My plea for a new deal for health in Devon’s towns falls on deaf ears, as Devon’s Conservative Cabinet refuses to generally defend community hospitals
The indomitable Claire Wright made a new challenge to Devon County Council’s Cabinet yesterday to support keeping our Community Hospital buildings. I made a strong appeal which you can watch here for a new health deal for Devon’s towns, saying that if we really have ‘integration’ of health, wellbeing and adult care, DCC must take its share of responsibility.
As Claire writes (I had to leave before the discussion concluded) the Conservatives largely refused this – it amounts to the fact that we’re not integrated when it comes to the hard choices, which are being left to the CCGs.
Interestingly, the Chief Executive, Dr Phil Norrey, proposed the backstop position that funds from selling buildings should be retained and reinvested in Devon, rather than ‘hoovered up’ by the national NHS Property Company. Let’s be clear – they should be used for Devon’s towns, and especially in any towns which lose their hospitals, and not hoovered up either into funding the acute hospitals.
ENT returns to Seaton Hospital, but not Dermatology, as RD&E’s meeting with Seaton Area Health Matters to discuss local services is postponed for a month
Readers may recall that since April I have been querying the apparent withdrawal of ENT and Dermatology clinics from Seaton hospital. I have finally had an explanation. The ENT service at Seaton is provided is by Dr Rob Daniels, GP at Townsend House, who is directly commissioned by the CCG to provide GP with a Special Interest ENT and nurse-led ear suction. Apparently Dr Daniels was on 6 months’ sabbatical, but has now returned and had a full clinic booked for the 15th August.
Dermatology, on the other hand, was provided using a GP special interest service (GPwSI) provided by Dr Joe Pitt, who has left the area, and it is not currently being replaced. The RD&E says, ‘At the moment the majority of the dermatology activity for the east is taking place at Axminster where the dermatologists can provide minor ops. If the dermatologists feel a procedure needs a more complex intervention then patients are asked to have this undertaken at Heavitree.’ (Although in my knowledge, as I have told them, patients are sometimes referred directly to Heavitree.)
This is a shame since there was a substantial uptake for Dermatology in Seaton. We will have a chance to discuss its possible return when Seaton Area Health Matters, chaired by Jack Rowland, meets RD&E leaders to discuss the opportunities for local provision of services in general. This meeting, originally envisaged for this month, now looks like being in late October or early November.
Since the CCG will not announce decisions about the future of hospitals until after the conclusion of these discussions (which are also taking place in other towns), these will presumably be put back into 2019 – maybe even beyond the local elections in May?
The NHS in South Devon has signed a deal with a private company to build new health centres in Dartmouth and Teignmouth and handed over all NHS buildings in the area to it. Privatisation steaming ahead!
From BBC Devon website on 22 August (from a Facebook post, so I don’t have the link):
The NHS in South Devon has signed a deal with a private company to build new health centres in Dartmouth and Teignmouth and a new emergency department at Torbay Hospital. The firm, Health Innovation Partners, will also be in charge of all NHS buildings in the area.
Torbay and South Devon NHS Foundation Trust says it’s an “exciting partnership” which will give the NHS access to funds and expertise so it can modernise its old buildings and also build new ones. Critics though are concerned it is privatisation “by the back door”.
Campaign against Accountable Care Organisation contracts allowed to appeal against High Court decision, while NHS England begins consultation on contract which may not be lawful!
The Court of Appeal has issued an order granting campaign group 999 Call for the NHS permission to appeal the ruling against their Judicial Review of the proposed payment mechanism in NHS England’s Accountable Care Organisation contract. I am supporting 999 Call’s legal case. At the same time, NHS England has launched its public consultation on the contracts, which you can respond to here.
‘999 Call for the NHS’ says:
The Accountable Care Organisation Contract (now rebranded by NHS England as the Integrated Care Provider contract) proposes that healthcare providers are not paid per treatment, but by a ‘Whole Population Annual Payment’, which is a set amount for the provision of named services during a defined period. This, 999 Call for the NHS argues, unlawfully shifts the risk of there being an underestimate of patient numbers from the commissioner to the provider, and endangers service standards.
In April, the High Court ruled against the campaign group’s legal challenge to NHS England’s Accountable Care Organisation contract – but the group and their solicitors at Leigh Day and barristers at Landmark Chambers found the ruling so flawed that they immediately applied for permission to appeal.
Although fully aware of this, on Friday 3rd August – the day Parliament and the Courts went on holiday – NHS England started a public consultation on the Accountable Care Organisation contract – now renamed the Integrated Provider Organisation contract.
The consultation document asserts that the payment mechanism in the ACO/ICP contract is lawful, because:
“The High Court has now decided the two judicial reviews in NHS England’s favour.”
Steve Carne, speaking for 999 Call for the NHS, said
“It beggars belief that NHS England is consulting on a contract that may not even be lawful.
And a lot of public funds is being spent on developing the ACO model – including on the public consultation.
We are very pleased that 3 judges from the Court of Appeal will have time to consider the issues properly.
We shall shortly issue our stage 5 Crowd Justice appeal for £18k to cover the costs of the Appeal.
We are so grateful to all the campaigners and members of the public who have made it possible for us to challenge the lawfulness of NHS England’s attempt to shoehorn the NHS into an imitation of the USA’s Medicare/Medicaid system.
We will not see our NHS reduced to limited state-funded health care for people who can’t afford private health insurance.”
Jo Land, one of the original Darlo Mums when 999 Call for the NHS led the People’s March for the NHS from Jarrow to London, added,
“All along we have been warning about the shrinkage of the NHS into a service that betrays the core principle of #NHS4All – a health service that provides the full range of appropriate health care to everyone with a clinical need for it, free at the point of use.
