The Future of Local Health Services in Northern Staffordshire
Response to consultation from North Staffs Pensioners’ Convention 12th March 2019
We confirm that we have read and accept the terms outlined within the data protection statement on page 3 of your survey document.
Consultation in name only
· This response is submitted in good faith but, on past evidence, we have no confidence that you will take a blind bit of notice of what we say.
· This whole four year process, from the initial consultation on the closure of Longton Cottage Hospital to ‘My Care, My Way, Home First’, to ‘The Future of local health services in Northern Staffordshire’ has been chaotic and error strewn, which has further undermined the democratic process and destroyed the confidence and morale of front line staff.
· Our local Councils have expressed their opposition to your plans as have all the area’s Members of Parliament but you have ploughed on regardless.
· Without formal consultation you have closed Community Hospital beds at a reckless pace thus hampering any attempts to persuade you to adopt a different strategy. You have already closed beds and then you are trying to sort out the implications of that decision afterwards both in terms of services and consultation with the public. Throughout, you have been intransigent and inflexible – you have stated that temporarily closed beds will not re-open so how is consultation meaningful?
· After ‘My Care, My Way, Home First’ was referred to the Secretary of State by Stoke-on-Trent City Council, the report of the Independent Reconfiguration Panel (IRP) was damning in its criticism of your whole approach. It stated ‘Throughout all the work done so far…legitimately interested parties have sought assurance about how the CCGs would make My Care, My Way, Home First work in practice. The panel considers that this consistent and reasonable holding to account has at no point yet been met with a proper and adequate response from the NHS.’ ‘The myth of temporary closures is reinforced by the NHS confirming that they have no plans to reopen the beds and that their financial plans for the last two years rely on almost £10m of savings from bed closures’. Despite the change of name from ‘My Care, My Way, Home First’ to ‘The future of Local Health Services in Northern Staffordshire’, in our view nothing fundamental has changed since then. The comments of the IRP still hold true.
· Despite the various periods of ‘consultation’ and ‘engagement’ that our members have participated in over all that time, nothing that they and others have said and none of the evidence presented to you has caused you to adapt your plans to any significant extent. For instance, you proposed to close 132 beds in 2017 and that figure has stayed the same from then on.
· You have stated that no decisions have been made on the future of Community Hospitals ahead of the consultation but every option you are putting forward in your document is for 132 beds to close. If you have an open mind, where are the options that deviate from the 132 bed model?
· When councillors or MPs behave in an arrogant and high handed manner and ignore the vast majority of the people they are there to represent, the electorate have the opportunity to remove them from office. Sadly, this is not possible with NHS bodies.
An attack on local communities
· Community Hospitals are at the heart of our local communities. They are valued by local people because they have provided excellent care for them and their families over generations. That is why the campaigns around each Community Hospital are so strongly supported.
· In-patient community hospitals continue to have a key part to play in care for the most vulnerable. Even if all the skills and systems were in place in the community we believe there is still a need for many more Adult Inpatient Rehabilitation beds than the 132 you are proposing.
· The impact of your reckless closure of Community Hospital beds has already been felt across the local Health system – particularly on the Royal Stoke Hospital and waiting times at the Accident and Emergency department. High readmission rates for complex discharge patients in our area, the repeated re-opening of Bradwell for Medically Fit for Discharge patients when the system reaches crisis point, the publicly expressed concerns of senior UHNM staff and individual cases of system failure such as those of Hazel Nutt all demonstrate that more beds are needed.
· Your preferred option would mean the number of community hospital beds would be cut from 264 to 77 with an additional 55 being provided in care homes. This is a huge reduction and such a savage cut will put, and is already putting, vulnerable people at risk.
· Our belief is that your plans are not based on patient need but on the drive to cut costs and are unsafe.
Community Hospitals not Care Homes
· All the commissioned beds should be provided by properly equipped and staffed NHS Community Hospitals not private care homes. In contrast to NHS Community Hospitals, care homes are not set up to provide rehabilitation. Also, the longer a patient stays in a care home, the higher the home’s income so there must be the chance that some care homes will be tempted to keep patients for longer than is necessary. The standards in care homes are often inferior. To improve the quality of rehabilitation in care homes it has been suggested that teams of NHS staff could go in. We say - why on earth not just bring the teams of staff into NHS Community Hospitals?
· Your stated policy says that all beds commissioned in care homes should be in homes that are considered ‘good’ or ‘outstanding’ by the Care Quality Commission (CQC). The trouble is that, in practice, you have commissioned beds in Brighton House – that found Legionella in the water pipes, and Stadium Court that was deemed inadequate by the CQC and closed to new entrants. At present, you commission beds from Bradwell Hall, Rowan Court, Goldenhill and Lawton Rise – all of which require improvement. Of 86 beds that you commission from the independent care home sector, 51 are in homes that require improvement. This is a complete failure to safeguard the people in your care. Even if the system was tightened up, standards in care homes change quickly. When the pressure is on to move somebody out of the acute hospital, can you really say that the proper checks will be made and that individuals will be being moved on to a place of safety? Contract levers as a method of ensuring quality and safety are protracted processes, reactive not pro-active, and are inadequate in ensuring quality and safety.
