East Devon is blessed in that it has a community hospital in almost every town. Whenever change comes it causes distress because these units are community assets that local people have over the years donated money to sustain and improve. The recent changes to hospital ownership have been no exception.
Unfortunately, the structure of our local health service is rather complicated. To put it simply, Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) is the commissioner - they buy services. They pick a provider, who delivers the health and social care services that the CCG commissions. Our current provider for community services in the Eastern locality of Devon – Northern Devon Healthcare Trust (NDHT) – is also the so called ‘owner’ of the hospital buildings. This essentially means that NDHT also has the role of a landlord. The change that is happening is that our local hospitals will soon have a new landlord called NHS Property Services.
The controversy is that NHS Property Services charges market rents for the use of its properties, something that currently is not happening. The reason they want to do this is to keep our community hospitals sustainable and raise money to reinvest in the estate. If communities want their hospitals to stay in their locality there needs to be more efficient use of space and resources. This is especially important at a time when our CCG is nearly £40m in debt.
The important thing to stress is that the Department of Health has agreed with NHS England that it will meet any increase in property costs that have come about for the NHS as a result of these changes in 2016/17. Arrangements in relation to funding in 2017/18 and beyond will be agreed by the Department of Health and NHS England later this year.
I have asked the Secretary of State’s office for clarification on why the role of landlord was given to NHS Property Services. It has been made clear that when NHS provider Trusts own properties like community hospitals (that used to belong to the Primary Care Trusts before the 2013 health reforms), it can be a disincentive for investment as the Trusts do not know if they will continue to own the assets if they lose their service provision contracts. The properties need long-term security of ownership, and this will be achieved by transferring ownership to NHS Property Services.
Many myths, unfortunately, have been propagated against NHS Property Services including that it is a private company that will sweep in and steal our assets in order to make a profit. NHS Property Services is none of these things, as I said, it is part of the NHS, it does not make a profit and any surpluses are reinvested in NHS services. Yes, they say, but they might well sell off our hospitals to developers. The truth is they can’t, unless healthcare commissioners (i.e. NEW Devon CCG and/or NHS England) have said a property is surplus to the needs of the local NHS, only the CCG could close our hospitals and they have given me repeated assurances that they won't. It’s worth remembering the CCG’s have local doctors on their board who have a genuine interest in strong health provision in their communities.
I recently wrote to the Chair of the CCG, Dr Tim Burke, and asked him whether this change of ownership would detrimentally affect plans to transform Ottery and Budleigh hospitals into health and wellbeing hubs. In his response he said that he is confident that it will not.
Will these changes throw up challenges? Yes. In particular, potentially higher rents may pose difficulties for hospitals such as Budleigh and Ottery as they become health and wellbeing hubs. These facilities will include services run by third sector organisations meaning that it is vital that these groups can afford the rent. NHS Property Services has committed to working with any potential tenant, whether they are NHS organisations, GPs, businesses or charities, to agree property solutions for the wider benefit of NHS patients.
I met with Jeremy Hunt last year to discuss this matter and I have subsequently been in correspondence with him and a number of Health Ministers and CCG representatives on this issue. However, ultimately these challenges will be overcome at the local rather than national level. I am currently liaising with a number of key stakeholders to find a way around these challenges and ensure that our excellent community hospitals are protected and improved. I can’t see into the future, but where we stand at present our hospitals are here to stay although some will be restructured into health hubs.
WHAT IS A HEALTH HUB? AND WHY IS IT THE FUTURE?
The idea of a hub is to create a health and well-being centre based around the community hospital, bringing together health, social care and the voluntary sector including an intergenerational aspect appealing to all members and ages of the community. In the past our community hospitals have concentrated heavily on geriatric care often excluding other uses. This is not to say that the elderly will not be catered for; a hub will be underpinned by excellent reablement services and specialist medical and allied medical clinics. It will no longer have any inpatient beds, as it is believed that more people can achieve far more health gain by having a greater range of services delivered from the site. Those services would include geriatric outpatient care, community nursing, practice nurse clinics, day hospital, Age Concern social care, a café, audiology, podiatry, physiotherapy, mental health services including dementia care.
