NHS Consultation on ‘Making Purbeck Healthcare Fit for the Future’

The first phase of the consultation process finished on 20 July and what follows formed the basis of the Society’s submission to this process. The NHS tell us that they will formulate firmer proposals based on the comments received in this first phase consultation and will be submitted for further consultation in the Autumn.

Members of the Society were appalled at the proposals to relocate the Swanage Health Centre and close the Swanage Hospital to be replaced by a polyclinic, as were the vast majority of the residents of Swanage a large number of whom besieged the Mowlem on the evening of 20th July.

So far as Swanage is concerned, we submit, there are two aspects of the provision of healthcare to be considered : the Health Centre and Swanage Hospital, although of course there is some linkage between them.

1 Swanage Health Centre
The present Health Centre site was purposely established in a central area to serve the needs of the town’s residents. Furthermore by being next to the bus station and taxis it is convenient for the majority of people living further away. Many can walk to it and it is easily accessible to the town’s amenities, shops etc.
It is our firm belief that the Health Centre must remain centrally sited. The present building, we are told (Phil Dowding on a visit made to the centre in 2011), was built as a clinic in the 1980s and was subsequently purchased by the GP practice when it moved from Harberton, and has been progressively adapted to meet the developing needs of the practice.

However, the building does not make the best use of the site. Its awkward footprint suggests extensions could be made towards the Kings Road frontage, albeit at the expense of some of the green space in front of it. It has been suggested that the flood relief tunnel passes beneath the building but Wessex Water has a drawing showing that the tunnel passes to the south of it. We are told that the building is constructed on piled foundations (NHS Consultation 26/6/12). This suggests that progressive redevelopment could take place with additional pile foundations to extend the building’s footprint and also allow extensions upwards by the use of modern construction techniques on the existing foundations. This view is supported by a structural engineer. The different levels could easily be accessed by a lift which would be wheelchair accessible. Admittedly, redevelopment and extensions on the existing site would present problems while work is being carried out with, we suggest, some services temporarily diverted elsewhere, perhaps to the Swanage Hospital or to Portakabins located in the car park. Such temporary inconvenience would, we are sure, be tolerated if the end result was an improved facility on the present site.

An opportunity for redevelopment of the present site may offer itself in conjunction with an extension to the Co-op. This would be very beneficial if it could be achieved. If the need is really as urgent as has been suggested and agreement with the Co-op, planners etc. cannot be quickly reached, phased redevelopment of the existing Health Centre, as has been suggested above, should take place independently. An alternative location has been suggested at the present business park in King’s Road West, between Court Hill and the railway. While this can be fairly regarded as a central location, it is not conveniently accessible for users of buses and taxis or for easy walking distance to shops in the town.

It is said that the present building cannot meet current needs and it has to be admitted that the treatment rooms are less than ideal – it being difficult to maintain patients’ dignity and privacy. However it appears that some rooms are greatly underused (from personal experience when attending the practice nurse, the doors to the lower corridors have to be unlocked and the lights switched on, and then switched off and doors locked again after a 15 minute consultation!) This hardly suggests intensive use of these facilities!

The financial constraints facing public expenditure are understood. Therefore it seems perverse to spend an estimated £15 million each (NHS consultation 26/6/12) on polyclinics at such a time, to provide some additional services such as X ray examinations and outpatient appointments already available at the present Swanage Hospital. Furthermore polyclinics would have to be financed by interest bearing loans and the alleged savings by closing beds NHS beds at Swanage and Wareham hospitals. It was said at the same consultation meeting that the changes are to meet future needs, i.e. that these additional facilities are not needed immediately and not necessarily all at once. The ‘direction of travel’ (a much used phrase during that consultation meeting) is to meet health care service needs for the next 10 – 20 years (there seems to be some confusion as to which) during which time ideas will have once more changed rendering decisions taken now, perhaps hastily, to take advantage of ‘a unique opportunity’ will prove to be erroneous. Surely, it is far better to develop services and the infrastructure to provide them incrementally as the detailed requirements as to staffing and equipment become known.

It seems that the ‘direction of travel’ is being driven by the desire of certain GPs and healthcare professionals to be all in one location on the grounds of increased efficiency. This may be an ideal but in the real world it just may not be achievable and some compromise has therefore to be made. Good communication does not have to depend on professionals all working in the same building. Structured working practices and effective use of modern IT should achieve this. Also, with the emphasis that is being placed on greater care of patients in their homes, most of the carers, nurses and social workers should be out on visits and not sitting in offices in the centre!

