Community Hospital Consultation Nov 2016

Exmouth Hospital

Exmouth Hospital


Monday 21 November 2016   From Phil Twiss, Group Secretary 

Conservatives call for second opinion

on Devon NHS funding crisis treatment 


East Devon Conservatives are deeply worried about proposals from the NEW* Devon Clinical Commissioning Group to restructure hospital care in the North, East and West of the county in a bid to plug a £400 million budget shortfall over the next three years. 

They believe the hospital bed closures proposed by the Devon health provider as the cure for a funding crisis may be the wrong treatment – and could have harmful side-effects for patients. 

The majority of the Conservative members of East Devon District Council are sending a collective response to the CCG’s current consultation in the hope of persuading the NHS commissioning group to change its approach to tackling the immediate £100m funding gap, expected to rise to £400m by 2020. 

The Conservative councillors are advising the CCG that it would be dangerous to move from a system of mostly inpatient treatment to care at home until a robust structure is in place to provide the alternative cover. Taking this step without the necessary resources in place and with no vital transition budget to call upon, could put patients at risk, they say. 


Having studied the CCG’s report, Conservative group members were unimpressed with the strength of the argument in favour of bed closures and home care, especially because the CCG has not been able to provide accurate and meaningful financial detail or convincing trial evidence to back up its proposed Community Care Package. 

They also wonder if the massive funding gap could not be closed by greater attention to efficiency savings. 

And they are counselling the commissioning group not to adopt a “one-size-fits-all” approach to tackling the area’s financial ills, bearing in mind the differing demographics and age profiles of each local authority area in Devon, especially remote rural communities. Patient vulnerability and loneliness must also be addressed. 

The CCG appears to favour a new model of care that has been subject to limited testing, with little hard evidence that it improves the service to patients.

The Conservative group are not convinced by the scant evidence provided after their requests for more detail and are nervous of the CCG’s reliance on a notional target of county hospital beds, regardless of variations in proven need. 

Blunt instrument

They want to know more about the 80 clinicians the CCG claims to be in support of the new model. And they are sceptical of a ‘blunt instrument’ approach to treatment, especially when many elderly patients have dementia in addition to multiple clinical problems. 

Finally, the Conservative members contest that many areas in East Devon appear to have a reducing stock of nursing and residential home beds. This only aggravates the situation, because these beds are often required in the short or long term for patients stuck in hospital.

Phil Twiss, Conservative Group Secretary, said: “Some people want to boycott this consultation process – but that won’t help anyone. We believe constructive feedback is the best way. 

“We all agree that bed-blocking is a serious issue and we also accept that the clinical commissioning group need to save money. The question is how should they go about it so as to deliver results without making the situation worse. 

“We feel that they have the solution the wrong way round. They want to move to a care-in-the-home model at a time when the resources just aren’t there to support that model. It might be the right approach in theory, but it will only work in practice if the social care infrastructure is robust enough to take the strain – and it is not. 

Panic measure 

“We’re not convinced that the new model has delivered the right standard of success in trial areas and we don’t believe it can be rolled out across other parts of the county until the necessary support structure is in place. And we should not be moving to a new model as a panic measure to solve a funding shortfall that could be tackled by other means. 

“For example, a lot of money can be wasted on high-cost agency staff who appear to be a short-term emergency man-power fix but all too often are relied upon as part of the workforce establishment. 

“We don’t know whether the budget shortfall was perhaps caused by wasteful practices that are still in place, and so we don’t know whether the CCG could find alternative ways to save money. What we do know is that their current proposals are unconvincing and ill-advised”. 

East Devon Conservatives, will be responding to the CCG consultation with their views and will be calling on the commissioning group to think again. 


* NEW stands for North East and West Devon Clinical Commissioning Group 

Editor’s Notes

Below in more detail are the concerns of the Conservative Group members, set out under headings that will form part of the response to the CCG consultation.


