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.
“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