A letter to Admiral Sir Richard Ibbotson, dated April 13th 2017

Admiral Sir Richard Ibbotson KBE, CB, DSC, DLChairman of the Board of the Torbay and South Devon NHS Trust

Dear Sir Richard,

I write to you in your position as Commander of HMS Torbay! I assume you have ultimate responsibility for the actions, both good and bad, that take place under you. Thus I bring to you a very disturbing facet of the new plan for 'care at home'.

I am confident in writing to you because I was trained very well in all specialisms at St Mary's Hospital, qualifying in 1964. I then spent 11 years training in surgery, the last 5 being in orthopaedic and trauma surgery. I was appointed to serve in this role at Torbay in 1975. Although my 77th birthday is tomorrow, I have continued to take the closest interest in our medical services and in my fellow man, both here and in the world.

My central concern (among many) is contained in the annexe below - “prevention of hospital admissions”. This duty, as stated, is unethical. Furthermore, it places a burden on a person who has not been asked to provide evidence of any relevant qualification. Any conscientious GP would always consider whether admission to hospital was necessary and many would have the great benefit of observing/treating some patients in the local Community Hospital. So the only words which have an ethical basis is 'the Assistant Practitioner/Intermediate Practitioner will bring any concern about the patient to the GP.' He or she will consider the need for hospitalisation. (The title of this 'practitioner' is nebulous and should be clearly defined.)

There is much that I would say. Included is the fact that diagnosis is often difficult, especially where there is multiple pathology in the elderly and worse still if there is confusion or actual dementia. The presence of good light and a good bed helps. There are anecdotes in my mind. A 60yr old in our last village with severe abdominal pain c. 1995. Visited 3 times by Devon Doc or similar but the correct diagnosis was not made. Died at home in very severe pain with a ruptured abdominal aortic aneurysm. (Some do not survive surgery for a 'hot' aneurysm but he should have been in hospital.

Very strict rules will need to be in place if 'care at home' is to continue. Death at home without a clear diagnosis made by a professional, with evidence, should be followed by a post-mortem examination.

I would be happy to discuss these things with you. I have great concerns about the shift from hospital based care based on dogma (no pilot studies), expediency and economy. You will see at the foot (THREE). I regard the UK population as being one of the most sickly and yet it will soon have the least hospital beds per 1000 of all the 33 OECD countries. So more 'care at home' as doctors, carers and social workers flee the service.

for truth and with best wishes

David Halpin MB BS FRCS

ANNEXE

ONE

An advertisement with a closing dateof the 6th August 2016. (Incidentally the starting date for the consultation run by the SD&T CCG was 1st September – showing that it was a sham.)

Assistant Practitioner

Torbay and South Devon NHS Foundation Trust is a newly integrated care organisation which aims to provide high quality, safe and effective health and social care at the right time, in the right place to support the people of Torbay and South Devon to live their lives to the full.

Our continually developing Intermediate Care Services have an excellent opportunity for an enthusiastic, forward-thinking full time Assistant Practitionerin the Coastal (Teignmouth and Dawlish) locality.

The role will involve working within a developing Intermediate Care Service which facilitates crisis management in the community, prevention of hospital admissions, and quicker discharge from hospitaland supports people to remain as independent as possible at home. Patients are seen within the most appropriate setting; at home and in intermediate care placements in nursing and residential care homes.Duties include one to one rehabilitation work, managing your own caseload and utilising competencies in a range of Physiotherapy, Occupational Therapy and Nursing interventions, supported and supervised by these health professionals within the team.

The post holder will also work closely with the community matron in supporting clients with long term conditions and helping to prevent these people slipping into crisis where possible

The post holder will be well supported by senior staff, as well as by the wider multi-disciplinary team, which will include medical support. There are excellent CPD training opportunities, including training from the South Devon Health Services training and development team, Clinical Interest Groups and peer support. Salary £19 – £22.000 ))

(Note – no required qualifications mentioned)

TWO

Mid-Devon Advertiser April 7th 2017

Article entitled Demands to retain women's ward fail.

The trust was quoted regarding the reasons for this and for an increased emphasis on community based health services. These words were included. “…... extending and enhancing our intermediate care teams. These are skilled, multi-disciplinary teams, including local GPs, who support people to be cared for at home either preventing a hospital stayor enabling earlier return home following a hospital stay. We believe, with these additional resources in place, the time is right to plan to reduce the number of beds we need in Torbay Hospital.”

THREE

Beds – UK has least of almost all OECD countries but is the sickliest

scroll down

https://en.wikipedia.org/wiki/List_of_the33 OECD_countries_by_hospital_beds

Beds per 1000 people 2011 

France 6.37 8th of 33 countries

United Kingdom 2.95 27th of 33 countries