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Hospital bed cuts to be referred to Secretary of State for Health unless raft of assurances given

Tuesday, 07 March 2017 13 Comments by Claire

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):

This committee:

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

Comments

1. At 08:56 pm on 07th Mar Jack Rowland wrote:

Congratulations on getting the resolution passed. Thanks for what you achieved today and I’ll brief Seaton Town Council accordingly.

2. At 10:32 pm on 07th Mar Helen Tucker wrote:

Well done.  This is what the Scrutiny committee is there for.  There is much to challenge in the proposals, as well as the consultation process.  Thank goodness you are calling the commissioners to account.  The areas you outline where reassurance is needed is spot on.

3. At 12:11 am on 08th Mar Malcolm Lee wrote:

Thank you for this excellent update and for the hard work still being put in by you and others who are trying to halt this hospital bed closure madness.

4. At 01:02 am on 08th Mar Chris East wrote:

Excellent work Claire.  They are on the run, but referal to the Sof S will need even more astute handling.

5. At 07:43 am on 08th Mar John Wardman wrote:

A tour de force, you really socked it to em on scrutiny Claire. What are the 5 councillors who opposed thinking about? Have they no concern for the health and well-being of those constituents that they represent?

6. At 07:55 am on 08th Mar Di Fuller wrote:

Well done Claire. An excellent outcome. I’m still amazed that any councillor would vote against your motion. The whole consultation has been a sham.

7. At 08:12 am on 08th Mar Roger Giles wrote:

NEWDevon CCG carried out a consultation on its proposal to slash the number of hospital beds and to close several community hospitals in Eastern Devon. There were 2,000 responses. The CCG spent several weeks analysing the responses. The CCG made a planned visit to the Health and Wellbeing Scrutiny Committee to explain their closure plans following the consultation. Yet when you asked how many of the responses were objections, the CCG chief officer claimed not to know!! If one were looking for compelling evidence of the CCG complete lack of credibility its own chief officer provided it at the Health and Wellbeing Scrutiny Committee on 7 March 2017.

8. At 09:53 am on 08th Mar Dr David Seamark wrote:

Thank you Claire This is encouraging. Having worked in community hospitals for 25 years and witnessed the shambles that is’community care’ I have very little confidence that adequate care can be provided in the community under current arrangements.

9. At 01:16 pm on 08th Mar Robert Crick wrote:

Claire your success is a fitting celebration for International Women’s Day!

Our MP should have received the letter below in time for budget day:

Dear Sir Hugo,
Re: Our Future Care

The consultation is now complete. The CCG announced its decision yesterday in the presence of a large number of concerned citizens.

The Business Case presentation by the CCG acknowledged that the decision on which beds to close was “finely balanced” and was not based on the responses to the Consultation process, which strongly favoured option A (i.e. to retain beds at Seaton rather than Sidmouth). It seems the whole £7.5 million exercise was not only flawed by loaded questions and inadequate evidence but was also an irrelevant distraction.

Today the CCG announced the “temporary” closure of a further 16 beds, due to a shortage of nursing staff, at Holsworthy. Thus in four years NEW Devon has experienced a cumulative closure of 199 of its previous 314 community beds.

Your support for hospitals in Sidmouth and Exmouth is understandable and you must be gratified by the outcome. However, the closure of 63% of the hospital beds in neighbouring towns will have immediate adverse effects within your constituency.

Page 44 of yesterday’s CCG Business Case offers reassurance on implementation of the future model of care. I do not doubt the managers’ sincerity but people are concerned about their ability to deliver and can see no line of accountability following the 2012 Act’s removal of responsibility from the Secretary of State. Please can you suggest how we might monitor the effectiveness of the outcomes?

The nub of the challenge is, as you know, the collapse of our social care system. Your November “cart before the horse” comments have been universally endorsed. However, while the emergency re-allocation of some funds is a welcome signal, your constituents, who are struggling to substitute for professional carers, expect determined political leadership. Please bear this in mind during the forthcoming budget allocations.

Rather than tinkering with a broken system, should not government undertake an urgent and courageous re-examination of priorities?

Yours sincerely,

Robert Crick


P.S. Thank you for your 22 December letter. Unfortunately, your response failed to address the concerns I raised on 13 December. I enclose my response to the Consultation with a duplicate of my earlier letter.

Your letter did however raise a range of separate issues on which I comment below.

While your figures prove that the NHS is generously funded, the effective delivery of the service is being compromised. Market reforms introduced into what was once the most efficient health service in the world now divert an ever-increasing proportion of these resources from the care and treatment of patients into transaction costs and administrative costs. There are other inefficiencies of course, including the high cost of caring for homeless people that I wrote to you about in December. Community hospitals are cheaper and more convenient than acute hospitals for most purposes.

