THERE was disappointment among the crowd that attended the public meeting in Holsworthy’s Memorial Hall on Wednesday, March 15, to discuss the temporary closure of inpatient beds with chief executive of the Northern Devon Healthcare NHS Trust, Dr Alison Diamond, after no assurances on the future of the hospital were made.

The meeting was set up by the mayor Jon Hutchings, with the help of the town council, in the hope of getting some answers following the announcement on March 3 that the community hospital’s inpatients beds were to close.

Cllr Hutchings chaired and introduced the meeting. Cllr Hutchings explained there were three main points the public wanted answers to: the reason behind the closure of the Holsworthy Hospital inpatient beds; what is being done to reopen the hospital; and to make assurances that it is not a permanent closure.

Dr Diamond gave a presentation to the estimated 550 people in attendance to answer these questions and try to explain why the Trust had taken the decision to close the inpatients beds ‘temporarily’.

She said: “I will go as far as I can to explain the rational of why we have had to make this difficult decision. So, Holsworthy is a 16 bedded unit. In 2015 there was a consultation that saw the reduction of community hospital beds to 40 to serve the Torridge and North Devon area. We have spent a lot of time during the years since that decision investing in our communities and we are now caring for significantly increased numbers of people in their own homes.

“Currently the types of people who are seen in the community hospital inpatient unit are those that are transferred from the acute Trust to the community hospital for their ongoing rehabilitation, those who are admitted from their GP practice for a period of rehabilitation or possibly to avoid admission, and patients who may be at the end of their life.”

Dr Diamond explained that there were ‘two main issues’ that lead the Trust to make the decision to close the community hospital’s beds, she said: “Firstly our reliance on agency staff to support our existing staff in the community hospital — this is to maintain safety levels, we are required to have two registered nurses on every.”

Dr Diamond told those present that the Trust have ‘held many recruitment drives’ and said they had many difficulties recruiting both nursing staff and therapy staff. She said they had tried international recruitment as well as local and national but to no avail.

Dr Diamond said the increase in agency staff usage could also be put down to the current staff sickness levels which ‘are at around 11%’. She added: “We have a lot of experience using agency staff and we know that when we reduce the usage the safety for the patients increases and there is far less risk of falls and pressure damage [also known as bed sores]. We actually have difficulty getting agency staff to fill those shifts [sickness cover], which leaves us in a predicament because we cannot unsafely man a ward.

“We have tried transferring staff from other hospitals to support, that is fine when we are able to do so but we aren’t able to rely on that due to winter pressures we have every winter.”

Cllr Hutchings confronted Dr Diamond about the suggestion that safety levels were low due to the use of agency staff. He said: “You say you rely on professionals to tell you whether the hospital is safe. At the moment we have a number of nurses on the bank scheme; they are qualified nurses, so does that mean they are not professional?”

Dr Diamond responded: “Agency staff are qualified in their own right and they do have a governance around them to make sure they are safe practitioners. The difficulty with them is, not their skill set, but their awareness of the environment they’re working in.”

She went on to speak of the continuity of care for patients and that that was not met by the use of agency staff.

The second ‘issue’ Dr Diamond said the Trust had based its decision for closure on was the ‘low bed occupancy’ at the community hospital. She said that ‘on average you have ten patients in the 16 bedded unit’. This statement was met with great scrutiny from the audience.

She said: “We have had, even at times of escalation in the hospital, a difficulty in filling the beds. Most of this is because we have a ‘home first policy’; people are rehabilitated far better in their own home environment when it is best to do so.”

One man called out, ‘you have actively stopped people filling those beds’.

Cllr Hutchings added that ‘people were told family members couldn’t come to Holsworthy Hospital because it was full’ and that this was the reason numbers of patients in the community hospital are reducing.

Dr Diamond said: “More people are going straight home, there is a lot of evidence that suggests being cared for in your home is the right place and that rehabilitation occurs a lot quicker when you are in your home environment.

“So, we have a dilemma then, we have decreasing number of people wanting/having the need of Holsworthy Hospital and we also have the difficulty of staffing the ward.”

