At a time when the state of the nation’s health and social care provision is headline news and with claims of both sectors being “in crisis”, South Petherton played host to a lively public meeting about the proposed Somerset Sustainability and Transformation Plan (STP) on 11th January 2017.
The League of Friends of South Petherton Hospital (LoF) arranged the evening event in order to provide a forum for our community to learn about the aims of the Somerset STP and to foster open discussion amongst those present. The evening was launched by Helen Chaloner, chair of the LoF, who welcomed those present and provided a summary of the background to the STP:
“The Somerset STP has been developed jointly by the leaders of Somerset’s hospital, community and mental health organisations, Somerset County Council and Somerset Clinical Commissioning Group. It outlines huge changes to health and social care in Somerset, including reducing the number of community hospital beds. We organised this meeting to increase public understanding and enable people like us to participate effectively in any public consultations about the STP that may happen.”
The audience then heard a presentation from Dr. Nick Broughton, Chief Executive of Somerset Partnerships NHS Foundation Trust, followed by Open University lecturer Geoff Barr, who is also Governor of Royal Devon and Exeter NHS Foundation Trust and a member of Keep Our NHS Public.
As a principal author of the Somerset STP, Nick provided an overview of the plan and summarised its goals. Nick started by stating, “I’m aware that to date, for a variety of reasons that have been outside the control of people like myself, the extent of public engagement has been rather limited.” He went on to explain that Somerset’s STP is a response to NHS England’s vision for healthcare; “the principles of which are the integration of physical and mental health services, of primary and acute services, and of health and social services. We have a lot of organisational barriers in our health and social care today…and having a lot of divisions is not good for ensuring that patients have the best possible outcomes. Essentially the STP is a plan to ensure that we have health and social care across the county of Somerset which is sustainable. It is about how we can collaborate better together in the health community, in the social care community, within the third sector and within the wider community that we work in.
“The plan that you have in front of you today is very much a plan for a plan. It lacks a lot of detail, it provides a direction for travel – a vision going forward. The task now is to develop that detail…Change is difficult and unpopular when it comes to the health service…People ask ‘why isn’t the government giving us more money?’, the fact is they’re not. We have to make do with what we have to ensure that we maintain and improve the quality of care that we are providing to you and to the rest of the county… We have real difficulties with recruitment and retention of our workforce, GPs for example. Our GP population is also ageing and we anticipate that 30% of our GPs may retire. A challenge for us is how to provide high quality care across the county. Historically, there has been a lack of investment in prevention and health promotion, and a lack of investment in out of hospital care and mental health services.
“In Somerset we have 13 community hospitals. There aren’t many counties in the country that have as many community hospitals as we do, Dorset is one, [as well as] Devon and Cornwall. Because we have been investing a fair amount of money in our community hospitals we haven’t been investing as much as we should have done in things like district nursing, health visitors, in the services you need to be able to support people in their own homes.
“We hope the STP will enable us to provide a far more joined up approach to care needs… about delivering personalised care. The STP is about us working as one system. Many of you will think this is obvious and ask hasn’t it been happening already? The sad fact is that it hasn’t. The organisation I’m responsible for has been operating in a fair bit of isolation from the others… The legislation that led to the setting-up of Foundation Trusts encouraged competition between Foundation Trusts. We’ve now moved away from that.
“What we want to do is provide far more comprehensive services to people in their own homes. Hospitals are not particularly healthy places to be. The chances of catching an infection are far higher in hospital than they would be in their own home. If you are in a hospital bed, or any bed, for a week you will lose muscle mass, the more muscle mass you lose it will be more difficult to remain independent. You are more likely to fall in a hospital ward than you are in your own home. There are significant risks afforded by being in hospital.
“We need to make our acute services better, more sustainable. We need to use our resources that we have in our two acute hospitals more effectively. There maybe some services that are currently provided on two sites which we should only provide on one site, as we’ve only got the resource to provide it on one site.
“We are on the start of a journey. We are on the start of the process to populate the plan and we hope to go out to consultation with you and with the wider community during the course of this year. The consultation document will set out principles and the direction of travel, and it’s for us together to think about what the details should look like.”
