Health Scrutiny Committee

‘Defer the Integrated Care System’ says Health Scrutiny Committee, after campaigners and councillors challenge CCGs’ failure to provide proper information on controversial scheme

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Following my request for Health Scrutiny to consider the CCGs’ plans (at the last meeting in January), and challenges to the Conservatives’ attempts to push them through at DCC’s Cabinet 10 days ago, this Thursday’s Health Scrutiny called for a slow-down in the rush to implement a major reorganisation of the NHS which the public hasn’t been informed about – let alone consulted on. 

County Councillor Claire Wright (Independent, Otter Valley) writesThe brake on the process was applied at yesterday’s (Thursday 22 March) Devon County Council’s Health and Adult Care Scrutiny Committee, which also recorded its concerns at the plans, set to be put in place next month.

The new system, which is coming into force in health areas across the country, will mean a merger of the two clinical commissioning groups in Devon, at least at board level to start with, and is widely being seen by campaigners across the country, as the beginning of a break-up of the NHS – and a clear route through to more privatisation and less public accountability.

Nationally, there are legal challenges by senior medics who are convinced that the move to ‘accountable care’ as it was originally called, will be disastrous for patient care and the public functioning of the NHS.

We are repeatedly told by local NHS and social care managers that it is just about integration of health and social care and is another step on a long journey.  But that is disingenuous.

This is the start of a very new style of working and no one is very clear where it will end up.  What is certain though, is that it is being driven by Conservative Secretary of State for Health and Social Care, Jeremy Hunt and if he tells the NHS to move in a certain direction, they must do as he says.

So although this new system debated at Devon County Council’s Health and Adult Care Scrutiny Committee yesterday is at an early stage, its direction of travel is clear. We are heading for a more formal set up of groups of organisations and no one can reassure members of the public how the governance or funding will operate.

For example, the NHS is free at the point of use and social care is means tested. So if budgets are merged, will social care become free at the point of use? Highly unlikely.  So what does this mean for NHS care?

At yesterday’s Health and Adult Care Scrutiny Committee meeting, very well informed and articulate members of the public from the Devon Save Our Hospital campaign group addressed councillors, as well as Cllr Martin Shaw.  Also, Cllr Julian Brazil (speaking on behalf of the LibDem group) who are very concerned about the plans.

Cllr Martin Shaw (Seaton Independent) was successful in getting the health scrutiny committee to take on this issue earlier this year and is incredibly well researched and informed on the issue.

Feelings and anxieties were running high during the meeting. Some speakers were heckled by members of the public, which prompted chair, Sara Randall Johnson threaten several times to throw them out.

Committee members had received dozens of emails from members of the public who wanted councillors to object to the plans.

Most of the committee fortunately, seemed concerned. I made the following proposal, which was agreed unanimously.

The section in brackets was very disappointingly, deleted by the Conservatives on the committee, despite the NHS representatives agreeing to a period of public engagement . This is a great shame, but I remain pleased that the rest of my recommendations were supported.

(a) record the Committee’s concerns over the emerging Devon Integrated Care System being a single Integrated Strategic Commissioner, a number of Local Care Partnerships, Mental Health Care Partnership and shared NHS corporate services;

(b) defer the Integrated Care System process until assurances are provided on governance, funding, the future of social care from a democratic perspective (and when a full engagement process has taken place – the part on public engagement was deleted by the Conservatives unfortunately);

(c) recommend Councillor Ackland’s paper and proposals on the reformation of the Health and Wellbeing Board as a sound democratic way forward to provide the necessary governance on a new integrated system;

(d) give assurance that the proposals will not lead to deeper cuts in any part of Devon as a result of the ‘equalisation of funding’;

(e) provide a copy of the business plan being developed and a summary of views from staff consultations.

Cabinet will now need to consider these recommendations.

If you wish to watch the debate, here’s a link to the itemised webcast – https://devoncc.public-i.tv/core/portal/webcast_interactive/318671

Pic:  Standing room only. Yesterday’s Health and Adult Care Scrutiny Committee meeting.

Save Our Hospital Services demonstrating outside CCG and Health Scrutiny at County Hall on Thursday 22nd

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Save Our Hospital Services (SOHS) Devon are lobbying against plans to introduce structural changes in NHS delivery of services from April 1st
with a demonstration at midday at County Hall, Exeter on Thursday 22nd March.
Campaigners will also address the DCC Health & Adult Care Scrutiny Committee at 2.00pm on Thursday with 12 key questions about Integrated Care Systems (ICS)
planned for introduction by NHS England from April 1st without consultation. SOHS have sent these 12 questions to Dr Tim Burke, Chair of the NEW CCG
which meet also at 1.00pm on Thursday at County Hall.