Budleigh Salterton could be the first Hub and if successful, the model could be rolled out elsewhere in the county. So why there? In Budleigh Salterton there is a significant elderly population, which is forecast to rise; 8.4 % of this population are over the age of 85 years, the rest of England is not expected to reach this same percentage until 2050. Budleigh has over 500 people over the age of 85 years living at home, many of these are alone. There is a large unmet need in a frail vulnerable sector of the community, made worse by the increasing financial constraints within both the health and social care sectors. A system that currently does not seem integrated always from a patient and carer perspective.
We also know that associated with older age there is a rise in long term conditions and also a number of dependencies that can have a real impact on peoples’ lives including illnesses such as depression and dementia which are made worse by isolation and loneliness. Health professionals are often unaware of the many activities and support taking place within the community. This can lead to patients not accessing services that would have been of benefit to them. These services are frequently the ones that help combat isolation and promote engagement and lead to well-being and as a consequence mean less reliance upon traditional healthcare models.
Clinical evidence has shown that there should be greater focus on prevention and a pro-active approach to sustaining health and wellbeing for older people and we know this is what older people themselves would want. The Kings Fund have produced a large amount of research into health and social care for older people and this is telling us that it is time to think differently, there is a need to find innovative ways to deliver high quality care. The research suggests there is a pressing need for more specialist skills within the community with a focus on integration between health and social care services with multi skilled staff that can work across boundaries.
The following extract is taken from ‘The Kings Fund, Time to think differently – buildings’ paper: ‘The NHS has many under-utilised properties and building utilisation is often not actively managed, there needs to be more ambition in the way the NHS estate is used. The objective of any change needs to be to support and encourage new or improved models of delivery that bring health care, social care, housing, private sector provision of long-term care and other related services together in a more integrated way and create more value for the wider community. Innovative approaches to the estate could help to break down the barriers between primary and secondary care, mental health, and social care. There is a case for creating multi-purpose, flexible facilities for extended primary care teams, integrated community and social care staff, diagnostics and specialist consultation. As well as the possibility of generating income from property (working with commercial partners) but at the very least the contribution the estate can make to ‘social value’ .
“YES, BUT WE WANT BEDS NOT HUBS"
This is the cry from protesters who want to keep the status quo and regret the loss of beds. I asked the CCG about this as well. Dr Alex Degan, a GP from Mid Devon and a GP on the NHS NEW Devon CCG Eastern locality Board, said:
“The inpatient beds have been concentrated on fewer sites to achieve more clinically and financially sustainable services.
“Although there are slightly fewer beds overall, the CCG focus is on building in flexibility at times of key demand, therefore patients who require inpatient care in a community hospital will still be able to access a community hospital bed when this is clinically appropriate.
“The hospitals with inpatient beds in East Devon District are Seaton, Sidmouth, Honiton and Exmouth. The inpatient stroke unit is currently based in Ottery St Mary.”
SAVE OUR NHS
The NHS has always been something of a political football between the parties and has consequently suffered far too many re-organisations. It is no wonder people are cynical about the future. Today NHS England leads the National Health Service (NHS) in England. They set the priorities and direction of the NHS and encourage and inform the national debate to improve health and care. NHS England shares out more than £100 billion in funds and holds organisations to account for spending this money effectively for patients and efficiently for the taxpayer. A lot of the work they do involves the commissioning of health care services that includes the contracts for GPs, pharmacists, and dentists. They also support local health services that are led by groups of GPs the CCGs. CCGs plan and pay for local services such as hospitals and ambulance services.
Politics is slowly being taken out of the equation but not totally, it still has to pay for it, and in this it has to remain accountable to the taxpayer as regards funding. The brutal truth is that the NHS is suffering from a massive deficit. This combined with the rise of an ageing population, expensive new drugs, and machinery, staff shortages and numerous other problems make it a political headache for any Secretary of State for Health and Government whatever its colour.
It is therefore regrettable that some of my political opponents locally are weaponising the issue for their own political advancement. I learnt this to my cost when I tried to allay fears of Ottery hospital being sold off at a planned demonstration.
In the end we all want the same thing and that is to keep our local hospitals open and sustainable. The public do not want to hear us trading blows over whether or not the health service is safe in our hands or theirs, or how we are going to trump each other’s spending commitments. They just want a functioning hospital in their vicinity that provides the services they need.
In the future we will have to have a debate about the NHS, what we are prepared to pay for and how. Until then NHS England will carry on valiantly with its strategic vision for the future, meeting the needs of patients and ensuring the NHS is financially sustainable.