Last Updated on Monday, 19 September 2016 18:31
Stroud Against the Cuts member Caroline Molloy submitted questions to the Gloucestershire County Council meeting on Wednesday 14th September. The same council meeting featured a debate on this topic prompted by a submission of petitions seeking to retain 24 hour opening at Stroud and Cirencester MIUs totalling 5,345 signatures (read more about Stroud Against the Cuts' position in our submission to the Gloucestershire Care Services' Review of Minor Injuries and Illness Units). The answers have now been published (see the full set of public questions and answers via a PDF)
Question: Minor Injury Unit proposed closures, Sustainability & Transformation Plans.
Gloucestershire’s emergency services have already had cuts to Cheltenham A&E provision. We now face proposed widespread cuts to district hospitals acute/urgent provisions, AND a separate Out of Hours healthcare review with no guarantees that the same level of local service provision will be maintained, AND a separate ‘Sustainability and Transformation Plan’ being prepared now, in unminuted meetings of chief executives and so on, which is explicitly about delivering £100s of millions of cuts to NHS services locally as part of the Five Year Forward View. Whilst recognising the short term issue is one of staff shortages, and pressure from central government to come up with heroic levels of savings, I would like to ask the council's position on the following:
1. The Kings Fund have said “major acute sector reconfiguration rarely saves – and frequently costs – money, and sometimes also fails to improve quality”. The Kings Fund has also said: “Some reconfigurations make bold assumptions about managing demand and reducing length of stay. There is certainly scope to do this but experience suggests it is difficult and that unless very significant reductions in overhead costs can be made, it cannot be assumed that out of hospital alternatives are any cheaper. The direct costs of hospital care may in fact be lower unless significant costs can be shifted to carers or social care – neither of which are easy. In any case, switching to community settings just to save money risks increasing the burden on carers and adding to pressures on social care services, or disguising what are effectively poorer quality services”. Can the council advise how these risks will be avoided?
ANSWER (via Cllr Dorcas Binns): Acute Sector reconfiguration is something which the council has been a consultee on in the past, and where, in the case of Cheltenham Accident and Emergency night time closure, councillors have expressed concerns. Ultimately, however, these are matters which the council has no power to decide, and are the responsibility of the NHS
2. Nigel Edwards of Nuffield Trust said this month that healthcare senior financial managers think there are “big risks around implementation and governance” of these Sustainability and Transformation Plans and adds “Later in the process, some of the proposals may come as an unpleasant surprise to patients and communities.” My research into these plans nationally leads me to fear the closures of minor injury units at night, coming on top of the Cheltenham A&E downgrade and as yet unspecified further cuts to face to face healthcare services and units in Gloucestershire as part of the Sustainability and Transformation Plan, threaten the long term survival of many of our district hospitals. I fear they become nothing more than glorified nursing homes/pharmacists - or flogged off and sold for housing. Can the council guarantee that we will not lose our district hospitals, as full hospitals with medical beds and acute treatment options? What will it do to make sure this doesn’t happen?
Answer (via Cllr Dorcas Binns): The Council does not control the NHS. Questions about their future plans should be addressed to Gloucestershire Care Services NHS Trust.
3. What opportunity have councillors had to see the Sustainability and Transformation Plans as they are developed (drafts submitted to NHS centrally in Jan, April and June)? Does the council feel it has been able to fulfil its democratic obligations to represent the public, given the widespread criticisms of this planning process?
Answer (via Cllr Dorcas Binns): Gloucestershire’s STP is the responsibility of the NHS, rather than the County Council, although we do input into them, particularly on issues like adult socialcare, which are our responsibility. I expect that the NHS will publish the plan when it is completed, but it would be unusual to publish a document in draft. No doubt when it is published they will invite a wide variety of stakeholders to comment, including councillors.
Last Updated on Wednesday, 07 September 2016 12:25
Below is the letter we sent to Gloucestershire Care Services (GCS) as part of their Review of Minor Injuries and Illness Units (MIIUs) in Gloucestershire. The public engagement period concluded on Wednesday August 31st, and a final decision on new - reduced - opening hours at local MIIUs will be made at the next board meeting of GCS (the next Board Meeting of Gloucestershire Care Services NHS Trust will be held on Tuesday 20 September 2016 at the Stroud Subscription Rooms, George Street, Stroud. The meeting will run from 1.45pm). The letter includes questions we have requested answers to under Freedom of Information, and was also sent to Gloucestershire Clinical Commissioning Group.