You quote “Success Regime” assertions on the comparative cost of care in community hospital beds and care at home. I urge you to consider:
The home situation of at least 30% of our neighbours means that care at home is not a viable option.
By their own admission the CCG had not collected the statistical evidence for their proposals before or during or after the consultation process. It was not until February 2017 that baseline data on NEW Devon’s bed closures was provided after numerous requests and it has still not been published. The figures reveal that the “equitable” levelling down of bed numbers in the Eastern Locality could be justified only thanks to recent mass closures elsewhere.
Furthermore, Ms Peddar’s own figures show that in any one month it is 15% cheaper to treat and care for 82 people if each one stays in a 16-bed hospital for an average of five days, than it would be to send NHS workers out to visit their homes.

10. At 03:31 pm on 08th Mar Tim wrote:

As an (adopted) Exmouthian I do not consider that we ‘won’ anything in this sorry state of affairs though it is, from memory, what our MP wanted. Thank goodness we have Claire batting for so many of is. Thanks Claire.

11. At 03:41 pm on 08th Mar Chris Wakefield wrote:

Having watched the Health & Wellbeing Scrutiny Committee webcast it is easy to see why we are where we are with this. Here’s a selective personal account for anyone who missed the live action.

CCG’s team was out in force, with a front bench of four, bolstered by some invisible ‘friends’ mentioned by the chairman but never seen by us, to urge them on. They kicked off with a slightly nervy CCG presentation mainly to tell us why the consultation was such a remarkable achievement - an award-winning consultation - endorsed by all sorts of benchmarks, quality marks, kite marks, hall marks and all; and it is hard to fault it against the measures offered to us. The only down side is that everyone else thought it was a ready-made decision seeking a post-facto endorsement. Neil Parish MP called it a ‘sham’ and few would disagree with him.

The councillors on the committee, in the main, then laid into them, and voiced what the feeling was among their constituents, which was justifiably murderous, and which prompted CCG’s Rob Sainsbury to launch into vigorous technicalities, emphasising his case with staccato hand movements, and showing the clear strain of casting his carefully modeled pearls before such porcine auditors. There were questions, to which most answers were inadequate, and others not given. There was talk, (threats possibly) of FOI demands, which is alarming given that all these people are in public employment, and I have never worked out why any information is not forthcoming simply for the asking.

Anyway, a few highlight will cheer us up - first the pleasure of watching old hands in action - Cllrs Westlake and Greenslade in particular, the latter quite chirpy considering the doleful nature of the business at hand, leaping on Simon Kerr’s foot-in-mouth remark about the complete absence of responsive social care in Axminster, and brazenly cutting to the chase, asking how much the Success Regime was costing us. (An interim cost was £2.6m I thought I heard, but I could be wrong - that seems like an awful lot of cutter for a man-and-a-dog outfit like Carnell Farrer).

No one in fact was inclined to give wholehearted support to the CCG in their plans; there were a few limp equivocations - cllr Diviani told us (once he could get his voice going - the key is turned but the engine always takes ages to actually start) that he’d been in hospital and it was brilliant, and one or two others wrung their hands over the clear lack of social care provision, while not condemning the process that brought us the crisis. Claire was invited to make her proposal for the committee to vote on, whereupon the snappily dressed cllr. Brook, clearly confused that Claire has prepared for the meeting by writing down her proposal, suggested that people who wrote things down were clearly trying to subvert the democratic process. (Tories have traditionally held that teaching the working classes to read and write had been a mistake - and that tendency has played into our education system ever since 1872, which is why legislation has studiously avoided any education in matters of politics, in order to forestall indiscipline in the ranks. There is a cracking story on that topic, but I’ll skip it for the moment). Cllr Westlake, from the chair, reminding cllr Brook that writing was OK, proposed that Claire’s proposal was put to the vote. Result 7 - 5 in favour. That’s OK, good even - but what is there to vote against one wonders, the proposal is merely to make sure we do the utmost to get things right before trashing the existing local health infrastructure. And when you hear ‘We are very cautiously optimistic that the new model of care can be implemented’ from the CCG, then caution seems eminently sensible.

Just watched the budget in the commons. Must pack this in - politics is infuriating enough without hours of watching it on the telly as well. Except that it is primary data, and bypasses the media, so it does help us to see what actually is going on.

It will be interesting to see how much of the £1bn for top performing STP planners comes Devon’s way. Probably in proportion to the extent of fawning the local MPs can summon for Mrs May’s other tricky issues on the government’s agenda.  Well done Claire.

12. At 06:18 pm on 08th Mar marian cleaver wrote:

Very well done Claire. I have just come back from visiting my 87ys old friend/neighbour who is in Bovey ward RD&E, a package of care has been requested since January 6th and escalated from the hospital where she has been for 3 weeks, desperate to come home, family abroad. and no money to pay for her own care. As I understand it there are many patients in that ward waiting for home care, so how many in the hospital in the same position - bed blocking! There is no care in the community, agencies just don’t have enough staff. As a retired nurse of 35yrs service I like you despair of the future. Thank you.

13. At 10:39 am on 09th Mar Jan Goffey wrote:

Thank you Claire! If it wasn’t for the millions the CCG themselves cost, the NHS would have enough money! Cut the bureaucracy Not the beds!  Where is this Home Nursing Care system actually working successfully - and independently verified to be so?

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