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.
‘Absolutely no change to physiotherapy services at Seaton’, I am assured, despite removal of some equipment
Residents have contacted me because some equipment has been moved from the gym, part of the radiotherapy area at Seaton Hospital. I have spoken to Theresa Denning, the Locality Manager based at Axminster who is responsible for physiotherapy, and she assures me that ‘there is absolutely no change to physiotherapy services at Seaton’. She tells me that some under-used equipment has been moved to make room for other equipment to be used by the community rehabilitation team to treat patients who are being brought in from home. Seaton Hospital reception also confirmed that they are continuing to book physiotherapy appointments as and when needed.
NHS Chair: “We are more scared than we have ever been. We have the strong likelihood of hospitals being inundated with people suffering flu.”
The chairman of NHS England, Prof Sir Malcolm Grant, speaking at the national children and adult services conference in Bournemouth yesterday, said: “We face winter better prepared than we have ever been, but more scared than we have ever been. We have the strong likelihood of hospitals being inundated with people suffering flu.”
Still the right moment to have closed our community hospital beds?
Seaton Hospital page updated to show how the community raised £4 million for it over the last 3 decades
Go to https://seatonmatters.org/seaton-hospital/
The new model of care is working, they say, but patients who could have been treated in Seaton Hospital are still bed-blocking in the RD&E
Below is the RD&E’s latest publicity leaflet for the ‘new model of care’ boasting ‘no complaints’ from people who were treated between 28 August and 10 September. On the reverse side it features Doug – is it a coincidence that he is from Seaton? – who has had a knee amputation and is being cared for at home after two weeks on an acute ward. He says, ‘I cannot praise enough the wonderful care and treatment I have received right through from the surgical team to the community healthcare professionals. The skills and attention to detail they have shown is remarkable. It’s been a pleasure having them in my home.’
I am sure that the dedicated professionals working in the new system are doing their best for the patients. But are all the people who would have been transferred to the community hospitals actually getting the treatment at home which they are promised by ‘Your Future Care’? At the same time I received this comment from a Seaton resident: ‘A friend of mine’s husband has been in the RD&E for about 10 days. He could have come home 4 days ago, but there was no home care arranged for him – no one available to do the job, so his wife is paying privately to get help, and he will now be coming home some time on Sunday. He will have been bed blocking for 1 WEEK. It says it all doesn’t it?’
Devon Conservative machine backs Health Scrutiny travesty, blocks my last-ditch attempt to defend our hospital beds
Yesterday the Conservative Party machine defeated my final attempt to get Devon County Council to take action over the closure of community hospitals beds. My motion, seconded by Claire Wright, asked the Health Scrutiny Committee to look again at the issues it failed to scrutinise properly in July, and asked the Council to write to the Secretary of State for Health to alert him to our concern about hospital beds. I highlighted widespread NHS concern that there will be too few beds if there is a flu epidemic this winter. My speech is printed below and you can watch it here.
The Tory response was an amendment, moved by the leader, John Hart, which took the guts out of the motion. Despite all the evidence to the contrary, it said that Health Scrutiny had ‘extensively considered the issues and concerns from members of the public, elected members and others, including medical professionals, all matters relating to the closure of some community hospital beds in Honiton, Okehampton, Seaton and Whipton.’
Instead of my proposal to write to the Secretary about the beds closures, the amendment proposed to write ‘seeking reassurance that appropriate funding is provided by government to deliver the necessary health and social care services in Devon’. Not a dicky bird to the minister about community hospital beds, the whole point of the debate.
In reply I told the Council (at 3.10) that if they passed this amendment, they would be ignoring East Devon opinion just like Kensington & Chelsea Council ignored the residents of Grenfell Tower; and the Conservative Group as a whole would have made itself responsible for the failure of scrutiny.
The result Although they were not formally whipped, 40 Tories fell dutifully in line to support the amendment. There were 16 votes against (these were Liberal Democrat, Labour, Independent and Green members, together with only one Conservative, Ian Hall of Axminster).
Claire made a valiant attempt to put some guts back into the motion, with another amendment – but the Tory machine squashed that too.
During the Council meeting, the overhead display announced the date as ‘5 Octobe’, losing an ‘r’ in apparent tribute to the recent successful Tory conference, on which Steve Bell comments in today’s Guardian:
Text of my speech:
I represent a large division in East Devon. 2 years ago Seaton, Axminster and Honiton hospitals had in-patient beds, universally appreciated by patients & doctors, and supported by local communities. Today large parts of each hospital lie empty – nurses and other staff are dispersed – volunteers have been told they are no longer needed. We don’t even know whether the buildings will survive as centres of health services or be sold off.