From observation, it would seem that a great proportion of the usage of the Health Centre is for routine appointments, check-ups, clinics etc. These visits to the Health Centre are carried out as part of patients’ everyday lives prior to going on to use the facilities of the town. This is especially beneficial to elderly people, saving on effort and expense in making the journey when they can do their shopping etc on the same visit to town. As has been stated the number of elderly with age related conditions is expected to increase in future. By definition, these conditions are likely to require periodic, regular routine visits – an out of town/edge of town location would be a real disadvantage to the great majority adding to unnecessary stress and expense for them. Glib promises of additional bus services are unrealistic. Not only would these have to be paid for (presumably from the public purse) but what would the frequency be? Every ten minutes? Fifteen minutes? Most likely, hourly, in which case a present fifteen minute appointment would take half a day. In any case such services, if provided at all, would soon be withdrawn as they would be prone to funding cuts. So much for sustainability.

In June 2011 a survey of people who used the Health Centre was conducted with the following result:

Do you agree with the suggestion that the Medical Centre moves from its current location, to a new edge of town site? To which the responses were Agree, Disagree or Don’t Know.

The total number of respondents over 6 hour period was : 517, of whom 40 (7.7%) Agreed, 438 (84.7%) Disagreed, with 39 (7.5%)‘Don’t Knows’. A pretty clear indication that public opinion wishes the Health Centre to remain central.

Furthermore, one is led to ask if all the proposed additional services have to be provided at the Health Centre. Why could not some of them be provided at/from an extended Swanage hospital? These should be those of a specialist or non-routine nature due to the added difficulty of getting to the Hospital as compared to the present Health Centre, and be complementary to those provided there.

The GPs have trying to find an alternative site for the Health Centre for the last ten years without success. This has led to a continuing uncertainty as to how/where future health care provision will be made. I suggest that there is one certainty – the present site. It is interesting to note that a new surgery has just been opened in the centre of Corfe Castle village – not on its outskirts.

Finally, much emphasis is being placed by the GPs in providing an improved service. However the system whereby one could simply make an appointment to see one’s GP has been abolished, for the present one involving a call to the surgery and a wait for a doctor to call you back. This, probably, is a more efficient use of the doctor’s time but is more impersonal and not regarded by patients as an improvement. Furthermore, the out of hours service leaves something to be desired, GPs not being available at weekends or bank holidays. And why does the Health Centre close between 1pm – 2pm? Surely at least, the front desk could be staffed during that time or enquiries, collection of prescriptions etc – this would benefit those who work in town and could then visit in their lunch hour. These concerns were also reflected in the survey mentioned above. It is respectfully suggested that if there was genuine concern to provide a better service for patients it is these areas could be addressed rather than spending millions on polyclinics and the proposed changes, and tens of thousands of pounds on the resulting consultation on proposals, which from the survey and the more recent consultation meetings attended, the majority of residents do not want.

2 Swanage Hospital
The Swanage Hospital is a much loved institution cherished by the people of the Town. It has a vibrant Friends organisation which willingly voluntarily supports the Hospital in many ways including fund-raising. Over the years, under a process started by Maggie Hardy when she was the Hospital Administrator, investment of over £1m has been raised for equipment and refurbishment to bring the hospital up to modern standards. It was the generosity of the Burt family, which gave Swanage this hospital and it would be a betrayal of not only the Burt bequest but also the hard work and dedication of the present Hospital staff and Friends if this were to be sacrificed – this would be seen as a betrayal by the NHS.

It has said that we should concentrate on facts, not emotions. However one’s health and well-being and that of one’s family and friends is to do with the emotions and feelings – not just one’s physical health but also one’s mental health and psychological well being and the avoidance of undue stress to patients and their families. But consider some facts:

The present hospital is clean, bright, well equipped and appointed and serves Swanage and its residents well. It has a loyal and efficient staff and an atmosphere of peace and calm pervades it.

The building has been sympathetically extended over the years with new and updated equipment installed.

The present hospital is well loved, is well supported by the Friends, who are horrified that once again the existence of the Hospital is threatened.

Everest, the adjacent property has lain empty for years due to problems of subsidence, caused we understand when the ambulance station was built. The site could be redeveloped to enable additional facilities to the Hospital. Alternatively, if the additional healthcare services required can be satisfactorily provided on either or both of the existing Health Centre and Hospital sites, the Everest site should be sold or redeveloped to provide funding for retention of the existing beds or some of the additional services/facilities that the NHS wishes to provide.