Health Scrutiny hears there will be no precipitate decisions on community hospitals – local conversations with CCG and RD&E offer chance to shape ‘place-based health systems’ around towns

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In my third and final report from yesterday’s Health Scrutiny, I come to the report on the future of the hospitals by NEW Devon CCG and NHS Property Services, in response to the Committee’s request for clarification. (This arose from my presentations at the September and November meetings). While NHS PS stressed that in principle they will eventually have to charge market rents, Claire Wright elicited the useful information that currently NHS England are still paying for the buildings, and the company said they are ‘always happy to work with local communities to consider local services’. Scrutiny’s resolution requested that NHS PS ‘uphold this undertaking’ and keeps the Committee informed on the timeline for changes in the status of the hospitals.

The CCG’s Sonja Manton confirmed that the community conversations the CCG and RD&E are now promoting to develop ‘place-based systems‘ around ‘market towns’ – which have already begun in Honiton and Okehampton – can certainly include the services people want to have delivered locally in the hospitals. While there are cost constraints and not everything which people want will necessarily be delivered, local communities can certainly discuss these services with the NHS organisations, as well as how voluntary organisations can help the NHS and adult social care. Okehampton’s Conservative county councillor, Kevin Ball (below front left, with Non-Aligned Group leader Frank Biederman behind), stressed the progress his community had made in the recent meeting in the town. He and Okehampton’s mayor, Jan Goffey, mentioned that FORCE Chemotherapy will soon be opening a service in the hospital.

Health Scrutiny Jan 2018 with Kevin Ball

In my speech (1:34:20) I welcomed the new ‘place-based’ focus and stressed the importance for towns like Seaton – which is 45 minutes to an hour from acute hospitals – of using the free space in the community hospital to deliver routine treatments and operations for which people currently have to go to Exeter. I pointed out that constituents complain to me all the time about the stress, strain and cost of repeated travelling, often when unwell, without parking, park-and-ride space or bus services – while Exeter complains of congestion!

I mentioned the request of the RD&E’s Em Wilkinson-Bryce, in Honiton last week, for the community to trust the NHS organisations, and said that a serious conversation about local services – in which the NHS takes on board what people want – would be the best way to create this. We wanted to keep the beds, but now they are gone proper ‘place-based’ strategies for each of our towns offer the prospect of working together with the NHS. Preparations are underway for a meeting similar to ‘Honiton’s Health Matters’ in Seaton in March, and I will give more information as soon as the date is fixed.

Devon’s health system’s declining performance over last 12 months – and Health Scrutiny still waiting for winter crisis evidence

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Health Scrutiny 25 Jan 18At yesterday’s Health Scrutiny Committee, I presented evidence (at 2:10:45) of an across-the-board decline in performance by Devon’s four NHS trusts against 3 key national targets, over the last 12 months.

Devon’s A&E departments are slipping back against the target of 95 per cent of patients to be seen within 4 hours (as we were meeting the average waiting time in Wonford according to the ironically named NHS Quicker app was 5 hours 13 minutes). The hospitals are slipping back against the target of treating 85 per cent of cancer patients within 62 days of urgent referral by a GP – our trusts average between 75 and 80 per cent and one trust, Northern Devon, is seeing 17 per cent fewer within the target than a year ago . And they are further from meeting the target of carrying out 92 per cent of routine operations within 18 weeks – and this was before ‘elective admissions’ were ‘deprioritised’ (in the language of the report) in January. Similarly, it appeared that the SW Ambulance Service was getting to a smaller proportion of the most urgent calls within target.

My comments were a corrective to an over-optimistic report by the CCGs and the County Councils’ social care team, which stressed the halving of Delayed Transfers of Care from hospital (bed-blocking). While this is very welcome, it is less important to most patients’ experiences than the 3 main indicators which the NHS itself has chosen to measure its performance against. The delays in cancer treatment (which the report didn’t even mention) are particularly scandalous – they will cost lives.

Elsewhere on this item, Claire Wright made a valiant attempt to get information about the winter crisis in Devon from the CCG (and earlier from the Ambulance Service). She was promised that evidence would shortly be provided to the committee.

PERFORMANCE AGAINST KEY TARGETS OVER LAST 12 MONTHS ROYAL DEVON & EXETER TORBAY & SOUTH DEVON N DEVON PLYMOUTH England average
A&E Target: 95% treated or admitted in 4 hours. 87.2% (-5) 88.3 (-1.7) 88.5 (-6.1) 79.3 (-4.8)

85.1

CANCER CARE Target: 85% begin treatment within 62 days of urgent GP referral 80.4 (-2.9) 77.3 (-16.9) 75.3 (-12.9) 78.5 (+1.7)

82.5

PLANNED OPS Target: 92% waiting less than 18 weeks 88.4 (-3.2) 83.7 (-5.3) N/A 82.4 (-2.6)

89.5

Health Scrutiny agrees to my request to scrutinise controversial plan for Accountable Care System in Devon from 1st April – I tell them there is no public consensus for private companies running our NHS

