Healthcare in Devon was the responsibility of two
clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s until July 2022, one covering Northern, Eastern and Western Devon (which is the country's biggest, an area with 900,000 people), and one covering South Devon and Torbay. It was announced in November 2018 that the two were to merge.
History
From 1947 to 1974 NHS services in Devon were managed by the South-Western
Regional Hospital Board
In geography, regions, otherwise referred to as zones, lands or territories, are areas that are broadly divided by physical characteristics (physical geography), human impact characteristics (human geography), and the interaction of humanity and t ...
. In 1974 the boards were abolished and replaced by
regional health authorities. Devon came under the South West RHA. Regions were reorganised in 1996 and Devon came under the South and West (Wessex and South Western) Regional Health Authority. Devon Area Health Authority from 1974 had four
district health authorities based in Exeter, North Devon, Plymouth and Torbay. In 1993 Exeter and North Devon were combined, as were Plymouth and Torbay. There were eight
primary care trust
Primary care trusts (PCTs) were part of the National Health Service in England from 2001 to 2013. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. Until 31 May ...
s established in the county in 2002: North Devon PCT, Mid Devon PCT, Exeter PCT, East Devon PCT, Teignbridge PCT, South Hams and West Devon PCT, Plymouth Teaching PCT and Torbay PCT. Torbay PCT became a
care trust
A care trust is a type of NHS trust in the English National Health Service and NHS Wales that provides both health and social care. They may carry out a range of services, including social care, mental health services or primary care services. Car ...
in 2005. They were managed by the South West Peninsula
Strategic Health Authority
Strategic health authorities (SHA) were part of the structure of the National Health Service in England between 2002 and 2013. Each SHA was responsible for managing performance, enacting directives and implementing health policy as required by the ...
from 2002 until 2006. Following the "Commissioning a Patient-Led NHS" restructure, the PCTs in Devon (excluding Plymouth and Torbay) merged to form Devon PCT, overseen by NHS South West.
The
clinical commissioning group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s (CCG) took on the responsibilities of the former PCTs of NHS Devon, Plymouth and Torbay in April 2013.
Relations between Northern, Eastern and Western Devon CCG and
Northern Devon Healthcare NHS Trust
Northern Devon Healthcare NHS Trust ran North Devon District Hospital in Barnstaple and community hospitals in Ilfracombe, Bideford, Holsworthy and Bideford. It merged with the Royal Devon and Exeter NHS Foundation Trust in April 2022 to form the ...
were reported by
David Flory
David Flory is a British National Health Service (NHS) manager, formerly the Chief Executive of the NHS Trust Development Authority. He was previously the director general of NHS finance, performance and operations.
Flory was said by the Health Se ...
to have been “strained over the last two years” in 2015. He reported that a “facilitator” had been appointed to support contract negotiations between the two organisations.
North, East and West Devon was one of three areas proposed for the new “success regime” by
Simon Stevens
Simon Laurence Stevens, Baron Stevens of Birmingham, (born 4 August 1966) is a British public policy adviser, former CEO, and independent member of the UK House of Lords. He served as the eighth Chief Executive of the National Health Service ...
in June 2015, in which
NHS England
NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
will work in partnership with
Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West Vir ...
and the
NHS Trust Development Authority
The NHS Trust Development Authority (NHSTDA) was an executive non-departmental public body of the Department of Health. Its formation came as a result of reorganisation of the National Health Service (NHS) in England outlined in the Health and Soci ...
to tackle problems in the local health economy. In October 2017 it was announced that the four acute trusts in Devon were to share staff to help tackle workforce deficiencies and to support service standards for the wider population.
Sustainability and transformation plans
In March 2016,
Angela Pedder
Dame Angela Pedder Order of the British Empire, DBE is a British health care administrator and NHS manager.
Pedder started her career in the NHS as a management trainee in 1975. In 1987 she was appointed Unit General Manager of Community Service ...