From the beginning the CCG have been reluctant to examine and discuss, in any depth, the budget drivers and financial imperatives needed to reduce costs. Initial figures they produced made no economic sense and were not explained. The business plan proved difficult to read and thus difficult to prompt conclusions. The group agreed we should demand from the CCG a clear breakdown of the economic drivers and the true cost elements relating to the pressing desire to reduce beds. The CCG appeared reluctant to provide such information and without it neither alternative conclusions nor agreement with the business plan could be made. The group understood the degree of difficulty faced by the CCG in relation to the chosen model of care and the need to save over £400m in a very short time. But the approach adopted by the CCG was not supported due to concerns related directly to standards of care in far-flung rural communities. 


Delays almost always resulted from a lack of care packages leading to congestion and bed- blocking.  The CCG have concluded that they must close beds to provide for Care in the Community. This is backwards thinking and will put patients at risk when the standard of care falls short of what is needed.  Existing Care Commissioning trials are scattered, lack direction and lack the necessary particular skill-based teams required to care for complex cases. 


The CCG insists that some areas in Devon are working well, that outcomes are good and patient vulnerabilities are significantly reduced.  However, the public reaction to this contention was negative, volatile and immediate, especially from the Torridge area. The group was concerned at the lack of evidence provided to back up the CCG contention that outcomes were good and the model of care was working well. Only anecdotal reassurance has been presented. We also needed examples of true costs of the trials concluded in North Devon and to what degree the results were skewed by investment or funding from elsewhere.  


Discharging patients once beds are closed, without a proper care and rehabilitation package in place, is irresponsible and unethical. The issue is being addressed back to front.  If care in the community worked, there would be a case to reduce beds except for complex or special circumstances. The CCG started the process from the wrong place.  Put the care packages in place, technically resourced and nursing care led, and the need for hospital beds would simply fall away.  BUT the resource needed has not been addressed and it must be accepted that without a properly funded transition budget the desired outcome will not be achieved.  Robbing Peter to pay Paul will not work. Intermediate beds would always be needed but the true need was not identified. The only justification was the experiment in North Devon, which we have rejected.  All the evidence, and a lack of same to the contrary, suggests that there are insufficient choices other than a “much needed elsewhere” hospital bed. The model of care regime has clearly been adopted but the initial funding support is not evident.  Indeed it could be concluded that the CCG and their funding partners were trying to avoid costs but were risking levels of patient care as a result.

The group remained concerned that the necessary investment in nurses and clinicians had been underestimated and as a result trying to fund the process by closing hospital beds had been adopted as an alternative to that very necessary investment. This concern raised questions related to the responsibilities and providers of care systems, including the NHS, Devon CC and the CCG. Concerns were raised that plans to cut community care by £30m were misguided and should be suspended until the Community Care Package scheme was running successfully and properly funded.   

Other questions

There are special questions to be addressed within the overall community care process regarding the use of community hospitals, associated Hospice facilities and the formation of MIU centres and Clinical Hubs whether managed by GPs or not. The group were really concerned about the future of the services from the buildings and the considerable element of care they continued to provide in support of their communities.

The discussion regarding the future provision of such services and care centred hubs cannot be set to one side and ignored during the on-going debate over beds and rural clinical care.

The staffing levels needed to make this work are not attainable locally or nationally. 


There is no plausible argument that supports closing beds before the alternative is up and running.

Going into hospital is easy – it is leaving hospital that is difficult. There are neither enough choices available nor are there sufficient resources to cover the medical and clinical needs.

The older age demographic, single person issues and rural delivery variables have not been addressed in a way to satisfy even impartial observers. The fear is that patients will be even more vulnerable than they are today and bed occupation rates will increase leading to impoverished clinical outcomes especially in rural areas.

The hoped-for ‘Model of Care’ cannot be done in bits and pieces.  It needs investment on a spend-to-save principle. If the community care package works, and there is some evidence that it might, some of the beds will prove to be unnecessary, and clinical outcomes will improve.

Some aspects of patient vulnerability are greater in a rural, lower populated area, particularly when social and family care is missing. Loneliness must be understood and its part in causing poor clinical outcomes must be properly considered.