Chris Bowman, deputy medical director, later said: “The principal issue we have around the bed occupancy is, there is a restriction on the number of patients we can transfer. There are two reasons for that: passing of the medical cover to manage the number of patients being transferred and there are a limit to the number of patients the local GPs can manage, that is also compounded by the fact that there is obviously, to ensure that patients are properly cared for and that we are not putting their care at risk, there is only a certain type of patient that is appropriate for us to transfer out of the acute hospital to the community hospital.”

He added that more people are either being transferred straight home from acute hospitals under the government’s new ‘care at home’ programme, or those who are unable to be sent home ‘are generally those who actually need to be in the acute hospital’.

Dr Bowman concluded: “There is a limit to the capacity the medical cover can support at this present time. We are very grateful to the GPs for the support they provide for the patients but there is a limit — you need medical cover; nursing cover alone is not adequate.”

Taking into account the issues raised and in response to Cllr Hutching’s initial question, ‘what is being done to reopen the hospital’, Dr Diamond said the Trust had looked at moving staff from North Devon District Hospital (NDDH), recruiting to vacancies, and have regular nursing initiatives including roadshows encouraging people to join.

She also said they have been looking into a new ‘model of care’ to see if more patients could be brought into the hospital and that the Trust have been working in conjunction with the Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG), who purchase services, to see if they can resolve any of the work force or occupancy issues.

Dr Diamond concluded her speech by providing a timeline of events. The announcement of temporary closure was given on March 3, the following day [March 4] admission to Holsworthy Hospital ceased.

Dr Diamond said: “We have made an active decision to keep all the patients who were resident in Holsworthy Hospital in the hospital until they are fit for discharge, we did not think it was right to displace those as part of this initiative.”

During the meeting a recorded interview with terminal cancer patient Penny Smith, 62, from Chilsworthy, was shown. She faces an uncertain future due to the Trust’s decision to close the community beds.

Mrs Smith explained how the temporary closure has affected her, and how she felt the ‘care is second to none’.

Mrs Smith has said before, she does not want to die in Barnstaple’s NDDH. She feels passionately about the fact she wants to spend her final days in her local community hospital, close to her family.

She said: “I hope and pray this hospital is still here. This is where I would like to spend my last days.”

Dr Diamond was asked to respond to the points made by Mrs Smith, to which she repeated her earlier statement that the Trust will keep people in their beds until ‘such time as they are ready to go home’.

Next to speak, in support of keeping the community hospitals beds open, was Conservative Devon County Councillor Barry Parsons. He said he was ‘struggling big time with the reasons why this decision has been made’, a sentiment shared by the crowd.

“I am struggling with the timing of the decision — especially on the back of Simons Stevens talks on the accountability of Trusts as from April 1. He says they will become more accountable if they are going to close the beds.”

Cllr Parsons’ cabinet portfolio remit at Devon County Council includes human resourcing and he said in his experience: “I don’t find it acceptable that we say there is insufficient staff out there if we are not prepared to do much about it ourselves.

“It is not just us who have this problem, it is a problem all over the country. It is not good enough to say agency staff pose a high risk because if they are posing it here they are going to be posing it in other parts of the country — why should we be the ones to suffer in that regard?”

Cllr Parsons felt that staff sickness being used as a reason to temporarily close the beds was ‘frustrating’ due to the use of statistics. The Trust released figures suggesting that 11% of staff members were off on sick leave.

He said: “What I really don’t like and what really doesn’t help the Northern Devon Healthcare Trust, is that you need to establish trust. But if you’re going to say 11%, well that sounds quite high doesn’t it? But when you’re actually only talking about two or three people it means something completely different — so I think that is really unfair to move in that direction [as a reason for closure].”

His final point was with regards to the difficulty in recruiting staff. “My response to that would be that if you have a situation where you are, gradually, seemingly, running something down and there doesn’t seem to be a future for that organisation, then people are not going to be looking towards working there!”