, Chief Executive of
Royal Devon and Exeter NHS Foundation Trust
The Royal Devon and Exeter NHS Foundation Trust ran Royal Devon and Exeter Hospital, Honeylands Children's Centre (for specialist assessment and support for children with special needs and their families), the Exeter Mobility Centre (providin ...
was appointed the leader of the Devon
Sustainability and transformation plan
In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service. The ...
footprint. She retired in August 2017 and was replaced by Mairead McAlinden from
Torbay and South Devon NHS Foundation Trust
Torbay and South Devon NHS Foundation Trust is the main provider of NHS services in Torbay and South Devon. The organisation is seen as pioneering in the English NHS because of the work done with Torbay and Southern Devon Health and Care NHS Tr ...
and Suzanne Tracey from
Royal Devon and Exeter NHS Foundation Trust
The Royal Devon and Exeter NHS Foundation Trust ran Royal Devon and Exeter Hospital, Honeylands Children's Centre (for specialist assessment and support for children with special needs and their families), the Exeter Mobility Centre (providin ...
. The plan proposes to make savings of £144million in 2017/8. At the same time Nick Roberts, who is already chief clinical officer at South Devon and Torbay CCG, is taking over the leadership of Northern, Eastern and Western Devon CCG. 71 inpatient beds across four community hospitals were closed by the
Royal Devon and Exeter NHS Foundation Trust
The Royal Devon and Exeter NHS Foundation Trust ran Royal Devon and Exeter Hospital, Honeylands Children's Centre (for specialist assessment and support for children with special needs and their families), the Exeter Mobility Centre (providin ...
in August 2017 as services were moved out of hospital. 170 staff were redeployed into enhanced community teams.
Primary and community care
There are 130 GP practices in Northern, Eastern and Western Devon and 35 in South Devon and Torbay. The GP Patient Survey for 2013/14 showed 18% of patients in South Devon and Torbay had to wait longer than a week to see a GP better than the national average of 24%. 90% of patients in the area rated their overall experience of GP surgeries as good, above the national average of 86%.
Four practices in Plymouth (all in the marginal
Plymouth Sutton and Devonport constituency), were granted a total of £100,000 for improved facilities in March 2015.
In 2019, the Mannamead Surgery in
Plymouth
Plymouth () is a port city and unitary authority in South West England. It is located on the south coast of Devon, approximately south-west of Exeter and south-west of London. It is bordered by Cornwall to the west and south-west.
Plymouth ...
with a patient list of about 10,000 announced that it was abandoning its
general medical services
General medical services (GMS) is the range of healthcare that is provided by general practitioners (GPs or family doctors) as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are e ...
contract. About 34,000 patients in the city are without a fixed GP.
Out-of-hours service
Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the ...
s are provided by Devon Doctors, a community interest company, which also runs the Mayflower Medical Group, six practices with about 40,000 patients. In 2021 Mayflower was rated inadequate by the
Care Quality Commission
The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England.
I ...
and threatened to have its license suspended. Devon Clinical Commissioning Group is running a procurement for a new provider of the practices’ services from April 2022.
Commissioning
Northern, Eastern and Western Devon CCG decided in November 2014 that
Royal Devon and Exeter NHS Foundation Trust
The Royal Devon and Exeter NHS Foundation Trust ran Royal Devon and Exeter Hospital, Honeylands Children's Centre (for specialist assessment and support for children with special needs and their families), the Exeter Mobility Centre (providin ...
would be its preferred provider of community services. This decision was challenged by
Northern Devon Healthcare NHS Trust
Northern Devon Healthcare NHS Trust ran North Devon District Hospital in Barnstaple and community hospitals in Ilfracombe, Bideford, Holsworthy and Bideford. It merged with the Royal Devon and Exeter NHS Foundation Trust in April 2022 to form the ...
which had been providing these services and in February 2015
Monitor
Monitor or monitor may refer to:
Places
* Monitor, Alberta
* Monitor, Indiana, town in the United States
* Monitor, Kentucky
* Monitor, Oregon, unincorporated community in the United States
* Monitor, Washington
* Monitor, Logan County, West Vir ...
announced that it would investigate this complaint. Northern Devon said the decision would mean that it would have to give up ownership of some of its community hospitals. Ownership of twelve of the trust’s community hospitals would “in all likelihood” transfer to
NHS Property Services NHS Property Services is a limited company owned by the Department of Health in the United Kingdom that took over the ownership of around 3,600 National Health Service (NHS) facilities in April 2013.
