Tuesday, 17 July 2018

"We don’t need all those beds”

ONE of the health chiefs involved in the introduction of a new model of care at

ONE of the health chiefs involved in the introduction of a new model of care at Townlands Hospital in Henley admits the issue should have been handled “differently”.

Dr Andrew Burnett, clinical director of the Oxfordshire Clinical Commissioning Group, also says the new £16million “health campus” must be managed carefully or the new hospital will be at risk of closure.

At a meeting last month, the group agreed to install a rapid access care unit at the hospital, alongside eight NHS beds at the neighbouring Orders of St John care home, and up to 14 “on demand”.

This was despite a campaign to have an 18-bed Peppard ward in the new hospital, as was promised in the original plans. More than 3,000 people signed the Henley Standard’s Save Our Beds petition and 2,000 took part in a march around the town in July.

The decision means the hospital will open in December with an empty floor while the care home will not be open until next summer, so patients will be sent to Wallingford Community Hospital until then.



The new unit is designed to enable more patients to be cared for at home and Dr Burnett says it will provide a “far better deal” for patients and will be a “frontrunner”.

“I’m really sympathetic to people and I can understand how they like things the way they are,” he says.

“It’s a very hard concept to put across but everything in medicine is changing rapidly and the model of care which was accepted in the Seventies and Eighties is no longer valid.

“If I could go back I’d handle it differently but we knew this was going to be controversial. When people are expecting one thing and then the message changes it was always going to cause unhappiness, there’s no way of getting round that. We did try to brief everyone carefully.

“One of the things which is clear from the debate is that people are interested in their local hospital.

“The reason there has been this controversy and upset is because we are having to change our plans but if we don’t do it now and get the model right then the hospital would end up closing.”

Dr Burnett, a Sonning Common GP, says the new unit will mean a pioneering approach to healthcare.

“I’m really confident this is going to work,” he says. “It will need tweaking and won’t be perfect but one thing I’m convinced of is that this model is much better then having a ward with lots of people waiting. Henley has the choice to be a frontrunner or a backwater and I would rather be a frontrunner. There’s no way we should be having a bedded ward — that would be a retrograde step and doesn’t provide ideal care in the long term, even though the staff are devoted and caring.

“I feel passionately that this is the right thing to do. We have tried to explain and, of course, we could have done this differently. I can understand the community’s apprehensions.

“People always worry about any change and question if large organisations are remote. I’m a local GP, these are my patients and I firmly believe the service in the new Townlands provides a far better deal for my patients than the old hospital did.

“It could have been handled differently but it would still have been controversial and had the same level of interest and debate. I’m not afraid of that and it’s good that people are interested in healthcare.

“It’s sad that there was an element of personal victory about it for a small element but most people were engaged and interested about what happens in the community. If I’d signed up to an easy life I wouldn’t be doing this.”

The new unit is based on existing services in Reading and the emergency multidisciplinary units in Abingon and Witney and Dr Burnett is confident it can work in a smaller community.

He says: “People in beds become less able, that’s been established and that’s why having people in beds is not healthy. Old people in hospital for just two or three days start to become less able to get up and look after themselves.

“If they go to the care unit you can deal with the crisis on the day, send them back to their own house with someone to make sure they are okay at night and get them back to the clinic the next day to see how they are doing. This rapid access care unit is part of a wider service jigsaw. There will be consultants there every morning, a team of therapists, staff nurses and social workers who will all work in teams.

“What this is trying to do is support people to manage in their own homes, working with the wider integrated locality team.

“When people need help, like transfusions, they can come to the care unit. When they need specialist expertise they can come to the care unit. It doesn’t mean they then won’t go back to their own homes.

“The bedded ward, while very well-staffed, is doing a different thing and it’s like comparing apples with pears. It’s a halfway house, where the majority of patients are waiting to go to other accommodation like a nursing home and are in limbo.

“Some people were admitted from the community to Peppard ward but that was a minority. We want the new care unit to be focused on managing people in their own homes, not picking up the pieces from other hospitals.

“In order for that to work they will need access to some beds, which will be rented from the nursing home. The exciting thing is we will have more outpatient clinics from the Royal Berks, which we didn’t have before and we can expand the clinics. We have the opportunity for extra things like minor operations for cancer and clinics that we couldn’t have in the old Townlands Hospital.”

Dr Burnett says evidence shows people who stay in hospital are more likely to become dependent on care or pick up other illnesses.

“The truth is the longer patients stay in hospital the more disempowered they become. The reason for that is when people are in hospital beds they lose the ability to care for themselves.

“It’s easy to sit in bed and wait for something to happen but when you are at home you’re more likely to get up and do something like make a cup of tea for yourself. It’s better to discharge people to their own homes rather than another hospital. Having people in hospital beds is bad.

“If you ask an old person if they want to stay at home or in a hospital bed, nine out of 10 will want to be at home. There will be beds available but it’s not voluntary — every person in a bed will have to be justified. If someone really wants to go to hospital we will ask them why and if they are too sick to be at home then a hospital bed is where they should be.

“One of the things that people are worried about is what will happen to old people and who will look after them? It has spilt into concerns about social care, whereas the hospital provides healthcare. John Jackson (director for adult social services at Oxfordshire County Council) has been very active in this and social care will be putting in more packages. Social care will be co-ordinated and built into this service.”

Dr Burnett says that data from bed usage at Townlands hospital showed only around seven patients used a bed at any time in the hospital’s current 14-bed Peppard ward.

The data looked at patients from the RG4, RG8 and RG9 postcodes but didn’t take into account those from nearby villages like Remenham and Wargrave, which are not in Oxfordshire.

He says: “Our job is to commission healthcare for Oxfordshire, not Berkshire. If there was a huge usage we could have worked out an agreement but there isn’t. There is no point setting something up that won’t be used.

“The debate has been all about the beds and it has missed some of the really exciting stuff. Most people in Henley use the outpatient service, a minority use the beds, only 150 on average a year. We recognise that some people do need those beds if they are coming out of other hospitals or are waiting for a care package or nursing home.”

Dr Burnett rejects claims that the new unit will be doing the job of local GP surgeries and says it is based on the emergency multidisciplinary units..

He says: “The care unit will have expertise and diagnostics on the spot. GPs need to get a sample and send it off to be analysed whereas the unit can get it straight away. This could all be done at a GP surgery but it’s about cost. GPs are working under huge pressure and are expected to deal with patients in 10 or 15 minutes.

“The care unit will look at four patients a day on average to start with, with room to flex, so there will be more time. If you can invest more time you can deal with a lot of problems and it’s important that a patient doesn’t feel rushed. They will feel unhappy if the service is rushed or impersonal and that’s what we’re trying to avoid.

“We are trying desperately to avoid putting old people in hospital. In an emergency multidisciplinary unit, 80 per cent of people are turned around on the same day, 10 per cent have a short-term bed and 10 per cent long-term.”

Dr Burnett admits the new model of care could take time to settle in but in the end it will be the best thing for the community.

He says: “The objective of this whole service is to provide better healthcare for local people. In a year’s time things will be different.

“I can’t promise it will be perfect but I can promise we will end up with a far better service.”



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