Much less headline-grabbing on the time was its pernicious impression on rural healthcare companies, a few of which had been withdrawn solely to finally resume in a digital or scaled-back type – or by no means.
In Dumfries and Galloway, 4 cottage hospitals – in Kirkcudbright, Moffat, Thornhill, and Newton Stewart – had been mothballed.
They’ve by no means re-opened and a proposal to shut them completely and dump the websites is certainly one of six choices now into consideration by the area’s Built-in Joint Board (IJB), with a closing determination due in September.
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“The specter of closure of cottage hospitals has been round for a very long time, however – name me cynical – lots of people really feel that the pandemic provided a possibility,” mentioned Dougie Campbell, an unbiased councillor whose Dee and Glenkens constituency encompasses Kirkcudbright.
“The cottage hospitals had been closed on the premise that they’d be a troublesome house to attempt to forestall the unfold of the virus.”
Previous to the pandemic, Kirkcudbright cottage hospital had 14 inpatient beds offering palliative care, outpatient companies, and step-up/step-down care to assist hold frail aged sufferers out of – or velocity their discharge from – acute hospitals, for instance with post-operative rehabilitation.
In the present day, sufferers must journey round 30 miles to the Royal Infirmary in Dumfries or almost 50 miles to the group hospital in Stranraer.
Mr Campbell, a founding member of the Kirkcudbright Neighborhood Hospital Motion Group, mentioned: “We have very poor public transport. We have a really vital ageing inhabitants.
“We lose younger individuals and achieve individuals who come her to retire – together with me. I got here down from Glasgow in 2011.
“Issues aren’t trying good for us regionally, however so long as the ultimate determination hasn’t been made in regards to the cottage hospitals we’ll hold preventing.
“Throughout the board, companies are lowering and lowering, and it feels as if rural companies are a straightforward goal.
“Our frustration is that they do not appear to understand how troublesome it’s for individuals to entry companies.
“We have had conditions the place individuals have been terminally in poor health and relations have had nice problem getting to go to them as a result of they’re both in Dumfries or Stranraer.”
Issues have additionally been raised about IJB plans to purchase up 31 “flexi” beds as a substitute within the area’s privately-owned care properties – together with 5 within the Kirkcudbright space.
The initiative is anticipated to price round £1.2 million, however there are warnings that social care in Dumfries and Galloway is already stretched and under-staffed and that care properties are ill-equipped to supply rehab and palliative take care of hospital sufferers.
In a letter to NHS Dumfries and Galloway’s chief government, Jeff Ace, dated March 7, Pauline Drysdale – chair of the council’s social work committee – mentioned she and her colleagues had “grave considerations” in regards to the plan.
She famous that Care at House provision within the area is already working at a shortfall of round 3,500 hours per week “attributable to a scarcity of frontline employees”, with these points additionally affecting care properties.
Roughly 90 care dwelling beds are unoccupied as a result of there are too few employees to function them safely, resulting in fears that if current obtainable beds are ring-fenced for the IJB it may in the end result in even longer waits for aged individuals in want of a care dwelling place.
Ms Drysdale added: “If employees can’t be recruited to work within the social care sector, we’ve grave considerations that any change to care dwelling function and performance will merely lead to much less long-term care dwelling locations.
“When mixed with an absence of Care at House service provision, extra reasonably than much less of our aged residents could require an prolonged keep in acute NHS institutions.”
Regardless of its aged inhabitants – 27% of Dumfries and Galloway residents are over 65 – the variety of care dwelling beds within the area has shrunk by 12% over the previous decade, 4 instances quicker than the Scottish common.
In the meantime, the variety of acute hospital beds fell from 398 in 2016/17 to 313 by 2021/22.
In line with figures for January, a median of 95 acute beds – 30% – had been occupied at anybody time by a affected person able to be discharged. The nationwide common is 14%.
The present proposals by the IJB comply with its Proper Care Proper Place programme, a means of group engagement and session launched in October 2022.
In its report on March 5, it mentioned that “excessive numbers of individuals within the cottage hospitals might be higher supported in different settings” and that suggestions concerning resuming bed-based companies at these websites had come “largely from hospital motion teams, employees and elected members reasonably than members of most people”.
No closing determination has been taken on their future, with different choices into consideration together with utilizing them for a mix of outpatient clinics and day therapy and even transferring them into group possession.
It comes as NHS Dumfries and Galloway predicts that it’s headed for a funds deficit of £35 million by the tip of the monetary 12 months in April.
In opposition to this “very stark monetary scenario”, fears at the moment are mounting that the cuts may transcend the cottage hospitals.
