No beds and no  tier four services

Dear Sir, — The decision regarding the future of healthcare in North Staffordshire has finally been made.
On 21st January the clinical commissioning group delivered its verdict by a majority vote that all beds in local cottage hospitals would go for good. 
Seventy seven beds would remain at the Haywood and the remaining 55 will be commissioned via private care homes. 
In addition, Leek Moorlands hospitals will lose its tier four services that include gynaecology and rheumatology outpatient clinics. 
However, they will make a multimillion-pound investment in Leek by building a CareHub. 
We are not yet sure what facilities will be in this hub, but we certainly know that there will be no beds and no tier four services. 
Therefore, the Moorlands will no longer have a hospital.
I am a councillor for Biddulph Town Council and Staffordshire Moorlands District Council. 
So while these changes will not have a major impact on the people of Biddulph, as they may be accustomed to travelling to Stoke, it will have a huge impact on our very rural communities and I have a duty not only to Biddulph but the Moorlands as a whole, especially as a member of the Health Scrutiny Committee.
Many will lay sole blame for this decision at the feet of the clinical commissioning group but I do not see it that way. 
In 2012 the Health and Social Care Act came into being, with one of its main actions to create clinical commissioning groups that commission services closer to the population that they serve. 
They have the job of getting best value for money for the taxpayer by using state run services, third sector organisations or private companies. 
This is why our clinical commissioning group has been allowed to commission 55 care home beds. 
They (by Marcus Warnes’ own words) are cheaper than the beds in our cottage hospitals. 
With more than £100,000 to find and being our clinical commissioning group is in financial special measures as a result, you can understand the need to find the cheapest services! 
I absolutely agree that people who are no longer sick enough to need blood transfusions or IV medications should not be in a bed in our acute hospitals. 
However, those people may still be too sick to go home and cope alone. Therefore, the clinical commissioning groups are required to provide intermediate rehabilitation care to get them ready for home.
Care homes do not have the skilled personnel or expertise to deliver these specialist services. 
They don’t have their own physiotherapists, nutritionists, speech therapists, occupational therapists, continence assessors. It is therefore quite clear why these beds are cheaper than the cottage hospital alternative. 
The care sector struggles to recruit and retain staff; care homes the clinical commissioning groups have commissioned have been rated by the Care Quality Commission as being inadequate providers of care. 
It’s my firm belief that care homes do not rehabilitate and get people back home. Healthwatch 2017 concurs in a report that they commissioned, which explored these exact issues. Healthwatch is an organisation that the 2012 Health and Social Care Act also instated. A body that allows people to influence the kind of care that they want in their communities. Here is an extract from the 2017 report: “There are also questions regarding the quality of care in nursing homes and a fear that people may be sent to nursing homes by default, with less chance of receiving rehabilitation.
“It is feared that they will just be warehoused. There is also a lot of continuation of treatment that currently takes place in community hospitals that people are concerned may not necessarily be duplicated in a nursing home, such as managing pressure damage and monitoring tissue viability or providing one-to-one care.
Respondents fear that the quality of that delivered in nursing homes is not on a par with current provision. The private sector is also understood by some to be driven by profit, with targets to be hit and risk of impacting numbers and quality of staff. Respondents question the motivation for people to be moved on from nursing homes.” There’s another system that this shake-up of services locally has initiated and this is called Home First. 
It’s a system of support in people’s homes after they leave hospital in order to allow recovery, rehab and a return to independence. It’s commissioned by our clinical commissioning groups and the most recent inspections of Home First have rated services in Stoke and the Moorlands as inadequate. 
Here’s a quote from the Moorland’s Home First 2019 inspection: “Due to poor staff deployment, people’s safety was placed at risk of harm and some people did not receive their prescribed medication at a time they should … the number of missed visits to people’s homes had significantly increased. One person said, ‘I have been missed off the rota four times’… On occasions staff were given a rota which expected them to be in two different places at the same time, this meant that people did not always get their calls on time…Staff told us they did not always have time to travel between calls, due to the large geographical area they needed to cover…staff did not know people well.
“One person said, ‘I would like to see some continuity, I don’t know who is coming and at what time’…The provider did not continually seek and act on feedback from the registered manager and failed to improve the service for people…” 
So yes the clinical commissioning group has made its decision but the legislation to allow this conclusion came back in 2012 and in my opinion every politician that voted for its implementation has enabled this situation to occur; that includes our own MP. 
Our clinical commissioning group will be made the scapegoat but it is just part of the scheme that came from the highest echelons of our Government. 
Our MP promised to help to save Leek Hospital; Leek will no longer have a hospital; it will have a CareHub. 
Karen Bradley promised to retain services and enhance them; we have just lost all tier four services. 
Clever spin by Karen’s PR machine will make this sound like a triumph — however, it’s my firm belief that the decisions made yesterday are an injustice to the people of the Moorlands, a travesty in fact. 
Peter Dartford, the former chief executive of Staffordshire Fire and Rescue Service is a lay member of the clinical commissioning group. 
Even he — with an in-depth understanding of the public sector — saw this decision for what it was because he and other lay members either abstained or voted against the motion. 
Good on them I say and thank you for putting up a fight for the people of the Moorlands. 
People will suffer as a result of this decision. 
Community care is an admirable ambition and even I acknowledge that I would like to be in my own home as long as I possibly can be. But the facts are, society is currently ill-equipped to deal with this utopia and until it is, people should be cared in places where they have the most equipment, skill and expertise. 
In 2020 Staffordshire, that is not care homes or home care. Those staff do care and do a sterling job but they don’t have the knowledge, time or staffing levels to rehabilitate those who have the potential to live independently once again after a period of serious illness. — Yours faithfully,

JILL SALT
Biddulph.