Cllr Parsons said that he didn’t feel the town had been ‘consulted anywhere near enough’. Cllr Parsons directed a number of questions at Dr Diamond, but said his most important question was: “This will put a lot of pressure on you as an individual, because you are the chief executive and it appears to me that this matter is not seen of sufficient importance to warrant further consultation, in other words its deemed operational not strategic. Why can you not then, personally, considering this is operational, tonight show some real leadership and say, right now, that you will overturn that Trust decision?”

It was clear from the reaction that Dr Diamond’s response was disappointing to many in the audience. She said: “As I said at the beginning of the meeting this is a very difficult decision for the Trust.”

She added that there was ‘absolutely no way, under the current circumstances’ that they will be able to overturn the decision.

In response to ‘how long will the temporary closure be’ Dr Diamond said the temporary closure ‘will be maintained whilst we [the Trust] work with the CCG’ repeating that they need to look into the staffing and occupancy of Holsworthy Hospital.

She added that the conditions needed to be met are the two outlined in her original presentation.

A statement was read out from the Conservative MP for Torridge and West Devon Geoffrey Cox, who was unable to attend the meeting.

Mr Cox said he has set up a meeting with the Secretary of State for health to raise with him directly concerns of the closure of beds in Torridge — particularly Holsworthy.

Mr Cox has previously stated that he believes there is a ‘strong possibility that the Trust will not restore [the] beds’.

In his letter he said: “Ultimately, this is a matter for the Trust who are the only body with the legal authority to make these decisions, and which I have the power neither to prevent nor reverse, but I have made it plain that I will monitor closely its actions and that I shall fight a move to close the beds in Holsworthy Hospital permanently. Let us put the Trust to proof. If they can convince by the evidence, then so be it. If not, let them restore the beds immediately.”

After the meeting Mr Cox announced that he will be holding a meeting to review the decision taken by the Trust and has requested the attendance of relevant managers and records to do so.

He told the Post: “I wish to carry out a full review of the evidence base for this decision. I very much hope and expect that the Trust will facilitate the requests I have made.”

Last to speak was Ben Longhurst-Prior, creator of the #saveourstaff campaign, who Cllr Hutchings said ‘started the ball rolling’.

He raised the issue of ‘blame’, and said: “One could certainly take from that [the Trusts’] statement that the severe safety concerns was actually blaming the staff.”

Mr Longhurst-Prior said he had contacted the Trust in September 2016 regarding the treatment of staff. Their response had been ‘all of our staff are highly valued’, but he added: “The statement in fact makes staff look as though they were one of the main reasons behind that severe safety concern and furthermore that statement could be seen as prejudicial to their future role or career as they could be labeled as unsafe.”

With regards to the suggestion that sickness levels were a reason for temporary closure, Mr Longhurst-Prior said: “I would very much like you to allow us to see the sickness level of North Devon District Hospital so that we may be able to see a comparison.”

Dr Diamond explained that that would be an unfair comparison and in response to the question of blame, Dr Diamond said: “There was absolutely no intention and if it has been implied or suggested in the way the words have been written that we were in any way critical or undervaluing our staff, our staff are our most important assets, it is our staff who deliver our services. We are very proud of the services we deliver and we are very proud of our staff who deliver them. I will apologise if that is how it came over, it was not the intention at all.”

On the evening, councillors — both district and town — were handing out forms for people who were not able to ask a question to fill in so that the Holsworthy Town Council can forward them on to Dr Diamond.

In the Manor Offices foyer is a ‘red box’ with some already completed forms in. People can pop in to the offices anytime from Monday to Friday between 9am and 1pm. There are a number of spare forms in the box next to it for others to fill in.

Following the meeting the Trust will be holding a series of engagement events. These events, they say, will provide an ‘opportunity for people to understand more about the rationale behind our decision and express any concerns or anxieties they might have’.

Drop-in sessions will be held in Holsworthy Community Hospital on March 20, from 10.30pm to 1pm and on March 30, from 9.30am to 12pm.

It is necessary to book a slot. To book email [email protected] or call 01271 322460

There will then be two sessions of public meetings in Holsworthy Memorial Hall on tonight (Thursday, March 23), from 3pm to 4.30pm and from 6pm to 7.30pm.

(video credit: Steven Barnes, Devon Tech Services)