A BID to replace two community hospitals and two care homes with ‘extra-care’ housing has been approved by health and social care chiefs.

Belhaven and Edington Hospitals, in Dunbar and North Berwick respectively, and The Abbey (North Berwick) and Eskgreen (Musselburgh) care homes will be replaced by extra-care housing “or the equivalent alternatives” under plans to bring their ageing facilities into the 21st century.

East Lothian Integration Joint Board (IJB) put its proposals out for public consultation in February after announcing a plan for the “reprovision” of the services.

This week, the board accepted the “model of care principles and strategic direction” to replace the facilities with the development of extra-care housing or equivalent alternatives.

Moves are now under way to appoint a project manager to oversee three teams which will take forward the changes.

A business plan will be drawn up to go before NHS Lothian and East Lothian Council in the coming months.

Peter Murray, IJB chairman, stressed the board’s approval of the plans was only the first step to “kickstart” the way ahead for care in East Lothian.

And he insisted that the new-look facilities would be a “co-production” by health chiefs and residents.

He said: “Local communities have been instrumental in helping us to get this far and we are looking forward to working together closely with local representatives throughout the next phase. We want to come up with local solutions that meet the individual needs of each of the three communities.

“We shall begin the recruitment process for the project manager as soon as possible in the new year and will then look to begin setting up our local project teams as soon as we have appointed to the post.

“I see this as a very exciting time for health and social care in East Lothian and I am delighted that we now have the green light to start taking things forward in terms of preparing business cases.”

It has been estimated that there is potential on these four sites to build up to 200 extra-care housing units, but though some of the locations had historic and archaeological restrictions.

There are currently 93 beds provided across the four facilities.

A separate review of minor injuries provision currently offered at the Edington is being undertaken for the IJB and day treatments are likely to be provided at the new East Lothian Community Hospital, under construction in Haddington.

Among areas of concern raised during the public consultation were whether the new housing would have high enough medical support for end-of-life care and what happened to a tenancy if one person in a couple died.

Extra-care housing is a step up from sheltered housing while still retaining a resident’s independence. Often described as “assisted living” or “very sheltered housing”, it comes in a variety of forms, from blocks of flats to groups of bungalows. In most cases, medical assistance is available 24/7 onsite.

There are different models of extra care around the world and the Dutch Buurtzorg model, which is currently being piloted in Moray, is under consideration. It involves having a team of professionals based locally who are self-managed and structure their roles around the current clients living in the housing.

Some extra care housing also includes a small unit of NHS beds which are available for emergency admissions.

East Lothian MSP Iain Gray said it was important new services continued to meet local needs.

He said: “My long-standing view on any plans to reprovision existing services, such as those at the Edington or Belhaven, has been that the new services must meet the same local needs as those offered at the existing sites.

“Of course, this does not mean provision being exactly the same, and there is undoubtedly a case for modernising and updating the way services are provided.

“However, I do not want more local health and social care services to leave East Lothian.”

Further consultations are expected to take place over the next 12 to 18 months as the project moves forward.

Dr Deborah Ritchie, who chairs North Berwick’s health and wellbeing association, said the group welcomed moves to include the communities in planning the future model. But she warned that services on the Edington site would need to be retained, calling for a new health centre to be created on the land.

She said: “We are very keen to be involved as equal partners in the next stage of planning the new health and social care provision in North Berwick.

“We welcome the opportunity to develop a bold and innovative service for our future health and social care needs.

“We have some priorities for any reprovisioning. First, we must have a new health centre, and second, we must not lose the local NHS provision for respite and end-of-life care. In addition, we must retain our minor injuries clinic.”

Councillor Paul McLennan, ward member for Dunbar and East Linton, said that while he generally supported the move, there remained many unanswered questions.

He said: “The main questions that need to be answered are: will they be involving any other care providers, and what timescale are we looking at? Also, who will be the first site in East Lothian to make the change?

“For this to move forward, they need to heavily involve the community and build trust. Overall, I believe this is the right care model, but there are many details that need to be made clear before any other movement can be made”

However, Councillor Stuart Currie, whose Musselburgh ward includes Eskgreen, said: “The direction of travel of this thinks that extra-care housing will solve all problems, which it won’t.

“What will happen if a couple move in, and one of them dies within a few years, what happens to the person left behind?  “There’s no way that the home would allow someone with no care need to stay, so where would they go?

“Every time this question is asked, they say a panel will look at it, which isn’t a proper answer.”

Mr Murray said all areas were still up for consultation and further discussions would be addressed as the project progressed.

He said: “We are mindful and equally concerned about getting the model right and the areas which need to be looked at as we go forward in more detail.”

The next stage will be drawing up an agreement between the IJB and NHS Lothian over funding before the project manager and teams are in place.

Councillor Fiona O’Donnell, council health and social care spokesperson, said: “Communities have been very generous in giving their time and putting a lot of thought into their contributions.

“One of the things that they were clear about was that they didn’t want to see changes until there were equivalent or better supports in place.  “The IJB is in complete agreement with that and it will inform the work of the local project teams as they work on their business cases.”