The recommendation, which was debated on Thursday (22 November) was part of a set of measures set out in a scrutiny spotlight review aimed at supporting the care at home service (or rapid response) to be more effective.
Highlighted in particular as a challenging area were services for end of life care, which have been put under considerable pressure, especially since the loss of community hospital beds.
I chaired the spotlight review, which took place this summer and published its findings last week in a report that can be found here – https://democracy.devon.gov.uk/mgConvert2PDF.aspx?ID=22439
Also struck out by conservative councillors was a proposal to review all intermediate care provision (bed based care for people are not yet well enough to return home after hospital) with a view to reopening some community hospital beds on a flexible basis.
Over 200 Devon community beds have been cut in the past five years and the facility known as rapid response, which provides care at home, was supposed to have been beefed up to cope with the extra demand.
Unfortunately, this does not appear to have worked due to a lack of staff, particularly in the Exeter and East Devon area.
The local NHS and Devon County Council have (and are still) advertising extensively but still many vacancies remain.
Some GPs, particularly those in East Devon, have outlined problems with availability of paid carers (see appendix to the main report), and stated that they have lost confidence in the system and are instead admitting patients to hospital, because it takes so long to arrange care, or because care is simply unavailable.
Rapid response was established to avoid hospital admissions where possible and instead care for people in their own homes.
Care of dying patients, very sadly, appears to be the worst hit, with a director from Hospiscare confirming that care from rapid response is too often not available.
Ann Rhys, assistant director of care with Hospiscare, told councillors that in a three month period over the summer, 40 end of life patients were unable to access rapid response.
In one month during the summer one East Devon Hospiscare nurse alone reported eight instances where no care was available.
Hospiscare has seen a “large increase” of patients dying in their in-patient unit in the past 12 months, as a result.
The community hospital beds recommendation proposed to be deleted by Exmouth councillor, Richard Scott was seconded by Cllr Paul Crabbe, who described the proposal for no further bed cuts as “nonsense.”
Cllr Scott claimed there was no evidence for the proposal and replaced it with what I can only describe as a rather meaningless collection of words, which I had to ask for clarification on twice.
Voting in favour of deleting the community hospital bed recommendation was one Labour councillor and all the Conservative councillors on the committee, except chair, Cllr Sara Randall Johnson who abstained. A LibDem councillor and I voted against.
The rest of the recommendations, which can be found in full here at the beginning of the report were supported with one or two with minor tweaks – including writing to the chief executive of the NHS and the Health Secretary about a review of wages for paid carers. https://democracy.devon.gov.uk/mgConvert2PDF.aspx?ID=22439
Also, remaining was a recommendation urging the local NHS to review its funding for Hospiscare and other local hospices.
Hospiscare receives £1m from the NHS and must fundraise for the remaining £7m and this is becoming harder as pressures on the service increase.
Before the vote I reminded the committee of the words of the county solicitor who addressed the committee earlier this year on our role on the committee as community representatives.
I said we were on the committee as representatives of local people not mouthpieces of council officers and NHS managers.
The webcast is a little out of kilter and some of it seems to be missing, but if you’d like to watch the debate the link is here starting at item 12 – https://devoncc.public-i.tv/core/portal/webcast_interactive/369535
I have been asked to take down the witness statements as although I had consent from the witnesses concerned I did not publish the statements from the county council or NHS (I did not have consent to publish these).
Pic: Devon County Council’s Health and Adult Care Scrutiny Committee.