NHS local community hubs

Casdon

Why do you think it is an artificial grouping ronib, I don’t understand what you mean? Is it artificial to provide services which can be provided locally, which the primary care team says is needed, locally? I think it is what patients want, rather than to trek off to a district general hospital if they can get the service near home. I’d be interested to hear what other people think.

I wondered what this criticism meant too. Before 1948 there had never been a National Health Service so it was created to fit the needs then - I doubt it was ever perfect.

I hope the reforms mean that GPs go back to being the people with an overview of a patient's issues. Just before Covid struck I developed breathing problems, and blood tests to try to find the cause revealed that I also had a very erratic thyroid. I was referred to two separate consultants who couldn't talk to one another. The pulminologist suspected the breathlessness might be an endocrine issue, but couldn't consult the endocrinologist on my behalf. I asked him to write to my GP, who them passed on his observations to the endo guy, but as this was now in lockdown everything took ages and appointments were by telephone.

My GP was (almost) as frustrated as I was by the delays and difficulties in the system. At one time he would have co-ordinated everything, but instead was only able to refer me to various people who in turn were hidebound by protocols which seem to differ between surgery and hospital.

Everyone wanted to help, but they were all stuck with what seemed an unnecessarily rigid system. I think the idea was to free up GPs for diagnosis rather than cure. My local surgery has facilities for X rays, ultrasounds and other tests, but as soon as I was in the hands of the hospital I had to have those things done there (I assume for budgetary reasons). The hospital is far less convenient to get to since secondary care was centralised and the local hospital and cottage facilities were closed. Local hubs seem to me far more sensible and patient-centred.

I live in Wales and so the NHS is devolved. Our local NHS trust recently introduced a system where we cant have blood samples taken at the GP’s surgery any longer, only at the hospital. The car parks are always rammed anyway or its two buses for me. So just the opposite of the plan for NHS England

I have serious reservations about this. Primarily I wonder where the staff are coming from to man these centres? They can't be conjured up from fresh air and we already have a shortage of nurses and doctors. Is this going to dilute the staff/expertise in the hospitals? Secondly I wonder where the money is coming from. Those perfectly good cottage hospitals may have been repurposed or fallen into disrepair and will have to be updated, new equipment, IT systems etc will be needed. Is there new money available or will it be deducted from hospital budgets?
Personally I think sorting out the accessibility to GP's would go a fair way to sorting out the A&E hospital chaos and then arranging some sort of convalescent homes for those who unfortunately can't be discharged although medically fit.

We have excellent health service provision in our area. It is the peripheral services which let them down. OH had to wait 38 hours for medication from the pharmacy before he could be sent home. District nurses visited 3 times a week for the first 2 months and the 2 times a week for another 2 months but physio only came to see if he could walk up stairs and get in and out of the car and to bring a waking stick and a stool.
Two years, on he had a slight bleed /stroke . 24hours on a trolley {not called a trolley now} in a designated corridor space with dedicated nurses. At home he has weekly visits from a speech therapist and some visits and advice from a physio, which he needs after his original op on his leg
Then there is podiatry services. The local hub won't cut toe nails, they recommend Age UK who won't do it if you are on anticoagulation meds.
Ear wax removal was cancelled but we have been told has now been reinstated.
We can usually get a doctor's appointment within 24hours as there are several trainee GPs in addition to the group doctors.

I can see that staffing is, currently, a worry but surely the more efficient the system the fewer staff will be needed. Also, the more technology reduces laborious tasks the fewer staff are needed. Granted we may still be drawing on a less than perfect number either way but this should make better use of that number. It should also reduce the pressure on staff and hopefully that will increase the numbers available.

The only perfect system would be found in heaven. But the next draft and the next one ensure continuous improvement.

knspol You've raised some valid points and I'm sure I don't have the answers.

It will undoubtedly depend on local conditions. In my town there has been a a local hospital with empty space for as long as I can remember. There have been various attempts to sell it off, but all have failed - fortunately. There was no capital expenditure to buy property, although there does seem to have been investment in renovation.

