BLOG: hospital beds and social care

The big local political drama last month was the announcement of plans to close

72 community hospital beds in East Devon, and possibly Exeter, so that new models of health care can be delivered. Where those cuts are to be made will be the subject of a public consultation, which has now begun. The four options being proposed will reduce the number of community bed units to three in the eastern locality of NHS Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group (CCG) who will ultimately decide which beds to close. We have been targeted, by that I mean the Eastern flank of the county, because we have double the number of community beds compared to the Northern and Western parts.

The consultation going ahead will be the first of many because Devon has been chosen as one of three areas of the UK chosen for pilot schemes for NHS changes called the Success Regime. And Devon was selected to be part of the national intervention programme because of its significant financial deficit.

So what we know is that there will be a 32-bed unit, a 24-bed unit and 16-bed unit, and the only certainty at the moment is that Tiverton has been chosen for the largest unit. Honiton and Oakhampton are not included in the new plans so their beds will close.

The four options under consultation are...

A) 32 beds in Tiverton, 24 beds in Seaton and 16 beds in Exmouth.

B) 32 beds in Tiverton, 24 beds in Sidmouth and 16 beds in Exmouth.

C) 32 beds in Tiverton, 24 beds in Seaton and 16 beds in Whipton.

D) 32 beds in Tiverton, 24 in Sidmouth and 16 beds in Whipton.

Angela Pedder, lead chief executive of Your Future Care (Success Regime), has confirmed that her preferred option is A because of travel times and accessibility for carers. It also takes into account the physical size of buildings as, in her view, they have the physical capacity to deliver the options.

As the local MP I will be putting my weight behind option B, which would see beds retained at Sidmouth, Exmouth and Tiverton hospitals. These hospitals are vital for on-going medical care and rehabilitation for patients from the Royal Devon and Exeter who are not well enough to be cared at home. Sidmouth, we must remember, has a much larger proportion of elderly and frail patients in comparison to other areas and is a good 15 miles from the nearest acute hospital. But these hospitals are also important for terminally ill patients. I firmly believe that this option - Option B - makes geographical sense and I will be fighting tooth and nail in an effort to get this particular proposal adopted.

But, I have to stress, this is a community issue and needs a community response. I intend to encourage all of my constituents to take part in this consultation and support the best option for East Devon.

I would also urge everyone to pull together – yes, even my political opponents – and get behind the best option that is being presented to us for the area. After all, every corner of Devon and every constituency will be fighting for their preference; and we must do the same.

As to the blame game, it simply won’t get us anywhere. We are where we are and we now need solutions. A romantic notion that everything can stay the same is simply not pragmatic. Devon’s NHS is currently in dire financial straits. Steps need to be taken now otherwise our local NHS could be facing a £400m deficit by 2020/2021. Establishing a new, efficient and patient-centred model of care is absolutely vital for the long-term sustainability of our local healthcare service. And we need to assess the facts calmly and without hysteria; for example, the cost of running a 16-bed community hospital ward is £75,000 a month. In that time around 21 people will be treated. According to Angela Pedder if we use those staffing and resources differently to care for people in their own homes, 82 people could be cared for, for the same money. People are always telling me they want care at home wherever possible and where it is safe to do so. Is that such a bad thing?

The trouble with Devon health provision is that we seem very dependent on beds. At any one time across the area over 600 people are in a hospital bed that don't need to be there. It is important to note this for a variety of reasons, but from a patient point of view, the longer someone is in bed and doesn't need to be, particularly if they're frail and elderly, their ability to return to the level of independence they had before coming into hospital decreases, and they suffer muscle loss and are exposed to infection. If they had the right package of care they could go home. The local NHS has now been working with 80 clinicians over the summer months to begin to develop a model of care, which enables people to be treated at home as far as possible.

But here’s the caveat, and one, which I will be raising in Parliament and with local providers. Home care is currently in trouble with local authorities having cut their funding. Two of the largest home-care providers have recently withdrawn from the market and two others have made losses in their home-care divisions. The ratio of GPs to the elderly has declined and so has the number of district nurses. So while the new model looks attractive for patients who want to be treated in their own homes, will the community services actually be sufficient to avoid the elderly going into hospital or care homes? Or will we see increased admissions to RD&E? Besides, these new models of care have yet to be agreed and surely will take time to test and establish.  Or are we going to see a new cultural shift towards families and neighbours lending more support which for many is simply not a feasible option.

