The North Derbyshire and Hardwick Clinical Commissioning Groups (CCGs) in July agreed controversial proposals for changes to community health services in the north of the County, which include closing older people’s mental health beds in the Cavendish Hospital in Buxton (as well as Newholme Hospital in Bakewell). A specialist older people’s mental health inpatient service will be developed in Walton Hospital (in Chesterfield), along with the development of ‘Community Dementia Rapid Response Teams’ intended to provide care for patients in their own homes.
Also included in the proposed changes are a phasing out of provision in the Cavendish Hospital for older people with ‘functional’ mental illness (that is mental illness other than dementia), with the service being transferred to Stepping Hill hospital. ‘Intermediate care’ beds in community hospitals in Bolsover, Clay Cross, Newholme and Whitworth hospitals will also close, with the development of a specialist rehabilitation service with beds in Chesterfield and Cavendish hospitals, ‘beds with care’, and an ‘Intermediate Care Service’ to provide more domiciliary care.
Why is change thought to be needed? There are three main reasons.
The need for health care is steadily increasing, particularly the need for health care for older people. This is primarily as a result of people living longer, and with that there being a steady and significant increase in the number of old and very old people, among whom, of course, dementia and other illnesses are more common.
It is thought that there is too much emphasis on bed based care, poor integration of services, and a lack of specialisation where that could lead to better outcomes for patients. So even if there were no increase in demand, and no shortage of resources, the arguments for change would still be strong.
The NHS budget (determined of course by the National Government) is static. Although it is not being cut in the way that budgets for many other public services have been, it is nevertheless not increasing in the way that is needed to meet pace with increased need. At the same time the social care budget (paid for by Local Government but dependent on National Government funding), is being cut back significantly. The result is that it is anticipated that there will be a £219 million gap between Derbyshire’s projected health and social care budget in 2020/21 of £1,914M, and what would be needed to fund services if they do not change.
When the CCGs put these proposals out for consultation, they met with a lot of criticism.
Many people were concerned about the closure of beds in community hospitals (including the complete closure of Newholme and Bolsover hospitals), as well as a real concern that alternative services (‘Dementia Rapid Response Teams’ and ‘Intermediate Care Service’) would either not be developed, would not be developed in time, or would not be good enough to replace the services lost. In response, the CCGs have given a commitment that no services will close until appropriate alternatives are in place.
What are we to make of these changes?
From a Green Party perspective, a number of things are clear.
The crisis in our health and social care system is primarily caused by the Westminster Government’s failure to provide the necessary resources needed to cope with increasing need due both to the increase in the number of old people with high care needs and the increasing range, complexity and expense of interventions (drugs, operations, devices) that are now available. This is clearly linked to the Governments failed ‘austerity’ agenda, and their misplaced priorities.
The other major failing of both the Westminster Government and local councils has been the cutting of public health (prevention) budgets in recent years. Good public health programmes prevent ill health and disability and so reduce the need for health and social care. Since the transfer of public health to local government in 2013 public health budgets have been cut, and the damage further exacerbated by siphoning off public health funds to pay for things previously funded by local government. Major opportunities to improve health and reduce the need for expensive care have been, and are being, lost.
However even if more money were available, services need to change.
One vital consideration that appears to have been missing in the CCGs deliberations and consultation has been the overall impact on the environment of the proposed changes.
If any environmental impact assessment was undertaken, it was not published. Some attempt was made to assess the impact of changes on travel times, and it is claimed that although some patients, and more particular carers, family members and other visitors, will have to travel further in the new arrangements, this is offset by the reduction in travel for people who will have care delivered in their own homes. What is not clear is what the overall impact of increased travel for staff delivering domiciliary care will be, and how the closure of hospital beds, and whole hospitals, will impact on carbon emissions overall. Ideally, any changes that do require increased travel, even if only for a minority of affected patients and visitors, would be combined with a review of public transport to make sure that visitors can get to wherever services are moved to. This does not appear to have happened, though it is not too late to do that now.
Greens should support service changes that support independence (and help to restore it when lost), and equally should support changes that bring care closer to home, as these are intended to do. But that should not come at the cost of a reduction in the quality of the care provided. It is imperative, therefore, that the CCGs are held to their commitment that no services will close until appropriate alternatives are in place.
We should also prioritise the welfare and interests of the staff who work in the services. Recruiting and retaining staff has become a major problem for the NHS. Staff have had below inflation pay increases for some years, effectively pay cuts, and the EU referendum result has led to a big fall in the number of nurses and others wanting to come to work here. More than any other section of the economy, health and social care depends on the dedication and commitment of its staff, so any changes must be managed with, rather than imposed on, the staff who have to deliver it.
Managing and modernising health services is always challenging, and never more so than when resources are inadequate and staff morale is low. But services have to change, and the CCGs’ proposals are reasonable. What is critical now is that the promises made with regard to implementation are kept, and no services are closed until better alternatives are in place. The High Peak Green Party will be holding North Derbyshire CCG to account to make sure they deliver this.