Shocking tales of the creeping privatisation behind the NEW Devon CCG’s cuts.
The NHS’ new “Success Regime” aims to put a firm brake on health spending, but it’s proving to be a bonanza for consultants on lucrative contracts who oversee the process. And some of these consultants are former senior NHS managers who received generous payoffs when their jobs disappeared as a result of the Tories’ top-down reorganisation of the health service in 2012.
There were a few wry smiles, therefore, at Monday evening’s public “consultation” in Sidmouth to discuss closing the town’s community hospital beds, when Dame Ruth Carnall, chair of the “Success Regime” which is monitoring these cuts, bemoaned the disastrous “fragmentary” effects of the 2012 Health and Social Care Act.
She may not like it, but as chief executive of NHS London which was abolished by the Act, she received a payoff in 2013 which included a £2.2 million pension pot.
Then with another former NHS executive she created…
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On the heels of yesterday’s successful meeting with nearly 300 people in Seaton Town Hall (see right), Independent County Councillor Claire Wright has now linked to the CCG’s Sustainability and Transformation Plan from September which sets out the need for cuts, including, she says:
- 100s of more bed cuts to acute hospitals such as the RD&E.
- cuts to stroke, A&E, paediatrics, maternity, breast services, ENT, radiology, heart surgery and vascular surgery
Claire says, ‘It is more important than ever that our MPs back Sarah Wollaston and ask for more funding in the chancellor’s Autumn Statement.’ This is the point that Seaton Town Council also identified and which I put to Neil Parish MP yesterday. Parish accepted the point and said he will work for ‘more resources’, collaborating with Wollaston.
In response to a question from Paul Arnott of Colyton, former Chair of East Devon Alliance, Parish indicated that he would be prepared to vote against the Government on the Autumn Statement (23 Nov.) if there was no more funding for the NHS in Devon. Watch this space!
A troubling thing from yesterday’s meeting – Parish specifically asked Rebecca Harriott, CCG Chief Officer, if more funding would mean the community beds cuts would be reviewed: she refused to give that assurance.
Dear Mr Parish,
Like most people in Seaton and the Axe Valley I am alarmed at the two options in the NEW Devon NHS Clinical Commissioning Group’s consultation on community hospitals which would remove all beds from Seaton Hospital. Therefore I am glad that you will be speaking at the public meeting in Seaton Town Hall on Friday 4th November to discuss these proposals.
I was surprised, however, that in the parliamentary debate on the NHS in Devon (18th October) you focused entirely on Honiton hospital and did not even mention Seaton. Certainly, the threat to Honiton is greater: it would lose all its beds under all 4 options consulted on, whereas under 2 options, including the one the CCG prefers, Seaton would keep its beds.
However there is a serious threat to Seaton. Your colleague Hugo Swire, MP for East Devon, says that if it is necessary to choose between the 4 options the CCG has put on the table, ‘option B, which sees the beds retained in Tiverton, and also in Sidmouth and Exmouth, is the option worthy of support’. This would mean Seaton losing its beds.
Against this false choice between Seaton and Sidmouth, you were absolutely right to say: ‘I really feel that all our MPs across the whole of Devon need to unite, because over the last two years the number of beds in our community hospitals has been halved. I rather fear that we will be standing here in two years’ time saying that they have been halved again. Rather than fighting between each other over which hospitals are kept open and which are closed, let us fight all the closures across Devon. Otherwise we are just being picked off one by one, Minister, and this is not the way to run a health service in Devon.’
However I put it to you that the only way we will not be forced to choose is if the Government finds more money for the NHS. The NEW Devon CCG’s deficit stands at £122 million and is careering towards £384 million by 2020. To offset this, the CCG’s ‘Success Regime’ – a strikingly Orwellian name – is desperately looking to cut costs, but all the ‘efficiency savings’ in the world will not deal with the problem.
Nursing costs for 16 beds in a community hospital are £914,000 per year. 24 beds may cost £1.32 million. Clearly even closing all community beds would still leave the CCG looking for huge savings elsewhere. A year ago I developed a hernia and was told the CCG policy was that I should try to live with it. The advice was rescinded and I had my operation, but I fear many people with ‘routine’ conditions will soon receive similar advice if the Government does not act.
