Bridport Town Council has considered the proposed Clinical Services Review on a number of occasions over the past year or so. This has included a presentation on the initial proposals at its full Town Council meeting on 15 March 2015 with representatives of the Clinical Commissioning Group. It also hosted a very well attended public open forum at its full Council meeting on 22 November. This response by the Town Council reflects some of the concerns that were raised at the 22 November meeting.
The Town Council felt that it was very difficult to respond to the consultation and that there were very limited opportunities to suggest other options. It was difficult for a layperson to understand some of the terminology and the impact of the proposals was not always apparent in the questions. The Town Council was aware that other separate proposals had been reported for changes to the GP surgeries, a separate consultation had just started on Mental Health services and the ambulance service was not included. It was felt that these issues should have featured as part of this review, as if what is proposed is a joined up inter-dependent service, then all elements of that service need to be transparent and able to be considered at the same time and as a whole.
The Town Council feels that the changes will adversely impact on rural areas and would question whether there would be an equality of provision across the county. There was also no recognition of the changes under consideration to establish unitary authorities in Dorset, with a separate unitary proposed for rural Dorset. If this does go ahead, then there would be a need to retain and enhance services at Dorchester hospital to serve the rural Dorset unitary area.
Integrated Community Services – Options for Change
The Town Council supports the general intention to provide services closer to people’s homes, which is especially important for a market town and rural community like Bridport. It welcomes the proposal to retain Bridport Community Hospital, which is such a key asset for the community. However, it is understood that the number of beds could be reduced and also that there could be more “back office” functions re-located from GP surgeries into that Hospital. It is concerned that this could impact on the provision of services at the Hospital. It also notes the proposal for a community hub at Dorchester County Hospital with access to the community beds at Bridport with the consequent additional pressure on services at Bridport. The Town Council would not support any reduction in services delivered or beds provided by Bridport Community Hospital.
The Town Council was concerned that the number of beds to be retained in each community hospital did not appear to be specified. Without this information, it was difficult to comment on the proposals.
It was also concerned if care home beds were being proposed as an alternative to hospital community beds.
The Town Council would like to see some recognition of the need to work more closely with Dorset County Council social care services, especially bearing in mind that in Bridport the County Council is proposing to build a new community hub “Bridport Connect”.
This consultation does not cover GP surgery changes, which are set out in the Primary Care Commissioning Strategy. However, the proposed reduction from 8 surgeries in West Dorset to 3-5 and the re-location of services into the community hospitals, will have a major impact on some GP practices and the hospitals. The Town Council would not support any proposals that could result in the loss of GP surgeries locally and it is concerned that the GP proposals are not included within this consultation
There have been a lot of concerns raised about the table in the consultation document (page 32) showing the timings for people in Dorset to reach their nearest major acute hospital if it is in the county. There has been a lot of concern and a lack of clarity on what this means, as people in much of the county and certainly in the Bridport area could not reach Bournemouth or Poole in the timings quoted either by blue light ambulance, private car or public transport. Whilst it is understood that in parts of Dorset, emergency care will still be provided outside of the county, including in Yeovil, Exeter and Salisbury, this is not clear either in the consultation document or in the table.
Transport is a key issue for Bridport and for all types of appointment the difficulty of travelling to the east of the County was raised by a large number of people who addressed the Town Council in its Public Open Forum. Public transport in this area is poor and is forecast to get worse, as the County Council’s subsidies are reduced. It is not considered that the level of rural transport provision has been fully assessed as part of this review.
The time taken by ambulances waiting at the hospital needs to be considered and, whilst they are waiting and travelling to Bournemouth, they would not be available to respond to incidents in Bridport. There would be increased pressure on emergency response times, if there was just one major A&E, located in the east of the County.
In respect of maternity services, the proposals to integrate services with Yeovil and Dorchester would be preferable to moving all the services to the east of the County. However,the reduction in consultant cover in Dorchester and with no overnight paediatric consultant, this could lead to problems with the need for transfers to Bournemouth. Travelling further to Bournemouth or Yeovil at such a critical time would be a risk. The downgrading of these key services at Dorchester could also make it harder to attract staff, leading to further deterioration of the service. The Town Council would wish to see consultant led maternity services retained at Dorchester and it opposed the loss of overnight paediatric services at the hospital.
The NHS is valued by the community and, whilst it is recognised that the NHS is facing pressures, the Town Council does not feel that the document has clearly set out the case for change. There needs to be an opportunity for the public to comment on the GP surgery changes, which are not part of this consultation. For rural West Dorset, there needs to be more re-assurance about local service provision, travel times, emergency blue light coverage and integration with other services.
The Town Council also supports the comments made by the Bridport Local Area Partnership (by letter dated 8 February) questioning a number of assumptions in the review.