Hospital beds at The Knoll under review

The Knoll Hospital could be closed to in-patients as NHS Borders looks at a new 'hospital at home' model of care.
The Knoll Hospital could be closed to in-patients as NHS Borders looks at a new 'hospital at home' model of care.

‘Hospital at home’ is a new form of patient care being considered by NHS Borders and if they go ahead it could spell the end for community hospitals such as The Knoll.

As NHS Borders undergo a service review they are looking at cost savings and making services person-centred and safe.

But news that community hospitals at Duns, Hawick, Kelso and Peebles could go the same way as Coldstream and Jedburgh cottage hospitals that were closed in 2006, is starting to cause concern.

Mark Rowley, chairman of Lammermuir Community Council has written to Dr Sheena McDonald following comments she made in an interview to the BBC last week.

He said: “Whilst not pre-judging your proposals in any way it might have been helpful for NHS Borders to have learned some of the lessons of last year’s removal of emergency services based in Duns.

“Surely with significant changes such as these it would be far more appropriate to have started the engagement process with communities first, rather than engage in management by press release?

“We would be very pleased to hear of your consultation plans as early as possible and would be very grateful to hear what status this proposal has - is it just an option being floated or are your plans well-advanced?”

During her interview with the BBC Dr McDonald said that saving money on buildings could allow them to invest in areas such as staffing.

“At the moment health has three big areas of spending - one on staff, one on buildings and one on drugs,” she said.

“If we can reduce our

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spending on buildings and less overheads for heating and lighting that will allow us to use the same amount of resource for a much larger group of people by investing in more staff.”

NHS Borders issued a statement explaining their rationale for considering the future of community hospitals: “In common with all health boards across Scotland, NHS Borders faces significant financial challenges.

“We are currently reviewing the way we deliver all of our services to maintain the quality and coverage that we provide.

“Service reviews provide us with an opportunity to innovate; transforming the traditional models of delivery by exploring new models of care.

“An example of this is ‘hospital at home’, which has been successfully piloted in other areas and enables patients to be cared for in their own homes, avoiding unnecessary admissions to hospital.

“All NHS Borders services must be person-centred, safe, high quality and efficient. Any potential long term changes to the provision of services will be made according to the key principles outlined in our recently agreed Clinical Strategy and any proposed major service changes will be subject to public consultation.”

The North Lanarkshire Partnership ‘Hospital at Home’ initiative has been piloted over the past year. It involves a team of nurses, allied health professionals, healthcare support workers, social care staff, GPs and consultants caring for patients at home, allowing them to remain in familiar surroundings with family and friends close by.

GPs refer patients to the Age Specialist Service Emergency Team (ASSET) and according the Scottish Government, since the start of the pilot 80 per cent of patients over the age of 65, referred to the team have been able to stay in their home rather than being admitted to hospital.

Berwickshire MSP John Lamont has criticised NHS Borders for considering removing community services in the region.

“I understand that NHS Borders is facing a tough financial situation and is looking to make savings, but I cannot support the removal of vital community services in Hawick, Duns and Kelso,” he said.

“Closures will surely only mean more patients are sent to BGH at an increased cost to the health board.

“We have already seen the closure of hospitals in Jedburgh and Coldstream, any further removal of these important facilities would be deeply unwelcome and deeply unpopular.”

Earlier this year NHS Borders invited the region’s residents to have their say on the key principles for high quality health care in the Borders.

After the public consultation period they drew up their ‘clinical strategy’ for the future. However, the devil is often in the detail, and detail at that stage was lacking as to how NHS Borders was going to deliver the key principles of health care.

However, there are a few hints that major changes could be ahead in the way: “We acknowledge that there are challenges ahead of us.

“Challenges which will require us to think differently, with you and our partners, about the way we deliver our services to maintain the quality and coverage we are currently able to provide.”

“There is an opportunity for the organisation to trial innovative models, moving away from our current traditional, bedbased systems.”