The increasing age profile of Swanage and Purbeck’s population is frequently mentioned. Beds for local residents, who do not need the services provided by a hospital, such as Dorchester, Poole or Bournemouth, are currently adequately provided for in the present Swanage Hospital. It is said that usage of these beds from 190 to a projection of around 70- 75 is justification for closing them. However contracting with local nursing or residential care homes (again there was lack of clarity by the NHS as to which) cannot be an answer when there is only one with limited nursing accommodation (Wordsworth) and few residential homes, two of which (York House and Cliff Top) periodically apply for planning consent to demolish and construct flats in their place. This is in addition to the number of care homes that have closed in recent years, e.g. Magnolia House, James Day, Shore House and Westbury.

The uncertainty of where patients needing this care would go, adds to their stress and also that of their families; as against the certainty of being able to go to the known facility at the existing Hospital. Of course if possible patients prefer to be treated in their own homes but more and more elderly people live on their own and do not have family available to provide 24 hour care. A carer spending half an hour a day is no substitute. Even if a patient needing care has a partner they too, in all probability, will be elderly and would not be able to cope with providing the care needed.

Patients in hospital have, and need, visitors to aid their recovery or comfort them in their last days. Friends and family of patients, who may themselves be elderly and not physically very able, need to have as easy as possible access to patients at what is inevitably a very stressful time. Some will be making repeat stays and being in familiar surroundings will be beneficial to vulnerable patients and those suffering from dementia or similar conditions.

The uncertainty of the availability of alternative sites has been mentioned in connection with the Health Centre above and also applies if replacing the Swanage Hospital. The certainty is that the Hospital exists on its present site. It could be further extended if necessary, without waiting for development opportunities elsewhere which may or not occur in the foreseeable future. We understand a feasibility study to examine the options for such extensions has been commissioned.

The question of finance was also discussed above. Why ignore an institution that, by general consensus, is fit for purpose? It would seem that 80% or 90% of the present Hospital’s facilities would require little or no further investment; the Hospital is well equipped, has friendly committed staff and functions well. “If it ain’t broke don’t fix it!” If £15 million can be raised for a polyclinic so could that, or probably a much lesser sum, be used to provide the same care as currently proposed in the existing premises which, throughout the consultation process, has been demonstrated to be what the populace wants.

We are sure that many of the above considerations would be relevant to the Wareham situation.

3 Conclusion
There is widespread concern that the provision of a polyclinic to supplant Swanage’s conveniently sited Health Centre and much loved Hospital is being used as a pawn in the planning process, which has been used as a ‘sweetener’ by landholders to gain consent to build hundreds of houses for the commercial market. Despite assurances to the contrary, there is still the suspicion that the GPs wish to vacate the town centre site for commercial reasons.

Despite assurances to the contrary given in the consultation meetings, the impression given is that these proposed changes are being led by remote bureaucrats. (Although it may have been a momentary ‘senior moment’ – one of the speakers at the meeting on 26th June could not be sure of the location of an example he was quoting – was it Charmouth or Charminster? Hardly inspiring confidence!) It would seem their concern is merely HOW to provide the services laid down by NHS technocrats. It is easy for professionals to be seduced by promises of efficiency, cost savings (providing ‘more services for more people for the same money ‘ as it was stated) and greater ease of delivering these services by being located on one site, to go along with these ideas. The customers (patients) appears to figure low in the thinking, the presumption being that they will go to wherever the healthcare services are to be provided, rather than respecting the patient’s requirements of psychological well-being, minimising stress to them and their relatives, their convenience and cost of transport to access these services. This is assuming that these proposed additional services are proven to be really necessary to meet actual clinical needs (and not just for target setting and achieving).

It is unfortunate that the ‘Making Purbeck Healthcare Fit for the Future’ consultation document is seriously flawed implying that there are only two options, which it was admitted were too restrictive. There is no option put forward with the pros and cons of a ‘Do Nothing’ option. In response to a question this was dismissed by the NHS officials at the consultation meeting on cost grounds, nor that there was a ‘Develop the Existing Sites’ option. As will be seen from the foregoing this is a real option, which meets the majority of local residents needs and aspirations. It is to be hoped that there will be a real openness and willingness to take residents’ opinions into account when firmer proposals are put forward. Failure to do so will show these consultations to have been a costly farce, undermining confidence in the NHS, its planning and administration.

Updated 25 July 2012