NHS funding is a problem across Devon and the whole of England. The RD&E Trust and the Torbay and South Devon CCG are also in deficit. Nationally NHS bodies have combined deficits of £2.45 billion and rising. The Head of the NHS in England, Simon Stevens, told Parliament this week that the NHS has not been given the minimum funding it needs to meet its commitments in 2017-18, 2018-19 and 2019-20.
Apparently the Prime Minister has told Mr Stevens the NHS must live with the allocated money and follow the example of the Home Office in making savings. Mr Stevens replied that ‘while crime had fallen in recent years, demand for NHS care had risen, was still growing and would continue upward. For example, demand for cancer care had risen 55% over the past five years.’ The Royal College of Physicians says, ‘demand increases by 4% every year but, in real terms, NHS funding will increase by only 0.2% per year to 2020.’ The independent Kings Fund agrees: ‘The principal cause of the deficit is the fact that funding has not kept pace with demand.’
Will you now recognise that we need a serious change in Government policy if every year we are not going to face further bed closures and other cuts? The majority of people in East Devon voted to leave the European Union, and many believed the claim (which Boris Johnson backed) that the NHS could gain an extra £350 million a week. It is now clear that leaving the EU will not produce this sort of money – but these Leave voters were absolutely right to think that the NHS needs a lot more.
When the new Chancellor announced he was dropping the target of ending the national deficit by 2020, many hoped there would be extra funding for the NHS in his Autumn Statement. The Prime Minister has now ruled this out. Yet there are many ways that money could be found: halt HS2, rule out a third runway for Heathrow, outlaw offshore trusts, make global corporations pay the right tax in the UK.
If, as you say, ‘all our MPs across the whole of Devon need to unite’, what are they going to unite for? Not, surely, just to criticise the Success Regime’s consultation document. The problem is bigger than the CCG. The only answer that makes sense is more Government funding.
A year ago, many of us were impressed when you defied the Government over tax credit cuts. The NHS crisis is an even bigger issue, which affects us all. We are relying on you, as our MP, to make clear publicly that the funding situation is not acceptable. Will you now take the lead in demanding that the Chancellor amends his spending plans to provide the NHS with adequate funds, and directs a large chunk to Devon?
PARLIAMENT DEBATE ON HOSPITAL BED CUTS MAY HAVE BEEN USEFUL BUT HEALTH MINISTER STONEWALLED MPs
Hugo Swire’s scheduled debate in parliament this afternoon about Devon’s NHS cuts was attended by almost all Devon MPs.
Ben Bradshaw and Sarah Wollaston unfortunately were unable to be there as they were in a health select committee meeting.
Although the health minister present (I don’t know who it was) pretty much stonewalled all the requests for more funding I do think that virtually all Devon’s MPs getting in a room all collectively complaining that NHS services in their areas being cut, was quite powerful.
It was an interesting insight into the differences between what were all conservative MPs views. Some simply argued against the plans of the local NHS in Devon. Others argued quite vociferously for more funding. But all appeared to fall on deaf ears, if the minister’s anodyne response was anything to go by.
Hugo Swire referred at the beginning to a long list of “demands and asks” – yet at the end of his 10 minute speech all I heard was a list of concerns. The only thing I heard him ask for was a letter from the minister relating to the loss of GP out of hours service in Exmouth.
He was articulate and easy to listen to but lacked the conviction of someone who really wanted to change anything.
Hugo Swire also claimed that those who blamed the conservatives for health funding problems were “immature.”
Other MP speakers included Oliver Colville and Anne Marie Norris – both of whom I thought were long-winded and ineffectual, Geoffrey Cox argued strongly for a fairer funding formula for Devon (he also sounded as though he was auditioning for Shakespeare), Peter Heaton Jones, who also argued for more funding (and stuck to his guns when the health minister tried to slap him down) and Neil Parish, who I thought was the best speaker.
