• My response to Eastern Devon community hospital bed closures consultation

    6th January 2017 | News | Claire
  • Proposal to cut the remaining community hospital beds in Eastern Devon

    Consultation response

    Claire Wright
    Devon County Councillor
    Ottery St Mary Rural Ward

    1. Overview
    My view is that it is wrong and short-sighted to cut the remainder of community hospital beds in Eastern Devon down to 72. 

    I don’t believe that the there is evidence to support the move as being positive or safe for patients, nor do I believe that it will save money.  It is more likely to shift the pressure from the NHS to Devon County Council’s adult social care department, which is already under significant pressure, with a £5m overspend.

    2. History
    As recently as 2012 there were 244 community hospital beds across Eastern Devon, including at Okehampton, Moretonhampstead, Crediton, Tiverton and Exeter.  Year after year they have been steadily cut. We currently have 143 beds in the area – and now they are proposed to reduce to 72.

    In 2013 virtually all Devon County Council owned care homes closed due to austerity measures.  The remaining privately owned care homes struggle to accommodate the number of people they need to for intermediate (step down) care and there are significant problems in recruitment and retention of paid carers.

    Nationally, we are told that social care is at a ‘tipping point’ with chronic underfunding and major government cuts each year .

    The CCG consultation document plays down any of these social care difficulties. I don’t believe there is evidence to show that without the required intermediate (step down) care available, most people can be effectively cared for in their own homes.

    3. Increased number of delayed discharges
    We have seen a considerable rise in delayed discharges at the RD&E during this time period, with many and repeated durations of black and red alert.  On any given day we are informed that there are around 80 people waiting to leave hospital but cannot due to problems with arranging safe discharge and care packages.  It seems likely to me that the historic closures of community hospital beds and care homes are linked with the increased pressure in discharging people from the RD&E hospital.

    4. Bed ratio
    We are repeatedly told that East Devon has more beds than anywhere else in Devon.  But this is because other parts of Devon have already experienced bed closures.

    In fact, according to the Community Hospitals Association, the proposals for bed cuts in Eastern Devon will reduce the bed ratio to 1.85 per 10k population, which will be the lowest in the county.  I don’t believe that this is safe for patients.  Nor have I seen convincing evidence that the answer to delayed discharges is to cut more beds.  Rather, it is counter intuitive.

    5. Misleading information
    During the consultation phase we have been given misleading information by the CCG including:

    1. An official video broadcast at events such as Devon County Council’s Health Scrutiny Committee, resident consultations and via social media. This video purports to depict the new ‘model of care’ for Eastern Devon but in fact interviews a couple who have experienced Exmouth and Budleigh Salterton’s Hospital At Home scheme, which costs almost £1m a year and is consultant- led. This is very different from what is proposed in this consultation.

    2. In the agenda papers of September 2016’s health scrutiny committee a report from NEW Devon CCG stated that one third of community hospital beds in Eastern Devon were empty.  When I queried this I was told it came from the Public Health Acuity Audit 2015. Yet the Public Health Acuity Audit 2015 clearly states that bed occupancy rates in Eastern Devon are at around 90 per cent and at around 85 per cent across the county. 90 per cent is HIGHER than national guidance recommends for the efficient running of a community hospital.

    3. When this message was dropped it changed to ‘one third of bed space’ being empty. This seems a rather random statistic, not recorded in any documentation I have read, unable to be independently checked – and not in any way persuasive in terms of making a case for more bed cuts.

    These misleading communications do not inspire confidence or trust in the proposals.

    6. Staff shortages
    Dr Tim Burke, who attended a meeting at Ottery St Mary Kings School in November, revealed that there would need to be around double the current number of NHS staff for the new model of care to work.

    Firstly, this raises major questions over the claims of money that is claimed to be saved and secondly, it raises practical issues over where and how staff will be recruited, given the current shortage in just about every health service professional discipline.  We are repeatedly told that community hospitals are difficult to staff so it is surely overly optimistic to be proposing a new system that requires double the number of staff.

    7. Process and effective exclusion of Okehampton and Honiton Hospitals from consultation
    I don’t believe the consultation is fair to the communities targeted.  It clearly seeks to pit one against the other in my view to detract attention from the real issue, which is a loss of beds across the area, and this causes upset and arguments between towns.  While this is a personal view, I know it is shared by many people in communities across Eastern Devon.

    I also don’t believe that there is evidence to justify the blanket removal of Okehampton and Honiton Hospital’s beds. In fact, the CCG’s appraisal states that the options of Seaton and Honiton or Sidmouth and Honiton score as neutral – no negative impact … so why have Honiton and Okehampton been singled out and why have those communities effectively been frozen out of the consultation?

