Having addressed the meeting to stand up forcefully for his constituents who have lost most from this review, he commented on the individual elements of the plan:
1. Formal consultation
It is very disappointing that after all this time the health sector in Shropshire cannot get its act together to let us know the full picture. Much of the PCTs proposals rely on the Acute hospitals reconfiguring, so it is hard to assess only seeing half the picture.
2. Ludlow
2.1 Whitcliffe ward
Closure will be vehemently resisted by local people. This decision is purely financially driven, as admitted by the Mental Health Director, who confirmed his service is in surplus and being forced to make more savings to help plug the whole elsewhere.
I called on the Overview & Scrutiny Committee to request formally for the Independent Reconfiguration Panel to review the way this decision appears to have been taken before last Christmas and only now formally acknowledged by the PCT.
I also called on the Scrutiny Committee to insist on involvement by South Staffordshire Healthcare Trust which is due to take over responsibility for mental health provision in Shropshire from 1st April next year. As this Trust will soon be responsible, its managers may take a very different view on the quality of patient care available in Ludlow and the impact its closure would have on the families of those concerned.
Patient care for the most vulnerable in our communnity does not seem to be driving these proposals.
2.2 Clee ward + District Nursing
The plans to close between 15 and 20 beds in Ludlow rely on an assessment of local need. The PCT claim many beds used in Ludlow are for rehabilitation of patients who should be closer to their own homes. Well if so, why has the PCT not been transparent and set out that information in the consultation document?
The Acute hospitals are regularly sending patients to Ludlow since they have no beds. Clee ward should not be considered for closure until it is clear the necessary beds will be available in Shrewsbury or elsewhere to take care of these patients. This is a good example of the problems posed by this two-stage consultation.
The longer duration stays in Ludlow are due in part to the lack of available District Nursing and Social Services care in the home. The PCT needs to be able to show that resources are there to provide care at home. Proposed savings of £400,000 from District Nursing and Health Visiting is worrying.
I cited the example of a lady in Ludlow hospital right now who is diabetic but unable clinically to continue injecting herself with insulin. There is no District Nurse cover available to do so at her home in the evenings, so she cannot be discharged from hospital. Such problems are likely to become more not less frequent with these proposals and increasing incidence of diabetes in the county.
I warned the PCT that the community in Ludlow and the surrounding area will oppose these cuts vigorously.
3. Bishop's Castle
The proposed closure of Stone House and replacement with NHS funded beds in an expanded residential home remains uncertain.
The huge write-off of £700,000 required in the current year's Trust accounts of such a change of use of the hospital will itself take 5 years of the £150,000 full year's savings to pay off. This appears to exacerbate the Trust's current year deficit rather than improve it.
The number of NHS beds needs to be firmed up. Local GPs tell me 12 is not enough. We need to see a long-term contract between the Trust and the residential home operator, I have argued for 10 years, so the NHS does not chip away at the number of beds funded as soon as it can. I accept the need for periodic review of any contract to ensure usage and standards are maintained.
4. Bridgnorth
I welcome the decision not to make cuts to the number of beds or facilities in Bridgnorth. I understand vacancies arising within the Community Hospital will not be filled, unless for a critical role. Also the PCT is exploring increasing the day case surgery usage as it is operating at only 50% of capacity. This is potentially of concern if the conclusion of this review is to close rather than increase its usage.
But generally Bridgnorth is reprieved which is good news, and acknowledged as a model for community healthcare provision in the county.