Mr Parish displayed what appeared to be genuine passion for local services and frustration at Honiton Hospital being cut out of the consultation. He asked the minister for action on this, but the minister merely replied that it was a consultation and people should respond regardless!
Mr Parish called for all Devon MPs to oppose the bed cuts rather than a piecemeal approach, which is a position I entirely agree with. He stopped short, however, of calling for more funding.
The health minister’s repeated “gentle reminders” to his conservative MPs felt to me to have a rather menacing element, as though he resented being called out from his office to listen to a group of his own irksome backbenchers. They were “gently reminded” about a range of issues such as the consultation and NHS funding – which the minister said had already been uplifted for Devon.
The bottom line (and only piece of action it seemed to me) was that the minister agreed to write to Hugo Swire about Exmouth out of hours GP cuts. I think that this was it.
Hugo Swire did attempt a last minute currying of favour with the minister by reminding him that it was the Devon MPs who won the general election for the conservatives. Unfortunately the appeal seemed to fall upon stony, if not rocky, ground.
I would have liked to have seen a united front with a clear list of “asks” shared by all Devon MPs (after all they are of the same party), and speeches peppered with searching questions.
I hope that this will be the start of many more such similar debates on behalf of the residents of Devon.
As almost everyone in Seaton must now know, the NEW Devon (North, East and West Devon) Clinical Commissioning Group is currently consulting on which few beds should be retained in community hospitals. Although Seaton will keep 24 beds under Options A (the CCG’s preferred option) and C, under options B and D these beds will go to Sidmouth.
Indeed having removed the beds from Ottery St Mary and Axminster hospitals, the CCG now proposes to take all beds from Honiton and Okehampton, leaving only 32 beds in Tiverton, 24 in either Seaton or Sidmouth, and 16 in either Exmouth or Exeter (Whipton), to serve 900,000 people in most of Devon.
The Town Council has expressed its grave concern at the threat to Seaton Hospital and the wider removal of community beds. With Councillor Martin Pigott taking the lead, I and other councillors have met with representatives of the Hospital League of Friends and the GP practices (who have questionnaires available for you to express your views to the CCG). We will be organising a public meeting, probably on Friday 4th November, with Neil Parish MP – the CCG will be invited to send a representative.
The community hospitals are an essential half-way house, much valued by patients, between the acute beds in the Royal Devon & Exeter Hospital and care in the community. The whole point is to have them local. Taking their beds away will make only a small difference to the CCG’s ballooning deficit – the only thing that will really change it is for the Government to finally put in the extra funding which everyone knows the NHS needs. We need to link up with others in East Devon to make this a common battle.
Democratic deficits in Devon: what do we do about monopoly Tory control, achieved with a minority of the votes, but leading to a crisis in local services? My new post on openDemocracy.
The Conservative hold on power in Britain is stronger than its majority of only 17 in the 650-seat House of Commons implies. Labour, the only alternative governing party, needs to gain around 100 seats even before the impact of the newly announced boundary changes is taken into account – or else forge an agreement with the Scottish National Party which looks no more possible than in 2015. As the Labour leadership contest draws to a close, the party’s road to power, whoever wins, is extremely difficult to forsee.
The Tory elective dictatorship rests on an almost complete dominance in southern England (outside large cities and university towns), which was also the principal area of support for Brexit. In the 2015 General Election, the Tores’ targeted wipeout of the Liberal Democrats across the South West delivered their unexpected majority. South and west of Bristol there is only one non-Tory MP (Labour’s Ben Bradshaw in Exeter). Even more than in the much-discussed case of Scotland under the SNP, the South West has become a virtual one-party state.
Some outside the region have speculated that a Liberal Democrat recovery might help enable a ‘progressive alliance’ as an alternative to Theresa May’s Tories. However a recovery to pre-2015 levels would not only be insufficient to offset Labour’s deficits in Scotland as elsewhere, but it ignores the extent to which the Tories have concentrated power to make it difficult for any opposition party to change the regional balance.