This is the biggest crisis East Devon & Okehampton have faced in many years. Local communities have been united in their opposition; councillors of all parties have opposed the decisions.
After a biased consultation and unjust decisions, we looked to the Health Scrutiny Committee to hold NEW Devon CCG to account, and they have failed us. My proposal today is not a motion of NO confidence in any councillor or party. It is a motion to RESTORE confidence in this Council’s ability to represent Devon communities and stand up for their interests.
The tragedy is that Health Scrutiny started sensibly by asking the CCG 14 questions, in order to decide whether it should use its legal power to refer their decision. This proposal had cross-party backing, with the support of more Conservatives than members of any other party. A minority of the committee were, however, determined from the beginning to disregard public concern and voted not even to ask the questions.
The CCG replied to the questions but the Committee found their answers inadequate and wrote back detailing areas of concern. So far so good – a model of scrutiny. But things started to go wrong when the issue came to the new Health & Adult Care committee in June. The new Chair argued that members were insufficiently experienced to decide the issue and recommended delaying a decision until September 21st. It escaped no one’s notice that this was after the date given for permanent closure of the beds. It was seen as an attempt to prevent effective scrutiny.
Fortunately, the Committee agreed instead to a special meeting in July. For this meeting, the County Solicitor prepared a guidance paper outlining 6 issues outstanding with the CCG. Councillor Ian Hall, Councillor Mike Allen who is a Conservative District councillor, and others joined me in pressed the local communities’ case.
However the CCG gave a long powerpoint presentation which simply did not address most of the 6 issues, and before any debate could take place, Councillor Gilbert proposed there be no referral. In case anyone believed that he still wanted to scrutinise the issues, he made a point of emphasising that not referring would ‘save the committee a huge amount of work ’.
Councillor Diviani then told the committee that referral would be a waste of time, because ‘attempting to browbeat the Secretary of State to overturn his own policies is counter-intuitive’.
The Committee never discussed most of the remaining issues that the guidance paper had identified. Let me mention just one, the surprise decision to close Seaton’s beds, removing all provision from the Axe Valley. Neither the CCG nor any member gave any reason for believing this decision was justified – yet the committee voted for it anyway and the empty wards of Seaton hospital are the consequence.
There was no broad support for the anti-scrutiny motion: it was supported only by 7-6 ; 4 members abstained or were absent. The meeting was widely seen as an abdication of scrutiny. The Standards Committee says it ‘may not reflect well on the Council as a whole’. I would go further: it did not reflect well on this Council.
Since then, it has become obvious that cutting beds to the bone brings great risks. The Head of the NHS, Simon Stevens, has called for more beds to be urgently made available this winter in face of a possible flu epidemic. Expert bodies like the Kings Fund, the College of Emergency Medicine and NHS Providers have backed the judgement that the NHS is cutting too far, too fast. These are new reasons to question the CCG’s plans.
This motion therefore proposes that
- The Scrutiny Committee should look again at the issues which were not satisfactorily addressed.
- The Council should tell the Secretary of State that the CCG’s decisions and the wider STP process have aroused great feeling in Devon, that people are not happy with either the decisions or the way they were made , and we are worried that we simply won’t have enough beds for the coming winter.
- Finally, following a more constructive Health Scrutiny meeting on 21st September, this motion welcomes the Committee’s help in securing community hospital buildings.
Some of you may still wonder if Cllr Diviani was right, and all these proposals will be a waste of time. The answer to this is given in a recent letter from the Secretary’s own office: ‘As you may know,’ it says, ‘contested service changes can be referred to the Secretary of State, who then takes advice from the Independent Reconfiguration Panel.’ So a referral is not something the minister deals with personally; it is a legally defined procedure.
The letter continues, ‘However, as you are aware, Devon’s Health Scrutiny Committee … passed a motion … in favour of not referring the CCG’s decision to the Secretary of State.’ Cllr Diviani suggested that referral was pointless because of the minister’s opinions: the minister’s office implies it WOULD be meaningful, if only Devon would take action.
I ask you to restore this Council’s reputation and take the action which it is within your power to take, even at this late date, to save our community hospital beds.
