Thursday, 27 October 2016

The NHS and 'sloganising' in Devon >>> and meanwhile, the 'Success Regime' claims that hospital beds are "unused" and care at home is "more efficient"...

The proposals to reduce hospital beds are producing a lot of political heat:
Futures Forum: The future of Sidmouth's hospital >>> campaigns, petitions, meetings

The front page of the latest View from Sidmouth shows the 'quiet bunch' of Devon MPs determined to 'fight tenaciously to protect the livelihoods of the constituents':

MPs ‘will come together’ in beds battle

Peter Hodges - October 25, 2016

SIDMOUTH MP Sir Hugo Swire joined with fellow Devon MPs to voice his concern regarding hospital bed closures in the county – and warned the government that Devon MPs ‘will come together to protect our vital services for our constituents’.

Speaking at a Westminster Hall debate concerning healthcare provision in Devon, Sir Hugo warned health minister Philip Dunne, that while the MPs in Devon are a ‘quiet bunch’ they will ‘fight tenaciously to protect the livelihoods of the constituents.’

Sidmouth Hospital beds are currently under threat of closure, after the NEW Devon Clinical Commissioning Group revealed in a consultation document their preferred choice of the future of community hospital care in Devon. Sidmouth would lose out to beds in Tiverton, Exmouth and Seaton, and join Ottery St Mary, Budleigh Salterton and Axminster in having no inpatient beds.

The debate, which had been called by Sir Hugo, saw Conservative MPs from Devon discuss the current situation in regards to healthcare in Devon. Labour MPs Ben Bradshaw and Sarah Wollaston were unable to attend as they were part of a Health Select Committee interviewing the Secretary of State for Health and the Chief Executive of NHS England.

Sir Hugo started by explaining some of the history surrounding Sidmouth Hospital and the support it receives from local residents.

Sir Hugo said: “Over the years, many local residents have donated significant sums to the hospitals. In Sidmouth alone, the Sidmouth Victoria Hospital Comforts Fund has raised over £5 million. Local people are prepared to invest in ensuring first class local health services. I pray in aid the position of the Sid Valley Admiral Nurse – the Admiral Nurse helps people with dementia – which was hugely supported locally. I am pleased to say that I was able to play my part in obtaining additional funding for that position from the Big Lottery Fund. If there is an identifiable health issue locally, people are prepared to back care with their own money.”

Sir Hugo then sent a warning shot across Mr Dunne’s bows reminding him of Devon’s contribution to the country.

He said: “I say to the minister in the friendliest manner possible that we are a pretty quiet bunch in our part of the world, and we do not seek trouble, but we do fight tenaciously to protect the livelihoods of our constituents. Too often, we feel that people forget about us in the South West, and that money is diverted to all kinds of infrastructure projects in the huge urban conurbations, the Northern Powerhouse and so forth.

“This time, we will speak as one to ensure that whatever comes out of these consultations, and wherever we end up after them, we can argue these points in a mature way. It is simply no good saying, ‘It’s a lack of money. It’s Tory cuts’. That is an immature conversation to have. We have to, between us, design a health and social care service that is fully integrated, makes use of technology, and cares for all of us as we get older and more dependent. We need to be brave, but political ‘sloganising’ is not the answer.”

Sir Hugo left Mr Dunne with one final thought, in regards to the current situation in Devon, saying: “I leave the minister with one thought – as the previous Prime Minister freely admitted, it was the Conservative party in the South West that delivered a victory at the last general election. The minister has seen how formidable we can be when we come together, and come together we will, to protect our vital services for our constituents across the county of Devon.”

MPs ‘will come together’ in beds battle - View News

Unfortunately, the figures are very unclear, to say the least - as posited by Sir Hugo's political rival:

Devon health watchdog councillor says bed figures are ‘sketchy at best’

25 October 2016 Eleanor Pipe

Sidmouth Victoria Hospital Ref shs 3264-50-14AW. Picture: Alex Walton.

Questions raised over case for cutting community hospital beds

Figures supporting proposals to cut community hospital beds are ‘sketchy at best’ and ‘misleading at worst’ – according to a member of Devon’s health watchdog.

County councillor Claire Wright believes she has uncovered evidence which sheds doubt on a claim by the NHS NEW Devon Clinical Commissioning Group’s (CCG) ‘success regime’ that ‘a third of beds are not being used’.

Cllr Wright says this statement issued to Devon County Council’s health and wellbeing scrutiny committee is at odds with figures detailed in a public health audit that shows occupancy in acute and community beds now averages 96 per cent.

The ‘success regime’ is putting forward proposals for a new model of home-based care in a bid to plug an expected £384million deficit by 2020/21 and says its proposals will be better for patients.

But Cllr Wright - a prominent hospital campaigner - argues the authority is basing its case on flawed evidence. Cllr Wright said: “The information given to residents to help inform them of the reasons these proposals are being made, I believe, is sketchy at best. At worst, it is distinctly misleading.

“The success regime is relying partly on a public health audit published in October last year to argue its case for more bed cuts. The regime submitted a report to the health scrutiny committee last month that stated a third of beds in community hospitals are not used. When I enquired where this information came from, I was told that it came from the public health audit. I have studied the audit carefully and cannot find this statement anywhere.”

But she said the audit does refer to bed occupancy that for community and acute hospitals has increased to a 96 per cent average. She also highlighted reasons given for delays in discharging people from hospital – with the most common being patients awaiting a community hospital placement or social care package.

A CCG spokesman responded to the claims and said: “These figures are not comparable. The first measures how much of the space available for beds within a community hospital is being used, while the second measures whether or not the beds themselves are occupied. Every day, there are 600 people in hospital beds in northern, eastern and western Devon who no longer have a medical need to be there.”

