Healthcare in Devon

Healthcare in Devon is now the responsibility of the two Clinical Commissioning Groups, one covering Northern, Eastern and Western Devon (which is the country's biggest, an area with 900,000 people), and one covering South Devon and Torbay. It was announced in November 2018 that the two were to merge.[1]

History

From 1947 to 1974 NHS services in Devon were managed by the South-Western Regional Hospital Board. In 1974 the Boards were abolished and replaced by Regional Health Authorities. Devon came under the South West RHA. Regions were reorganised in 1996 and Devon came under the South and West (Wessex and South Western) Regional Health Authority. Devon Area Health Authority from 1974 had four District health authorities based in Exeter, North Devon, Plymouth and Torbay. In 1993 Exeter and North Devon were combined, as were Plymouth and Torbay. There were eight Primary care trusts established in the county in 2002: North Devon PCT, Mid Devon PCT, Exeter PCT, East Devon PCT, Teignbridge PCT, South Hams and West Devon PCT, Plymouth Teaching PCT and Torbay PCT. Torbay PCT became a Care Trust in 2005. They were managed by the South West Peninsula Strategic health authority from 2002 until 2006. Following the "Commissioning a Patient-Led NHS" restructure, the PCTs in Devon (excluding Plymouth and Torbay) merged to form Devon PCT, overseen by NHS South West.

The CCGs took on the responsibilities of the former PCTs of NHS Devon, Plymouth and Torbay in April 2013.[2]

Relations between Northern, Eastern and Western Devon CCG and Northern Devon Healthcare NHS Trust were reported by David Flory to have been “strained over the last two years” in 2015. He reported that a “facilitator” had been appointed to support contract negotiations between the two organisations.[3]

North, East and West Devon was one of three areas proposed for the new “success regime” by Simon Stevens in June 2015 in which NHS England will work in partnership with Monitor and the NHS Trust Development Authority to tackle problems in the local health economy.[4] In October 2017 it was announced that the four acute trusts in Devon were to share staff to help tackle workforce deficiencies and to support service standards for the wider population.[5]

Sustainability and transformation plans

In March 2016 Angela Pedder, Chief Executive of Royal Devon and Exeter NHS Foundation Trust was appointed the leader of the Devon Sustainability and transformation plan footprint.[6] She retired in August 2017 and was replaced by Mairead McAlinden from Torbay and South Devon NHS Foundation Trust and Suzanne Tracey from Royal Devon and Exeter NHS Foundation Trust. The plan proposes to make savings of £144 million in 2017/8. At the same time Nick Roberts, who is already chief clinical officer at South Devon and Torbay CCG, is taking over the leadership of Northern, Eastern and Western Devon CCG.[7] 71 inpatient beds across four community hospitals were closed by the Royal Devon and Exeter NHS Foundation Trust in August 2017 as services were moved out of hospital. 170 staff were redeployed into enhanced community teams.[8]

Primary and community care

There are 130 GP practices in Northern, Eastern and Western Devon and 35 in South Devon and Torbay. The GP Patient Survey for 2013/14 showed 18% of patients in South Devon and Torbay had to wait longer than a week to see a GP - better than the national average of 24%. 90% of patients in the area rated their overall experience of GP surgeries as good, above the national average of 86%.[9]

4 practices in Plymouth (all in the marginal Plymouth Sutton and Devonport constituency), were granted a total of £100,000 for improved facilities in March 2015.[10]

In 2019 the Mannamead Surgery in Plymouth with a patient list of about 10,000 announced that it was abandoning its general medical services contract. About 34,000 patients in the city are without a fixed GP.[11]

Out-of-hours services are provided by Devon Doctors.

Commissioning

Northern, Eastern and Western Devon Clinical Commissioning Group decided in November 2014 that Royal Devon and Exeter NHS Foundation Trust would be its preferred provider of community services. This decision was challenged by Northern Devon Healthcare NHS Trust which had been providing these services and in February 2015 Monitor (NHS) announced that it would investigate this complaint.[12] Northern Devon said the decision will mean it will have to give up ownership of some of its community hospitals. Ownership of 12 of the trust’s community hospitals will “in all likelihood” transfer to NHS Property Services.