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Yesterday’s meeting of the Devon Health and Adult Care Scrutiny Committee agreed to my request for a special meeting to discuss the introduction of an Accountable Care System in Devon, if this goes ahead as planned on 1st April. However if the system is delayed, it will discuss the system at its scheduled meeting on 22nd March.
I told the Committee that in the light of the controversial nature of Accountable Care Systems, it was wrong that no consultation had been held with the Committee, the County Council or the public.
I pointed out that in Cornwall, an open inquiry into a similar proposal had been held, and that the parliamentary Health Select Committee, at the instigation of Dr Sarah Wollaston MP, had launched an inquiry into Accountable Care Organisations (ACOs), the new kind of contract proposed within Accountable Care Systems. Jeremy Hunt, the Secretary of State, had welcomed this inquiry and while the Committee was meeting, NHS England announced a 12-week public consultation into these organisations.
I said that a major concern was that ACOs would be 10-15 year commercial contracts and could be given to private providers. Although NHS England’s statements points out that the two contracts so far proposed are going to NHS organisations, Mr Hunt’s letter to Dr Wollaston on 22nd January makes it clear that they can equally go to private companies. ‘Especially after Carillion, there is no public consensus that private companies should run large areas of our NHS’, I told the committee.
Moreover, at the hear of ACOs is the idea of ‘capitated care’, which I told the committee ‘could lead to rationing of routine operations and treatments, forcing better-off patients into private care and leaving a second-class service for those who rely on the NHS’.

Claire Wright reveals – CCG claims it isn’t in a position to give Health Scrutiny information on the winter crisis in Devon’s NHS

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CLAIRE WRIGHT, Devon County Councillor for Otter Valley, writes: I am really disappointed to report that despite me asking at the beginning of January for the winter pressures information to be available at the 25 January Health and Adult Care Scrutiny meeting, it is not going to be provided.

Given the avalanche of very worrying “NHS in Crisis” press stories I sent several emails to committee chair, Sara Randall Johnson, at the beginning of January asking for information such as delayed discharges, A&E waits, levels of norovirus, staff vacancies and various other pieces of information.

I am really disappointed to report that despite me asking at the beginning of January for the winter pressures information to be available at the 25 January Health and Adult Care Scrutiny meeting, it is not going to be provided.

I was told it would be published as part of the performance review. However, when the agenda papers were published last week, the performance review charts gave information until the end of November only.

I have since been told by the committee chair that a representative from the NEW Devon CCG claimed that they weren’t in a position to provide the information because it would give councillors an incomplete picture.

If this isn’t infuriating enough, winter pressures data is updated on a daily basis and circulated to NHS and social care managers. They have the information. And it’s as up to date as today.

The health scrutiny committee chair indicated during a phone call with me on Saturday that she thought this was acceptable and that this data not being provided until the March meeting was fine!

When I asked (as per the email below) for the data to be provided under ‘urgent items’ I was told the issue wasn’t urgent and there wasn’t time to get the paperwork out in any case.

The refusal to supply this information, is in my view, a deliberate obfuscation. An attempt to interfere with the democratic and legitimate process of scrutiny and the NHS should have been pressed to provide it for this meeting.

Here’s my email to chair, Sara Randall Johnson, sent last Wednesday (17 January).
……………………………………………………………………………….
Dear Sara

I am very disappointed that there will be no specific written report on winter pressures at next week’s meeting.

I think that most people, given that ongoing national crisis that the NHS is experiencing right now, would find it inconceivable that our committee did not have this important information to assess how our major hospitals are managing during winter.

I see that there is an agenda item for urgent items at the beginning of the meeting.

Can I ask that this information as I previously asked for, is included in the form of written reports from the four NHS acute trusts, as an urgent agenda item. This to include delayed discharges for the winter period and up until next week, A&E waits and numbers, staffing vacancies, levels of norovirus and all the other standard winter pressures reporting that the trusts do on a daily basis for their managers.

I look forward to hearing from you.
Best wishes
Claire

Pic: Demo at Totnes last month.

After Sarah Wollaston calls for delay in introducing Accountable Care Organisations, I have submitted evidence about Devon’s Accountable Care System to the parliamentary enquiry

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Sarah Wollaston, the chair of the Commons Health Committee, has written to the Health and Social Care Secretary urging him to delay a new contract for Accountable Care Organisations (ACOs), due to be implemented nationally later this year. She claims there is a “great deal of concern” over the plans which she considers “have not been well aired publicly up until now”.

This is precisely the point which I have made about Devon’s Accountable Care System -intended I believe as a precursor to Accountable Care Organisations – which is due to begin on 1st April. Neither Devon’s Health Scrutiny Committee nor the public has been made aware of this, and what it involves is still unclear.

I have submitted the paper – with 8 key questions – which I prepared for Health Scrutiny on Thursday to the parliamentary Health Committee’s Sustainability and Transformation Partnerships inquiry. Thanks to Mike Allen for drawing my attention to this just before last night’s deadline for submitting evidence.