The report submitted to DCC’s health and wellbeing scrutiny committee in September says: “In community hospitals there are people in a hospital bed who could be cared for at home, as well as more than a third of beds not being used at all.”

The consultation document can be viewed at www.newdevonccg.nhs.uk, as well as libraries, GP surgeries, hospitals and leisure centres.

Devon health watchdog councillor says bed figures are ‘sketchy at best’ - Home - Sidmouth Herald

Moreover, there are distinct feelings that there are other reasons for reducing hospital beds:


26 October 2016

Upgraded comment from Paul F to previous post:

“Behind these proposals is an organisation desperate to cut costs. The “Success” in the title of the “Success Regime” is success in cutting spending in Devon to meet the NHS budget – it is not about successful healthcare for people, it is all about saving money.

They talk about “efficiency savings” rather than “cost cutting” and the difference is vitally important. “Efficiency savings” are when you can provide the same level of care for less money by being more efficient, whilst “cost cutting” is when you reduce your costs by reducing the quality of care.

The underlying principle of their proposals is that home-based care is as good medically but can be provided at a fraction of the cost.

On top of the reduction in hospital beds that would result from home care, they claim that beds are already under-utilised and that even more beds can be cut if we can cut bed blocking (so that social care support is available for patients who need it so that they can leave hospital).

All these make sense if the evidence is there to back them up, but these claims need to be independently analysed and verified. Additionally there is the inevitable fight about where the cuts in beds will be made, and questions about whether the replacement home care and social services will be in place and fully ready before the cuts in beds are made.

Like Claire, I set out to see whether the written evidence actually supports these proposals or whether the evidence has been fudged.

The Home Care proposal is based on pilots already undertaken in North Devon – and on formal reports that have been written following these pilots. When reading analyses like these, I want to see them take the data, ideally using objective measures of health improvement (such as mobility resulting from physio on some standardised scale) though subjective surveys of patients also have a value, and then summarise the good and bad points and only then draw conclusions about whether the pilot should be extended to the whole of the CCG area.

Unfortunately the reports are lacking in objective medical assessments of home care vs. hospital care, relying almost exclusively on subjective patient surveys of home care and without comparative subjective patient surveys of hospital care.

Even more worrying is that the reports seem to have been written in the wrong direction, starting with an objective in mind (i.e. a decision to roll home care out across Devon) and then selecting data to support this case (i.e. they give lots of individual survey comments about how good home care is but gloss over the negative comments).

The analysis is also deficient in highlighting potential down-sides to their proposals (for example increased difficulties for patients and visitors who do need hospital care to travel to the now much more distant hospitals) or the risks that might be inherent in these changes of approach (i.e. availability of immediate help from hospital nurses cf. planned visits from home carers, ability to handle emergency complications that need hospital facilities which are not available when people are being treated at home).

The reports do not give proposals for improving availability for social care for people who should be leaving hospital, because that is not funded by the NHS and so outside their control, but nevertheless they are going to cut those beds.

I guess they see this as a one-off issue, because once they have implemented home care, the people won’t be blocking hospital beds because they won’t actually be in hospital. Of course, that doesn’t deal with either this one-off issue of people who are in the beds when they are cut, or the resulting long-term issue of people now being treated at home who start to need social care in the same way that they would if they had been in hospital – but their thinking is presumably that at least these people are not blocking their beds.

The bottom line on home care is that it may well be as good or even better (for certain types of patients and conditions) but the evidence is insufficient to show this, and there are no guidelines set to ensure that the new approach is only chosen for patients who will benefit and not be at risk from home care.

BUT, suppose we assume that there is solid evidence that home care really works – the next issue is where to cut these beds.

The issue with the CCG approach is that they are looking simply at financial numbers, and not at the impact it may have on the ability of patients or visitors to get too and from hospitals which may now by 30-50 miles further away.

For example, the beds in Ottery St Mary [Axminster] and Budleigh Salterton hospitals are already gone, the beds in Honiton hospital are going in every option currently put forward by the CCG, and yet one of the options proposed also eliminates the beds in Sidmouth hospital. That would mean that ALL the community beds in central East Devon will be gone. How can this be right?”

Finally, we also need to be careful about use of terminology – whether to call it “over spending” or “under funding”.

We need to be realistic that if we decided to treat every medical condition, however minor, using the best possible drugs, however expensive, NHS costs would probably be unaffordable.

The reality is that NHS care has to be prioritised, with some treatments rationed or unavailable. So the issue is whether this prioritisation is undertaken nationally to set the national budget with regions spending what is needed to achieve this standard of care, or whether you continue as at present and fund each region individually (with inevitable inequalities in funding because demographics e.g. an older than average population or population growth due to massive house building or new towns are not properly factored in) and allow them to do the best with the funds they are given, which inevitably results in variations of care which get called postcode lotteries – and these regional variations in medical care (postcode lotteries) are likely to increase when you use local “Success Regimes” to cut costs (oops sorry – make efficiency savings) in individual regions rather than deal with matching treatments to budget at a national level.

(Disclosure: I have been told by my own doctor, for instance, that I can’t have a treatment I might need because it is not available in Devon, but if I lived in Gloucestershire – the nearest available location – I could have it. Fortunately not life threatening – just somewhat detrimental to my quality of life.)

The real rationale for bed cuts? And where is the evidence? | East Devon Watch

Besides, it seems that 'care in the home' ain't going to happen anyway:


27 October 2016

Care providers in Cornwall say there’s a crisis in the care of elderly and disabled people at weekends because there are just not enough workers.

One relative called every care agency in Cornwall but could not get weekend help for her grandfather.

South West councils pay the highest average hourly rate in the country, but its still not enough to attract new carers.

BBC Devon Live

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