The sites that could be affected are:

  • Tiverton and District Hospital;
  • Honiton Hospital;
  • Axminster Hospital;
  • Ottery St Mary Hospital;
  • Seaton Community Hospital;
  • Sidmouth Hospital;
  • Exmouth Hospital;
  • Budleigh Salterton Hospital;
  • Exeter Community Hospital;
  • Moretonhampstead Community Hospital;
  • Crediton Hospital;
  • Okehampton Community Hospital.[13]

Community Services

Plymouth Community Healthcare was established under the Transforming Community Services programme in 2011. It took over social services in the city in 2015.[14]

Palliative care is provided by Children's Hospice South West, Hospiscare, Rowcroft Hospice, St Luke’s Hospice Plymouth, and North Devon Hospice.

Millbrook Healthcare runs the wheelchair service in Plymouth and South Hams.

In September 2018 it was reported that Devon Children and Families Alliance (composed of the NHS trusts in the county with Livewell Southwest (a community interest company) would get the seven year contract for children's community health and wellbeing services across the county, currently provided by Virgin Care.[15]

Social care

Mears Group won a contract to provide home care services for Devon County Council in March 2016. [16]

In January 2019 arrangements were concluded to enable social workers to access individual children’s electronic health records using the ECLIPSE management system developed with OLM Services. This alerts nurses and social workers if a vulnerable child makes an unscheduled admittance to A&E, or a walk-in centre.[17]

This implementation cost Devon County Council more than a million pounds in internal resource costs, in addition to licence and implementation fees paid to OLM. [18]The Council did not follow any procurement process in selecting this system, which is unusual.

Hospital services

The main hospital providers in the county are University Hospitals Plymouth NHS Trust, Northern Devon Healthcare NHS Trust, Royal Devon and Exeter NHS Foundation Trust and Torbay and South Devon NHS Foundation Trust. The leaked Sustainability and transformation plan for the county, intended to tackle a predicted funding gap of £572m in 2020/21, suggested that 600 hospital beds could go, and that most acute services, including the maternity unit, would move from Barnstaple to Exeter and Plymouth. [19] Stroke, vascular service, paediatrics, maternity and ear, nose and throat services would be consolidated onto fewer sites. Community hospital provision would be considerably reduced. [20]

Royal Devon and Exeter NHS Foundation Trust took over Exeter’s NHS walk-in centre from Northern Devon Healthcare NHS Trust in March 2018. It also runs Honiton Minor Injury Unit.[21]

North East and West Devon had 250 patients, the highest number in England, waiting more than 12 months for treatment in November 2018 [22]

Patient involvement

Healthwatch was set up under the Health and Social Care Act 2012 to act as a voice for patients. The county has Healthwatches based in Plymouth, Torbay and Exeter.

Financial pressure

Devon was named one of the 11 most financially challenged health economies in the country in 2014. NEW Devon and the two main acute providers – University Hospitals Plymouth NHS Trust and the Royal Devon and Exeter NHS Foundation Trust predict a combined deficit of almost £45m in 2014/5. The CCG has a turnover of £1.1bn. It has introduced some demand management measures - such as requiring smokers to quit for six weeks prior to routine surgery, and a ban on procedures of low clinical value - because demand for services is outstripping what they can afford.[23] In November 2014 it produced a list of 24 procedures it was considering for decommissioning.[24] It had identified £80m worth of savings and has plans to save up to £159m more from a deficit expected to reach £430m by 2019.[25] Proposals included reorganising beds in community hospitals.[26] According to Rebecca Harriott, chief officer of the NEW Devon Clinical Commissioning Group because of the significant ageing population in the area "we’re experiencing now what many health economies won’t experience for another 20 years’ time in terms of the demographics.”[27]