Geoff offered a different perspective, one that positioned the Somerset STP – as well as those in Devon and Cornwall – as a ‘fantasy’. At this point it should be noted that both speakers were passionate advocates for the NHS and support integration between England’s health and social care provision. Where they differed significantly, and openly disputed each other’s claims, was on how to achieve integration that provides excellent and affordable* services for all citizens. The public meeting was made much richer and more informative by the presence of these opposing views. Geoff’s presentation started with his experience in Devon:
“Devon is a bit ahead of Somerset, we’ve had a lot of consultations and despite not being from Somerset, I’ve got an idea of where things are going. Some key issues first: Nick’s ideas are very good, the trouble is that I think they’re a fantasy. Much of the plans are very similar to those in the rest of the country. A lot of them sound very good, yes there should be integration and there should have been for decades, it’s been absurd that county councils and hospitals have played pass-the-parcel with people, with human beings who are sick. There should be co-operation for sure. No doubt. Paying attention to the broad social factors that play a part in health is also worth emphasising.
“Look at the mess the health service is in according to the newspapers. More than a million people wait more than four hours in A&E. One in four wards is unsafe, we can’t meet the four hour pledge so we’ll scrap it for one we can meet.
“Massive improvements that Nick’s outlined so vividly cost a lot of money, and yet he’s going to do it on less money. It’s a fantasy world. The magic is rising productivity, the first bits are easier and the next bits are difficult as it gets harder to raise productivity. Everything rests on impossible levels of improvements. It’s expensive, and yet they’re going to save money. Public health in Somerset is being cut, and so while they’re telling you to give up smoking and get more active, they are cutting the people who offer the advice. It’s an impossibility.
“The wider the gap between rich and poor, the worse health is. What’s happened recently is that gap has risen. The first duty of any public servant is to speak truth to power. The argument that Nick presented is that we are overspending. We are not overspending, we are underfunded, that is the problem. Between the foundation of the NHS and 2010 about 4% increase in NHS funding year on year, it had its problems, it was never perfect. Between 2010 and now it’s barely changed. Everybody engaged in health is afraid that we are hitting the buffers, it just can’t be done, this is why this is such a fantasy. The big issue is not over spending, it is underfunding and we need to be clear on that.
“The NHS is a remarkable achievement that is being thrown away by massive cuts that are unsustainable.”
“The part Nick didn’t dwell on is the reduction on the number of community beds. In East Devon they are going to be halved in number, I don’t think any should go. I think there is something crazy in a situation in which we hear that hospital beds are massively over-subscribed but you can cut them out! It’s simply mad.
“Everyday in most of our hospitals there are ceaseless meetings going on about how you can get patients into beds. At times they are pushing people out of beds prematurely because they simply have somebody even worse off in the queue. How do we compare with other countries? Germany has 8.27 beds per thousand people, and France has 6.37 beds per thousand people whereas we are under 2.95 beds per thousand people and we are proposing to go down. I find it unacceptable.
“Funding is the real basis of these proposals. Hospitals like yours are under threat. You have a beautiful hospital in South Petherton and a superb facility. I would dread to think that it was in any way being challenged.
“Nick is right, there is a lot of potential in modern technology and the health service has lagged behind the rest of the community in its application of electronic technology over a long period of time. But the idea that we will be pushed into using technology, often very elderly people who are very frail and possibly confused will be expected to use technology that they just can’t get a grip of or of have been neglected, that’s the great danger. We are told that teams will rush in. In North Devon where a lot of this has been done, and we were given these assurances, there’s very little signs that these teams can actually do the job. The experiences are there, it’s a really serious problem. It is not cost-free, it is devolving cost elsewhere, some of it to the general economy.
“The retiring GPS. The GPs are going to be given more work. That is a real problem. There’s no proposal to adequately replace that number as they come under more pressure, with more people calling them.
“The next steps. When the consultation starts – go along. We have a strong feeling that they have already made their minds up…but go along and firmly state the case. Join the health campaigns, like Keep Our NHS Public and Health Campaigns Together, we’re demanding adequate funding to meet much needed changes – many of which are quite sensible if only they could be properly funded. The danger is that the net result of this will be that you lose your hospital beds, and the other services will not be much. What you’ll have is Mid Staffs in separate homes rather in a big hospital ward.