We now have a hub/local hospital which is ideal for the new plans. One GP practice has already been moved in. The practice works in a consortium with other local practices, so they've been able to pool their resources to afford resources which wouldn't usually be available in a standard GP practice.

Empty space is now being used for a variety of outpatient clinics provided by various trusts, so patients don't have to travel to more distant hospitals. They're staffed by nurses and doctors from the hospitals. One of the wards has remained open for over 60s rehab in-beds. It isn't the same as A and E or minor injuries, which unfortunately aren't (yet) available, although the local ambulance depot is located onsite.

There are other hubs within a few miles offering different specialties. Again, they're staffed by local hospitals. The idea, I think, is to provide services closer to people's homes and in a less high-tech environment than hospitals.

There need to be enough people in an area to make it worthwhile - and to have enough patients so that clinicians aren't working in isolation. For example, it would be silly and dangerous to have a specialist cardiologist working in an isolated hub because he/she needs the experience of seeing a number of patients on a regular basis. It wouldn't really work in very isolated areas, but would work in areas where there are clusters of villages or small towns without a general hospital.

In the past, my elderly relatives would go into a convalescent home when discharged from hospital. They looked after them, fed them up, got them mobile, fresh sea air for some and then rejuvenated they returned home. It’s a shame there’s so few available nowadays.

woodenspoon

In the past, my elderly relatives would go into a convalescent home when discharged from hospital. They looked after them, fed them up, got them mobile, fresh sea air for some and then rejuvenated they returned home. It’s a shame there’s so few available nowadays.

I agree with you about this. Nevertheless, they do still exist. I know somebody who has just been moved into one. It would really make a difference to the issue about bed-blocking in acute hospitals and would surely be less expensive than home visits by carers and district nurses.

Yes there’s definitely a need for them particularly if the elderly person lives alone. We are on the south coast and an old friend has been to one not far from us. She thought it was superb.

Casdon,
I'm not sure what part of Wales you are in but here in my part of The Vale of Glamorgan, there is no sign of any Neighbourhood Care Networks, if they are around they are certainly well hidden as no one I have spoken to has heard of them.

I have just looked the Neighbourhood Care Centres up. They are only in one Health Board in Wales.

woodenspoon

In the past, my elderly relatives would go into a convalescent home when discharged from hospital. They looked after them, fed them up, got them mobile, fresh sea air for some and then rejuvenated they returned home. It’s a shame there’s so few available nowadays.

Our system still does this. It's in a purpose built building which used to be used as a council run care-home until care was subcontracted. It works well, assessing people's needs while they are there, normally for up to six weeks. It must be much cheaper than keeping people in hospital.

Things change though. So many thing can be done now that couldn't be done when we were born. What we once needed hospitals for can now be done as effectively but cheaper in clinics. Hospitals now do so many things we could not once have dreamt of. We do have to be prepared to change with the changes.

I agree with you PoliticsNerd. When I had my tonsils removed as a child, I had to stay in hospital for a week. I found the whole experience a nightmare. The nurses were dragons and the food was horrible and unsuitable for somebody with a sore throat. Even now, I don't really understand why I had to stay for so long. It put me off hospitals for years.

Fast forward ... I had half my breast removed two years ago and didn't have to stay in hospital for longer than necessary. I went into hospital at 7.30am, had the op mid morning and was discharged by the late afternoon. I had arranged for somebody to be with me at home and knew exactly what to expect. I had everything I needed at home, so didn't need to go shopping and just slobbed out for a couple of days. The hospital rang me the day after the op to check I was coping. The big advantage was that I could actually sleep in my own bed rather than having to sleep on an uncomfortable hospital bed in a noisy, unfamiliar ward. I recovered well.

I hope no one is proposing to have breast surgery or tonsils removed in a clinic/hub?

