What does the Neighbourhood Plan have to say about Health?
Under its Steering Group workshop's: Key themes, priorities and objectives heading... nothing. Under Threats, it certainly does not say: Loss of health services.
Update: February 2022 Version to go to South Hams District Council: Still no mention of Loss of health services.
However, the community consultation did produce the following under a Health and Wellbeing heading:
• Potential to expand health facilities as population expands
• Easy access to health facilities for the whole parish
• Re-use of former NHS sites to include community uses
• Safeguarding and improving community facilities
• Improved social care facilities
In a postal survey in 2016, some 1,240 points were made under the heading "Healthcare, Hospital, Social Care, Health and wellbeing". These are summarised under the following topics:
Another doctor’s surgery
Re-provide hospital services
New health and wellbeing centre
A and E needed
Expand ambulance service
5. About the town and parish of Dartmouth– key facts, background, history and challenges for the future.
In this background section, the plan acknowledges:
Dartmouth has an ageing population which will present two key problems over the plan period. It will almost certainly generate increasing demand for services to meet the specific needs of that ageing population and it will, without significant interventions, not have an indigenous population fully able to meet existing and emerging needs going forward.
This is not the only place in the plan that the "ageing population" issue is highlighted.
A tacit nod to health care provision is made subsequently (referring to the number of people engaged in the health care sector):
Whilst the health and social care element might have reduced as a result of NHS restructuring, it is probable that the broad percentages in the key areas have remained broadly constant.
A vague reference to "NHS restructuring" is not much use. Indeed, it's deflection.
In the section 5.8 Health and Wellbeing several contentious subjects are touched upon:
In terms of healthcare provision the resident population quoted above increases to about 8,000 based on temporary visitor registrations with the sole GP practice located in Victoria Road. The additional registered numbers also come from surrounding parishes. After the closure of the Dartmouth Cottage Hospital on the South Embankment in 2016, the only remaining health facility is the Dartmouth Clinic, in the centre of town in Zion Place this accommodates limited health services. Two intermediate care beds are also commissioned from the Beacon Court care home. There are currently two pharmacies operating in the centre of town.
Particularly note the "intermediate case beds".
Update: February 2022 Version to go to South Hams District Council: The section above has been rewritten to:
In terms of healthcare provision the resident population quoted above increases to about 8,000 based on temporary visitor registrations with the sole GP practice located in Victoria Road. The additional registered numbers also come from surrounding parishes. During the tourist season day visitors can result in around a further 12/15,000 people in the town at peak times. Many arrive by coach or ferry. Short term occupants of furnished holiday lets are not included in these estimates. Following the creation of Torbay and South Devon NHS Foundation Trust (TSDNHSFT) as an integrated care organisation combining acute and community services, a new model of care has been developed which seeks to support individuals as close to their home as possible. A consultation led by South Devon CCG in 2016 resulted in the decision to close Dartmouth Cottage Hospital.
Note the additions to justify the closure of Dartmouth Hospital (after a consultation - implying that residents were supportive of the closure), and extolling a "new model of care".
The Board of Torbay and South Devon NHS Foundation Trust has agreed to site a new Health and Wellbeing Centre at the top of town, at the site of the current overflow car park for the Park and Ride Service. Construction is planned to start in 2021. The new Health Centre will house the Dartmouth Medical Centre, which will relocate from the centre of town, the existing services provided from the Dartmouth Health and Wellbeing Centre in Zion Place, a retail pharmacy and rooms for the Dartmouth Caring charity, as well as a café. The nearest District General Hospital is Torbay Hospital. There is an existing ambulance station in Dartmouth and the Devon Air Ambulance is also able to land in Coronation Park.
No mention is made of the health services that will not be 'relocated' and that will require a long journey to Torbay Hospital.
Update: February 2022 Version to go to South Hams District Council: The section above has been rewritten to:
At the moment, TSDNHSFT provides a limited range of services in the Dartmouth Clinic in the centre of town at Zion Place and two intermediate care beds are commissioned from the Beacon Park care home. There are also two pharmacies operating in the centre of town. A new £4.8m H&WC is under construction on the park and ride overflow car park at the top of the town. This is due for completion in late summer 2022. This will house the Dartmouth Medical Centre (GP Practice), services provided by TSDNHSFT, Dartmouth Caring’s voluntary operations, a retail pharmacy, and a cafe. This will help secure greater integration of health services locally as envisaged by the model of care. However, residents and visitors to the town will continue to need to travel for minor injuries (Totnes – currently temporarily closed due to Covid -19 pressures), urgent treatment (Newton Abbot) and accident and emergency (Torbay Hospital). The town is served by an existing Ambulance Station and Devon Air Ambulance can land at Coronation Park. The nearest District General Hospital is located in Torquay.
There is now acknowledgement of how far resdents will have to travel for even minior injuries. This is of concern due to the fact that Totnes minor injuries unit may never re-open.