Since we first started work two years ago on bringing this judicial review, there have been more and more examples of restrictions and denials of NHS care, and the consequent growth of a two tier system – private for those who can afford it, and an increasingly limited NHS for the rest of us.”
Jenny Shepherd said
“NHS England’s rebranded Accountable Care Organisation contract consultation is a specious attempt to meet the requirement to consult on a significant change to NHS and social care services.
We don’t support the marketisation of the NHS that created the purchaser/provider split and requires contracts for the purchase and provision of services.
Integration of NHS and social care services, in order to provide a more straightforward process for patients with multiple ailments, is not aided by a system that essentially continues NHS fragmentation.
This new proposed contract is a complex lead provider contract that creates confusion over the respective roles of commissioner and provider. It requires multiple subcontracts that are likely to need constant wasteful renegotiation and change over the duration of the lead provider contract. This is just another form of fragmentation, waste and dysfunctionality.
The way to integrate the NHS and social care is through legislation to abolish the purchaser/provider split and contracting; put social care on the same footing as the NHS as a fully publicly funded and provided service that is free at the point of use; and remove the market and non-NHS bodies from the NHS.
Such legislation already exists in the shape of the NHS Reinstatement Bill.”
The campaign team say they are determined in renewing the fight to stop and reverse Accountable Care. Whether rebranded as Integrated Care or not, they see evidence that it is the same attempt to shoehorn the NHS into a limited role in a two tier healthcare system that feeds the interests of profiteering private companies.
Steven Carne emphasised,
“It is vital that we defend the core NHS principle of providing the full range of appropriate treatments to everyone with a clinical need for them.”
999 Call for the NHS hope the 2 day appeal in London will happen before the end of the year. The Appeal will consider all seven grounds laid out in the campaign group’s application – with capped costs.
Details on the first instance judgment can be found here, and the judgment itself here.
David Lock QC and Leon Glenister represent 999 Call for the NHS, instructed by Rowan Smith and Anna Dews at Leigh Day.
Richard Anderson, the Health and Social Care Community Services Manager for Sidmouth, Axminster and Seaton, has asked me to publicise the fact that NHS Support Worker jobs are available now in the three towns.
Good rates of pay, pension etc. Please ring Julia Blake on 07592 579919.
Devon STP: there is ‘no rush’ to make decisions on community hospital buildings. What’s more, it hasn’t agreed what a ‘health hub’ is or how many there should be
Speaking for the Devon NHS Sustainability and Transformation Partnership (STP), Dr Sonja Manton told a meeting of county councillors this morning that there was ‘no rush’ to decide the future of community hospital buildings.
Contrary to Dr Simon Kerr’s suggestion in April that decisions would be made in July, Dr Manton was clear that the end of July is a deadline for the Devon Clinical Commissioning Groups (CCGs) to bid for capital funding from NHS England, but not for decisions about the local estate. If these two were previously linked, they are not any more.
She also confirmed what she said to me some months ago, that no decisions will be made about buildings until after the conclusion of the ‘community conversations’ such as Seaton Area Health Matters and Honiton Health Matters, launched earlier this year, and that discussions are still going on about the distribution of local services.
Dr Manton, who was launching the STP’s two-year report, also stated that there was no agreement yet on what a ‘health hub‘ is, or how many of them there should be.
There is no room at all for complacency, however, since the report states:
We know a large amount of space in our community hospital buildings is underused. The revenue cost of our community hospital estates is in the order of £20 million; money the NHS could use to improve other services. Working with other public sector partners, as part of the One Public Estate initiative, we will review the space that is required to deliver care, and plan to consolidate the number of sites to free up estate and generate money, which can be re-invested in technology and infrastructure.
It also appeared from the meeting that midwife-led maternity services are unlikely to be restored in Honiton or Okehampton any time soon. References were made to staffing difficulties and also safety issues in case of difficulties during birth.
Beds, beds, beds – Devon’s NHS couldn’t or wouldn’t give me their overall occupancy figure for the recent winter: but they were forced to buy in more capacity and there were ’12-hour trolley breaches’
Devon NHS’s Sustainability and Transformation Partnership (STP) admitted in a report to Health Scrutiny yesterday that they had been desperately short of beds during the recent winter. They had to buy in extra beds to keep up with more patients staying longer, because of complex conditions. There were ’12-hour trolley breaches’, where patients had to wait more than 12 hours to be seen.
Despite my asking them directly, they did not give a figure for overall occupancy levels, although they did not deny my suggestion that they had been as bad as or worse than the nationally reported level of 95 per cent. (The nationally recommended safe level is 85 per cent.)
Jo Tearle, Deputy Chief Operating Officer for the Devon CCGs, rebutted my suggestion that cutting community beds had contributed to this crisis, saying that these were not the kind of beds they had needed, and that there had been capacity in community hospitals most of the time. However this suggests that there was no capacity some of the time. It is difficult not to believe that extra community beds wouldn’t have given them more leeway.
Meanwhile, Kerry Storey of Devon County Council indicated the strains that the ‘new model of care’ at home had been under. She said that maintaining personal care at home during the winter had been ‘a real challenge’, requiring ‘creativity and innovation’ – you don’t need much imagination to see that it will have been a real crisis time with frail people at home in isolated areas, care workers and nurses struggling to get through the snow, and staff themselves suffering higher levels of illness.
I and others predicted that because of the closure of community beds, there would be severe pressure on beds in a bad winter or a flu epidemic (and actually, this was not overall a bad winter and the snow episodes were late and short; despite higher levels of flu, there was no epidemic this winter).