Mel Kendal, leader of New Forest District Council

Mr J Richards, Chief Executive
SW Hants PCT Alliance
8 Sterne Road
Tatchbury Mount
Calmore
SO40 2RZ

Our ref:   MK/MJ/letters

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