A: As the commissioner of health services across Northern, Eastern and Western Devon (NEW Devon), the NEW Devon Clinical Commissioning Group (CCG) is leading this consultation.
Q: What is the NEW Devon CCG?
A: NHS Northern, Eastern and Western Devon Clinical Commissioning Group, more concisely known as NHS NEW Devon CCG, is the largest CCG in the country. We have an overall budget of £1.1 billion. We serve a total population of 898,523 and cover a total area of 2,330 square miles. Approximately 11% of the overall £1.1billion budget is spent on community services.
Q. Where have the ideas come from?
A. The principles and priorities were set out in the Transforming Community Services programme, and more recently in the Case for Change work of the Success Regime. The proposals set out in our consultation document have been developed by GPs and other clinicians working on the new model of care to address the major challenges facing our communities.
Q: Are the proposals under Your Future Care the same as Transforming Community Services? If not, how are they different?
A: Transforming Community Services is NEW Devon CCG’s plan to provide preventative and personalised support, alongside urgent and specialist care, in local communities. The programme was launched in May 2013 with the specific aim of setting the direction and delivery arrangements to do this. The priorities were set out in the TCS Strategic Framework published in 2014. These were consulted on and many changes have already been made. Since this work, local clinicians have been further developing place-based care for health services, focusing on patients who are likely to benefit the most. These were identified as frail and elderly people, people with dementia and people with long-term conditions affecting their physical and mental health. The aim is to join up care more effectively in some areas so people are not being sent to hospital just because services are not available to keep them at home.
Q: Why do things need to change?
A: The rising numbers of older people with increasing frailty and complexity of health needs means that, whilst there are examples of excellent practice in many areas, the current model of care is increasingly out of step with people’s real needs. Local health services are also under severe financial pressure. In NEW Devon, local health and social care organisations are facing a financial shortfall in 2015/16 of £122m, which will rise to £384m in 2020/21 if nothing changes. At the same time, many people are in hospital beds who could be cared for at home or closer to home. With the right care, people can be supported to be in their own home, and this is our goal.
Q: So are you saying the current system doesn’t work or current services are poor?
A: The NHS in our area delivers generally good care – but not for everyone. In truth, it faces significant problems delivering consistently high quality services within the available budget. Staff work incredibly hard and in some parts of NEW Devon, large numbers of patients are already being cared for in their own homes by health and social care teams, working well together to meet their needs. This standard of care should be available to everyone in NEW Devon.
Q: What are you proposing?
A: In order to deliver this model of care where more people receive proactive support in their own homes, avoiding hospital admissions and getting home from hospital sooner, we need to increase the number of staff in the community teams. To achieve this we need to take the skills, expertise and resources from delivering inpatient care to delivering care in people’s homes.
There are three characteristics of this model of care. People will receive:
- A comprehensive assessment and identification of patients at risk
- Support from a single point of access
- Rapid response to avoid deterioration of people’s health
Q: Are you proposing to close some community hospitals?
A: Clinicians working on the new model of care agree that fewer community hospital beds are needed. In Eastern Devon the number of beds per person compared to Western or Northern Devon, is much higher – even after the growth in the older population is taken into account. Clinicians working on the new model agree that 72 beds are required in Eastern Devon, compared to the current number of 143 beds. Further changes could also be made in Western and Northern Devon in the future as we continue to develop our services to meet the needs of patients. But that is not the focus of this current consultation. This consultation is about the best locations for those community beds in Eastern Devon.
Q: So that means you are closing community hospitals doesn’t it?
A: The removal of inpatient beds from a community hospital is not the same as closing it.
Community hospitals provide a range of different services and the majority of them offer a mixture of day services such as outpatients, clinics, minor injuries or classes. The full range of services often takes people by surprise. These services will continue and are unaffected by this consultation. We do not currently have plans to change the location of these services. The CCG has launched an estates work stream to consider the NHS estate in Devon.
Q: How will you involve local communities in decisions around the estate strategy?
A: Members of the public will have the opportunity to comment on the Estates Strategy at a later date. Under the NHS’s duty to engage, there is a requirement for us to consult if alterations to or the disposal of buildings significantly changes services.
Q: What are the options and is there a preferred one?
The four shortlisted options are as follows - all including Tiverton as the 32-bed hospital:
- Option 3: 32 beds at Tiverton, 24 beds at Seaton and 16 beds at Exmouth (from now on referred to as option A)
- Option 4: 32 beds at Tiverton, 24 beds at Seaton and 16 beds at Exeter (from now on referred to as option C)
- Option 11: 32 beds at Tiverton, 24 beds at Sidmouth and 16 beds at Exmouth (from now on referred to as option B)
- Option 14: 32 beds at Tiverton, 24 beds at Sidmouth and 16 beds at Exeter (from now on referred to as option D)
This consultation aims to gather people’s views and we would welcome other options or proposals which show that they can improve local care, while better meeting the criteria described above. We will make sure that information is available so that anyone who is interested in making proposals is able to do so, and we will fully and fairly consider any further options.
Q: So how exactly will care be different for patients?
A: Over the last 12 months, local clinicians have been further developing the new model of care for health services. Support and care will be provided in peoples’ homes either through home visits or regular checks over the telephone. Where it is beneficial to deliver care in groups, this will enable us to bring more care out to the community – for example dementia diagnosis support groups and carer support groups. Where there are good clinical reasons to treat somebody in hospital, there will always be a bed available for them.