also rapidly support carers as well as patients 

- Further information will be shared, as and when available, to ensure we keep our communities updated