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The Swanage Hospital debate

Proposals to close the much-loved community hospital in Swanage have provoked a furious reaction. John Newth gives the background and hears both sides of the argument.

Swanage Hospital: a much-loved local institution

The facts
In May 2012 NHS Dorset published a leaflet entitled ‘Making Purbeck Healthcare Fit for the Future’. It was sent to hospitals, surgeries and libraries in Purbeck, appeared on the NHS Dorset website and was emailed to some members of the community. In it they outlined proposals that would combine GP surgeries and some hospital services, and would mean the closure of Swanage Hospital with the loss of its fifteen in-patient beds and surgery procedures requiring a general anaesthetic.
Option one was two new purpose-built polyclinics providing a wide range of services, one in Wareham and one in Swanage. Limited in-patient care would be provided by the NHS funding beds in nursing and care homes. Option two was a brand-new Purbeck Community Hospital with up-to-date facilities based in Wareham, and a modern, purpose-built polyclinic in Swanage.
Reasons given for the proposals were that the hospital buildings are old and expensive to run, and that there is a rare opportunity to develop a site in Swanage for a new polyclinic; the local GPs have been looking for somewhere for a long time without success because they believe that Swanage Health Centre has outgrown its present site.

Taken within a decade of its being built in 1890, and over half a century before it came under NHS control, this image of the original building is still clearly recognisable

The leaflet described the process. During Phase 1 a number of meetings and workshops were held throughout Purbeck for the public to hear about the proposals and ask questions. A response form was provided with the leaflet and online which asked people which of the two options they preferred. This phase has been completed. NHS Dorset are currently evaluating the feedback but have stated that their preliminary findings show two main areas of concern about the proposals: the quality of care and where the in-patient beds would be located. The next phase will see the publication of a new set of proposals, leading to a formal consultation period, it is hoped during 2013.

NHS Dorset: The case for change
Currently around £4.5m is spent on healthcare for the 33,000 or so people of Purbeck, of which approximately £2.5m is spent on hospital beds in Swanage and Wareham. The proposals put forward by NHS Dorset – on the initiative of local clinicians and working with the current provider, Dorset Healthcare – are about changing how care is delivered in the locality, not about reducing services; the local healthcare community will benefit substantially from the re-investment into community-based services.
No decisions have been made and no decisions will be made without giving local people the opportunity to have their say.
It cannot have escaped anyone’s notice that the NHS is undergoing considerable change in how services will be commissioned (purchased) and in who will provide these services. Budgets will be under more pressure, with more emphasis on patient outcomes, experience and safety. In addition, people are living longer and are more likely to begin to experience illnesses which can now be managed, such as diabetes, chronic obstructive pulmonary disease (often as a result of smoking), dementia, cancer, heart failure.
The reality of future healthcare is that hospitals cannot be places where long-term conditions like these are managed. Today, people with a long-term condition who have a sudden deterioration in their health will often be admitted by ambulance to an acute hospital, where they will be admitted for a short period to be stabilised before being sent home. There is now a lot of evidence of people taking much more control of their own long-term conditions, managing themselves or with the help of partners and carers, supported in some cases by remote monitoring systems such as telehealth.
The recent National Intermediate Care Audit has demonstrated that home-based services – healthcare, rehabilitation and in some cases social care received at home or in a community bed setting (hospital, nursing or residential home) to prevent unnecessary acute hospital admissions or premature admissions to long-term care – have seen better patient outcomes than bed-based services. In home-based services 82% of patients retained their level of independence, compared with 72% in the bed-based services. Only 13% of patients receiving home-based services moved to a more dependent setting, compared with 24% of patients who received bed-based services.
There are significant cost differences in NHS bed-based intermediate care services compared with community-based services. For every patient being treated in a NHS bed-based service, four patients can receive care in the community.
The elderly population in Purbeck is increasing. By 2035 the number of people aged over 65 is expected to have increased by 54.8%, that is to 13,484 compared with the present number of 8711. In addition, Swanage Medical Practice has recognised that their building is not coping with present demand, and that changes will need to be made in order to cope with any additional demand.
What would changes mean for local residents? Moving primary (GP) and community health services – ‘co-location’ – means that patients will benefit from improved access to services, while closer working between medical and nursing teams means communication will be more effective. Staff will be able to make better use of their time, increasing capacity to provide more services and support patients and families. GPs and local commissioners will be able to ensure that care pathways are in place that will support early intervention, diagnosis and treatment, and that there is more support and prompt intervention for the management of long-term conditions.

The Friends of Swanage Hospital, pictured in resolute mood, in front of the hospital which is threatened with closure

The Friends’ case against closure
(Jan Turnbull, Chair, Friends of Swanage Hospital)
Swanage Hospital provides a high-quality service that is trusted and valued and has always been very generously supported by the community. The Friends have donated over a million pounds in the last ten years to make sure it remains a centre of excellence. A new wing for out-patient clinics was opened in 2004 and building a new polyclinic when there are excellent facilities at the hospital seems a senseless waste of money. The Friends suggested that, if it was really needed, a new health centre could be built on the available land next to the hospital, or the hospital could house the district nurses, freeing up space in the current health centre. Ways of providing healthcare services can be re-designed and budgets pooled without ‘co-location’, as has been done in other parts of the country.

A counter proposal for the site of a new Swanage GP's surgery, on the site next to the hospital

The local MP, Richard Drax, gave an impassioned speech in favour of Swanage Hospital in a debate about the role of community hospitals in the House of Commons. In that debate the Under Secretary of State for Health said: ‘We [the Government] know that community hospitals make it easier for people to get care and treatment closer to where they live…. They can also help to save the local NHS money by moving services out of acute hospitals and closer to the people who use them.’
Swanage Town Council’s response was also vehement opposition to the proposals, listing twelve major concerns and stating: ‘The very fact that Swanage’s hospital – as both an iconic building and a successfully functioning in-patient hospital – enjoys such a high level of confidence, trust and affection is itself a most important reason for its retention.’
Throughout the summer Swanage people expressed their opposition to the proposals. At all the consultation meetings in the town there was a sense of outrage and disbelief, and at a public meeting in July, the Mowlem Theatre was filled to capacity, leaving hundreds of people outside chanting ‘Save Swanage Hospital!’ A petition rejecting the NHS Dorset proposals was signed by over 3000 people.

Anti-closure protesters on the beach at Swanage

The Friends appointed an expert consultant in healthcare to help them respond to the proposals. Helen Tucker’s report (a 45-page document) concludes that the process itself does not meet many of the key Government and NHS requirements necessary when a hospital closure is proposed. Fifteen limitations within the process are identified: in particular a lack of engagement, inadequate supporting information and failure to make a case for change. The response from NHS Dorset to the Tucker Report said they were confident that their ‘engagement’ process had followed correct procedures.
Once again, local people have not been part of the planning of the new proposals to be published in the New Year, which the Friends regard as a missed opportunity. ‘No decision about me without me’ is supposed to be the new mantra; the Government pledge that all service change must be led by clinicians and patients, not driven from the top down, seems to have been ignored in Purbeck.
Swanage’s demographics and geographical isolation make it special and make its inhabitants fearful of any change that would mean a loss of services. So the fight to save Swanage Hospital continues and the Friends aim to show there are ways to provide care closer to home which have the community hospital at the heart of the provision of quality, integrated care.

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