Devon STP: there is ‘no rush’ to make decisions on community hospital buildings. What’s more, it hasn’t agreed what a ‘health hub’ is or how many there should be
Speaking for the Devon NHS Sustainability and Transformation Partnership (STP), Dr Sonja Manton told a meeting of county councillors this morning that there was ‘no rush’ to decide the future of community hospital buildings.
Contrary to Dr Simon Kerr’s suggestion in April that decisions would be made in July, Dr Manton was clear that the end of July is a deadline for the Devon Clinical Commissioning Groups (CCGs) to bid for capital funding from NHS England, but not for decisions about the local estate. If these two were previously linked, they are not any more.
She also confirmed what she said to me some months ago, that no decisions will be made about buildings until after the conclusion of the ‘community conversations’ such as Seaton Area Health Matters and Honiton Health Matters, launched earlier this year, and that discussions are still going on about the distribution of local services.
Dr Manton, who was launching the STP’s two-year report, also stated that there was no agreement yet on what a ‘health hub‘ is, or how many of them there should be.
There is no room at all for complacency, however, since the report states:
We know a large amount of space in our community hospital buildings is underused. The revenue cost of our community hospital estates is in the order of £20 million; money the NHS could use to improve other services. Working with other public sector partners, as part of the One Public Estate initiative, we will review the space that is required to deliver care, and plan to consolidate the number of sites to free up estate and generate money, which can be re-invested in technology and infrastructure.
It also appeared from the meeting that midwife-led maternity services are unlikely to be restored in Honiton or Okehampton any time soon. References were made to staffing difficulties and also safety issues in case of difficulties during birth.
Beds, beds, beds – Devon’s NHS couldn’t or wouldn’t give me their overall occupancy figure for the recent winter: but they were forced to buy in more capacity and there were ’12-hour trolley breaches’
Devon NHS’s Sustainability and Transformation Partnership (STP) admitted in a report to Health Scrutiny yesterday that they had been desperately short of beds during the recent winter. They had to buy in extra beds to keep up with more patients staying longer, because of complex conditions. There were ’12-hour trolley breaches’, where patients had to wait more than 12 hours to be seen.
Despite my asking them directly, they did not give a figure for overall occupancy levels, although they did not deny my suggestion that they had been as bad as or worse than the nationally reported level of 95 per cent. (The nationally recommended safe level is 85 per cent.)
Jo Tearle, Deputy Chief Operating Officer for the Devon CCGs, rebutted my suggestion that cutting community beds had contributed to this crisis, saying that these were not the kind of beds they had needed, and that there had been capacity in community hospitals most of the time. However this suggests that there was no capacity some of the time. It is difficult not to believe that extra community beds wouldn’t have given them more leeway.
Meanwhile, Kerry Storey of Devon County Council indicated the strains that the ‘new model of care’ at home had been under. She said that maintaining personal care at home during the winter had been ‘a real challenge’, requiring ‘creativity and innovation’ – you don’t need much imagination to see that it will have been a real crisis time with frail people at home in isolated areas, care workers and nurses struggling to get through the snow, and staff themselves suffering higher levels of illness.
I and others predicted that because of the closure of community beds, there would be severe pressure on beds in a bad winter or a flu epidemic (and actually, this was not overall a bad winter and the snow episodes were late and short; despite higher levels of flu, there was no epidemic this winter).
Shock revelation at Health Scrutiny suggests the ‘new model of care’ is more about switching intermediate care from community hospitals to ‘block bookings’ in private nursing homes – saving costs and freeing up assets. How long will it last?
There was a staggering revelation yesterday at Health Scrutiny from Liz Davenport, Chief Executive of South Devon and Torbay NHS Foundation Trust, that they had made ‘block bookings of intermediate care beds in nursing homes’ when they introduced the ‘new model of care’. South Devon has closed community hospitals in Ashburton, Bovey Tracey, Paignton and Dartmouth and is currently consulting on the closure of Teignmouth – where I spoke at a rally last Saturday.
The ‘new model of care’ is supposed to mean more patients treated in their own homes, and there does seem to have been an increase in the numbers of patients sent straight home from the main hospitals.
But the idea that all patients can be transferred directly from acute hospitals to home is untrue. There is still a need for the stepping-down ‘intermediate care’ traditionally provided by community hospitals – the only difference is that now it’s being provided in private nursing homes instead.
It’s likely to be cheaper to use private homes, because staff don’t get NHS conditions, and crucially it frees up space in the hospitals so that the CCGs can declare buildings ‘surplus to requirements’ and claim the Government’s ‘double your money’ bonus for asset sales. It seems NEW Devon CCG has also made extensive use of nursing home beds, but we don’t yet know if there were ‘block bookings’.
However the private nursing home solution may not last – DCC’s chief social care officer, Tim Golby, reported that nursing homes are finding it difficult to keep the registered nurses they need to operate, and some are considering reversion to residential care homes.
This may be where the South Devon trust’s long term solution comes in – it had already been reported that it is looking to partner with a private company in a potential £100m deal which will include creating community hubs that contain inpatient beds.
The new model of care is also about privatisation.
‘A wake-up call for East Devon … the threat is even more serious than the loss of beds last year’ – my letter in The Paper for Honiton on the fallout from Dr Kerr’s statement that Seaton and Honiton hospitals are ‘at risk’
Seaton & Area Health Matters holds successful second meeting – steering group set up and agreement on Axe Valley approach
On Thursday, the follow-up took place to the inaugural meeting of Seaton & Area Health Matters. After an informative presentation by Richard Anderson, manager of the community team for Seaton, Exmouth and Sidmouth based at Seaton Hospital, the meeting broke into workshops, and when we reconvened agreed on an approach which envisages an Axe Valley health hub centred on Seaton and Axminster hospitals. Axminster is having a similar process of discussions and we will liaise with them down the line. The Seaton steering group will meet shortly – members (I haven’t got the full list) include Cllr Jack Rowland, Dr Mark Welland and myself.
It has been revealed that Dr Simon Kerr, Chair of NEW Devon CCG’s Eastern Locality, told a meeting with representatives of 38 Degrees on 5th April that Seaton and Honiton hospitals were ‘at risk’ in the CCG’s Local Estates Strategy due in July. His remarks were taken down by the 38 Degrees member who produced draft notes of the meeting, and have been confirmed by other participants, but have not yet been confirmed by the CCG.
Although the hospitals both lost their inpatient beds last summer, Seaton Hospital currently hosts over 50 outpatient services (and there are probably at least as many in Honiton). Both are vital community health resources, created with decades of financial and practical support from people all around the Seaton and Honiton areas.
As part of a move to promote ‘place-based care’, the CCG and RD&E are currently taking part in two ‘community health conversations’, Honiton’s Health Matters and Seaton and Area’s Health Matters, which local voluntary groups, town and parish councils etc. are involved in. However if place-based care means anything, it should mean that communities should keep their local hospitals as health hubs, with more rather than fewer services.
Together with Cllr Jack Rowland, who stood down as mayor of Seaton last week but remains the town council’s representative on the Health Matters organising group, have written to Dr Tim Burke, Chair of the CCG, to ask for an unequivocal assurance that the hospitals will remain open.
I am hoping to shortly announce a meeting of the hospital campaign group.