Wednesday 31st August
Paul Jennings, Chief Executive Officer of Gloucestershire Care Services and Mary Hutton, Chief Officer of Gloucestershire Clinical Commissioning Group
Re: Review of Minor Injuries and Illness Units (MIIUs) in Gloucestershire, including reduction in opening hours of Stroud MIIU
Dear Mr Jennings and Ms Hutton,
We have been troubled by the recent sporadic overnight closures of Stroud (and Cirencester) MIIU, and are not reassured by statements in the booklet that the proposed changes in opening hours are related to a “lack of available staff”, and “attendances between 11pm and 8am [being] comparatively few”. We would like to express our strong disappointment that 24 hour opening is not an option for Stroud or Cirencester. We do not believe you have public support for removing services unless you have shown how other local services will fill the gap, or at least until you have explained in detail what impact of a reduction in opening hours you expect on the emerging chaos and crisis in urgent care in Gloucestershire, and what steps have been taken to mitigate this.
As such, we would like clarity regarding the impact of these changes on other local healthcare services. The booklet states that “this review does recognise that by reducing access to MIIUs, there may be some additional minor pressure upon other parts of the urgent care system: this impact has already been discussed with the Trust’s partners”. We believe it is essential that the outcome of these discussions is public. Specifically, we ask: what have Gloucestershire Care Services and the Gloucestershire Clinical Commissioning Group done to assess the impact of changes to MIIU opening hours on Out Of Hours and urgent care services in Stroud and Gloucestershire?
We note that local Out of Hours provision is already in turmoil, with the service having been closed for 560 hours at The Dilke, and 195 hours here in Stroud in a single year, and South West Ambulance Service Foundation Trust say they “do not believe we can continue to offer this service effectively, and within the current contractual constraints, the trust does not have the resources to improve the service to a level that is satisfactory for ourselves, patients or commissioners”. We further note that the relatively recent downgrading of Cheltenham A&E has predictably contributed to a worsening situation with regard to Gloucestershire Hospitals NHS Trust meeting its target to treat 95% of Accident & Emergency (A&E) patients within four hours, which has been missed every month for a year.
We believe there was a rationale for the Stroud and Cirencester service being open 24 hours in the past, or this would not be the situation prior to this review. Our position is that 24 hour opening is important to ensure universal provision that can catch occasional need and that it further provides important reassurance for the local population that care is available nearby if needed. It is clear to us that GCS itself felt 24 hour opening at Stroud was important when opening hours at the Vale Hospital were reduced in 2014, as Susan Field (then Director of Service Transformation) publicly stated at the time that this change was partly about “enabling us to keep the MIU service at Stroud General Hospital running 24 hours a day.” We would appreciate further detail on attendances over this time period and ask for data on full year attendances at Stroud, Cirencester, Lydney and the Dilke as individual MIIUs annually from 2010 to 2015.
We support the sentiment behind David Miller, Chairman of Stroud Hospital League of Friends, endorsement of Option 2 in your review, which would keep Stroud and Cirencester MIIUs open for the longest possible hours with least impact on other units, but also his comment in a letter to the Stroud New and Journal: “Ideally we would like to continue opening for 24 hours but if this is unacceptable then at least until midnight.” While we have been encouraging people to sign local petitions to make clear the level or desire for 24 hour opening and support for MIIUs, we understand that this has not been included as an option for a reason. Our desire is to make clear our opposition to the erosion of NHS services locally. We note that at time of writing 2,325 people have signed Liberal Democrat County Councillor for Cirencester Cllr Joe Harris’ petition to “Keep Cirencester Hospital open overnight”, and 700 people have signed the Labour Party petition online to “Ensure 24 hour, urgent care is provided at the Minor Injuries Unit at Stroud Hospital” – with around 1,000 more signing the same petition in paper form. Regardless of the reasons and the justification for them, we see these changes in opening hours as a cuts that undermine the NHS principles of universal, comprehensive, easy to access care – and as such we wish to convey our clear opposition to them. We do not wish to endorse options which involve a reduction in opening hours, nor can we support an outcome which preserves Stroud’s MIIU at the expense of services in other parts of the county. We wish to communicate our concern that people be expected to travel greater distances, which is expensive at best and out of reach to many who are unable to drive, or to afford taxi fares. We are troubled by the way in which GCS treats increased travel distances by suggesting that because “the two sites [in the Forest of Dean] are less than 9 miles apart”, “there is sufficient capacity to handle demand in just one of the MIIUs”, particularly given the difficulties SWASFT is having in meeting Ambulance response time targets and poor performance of the Non-Emergency Ambulance Service.
