Wednesday, 5 October 2016

The future of Sidmouth's hospital > consultation to start >>> "Encouraging self care as prevention and care at home in preference to hospital treatment is laudable, but the resources will not be in place by next April."

NHS managers met last week to consider its options:
Futures Forum: The future of Sidmouth's hospital > NHS NEW Devon CCG to present consultation in Exeter: Weds 28th September: meeting open to the public

And now a new period of consultation has started:
Devon community hospital bed closure consultation is given go ahead | Exeter Express and Echo

There has been widespread dismay at the choices having to be made - and, indeed, a new option has just been added:
Public consultation on hospital bed closures to now include an option that could see Okehampton Hospital retain its in-patient beds | News | Okehampton Times

As the EDW blog notes, however:


NHS bed closure ” consultation” to begin | East Devon Watch

Here is the view from a member of the County Council's health committee:

The case for cutting hospital beds in Eastern Devon gets off to a shaky start

Monday, 03 October 2016

This week a three month consultation starts on proposals to cut around half (from 143) of the remaining community hospital beds across Eastern Devon.

It will include plans to close all inpatient beds at Okehampton and Honiton Hospitals.

Sidmouth and Whipton Hospitals are also at risk of losing all inpatient beds as they are not included in the favoured option of retaining beds at Exmouth, Tiverton and Seaton Hospitals.

The intention is to invest money in caring for more people in their homes…......

Of course, we have already lost inpatient beds at Ottery St Mary, Axminster, Budleigh Salterton and Crediton Hospitals. Oddly, Budleigh Salterton Hospital is held aloft by Hugo Swire MP as a fine example of a “health hub,” despite the fact that the building has been closed for around three years.

Mr Swire has plumped for an option of bed closures which would see beds retained in hospitals in his own patch. Convenient.

The Success Regime is running the consultation – a task force set up by the government in order to slash the deficit in Devon as it is one of three most indebted health areas in the country.

This organisation is doing the government’s bidding. It must cut costs. That’s its job.

However, the information given to residents to help inform of them of the reasons these proposals are being made, I believe is sketchy at best. At worst it is distinctly misleading.

The Success Regime says that other parts of Devon has fewer beds (because they have already been cut). And to ensure that everyone has a similar service beds now need to go in Eastern Devon too.

Our community hospitals have experienced a slow and steady decline of beds for years so the headline figures should really be taken into context alongside how many community beds there were 10 years ago let’s say. Ottery St Mary Hospital’s capacity is 24 beds for example, yet when the CCG last year decided to cut all Ottery’s inpatient beds, the numbers were based on the 10 beds remaining.

The Success Regime is relying partly on a public health audit published in October last year to argue its case for more bed cuts. This audit also underpins proposals for major acute bed cuts, which will be consulted on next year.

The Success Regime submitted a report to health scrutiny committee last month (which I am a member of) 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, what I can find is a statement on page 1 revealing that occupancy rates of hospital beds –both acute and community – have INCREASED in recent years to 96 per cent.

The audit, undertaken on 19 May 2015 –examines on page 9, the delay in discharging patients on the day of audit - and identifies a range of reasons for the problem. The most common being:

- patients awaiting a community hospital placement – 79
- patients awaiting a social care package - 59
-ward closed due to infection – 40 (there were no wards closed in community hospitals for this reason on the date of the audit)
- patients awaiting a health package of care – 38

There’s more…

The local NHS has claimed for some years that community beds are more expensive than acute beds. This is counter-intuitive and contrary to previous understanding. We are also told that caring for people at home will save money.

BUT the audit, on page 3, notes that acute beds are more expensive or cost the same as community beds. Looking after a patient in alternative settings, including at home the report says, costs the same as hospital care!

Yet health bosses insist that community bed cuts will save £5-6m a year. They say 20-40 per cent of running costs will be reinvested in providing care in people’s homes – which is apparently between £1 and £3m – a rather broad sum.

NHS England denies that Devon’s health service is underfunded, but with a projected deficit of £430m by 2020 it is one of three most financially challenged health areas in the country, and there is clearly a problem!

As a member of Devon County Council’s health and wellbeing scrutiny committee I proposed at the 19 September meeting that we refer the issue of chronic health underfunding in Devon, to Sarah Wollaston MP, who chairs the Health Select Committee. This was agreed.

Some members of the health scrutiny committee, including me, will also investigate the government’s funding of our health area.

East Devon’s MP, of course, has been silent over the issue of funding.

My analysis of the evidence continues.

The consultation starts on Friday 7 October.


 At 11:38 am on 04th Oct Di Fuller wrote:

The plans drawn up all over the country are all very similar as they have been directed by the Department of Health to shift their delivery emphasis from hospital care to community based care, or care at home. 

Devon is the same as elsewhere, but the analysis is interesting, as Claire says. The numbers of people in acute hospitals who do not need to be there is increasing and accurate numbers are hard to get hold of . This will get worse as community hospital beds are closed as those options will reduce. 

Encouraging self care as prevention and care at home in preference to hospital treatment is laudable, but the resources will not be in place by next April. Even if they were, there are many for whom it would not be appropriate, like stroke patients, the very frail and terminally ill. 

The argument that the patient is at the centre of this plan is a nonsense and very definitely not the case. The changes are led by funding shortfall. As one of the richest countries in the world, left behind by many European countries in levels of health spending, we are pathetic!

The case for cutting hospital beds in Eastern Devon gets off to a shaky start - Claire Wright

It is clear, however, that difficult decisions have to be made:
Futures Forum: Having to make decisions on health spending > and making sure the decision-making is accountable

And managers are stressing that it's about balancing care in hospitals with care at home:

GP Dr David Jenner, chairman of the Eastern locality for the Clinical Commissioning Group, said: "Too many people are currently in hospitals that don't need to be there and they could be receiving a better service at home. We do expect there will be concerns. What we are aiming to do is to talk to people about the new way in which we would like to provide services.

Dr Jenner added that they were working with councils and were "absolutely not" trying to offload care costs.

Mass protest outside Okehampton hospital as anger at health cuts and bed closures grows | Plymouth Herald

However, the reality of improving out-of-hospital care does not seem to be measuring up to the promises being made:
Hospital patients being discharged too early with dangerously inadequate social care” | East Devon Watch

With more news and comment:
Closure of Honiton and Okehampton hospitals beds criticised | Exeter Express and Echo
Sidmouth widower highlights importance of community hospitals ahead of closure consultation | Exeter Express and Echo

No comments: