Dr John Womersley: 'People would like to be cared for in own home'

Rebalancing community care in North Devon

(by Dr John Womersley)
Over the past two years we have been talking to people in North Devon and Torridge about community healthcare services. Generally people are happy with local services; a fact that is backed up by an inspection by the Care Quality Commission inspection which rated them as ‘Good’.
People also said they would like to be cared for in their own home, rather than in hospital, if it is clinically safe to do so; that is no different to what people have said in the rest of Devon and indeed the rest of England.
Most importantly people tell us that when they are near the end of their life they want to be in their own home, close to their family, and not in a hospital bed.
The plan that addresses these requests from people to transform community services is called ‘Care Closer to Home’. We want that care to be clinically and financially effective while also being safe and a good experience for those who need to use it.
To discover what works well local GP’s looked at national evidence and what is already known from the experiences of those who provide services here at present.
We then looked at what benefit increasing services would provide. We noted that increasing services for people still at home helped to prevent illness and that when people did fall ill they could be quickly supported.
This particularly applies to frail, elderly people and those with complex, long-term conditions. There is clear evidence that focusing on community services reduces the number of people reaching the point where they need admission to hospital and that fewer people need to enter residential care. Stroke services have not been part of this review.
When we judged what we have now against what we felt would improve care for people in Northern Devon (taking into account our growing elderly population and our rural geography) our unanimous conclusion was that the balance of services is not right.
We have too few local community services and too many community hospital beds; some beds are used for services that should properly be provided to patients at home and other beds are incorrectly used for social care instead of nursing or medical problems.
Our budget is only for healthcare services and at present they are costing more than our allocated fair share of NHS funds.
There is no doubt that providing care in small units is expensive; each bed in an 8 bedded unit costs £75,000 per year against each in a 24 bedded unit costing £46,000.
None the less we calculate that we do need about 40 community beds for people who are too unwell to be looked after at home but do not need the full range of services at the more expensive acute hospital in Barnstaple.
Concentrating the beds in larger units is obviously better use of taxpayer’s money and will release funds that can then be used for increased services in district nursing, physiotherapy, rehabilitation and other primary care services.
Having decided how many beds correctly meet northern Devon’s clinical needs the next decision is where those beds should be situated.
We are going to discuss this further with local stakeholders to discuss and fully appreciate the many issues involved. We will not rush this because we want people to trust the service changes we are making and fully understand the final decision.
We also need time to carefully plan the increase in community services needed to replace the beds we are removing.
Lastly, we want to work with the voluntary sector to help tackle social isolation and other issues that affect people’s health when at home.
There are many factors that could help decide the right location for beds: they include local levels of health and illness, the number of older people, standards of accommodation, being able to easily recruit staff, social care provision, housing, deprivation, access, social isolation and transport.
We will consider all these along with the cost of any changes, clinical safety data and value for money. The organisation that presently provides the services will have a view, as will local councils and the public generally.
We appreciate that people want a quick answer but as the solution will not be agreeable to everyone we want to spend a bit more time before making this decision. Following that our ‘Gateway Process’ will begin; this is our list of services that must be securely in place, safe, sustainable and deliverable, before we can proceed to reduce bed numbers.
Clinical experience and evidence has convinced us that this is the right model for the future and we will ensure we get the right balance of community services in the right balance, in the right place and delivered by staff with the right skills.
Dr John Womersley
Chair – Northern Locality
NHS Northern, Eastern and Western Devon Clinical Commissioning Group

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