Cranleigh Village Health Trust (CVHT) spoke with healthcare professional and local resident Rosemary Hurtley to hear about:
-progress with the Better Care Together consultation and urgent care needs in Cranleigh;
-why urgent care is entirely separate from CVHT’s proposals;
-the massive changes in the NHS in recent years;
-rising demand for later life care in the local community
-what makes an NHS hospital bed the worst place for an older person;
-and why keyworker accommodation is an essential part of the CVHT proposal.
Here’s a comprehensive transcript of this video.
My name’s Rosemary Hurtley. I’ve lived in Cranleigh for over 35 years, and passionate about this community.
I am a consultant occupational therapist. I have a background in specialist care of older people. I worked as a head OT in Horsham and in other parts of Sussex before I left the NHS, and subsequently I’ve spent 30 years working in the charitable and independent sectors, but predominantly around care of older people and care homes and quality improvement.
I’ve also worked, interestingly, in the change agent team in the department of health looking at dignity and how do we get dignity for older people? So I’ve been very passionate about the perspective of an older person and how important that is and their families.
I have subsequently had my own business and I do quality improvement work in care homes. I’m working on a project in Malta at the moment.
Locally, I’m doing a little bit of work with the transformation team, with the ICP, which is about bringing the whole system, that’s including the NHS, local authorities, voluntary sector, and the community together.
And the community bit is what I’m really interested in, and hence, I’ve been a director of SMART Cranleigh, which is about bringing the community together, a catalyst for change, so that people can work together on issues affecting health and wellbeing and quality of life. And also I’m a trustee for several years of the League of Friends.
I don’t know if people remember that there was a Better Care Together consultation very recently, and it was in the village hall. It was attended by about 40 people. And it was about looking at the urgent care needs.
Now ‘urgent care’ needs a little bit of explaining, but it’s to reduce the [pressure on] A&E services at the Royal Surrey, and providing alternatives to that. And obviously the 111 service is part of that and out of hours and other aspects of a GP services.
But importantly, we pulled together a small group to look with SMART Cranleigh and the League of Friends, we’ve been working since January for the last six months and latterly through this COVID period, we’ve met every single week because of the power of Zoom, which is fantastic.
And we’ve got a great group of people. We’ve got two GPs. One of them is a former GP in the practice here. Another one is a national GP that’s helping me with SMART Cranleigh, and we’ve got physiotherapist educators. There are a number of people from the community who understand health in its wider sense.
So we’re working with the CCG to actually look at what Cranleigh needs. We’ve concluded that Cranleigh can’t accommodate, even with the surrounding area, an urgent treatment centre, but it could be considered as an alternative community service or alternative clinical service. And we’ve opted for an acute treatment centre, which is one level up from a minor injury unit. So that would work out of Cranleigh Village Hospital, and we would like it to be supported by the Royal Surrey. So that’s our proposal.
And the great thing is, because of the quality of people in our group, that all are terrific, we’ve put in a bit of a humdinger of a report, and because of that report, it’s managed to get through to the shortlist of options. We have to get through a bit of a… It goes over a hurdle to ensure that we have an exceptional case, and our exceptional case, as many of you will identify with, is our geography access. And we have a number of other things that are unique to Cranleigh.
So we put a lot of research, a lot of statistics into this report to give it some gravitas. So there’s a long way to go, but this is totally separate to the CVHT project. The urgent care is for everybody, for all the people who fall in the street, people who cut themselves, children who bang their toes or kick the side of the bathroom door, which my son did and nearly broke his toe and blood everywhere. Those sorts of things that happened to us all. That’s really what this is for, with a nurse-led facility.
The CVHT project, my work with the ICP helps me to understand the fact that through this journey in Cranleigh, and having been the parish councillor and learning the context that it’s not affordable to actually run community beds in a safe way, because it’s so expensive the NHS would not be able to build a hospital here with small numbers.
Today’s world has massively changed over the last 10 to 15 years. And the last two years, particularly. We understand that people do not want to go into a care home until they absolutely need to. We understand that we have to have care homes, particularly for people with dementia, who with wonderful domiciliary care services cannot provide sufficient care, particularly where family care breaks down. And we have a lot of ageing carers in Cranleigh. We have an ageing community in Cranleigh. We also have some wonderful young families. But we must be realistic.