The situation in the region’s largest county, Devon, shows the depth of the problem. But at the same time, it is where local activists are devising new ways of doing politics that are challenging Tory control.
A microcosm of Tory power
The Tory monopoly in Devon is even more complete than in neighbouring Cornwall and Somerset. Conservatives have overwhelming control of local government (both unitary authorities, the County Council and almost all the districts). In the urban areas, the general election results were close and Labour (Plymouth, as well as Exeter where they recently consolidated their control of the City Council) and the Lib Dems (Torbay) remain in contention. But in the rural areas and small towns, the majority of the county, Tory dominance is almost absolute at every level – barring some town and parish councils where politics is less partisan.
Some rural areas have never had a non-Tory MP. The Tories had six of the seven non-urban Devon seats even in 2010. At least one council, East Devon, has been Tory since it was created in 1973. In semi-rural Devon, even an unlikely Lib Dem revival would make little difference. How then can things ever change?
It is important to understand that Conservative rule is based neither on majority support or extensive party membership. In 2015, the party gained under 45 per cent of all votes. Even in the seven non-urban seats, the 2015 increase in Tory support brought them only up to a 49 per cent average; in the urban seats they squeaked in on the same 37 per cent that gave them their national majority. Yet the non-Conservative majority are virtually unrepresented.
The Tory party is hollowed out and probably has far fewer members than Labour. The party could only take Torbay and North Devon from the Lib Dems with the aid of the notorious ‘battle bus’ activists, whose costs their Torbay agent, Alison Hernandez – like many others – failed to declare. Even after Channel 4 broke the scandal in 2016, Hernandez was narrowly elected as Devon and Cornwall Police and Crime Commissioner, but refused to stand aside as she was investigated (the case was transferred to another force and is still pending).
As ever where one-party rule is so entrenched, corruption is not far away. Revelations like those in 2013, when East Devon Tory councillor Graham Brown was forced to resign after telling a journalist he could obtain planning permission in return for cash, fuel widespread cynicism about local power which make the ruling party vulnerable.
The flexibility of local Tory MPs over Brexit – ‘pro-Remain’ Neil Parish MP, Chair of the parliamentary Environment committee, quickly backed Boris Johnson and Andrea Leadsom in quick succession for the leadership and now describes Brexit as a ‘glorious opportunity’ – is likely to create a new constituency for opposition.
Failure of the opposition parties
The situation in which non-Tory votes largely fail to count is also because Labour and even Lib Dem leaders have failed to reform the electoral system for Westminster and councils. Tony Blair’s government never held the referendum on Proportional Representation to which its 1997 manifesto committed it. Current Labour leader, Jeremy Corbyn, has never campaigned for PR during his 33 years in Parliament, and together with his rival Owen Smith continues to fudge the issue in recent responses to the Electoral Reform Society.
Nick Clegg abandoned the Lib Dems’ longstanding committment to PR to obtain office in 2010, settling for the promise of a referendum on the weaker Alternative Vote without even securing government support for change. In the South West, the Lib Dems’ collective political suicide through the Coalition has broken the residual credibility of the first-past-the-post system.
Because Tory dominance is so extensive, the party has largely taken voters for granted. Devon is suffering sharply from the general underfunding, Balkanisation and creeping part-privatisation of public services. The NHS trust running the flagship Royal Devon and Exeter Hospital has been forced from a healthy surplus into deep deficit. The NEW Devon Clinical Commissioning Group, also in chronic deficit, tried to bar some patients from routine operations until obliged by public pressure to abandon its plans. Local Community Hospitals have lost beds and have been handed over to NHS Property Services, which can put up rents or, worse, sell off the sites.
Devon is a region of heavy immigration, mainly of retirees from other English regions (although with some international migrants, concentrated in its cities). As in the NHS, the gap between funding and need threatens adult social care. Child protection services are deemed inadequate. Since Tory Devon retains grammar schools, there are concerns about the effects of Theresa May’s proposed expansion of these schools on the excluded majority of children.