Now, on to the guts of the neighbourhood plan: the policies. It's worth being clear that the only sections of a neighbourhood plan that matter to a planning committee (when considering development proposals) are the plan policies. Not background information; and certainly not community aspirations.
6. Proposed policies for the Plan area
Consider this section:
This plan supports a positive strategy for the conservation and enjoyment of the historic environment of the town centre and wider parish, including heritage assets most at risk through neglect, decay or other threats. Maintaining and enhancing these features in a progressive but sensitive way, so that it remains an attractive destination for residents and visitors alike, will be essential to the future prosperity of the Town.
Note the bold we highlighted. It is somewhat indicative of the attitude of the current owners of the now derelict Cottage Hospital building that the it is being damaged and allowed to fall into a delapidated state.
The following policy is clearly being ignored (and it's not even in effect yet!):
Policy DNP TE3 Safeguarding Designated and Non-Designated heritage assets and the conservation area of Dartmouth
a) Respect and enhance the Dartmouth Conservation Area and make a positive contribution to the heritage assets and their setting.
The plan lists the hospital building as a heritage asset: "LHA11 Dartmouth Cottage Hospital".
When considering new build, national government guidelines (which, incidently always take precedence over local plans and neighbourhood plans) “encourage the effective use of land by reusing land that has been previously developed (brownfield land), provided that it is not of high environmental value”.
The actual relevant policy states:
Policy. DNP TE5 Brownfield first
The brownfield sites considered suitable for long term re-development as and when there is landowner support and they become available include existing builders merchants, former health facilities, post office, a carpark located within the urban area of Dartmouth. Within the lifetime of the Neighbourhood Plan such sites may become redundant or would benefit in the long term from intensification of existing employment sites and more effective use of land or change of use to C2 Residential Institutions C3 Housing or mixed use (C3 Housing and E Commercial, Business and Service.)
The conversion of existing buildings are also subject to the other policies of this plan. Priority will be given to new uses that provide maximum community benefit and are appropriate for the site in terms of accessibility and minimum traffic generation.
In Appendix R2, the "Former Dartmouth and Cottage Hospital" is listed as a site "considered suitable for intensification or re-development". This is important; certainly more so than community aspirations: the policy opens the door to planning applications that propose to develop the hospital site.
Update: February 2022 Version to go to South Hams District Council: The phrase "Priority will be given to new uses that provide maximum community benefit" is still in the policy but it remains to be seen how much weight will be given to it when (if?) the hospital site is sold on the open market.
Main Policy Section: 6.6 Health and Wellbeing
As background, reference is made to the planning policies set out in the Joint Local Plan (JLP) for Plymouth and South West Devon (that cover South Hams District). Strategic Objective SO6 promotes: “school, health, and recreation facilities of a high quality in order to reinforce strong communities.”
It's worth reading that last bit again: “school, health, and recreation facilities of a high quality in order to reinforce strong communities.”
To break down the plan narrative that precedes the all-important policy:
Health Facilities Health facilities in the plan area will need to accommodate residents and visitors and the expected increase of population over the plan period including the new West Dart neighbourhood. By 2030 there is expected to be 37% more people aged over 75 compared to today, in the South Hams area, with resulting increased health and social care needs.
From this point, there are "increased health and social care needs".
While the new proposed Dartmouth Health and Well-being Centre proposal will make a major contribution to meeting these objectives, the loss of Dartmouth Hospital has been keenly felt by local residents.
Update: February 2022 Version to go to South Hams District Council: The above line has been replaced by:
While the loss of the Cottage Hospital is keenly felt in some sections of the community, the new H&WC will bring together primary, secondary, and voluntary health services in a modern facility enabling greater integration of care.
Note the subtle addition of the words "some sections", followed by more promotion for the new centre.
The plan acknowledges there is an issue.
The new Health and Well-being Centre will move the centre of gravity of healthcare provision from the Lower Town to the Upper Town, nearer the expanding population base. This will leave no health care facilities in the Lower Town for the resident population, many of whom are elderly and less able.
"This will leave no health care facilities in the Lower Town."
Update: February 2022 Version to go to South Hams District Council: The "no health care facilities in the Lower Town" phrase has been removed. And replaced by much pro-new H&WC blurb. (But the phrase does appear in Appendix S2 - see below).
The new centre highlights the following objectives for this plan;-
• Allow space for future expansion of the centre, in line with planned population growth, and increases in the age profile of the town.
• Ensure that good transport, parking and access is available, particularly improved public transport links, between the Lower Town and the new Centre.
• The reuse of the NHS sites to be vacated: the Hospital on the South Embankment and the Clinic at Zion Place. There is a presumption within community that new development and uses should incorporate and focus on the needs of key workers, new community uses, especially with a health and well-being emphasis.