Following the Health and Social Care Act 2012, s ...
.
As of 2015, the sites that could be affected were:
*
Tiverton and District Hospital
Tiverton and District Hospital is a health facility based in Kennedy Way, Tiverton, Devon, England. It is managed by Royal Devon and Exeter NHS Foundation Trust.
History
The hospital has its origins in a facility in Bampton Street which opened as ...
;
*Honiton Hospital;
*Axminster Hospital;
*Ottery St Mary Hospital;
*Seaton Community Hospital;
*Sidmouth Hospital;
*Exmouth Hospital;
*Budleigh Salterton Hospital;
*Exeter Community Hospital;
*Moretonhampstead Community Hospital;
*Crediton Hospital;
*Okehampton Community Hospital.
In May 2021 Devon Clinical Commissioning Group and
Plymouth City Council
Plymouth City Council is the unitary authority for Plymouth, Devon. It has traditionally been controlled by Labour or the Conservatives. The council is currently in a state of no overall control, with the Conservatives governing as a minority ad ...
established a 10-year contract for community, mental health and social care with
University Hospitals Plymouth NHS Trust
University Hospitals Plymouth NHS Trust, formerly known as Plymouth Hospitals NHS Trust is the organisation which runs Derriford Hospital, and the co-located Royal Eye Infirmary (REI), as well as the Child Development Centre in Plymouth, Devon. ...
and the Livewell Southwest Community Interest Company. The contract covers a population of around 360,000 and costs £1.6 billion.
Community services
Plymouth Community Healthcare
Livewell Southwest, formerly known as Plymouth Community Healthcare is a community interest company established under the Transforming Community Services programme in 2011.
It employs two mental health teams working within Derriford Hospital, o ...
was established under the
Transforming Community Services
Transforming Community Services was a programme in the English NHS which operated from 2008 at a national level and continued during the implementation of the Health and Social Care Act 2012. Although the rhetoric of the programme was about improv ...
programme in 2011. It took over social services in the city in 2015.
Palliative care is provided by
Children's Hospice South West
Children's Hospice South West (CHSW) is a registered charity that provides palliative, respite, end of life and bereavement care for life-limited and terminally ill children and their families from the South West England region. It oversees th ...
,
Hospiscare,
Rowcroft Hospice,
St Luke's Hospice Plymouth, and
North Devon Hospice.
Millbrook Healthcare Millbrook Healthcare is a provider of community equipment services, wheelchair services, and Technology Enabled Care services. It also runs a home improvement agency and was awarded the Foundations HIA Service of the Year Award 2017.
The firm is b ...
runs the wheelchair service in Plymouth and South Hams.
In September 2018, it was reported that Devon Children and Families Alliance (composed of the NHS trusts in the county with Livewell Southwest (a
community interest company
A community interest company (CIC, colloquially pronounced "kick") is a type of company introduced by the United Kingdom government in 2005 under the Companies (Audit, Investigations and Community Enterprise) Act 2004, designed for social ente ...
) would get the seven year contract for children's community health and wellbeing services across the county, currently provided by
Virgin Care
Virgin Care was a British private provider of community health and social services, commissioned by the National Health Service and local authorities in England. From 2010 the company was known as Virgin Care and was part of Virgin Group. In Dec ...
.
Social care
Mears Group
Mears Group plc is a housing and social care provider. It repairs and maintains over 700,000 social homes across the UK.
History
The company was founded in 1988 in Gloucestershire, where it is still based, and floated on the Alternative Invest ...
won a contract to provide home care services for
Devon County Council
Devon County Council is the county council administering the English county of Devon. Based in the city of Exeter, the council covers the non-metropolitan county area of Devon. Members of the council (councillors) are elected every four years to ...
in March 2016.
In January 2019, arrangements were concluded to enable social workers to access individual children’s electronic health records using the ECLIPSE management system developed with OLM Services. This alerts nurses and social workers if a vulnerable child makes an unscheduled admittance to A&E, or a walk-in centre.
This implementation cost Devon County Council more than a million pounds in internal resource costs, in addition to licence and implementation fees paid to OLM. The Council did not follow any procurement process in selecting this system, which is unusual.