Devon Tories’ unaccountability is also evident in how they have embraced the half-baked, patchwork ‘devolution’ launched by George Osborne, which offers limited ‘additional’ money – while core government funding for local services is pared down or eliminated. Although Devon is a much larger and more populous county than neighbouring Cornwall which has a sole devolution deal, Devon is being forced into a merger with Somerset in a new brand, an affront to local identities, ‘Heart of the South West’.
The principal rationale for the linkage seems to be to create a larger base for the anachronistic and hyper-expensive Hinckley C nuclear project. Any benefits, if they materialise, will be overwhelmingly for the neighbouring county. The proposed devolution, with a hyper-aspirational prospectus which bears comparison to Vote Leave’s notorious offer, is being run through the Local Economic Partnership, dominated by unelected business leaders.
County election challenge
Devon County Council comes up for reelection in May 2017. In 2013, the Tories won 38 of the 62 seats on a mere 35 per cent of the vote. Under first past the post, the divided Lib Dems, Labour, Greens and Independents between them won only 20 seats for 41 per cent of the vote. (UKIP, which polled 23 per cent, won 4 seats.)
It is obvious that none of the three centre and left opposition parties can win a majority in 2017. The Lib Dems may keep some strongholds, but they are still picking themselves up from their 2015 battering, and elsewhere local activists are thin on the ground.
Despite a deep conflict between Bradshaw and pro-Corbyn Momentum activists, Labour will probably keep its Exeter seats, but is unlikely to win in the rural areas and small towns. Rural Labour parties have seen the Corbyn surge in membership but with modest benefits for local activism – a constituency party which has trebled its membership to 500 may still only get about 15 people to its meetings. Members vote for their preferred leader, but have too little scope to change things locally. Even if it advances, Labour is starting from a very low base, and the Greens are smaller.
The 2015 elections saw important steps forward for a different kind of politics in semi-rural East Devon. From a standing start, Independent candidate Claire Wright leapfrogged UKIP, Labour and the Lib Dems to take second place in the East Devon parliamentary constituency of Hugo Swire, a ‘Cameron croney’ since knighted in his resignation honours. It was the only Independent second place anywhere in England, after a grassroots campaign typically ignored by the national press.
In parallel, the East Devon Alliance, formed in 2013 out of revulsion at the Brown case and East Devon’s pro-developer bias, put up over 30 district council candidates and succeeded, despite the simultaneous Tory general election victory, in taking ten seats from the Tories (this writer was an unsuccessful candidate). Independents led by EDA replaced the Lib Dems as the official opposition.
An investigative blog, East Devon Watch, has played an important informational role in the new politics, now matched by a South Devon Watch site. An Independent group successfully challenged for control of Buckfastleigh Town Council, in the Teinbridge district, at the same time as the better-known ‘flatpack democracy’ of Frome in Somerset. A loose Independent network is emerging across the South West, including Cornwall.
Although social media played an important part in these campaigns, many relied heavily on old-fashioned doorstep campaigning. A new campaign to influence the County Council elections, Devon United, is perhaps the first – certainly the most ambitious – initiative to be actually launched through social media. Its first meeting in October will be addressed by Paul Hilder, co-founder of OpenDemocracy.net and CrowdPac and former global campaigns director for Avaaz and Change.org.
I have written recently about the limitations of the national progressive crowdsourcing campaign organisation, 38 Degrees, during and after the Brexit vote. It remains to be seen what happens when crowdsourced politics meets local electioneering, and how the division of the anti-Tory vote will be overcome. But this initiative shows that the new politics is alive and kicking in a county where the old politics has so manifestly failed.
At the 2015 election hustings in Seaton, MP Neil Parish enthusiastically supported holding the Brexit referendum.
When Cameron announced the vote, however, he was for Remain, although neither he nor the local Conservatives did much obvious campaigning.
After the vote, Parish backed Boris Johnson, the chief Leaver, for the Tory leadership.
When Michael Gove forced Johnson out, Parish plumped for another Leaver, Andrea Leadsom (the one who robotically repeated ‘We need to take control’ in the TV debates).
Does it even matter to Parish whether we’re in or out of the EU?