The picture in Waverly in terms of our statistics is we’ve got over the next number of years, 5,000 more people over 75, so many of whom are likely to need care in this area. Now we’ve got some other care homes with capacity. That is true at the moment, but that won’t be true and that will change over the next few years considerably. We need to plan for the future. I believe that family visits and friendships and keeping families connected in local communities is absolutely key.
I also understand people’s concerns about a large care home group. I have worked with the largest care home group in the country. I’ve worked with Bupa, I’ve worked with Ashbourne, I’ve worked with many of them. I’ve worked with Surrey county council care homes. I’ve worked with all sorts of different charitable care homes.
I understand, and people may not realize, that all care homes now, or very few, there’s hardly any beds that are provided by local councils anymore, and that all the beds that are funded are actually in independent care sector homes, whether they’re for profit or not-for-profit.
We also need that with Brexit and all the things coming our way, with the uncertainties, that we need economies of scale. We need larger care home groups who can take the ebb and the flow of financial hits.
And we also want a care home group that is about kindness, compassion, and joining together and involving the community. Now, if companies say that’s what they’re about, I’m the first to say, let’s call you to account. Let’s prove that you want to be compassionate and kind, and let’s get the community behind you, work with you, and actually call you to account for the care that you provide.
The worst place for an older person and the unsafest place for an older person is an NHS hospital bed, I have to say. After five days, their health is significantly compromised. So if we can get them out into a more homely place, professionally run, we will have much more chance to get a better outcome for those individuals where they can be assessed in good time at a slower pace where people can really demonstrate what they can do, and we can then find the best place for them in the locality.
Maybe that particular home, they’ll assess their finances, and if they haven’t got the finances, and this is a good place for them and their families, this would be a great option for that group of people. Care homes are now having to step into a much more complex place, and the hospitals now have massively changed from what they were.
The big issue for Cranleigh is the development that’s been allowed here. Majority of the houses are for four to five-bedroom houses, expensive housing, and we know nationally that the Surrey Hills are now seen as the shores of Worthing and other places, where people retire to. They want to be near their families, and they downsize, inverted commas, and come and live in larger properties down here. And we’re going to get more older people. So we’re not actually providing the much accommodation that is affordable for the type of key workers we have.
Now, as far as care homes are concerned, the care home research that I’ve done through SMART Cranleigh is that talking to them, domiciliary care agencies and care homes, they have to rent property. The rents here are very expensive. They have to rent houses with four or five care workers in them. There may be sharing one or two bathrooms. It’s really not that brilliant.
We know that people require higher standards now, and I think the team here have worked hard to try and listen to what people wanted and adapt to that. Keyworker accommodation is absolutely essential. No care home should be built, in my view, without accommodation.
We used to have nursing blocks years ago. It’s very much going to be the way we move forward. It’s too expensive for people to live here. I’d like to see the key worker scheme for the housing. I’d like to see home share schemes for larger properties, where people can do be more innovative in how we support key workers in our community. That’s domiciliary workers, as well as care home workers, and many other key workers. People working in shops. It’s not just health, but this particular facility is for health and social care workers.
And the health and social care, thankfully, has been more understood through this COVID-19, because social care was left as the second cousin. It’s now very much the social care workforce we need to build up. We need to give them a diamond status. We need to provide good quality care and facilities for them. These are the jobs for the future.
So let’s look at the reality and try and stare this in the face. I’d like to see the community coming together. I really would like to see some restoration of understanding here, because we just want people to understand that here is an opportunity. It’s been through many hoops. It’s been through changes. There’s been difficulties with planning. There’s been difficult as in the NHS itself. We won’t go into that history, but we are where we are.
And this is our last chance cafe of getting anything like this in Cranleigh. We won’t have the chance again. And I’d like to see this as a potential for really getting a centre of excellence for care of older people where we can work with a domiciliary care providers and actually create education that is different from other places, and it will be a centre for excellence. So that’s how I see it.