The Cost of Community Hospital Beds
· Across the UK NHS Community Hospital beds cost an average of £1,800 a week each. Why are you paying £2,100?
Step up as well as Step down
· Real integrated care should have step up (from home into an Adult Inpatient Rehabilitation bed) as well as step down (from an acute hospital into an Adult Inpatient Rehabilitation bed) and was part of the original proposals in ‘My Care My Way Home First’. Has this now been kicked into the long grass? What will happen to people who need a short period of bed based rehabilitation to prevent a stay in an acute hospital? Real integrated care should address the needs of the vulnerable both after a stay in hospital and to prevent a stay.
Care services in the home
· If asked, of course people would say they would prefer to be cared for at home rather than in hospital but they would want to know that they are safe.
· And some would benefit from being looked after at home. However, you have been implementing the policy you are supposedly consulting on for over 4 years and you have completely failed to convince us that safe and effective care is replacing NHS community hospitals.
· Your plan requires intensive skills to be in the right place at the right time. It requires co-ordinated and effective multi disciplinary teams in the community with all the appropriate skills.
· There are shortages of Social workers and domiciliary care workers. The social care system continues to be in crisis.
· There is a significant shortage of all appropriate skills – fully qualified and trained district nurses, tissue viability nurses, community nurses, community mental health nurses, community geriatricians, General Practitioners, pharmacists, physiotherapists, Occupational Therapists, speech and language therapists, podiatrists, dieticians, liaison psychiatrists, liaison mental health nurses etc. A practical strategy would need to employ all these disciplines.
· Cases that we have shared with you in the past and the recent experience of Hazel Nutt (See Sentinel Editorial at the end of this document) and others demonstrate that the theory of safe discharge into the community and ‘Discharge2Assess’ (D2A), does not match with the practice.
· Re-admission rates for complex discharge demonstrate that D2A in this area is not working. In the last 12 months the 30 day readmission rate when discharge to home care is 21% and 90 day readmission rate is 33%. This is considerably higher than the national average.
· Services should never be set in stone. If, in the future, you could convince us that effective rehabilitation services were in place in the community to replace beds in NHS Community Hospitals and, consequently, readmission rates were to improve, we would accept some movement away from the community hospital based model of care. However, it is clear that this is not yet the case.
Integrated Care Hubs
· We agree with the integrated care hub concept. But when will these services come on stream? New build is intended. It is not clear how you going to ensure that the services will be introduced without an adverse impact on the most vulnerable and the morale and effectiveness of the workforce.
An attack that goes to the heart of our NHS
· The North Staffs Pensioners’ Convention (NSPC) is a broad church. We have hundreds of members from across the political spectrum. However, whatever their political differences, they are all passionate about is our NHS. Your abandonment of Community Hospitals without the provision of effective services for people in their own homes is seen by NSPC members as an attack that goes to the heart of our NHS and is putting the safety of all who rely on these services at risk. We urge you to think again.
Please find below the Sentinel editorial on the case of Hazel Nutt – Friday 18th January 2019.
‘Hazel’s Case shows NHS still has a long way to go
In 1951, Aneurin Bevan, the architect of our NHS, resigned from Clement Atlee’s government in protest at plans to introduce prescription charges for glasses and dentistry.
Quite what the fiery Welshman would have made of a 78-year-old grandma having to pay £1,000 of her own money for two weeks in a residential care home is anyone’s guess.
But that’s what happened to Hazel Nutt just days after she underwent heart surgery at the Royal Stoke University. Hazel, who lives on her own, forked out the cash so she wouldn’t have to return home when managers overrode her protests after she was assessed as fit to be discharged.
As she says in today’s newspaper: “The operation and intensive care was very good. But once I got on the ward I got the impression that all they wanted to do was get you out.”
What a sad indictment that is of our NHS in 2019. But the money is not the only troubling aspect of Hazel’s ordeal. On her second night at the care home she suffered a fall. Being in a home meant that the response was immediate, but as she points out: “If I had been at home alone I could have lain there for hours or days before anyone came.”
Such a scenario is frighteningly plausible, because, as Hazel says, no assessment of her home had been carried out before she was discharged.
Luckily for Hazel, her GP put her in contact with Home First – the NHS-run service that provides personal care for people ‘clinically fit’ for discharge. – which provided her with daily carer visits and fitted handrails at her property.
But perhaps the most worrying aspect is that North Staffs Pensioners’ Convention is ‘not surprised’ about Hazel’s treatment after her operation.
Her case does indeed throw light on the pressures facing our acute hospitals, and reopens the debate over the future of care beds in our community hospitals.
Readers will know this is a subject The Sentinel has investigated at length. We have heard it said many times how the best place for recovering patients is in their own homes..
But Hazel Nutt’s experience once again demonstrates just how far we are from being able to put that ideal situation into practice.’