Today is the last day on which you can have your say about the future of health provision in Devon. The proposals put forward by the Clinical Commissioning Group are Draconian and must be challenged.
Please make the time to submit your response to the proposals today (January 6). You can find the full document here, http://www.newdevonccg.nhs.uk/about-us/your-future-care/consultation-document/102081. The link to the response form is here, http://www.newdevonccg.nhs.uk/about-us/your-future-care/have-your-say/102083. You will be given the opportunity to express your views on closure of community hospital beds and then asked to respond to a multitude of questions which are entirely irrelevant, but won’t take long to answer.
My response is here:
The plans have been a source of major concern to all residents of the locality, all of whom at some point or another will need to access health services in their area. Cross-party condemnation of the plans has been voiced at Parish, District and County level. Our MPs have also been vociferous in expressing concern.
Given the demographics of this area (28% of the population of East Devon is over 65) and the rapid increase in new housing (17,100 new homes in East Devon for the period to the end of 2031), our already hard-pressed medical services are likely to be stretched still further and indeed may well be stretched beyond breaking point in the very near future.
I support fully the concept that people should spend as little time as possible in hospital. However, while major hospitals rarely provide an environment conducive to relaxing and reassuring progress towards full health, this can be found if the patient is able to convalesce either in their own home with the right support package, or in a community hospital. Our region is fortunate enough to have a number of excellent community hospitals fulfilling such a service, and which benefit not only from the goodwill of the community, but from financial support from this quarter as well.
My concern about reducing the number of community hospital beds is that there are simply not enough staff available to work in people’s homes in order to bring convalescing patients the level of care required. This attention is not simply about personal care, but the kind of care previously carried out by auxiliary nurses, e.g. changing dressings and catheters.
My personal experience of a self-funding relative who is in need of personal/social care (not medical care) is that basic care provision is barely adequate at best. While some staff are excellent, the majority are not committed to care as a long-term career option and probably would not be accepted into the nursing profession. My request to increase the level of care currently offered has been met with the response that the agency is under-strength and unable to recruit suitable staff. There are just not enough suitable applicants to fill the home care roles available. Given that the sector locally is already struggling to fill vacancies with suitable staff, what will happen when the number of beds in community hospitals is drastically reduced or, in some instances, removed completely?
I am gravely concerned that on page 4 of your consultation document it states that, ‘Our community services should … think carer think family …’. This statement is not fully explained in the document, but it reads to me as though the CCG is putting the onus of patient care on to the patient’s family. I hope I am mistaken in this and perhaps the wording of the statement is ambiguous. However, to expect the family (almost inevitably a female member of the family) to take on provision/management of care is grossly onerous on a demographic which is already expected to work long past the previous retirement age and frankly naïve to imagine that family members live in some Halcyon 1950s scenario where they can just drop workplace and family responsibilities to take on the medical/social care of a relative who may live many miles away.
The CCG has carried out an initial exercise (‘Hospital at Home’) in the WEB locality which is now live and is the model of care for those living in that area. What lessons have been learnt from this exercise? I seek clear and unequivocal answers to the following questions:
• What is the hospital readmission rate for patients discharged to the consultant-led ‘Hospital at Home’ system?
• Does the CCG see this readmission rate increasing under the ‘Care at Home’ system?
• Has there been an increase in mortality rates following this initial WEB trial?
• Crucially, has the ‘Hospital at Home’ experiment seen significant savings in the NHS budget, given that this seems to be the whole purpose of the major overhaul of hospital care provision?
• If savings have been shown, what are the projected savings if/when the ‘Care at Home’ scheme is rolled out across the region?
If the answer to any of the above has not been established, then the CCG should postpone further action in order to look again at the proposals. The evidence gathered from this exercise should be scrutinised and made public, so that the entire communities affected can feel confident that decisions are being made in the best interests of patients and not as a result of Government austerity measures. Indeed that the measures are not being driven by the simple and crude desire to save money.