The decision by the NEW Devon Clinical Commissioning Group (CCG) to close in-patient beds in Seaton Hospital is ever more deeply flawed the more closely you look at it. The ultimate answer may be for Seaton Town Council, Seaton Hospital League of Friends and the Seaton GP practices to launch proceedings for Judicial Review of the decision.
As a first step, Devon County Council’s Health and Wellbeing Scrutiny Committee should refer the decision back this Tuesday on the grounds that the reasons advanced do not stand up to examination. (I emphasise that the purpose here is not to force the removal of Sidmouth’s beds which are needed too, but to save Seaton from a completely unfair decision.)
At the same time, Chairman Dr Tim Burke and his colleagues from the CCG must come and explain the CCG’s decision to a public meeting in Seaton. We need to make them account to the people whom this decision will affect.
A flawed case
The CCG has published its ‘business case‘ for the decision (not ‘service case’ – the terminology is very revealing). One of the few comments quoted (from hundreds received) is this on p. 22: ‘Sidmouth is a better location for community beds than Seaton because it a) is a public transport hub for the surrounding towns and villages and so more accessible for carers/families, b) has a larger population and c) has a larger proportion of frail and elderly than Seaton.‘
This is very misleading as I show below, but its logic then enters the CCG’s own reasoning on p. 35, section 6.3, ‘Duty to reduce inequalities’ which contains the key arguments for their preference for Sidmouth. I quote what they say with my comments in italics:
- ‘Sidmouth is a better location for community beds than Seaton because it a) is a public transport hub for the surrounding towns and villages and so more accessible for carers/families.’ Seaton is also a public transport hub for surrounding areas and is much more accessible for the eastern part of East Devon, especially the Axe Valley, than Sidmouth. People travelling to Sidmouth from Axminster by public transport face a 2-hour bus journey, with a change, and the last return bus is at 4 pm. Therefore the CCG ignored important relevant data.
- ‘In the light of the process not strongly confirming a single option, the CCG following review decided to consider additional evidence in relation to the CCG duty to reduce inequalities.’ – The premise is simply false. Of those expressing a preference for one of the CCG’s 4 options, the majority opted for Option A including Seaton, which received twice the support of Option B including Sidmouth. The CCG has simply ignored the results of the consultation and on these grounds alone the decision should be reviewed. The majority of those who did not support one of the CCG’s 4 options supported retaining all the hospital beds; therefore a majority of all respondents supported retaining those in Seaton. The CCG has ignored this outcome of the consultation.
- ‘The purpose was to identify any further, more detailed differentiating factors between the two closely scored preferential options and also to test the same evidence against the other two of the top four options. This included taking into account the views of hard to reach groups in the consultation; and interrogating the JSNA data to identify indicators linked to deprivation and inequalities in relation to Sidmouth and Seaton.
- ‘Hard to reach focus groups noted that it was important to achieve a good geographical spread of inpatient units across the area.’ – However the CCG has ignored this by concentrating all inpatient beds in the western part of East Devon (Exmouth and Sidmouth) and none in the eastern part (Seaton: Axminster’s beds having already been removed). By excluding Seaton, the CCG is failing in its duty to provide good spread of inpatient units across the area. This is a clear reason for review.
- ‘The JSNA has been reviewed based on inequalities and taking into account critical mass and population need with Sidmouth being more populous than Seaton.’ – It is true that Sidmouth, taken on its own, is somewhat larger, but the assertion is misleading because the Axe Valley including Axminster as well as Seaton has a larger population than Sidmouth. The failure to acknowledge this larger catchment area of Seaton Hospital in these comparisons is another failure which requires review of this decision.
- ‘Whilst Seaton and Sidmouth are more comparable in deprivation terms, there is an older population profile and larger population in Sidmouth.’ – There are pockets of socio-economic deprivation in both towns but neither figures in Devon County Council’s overall survey of deprivation. However the more detailed Joint Strategic Needs Assessments to which the CCG refers show that on some key issues (e.g. life expectancy and educational attainment) Seaton is significantly worse off than Sidmouth. The data show that Sidmouth is more affluent and less deprived than Seaton, as anyone who knows the two towns could have told the CCG. The CCG’s failure to recognise this is another reason for requesting review.
- The statement that Sidmouth has an older population profile is simply false. DCC data from 2016 shows in both towns 7% of the population is over 85, while in Seaton 33% and in Sidmouth 32% are between 65 and 85. Therefore Seaton’s and Sidmouth’s profiles are so nearly identical that this should not have been given as a reason for preferring Sidmouth, and the fact that it has been is another clear reason to justify review of the decision. (The towns have the oldest and second oldest profiles, respectively, in the whole of Devon, and therefore both should keep their beds). DCC do say that Sidmouth Town ward is the ‘oldest ward’ in Devon, but this ward is only one-third of the Sidmouth area.