17 APR 2016

Community Hospitals; a precious community resource

Our community hospitals are immensely valued and so any changes, especially those that could lead to bed closures are a serious concern. Community hospitals are about far more than their bricks and mortar, they are at the heart of delivering a service to local communities that allows people to be cared for closer to home, sometimes to be able to be cared for near loved ones at the end of their lives or to avoid having to be admitted to a larger hospital too far away for friends and family to be able to visit. Community hospitals provide personal, high quality and supportive care and are extraordinarily important to all the communities and individuals they serve.

To be clear, I do not want Paignton or Dartmouth hospitals to close. But our ageing population and the rising demand for services especially as a result of the growing number of people living with long term conditions mean that those planning services have to look at how we can care for as many people as possible close to home within the resources available. That means looking at the whole system of primary care, community nursing, social care, mental health services and voluntary services alongside community hospitals and Torbay hospital. We cannot look at them in isolation.

Across South Devon our primary care and community services are under great pressure with difficulty recruiting staff and in some cases working from totally inadequate premises. The closure of the minor injuries service at Dartmouth happened because they could not recruit or retain the highly skilled staff to maintain a safe level of service. Local health and social care is also under great financial pressure and our Clinical Commissioning Group is on course for a £15million shortfall in 2016/17.

Torbay and South Devon Foundation Trust and the CCG will be publishing their final plans on April 22nd but it is worth looking now at the links from the CCG website for Paignton and Brixham as well as Moor to Sea. These set out the challenges around age, deprivation and health inequality as well as the financial pressures facing our local area alongside the draft proposals.

If the plans just involve cuts to services and beds I will not support them. If a strong case can be presented for how money would be invested in genuinely improving services for patients then I think there must be a clear promise about how that will be guaranteed and greater detail on what it will look like.

The beds that are so valued by communities, close to home, can sometimes be provided as beds with extra support within a nursing home or residential care but there must be complete honesty about what the money saved, estimated at £3.9m would be invested in to make the overall service better at allowing people to be supported in their own homes without needing hospital admission in the first place.

Our community hospitals were gifted to local communities and supported over many years by generous donations and bequests. If any are sold, and it remains a big if, that resource must stay for the benefit of the local communities to which they were gifted and be used to build primary and community care facilities that are fit for the needs of today's patients. Those changes must have the support of communities and that will only come if the case can be clearly made for why the service could be better if provided in a different way. We know for example that NHS community bridge workers working alongside voluntary services can make a great difference in supporting people as they leave hospital and in reducing the risk of unnecessary admission. Community teams can include physiotherapists, occupational therapists and community mental health professionals as well as community nursing and social care but they need a base. Multidisciplinary teams can work even better if located alongside primary care so the consultation needs to set out a vision for the whole service and clear evidence for why that would be better than our highly valued local network of existing community hospitals. There is a strong case for community hospitals to do more, not less but that may mean using them in a different way focusing on prevention and care for people living with long term conditions.

There is not enough detail in the draft proposals on how the new arrangements would improve or work alongside GP services and far more detail is needed about where nursing home or residential 'intermediate care' beds would be provided if not at the local community hospital. The proposed closure of 28 beds at Paignton and 16 at Dartmouth would be a great loss and local people will need a clear explanation of how the money saved from closures would be invested both to improve services for local people and allow care to provided more efficiently rather than it just being sucked into plugging a financial gap.Whilst some admissions can be avoided with better community care, that is not always going to be the case. Torbay hospital is already under pressure and, without a clear plan for community beds, there is a danger that we could see people being admitted to even more costly hospital beds further from home as well as greater difficulty discharging patients at the end of their stay, one of the main causes of delays in casualty departments. It is very important that the beds from St Kildas are also taken into account.

The proposed closure of minor injuries units also means more people turning up in A&E from where they are more likely to be admitted unless there are really effective measures in place to avoid this. Anyone who has tried getting from Brixham to Torbay at peak times in the summer will know how difficult this can be and a Brixham hub should include access to a MIU in my view.

