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Photo from the national demonstration for the NHS in London yesterday.
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.
The decision by the CCG to remove in-patient beds from Seaton Hospital is shocking. They have issued a press release with the Orwellian heading, ‘Public consultation influences doctors’ decision on Your Future Care’: many of the CCG governing body are not doctors and their own consultation results showed a huge preference for the option including Seaton.
The only reasons given are that Sidmouth has a larger population and (therefore) more elderly people than Seaton. But everyone knew those facts before this hugely expensive and now disregarded consultation was launched. And since Seaton serves the whole Axe Valley, the population of our catchment area is greater than that of Sidmouth. All the community beds will now be in the west of the district.
Cllr Peter Burrows says Seaton’s beds are ‘gone’ – but this is not the end of the story. No date has been given for implementation. Meanwhile the whole Seaton community must fight this decision. We must demand that Dr Tim Burke, head of the CCG, and his colleagues come and explain their choice to a public meeting in the Town Hall. The Town Council must explore all possible avenues for formal review (discussions are happening about when we will discuss the decision). Together we must make them keep Seaton’s beds.
Go to https://eastdevonwatch.org/2017/02/27/seaton-heights-up-for-auction-at-2-5-3-million-next-month/
The papers for the CCG meeting on Thursday are available online. On a quick reading of the 92 pages of the report on the consultation, it is impossible to say clearly what outcomes they point to. All the report says about how the meeting will approach the decision is: ‘The scheduled date for the Governing Body to make a decision is the 2 March 2017, although a key feature in that meeting will be assessing readiness for such a key decision. The CCG has already confirmed the papers will be published and the decision will be made in public, and communicated to stakeholders afterwards. If it is decided that further work is needed prior to decision, it will be for the Governing Body to confirm the rationale and when the decision will be made.‘
However the summaries of the consultation highlight some things which are hopeful for Seaton, and maybe for the wider aim of keeping more beds in more hospitals than the CCG envisaged:
- The public meeting in Seaton organised by Seaton Town Council, the League of Friends and the GP surgeries was easily the largest event (estimated at 250 people – I thought 300) of the whole consultation.
- The EX12 postcode (Seaton) produced about 400 responses, almost twice the number in any other postcode (and there were about 100 from EX24, Colyton, on top).
- The Seaton option (A) was the most supported of the CCG’s four options.
- However ‘other (write-in) options’, many of which included retaining more beds than CCG envisaged, were even more supported than Option A overall. Almost half of all respondents did not support any of the CCG’s options.
At the very least, we can say that the Seaton community did a good job in creating awareness and promoting responses, with keeping beds in Seaton hospital strongly favoured – and much support for keeping many more beds than the CCG options offered.
- Email firstname.lastname@example.org
- Phone 01392 267 670 or 01392 267 638
Did you even know that East Devon is proposing to be part of a Greater Exeter Strategic Plan (GESP)? This could supersede the Local Plan which the district has so painfully drawn up over recent years, and which is supposed to last to 2031.
Ed Freeman, who is the Service Lead – Planning Strategy and Development Management, writes to EDDC councillors on the consultation for GESP:
“… The consultation paper is attached for you to get an advanced preview and we would welcome your comments by 10th April. Alongside this will be a call for sites to land owners and developers for housing and employment land across the area which can then be considered for allocation to meet the needs of the area for homes and jobs in the future.
So if you are secretly sat on a few acres of land and would like to put it forward for development now is the time to tell us! …”
As East Devon Watch, which broke the story, says, ‘yes, you read that right. Let us know about any secret land holdings you are sitting on. NOT so we can report you to the Monitoring Officer for not listing them on your declarations of interest – but so that we can do our best to help you to get them developed.’
This from the Council which gave us Graham Brown, who had to resign in 2013 because he boasted to the Daily Telegraph that he could get planning agreed for £25,000.