Hospital services in northern Devon

In June 2018, a collaborative agreement was established between Northern Devon Healthcare NHS Trust and the Royal Devon and Exeter NHS Foundation Trust to provide support to NDHT in the short to medium term in addressing some of the challenges we face in providing acute services.

This agreement built on the long-standing clinical networking arrangements already in place between the two trusts and initially ran until summer 2020. It was agreed that by then we needed to have developed our plans for hospital services in northern Devon to ensure we have sustainable arrangements for the future.

To do this, we undertook a review of a selection of the key services needed by the population of northern Devon, with the starting place being that we need a hospital in North Devon with a 24/7 A&E.

There are three challenges which have affected our clinical and financial sustainability for many years.

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  • Remoteness: North Devon District Hospital (NDDH) is the most remote acute hospital in mainland England.
  • Workforce: Remote hospitals tend to experience heightened workforce challenges and being a smaller hospital means that vacancies can have a greater impact on teams. The graphic (right) illustrates how workforce challenges affect us locally and some of the work we are doing to reduce this impact.
  • Finance: Both remoteness and workforce pressures mean some of our services cost more to run than other NHS hospitals and this has led to increased pressure on the Trust’s financial position. The Trust ended the 2018/19 financial year with a £17m deficit, with a plan beginning in 2019/20 to move towards financial balance.

We wanted to understand how these challenges impact our services more fully to determine how we can best provide sustainable services for the future.

The findings of this work have been fed into Devon’s Long Term Plan, as well as the work that has commenced on a Peninsula Clinical Services Strategy.

Suzanne Tracey, chief executive of NDHT and the RD&E, said: “The acute services review work showed clearly that we need a hospital in North Devon with a 24/7 A&E and other supporting services.

“We now need to look closely at how we deliver on that commitment and ensure that we achieve safe, high quality and sustainable clinical services for the population of northern Devon.

“In the time I’ve been in post, I’ve heard from many of you about the transport and access difficulties people face locally, and how important our services are to people.

“We are really committed to providing as much as we can locally and I want to recognise and build on how innovative our staff have been in coming up with solutions and different ways of working to support this.

“However we need to be realistic about what we can do. We have been experiencing significant workforce challenges in some of our services as a result of national shortages for some time and these are unlikely to be resolved in the near future.

“We will be looking closely at these vulnerable services and those which are crucial to supporting A&E to help us develop our future plans, which will set out how we will deliver sustainable services to the population of northern Devon for years to come.”

Which services did we look at?

Our agreed starting point was that we need a hospital in North Devon with a 24/7 A&E, so we are interested in ensuring our A&E is surrounded by strong services which meet the needs of the local population.

We focussed on 11 key services, shown in the table (note that two services appear in both columns).

Starting in March 2019 we met with the clinical teams leading these services to understand their vision and plans for the future, and what support they may need to achieve them.

This was a really positive and important piece of work that forms the cornerstone of our future plans for all local healthcare services. It is helping us to make a decision about what form the organisation will take in the future.



Last updated: August 4, 2020