SOCIAL CARE FUNDING SHORTFALLS AND THE FUTURE OF THE NHS

Along with many of my constituents, I am extremely nervous about the future of social care. And justifiably so.  Why? Well, the number of elderly people receiving social care from their local authority has declined by 26% and Devon is no different in that respect. By 2019-20 the funding shortfall nationwide, according to the King’s Fund, will be at least £2.8 billion.

Much of the problem lies in how social care is funded. Whereas NHS treatment is free at the point of delivery, social care is means tested and supplied by the local authority, whose grants, throughout the recent period of austerity have been cut. We can argue either way politically whether that was necessary but what is certain is that care for the elderly takes a huge chunk out of local government spending, some 42%. At present the threshold to qualify for help is £23,250 in savings or assets; anyone who has more than this pays their own way. Care homes for rich pensioners are doing well but now they are refusing to take Government funded clients because they say local authority funding does not cover their costs. With Brexit looming around the corner the fees could rise even higher because of pushing up staff costs; at present 7% of care workers are from the EU.

As for the general health of the NHS nationwide I will say this, I am not sure that the present model is sustainable. Governments continue to shy away from the debate, I suspect partly out of a sense of loyalty for the organisation and partly to do with the enormous standing it enjoys in the public imagination.

But the facts are brutal. Nine out of ten of the local trusts that run hospitals in our country are spending beyond their budgets; overall the service faces a funding gap of £20billion by the end of the decade.

So what is the diagnosis? It’s quite simple, and we see it in Devon, rising demand for healthcare from an ageing population is outstripping supply. After all we are now living a decade longer than when the NHS was founded. 

Is there a cure? If we increase the NHS’s capacity there will need to be far more focus on efficiency, which is what is currently happening in Devon. And there is room for more efficiency whatever anyone says. Doctor surgeries for example are still using faxes. Staff shortages are resulting in expensive overtime bills. Local hospitals that are expensive to run and deliver worse results are not as good as specialist ones. Larger surgeries can share back office functions better than smaller ones.

But even with efficiencies, even if wastefulness can be eliminated, closing the funding gap is to say the least hugely challenging. Britain spends less as a share of its GDP on health care than most other rich countries. If taxpayers want that to change they will have to pay for it.  And yes that might mean patients, diverted from expensive systems of care into cheaper ones. The issue of hospital beds is an important one. They are in short supply because the budgets for social care have been slashed. Many of our local hospitals have therefore become expensive replacements for old peoples homes and they need to be more than that. Health and social care needs to be amalgamated to sort this problem out. The process of moving the elderly out of community hospitals and treating them in their own homes is a good one if it can be achieved.

As for surgeries, why can’t doctors deal with some patients by e-mail? it would mean they could devote more time to the seriously ill when they come in. Some people already pay for prescriptions, as they do for dental health, so is the answer for some other services to be charged for? Certainly for those that can afford to pay, like myself, I don’t see why I shouldn’t pay a small fee to see my doctor in-person, while children, the elderly and those on benefits remain exempt. I have an online booking system for my surgery but my doctor tells me only a quarter of people turn up. This is a terrible waste of a doctor’s time especially if there are people out there who are seriously in need of a slot. Should people not be fined if they fail to show? My doctor thinks so. You can still have a proper cancellation policy in place.

Prevention also has to be part of the equation. If we are having health and well being hubs, such as the one proposed for Budleigh Salterton, which I support. Why do we not use them to treat obesity for example? It’s far cheaper than treating patients for diabetes. If we gave health providers budgets based on the health problems of their particular populations would it not be an incentive to use methods that gave local patients more responsibility for their own health rather than blitzing them with expensive and wasteful national campaigns.

These are only ideas, and for many they will feel like a bitter pill to swallow. But we cannot keep on trying to preserve an organisation that cannot cope with the new demands of an ageing population. Merely ‘protecting’ the NHS won’t make it better and it might just make it worse. We owe it to ourselves and future generations to at least have an honest debate.

The consultation is available via this link: http://www.newdevonccg.nhs.uk/about-us/your-future-care/102019