After the failure of the July Scrutiny meeting, I am asking Devon County Council to look again at hospital bed closures on 5th October
After the failed Health Scrutiny Committee meeting in July – which has led to repercussions in the County’s Standards and Procedures Committees as well as at EDDC – the full Devon County Council will be asked to look again at the issues on Thursday 5th October. I have proposed the following motion, which Claire Wright will second:
The County Council regrets the failure of the Health and Adult Care Scrutiny Committee on 25 July 2017 to be seen to scrutinise the decision of NEW Devon Clinical Commissioning Group to close community hospital beds in Honiton, Okehampton, Seaton and Whipton, especially in the light of the subsequent urgent recommendation by the head of the NHS in England, Simon Stevens, which is supported by evidence from the Royal College of Emergency Medicine and the King’s Fund, that more beds need be made available for the coming winter.
Noting also the Standards Committee’s conclusion that events at the Scrutiny Committee meeting ‘may not reflect well on individual members of the Council or upon the Council as a whole’, its recommendations for the Committee’s Chair and its general recommendations to both members and chairs of Scrutiny Committees, the County Council therefore
- requests the Health and Adult Care Scrutiny Committee to scrutinise those issues identified by the County Solicitor in her paper for 25 July which were not directly and fully addressed at the Scrutiny Committee in that meeting;
- consistent with the Council’s ‘community champion’ role, alerts the Secretary of State to the strength of feeling in the locality at the overall STP process throughout the County and the significant numbers of objections made by the public to the CCG’sproposals and that in the interests of democracy and democratic accountability he might wish to satisfy himself that all relevant process were properly undertaken and assessed and that the CCGs subsequent decisions are supported by the evidence; and
- welcomes the agreement of the Health and Adult Care Scrutiny Committee to examine, subject to the advice of the County Solicitor, means of safeguarding community hospital buildings throughout Devon as facilities for the provision of place-based health services.
Seaton and Axminster – combined health hub?
As I have reported before, Seaton Town Council, the League of Friends and I have been discussing the future of Seaton Hospital in the light of the removal of the beds. Full details of the proposals have not been finalised, so I can only quote the report of Councillor Jack Rowland, Mayor of Seaton, to next Monday’s Town Council:
‘The next campaign is to ensure that the site is retained with a compelling case for retaining the existing services and extending these. To this end I attended a meeting on 6 September to discuss the next steps. I cannot give fuller details at this stage, but broadly the idea is to set up a Steering Committee for an Axe Valley Health Hub and to work in conjunction with Axminster to build a case for retaining both sites with complementary services.’
I don’t want to comment at length on last week’s confidence vote at EDDC (which I missed while away for a week). I was pleased to hear that there were excellent public speeches, including from Seaton Mayor, Jack Rowland, and that two of Seaton’s councillors, Jim Knight and Peter Burrows, voted ‘no confidence’ in Paul Diviani, whose vote prevented Health Scrutiny from referring the beds decision to the Secretary of State.
I was disappointed to see that our third councillor, Marcus Hartnell, justified support for Diviani, seeing the attacks on him as purely politically motivated (apparently all other local councillors, for Coly Valley, Beer, Trinity and Axminster, also supported Diviani).
I would just like to put on record my belief that no council leader should be able to abandon the communities he represents without paying a high political price. I hope that the no-confidence motion will warn councillors aware that there will be an even greater public reaction, should they fail to block attempts to close any of our community hospitals in the forthcoming CCG Estates Strategy.
This is the RD&E’s leaflet showing all services in the hospital before the beds were closed.
Seaton Hospital League of Friends contributed over £3 million in today’s money over its first 25 years
I have been examining figures for the Seaton and District Hospital League of Friends’ contributions to the hospital.
It appears that the figure of £1 million in today’s money, based on the figures in Mary Ward’s booklet, grossly underestimates the contribution which the local community has made, through the League, to the building and running of the hospital.
I currently have full figures only for the first 25 years, from 1985 to 2009 inclusive. During this time the League contributed, taking all types of expenditure into account, £1,906,385.10 to the hospital in constant prices. However converting the annual figures into 2016 prices (using the Bank of England’s inflation calculator), the League contributed £3,012,425.42 over the period in today’s money.
I am waiting for fuller figures for 2010-17, as well as some clarifications on the nature of the expenditure, and I will post a more complete analysis when I have these.
I leave readers with a quote from Mary Wood, the first Matron: ‘The League of Friends is enormously grateful to the Exeter Health Authority for fitting the wishes of the people of Seaton and District into its financial plans. Over the past five years the Authority has backed us in the realisation of our dream. This must never be forgotten.‘
No one could say that of the NEW Devon Clinical Commissioning Group, which has sabotaged – with the support of leading East Devon Conservatives – the excellent hospital which the people of the area and the local NHS built up over the last 30 years. That too should never be forgotten.