NEW Devon CCG
As expected, Seaton Town Council unanimously decided last night to seek legal advice over the CCG’s decision to remove Seaton Hospital’s beds. Over 30 residents turned out to support the move and ask questions of the councillors.
In an extraordinarily generous gesture, Otter Nurseries have told Save Hospital Services – Honiton that they will give £10,000 towards the costs of a Judicial Review of the NEW Devon Clinical Commissioning Group’s decision to close the in-patient beds in Honiton Hospital. What an example for local campaigners in Seaton! If a lot of local businesses and individuals give a fraction of this amount, we can raise the funds to overturn the Seaton closures, too.
In a shock development, East Devon Conservatives have issued a statement which has appeared on Councillor Ian Hall’s Facebook page. They have already given up the fight against the removal of beds from Seaton, Honiton and Okehampton which the CCG has decided.
Independent County Councillor, Claire Wright (Ottery), writes of today’s Devon County Council health scrutiny meeting:
A decision to halve the remaining hospital beds in Eastern Devon will be referred to the Secretary of State for Health, unless a raft of assurances are provided.
A review of all community hospital bed closures across Devon since 2014, will also take place, including examining the role of social care.
I made the proposal at Devon County Council’s health and wellbeing scrutiny committee this afternoon and it was voted through by seven votes to five.
Last week, Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) made a decision to close 71 beds at Whipton, Okehampton, Honiton and Seaton Hospitals, retaining beds at Exmouth, Tiverton and Sidmouth.
Their proposal had previously been to retain beds at Seaton and close beds at Sidmouth, but the CCG’s governing body decided to shut beds at Seaton instead of Sidmouth for demographic reasons.
Following today’s health and wellbeing scrutiny committee meeting 14 assurances will now need to be provided by the CCG on its decision within 28 days, which the committee will examine in its new form after the elections on 4 May.
If the assurances are insufficient or inadequate, the decision to close 72 beds will be referred to the Secretary of State for Health.
From my own personal perspective it seemed to me that the four members of the CCG – Laura Nicholas – Director of Strategy, Rob Sainsbury – chief operating officer, Janet Fitzgerald – chief officer, and Dr Simon Kerr – GP from Ottery St Mary, who attended today were trying to convince the committee that the care at home system was going to work, but it was clear that they themselves had doubts.
At one point Laura Nicholas said: “We are very cautiously optimistic that the new model of care can be implemented.”
I asked the following questions:
– How much money will be saved? Answer: Between £2 and £5m
– How many more staff will you need? Answer: This will be variable and it depends. We are working these issues through (I had previously been told by the CCG chair, Tim Burke, that there may be around double the number of staff required for the new care at home scheme)
– How many objections were there out of the more than 2000 consultation responses received?
Answer: Cannot say. I then asked about an approximate percentage, but this couldn’t be given either.
– When are you going to implement the bed cuts? Answer: We don’t know yet. When we are confident that the new model of care is ready
– Sir Simon Stevens announcement last week about NHS England ensuring that health trusts must demonstrate that sufficient alternative provision is there before any future bed cuts are made. Are you confident that if this guidance was in place now you would be able to meet it? Answer: We will ensure the new model of care is ready before any bed cuts are made.
But… the decision to close the beds has already been made!
Chairman, Richard Westlake asked about the future of hospitals that would have their beds removed. But was told there was no hospital buildings identified for closure. It was that the beds were being removed.
Yet in the CCG papers I read last autumn it made it very clear that some hospital buildings would be deemed surplus to requirements and be sold.
Of course NHS Property Services now owns all community hospital buildings in the Eastern Devon area and is already charging its hefty commercial rents ……
We heard from three members of the public including Paul Hayward, Mayor of Axminster, who is concerned about the decision to close beds at Seaton, which will affect Axminster residents, who lost their beds at the same time as Ottery’s in 2015.
We also heard from Cllr Jack Rowland from Seaton Town Council who argued similar points to Paul Hayward and Philip Wearne, a north Devon hospital services campaigner.
Cllr Hayward had carried out some research and found that Devon County Council’s own statistics on demographics were at odds with those published by NEW Devon CCG last week to justify keeping Sidmouth’s beds open instead of Seaton’s.
He and Cllr Rowland also expressed concerns about travel distances to the nearest community hospital.
And to complicate matters, Northern Devon Healthcare Trust has just announced temporary closure of all Holsworthy Hospital’s beds due to staffing shortages and apparent low bed occupancy levels.
The difficulty is that during the consultation the CCG had advised that people from the Okehampton area would be referred to Holsworthy Hospital for inpatient care. Something that they cannot now deliver on.
Cllr Barry Parsons made a compelling case for why this decision was quite wrong and how upset the people of Holsworthy are.
Cllr Kevin Ball from Okehampton expressed his dissatisfaction with the consultation process which he viewed as unfair and how the loss of Holsworthy Hospital’s beds will negatively affect any alternative provision in Okehampton.
The CCG said they would do further work in Okehampton on this.
Caroline Chugg proposed that the committee should recommend no bed closures should take place until there was sufficient alternative provision in place.