In December 2014 the CCG announced that in the case of routine surgery for morbidly obese patients - with a body mass index greater than 35 - the patient would be required to have a BMI of under 35 or to lose 5 per cent of their weight before planned surgery, whichever is the lesser weight loss. Patients would be required to stop smoking for eight weeks before planned surgery.[28] This explicit rationing was denounced on all sides. Our NHS claimed the "end of the NHS is swimming into focus".[29] Eric Pickles, whose body mass index was reported to be 32, and falling said "The idea that you would say “You will not survive, you’ve had your chips, you are too fat, you smoke too much…” Exeter MP Ben Bradshaw told Nick Clegg that he would be denied an operation in Devon because he smokes, as would Eric Pickles because he’s too big. Pickles retorted that since he had lost weight he would not now fall foul of the policy.[30] The CCG announced that it was caving in to the pressure and would no longer impose a ban, but would "further promote smoking cessation and weight loss services to improve outcomes for patients".[31]

The CCG also abandoned a plan to restrict patients to only one hearing aid.[32]

NEW Devon CCG ended 2014-15 with a cumulative deficit of £38.9m and expects this to increase to £78.9m (after savings of £37.1m) by the end of 2015-16, the largest cumulative deficit of any CCG in England.[33] The success regime board headed by Ruth Carnall estimated in February 2016 that without change services in NEW Devon would be in deficit of £442 million by 2020/1. By that time nearly 25% of the population will be over 65.[34]

In May 2017 it was given new legal directions after it ended 2016-17 with a £42 million deficit.[35]

Mental health

Mental health services in the county are largely provided by Devon Partnership NHS Trust.

In December 2014 Paul Netherton, assistant chief constable of Devon and Cornwall Police, complained publicly after a 16-year-old girl suffering mental health issues was held in a custody cell in Devon for around 48 hours because there were “no beds available in the UK”. 750 mentally ill people – including 28 children – had been detained in police custody in the county during 2014. Adolescents with mental health problems in Devon have been sent to units in Hull, Newcastle and Lancashire, and several vulnerable young people in the county have also been admitted to adult psychiatric units.[36] Ben Bradshaw MP for Exeter complained that the chronic shortage of appropriate accommodation for young people and the chaos and confusion was caused by the Government’s disastrous reorganisation of the NHS "because there are now so many different organisations involved in commissioning and providing services, no-one takes ultimate responsibility."[37]

There has been an increase in the number of people presenting at the A&E Department at Derriford. In 2012 there were 2,700. In 2013:2,908. In 2014: 3,346.[38]

In August 2019 it was reported that autistic children and teenagers were waiting to be assessed following a referral for an average of 67 weeks with the longest recorded wait 122 weeks. There were 1800 on the waiting list. Devon Clinical Commissioning Group was looking for new autism assessment providers. According to Virgin Care, who provided the service from 2013 to April 2019, demand increased by 20% per year throughout the operation of the contract. [39]