Councillor Willie Scobie, whose constituency covers the Stranraer space, mentioned: “We’re clearly involved in regards to the cottage hospitals – that is a longstanding subject – however for the reason that well being board introduced that they have this £35m deficit, they slipped in beneath the radar that they had been going to ‘overview’ the Galloway Neighborhood Hospital.
“That is an enormous concern. We’re speaking about probably lowering the Galloway hospital – that does operations, A&E – all the way down to a minor accidents [unit].”
NHS bosses within the area confronted heavy criticism earlier this month after they didn’t attend a public assembly on the difficulty on March 8, however insisted that the overview is unrelated to its funds deficit.
The withdrawal of the hospital’s birthing suite in 2019 has beforehand been blamed for circumstances of “layby infants” as moms gave start in automobiles and ambulances parked along side the A75 after working out of time to get to Dumfries.
The well being board mentioned it had struggled to draw midwives, however an unbiased overview final 12 months really helpful {that a} maternity hub with on-call midwives needs to be arrange. No determination has but been taken.
Mr Scobie mentioned: “It is horrendous what is going on on down right here with maternity companies.
“We have had ladies giving start along side the highway. One lady travelled 7000 miles again and ahead to Dumfries throughout her being pregnant. Unbelievable.”
Each Mr Scobie and Mr Campbell have voiced considerations that the councillors who sit as voting members on the IJB will not be doing sufficient to problem or scrutinise decision-making.
A movement attributable to go earlier than the subsequent full council assembly on March 28 will urge them to “take extra of an curiosity within the menace to native healthcare companies”.
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John Locke, a retired GP who spent 35 years as a accomplice at the Solway Medical Observe adjoining Kirkcudbright cottage hospital, mentioned one of many largest losses was palliative care.
He mentioned: “For years, virtually no one who wanted end-of-life care died within the hospice in Dumfries – that was uncommon in Kirkcudbright.
“Almost everybody was cared for regionally, other than the odd actually advanced individual.”
He added that with the ability to hold sufferers within the cottage hospital, with healthcare employees who knew them, had additionally helped to keep away from over-treatment.
Dr Locke mentioned: “I all the time thought it was a part of my function as a GP to maintain individuals away from the ‘huge hospital’.
“They have an inclination to get quite a bit finished to them that they do not want as a result of they see medical doctors and nurses who do not know them – a number of assessments and scans and blood exams.
“Though a cottage hospital may look a bit costlier to run, and they’re a bit costlier since you’ve obtained economies of scale, quite a lot of the opposite issues are inexpensive and that is why.
“We might take someone into the cottage hospital and we’d know their stage, so to talk, and we would have a good concept after they had been again to that stage.
“Whereas if you do not know the individual, possibly you’ve got obtained unrealistic worries or expectations.
“So there’s lots of people coming [into hospital] now with a twice-a-day package deal of care and going out with a package deal of care 3 times a day, and that is usually why they’re ready – as a result of they’re ready for that further little bit of care to be added on.
“And naturally, social companies do not have the time to overview these packages, in order that they’re usually began up and simply hold going.”
Geoff Dean, who retired as a senior supervisor in Dumfries and Galloway’s social work division and is now the spokesman for the Save Kirkcudbright Hospital Motion Group, mentioned the Proper Care Proper Place session “hasn’t actually listened to individuals”.
He mentioned: “The largest feeling is that after once more it is rural communities being ignored and every little thing centralised.
“We had an incident lately the place an older individual fell over they usually needed to wait an hour for a taxi to take them to Dumfries the place beforehand they’d simply have popped up the highway [to the cottage hospital]. They had been dropping quite a lot of blood.
“Generally you may have a taxi flip up and say ‘I am not taking them, they’re too in poor health’.
“I do know it is troublesome to supply a well being service in rural areas however we simply suppose they need to be how they spend the cash, not simply saying ‘we will shut issues as a result of they price us cash’.
“They are not trying on the broader image.”
A spokesperson for NHS Dumfries and Galloway mentioned its session, group engagement, and up to date workshops had “produced a number of choices for supply of group well being and social care” within the space.
He added: “The following stage of the session course of is to appraise these choices and can contain stakeholders together with individuals from the communities for every respective space.
“The choices value determinations course of will likely be carried out throughout April.
“As soon as appraised the choices will exit to the broader group for formal session. This will likely be a 12-week course of working from April to July 2024.
“The formal session will likely be open to anybody. We will likely be welcoming curiosity and enter from people and group teams, all of whom have an necessary half to play within the total course of.
“The outcomes of this session will likely be offered to Dumfries and Galloway Well being and Social Care Partnership in August, and in September 2024 the Integration Joint Board will make its determination on the way to proceed.
“NHS Dumfries and Galloway, Dumfries and Galloway Council, and the opposite members of the Partnership will then put the IJB’s determination into impact.”