Finally, the CCG’s own health scrutiny paperwork admitted that this following damning staff response was a theme (p71): – http://democracy.devon.gov.uk/ieListDocuments.aspx?CId=130&MId=1981&Ver=4
“The potential financial savings of the proposed changes have not been clearly established and the actual costs of replacing hospital based care with community based care are not even estimated. The existing hospital nursing staff have not been consulted on their willingness to transfer to a very different pattern of working. Many of them are very concerned about the professional vulnerability that this presents and, at a time when there are many vacancies both in the NHS and through agencies, they are not likely to simply accept a situation that they do not see as professionally or personally secure.
“ Assurance was given that no hospital beds will be closed before the staff are in place for Care at Home. But assurance also needs to be given to local hospitals now, potentially blighted, to stay open, or staff will walk.”
Managers say that bed closures will affect only 20 patients a week, but this is over 1000 patients a year plus their visitors who may need to travel further to visit.
I have to say that I cannot fully blame NEW Devon CCG for this hopelessly rushed and poorly thought out decision. They are under the cosh of the government’s Success Regime as one of three most financially challenged health areas in the country.
The Success Regime exists as a hatchet programme of cuts because of the projected NEW Devon CCG deficit of £384m by 2020/21.
My understanding is that this deficit is largely caused by a growing elderly population in Devon with complex health needs, combined with a reduction in the annual growth funding from government, which has dropped from around six per cent to around 1 per cent in the past seven years.
My proposal was put to the vote and was immediately objected to by Cllr Jerry Brook, who claimed it was ‘pre-determined’ because I had typed it out and given it to officers beforehand.
He was reminded by the chairman that this was common practice.
The votes were seven votes to five in favour. Voting in favour (I believe) were: Me, Caroline Chugg, Andy Boyd, Emma Morse, Brian Greenslade, Robin Julian and George Gribble.
Voting against (I believe) were: Jerry Brook, Paul Diviani, Chris Clarence, Debo Sellis and Rufus Gilbert.
The issue will be pursued again after the elections on 4 May.
Here is the motion (it was altered in committee so may appear slightly differently in the minutes but this is the essence):
1) Objects to the decision by NEW Devon CCG to reduce the number of community hospital beds in Eastern Devon from 143 to 72
2) Resolves to refer the decision to the Secretary of State for Health on the following grounds if adequate assurances are not given on the points below:
a) It is not in the in the interests of the health service in the area
b) The consultation is flawed
3) Agrees to conduct a review of community hospital bed closures made across Devon since 2014 to establish the effectiveness of the replacement home care, including examining the role of social care
Notes relating to 2 above:
– That no beds are closed before there is sufficient alternative provision
– There is no clear explanation of what care at home will look like or work and this model has frequently been mixed up with Hospital at Home which is entirely different
– There may not be adequate care available in people’s homes, given the staffing shortages in the NHS, and the significant difficulties in adult social care
– That Hospiscare reported in its consultation response to the bed closure proposals 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 had wanted to be cared for at home
– There are no clear answers on how many more staff are required to make the new model of care work. And that there are shortages in many health professional disciplines
– Despite a significant budget deficit, there is no clear financial saving to be made. In fact once the new model of care is in place the savings may be extremely small
– That there is no clear plan on the future of hospital buildings that have lost their beds and are now in the ownership of NHS Property Services
– The new government direction that will come into effect next month which mean health trusts will need to prove that there is sufficient alternative provision before any beds close
– Okehampton and Honiton Hospitals were excluded from the consultation process
– The temporary closure of Holsworthy Hospital beds which is where Okehampton patients were to be referred
– The ongoing and significant pressure on the RD&E hospital beds and difficulty with discharge
– Doubt over the soundness of the data relating to the decision retain Sidmouth Hospital’s beds over Seaton’s
– Staff appear to be opposed to the plans
– Closure of many care homes
The link to the webcast is here – https://devoncc.public-i.tv/core/portal/webcast_interactive/268434
Additional info: all 5 councillors against the motion were Conservatives; those for included one each from Independents, Lib Dems, Labour and UKIP, plus 3 Tories. MS
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.
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?
At Devon County Council, Claire Wright (Ind.) proposed that the CCG consultation be suspended while the CCG included both Honiton and Okehampton in the options to retain beds. Conservative councillors voted it down and her resolution was lost 5-7.
Reblogged from the site of Claire Wright, indefatiguable independent councillor fighting non-stop on health service cuts.
NOTE: EDDC Tory Leader Paul Diviani sabotaged her effort to “stop the clock” on cuts to re-examine the effects of closing Honiton and Okehampton hospitals.
REPORT FROM CLAIRE WRIGHT, DCC HEALTH SCRUTINY COMMITTEE
“• CCG does not know how many more staff it needs
• No answer (yet) to public health stated assumption that care at home costs the same as care in big hospitals
My proposal at yesterday’s health and wellbeing scrutiny committee meeting to suspend the consultation which proposes to halve the remaining community hospital beds in Eastern Devon, fell by two votes.
There was a packed public gallery. Several members of the public, including Di Fuller, chair of Sidmouth’s patient and public involvement group and Cathy Gardner, EDDC Independent councillor for Sidmouth spoke powerfully, expressing deep concerns about the bed losses.
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