Scrutiny – not a word that this government either likes or, being charitable, understands. Scrutiny. It’s essential for a healthy society. It is essential if citizens are to have any trust in their public servants and institutions. Scrutiny, trust and truth have all been damaged in the course of the past few years and their destruction has accelerated under Johnson and here’s a story of a Devon community who have had their trust betrayed, their belief in scrutiny damaged and truth denied.
Save Our Hospitals Services (SOHS) sent us this press release:
On 12 December an exceptional meeting of Health Scrutiny at County Hall agreed that consultation and conclusions regarding the closure of one of Devon’s leading community hospitals had been seriously flawed.
None of the proposals to move services from Teignmouth Hospital out to Dawlish or a new health hub in the town centre had majority support – there has in fact been a huge campaign against them – and plans failed to produce evidence that care in your own home (known as community care) was an adequate replacement for hospital-bedded care. But now, six weeks later, despite strong reservations expressed in December, Health Scrutiny have backed off. Instead of using their power to refer the proposals to the Independent Reconfiguration Panel (IRP) which reports to Secretary of State Matt Hancock, they are simply going to ‘monitor’ the development and have ‘informal discussions’ with the IRP. In the words of Martin Shaw, who takes a contrary view to most of his fellow scrutineers, it looks [horribly] like they are giving the green light to the Clinical Commissioning Group, who are responsible for these plans.
County-wide as well as local campaigners are appalled by the way the public’s voice and all the evidence contrary to the CCG’s assertions has been completely ignored. Even worse, all this is planned to happen in the middle of the worst health crisis in the world for 100 years, when hospital beds for recuperation are desperately needed. Devon has lost 493 community hospital beds since 2010 (64 per cent of the total), contributing to an overall 12 per cent loss of in-patient hospital beds across the county. At the same time the population of Devon has risen by 8 per cent and the number of elderly residents has risen by 23 per cent. Only 11 hospitals have any beds left. Fifteen have been re-designated health ‘hubs’. These offer a range of clinics, but have lost beds and clinical services such as surgery, diagnostics, x-ray, urgent care and minor injury units. Some of these services have been ‘rationalised’ to larger hospitals, creating significant travel problems for patients. Some, such as out-of-hours urgent care, have been passed to primary care providers (e.g. Devon Doctors, which currently ‘requires urgent improvement’).
“The decision to close Teignmouth Community Hospital must be referred to the Secretary of State “We believe a complete pause and review is needed of all decisions related to community hospitals in Devon.
“This review should gather evidence on the impact of closures to date, looking at individual patient pathways and at knock-on effects for other parts of the health and care system including emergency and acute care, out of hours care, GP referrals, community and social care.
“It should look into bed and nursing capacity across the whole system, relative to current and projected future needs of the population.
“It should review NHS and social care workforce issues – and care sector supply issues – and determine realistically how these will impact on the likely success of treating people in their own homes, or in care homes, with a range of clinical and end-of-life conditions.
“It should take into account the many roles that community hospitals play in ‘care closer to home’, and could play in a post-pandemic health and care system.
“The Scrutiny Committee can be confident that the latest research and government policy support a pause and review. The new NHS Long Term Plan (2019) puts community hospitals at the heart of its proposals for integrated care. In September 2020 the Secretary of State for Health stated: ‘the future of the NHS is getting services into the community, including community hospitals’. A series of recent studies have highlighted the value of community hospitals in uncertain times: bed capacity; community response coordination; post-acute care reducing pressure on acute services and care homes alike. (‘Community hospital wards provide an effective and efficient model of care for older people recovering from illness’; ‘Collaborative working is a key feature of community hospitals’; ‘ Community hospitals represent a significant community asset)
“We are not asking for further consultation exercises that no longer have public confidence or credibility. They are a waste of time and money. These issues require a whole-system view that is the responsibility of elected representatives, not individual patients.
“We are not asking for any delay to the investment in primary care premises that is needed in Teignmouth, or in other towns. The CCG stated clearly in response to our enquiries (10/09/20): ‘The construction of the Health and Wellbeing Centre in Teignmouth is not dependent on funds from the sale of the Teignmouth Hospital site.’ The two issues were linked as a strategy to secure public support for closure of the hospital. The CCG can and should unlink them.”
There are essentially four elements to the ‘model of care’ promoted by NHS Devon CCG.
- Long-term reduction in hospital bed numbers and associated hospital-based nursing staff (saving money from NHS budgets).
- Management of long-term conditions at home as far as possible, meaning more responsibility placed on home-based care teams (primary care, community and district nursing, mental health care, social care, some third sector voluntary organisations – the goal being to reduce acute hospital admissions)
- Rationalisation of services to a small number of hospitals, based in areas of maximum population density (saving on estates, facilities and workforce costs)
- ‘Joined-up working’ through top-down reorganisation of the management of care services within local areas, eventually leading to ‘integrated care systems’