Hospital services
The main hospital providers in the county are
University Hospitals Plymouth NHS Trust
University Hospitals Plymouth NHS Trust, formerly known as Plymouth Hospitals NHS Trust is the organisation which runs Derriford Hospital, and the co-located Royal Eye Infirmary (REI), as well as the Child Development Centre in Plymouth, Devon. ...
,
Royal Devon University Healthcare NHS Foundation Trust
The Royal Devon and Exeter NHS Foundation Trust ran Royal Devon and Exeter Hospital, Honeylands Children's Centre (for specialist assessment and support for children with special needs and their families), the Exeter Mobility Centre (providing ...
, and Torbay and South Devon NHS Foundation Trust. The leaked
Sustainability and transformation plan
In England, a sustainability and transformation plan (STP) is a non-statutory requirement which promotes integrated provision of healthcare, including purchasing and commissioning, within each geographical area of the National Health Service. The ...
for the county, intended to tackle a predicted funding gap of £572M in 2020/21, suggested that 600 hospital beds could go, and that most acute services, including the maternity unit, would move from Barnstaple to Exeter and Plymouth. Stroke, vascular service, paediatrics, maternity and ear, nose and throat services would be consolidated onto fewer sites. Community hospital provision would be considerably reduced.
Royal Devon and Exeter NHS Foundation Trust took over Exeter’s NHS
walk-in centre
A walk-in clinic (also known as a walk-in centre) is a medical facility that accepts patients on a walk-in basis and with no appointment required. A number of healthcare service providers fall under the walk-in clinic umbrella including urgent ...
from Northern Devon Healthcare NHS Trust in March 2018. It also runs Honiton Minor Injury Unit.
North East and West Devon had 250 patients, the highest number in England, waiting more than 12 months for treatment in November 2018.
Patient involvement
Healthwatch
HealthWatch is a UK charity which promotes evidence-based medicine. Its formal aims are:
# The assessment and testing of treatments, whether “orthodox” or “alternative”;
# Consumer protection of all forms of health care, both by thorou ...
was set up under the
Health and Social Care Act 2012
The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.''BMJ'', 2011; 342:d408Dr Lansley's Mon ...
to act as a voice for patients. The county has Healthwatch groups based in Plymouth, Torbay and Exeter.
Financial pressure
Devon was named one of the 11 most financially challenged health economies in the country in 2014. NEW Devon and the two main acute providers – University Hospitals Plymouth NHS Trust and the Royal Devon and Exeter NHS Foundation Trust predict a combined deficit of almost £45M in 2014/5. The CCG has a turnover of £1.1billion. It has introduced some demand management measures - such as requiring smokers to quit for six weeks prior to routine surgery, and a ban on procedures of low clinical value – because demand for services is outstripping what they can afford.
In November 2014, it produced a list of 24 procedures it was considering for decommissioning. It had identified £80M worth of savings and has plans to save up to £159M more from a deficit expected to reach £430M by 2019. Proposals included reorganising beds in community hospitals. According to Rebecca Harriott, chief officer of the NEW Devon
Clinical Commissioning Group
Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
because of the significant ageing population in the area "we’re experiencing now what many health economies won’t experience for another 20 years’ time in terms of the demographics.”
In December 2014, the CCG announced that in the case of routine surgery for morbidly obese patients with a
body mass index
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...
(BMI) greater than 35 the patient would be required to have a BMI of under 35 or to lose 5 per cent of their weight before planned surgery, whichever is the lesser weight loss. Patients would be required to stop smoking for eight weeks before planned surgery. This explicit rationing was denounced on all sides.
Our NHS claimed the "end of the NHS is swimming into focus".
Eric Pickles
Eric Jack Pickles, Baron Pickles, (born 20 April 1952) is a British Conservative Party (UK), Conservative Party politician who served as Member of Parliament (United Kingdom), Member of Parliament (MP) for Brentwood and Ongar (UK Parliament co ...
