A clear theme runs across everything being said by Cumbrian people as part of this Success Regime consultation period.
Give us health services that fit our rural circumstances
Young or older, the diversity of their requirements means they want a proper general hospital in both of the key sites, Whitehaven (West Cumberland Hospital, WCH) and Carlisle (Cumberland Infirmary Carlisle, CIC), and older people’s services to be near to their homes.
Two examples of requirements mentioned by stakeholders (in no way official, just my take on what was said and reported):
- Women want consultant-led maternity to remain at both sites.
- Older people want beds in cottage hospitals to remain open, because they know they’ll probably need them.
41% of people whose official wishes are to die at home, die in hospital instead, as there are often unscheduled emergencies on the way to dusty death. Better to be closer to home.
Why we can’t have what we want
Those two particular services are linked, though you might not realise it. Both WCH and Alston Cottage hospital are struck by a lack of staffing. There is a staggering number of vacancies across the NHS in Cumbria, in quite specialist positions, and this results in either dangerously low levels of staffing, or locums being employed – at great expense.
For some reason doctors, consultants, nurses, and auxilliary staff, don’t want to risk their happiness by living out here permanently in the bleak north, or whatever it is others believe this beautiful place to be.
[EDIT: Maternity consultants at WCH emphatically disagree:
“We are also disappointed that our recent successes in recruitment have been denied publicity. The trust and Success Regime have not engaged with our new working models and new recruitment strategy, nor considered it as a way of improving recruitment within other departments.”]
Because they say they can’t get the staff for more remote areas, or the more grim places, the Success Regime wants the people to be able to receive care at home instead of hospital.
So you’d have thought they would have included health and social care services in the consultation and the proposed strategy.
Debbie Freake, an important member of Cumbria Clinical Commissioning Group, more or less admitted at the Kirkby Stephen consultation meeting that although the plans did lean more on health and social care, they hadn’t been included in the plans as there was a very wide scope just with health services.
And there’s the problem, right there. It’s a poorly thought-out plan that misses the obvious. It’s almost as though they intended to pass the buck to social care. If it was meant to work, they would have included all the services across health and social care, to create a joined up approach.
The consultation document contains 3 different ‘options’ for each of the areas under reform – maternity, hyper-acute stroke, children’s, and emergency and acute services. But those options are a joke!
The weird, laughable (scary) ‘options’
In each set of options they provide one they support, one that is similar to the first, but without some key service for some reason, and one option that is more or less unworkable.
(Images taken from the easy read’ consultation document).
Take the Emergency and acute options (pictured): the third option is ludicrous, just considering Carlisle’s roads and access to hospitals for A&E. But if anyone’s been to CIC’s A&E in recent years, it’s not exactly a tip-top service, with a bottleneck that starts with ambulances having to wait outside the unit, and ends with patients abandoned for hours on A&E until a bed can be made available … somewhere – anywhere. The real blockage is in the number of beds available. (Often none). So unless CIC increases its beds, an enlarged A&E service will go nowhere. And they said elsewhere that they hope to decrease CIC’s beds in years to come. The mind boggles.
So that leaves two.
Option 2 involves kicking out patients at 5pm from WCH if they aren’t ill enough to go to CIC – which could mean key workers or nurses having to ensure those patients will be adequately looked after at home … how many hours would that system run before it all came crashing down? In addition, and for extra incredulity, intensive care patients would have to travel the 50+ miles, presumably in an ambulance or helicopter. Are we sure that experience will improve their conditions?
Option 1, of course, is the most reasonable option, since that’s apparently the service they currently provide. Maybe it looks even more reasonable next to those other ideas.
All the others are like that, including maternity services:
Option 3, again, has just been popped into the document for a laugh. The idea of trailing up the motorway for some lubricant and an epidural seems pretty extreme, but are home births really that popular?! Are there going to be a lot of ladies having their babies on the side of the A595? The ridiculousness of the imagery is testament to how dumb that option sounds. In that circumstance, WCH could house nothing more than a social club for new mums and health visitors. Another part of what used to be a hospital becomes the dead white elephant everyone said it was.
[EDIT: New research shows that travelling in a car seat for more than 30 minutes can harm a baby under 4 weeks old. Whitehaven is a minimum of 40 minutes drive from Carlisle. More, if there’s an accident and a road closure. That means all but Maternity option 1 are risky to mothers in West Cumbria, even if the births went smoothly. Surely the plan is already dropping to bits?]
[EDIT 25 Sept 2017: Above, I wrote about ladies having babies on the side of the A595. Sounded like hyperbole, didn’t it? It wasn’t. It’s already happening, and we’re only a few months into the new arrangements.]
Why the Success Regime model doesn’t work for Cumbria
These options aren’t a proper choice. They’re weighted. There’s only one doable option in each set. Except this model doesn’t work for our dispersed rural communities. It doesn’t work for the fact that by 2020 25% of our Cumbrian population will be older adults. (People move here to retire, for heaven’s sake!)
Of course, it can’t address the loss of our public transport, our libraries, our post offices and ‘church spirit’. Of our essential communities made up of all ages. It’s not the health service’s fault how high property prices are under the spectre of the second home brigade, taking house opportunities from people who might have lived and worked in the area.
But most importantly of all, it’s an incomplete model. It doesn’t address the fact that the CQC thinks health and social care is at a ‘tipping point’ in the UK.
Also not covered:
- The problems already experienced by community health staff, even at the current levels.
- The problems in quality already experienced by residential homes and home care companies across the country.
- The fact that some care companies pass back contracts, calling them ‘undeliverable’. So some older folk get passed from company to company, and all the while they’re not being cared for. And that’s at current levels of care.
Yet they didn’t think they needed to involve Health and Social Care within the consultation?
This consultation is a disgrace.
Sources and additional reading links:
- Easy Read consultation document
- Bristol University: research on the effects of car travel on infants. Includes link to paper.
- CQC reports Health & Social Care in the UK is at a ‘tipping point’.