Q. Why is this consultation on the role of four cottage hospitals taking place?
Right Care, Right Place engagement began in early 2023 from a position of recognising a desire to see health and social care services provided within communities, as close to home as possible, and a need to continue to evolve services to help meet changing needs. The current consultation on the future roles of four cottage hospitals where inpatient care is currently suspended (Moffat, Thornhill, Kirkcudbright and Newton Stewart) is informed by those perspectives, and extensive engagement and consultation carried out over the past 18 months.
Q. Who is behind this consultation?
Dumfries and Galloway Integration Joint Board (IJB) is the body responsible for making strategic directions over the future of health and social care, and issuing directions to NHS Dumfries and Galloway and Dumfries and Galloway Council. On behalf of the IJB, Dumfries and Galloway Health and Social Care Partnership (DGHSCP) – which includes both NHS Dumfries and Galloway and Dumfries and Galloway Council – is undertaking consultation on six different options for the cottage hospitals in Moffat, Thornhill, Kirkcudbright and Newton Stewart.
Q. What has led up to this consultation?
Extensive community engagement began in February 2023, asking stakeholders to set out what was important to them in terms of health and social care within their communities. This led to the development of a flexible model for bed-based intermediate care which was consulted on over a period of 12 weeks last summer, and agreed by the IJB last September. At the end of 2023 and into 2024, developmental workshop sessions took place with local communities focused on the four cottage hospitals and how they can be used to meet wider health and social care needs in future.
Q. Hasn’t there already been a consultation?
An earlier consultation emerged from the initial Right Care, Right Place work, and took place in the summer of 2023. This included consulting on a definition of the term ‘bed-based intermediate care’, and a proposed new model for this care which would allow beds to be used flexibly – and not all beds in one location reserved for one type of care.
Q. What does bed-based intermediate care mean?
Bed-based intermediate care is the bed-based care provided to someone when they don’t need to be in hospital in an inpatient bed, but they are not able to manage at home either independently or with help. Examples of this type of care include step-up, step-down, respite, palliative and end-of-life care.
Q. Where will these flexible intermediate care beds be provided?
The Integration Joint Board has agreed an approach which will see beds commissioned for a variety of potential uses from the independent sector. Conversations are currently taking place with care home providers around securing beds which can be employed for a variety of intermediate-care needs. Crucially, this will not result in any care home residents losing residential beds. These beds will be commissioned across the region and, in some cases, will allow care to be delivered closer to home than was previously possible.
Q. Who will provide the care necessary for people occupying these flexible intermediate-care beds?
Care will be provided by care home staff alongside in-reach support from Home Team staff based within communities according to individual need. Home Teams are locally-based multidisciplinary teams providing community health and social care. These teams work dynamically, allowing the required staffing to be assembled in order to provide the short-term care required, and will care for people at home, in a flexible bed facility and after their return home again, ensuring continuity of care.
Q. Who will be chosen to occupy these beds?
These flexible beds will be considered for people identified as requiring bed-based intermediate care which cannot be provided at hospital or in home. It is the intention that these beds will allow that care to be provided appropriately within local communities.
Q. What are the options for the four cottage hospitals?
Six options have been developed for the four cottage hospitals where inpatient care is currently suspended. These options emerged out of developmental sessions with stakeholders who had previously participated in the Right Care, Right Place engagement. These options are: the status quo; status quo plus; a Community Health and Social Care Hub; an inpatient facility; community ownership; and closure of the site. Full details are available in the consultation materials provided online and at our consultation events.
Q. Who will make the decision on the cottage hospitals, and when?
The Integration Joint Board (IJB) are responsible for making strategic directions over the future of health and social care, and issuing directions to the NHS and local authority. The IJB will be presented with recommendations emerging from the consultation at their extraordinary meeting on 29 October 2024, in line with the process set out in the national document Planning With People.
Q. What will be considered when the IJB make their decisions?
The IJB will be presented with recommendations resulting from the work which has been undertaken. They will be asked to consider these recommendations, along with the options appraisal which was undertaken by stakeholders in advance of the consultation. They will also be asked to consider all the formal responses to the consultation. They will also be asked to consider a financial appraisal of the options, along with a workforce analysis and professional views. The meeting where the IJB will make their decisions takes place publicly, and the decision-making will be open and transparent.
Q. Are the other cottage hospitals part of the consultation?
The consultation taking place is focused on the future role of the four cottage hospitals where in-patient care was suspended – Moffat, Thornhill, Kirkcudbright and Newton Stewart. No options have been developed or are as yet proposed for the other cottage hospitals in Langholm, Lochmaben, Annan, and Castle Douglas. However, the work of Right Care, Right Place aimed at providing the right care as close to communities as possible will continue beyond the current consultation. Current use of beds for inpatients at Ward 1 in Mountainhall Treatment Centre will be reviewed following the outcomes of the flexible beds commissioning process. Galloway Community Hospital and Dumfries and Galloway Royal Infirmary are acute hospitals, and are not part of any work taking place around Right Care, Right Place.
Q. Are there any other options?
A proposal emerged during the options appraisal process for an approach mixing some in-patient and outpatient services at cottage hospitals. This approach has been articulated within the consultation materials, inviting people to offer a view, while work takes place to explore what might be involved with such an approach, and the resources required. This proposal will be presented to the IJB at their extraordinary meeting in October as part of their considerations.
Q. Has an Impact Assessment been carried out?
Yes. Equality Impact Assessments and Climate and Environmental Impact Assessments have been carried out for all four cottage hospitals. Detailed impact assessments will be completed as part of the reports to the IJB on 29 October. You can read the impact assessments here:
| Equality Impact Assessments | Climate and Environmental Impact Assessments |
| Kirkcudbright | Kirkcudbright |
| Moffat | Moffat |
| Newton Stewart | Newton Stewart |
| Thornhill | Thornhill |
Q. I have a question that is not answered in this document.
Your question may be answered in some of the other documents supporting this consultation. All of these are available online at dghscp.co.uk/rcrp-consultation. If you still can’t find an answer, please get in touch with us by emailing dg.rcrp@nhs.scot or writing to Communications Team, DGRI, A75, Cargenbridge, DG2 8RX, and we will do our best to help.