Devon community hospitals
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.
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.
Health Scrutiny hears there will be no precipitate decisions on community hospitals – local conversations with CCG and RD&E offer chance to shape ‘place-based health systems’ around towns
In my third and final report from yesterday’s Health Scrutiny, I come to the report on the future of the hospitals by NEW Devon CCG and NHS Property Services, in response to the Committee’s request for clarification. (This arose from my presentations at the September and November meetings). While NHS PS stressed that in principle they will eventually have to charge market rents, Claire Wright elicited the useful information that currently NHS England are still paying for the buildings, and the company said they are ‘always happy to work with local communities to consider local services’. Scrutiny’s resolution requested that NHS PS ‘uphold this undertaking’ and keeps the Committee informed on the timeline for changes in the status of the hospitals.
The CCG’s Sonja Manton confirmed that the community conversations the CCG and RD&E are now promoting to develop ‘place-based systems‘ around ‘market towns’ – which have already begun in Honiton and Okehampton – can certainly include the services people want to have delivered locally in the hospitals. While there are cost constraints and not everything which people want will necessarily be delivered, local communities can certainly discuss these services with the NHS organisations, as well as how voluntary organisations can help the NHS and adult social care. Okehampton’s Conservative county councillor, Kevin Ball (below front left, with Non-Aligned Group leader Frank Biederman behind), stressed the progress his community had made in the recent meeting in the town. He and Okehampton’s mayor, Jan Goffey, mentioned that FORCE Chemotherapy will soon be opening a service in the hospital.
In my speech (1:34:20) I welcomed the new ‘place-based’ focus and stressed the importance for towns like Seaton – which is 45 minutes to an hour from acute hospitals – of using the free space in the community hospital to deliver routine treatments and operations for which people currently have to go to Exeter. I pointed out that constituents complain to me all the time about the stress, strain and cost of repeated travelling, often when unwell, without parking, park-and-ride space or bus services – while Exeter complains of congestion!
I mentioned the request of the RD&E’s Em Wilkinson-Bryce, in Honiton last week, for the community to trust the NHS organisations, and said that a serious conversation about local services – in which the NHS takes on board what people want – would be the best way to create this. We wanted to keep the beds, but now they are gone proper ‘place-based’ strategies for each of our towns offer the prospect of working together with the NHS. Preparations are underway for a meeting similar to ‘Honiton’s Health Matters’ in Seaton in March, and I will give more information as soon as the date is fixed.
I’m making a new proposal to safeguard community stakes in community hospitals, tomorrow at Health Scrutiny
Community hospitals in Devon have always been built and maintained with a high degree of community involvement and support. In many cases, local communities took the initiative to build the hospitals and raised substantial part of the original funding, or even the entire funding of additional wings and facilities, as well as contributing to staff and other running costs, the introduction of new specialist services, etc.
Unlike Private Finance Initiatives undertaken in partnership with private companies, these ‘community finance initiatives’ – which sought no profit from their investments other than the improvement of the facilities and services they enabled – appear not to have secured their interests in the hospitals they helped to build. The Leagues of Friends and others who raised funds for hospitals trusted that their investments would continue to be used for the benefit of place-based health services in their local area.
Since the 2012 Health and Social Care Act, however, the organisation of the NHS has changed and the ownership of NHS buildings is in the process of being transferred to a new company, NHS Property Services, wholly owned by the Secretary of State and charged with managing the NHS estate in line with national priorities. NHS Property Services is enabled to sell off parts of the estate and to charge NHS organisations market rents for their use of NHS buildings.
This change creates dilemmas for local communities which have invested in Devon community hospitals. Clearly Leagues of Friends and other local bodies, including town and parish councils as representatives of communities which have raised large amounts of funding, can be considered ‘stakeholders’ in community hospitals. However these community stakeholders appear not to possess formal rights in the ownership and governance of the hospitals.
The proposal is that the Health and Adult Care Scrutiny undertake an investigation into
1. The changing ownership and governance of community hospitals in Devon and its implications.
2. The historic and ongoing contributions of local communities and Leagues of Friends to funding the hospitals.
The purpose of this investigation would be to address the question of
3. How community stakeholders’ interests should be secured in the future governance of community hospitals.
It is envisaged that in the course of this investigation, the Committee would both collect evidence and invite expressions of views from all stakeholders, including both local community organisations and NHS bodies, including NHS Property Services.
A planning inspector has ruled against Clinton Devon Estates’ attempt to build houses on half of the Budleigh Salterton hospital garden (the hospital is one that has already lost its beds): https://eastdevonwatch.org/2017/09/07/clinton-devon-estates-and-budleigh-hospital-garden-a-pr-nightmare-for-today-and-tomorrow/
The Royal College of Surgeons vice-president, consultant urological surgeon Ian Eardley, says that figures showing continuing over-occupancy of NHS hospital beds in England ‘suggest bed reductions have now gone too far in the absence of sufficient social care or community care alternatives.’
Exactly what we are all saying to NEW Devon CCG! Time to SUSPEND THE CONSULTATION AND GET ON WITH IMPROVING THE COMMUNITY CARE ALTERNATIVES.
The RCS leader added “We are now seeing increasing numbers of frail older patients in hospital because they have nowhere else to go. The lack of additional money in the autumn statement for social care and the NHS is only going to make this even harder.”
Neil Parish MP said he would press for additional resources – what will he do now that his Government has let him down?