When is a Hospital not a Hospital
Dartmouth had accepted the loss of its decrepit, no-longer-fit-for-purpose but revered old cottage hospital, and agreed the rationale of moving it up the hill to Townstall in return for a new bedded hospital unit (and clinical services). That assurance now turns out to have been a lie. We learn now from the CCG last week that Dartmouth Hospital is to close reflecting their interpretation of a skewed consultation process and their own claimed researches – and of course the CCG’s own predetermined decisions regardless ... Dartmouth Hospital is down-graded to a Health and Well-being Centre as if that, in today’s platitudes, will keep patients out of hospital or needing a bed for a while – eg post-op, end-of-life, mobilisation …
The new allocation at Riverview of 4 beds is a travesty and based upon an entirely untried new clinical care model that assumes that hospital beds will be freed and even intermediate beds will no longer be needed – everyone can be cared for at home. The claim of money saved by substitution of the new Care Hubs and teams nicely ignores the costs of the new and necessarily augmented Care teams – if that is they are trained and in sufficient numbers and resourced to provide the comprehensive home care that is still only defined in platitudes. The clinical carers are not yet defined in terms of qualifications, skills and availability. So what will be the real cost?
Despite all these uncertainties the CCG is apparently able to base all its community care planning on a drastic reduction in beds, transferring care to the community teams.
It is impossible to reconcile an isolated 4-bed unit as is now planned for Dartmouth as a reasonable substitute for our 14-bed cottage hospital – as was understood to have been assured. It is irrelevant that as detractors claim some patients come from outside Dartmouth – they still need beds. Such a unit will be too small to be viable as a hospital and will be wholly inadequate for local needs. This duplicitous, ill-informed decision – passed through the CCG on the nod - demands revision and the benefits not of hind sight nor optimistic wishful thinking but simply honesty and common sense that sadly seems to be absent from the CCG agenda – driven as it is seemingly by foregone conclusions and false assumptions.
So a Hospital is not a Hospital in Dartmouth – and nor is a 4-bed unit.I hope you will agree this needs and deserves a large dose of reality and a fresh unbiased look – if the CCG is to retain any credibility or local good will. Deeply unimpressed
Comment by Pierre Landell-Mills
Dr Newgass is doing the beleaguered CCG and ICO staff an injustice. After many long discussions with them, I know they have done far more work on the options open to them than he is prepared to recognise. I agree with Sarah Wollaston that they have been forced by the government's reduced funding to make some very difficult choices. But in any event, they needed to make some major reforms in the way health care is delivered locally and the principles and strategy of the new model of care seem to most people to be sound. The issue is whether there are sufficient resources to make it work. Unfortunately the answer is probably not unless the Chancellor is willing to recognise that the cuts have gone too far too fast with the result that we are heading for a monumental crisis in health care. Dr Newgass does no spell out what he thinks should be on offer in these circumstances....what he would do if he were in the CCG's shoes.
We are agreed that the Dartmouth Hospital is not fit for purpose and cannot under any scenario be retained. Faced with this situation we need to think through what it is we really want. The plan to create a new Health and Wellbeing Centre at River View is a real plus. It will provide modern facility where all local health services can be based in a "joined-up" way--surgery, clinics, a base for domiciliary care, pharmacy, and Dartmouth Caring. The 4+ intermediary care beds will be close to the doctors and have nursing care with committed NHS oversight. The NHS Rapid Response Teams are designed to provide the required intermediate home care. And we all accept that it is better for patients to be treated at home if they can be.
The issue is not surely one of programme design, but of the practicalities and affordability of its implementation. These two aspects are linked. The most critical issue at present is the underfunding of social care and an absolute shortage of trained carers. The proposal being promoted by various people in Dartmouth including Dartmouth Caring and the Friends of Dartmouth Hospital in collaboration with the ICO (not mentioned at last week's governor's meeting at Newton Abbot) is to provide a more attractive career for carers by providing NHS sponsored training and qualification, thereby opening up the possibility of career progression into nursing. What is clear is that the locally Community will need to take the initiative in solving the provision of local domiciliary care as well as in promoting more healthy living working with such local organisations ( e.g. Dartmouth Academy).
In short what we need now is some positive thinking about how we can work with the CCG and ICO to make the best of what is being offered (and Dartmouth is being offered far more than the other parts of our locality) and do our best to meet the looming crisis before it overwhelms us. Separately we need to support our MP in campaigning for more public funding for health and social care.
At the same time the CCG needs to be much more upfront with us about the funding constraints they face and about the calculations they have made regarding the options that we all face. The presentations to date have been very short on hard numbers; these need to be shared with us in a much more transparent way. We are sure that they are not "flying by the seat of their pants" but the proposals could be much more robustly presented if they were backed by evidence-based openly shared quantified analysis.
I hope others will contribute to this blog (send your contributions to firstname.lastname@example.org ), especially onf how best to get those in hospital who need not be there out of hospital and hence how best to provide affordable intermediate and end of life care.