See also

References

  1. "Fresh batch of CCG mergers approved". Health Service Journal. 30 November 2018. Retrieved 4 December 2018.
  2. "New commissioning group takes over from PCT". Plymouth Herald. 1 April 2013. Retrieved 21 November 2014.
  3. "Relations between Devon health organisations 'strained', TDA chief admits". Health Service Journal. 15 January 2015. Retrieved 19 January 2015.
  4. "Regulators to take over NHS services in three English regions". Guardian. 3 June 2015. Retrieved 9 June 2015.
  5. "Devon trusts to share staff across region". Health Service Journal. 10 October 2017. Retrieved 23 December 2017.
  6. "Leaders named for eight major STP patches". Health Service Journal. 15 March 2016. Retrieved 22 March 2016.
  7. "Trust chiefs to jointly lead STP after regional leadership shake-up". Health Service Journal. 15 August 2017. Retrieved 5 October 2017.
  8. "Staffing problems prompt trust to bring forward bed closures". Health Service Journal. 16 August 2017. Retrieved 5 October 2017.
  9. "Clinical Commissioning Group defends research that shows nearly a fifth of people cannot see a GP in a week". Torquay Herald Express. 4 November 2014. Retrieved 14 December 2014.
  10. "Four Plymouth GP surgeries to receive share of £100,000". Plymouth Herald. 27 March 2015. Retrieved 28 March 2015.
  11. "10,000-patient practice to hand contract back in crisis town". Pulse. 11 April 2019. Retrieved 20 May 2019.
  12. "Health regulator seeks patient views on integrated community services". Mid Devon Star. 5 February 2015. Retrieved 1 March 2015.
  13. "Local influence over community hospitals at risk, warns Devon trust chief". Health Service Journal. 16 February 2015. Retrieved 12 March 2015.
  14. "'We wouldn't go back into the NHS': Plymouth's pioneering social enterprise". Guardian. 16 July 2015. Retrieved 22 July 2015.
  15. "Virgin Care set to lose children's service contract to NHS consortium". Health Service Journal. 25 September 2018. Retrieved 4 November 2018.
  16. "Mears wins £100m Devon home care contract". Health Investor. 16 March 2016. Retrieved 17 March 2016.
  17. "New software gives Devon social workers access to electronic records". Digital Health. 29 January 2019. Retrieved 3 February 2019.
  18. url=https://www.whatdotheyknow.com/request/support_charges_for_carefirst |
  19. "Leaked report outlines plans to cut hospital beds and review acute services in North Devon". North Devon Gazette. 8 September 2016. Retrieved 19 September 2016.
  20. "Protests start today over proposed cuts to Devon's health and care services". North Devon Journal. 19 September 2016. Retrieved 19 September 2016.
  21. "Exeter's walk-in centres will no longer be run North Devon Healthcare Trust". Devon Live. 22 March 2018. Retrieved 7 September 2018.
  22. "New fines for leaving patients waiting more than a year". Health Service Journal. 10 January 2019. Retrieved 13 February 2019.
  23. "Devon CCG warns 'services will suffer' due to unaffordable demand". Health Service Journal. 27 October 2014. Retrieved 21 November 2014.
  24. "NEW Devon sets out service cut plans". Health Service Journal. 18 November 2014. Retrieved 21 November 2014.
  25. "Devon NHS Care Commissioning Group faces £430m deficit". BBC News. 6 November 2014. Retrieved 21 November 2014.
  26. "AXMINSTER: Hospital beds: now it's down to 'power of public' reaction". Tindle Newspapers. 23 December 2014. Retrieved 23 December 2014.
  27. "'Challenged' areas recovery plans demand integration and reconfiguration". Health Service Journal. 12 November 2014. Retrieved 1 December 2014.
  28. "CCG tightens up pre-surgery requirements on BMI and smoking". OnMedica. 4 December 2014. Retrieved 4 December 2014.
  29. Molloy, Caroline (4 December 2014). "Devon - the canary in the NHS coalmine?". Open Democracy. Retrieved 4 December 2014.
  30. "Tory Minister condemns Devon health "rationing"". Express and Echo. 8 December 2014. Retrieved 12 December 2014.
  31. "Devon health chiefs U-turn on surgery restriction plan for obese people and smokers". Express and Echo. 12 December 2014. Retrieved 12 December 2014.
  32. "CCG drops plan to ration hearing aids". Pulse. 9 January 2015. Retrieved 12 January 2015.
  33. "CCG forecasts largest cumulative deficit". Health Service Journal. 2 June 2015. Retrieved 27 June 2015.
  34. "Devon success regime finds £442m funding gap". Health Service Journal. 11 February 2016. Retrieved 14 March 2016.
  35. "Largest CCG given updated legal directions as finances sink". Health Service Journal. 4 May 2017. Retrieved 29 May 2017.
  36. "Government to end scandal of mentally ill teens being held in police cells". Western Morning News. 15 December 2014. Retrieved 16 December 2014.
  37. "Health bosses and police chief hit back at Jeremy Hunt over vulnerable teenagers held in cells". Western Morning News. 16 December 2014. Retrieved 17 December 2014.
  38. "Thousands presenting at A&E in Plymouth with mental health problems". Plymouth Herald. 1 July 2015. Retrieved 23 July 2015.
  39. "Spiralling child waiting list forces CCG to take action". Health Service Journal. 8 August 2019. Retrieved 11 September 2019.
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