Update on Knighton Community Hospital from Carol Shillabeer

I am providing this briefing as I understand that questions have been flagged regarding the role of the hospital in Knighton and in particular the inpatient ward. I hope you find the information in this bulletin helpful in setting out the work under way, as well as some of the challenges we continue to face. I hope, too, that it will provide an opportunity for us to work together to address those challenges.

Powys Teaching Health Board remains fully committed to the provision of high quality services for the people of Knighton and east Radnorshire. As a very rural area – and on the national border between England and Wales - there are clearly both challenges and opportunities for local people in accessing services, and for the NHS in providing those services.  Right now, a particular challenge shared by the NHS and the local community is how we work together to re-open the ward at the hospital.

First of all, I want to stress that I do recognise the local concern there is about services provided by the NHS. The whole of the health service across the UK has had to change dramatically to cope with the pandemic. It has been an extraordinary year in which healthcare staff and patients alike have needed to adapt to a different service. As you may know, back in March 2020, the health board, as with every other NHS organisation in the UK, had to rapidly develop respond to a new public health emergency. At that time, none of us could know the scale and extent of the pandemic or how long it would last. It was therefore absolutely vital that here in Powys we put in place plans that could be sustained over at least 6 months or potentially longer.

These plans included the decision to amalgamate the inpatient beds of Knighton and Llandrindod Wells Hospitals on a temporary basis. This was very carefully considered and - knowing now what has happened during the pandemic – it was the right decision in order to sustain the maximum number of community hospital beds for the people of Mid Powys. This was particularly important given the numbers of staff vacancies that already existed, as well as recognising the significant level of staff absence that was likely to occur either through shielding or through sickness. Powys was clearly not alone. Similar decisions were needed by healthcare organisations right across the UK.

Importantly, the rest of the services provided in the local community were maintained – although the way we access these has been very different due to vital measures to prevent the spread of infection and maintain social distancing. Our teams have adapted to provide services via telephone and digital channels, and to provide safe face-to-face services based on clinical need. We also acted to enhance community, home based care services - and I explain a little more on that later in this bulletin.

I am pleased to say that we have been able to make the best of the ward whilst it has not been open during this time: you may be aware that redecoration and significant maintenance was carried out in preparation for reopening the ward. Also, I was delighted to hear that the ward area has been used as a place for relatives to visit their loved ones who reside at Cottage View. This is especially important as we know that Cottage View is small and visiting is unlikely to have been able to take place if the ward area had not been available, which would I am sure have had a negative impact on residents and families alike.

Recently, the ward was used as a vaccination centre for people registered with the Presteigne Medical Practice. Rooms on the ward have also been used for additional clinic spaces to provide services locally. I hope this provides reassurance that, even during these challenging times, every effort has been made to enable the best use of the facility for the benefit of local people.

In terms of the ward itself, we established a project team who worked to re-open Knighton by the end of December. I believe it is well known that very difficult recruitment issues exist in the NHS. Unfortunately, Radnorshire as whole is a challenging area for recruitment for nursing and therapy staff.  This has affected the Knighton inpatient ward for some time, with the ward rotas extremely difficult to maintain even prior to the pandemic.  Recruitment efforts to re-open the ward in December were sadly unsuccessful. The availability of bank and agency staff to complement our permanent staff was also significantly affected both by the second wave of COVID and also by the efforts across the country to begin biggest vaccination programme the country has ever seen.

Due to the rurality of Knighton and its surrounding area new staff are likely to need to come from a wide catchment including outside Powys. This does of course mean that we are competing for NHS staff with other services such as the District General Hospitals in Hereford as well as Shrewsbury. These clearly are also vital for the people of East Radnorshire.

Given that so many vacancies remained, it was not possible to re-establish the ward in December. And, with the benefit of hindsight based on our experiences of the second wave of COVID during the winter, it was absolutely the right decision to maintain the amalgamated ward at Llandrindod Wells Hospital during this time.

One of the actions that was taken in preparing for the pandemic was to ensure we have more community based services available, with a focus on supporting people at home. At the start of the pandemic we knew there was a possibility of hospital services being overwhelmed. So, making sure we could help people stay at home and provide care more directly to them was essential. We put in place enhanced services for those who needed extra care and support. A Discharge to Recover and Assess Service has meant that many people admitted to District General Hospitals have been offered and taken up this enhanced care and therapy service, which has meant that people have been able to return home without needing further community hospital stay. This was made possible by having additional therapists based in the community being able to provide tailored care at home.

As well as our own services, and those provided by the Council and third sector partners, I am also keenly aware of the tremendous community effort by people in the district to look out for their neighbours during this time. Thank you to everyone for all you have done to keep East Radnorshire safe.

In terms of the pandemic and the ongoing public health emergency, we are now turning our focus to ensuring that our highly successful vaccination programme can be completed. In addition, we know there is a risk of a third wave of the pandemic including the threat of new variants of coronavirus. We must remain ready for all this may bring, which includes providing a comprehensive Testing and Tracing Service.

Importantly there is a lot of work to do to catch-up on the backlog of care that has been disrupted by the pandemic. Waiting lists have risen significantly, and it may take several years for this recovery to be completed.

As we work on all of these matters, we continue our working to re-open the ward at Knighton. I feel I must be honest with you and indicate my continuing concern about the chances of successful recruitment for the ward. We know that we had significant difficulties previously and we know that the demand and opportunities for healthcare staff are now even higher given the pandemic and the other challenges mentioned above. Nonetheless, I give our commitment to do our very best in seeking to recruit and we would very much value the support of the local community in this effort.

Having a highly attractive offer is key given staff have multiple choices of where to work. In my long experience in the NHS, ‘Save our Hospital’ campaigns can make it harder to attract staff to come and work in the area. So, I hope we can capture the clear local energy to work together to promote Knighton as a great place to live and work.

In terms of the work currently under way, the project team is actively working on plans to reopen the inpatient ward. A meeting was held this week with staff from the Knighton Hospital to discuss the current position and to generate further thoughts and ideas on how best to attract people to the area.  This will take time, as the number of Registered Nurse Vacancies is currently the highest in Powys. The ward needs approximately 13 whole time equivalent (wte) registered nurses for the rotas to be filled, and currently there are over 8.5wte vacancies. The second highest vacancy rate is Llandrindod Wells inpatient ward, which emphasises the recruitment challenges we face in Radnorshire. Recruitment adverts have been permanently running for the Knighton inpatient ward and further local advertising is being planned, as well as continue to encourage staff to use their own connections to attract new nurses to the team. Whilst the recruitment continues, the project team has scoped ways for the existing staff and also staff who join the team to continue to work in and for the Knighton Community. This does provide a real opportunity for building on the enhanced care services put in place during the pandemic.

I hope this bulletin provides reassurance of our commitment to the provision of high, quality services to the people of Knighton and district, and that we continue to take steps to re-open the ward. I also recognise that local people may be concerned about future care provision and I would therefore welcome the opportunity to keep in touch with local community leaders and discuss together both the challenges but also the opportunities for care provision locally.

Thank you,

Carol Shillabeer, Chief Executive