, whose BMI was reported to be 32, and falling said "The idea that you would say “You will not survive, you’ve had your chips, you are too fat, you smoke too much…” Exeter MP
Ben Bradshaw
Benjamin Peter James Bradshaw (born 30 August 1960) is a British politician who served as Secretary of State for Culture, Media and Sport from 2009 to 2010. A member of the Labour Party, he has been Member of Parliament (MP) for Exeter since 1 ...
told
Nick Clegg
Sir Nicholas William Peter Clegg (born 7 January 1967) is a British media executive and former Deputy Prime Minister of the United Kingdom who has been president for global affairs at Meta Platforms since 2022, having previously been vicepr ...
that he would be denied an operation in Devon because he smokes, as would Pickles because he’s too big. Pickles retorted that since he had lost weight he would not now fall foul of the policy. The CCG announced that it was caving in to the pressure and would no longer impose a ban, but would "further promote smoking cessation and weight loss services to improve outcomes for patients".
The CCG also abandoned a plan to restrict patients to only one hearing aid.
NEW Devon CCG ended 2014-15 with a cumulative deficit of £38.9M and expected this to increase to £78.9M (after savings of £37.1M) by the end of 2015-16, the largest cumulative deficit of any CCG in England. The success regime board headed by
Ruth Carnall
Dame Ruth Carnall DBE (born July 1956) was the last Chief Executive of NHS London
NHS London (or "London Strategic Health Authority") was a strategic health authority of the National Health Service in England. It operated in the London region, ...
estimated in February 2016 that without change services in NEW Devon would be in deficit of £442 million by 2020/1. By that time nearly 25% of the population will be over 65.
In May 2017 it was given new legal directions after it ended 2016-17 with a £42M deficit.
Mental health
Mental health services in the county are largely provided by
Devon Partnership NHS Trust
Devon Partnership NHS Trust is a mental health trust established in 2001. It provides mental health and learning disability services in Devon (excluding Plymouth), England.
Services
In December 2016, the trust announced that it had applied for ...
.
In December 2014, Paul Netherton, assistant chief constable of
Devon and Cornwall Police
Devon and Cornwall Police is the territorial police force responsible for policing the ceremonial counties of Devon and Cornwall (including the Isles of Scilly) in England. The force serves approximately 1.8 million people over an area of .
Hi ...
, complained publicly after a 16-year-old girl suffering mental health issues was held in a custody cell in Devon for around 48 hours because there were “no beds available in the UK”. 750 mentally ill people – including 28 children – had been detained in police custody in the county during 2014. Adolescents with mental health problems in Devon have been sent to units in Hull, Newcastle and Lancashire, and several vulnerable young people in the county have also been admitted to adult psychiatric units. Ben Bradshaw MP for Exeter complained that the chronic shortage of appropriate accommodation for young people and the chaos and confusion was caused by the Government’s disastrous reorganisation of the NHS "because there are now so many different organisations involved in commissioning and providing services, no-one takes ultimate responsibility."
There has been an increase in the number of people presenting at the A&E Department at Derriford. In 2012, there were 2,700. In 2013:2,908. In 2014: 3,346.
In August 2019, it was reported that autistic children and teenagers were waiting to be assessed following a referral for an average of 67 weeks with the longest recorded wait 122 weeks. There were 1800 on the waiting list. Devon CCG was looking for new autism assessment providers. According to
Virgin Care
Virgin Care was a British private provider of community health and social services, commissioned by the National Health Service and local authorities in England. From 2010 the company was known as Virgin Care and was part of Virgin Group. In Dec ...
, who provided the service from 2013 to April 2019, demand increased by 20% per year throughout the operation of the contract. The waiting list continued to rise after the contract had been given back to an NHS consortium – Children and Family Health Devon. By February 2021, there were more than 3,200 under-18s waiting for an assessment and average waiting time had risen to 81 weeks.
See also
*
:Health in Devon
*
Healthcare in the United Kingdom
Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together wit ...
References
{{reflist
External links
NEW Devon CCGSouth Devon and Torbay CCGHealthwatch DevonHealthwatch PlymouthHealthwatch Torbay
Devon
Devon ( , historically known as Devonshire , ) is a ceremonial and non-metropolitan county in South West England. The most populous settlement in Devon is the city of Plymouth, followed by Devon's county town, the city of Exeter. Devon is ...