We hope our desire for the longest possible opening hours across all MIIUs is clear, despite 24 hour opening apparently no longer being possible. Nonetheless, we wish to emphasise our understanding of the importance of appropriate numbers of sufficiently qualified and competent staff. In Stroud Against the Cuts we have supported the 4:1 campaign that seeks mandatory minimum staffing ratios, and joined Sir Robert Francis in criticising the decision to halt work into safe staffing by the National Institute for Health and Care Excellence. We appreciate that “qualified nurses and especially Emergency Nurse Practitioners are in short supply nationwide”, but would request that GCS and GCCG make public statements regarding their understanding of the causes of this shortage and policies that can either contribute to help or hinder it in future. We note that, according to the Royal College of Nursing, pay has fallen by at least 14% in real terms thanks to the government's public sector pay freeze. RCN Chief Executive, Janet Davies, says the current shortage of nurses was “a preventable crisis, caused by years of cuts to student nurse commissions and a lack of long-term workforce planning. It could be worsened by the Government’s untested gamble with student nurse funding, which our members are clear will have a negative impact on the future supply of graduate nurses”. We believe that GCS and GCCG should make a clear statement that they oppose the changes to student nurse funding, and the imposition of contracts on healthcare workers outside of collective bargaining in general and specifically with regard to the current junior doctors’ contract – both policies which threaten to exacerbate staffing problems.
We would also like to know precise numbers regarding how many nurses have responded to recruitment offers by GCS in recent years, how many have been interviewed, and how many recruited?
The Gloucestershire Care Services booklet accompanying the review states that the proposals “are not about cost-cutting, as each option requires additional investment of between £210,000 and £460,000”. We would like to ask what period this additional investment applies to – is it annually or over a longer period? How does it relate to the existing budget for the MIIUs in Gloucestershire, and their budget in real terms over the past decade? Most importantly, we would like to ask about the future budget for Gloucestershire Care Services and encourage the Trust to state publicly any concerns about planned funding and demands for ‘efficiency savings’ over the next 5 years. In Stroud Against the Cuts, we fear for the future of local NHS services under the latest round of reorganisation and demand that Gloucestershire’s ‘Sustainability and Transformation Plan’ is made public as soon as possible, and GCS communicate swiftly any additional potential changes to either MIIU provision in the county or services at Stroud Hospital.
Finally, we note with disappointment that all the engagement events organised by Gloucestershire Care Services in Stroud have taken place during working hours and in the week, that they occurred with short notice, and that there was no advertising outside Trinity Church either before or indeed during the previous events. We would like to know how many people in total have attended these events as we believe it to be little more than a handful.
In summary, we would like responses to the following queries. Please treat these as Freedom of Information requests if necessary:
1. a) What has Gloucestershire Care Services done to assess the impact of changes to MIIU opening hours on Out of Hours and urgent care services in Stroud and Gloucestershire?
1. b) What has Gloucestershire Clinical Commissioning Group done to ensure a full impact assessment of changes to MIIU opening hours on Out of Hours and urgent care services in Stroud and Gloucestershire has been undertaken?
2. Please provide further details on numbers attending the county’s MIIUs from 2010 – 2015, broken down for Stroud, Cirencester, Lydney and the Dilke, by hour.
3. Please provide precise numbers regarding how many nurses have responded to recruitment offers by GCS in recent years, how many have been interviewed, and how many recruited?
4. What period does the “additional investment of between £210,000 and £460,000” cover? Is it annually or over a longer period? How does it relate to the existing budget for the MIIUs in Gloucestershire, and their budget in real terms over the past decade?
