A reportto be discussed on Tuesday provides alarming evidence that the NHS in Devon is continuing to fail patients with serious conditions, both cancer patients and patients who require what is classified as ‘elective’ surgery. On both counts, Devon yet again scores worse than the national average.
It shouldn’t need emphasising that with cancer, delays cost lives. With many other conditions, delays cause needless weeks and months of additional pain and suffering, with serious impacts on patients and their families.
The Government’s long-term failure to fund the NHS is primarily responsible, and staff shortages – exacerbated by Brexit (which is driving away European doctors and nurses) -make the situation worse.
Yet it is difficult not to feel that Devon’s NHS leaders (in the Sustainability and Transformation Partnership) are complacent about these failings. Once more, damning figures are buried in the middle of a report whose main focus is the overall Winter experience in 2018-19.
Where is the urgency to improve patients’ experience of our NHS, when they faced with life-threatening and life-changing conditions? When will the Health Scrutiny committee call the NHS to account for these failings?
THIS IS WHAT THE REPORT SAYS:
Cancer – time to treatment ‘Performance against national cancer waiting times standards for first definitive treatment within 62 days for urgent referrals showed significant variation throughout the year, with performance at Devon level consistently failing to meet national targets.’
Over the year, the figure varied from 68.4 to 80.2 per cent, against a national target of 85 per cent.
Cancer – time to see specialist ‘The time taken for patients to see a specialist after urgent referral for a suspected cancer within 2 weeks of an urgent referral improved during Winter, with overall performance at Devon level reaching an in-year high-point of 89.5%, but still failing to meet the national target of 94% of patients being seen within 2 weeks of urgent referral.’
In fact, the figures show that March 2019 was the best month of the last year, during which the figure varied from 80 to 89.5%.
Referrals to treatment within 18 weeks ‘We continued to see a deterioration in the proportion of people being referred to treatment within 18 weeks, dropping to 80.5% by the end of the year.’
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.
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.
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.
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.
At 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
A&E Target: 95% treated or admitted in 4 hours.
CANCER CARE Target: 85% begin treatment within 62 days of urgent GP referral
PLANNED OPS Target: 92% waiting less than 18 weeks
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’.
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).
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.
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.
Devon’s two Clinical Commissioning Groups (CCGs) are pushing ahead with far-reaching, highly controversial changes to the NHS in the County from 1st April – without alerting the public or even the public watchdog, the Health and Adult Care Scrutiny Committee at Devon County Council.
The changes will turn the Sustainability and Transformation Plan – which itself grew out of the misnamed ‘Success Regime’ which closed our community hospital beds – into a more permanent Devon Accountable Care System. The first phase, in the first part of the financial year 2017-18, will develop integrated delivery systems, with a single ‘strategic commissioner’ for the whole county.
However the real concern is the next phase, which will lead to the establishment of Accountable Care Organisations. These will lead to services being permanently financially constrained, limiting NHS patients’ options for non-acute conditions, and pushing better-off patients even more towards private practice.
Large chunks of our NHS will be contracted out for long periods, probably to private providers. The ‘toolkit’ for this fundamental change talks about ensuring ‘that there are alternative providers available in the event of provider failure’. In the aftermath of Carillion, do we really want most of our NHS contracted out to private firms?
Devon’s public are not being consulted about this change – unlike in Cornwall where the Council has launched a public consultation – and there is no reason to believe that they want a privatised, two-tier health system.
Yesterday the Conservative Party machine defeated my final attempt to get Devon County Council to take action over the closure of community hospitals beds. My motion, seconded by Claire Wright, asked the Health Scrutiny Committee to look again at the issues it failed to scrutinise properly in July, and asked the Council to write to the Secretary of State for Health to alert him to our concern about hospital beds. I highlighted widespread NHS concern that there will be too few beds if there is a flu epidemic this winter. My speech is printed below and you can watch it here.
The Tory response was an amendment, moved by the leader, John Hart, which took the guts out of the motion. Despite all the evidence to the contrary, it said that Health Scrutiny had ‘extensivelyconsidered the issues and concerns from members of the public, elected members and others, including medical professionals, all matters relating to the closure of some community hospital beds in Honiton, Okehampton, Seaton and Whipton.’