    8. Inaccurate postcodes
    The Community Hospitals Association (CHA) has revealed that inaccurate postcodes were used in the options appraisal for six community hospitals. This is a fundamental error which, if the plans go through as proposed will have significant consequences. I agree with the CHA that this in itself may have discredited the entire process.  Please see the CHA response for more detail on this.

    9. Independent reconfiguration panel (IRP) advice
    In the advice that was given by the IRP following the Torrington Hospital scrutiny referral it stated:  “A key lesson from Torrington is to be clear and specific about which patients will likely continue to need inpatient care and how their needs will be met in the future. “

    I have not seen any explanation or documentation stating which group of patients are likely to still need inpatient care.

    The IRP also stated in its letter:  “It is necessary to be up-front about the realities and trade-offs of service change.”

    During the consultation in 2015 that resulted in the closure of inpatient beds at Ottery St Mary Hospital we were told that Ottery Hospital would become a ‘health hub’ with a range of services. However, we have seen dwindling communications about this and the message seems to have changed from ‘Ottery Hospital will become a health hub’ to ‘Ottery Hospital could become a health hub’ – a subtle but fundamental change that may have something to do with NHS Property Services taking over ownership of our community hospitals and charging high rents to CCG.

    10. Community hospitals and community ownership
    I have seen CCG documentation that hints at community hospital building sell-offs in Eastern Devon.  If there are plans to sell any community hospital buildings the CCG needs to be open and honest about this with local people.

    Community hospitals mean a lot to local people, many who have worked hard to fundraise for equipment or volunteer through leagues of friends – and in some cases helped with funding new builds in the 1990s.  There is little or no mention of this in the consultation document, yet it needs recognition and NHS teams to work positively with MPs and communities on ways to retain community hospitals, despite the threat from NHS Property Services.

    11. Care of the dying
    The Hospiscare submission highlights the lack of attention paid to palliative care in the consultation document and urges the CCG to explicitly address care of the dying. 

    In 2013 almost 4000 people died in the East Devon locality and states that 75 per cent of patients would benefit from palliative care.  Another study estimates that between 69 per cent and 82 per cent of all those who die need palliative care support.

    Hospiscare refer to the ‘fragility’ of social care and that they are experiencing regular breakdowns in care packages in the community which often result in a patient being admitted to acute care or to the hospice, unnecessarily. 

    Worryingly, Hospiscare’s response reveals that during 2015 managers reported 58 incidents to the CCG where the breakdown of social care packages for people at end of life had caused distress. All of these people wanted to be cared for at home.

    Adequate social care is fundamental to the safe and appropriate working of your new model.  But social care is currently far from adequate and there is no expectation of improvement in the near or distant future of improvement, as yet more funds are stripped away from councils by the government.

    12. Evidence
    There is an assumption that closing community hospital beds will save money, yet on page 3 of the public health acuity audit 2015 it states: “Caring for a patient in an acute care setting is either more expensive than, or at least as expensive as, caring for a patient in alternative setting, including at home.” 

    I have raised this at the November health scrutiny committee with the CCG representatives and was promised a response, however, none has been made available.

    There appears to be a bias in the consultation document in evidence to support the case to close beds.  This evidence is notably limited, however, and my understanding is that where the care at home model has worked it is in places where there has been adequate adult social care and step down care.  This isn’t the case in Devon.

    In some places in the country such as Surrey and East Sussex they are actually INCREASING their community bed provision as a positive way of addressing their need for local community capacity.  This is outlined in their STP.

    13. The impact of previous community hospital bed closures
    It would be very helpful to see evaluations of the impact of closing beds at Axminster, Ottery St Mary and Crediton.

    We are led to believe that this hasn’t had too much of an impact, however, there has been to my knowledge no formal study. I believe that this is vital before further bed closures are made.

    Equally there is no baseline assessment included, which means it is difficult for residents to assess fully how the current situation will compare to the proposed model of care.

    14. Independent assessment of consultation responses
    I trust that the CCG will follow best practice and ensure that the consultation responses are independently assessed.

    I agree with the Community Hospitals Association that the six strategic principles as set out by the consultation document, are best served by retaining the remaining hospital beds.  I don’t believe that the CCG values community hospital beds as they should, rather beds are being regarded as an easy target to cut costs, which I don’t believe will happen.  I also agree with the CHA (and many other people across Eastern Devon) that now is the time to increase community hospital bed provision, not reduce it.

    I object to all bed closures as proposed.