5. Please inform us of how many people in total have attended the engagement events in Stroud.
We also restate the following requests:
1. Please make public statements regarding GCS and GCCGs understanding of the causes of the MIIU staffing shortage and national policies that can either contribute to help or hinder it in future.
2. Please make a clear statement of opposition to the changes to student nurse funding, and the imposition of contracts on healthcare workers outside of collective bargaining in general and specifically with regard to the current junior doctors’ contract.
3. a) Please could you state publicly any concerns about planned funding and demands for ‘efficiency savings’ over the next 5 years?
b) Please make public Gloucestershire’s ‘Sustainability and Transformation Plan, or any aspects of it that relate to Gloucestershire Care Services.
Stroud Against the Cuts
| 07734 058789
NHS campaigners to rally at Stroud Hospital - Press Release 22/08/2016
Contact: James Beecher 07734 058789 -
- · Organisers Stroud Against the Cuts to be joined by District and County Councillors from the Labour, Green, and Liberal Democrat Parties at Stroud Hospital from 7pm on Monday 22nd August.
- · Battle against withdrawal of 24 hour opening at Minor Illness and Injuries Units (MIIUs) in Stroud and Cirencester, reduction in opening hours at MIIUs in the county
- · Campaigners worried about future of urgent care and other health services in the county as NHS faces multi-billion funding gap and increasing privatisation
Campaigners from community group Stroud Against the Cuts – who successfully fought to prevent Gloucestershire’s community health services being privatised in 2011/12 – will hold a rally outside Stroud Hospital on Monday night 7-8pm as part of ongoing campaigns to ‘defend the NHS’. The latest event is spurred by plans to withdraw 24 hour opening of the MIIUs in Stroud and Cirencester and reduce opening hours at MIIUs in the Forest of Dean. Gloucestershire Care Services, which runs seven district hospitals in the county, is asking people to chose between 3 options – each of which will see Stroud and Cirencester MIIUs close at 8 or 11pm. Stroud League of Friends are recommending Option 2, which would keep Stroud MIIU open from 8am until 11pm. David Miller, Chairman of Stroud Hospital League of Friends, said in a letter to the Stroud New and Journal: “Ideally we would like to continue opening for 24 hours but if this is unacceptable then at least until midnight.” Meanwhile, over 1,000 people have signed Stroud Labour Party’s petition to “Ensure 24 hour, urgent care is provided at the Minor Injuries Unit at Stroud Hospital”.
People attending the rally will hear from members of a variety of organisations and political parties. As well as James Beecher from Stroud Against the Cuts and regional officer for Unite the Union Jo Galaska, speakers will include Dursley Cllr Doina Cornell from the Labour Party - Stroud District Council’s representative on Gloucestershire County Council’s Health and Care Overview and Scrutiny Committee, Stroud County Councillor Sarah Lunnon (Green Party), and Cllr Joe Harris, Liberal Democrat County Councillor for Cirencester – who has collected 1,484 signatures on a petition to “Keep Cirencester Hospital open overnight”.
James Beecher, spokesperson for Stroud Against the Cuts said: “The proposed cuts in opening hours at MIIUs in Gloucestershire including Stroud are the latest example of government attacks on our healthcare services. We fear for the future of local healthcare services. We’re holding this rally not only to challenge the MIIU changes across the county but to highlight the crisis the government is causing in the NHS and to begin organising to resist the dramatic changes to come as local health bosses work behind closed doors on their plan to deliver Gloucestershire’s share of £22 billion of cuts. We worry that our Out of Hours care and community health services could end up in the hands of a private company - like local non-emergency patient transport. Services must have enough well-trained staff to provide high-quality care but the government seems intent on making staff shortages worse with pay cuts, attacks on junior doctors, and the scrapping of nurse training bursaries.”
Stroud Labour Party Vice-Chair Debbie Hicks said: “Closing this vital service for the community overnight will only put more pressures on NHS services at the A&E at Gloucestershire Royal. This is a local service that local people rely on heavily. We must do all we can to make sure patients in Stroud have access to care 24 hours a day.”
Promoting the Cirencester petition, Cllr Harris “This will move will have an negative effect on vulnerable people in particular who struggle to get around, one resident told me the other day that due to staff shortages at the hospital she had to pay £70 for a taxi to Gloucester.”
