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Mr J Richards, Chief Executive
SW Hants PCT Alliance
8 Sterne Road
Tatchbury Mount
Calmore
SO40 2RZ
Our ref: MK/MJ/letters
Date:
23 September 2005
Dear John
At our most recent meeting, the District Council Cabinet
considered your consultation report on Community Services
for Older People. The meeting was joined by a host
of eminent members of the public, including the medical
and nursing profession, who spoke knowledgeably on the
topic and whose views are reflected in our response.
Process
Notwithstanding the high profile public meetings on this
topic, there is still concern that the timescales involved
have done little to reassure the public that alternatives
to your proposals will be given the consideration they
deserve. I will say at the outset that this Council
is utterly opposed to any of the options proposed in
your consultation document and fully supports the public
outcry this has evoked. We do appreciate that your staff
have put in considerable effort to produce the consultations
and attend public meetings on the subject. However, we
understand that local GP’s do not feel that they
were consulted at any level until the public consultation
took place. They are the main providers and users of
the services under review. Lack of consultation with
them seems to be a major failing of this exercise. Whilst
they continue to express concern about the current District
nursing situation, they fear further deterioration of
the service due to another reorganisation.
Financial
I will begin our comments with concern over the costings
of your proposals. There are inconsistencies, a
general lack of information justifying the action and
therefore a fundamental lack of confidence. For example,
the bulk of maintenance costs of £1.9m listed on
page B became £7.7m by page 38.
- It is generally considered fair to say that the cost
of home care is substantially more than that of community
hospital care. Given the size of your deficit and
your intention to redeploy staff (p39), we have reached
the conclusion that almost all your savings will need
to be found elsewhere. Our understanding from your consultation
papers is that closing Milford and Fenwick hospitals,
for example, could save running costs of the order of £0.6m
(before allowing for the substantial contribution made
by The League of Friends to the running costs). This
seems out of all proportion to the total savings you
need to make in terms of either your deficit or as a
percentage of your gross budget, as it is a relatively
insignificant amount of money in relation to the overall
disadvantages which we list in the paragraphs that follow.
- It, therefore, makes no sense to inflict such painful
and unacceptable changes on our communities for such
little financial benefit. It would be helpful to
receive your view of the savings arising from this report
as a percentage of your budget.
- The community has understandably developed a strong
sense of ownership over its community hospitals. They
are in every sense a community asset, originally provided
by public subscription and annually supported by volunteer
groups, who have spent years raising money to ensure
their continuance. We wish to know what will happen
to the assets released should your proposals be implemented.
If we are unsuccessful in our attempts to prevent this
going ahead, we want assurances that it would result
in reinvestment in new and appropriate services. We look
forward to your answer to the question raised and your
detailed proposals for reinvestment?
Service Model
- The public and the Council, equate closure of beds
with eventual closure of hospitals. It is a link
that everybody, reasonably, makes. We all know
that under many circumstances people prefer to remain
in their own homes and indeed our own housing policies
are moving in that direction. However, it must
be recognised that home care services are only to be
recommended where the patient retains a large degree
of self help and independence; usually the younger age
group. Older people take longer to recover from
illness and do so better in community hospitals than
they do in hospital older people wards. We are
at a loss to understand how you feel that the home care
services can begin to deliver a similar service to those
patients who have short or critical interval needs. Community
hospitals provide the services that are needed for an
ageing population where immobility, instability, incontinence
and intellectual impairment are difficulties to be overcome
and managed.
If you are insisting on setting up a new model of care
the bed closures should not go ahead until the Community
Service Model is fully operational.
- By their very nature home services are routine and
therefore inflexible and can be unresponsive; e.g. older
people requiring assistance to dress for bed often find
themselves receiving the required care visit during the
very early evening. This does nothing to aid recovery
and give the patient the feeling of control over their
life.
- Absence of these beds will undoubtedly lead to delayed
discharges from acute hospitals, or worse still will
lead to inappropriate discharges, both of which will
result in a marked deterioration in the standard of patient
care.
- The document fails to explain the strategic fit of
these proposals with, for example, the Lymington Hospital
Strategy, the Clinical Strategy, the new Out of Hours
arrangements or the alterations to the Southampton City
community schemes. Your arguments are, therefore,
unconvincing. Key to any change would be the links
with Social Services, but the proposals fail to give
any detail on how the Alliance proposals fit with Social
Services care provision.
- We would point out that the network of community hospitals
is clearly no accident, but their location assists greatly
the access communities have to local resources. Any
disruption to that will provide greater difficulties
for people, particularly those with poor transport links.
Staffing
- Our soundings would suggest that your confidence in
being able to staff the shift to home care is misplaced. On
the one hand, Health Visitors and School Nurses are under
threat of redundancy through reorganisation, on the other
you will need more nursing staff and cover to cope with
the change. It is inconsistent, to the point of
being worrying. It is our view that the morale
of district Health Visitors and Nurses has never been
lower, which in time will lead to difficulties in your
ability to deliver the improvements in health care that
we need.
- We question the support these proposals have amongst
those people that will have to make them work e.g. GPs
and District Nurses. We have received representations
which indicate a high level of concern amongst this group. At
a time when the configuration of PCTs is once again under
review and the NHS is developing its “Commissioning
A Patient Led NHS”, it is folly to reduce the options
available to GPs for treatment services.
- The ageing population of the New Forest will require
a complete range of services, in addition to those which
could be offered by acute hospital services proposed
in Lymington, or the proposed services offered by the
Home Care Team. In this connection, we have evidence
that we have lost over 700 care home beds due to property
development and stringent new requirements onerously
placed upon the private sector. As a response, Hampshire
County Council will be providing 80 new beds in the New
Forest and expecting the private sector to pick up any
slack. This will simply not be adequate and there will
be an additional strain on our community services in
many aspects of older persons care.
- We wish to point out the recent world events that have
demonstrated how difficult it can be to respond to civil
emergencies and disaster recovery. Removing these hospitals
fetters our ability to find adequate responses to such
situations
In summary, the Council is of the view that you are on
the point of destroying an irreplaceable system of well-run
small hospitals, which are providing vital services to
people who are too ill to be at home. You are proposing
to close hospitals at a time when they are needed more
than ever.
Care at home is a fine principle for those for whom it
is appropriate and with effective Social Services links
it could be built to add another effective arm to local
services, but it cannot be at the expense of our Community
Hospitals.
If the real drive for this has anything to do with the
financial difficulties the PCT finds itself in, then it
is a terrible price for the community to pay for the supposed
financial improvement of our local health services.
Our Council has an all-party unity on this issue and considers
itself to be representing the strongest possible objection
on behalf of the community it represents.
Yours sincerely
Cllr Mel Kendal
Copies to:
Julian Lewis MP
Desmond Swayne MP
Sandra Gidley MP
Senior Partners of the GP practices in the New Forest
Dr Raymond Ellis, Hampshire Health Scrutiny |
