37. Devon

What does the STP mean for your area?   

It is possible that 590 acute and community hospital beds  could be cut over the next five years. Amounting to a cut of one in six of the total beds.

Closure of 72 beds in the community hospitals in Seaton, Okehampton, Honiton and Exeter Community Hospital, Whipton.

Closure of community hospitals in Paignton, Dartmouth, Bovey Tracey and Ashburton & Buckfastleigh.

 

Brixham's minor injuries unit (MIU) is to close and it will become a ‘clinical hub’. Objections to the plan include concerns about the distance of travel to the nearest MIU unit. Should the one main route into Brix­ham become blocked, as has happened following serious road accidents, the town is completely cut off.

There were concerns that North Devon District Hospital's acute services - maternity unit, 24 hour A&E and stroke services - would be closed, forcing some parents to travel more than 50 miles for treatment and women would be forced to travel to Exeter, Plymouth or Taunton to give birth. In June 2017, a review of these services concluded that they should stay; campaigners were delighted however there is still concern that this may only be the first step in a campaign to keep services at the hospital.

In official documents leaked to the HSJ and reported by the Independent, additional cost cutting measures for Devon could include:

  • Longer waiting times for elective care
  • Closure of wards and theatres
  • Staffing cuts
  • Ending funding for some treatments and prescriptions
  • Delaying or avoiding funding newly approved treatments

For more information, see below.

What the STP aims to do:

  • To eliminate the projected 2020/2021 deficit of £557 million;
  • To improve overall health by increasing focus on preventing or avoiding ill-health;
  • To reduce reliance on bed-based care;
  • To introduce an innovative, fully integrated model of care that enables people to stay well and independent within their communities;
  • To invest in community, primary and social care services to support implementation of the integrated care model and improvements in care.

Further information

The STP does not contain details of exactly how the STP's aims are going to be achieved, particularly the elimination of the deficit.

Devon County Council has raised concerns regarding the STP.  At a full Council Meeting held on 8 December 2016 a Motion was carried stating ‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan [sic].

This Council also recognises that Governments have not provided the NHS with a fair  level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations.’

For full details see Agenda item – Cuts to Devon Health Services and the Success Regime.

See also Devon County Council Health and Wellbeing Scrutiny Committee

Residents and councillors have criticised the closure of Brixham’ MIU, arguing that Brixham residents would be more likely to travel to Torbay Hospital’s already overstretched A&E department than go to the two remaining minor injuries units.

Hospitals at Newton Abbot and Totnes will become clinical hubs with medical beds, minor injuries units and health and wellbeing centres and Torquay will get a new urgent care centre.

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The STP has prioritised the following services for review:

  • Stroke services (including hyper-acute and stroke rehabilitation);
  • Maternity (including consultant-led and midwife-led care);
  • Paediatrics and neonatology;
  • Urgent and emergency services (focusing particularly on the acute hospital provision of accident and emergency and co-dependent services).

As well as these large scale reviews, a number of smaller services will be reviewed because they are currently facing particular difficulties in remaining sustainable and safe due to workforce and other challenges.

The most urgent of these 'vulnerable' services to be reviewed are breast services, ear, nose and throat (ENT), interventional radiology, histopathology, neurology, interventional cardiology and vascular surgery.

In June 2017, a review of stroke, maternity and A&E services concluded that they should stay at North Devon District Hospital.  Ian Williams, of Save Our Hospital Services (SOHS), who had campaigned against the loss of services, said: “An excellent initial result and vindication of the SOHS team in establishing the isolation issue for North Devon."

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Changes across the area

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain high-spending CCG areas will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; this is known as the capped-expenditure process (CEP).  The 14 target CEP areas include Devon. The measures under discussion include the following:

  • Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations.
  • Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average.
  • Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence.
  • Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
  • Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year.
  • Selling estate and other “property related transactions”.
  • Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.