Notes for Editors:
1 Stroud Against the Cuts was formed in 2010. With other anti-cuts groups in Gloucestershire, it campaigned successfully against plans to hand Gloucestershire’s community health services to a private company (a so-called 'social enterprise') or conduct a competitive tendering exercise over who would run the services. Across the South West, handovers of similar services to 'social enterprises' did take place. Peninsula Community Health (PCH) - one such body - announced it would not extend its contract in Cornwall and the Isles of Scilly, blaming a "challenging financial climate", and more recently it has emerged that Virgin are set to take over these services in Bath and North East Somerset – from social enterprise Sirona which has run the services since 2011..
 The proposals form part of a "Review of Minor Injuries and Illness Units in Gloucestershire" that is being conducted by Gloucestershire Care Services (GCS). You can download/read the booklet online in pdf form: MIIU information booklet (pdf). The booklet outlines the reasons for change to the existing services and the three options to be discussed. "Discussions with the public" will take place till 31st August, with a final decision being made by the NHS Trust at its board meeting on 20th September 2016. GCS say that feedback received will be compiled into an outcome report and used to inform a new operating model for MIIUs that will begin on 1st October 2016.
Let’s be clear: the reduction in opening hours of Stroud Minor Illness & Injuries Unit is a cut in service. It goes against the core NHS principles of universal, comprehensive, easy to access care.
Already in Stroud we have fought unwise and expensive attempts to privatise our local district hospitals. Other local NHS services have been handed to private companies - non-emergency ambulances to Arriva; hospital pharmacy services to Lloyds. Cheltenham A&E was downgraded to a Minor Injuries Unit overnight. In 2014, Dursley’s Vale Hospital opening hours were reduced. Susan Field (then Director of Service Transformation) said that cut was partly about “enabling us to keep the MIU service at Stroud General Hospital running 24 hours a day.” Now Stroud MIIU hours will be cut as well.
Unsurprisingly, Gloucestershire Hospitals NHS Trust has been missing the target to treat 95% of Accident & Emergency (A&E) patients within four hours every month for a year.
What have Gloucestershire Care Services and the Gloucestershire Clinical Commissioning Group done to assess the impact of changes to MIIU opening hours on Out Of Hours and urgent care services in Stroud and Gloucestershire? Local Out of Hours provision is already in turmoil as the NHS trust currently providing the service has said the constraints of their contract mean they cannot continue to do so effectively (with the service having been closed for 560 hours at The Dilke, and 195 hours here in Stroud in a single year). We need answers.
Of course, services must have sufficient staff to provide safe, high-quality care. Ultimately, attention must be directed to the national context of sustained government attacks on the NHS - including a pay freeze, cuts to training and the scrapping of nurse training bursaries, and the attacks on junior doctors - that are producing financial stress, constant re-organisation, privatisation of services, and demoralised doctors and nurses retiring early, leaving the profession, or emigrating. Nurse's pay, for instance, has fallen by at least 14% in real terms thanks to the government's public sector pay freeze. RCN Chief Executive, Janet Davies, says the current shortage of nurses was “a preventable crisis, caused by years of cuts to student nurse commissions and a lack of long-term workforce planning”.
We fear for the future of local NHS services under the latest round of reorganisation: Like other areas, Gloucestershire is currently working on a ‘Sustainability and Transformation Plan’ behind closed doors, to deliver its share of a £22bn cut in funding, that will involve “the consolidation of unsustainable services”. In other words, services will be closed - potentially soon. Nationally, 14 A&Es were closed or downgraded between May 2010 and October 2014. Last week Grantham A&E in Lincolnshire cut its opening time by 14 hours for three months.
We need to ask, what makes these services ‘unsustainable’? Political decisions, wasting billions on a needless expensive system of markets and competition to give the private sector a toehold, and a destructive attack on the NHS’s most precious asset – it’s workers.
How can Neil Carmichael say he supports Stroud Hospital, whilst supporting all this?
We encourage anyone who can, to visit the Trust’s Information bus from 10-11.30am on Monday 22nd August on King St – and to sign the Labour Party’s online petition to “Ensure 24 hour, urgent care is provided at the Minor Injuries Unit at Stroud Hospital”, which can be found at goo.gl/4G4ihL.
Stroud Against the Cuts