Hard fought battle over NHS beds

Health Correspondent Mark Nicholls looks in details at Norfolk PCT's proposals for the future of intermediate care in the county and the battle to save Norfolk's community hospitals.

There were signatures, marches, noisy protest meetings and consultations.

The PCT went out to the community to present its plans for cottage hospitals and beds, and was met with a barrage of opposition.

Cynics “pooh-poohed” the validity of the consultation, there were claims that it was a “done deal” and that hospitals earmarked for closure were already doomed and their beds lost forever.

But the contents of the PCT's proposal to be presented to its board on Tuesday and drawn from the three-month consultation process during the spring will surprise - maybe even reassure - the most cynical.

There is little evidence of brutal culling of community beds and the random closure of cottage hospitals. There are casualties, but not on the scale feared.

The people of Aylsham - who perhaps held the noisiest, even the most aggressive protests - will be heartbroken to see that St Michael's Hospital will close.

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But other friends' groups will be jubilant to discover that units at Swaffham, Dereham, Kelling, North Walsham and Norwich will survive and even be developed.

There will still be a specialist stroke unit, although Dereham Hospital supporters may be concerned that it is not definitely being built there, as was indicated at one stage.

Even Cranmer House at Fakenham and Benjamin Court at Cromer are spared, with a continuing role to play in the rehabilitation of people who may have had major surgery or need additional care before being allowed home.

There will be few places as jubilant as Swaffham, which looked as though it would lose all its beds, but with a concerted effort from the League of Friends, now keeps 18. And Ogden Court in Wymondham, where mayor Joe Mooney has worked tirelessly to save the beds, will still have a role with supported beds.

Other groups have worked equally hard to save bricks and mortar they know affectionately as their community hospital.

Accusations have also been flying around that this is about cutting costs - a claim the PCT, which is £46m in debt, has vigorously denied.

The figures in the document show that rather than the saving of £1.1m a year from the original proposal to cut beds from 201 to 158, the new proposal is “cost neutral”.

The detail now shows there will be 104 rehabilitation and palliative care beds and 34 supported beds, along with about 40 beds in the stroke rehabilitation unit, wherever it is situated.

Those 104 beds will be split over five sites: Norwich Community (24), Dereham (24), Kelling (24), Swaffham (18) and North Walsham (14).

The “supported beds”, to further help people recover, will be spread across the county, some at the threatened units and others elsewhere. They will be at Fakenham (2) and possibly at Cranmer House; Aylsham (5), though not at St Michael's; Thetford (3); south east Norfolk (5); Wymondham, potentially at Ogden Court (6); Norwich (2); Downham Market (9) and north-west Norfolk.

Some of the locations have yet to be finalised.

Initially there were going to be up to 50 redundancies but that is now expected to be significantly fewer because the revised proposal needs higher workforce numbers than the original proposal. Redundancies, say the PCT, will be kept to a minimum.

The PCT's director of provider services Mark Taylor explained: “The stroke rehabilitation unit will still be built, as we believe it is the right thing to do. But the unit will be subject to a tendering process along with all other stroke services.”

It now remains uncertain where the stroke rehabilitation unit for central Norfolk will be sited but it is likely to be an operation run by the PCT's provider services arm, the Norfolk and Norwich University Hospital and the Queen Elizabeth Hospital at King's Lynn.

Elsewhere, some facilities will be lost at Ogden Court, though there are talks with social services to create an alternative use for it. Benjamin Court at Cromer will not have intermediate care beds but will have a long-term use for continuing-care beds.

Lascelles ward at Kelling Hospital, Holt, will close but Pineheath retained and expanded. The aim is to provide some of the Lascelles facilities at Benjamin Court.

As the changes to Lascelles were not specifically consulted upon, the PCT will liaise with the Norfolk Health Overview and Scrutiny Committee over the issue.

Mr Taylor said: “Our strategic objective is to invest more in supporting people at home and significantly enhance the way we rehabilitate people and in a way that is more cost effective.

“We think we have struck a balance and we hope we have demonstrated a readiness to listen to local people, though the people of Aylsham will be disappointed.”

The plan to change the face of intermediate care across Norfolk was first announced by the-then newly-formed Norfolk Primary Care Trust in a document released in the middle of October.

In the firing line were nine hospitals and the 200-plus beds used by patients for rehabilitation between acute units such as the Norfolk and Norwich University Hospital and returning home.

Health bosses projected a new vision for healthcare, delivered closer to, or in, the patient's home by a team of community-based nurses and health professionals who could meet the needs of mostly elderly people in the community they lived, rather than in a hospital ward.

Health chiefs knew there would be a long and intense battle ahead as this was a proposal that could see the loss of community beds and the closure of community hospitals that were held in high affection by the people who lived near and used them.

From the moment such a plan went public, a massive campaign swung into operation with “friends' groups” from hospitals, politicians and patients seeking to avoid any closure or downgrading of their specific hospital.

At first there was great unity between the supporters' groups, all voicing opposition to Norfolk PCT's plans with petitions, letters and also at a series of six pre-consultation public meetings. The EDP began the Save Our Beds campaign, a drive to trigger debate and raise public discussion of the important issue of changing the direction of intermediate care.

From the middle of February, the debate took a new twist as more detail, and clarity, emerged to the PCT's proposals.

Now, there were potential winners and losers as under draft proposals that were to go out to public consultation, some hospitals were provisionally earmarked for closure while others were saved and in some cases in line for expansion and development.

In the consultation document, the PCT proposed that community beds would be cut from 201 to 158 and split between fewer sites while other units continued to provide some clinical services.

That plan then was for the 158 beds to include a 40-bed stroke unit at Dereham Hospital; 26 rehab beds at Norwich Community Hospital; a further 26 at either North Walsham or Kelling Hospital and 40 “supported care” beds at undisclosed locations across Norfolk.

Cranmer House, St Michael's and Benjamin Court would lose all their beds and clinical facilities under the proposals, while Ogden Court at Wymondham and Swaffham Hospital would lose their beds. There would also be up to 50 redundancies.

That has now been amended after the consultation.

But against this backdrop emerged a picture of a PCT where all was not well. Interim chief executive Hilary Daniels left at short notice, ousted by the East of England Strategic Health Authority, and acting director of commissioning Audrey Bradford followed soon after.

In came new interim chief executive Julie Garbutt, since confirmed in the position, to steady a ship that was still heading toward the financial rocks.

And while the intermediate care changes were plans that were hitting the headlines, behind the scenes, radical and sometimes painful changes were taking place as the five former PCTS of North Norfolk, Norwich, Southern Norfolk, West Norfolk and Broadland became one as Norfolk PCT.

Once those plans were approved by the board on February 27, a three-month public consultation began.

This featured a series of meetings through March, April and May, often rowdy, confrontational and emotive as trust executives explained their plans to a partisan audience.

One meeting at Aylsham got out of control so it eventually had to be re-scheduled and forced the PCT to change the format of its consultation meetings.

The main themes to emerge were: concerns about capacity, blocked beds, doubts about whether home care would work, the benefit to the local community of these hospitals, rural transport, loss of perceived centres of excellence, concerns about demographic change.

At every stage, Norfolk PCT has stressed it was listening.

It appears those voices were heard.

The matter now has to be approved by the PCT board at a special meeting on Tuesday. It will be a year before there is any significant change. Only then will we begin to see whether the new strategy for intermediate care can deliver the treatment that people want and need, and where they want and need it.

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