Amongst the many principles set out for the proposed reorganisation, there is a specific reference to improving life expectancy especially in the most deprived areas. There is a serious question therefore about the impact of closures on our most deprived communities in Townstal and Paignton and what services would be put in their place to reduce inequality and improve health and wellbeing.

I will be closely studying the final plans once these are published and attending as many of the community consultation meetings as possible. As Paignton hospital is in the Torbay Parliamentary constituency, Kevin Foster MP will be leading the discussions on the proposals there whilst I will be doing so for Brixham and Dartmouth hospitals. We will be working together as people from across the Bay use and value all our community hospitals.

7 comments

Dartmouth Hospital is seen as prime real estate. It'll be sold to the highest bidder and turned into luxury waterside penthouses.
- Anon

as both Sarah and Kevin Know that in truth the deal has already been done all this rubbish about public consultation is a smoke screen the true Conservative policy is to CUT and promise to invest in better alternatives ,which will not happen this is yet another move to eventually have the N H S dismantled and private profiteer organizations to take over I fear for the younger generations that will be at the total mercy of corporations profit margins
- victor freeman

The problems with staffing have a lot to do with the gross lack of affordable housing. The problem with housing is that too many houses are being built to be sold on the open market to the highest bidders. The solution to the housing problem could well be the solution to the staffing problem - build more decent affordable housing.
- Victoria Trow

If there is closure of some community hospitals it is my understanding that staff that work in these hospitals are expected to offer an intermediate care service that would prevent hospital addmisions and allow people to remain in their own homes. Whilst this is a good idea and no doubt many people would prefer to remain and be nursed at home ,it would prove extremely difficult in practice. Many staff do not have their own transport and rely on public transport or lifts to work. How are these staff going to deliver a service in an area that has many rural and outlying villages . Its a logistical nightmare and if two staff are required to attend a patient that may have mobility problems and need the assistance'of two staff ,then the problem becomes even greater. Has anyone actually worked out how much more time and effort in delivering this service is likely to cost?
- valerie Husband

The loss of the MIU at Dartmouth is a very regrettable event. With the population of Dartmouth and Kingswear, as well as Kingsbridge/Salcombe and surrounding holiday sites swelling to capacity in the summer months, it puts lives at risk--especially children's--during these periods. If people are meant to travel to Totnes or Torbay for help it could mean people fail to get needed attention. A minor injury (if not addressed in a timely way) can become more serious and perhaps disfiguring if help is not prompt and effective. Dartmouth hospital needs to be saved not only because of the community element of care to local people, but also to reinstate, as soon as is practical, the MIU. The lifeblood of the area is tourism, and if the South Hams cannot take care of its own communities, it won't be able to care for visitors either. One would think that with all the private money pumped into the area for real estate and tourism, that a decent emergency and urgent care facility would be a basic priority of the local commissioning groups and councils.
- Prana Simon

I really do not want any small hospital to close. As we do not have Convalescence homes any more we need feeder hospitals to allow beds to become free in the main hospitals. . It also allows patients with less serious complaints to be nursed nearer home even though nursing patients in their home can be valuable at times. The cost of care homes is extortionate. For example, my mother needs an urgent cardiac procedure. The waiting time for an urgent procedure is 6-8 weeks. My mother is desperate for a replacement hip and at present is immobile. On her surprise on the time the Consultant commented that he had to cancel all his operations that day as there were no beds and that the NHS was "falling to pieces" . We need more beds, consultants, nurses etc and more local facilities. Travelling from Bude to Plymouth each day for a visit? Just think of that toll on families.
- Anon

Is the NHS safe, or soon to be franchised out ? Apparently a young man at Totnes Station yesterday had to wait 3 hours for an ambulance after hurting his back.
- worried devonian

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