“If you lose facilities, they’re gone… Maybe I’m a cynic?”
The meeting touched upon many issues and concerns regarding health care and the STP. Whilst we provided a fulsome account of the presentations, it’s beyond the scope of this article to cover all of the points raised during the meeting, instead, it highlights two key themes:
1. Current lack of Somerset STP public engagement and consultation plan
2. Community hospitals.
Current lack of Somerset STP public engagement and consultation plan
It was apparent from the public meeting that local residents hold a wealth of valuable opinions, insights, knowledge and questions regarding health and social care provision. It was also evident that there is a keen interest to participate in the Somerset STP public engagement and consultation activities. However, due to the current lack of a structured engagement and consultation strategy, noted by Nick Broughton, those organising the STP are presently unable to benefit fully from the understanding and opinions held within the community.
As identified in a prior article – at the moment there appears to be little clarity regarding the precise meaning of public engagement and consultation and how a strong community voice will be achieved. So as to clarify expectations for all stakeholders, the leaders of the proposed Somerset STP need to communicate what aspects of the STP will be open to formal public consultation and scrutiny, such that the community voice can genuinely help to shape the future provision of local health and social services. Then they need to explain the specific mechanisms they propose to implement for all engagement and consultation activities, as well as define what constitutes satisfactory public and patient participation. A spokesperson from the STP explained that they were in the process of forming an engagement plan for the year.
To a relieved audience, Nick stated “As chief executive of this trust I can categorically guarantee that the hospital will not be closed. To close a hospital that is only two to three years old would be madness. We need to use the facilities that we have across the county as efficiently as possible. We need to use assets like South Petherton as much as we can. We need to ensure that we are delivering as much patient care as possible from South Petherton and from the other great hospitals that we have across the county.”
Whilst it is good to hear that South Petherton’s fantastic hospital will remain, we have yet to learn whether there are plans to change the amount of hospital beds available in its highly regarded Mary Robertson Ward; reducing the amount of community beds in the county appears to be an aim for those who devised the plan. For instance, it is stated in the STP that ‘significant costs are tied up in provision of a heavily bed-based community model’, ‘…a reduced reliance on acute services and community beds’, and elsewhere ‘…resulting in redirection of resource from traditional bed based models of care into the community and a ‘right sizing’ of the whole system.’ Obviously, a plan that aims to reduce the amount of hospital beds available in the county may well affect South Petherton Community Hospital, as well as other community hospitals.
Nick assured those gathered that nothing has been decided about closing Somerset’s community hospitals, although this was met with a degree of cynicism from some of the audience. In defence of maintaining our community hospitals, one audience member stated “We have a sparser population in Somerset, Devon and Cornwall, therefore you have to have more community hospitals for people to be able to have access to a hospital. Public transport is also in a catastrophic state here, for instance you cannot get to Taunton, you must have a car, and that is a serious problem.”
Finally, the League of Friends wishes to thank all of those who participated in this public meeting. In particular, we are grateful for the time and quality of information that both of our esteemed speakers shared with us; we appreciate their passion for the NHS and their commitment to supporting the improvement and integration of public health and social care services in the South West.
*affordable – this is a contentious issue for some, as was illustrated by an audience comment at the meeting “if you imagine any organisation that is moving from one system to another, for a period it would need both systems running side by side, it would need increased expenditure for a period to get it over the hump. I can’t see anywhere an indication that there is going to be a period of increased funding in order to facilitate that change. It’s inevitable to think ‘what’s going to happen?’ because to go from one system to another, the risk is that you close the hospital beds and you haven’t got the community care in place.”
Somerset STP documents: http://www.somerset.gov.uk/stp/
Video of meeting: http://bit.ly/2jpD0Jo
Feedback to the STP
At the moment you can respond to the STP in the following ways:
Telephone: 01935 385240 (Monday to Friday. 9am to 5pm)
Post: Somerset Sustainability and Transformation Plan (STP),
Freepost RRKL-XKSC-ACSG (No stamp required)