Town Council responds to hospital closure plans

Buckfastleigh Town Council response to ‘Reshaping community-based health services’

Public Consultation by S Devon & Torbay Clinical Commissioning Group – 9/11/2016

Buckfastleigh Town Council met on the 9th November and agreed the following council response to the plans to close four community hospitals and replace them with community-based care. The consultation ends on 23rd November.

Buckfastleigh Town Council would like to make it clear that we strongly oppose the proposal to close the local community hospitals, including Ashburton/Buckfastleigh. We feel that they are a vital part of local health provision and would like to see instead community hospitals that are properly resourced and integral to the health care provision for the area.

Our objections to the current plans include the following:

1. Proposals are driven by financial considerations not care quality

The consultation documents make it quite clear that the primary motivation for the changes proposed by CCG is not to prioritise the best interest of patients and their health care but to cut costs. The overriding concern is to help cut the CCG’s deficit by £20.5 million this year as part of a program of ongoing cuts until at least 2020/21.

It is suggested that some of the money saved due to the cuts in hospital provision will be put towards providing more resources for care in patients’ communities, but our concerns are that…

  1. in the absence of any detailed specifications of the proposed improvements to community-based services, will these in the end actually be put in place, and…
  2. in the absence of any guarantees or ring-fencing, any funding put into improved community and home-based care, being less high-profile than hospital closures, will be easier to target in inevitable subsequent rounds of cuts.

Either of these likely scenarios would result in our communities being left with reduced and inadequate provision and result in poorer health and more deaths.

In their justifications for the proposed cuts, the CCG have stated that the explanation for their deficit is that this area is ‘taking more than it’s fair share of NHS funding’ and that changes need to be made to reflect the increasing financial demands on the NHS due to factors including ageing populations. However, to put this the local figures into context, 75% of NHS service providers UK-wide are now in deficit, with the overall NHS deficit having risen 300% last year – during which time waiting times have increased and performance targets are not being met.

In the light of this bigger picture, the reasons given for the local deficit are clearly inaccurate and any response should be evaluated in the context of the primary causes, which we suggest are a chronic under-funding of the NHS by the government and the misspending of public funds by increased out-sourcing of health services to the private sector (for example the £3 million plus annual ‘rent’ for the PPI hospital buildings at Newton Abbot).

2. Proposals are driven by political motivation not care quality

The proposals for replacing the care provided currently by community hospitals involves a desire to ‘stimulate care home/intermediate care market’ i.e. the private care sector. In other words some percentage of funds would be diverted from the provision of healthcare to profiting business.

With hospital provision provided entirely by the NHS, any investment can be committed completely to patient care. It is in our view unacceptable to attempt to replace this with services provided by the private sector, whose primary motivation is making profit for owners and share-holders in addition to providing an acceptable level of care. This can only be less cost-effective and result in the erosion of conditions of work for staff, levels of staff expertise and therefore quality of care. What we see here is another example of privatisation of the NHS by the back door.

The loss of some of the little remaining good, long-term employment left locally and its replacement by fewer, more insecure, lower-paid and lower quality jobs providing care at home or in care homes, also has a detrimental effect on our community, which is not being taken into account.

3. Alternative resources are not available or not sufficient

  1. Nursing/Care home provision
    The proposal is that some of the beds lost from hospital closures and cuts will be replaced by provision from private care homes. There is however, a lack of nursing/care homes in this area and nationwide the sector is in crisis.
    A major stated justification for closing the community hospitals, is that it is not cost-effective to support the necessary nurse-to-patient ratio of 6 to 1. If, because of the proposed hospital closures, patients are moved to private care homes, they would in many cases experience a patient to nurse ratio of 25:1 or lower. We feel that this is therefore not an acceptable replacement.
  2. Home Care
    The proposals emphasise research suggesting that many patients would prefer to be treated at home rather than hospital and suggest providing home rather than hospital care wherever possible. We would suggest that it is likely that this research does not specifically apply to community hospitals, which in our experience are far more friendly and welcoming environments than larger hospitals far from home.
    The proposals for more comprehensive home health care rely on a functioning and effective social care system being in place in the community. We believe that this is far from the case, with social care provision also in a chronically underfunded state.
    However, we wholly support suggestions for improvements to home-based health care provision but feel that this should be in addition to the existing community hospitals, not a replacement for them… For many sick and/or elderly people, who might be living alone in homes that are in a poor state of repair or are damp or inadequately heated, home treatment may very well not be the healthiest environment for their recovery and well-being. The local community hospitals are far better placed to provide this.
  3. End-of-life care
    It was suggested by the panel at public consultation meetings, that the end-of-life care which is a considerable part of the work carried out in community hospitals could be provided by the charitable sector. Rowcroft Hospice in Torquay is a major provider, typical of the very few ‘local’ charitable providers who are also under serious financial stress – it has cut services drastically this year, struggling with a £1 million short-fall in funding.
  4. Transport to major hospitals
    Transport within the rural parts of South Devon like Buckfastleigh is difficult, with public transport provided by infrequent and restricted bus services. For example, to get to and from Torbay Hospital to Buckfastleigh involves two buses and 2 to 3 hours travel, the cost is high and the travel times are very restricted. The suggestion made by the CCG panel is that transport can be provided by voluntary services like DASH & ‘Sharing Buckfastleigh’ – these journeys are however prohibitively expensive for many patients, with a round trip costing over £15 – a significant sum for patients and their families.

