The Moretonhampstead community is situated within the boundary of Dartmoor National Park with a population of 4,000 residents. The Northern Devon Healthcare Trust provides a range of services to support the local population, including:
- Inpatient service at Moretonhampstead Community Hospital
- Outpatient services – consultant, GP and allied health professional clinics
- Community Teams – including nursing, therapy and rehabilitation services
Moretonhampstead is our smallest and most geographically isolated community hospital. Occupancy rarely gets above 75% of nine beds and on occasions it can be running a full staffing complement with only 2-3 patients.
The issues surrounding the sustainability of this community hospital have been raised many times, over many years.
Background to the recent service changes in Moretonhampstead
Summary of recent events
24 January 2013 – Northern Devon Healthcare NHS Trust takes decision to temporarily suspend the nine inpatient beds on the grounds of quality and patient safety. This decision takes effect from 1 February 2013. Click here for press release
This decision was in response to concerns about patient safety and quality. The Board could not be assured that staff had sufficient exposure to patients to maintain their clinical competencies. The Trust held a public meeting to explain this decision to the local community.
July 2013 – the Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) holds a ‘Health Summit’ in Moretonhampstead as part of a pan-Devon engagement roadshow. This was attended by 250 people and the majority of feedback concerned the fears about the future of Moretonhampstead Community Hospital.
13 August 2013 – Northern Devon Healthcare NHS Trust reopens six of the nine beds following a successful appointment of registered nurse, full review of nursing competencies and completion of the action plan following the Care Quality Commission inspection (October 2012).
27 September 2013 – The Northern Devon Healthcare NHS Trust is forced to temporarily close the six inpatient beds due to staff shortages, including unfilled vacancies and staff departures. Click here for the press release.
October 2013 – the Northern Devon Healthcare Trust and Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) launches an engagement exercise to involve the community in future options for healthcare provision in Moretonhampstead.
The other event of note occurred in the preceding months before this decision. Moretonhampstead received an unannounced inspection from the Care Quality Commission. The Trust received the inspection report from the Care Quality Commission (date of inspection: October 2012) where the service was found not to be compliant with standard 14 – staffing.
In October 2012, the Trust immediately progressed an action plan to address these concerns, which was shared with the CCG. The proactive decision to close the beds in January 2013 reflected the view that insufficient progress had been made to improve the competency of our staff, and we had been constrained in our efforts by the challenges of service provision in a small, rurally isolated unit.
The risks posed by service provision in small, rurally isolated units are well understood. Recruitment to vacancies in community hospitals is harder than community nursing and therapy vacancies. As such community hospitals tend to be less resilient than larger acute hospitals especially during winter months at times of bad weather. Last winter staff had to stay for several nights to provide care because of a lack of access to the hospital when the town was cut off by heavy snowfall.
While the beds remained closed, the key stakeholders were kept fully informed of our progress either via direct conversations with the CCG, local GPs, League of Friends and the media.
To ensure core services continued to be delivered during this time, the NEW Devon CCG has arranged for the minor injury unit (MIU) to be hosted in the neighbouring GP practices and the Northern Devon Healthcare NHS Trust recruited an additional community nurse to support the care of patients in their own homes.