Threatened Community Hospitals

Closures, Threats and Reviews

The Community Hospital Association database shows 106 hospitals which are either under review, are threatened with closure or loss of services, or have actually been closed. Our networks with members and stakeholders concerned with community hospitals suggest that these numbers are a conservative estimate and that there may be many more community hospitals currently affected.

Hospitals such as Bradford Upon Avon have closed completely.  Doddington has lost its inpatient facility. Hartismere Hospital has lost most of its inpatient provision.  Many hospitals are under threat of complete closure, such as Walnuttree Hospital in Sudbury. Many community hospitals are under review, such as those in Cumbria which includes Penrith and Alston. Communities throughout the country are expressing concern and anxiety about the loss of valued community-based services provided in their local hospitals.  The database provides details of their current status.

Community Hospital Definition

The Government policy promoting community hospital services which advocates their role in services such as diagnostics, rehabilitation, intermediate care etc. appears to be at variance with the reductions and closures being experienced in many rural areas.

The model of community hospital shown in “Our Health, Our Care, Our Say” July 2006 suggests that there are four types of community hospitals according to the Department of Health.  One of these is a multi-purpose clinic. Our work with community groups and staff would suggest that their understanding of a community hospital is that one incorporates inpatient beds.  There may need to be some clarification and a public education exercise, as the Department of Health support for a “community hospital” that is in effect a clinic, will not be in line with community campaigners. Therefore, there is confusion about what is intended. This is particularly important where local groups are setting up social enterprises to manage their community hospital (with beds) and would not embark on this venture if the service was essentially a clinic. The public are understandably using the traditional definition of a local hospital, with core services such as beds, clinics, rehabilitation services and often a minor injuries service.

Another type of community hospital quoted in the guidance is a reconfigured DGH, which again will need some public education and clarification.

The other models are for integrated health and social care, or an intermediate care service. In reality, many community hospitals provide a range of integrated services, which include integrated care, but also extend to many other generalist services.

Therefore there is some confusion about what the Department of Health is including in the definition as a community hospital. So when the Government ministers are expressing support for “community hospitals” they are referring to a model which includes reconfigured DGHs and multi-use clinics without beds, whereas the public perception of a community hospital is a small local inpatient facility.

Social Enterprise Schemes

The Government is encouraging community groups, GPs and others to establish social enterprises, so that they may take over the ownership and management of their community hospital. Many have already been constituted, and are fundraising and preparing to take on their hospitals. In practice, new PCTs are already giving out a strong message of financial balance, affordability, and very limited commissioning scope.  This is being supported by SHAs in some areas. Therefore, local people are being encouraged to take on the risk and responsibility of their local hospital, whilst PCTs are stating publicly that they are unable to engage in this process.

Some of the community groups that we are working with are expressing confusion, as they believe that they are implementing the Government policy, and yet there is limited or no support locally.

Conclusion

Community Hospitals appear to be a significant component of the new architecture for the NHS, and will provide an ability for GPs to extend their practice in primary care to incorporate a range of community hospital services and facilities that integrate with social care. The policy focus and the unprecedented allocation of capital funds specifically for community hospitals is welcome.

However, the experience for many communities, GPs and staff is one of confusion, as these services are either closed, threatened with closure, or subject to review. PCTs are declaring their financial position as the main driver for this. Community Hospital Association members, which includes staff, managers and Leagues of Friends, are very concerned about the future of these services.

Communities, including their GPs, have a great deal to offer.  They are able to attract new streams of funding, expertise from individuals and groups, new partnerships across the third sector, and a significant time commitment. It is local people who appear to be doing their best to implement Government policy. Community groups have a vision of community hospitals as integrated health and social care resource centres where co-location can be offered to staff, particularly those working in rural settings.

Request for Clarification

It would be helpful if there was clarification regarding all of the 106 hospitals on our database from the PCTs through their SHAs and the Department of Health.  It is essential that a period of time be allocated to enable community groups, new social enterprises and PCTs to work collaboratively in order to explore all options for their local hospitals.  Those concerned wish to see a sustainable future for their community hospitals.

Listed Community Hospitals.pdf