It is unreasonable and impractical, in our opinion, to expect already-struggling charities and volunteer-run organisations to pick up the shortfall in provision currently served by statutory bodies.

4. The consultation process is not fit for purpose

The consultation is not being conducted according to the Governments consultation principles and fails the test on four of the 11 principles that it should meet. We also feel that the consultation questionnaire is unfit for purpose.

These are the 4 principles that are not being met:

  1. Do not ask questions about issues on which you already have a final view.
    The CCG consultation documents state quite openly that it plans to close four community hospitals (in Ashburton/Buckfastleigh, Bovey Tracey, Dartmouth and Paignton). Indeed, staff these hospitals have been told that they should look for other jobs. No alternative proposals have been put forward for public consultation.
  2. Give enough information to ensure that those consulted understand the issues and can give informed responses. Include validated assessments of the costs and benefits of the options being considered when possible.
    There are virtually no specifics about what the closures will be replaced with. The documentation is very vague, with no detailed costings provided at all, just some headline figures. There is no assessment of benefits or consequences of the proposals, nor is there a detailed assessment of patient needs.
    There is actually a section on ‘Money’ in the FAQs but it doesn’t include a single figure – not one – just vague statements about budgets and whether they have looked at costs.
    The only specific commitments are to put x-ray machines in Totnes, Newton Abbot and Dawlish minor injury units. Other than that there is vague talk of more community staff, well being co-ordinators, investing in clinics – but no specific numbers of staff by job description, no detailed costings and no current or future detailed budgets.
  3. Consultations should last for a proportionate amount of time
    This consultation closes on 23 November 2016, five weeks after the final public meeting. Given that the CCG states that it will go ahead with its proposal unless the communities affected can produce more appropriate plans, and given that virtually no data has been provided to create a plan for a complex requirement, this clearly does not give enough time for communities to respond. Many of those who would be in a position to analyse costings and propose alternative plans have full-time jobs and other commitments and to expect people to be able to produce a well-research, fully costed plan for healthcare for a large and diverse community in such a period is clearly not realistic. Indeed the CCG has said that it has taken two years to produce its plan and it has all of the data and numerous full-time staff.
  4. Consider targeting specific groups if appropriate. Ensure they are aware of the consultation and can access it.
    There has been very little publicity regarding the consultation. The CCG has not publicised the public consultation meetings by use of posters in towns affected. The principle is to ‘ensure’ people are aware of the consultation, yet the CCG has done very little to promote the process.

Consultation Questionnaire

We believe that the consultation is fatally flawed by the inclusion of the consultation questionnaire as a primary feedback mechanism as we consider it is not fit for purpose.

It is clearly manipulative and is designed to garner responses that the CCG wishes to see rather than to poll the genuine views of residents.

The format is in clear breach of the Market Research Society (MRS) code of conduct and, although the CCG is not a member of the MRS, it is reasonable to expect a publicly funded organisation to conduct research according to the highest professional standards, especially when it concerns such important decisions as the future healthcare of a large population.

For example, there are many instances of leading questions in the questionnaire, however, the most blatant is Section 9:

If the choice is between:
Using resources to keep open community hospitals which look after people from across the CCG area
Using the resources to expand community health services by recruiting trained nurses and therapists to help keep people healthier, out of hospital and supported closer to their home
Do you agree that it is better to do the latter? Yes No

The first of the two options is framed at best as a neutral statement. It does not suggest that there would be any improvement to the health of people – they would simply be looked after.

The second option is full of positive messages and lots of very active words: ‘expand’, ‘recruiting’, ‘trained’, ‘healthier’, ‘supported’ and it includes mentions of ‘nurses’ and ‘therapists’ and ‘home’.

It then invites the respondent to agree with the statement. To disagree would be much more difficult here, because it would be suggesting that the respondent is being in some way irrational in not agreeing with this expert suggestion.