• Take into account the covenants existing in the deeds on parts of the hospital site which stipulate “the land shall be held by the purchasers (TSDFT) as Trust Property for ever hereafter for the use and benefit of the Dartmouth and Kingswear Cottage Hospital” … and …” used for hospital purposes. These provisions were clearly intended to provide and protect benefits for the residents of Dartmouth and Kingswear.
• Establish that when the TSDFT is considering the future use of the hospital it should ensure that this reflects the spirit of the original intention of those who created the facility to benefit the community albeit that the use would not be that of an operational hospital. This could be best achieved by uses such as residential accommodation for key workers including nurses and other staff such as occupational therapists and for assisted housing. This would, in essence, provide a continuum of “hospital use”.
• The covenant was originally enforceable by the Dartmouth Town Council but the creation of the NHS and the transfer of property rights to SHDC when that body was formed need to be taken into account. It is understood that the Secretary of State responsible for the NHS is the authority which can enforce or vary the covenants on the hospital and needs to be approached to agree with variations necessary for the continuation of the protection of benefits for Dartmouth and Kingswear residents who remain the beneficiaries under the original covenants.
The problem here is that the plan has to present the current situation that is outside its control. Residents need to understand that the plan has very little influence.
The plan then summarises feelings into an aspirations section thus:
Community Aspiration; Healthcare for Dartmouth
a) There should be adequate GP provision within the Parish including out of hours care, for an expanding population with minimal waiting times for patients and choice of seeing their own GP. Suitable and safe reception and waiting areas and links to in-house pharmacy.
b) Easy access for the whole population to the wider multi-disciplinary health team is available ideally within the same building, including physiotherapy, pharmacy, mental health nurses and nurse prescribers.
c) Adequate provision of NHS Dental Care for the whole population.
d) Ensure adequate pharmacy services at both the new Health and Wellbeing Centre and in the Centre of town.
e) Ensure adequate district nurse, health visitor, midwifery, occupational therapy and “hospital at home” provision for all who require these services, to enable home based care as far as possible, linked with both GP and hospital based clinicians.
f) Ensure that health and social care are effectively coordinated for all patients and that third sector (voluntary) care is best embedded in the system.
g) When access to urgent medical services is not available within an appropriate time frame, consideration should be given to expansion of services if feasible. Access to emergency medical services should be provided safely with a rapid and efficient ambulance service within accepted national time frame standards.
But the all-important policy is:
Policy DNP HW 1
Re-use of the former hospital site. This plan supports maintaining a portion of health and wellbeing facilities and obligations under the title deeds in the former hospital once the facilities are re-provided in the new Health and Wellbeing Centre at the top of town.
The options for re-use or redevelopment of this site should include in all or part appropriate health and social care facilities, as part of a package to meet the on-going identified health and wellbeing needs in the Town.
A development brief expanding on the above qualities should be prepared in advance of a planning application . All redevelopment proposals should respect this brief.
This policy respects the provisions of a covenant on the original hospital, this is included in Appendix S.
The words in green help you to understand that neighbourhood plan policies cannot use the word: must.
Update: February 2022 Version to go to South Hams District Council: Policy DNP HW 1 has been completely re-written:
Policy DNP HW 1 Re-use of the former hospital site and health centre Zion Place.
This plan supports maintaining community provision and facilities capable of being used to serve the health and wellbeing of the local and visitor population in Lower Town on the sites shown in Map 17 once the facilities to be provided in the new Health and Wellbeing Centre (H&WC) at the top of town are established.
A development brief should be prepared in advance of any planning applications for these sites. The preparation of the briefs should be undertaken in such a way as to allow residents and businesses the opportunity to shape the future of the former hospital site in particular. The following requirements should be addressed in preparing the briefs: -
• The need, if still required, for the redevelopment to contribute to the funding of the new H&WC in Upper Town;
• The provision of community space capable of supporting health and social care facilities/services and first aid, particularly for the use of residents of and visitors to Lower Town;
• The massing and design of the development of the hospital site given its prominent location as part of Dartmouth’s historic waterfront and Conservation Area;
• The need to respect and avoid significant harm to existing designated and non-designated heritage assets;
• The need to address flood risk particularly in respect of ground floor uses;
• Other relevant policies as contained in the Development Plan.
A key purpose of the development briefs should establish the balance to be struck between the commercial/residential market, the provision of affordable/ key worker housing, if required, and community uses.
Evidence for maintaining community provision and facilities supporting health and wellbeing in Lower Town is included in Appendix S2.
Interestingly, the appendix S2 (https://dartmouthplan.org/wp-content/uploads/2022/01/Appendix-S2.docx.pdf) includes the following:
There are two major changes when comparing the position before 2015 and that which will apply once the new HWB Centre is operating. The first is that there will be no HWB provision in the Lower Town and the second is that some services will no longer be provided anywhere in Dartmouth.
That's worth repeating: ... SOME SERVICES WILL NO LONGER BE PROVIDED ANYWHERE IN DARTMOUTH.
Last Updated: Thursday 9 June 2022