Pippa000

Casdon,
I'm not sure what part of Wales you are in but here in my part of The Vale of Glamorgan, there is no sign of any Neighbourhood Care Networks, if they are around they are certainly well hidden as no one I have spoken to has heard of them.

You’ve definitely got them Pippa000.

cavuhb.nhs.wales/our-services/vale-community-resource-centre/

www.cavgp.co.uk/en/page/localities-and-clusters

If you search, there’s lots more information available.

ronib

I hope no one is proposing to have breast surgery or tonsils removed in a clinic/hub?

You know they aren’t. It’s been clearly explained on this thread what they do.

Pippa000

I have just looked the Neighbourhood Care Centres up. They are only in one Health Board in Wales.

See my response to your previous post, they are called different names in different places in Wales, but they exist everywhere, all operate to the same Welsh Government guidance.

ronib

I hope no one is proposing to have breast surgery or tonsils removed in a clinic/hub?

Of course they're not. Why on earth do you think that? Nevertheless, there are plenty of minor surgical procedures which don't need to take place in an acute hospital setting.

Oh did I misunderstand Politics Nerd … what we once needed hospitals for ….. etc?
So if we still need hospitals Casdon let’s make sure that they are funded and fit for purpose?

Casdon

Pippa000

I have just looked the Neighbourhood Care Centres up. They are only in one Health Board in Wales.

See my response to your previous post, they are called different names in different places in Wales, but they exist everywhere, all operate to the same Welsh Government guidance.

I did a quick Google and I also found some in different parts of Wales. I don't think they're the same as the proposed hubs anyway.

growstuff

woodenspoon

In the past, my elderly relatives would go into a convalescent home when discharged from hospital. They looked after them, fed them up, got them mobile, fresh sea air for some and then rejuvenated they returned home. It’s a shame there’s so few available nowadays.

I agree with you about this. Nevertheless, they do still exist. I know somebody who has just been moved into one. It would really make a difference to the issue about bed-blocking in acute hospitals and would surely be less expensive than home visits by carers and district nurses.

A few years ago we had a local convalescent home, which provided an excellent service to elderly patients who didn't need long-term care, but weren't well enough to go home until they recovered from a stroke or fall. It was in the middle of an established residential area, had a free car park and allowed elderly spouses and other relatives to visit without cars as there was a bus stop right outside. Patients had their own rooms with free TV, as well as a communal sitting room, so they had company when they wanted it and privacy and dignity when they were alone. There was a gym and facilities for X Rays and scans etc. Patients were long-stay, so having a pleasant environment was very important.

Despite a lengthy campaign to keep it open it was sold and is now a private care home charging £2000 a week. The patients now go to a general hospital on a ward with several others. They are charged for TV, parking is expensive and travel by bus is inconvenient (eg two buses from the convalescent home) A return taxi ride from there to the hospital cost 25% of one person's share of a basic pension at the time, so spouses who no longer drive can't visit as often.

I would love to see places like the convalescent home reopened.

ronib

Oh did I misunderstand Politics Nerd … what we once needed hospitals for ….. etc?
So if we still need hospitals Casdon let’s make sure that they are funded and fit for purpose?

What we don't need hospitals for is for patients to stay in in-beds for days before and after surgery, if they are better off being in their own beds at the end of a phone or computer if support is needed. Gone are the days when many people lived in overcrowded hovels and hospitals offered a relatively sterile environment with adequate nutrition.

ronib

Oh did I misunderstand Politics Nerd … what we once needed hospitals for ….. etc?
So if we still need hospitals Casdon let’s make sure that they are funded and fit for purpose?

Nobody is suggesting otherwise are they. What is being proposed is that minor things are treated in the community at the new hubs and, as a result, it will free up space so urgent ops will get done faster in the main hospital. I don’t understand why anybody would be against this happening.
Breast surgery is major. I know. This will take place in a cancer ward for breast surgery.

I agree with you Doodledog. I think they need to be looked at because they would surely offer a cost-effective solution to some social care issues. The issues aren't going to go away.