Weekend Diagnosis: New model of care

Published: 21 July 2016

This Weekend Diagnosis is from Mairead McAlinden, our Chief Executive

Many of you will have heard that there will shortly be a public consultation on changes to the way that health and social care will be provided in Torbay and South Devon, particularly to the inpatient care provided in our Community Hospitals. I know that people who use these services and the staff who provide them are concerned about these changes, so I want to use my column this week to explain the need for change, and to assure you that we are trying to change for the better.

Our Community Hospitals provide an excellent service, with dedicated nursing care and medical input provided by local GPs. The community hospitals look to provide care for people when their health has deteriorated or they have had a fall or other crisis and need rehabilitation, particularly after a period of treatment in an acute hospital. But providing this level of expert care is becoming more difficult. GPs are facing their own challenges with an increasing workload and difficulties in recruiting. Like the rest of the NHS we are experiencing difficulties in recruiting nurses and we have almost 100 vacancies for registered nurses across our hospitals, which we are trying to manage in many innovative ways including a recent recruitment drive in the Philippines. But the changes we are making are not just because of these challenges. Our population in Torbay and South Devon is 20 years ahead of the rest of England in terms of the proportion of older people, many of whom live healthy and productive lives and contribute much to our local voluntary sector and economy. However this does mean that there are many more people do need support from our health and social care services, and they want that care to support them in the way they want to live their lives – being as independent as possible with expert and compassionate care provided in their own home or where they chose to live.

Many older people are cared for by their family and friends or have the funds to organise their own care, but an increasing number of older people and their carers need support from Trust services. It is our duty to meet these needs by providing the best possible quality of care within the public funds we receive, and readers will be well aware of the restrictions on funding of health and social care.

This means choices have to be made – we cannot invest more money in the services that keep people well and prevent hospital admission and still keep funding the current model of hospital provision. So we are investing £3.9 million pounds this year in additional services to support people at home and in local communities – outside hospital – to provide care that keeps people as healthy as possible and avoids the crises that often leads to hospital admission.

In our Coastal locality which covers the Teignmouth and Dawlish area, we are already seeing changes, following a consultation led by our Clinical Commissioning Group (CCG) last year. There are now Health and Wellbeing Co-ordinators, employed by the voluntary sector, working with people to help them access services that will support their wellbeing. We have merged the minor injury units so that we now have one in the locality that opens from 8am to 8pm every day of the year. And later this month a long term conditions clinic will be supporting people who have more complex health needs with expert professionals regularly assessing and monitoring their conditions to avoid deterioration and to reduce the number of appointments they need to have. We are also strengthening our intermediate care team by recruiting more professional staff so that they can support more people in their own homes.

Later this year, our CCG will be consulting people on proposed changes across all our other localities to support our new model of care. Proposals include less reliance on community beds with the strengthening of community services and the closure of four of our nine Community Hospitals – Bovey Tracey, Ashburton, Paignton and Dartmouth. When these proposals were made public by our CCG, it was intended that public consultation would begin shortly afterwards, and we were confident that, we could maintain community inpatient services until the consultation process produced a decision. However, it now looks like the consultation will begin in the Autumn and this extended period of uncertainty has increased the challenge of providing safe levels of nurse staffing in these hospitals.

Because of this, we have had to temporarily reduce the number of beds in Paignton from 28 to 16 from this month. This is a temporary change made to protect patients and staff. We must ensure that our services are safe, and we will continue to provide a place in a Community Hospital to anyone who needs this type of care.

Last year we had to reduce beds in Brixham Hospital and to relocate the beds in Bovey Tracey Hospital to Newton Abbot because of medical and nursing shortages. These are also temporary changes pending the outcome of the public consultation, and we have been able to manage these changes without affecting the care we provide to local people, whilst maintain safe and high quality services.

There will always be a need for the acute care that only a hospital like Torbay can provide, but rehabilitation is now more often provided in the person’s own home or a local care home instead of in hospital. This is the right type of care, and much appreciated by people who receive it. We do not want people to have to stay in hospital, somewhere most people don’t want to be, unless it is medically necessary. And when they do need to come into hospital we want to make sure they get care and treatment by expert staff so they can return home as quickly as possible with the funding in place for the right support.

I know how much local people value the services provided by the Trust – I receive many lovely letters of thanks each week and staff are delighted that their care is so appreciated. I hope my column this week helps to explain the context for some of the changes we are making, and the changes we are asking for your support to make in the future.