Ottery Hospital bed closures: NHS quizzed

IN a week when a concerned resident told the Herald Ottery St Mary hospital had no space to grant her elderly mother an overnight stay, NHS Devon s plans to close nearly a quarter of the facility s beds by January have been slammed once again.

IN a week when a concerned resident told the Herald Ottery St Mary hospital had no space to grant her elderly mother an overnight stay, NHS Devon's plans to close nearly a quarter of the facility's beds by January have been slammed once again.

Health bosses plan to close seven beds at the 31-bed hospital.

Honiton councillor Alf Boom this week claimed 13 beds in Ottery are currently being taken up by dementia sufferers while The Bungalow in his town remains closed.

Ottery councillor Roger Giles said NHS Devon has got the "alarming" closures "the wrong way round," and asked "why hasn't a public body consulted the public?"

He fears the onset of winter and the danger of swine flu will see a bigger demand for beds in the town and has posed a string of questions on a raft of issues over the closures- and the Herald has seen the answers.

NHS Devon has said bed numbers in Ottery will be reduced temporarily, but winter plans allow for an increase at short notice.

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Below are the questions asked by Cllr Giles and answers from NHS Devon cluster manager for Honiton and Ottery, Geraldine Benson.

Q: I always understood that there was additional pressure for beds in the winter due to the weather and also due to older people falling. Do I understand you to be saying that there is less pressure for beds in the winter?

A: During the winter it is particularly important to ensure flexibility, specifically because there are pressures. By improving our efficiency we are able to increase our throughput of patients in the hospital.

Q: You say you have done a great deal of work to decrease lengths of stay, increase percentage occupancy levels and decrease delays. Could you please let me have the bed occupancy figures for Ottery Hospital for the period you have been carrying out the work referred to above?

A: The average length of stay has reduced from 15.4 days to 12.7 days over a 12 month period and bed occupancy levels from October 08 to October 09 have increased from 82.3 % to 100% currently.

Since the local development of a weekly core group and discharge meeting at Ottery Hospital, we have reduced our hospital delayed discharges. Over the last 11 week period there has been an average of just 1 delayed discharge which is among the lowest in the hospitals in eastern Devon.

Q: What arrangements have been made to cope with local impact of the flu pandemic, should this be necessary?

A: The NHS Devon winter plan provides the overarching plan. There is a planning structure in place which reports to the director of public health. The winter plan steering group meets weekly to monitor and respond to any pandemic flu activity in the region. This work is supported by national guidance from the Health Protection Agency and the Department of Health. The plan also takes into account

bed availability on a day to day basis and aims to ensure sufficient capacity to meet local needs, and the needs across Devon as a whole.

Q: If closed beds had to be reopened because of flu pandemic, or other reasons, how quickly could they be made available again?

A: As described above, we closely monitor the use of all our hospital beds daily and can increase the staffing quota to respond to increasing demand if necessary. Recently we reopened a number of beds to compensate for the Budleigh Salterton deep clean programme and this experience has shown that we are able to do this in a matter of days.

Q: You refer to providing services "within the resources we have". Does this mean that the beds are planned to be closed because of financial pressures? Has there been a reduction in resources for Ottery Hospital compared to the same period for last year?

A: NHS Devon provider services needs to work within the allocated financial resources. All NHS organisations are expected to manage their budgets and make efficiency savings year on year. For 2009/10 very other NHS organisation in the country must achieve a minimum 3% efficiency saving. .

We aim to deliver this by improving the efficiency with which we run services, without affecting the capacity we operate. However, this does mean that throughout 2009 we have needed to use our hospital beds flexibly. In each and every year, we do not expect to operate 100% of our beds for 100% of the time.

Q: If beds are to be closed at Ottery Hospital, is there to be a reallocation of staff at Ottery Hospital to work elsewhere?

A: Throughout the year we respond to increasing patient need and staff absence by using the Devon bank nurse service flexibly. The plan to reduce beds temporarily in Ottery Hospital does not require the relocation of staff, but we will reduce our use of bank and agency staff for the short period that our bed numbers at Ottery have been reduced.

However, if staff relocation did become necessary, it would be a temporary measure and as with our normal practice, this would be in full consultation with the staff and their representatives.

Q: If staff at Ottery Hospital are to be deployed to work at other locations, what discussions about this have taken place with staff representatives?

A: In accordance with our usual practice discussions are held with our Trade Union partners through our local consultative partners forum.

Q: If staff at Ottery Hospital are to be deployed to work elsewhere, are they to be given expenses to cover items of additional expenditure such as travelling expenses?

A: Should the need arise, our policy provisions afford staff reimbursement of any expenses accrued.

Q: What estimation has been made of such additional expenses?

A: None required.

Q: What arrangements have been made between DPCT and the Royal Devon and Exeter NHS Foundation Trust for payments for additional patients cared for at the RD & E as a result of bed closures at Ottery (and other community hospitals)?

A: In the main, GPs decide whether a patient can be cared for locally by direct admission to a community hospital, or whether they require the care that can only be delivered by an acute hospital such as the RD&E.

Community hospitals also receive significant numbers of patients who are transferred back to a more local hospital following a spell at the RD&E.

We work as closely as possible with GPs and the RD&E to ensure available community hospital bed capacity is used as fully as possible.

The RD&E receives payment for the patients it cares for under a contract with NHS Devon.

Q: What estimation has been made of such additional expenditure?

A: Making a direct link between one change in the local health system and payment in another is not straightforward, and NHS Devon provider services has made no estimate of such expenditure.

We will look to maximise the use of all available community hospital capacity to keep the need for acute hospital admissions to a minimum.

Q:What arrangements have been made between DPCT and the Royal Devon and Exeter NHS Foundation Trust for payments for "bed blocking" as a result of bed closures at Ottery (and other community hospitals)?

A: We work very closely with the RD&E to ensure that patients who are ready and appropriate for transfer back to a more local, community hospital bed after treatment in an acute hospital are transferred as soon as possible.

Q: What estimation has been made of such additional expenditure?

A: No additional expenditure is likely for this purpose.

Q: In your email you say "we are communicating this with doctors, staff and the wider public now". Why are you communicating about a decision made, rather than consulting prior to a decision being made?

A: This is not a permanent change in bed numbers. The change is temporary and part of an ongoing programme of deep cleaning and maintenance. We are reducing our expenditure on bank and agency as stated above. However, I personally have communicated with local GPs and discussed the issue of using our beds flexibly at the last Locality Health Board.

Q: Why have you not consulted, or even communicated, with local councils and councillors?

A: As stated above, this was discussed at the Locality Health Board (of which you are a member) in August.

Q: An important factor in people getting better is for their friends and relatives to be able to visit them in hospital. Closure of beds in Ottery Hospital could result in people from Ottery and the surrounding communities being in hospital in distant places - requiring visitors to make long and expensive journeys, often where there is limited public transport. What consideration has been given to transport needs of visitors?

A: We recognise that this is a difficult issue. We always try to accommodate patients in their most local hospital, although this is not always possible. The change at Ottery may make this more difficult for a short period, but we will make every effort to minimise disruption by using hospital beds as close to people's local community as possible.

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