Instead of my proposal to write to the Secretary about the beds closures, the amendment proposed to write ‘seeking reassurance that appropriate funding is provided by government to deliver the necessary health and social care services in Devon’. Not a dicky bird to the minister about community hospital beds, the whole point of the debate.
In reply I told the Council (at 3.10) that if they passed this amendment, they would be ignoring East Devon opinion just like Kensington & Chelsea Council ignored the residents of Grenfell Tower; and the Conservative Group as a whole would have made itself responsible for the failure of scrutiny.
The result Although they were not formally whipped, 40 Tories fell dutifully in line to support the amendment. There were 16 votes against (these were Liberal Democrat, Labour, Independent and Green members, together with only one Conservative, Ian Hall of Axminster).
Claire made a valiant attempt to put some guts back into the motion, with another amendment – but the Tory machine squashed that too.
During the Council meeting, the overhead display announced the date as ‘5 Octobe’, losing an ‘r’ in apparent tribute to the recent successful Tory conference, on which Steve Bell comments in today’s Guardian:
Text of my speech:
I represent a large division in East Devon. 2 years ago Seaton, Axminster and Honiton hospitals had in-patient beds, universally appreciated by patients & doctors, and supported by local communities. Today large parts of each hospital lie empty – nurses and other staff are dispersed – volunteers have been told they are no longer needed. We don’t even know whether the buildings will survive as centres of health services or be sold off.
This is the biggest crisis East Devon & Okehampton have faced in many years. Local communities have been united in their opposition; councillors of all parties have opposed the decisions.
After a biased consultation and unjust decisions, we looked to the Health Scrutiny Committee to hold NEW Devon CCG to account, and they have failed us. My proposal today is not a motion of NO confidence in any councillor or party. It is a motion to RESTORE confidence in this Council’s ability to represent Devon communities and stand up for their interests.
The tragedy is that Health Scrutiny started sensibly by asking the CCG 14 questions, in order to decide whether it should use its legal power to refer their decision. This proposal had cross-party backing, with the support of more Conservatives than members of any other party. A minority of the committee were, however, determined from the beginning to disregard public concern and voted not even to ask the questions.
The CCG replied to the questions but the Committee found their answers inadequate and wrote back detailing areas of concern. So far so good – a model of scrutiny. But things started to go wrong when the issue came to the new Health & Adult Care committee in June. The new Chair argued that members were insufficiently experienced to decide the issue and recommended delaying a decision until September 21st. It escaped no one’s notice that this was after the date given for permanent closure of the beds. It was seen as an attempt to prevent effective scrutiny.
Fortunately, the Committee agreed instead to a special meeting in July. For this meeting, the County Solicitor prepared a guidance paper outlining 6 issues outstanding with the CCG. Councillor Ian Hall, Councillor Mike Allen who is a Conservative District councillor, and others joined me in pressed the local communities’ case.
However the CCG gave a long powerpoint presentation which simply did not address most of the 6 issues, and before any debate could take place, Councillor Gilbert proposed there be no referral. In case anyone believed that he still wanted to scrutinise the issues, he made a point of emphasising that not referring would ‘save the committee a huge amount of work ’.
Councillor Diviani then told the committee that referral would be a waste of time, because ‘attempting to browbeat the Secretary of State to overturn his own policies is counter-intuitive’.
The Committee never discussed most of the remaining issues that the guidance paper had identified. Let me mention just one, the surprise decision to close Seaton’s beds, removing all provision from the Axe Valley. Neither the CCG nor any member gave any reason for believing this decision was justified – yet the committee voted for it anyway and the empty wards of Seaton hospital are the consequence.
There was no broad support for the anti-scrutiny motion: it was supported only by 7-6 ; 4 members abstained or were absent. The meeting was widely seen as an abdication of scrutiny. The Standards Committee says it ‘maynotreflectwellontheCouncilasawhole’. I would go further: it did not reflect well on this Council.
Since then, it has become obvious that cutting beds to the bone brings great risks. The Head of the NHS, Simon Stevens, has called for more beds to be urgently made available this winter in face of a possible flu epidemic. Expert bodies like the Kings Fund, the College of Emergency Medicine and NHS Providers have backed the judgement that the NHS is cutting too far, too fast. These are new reasons to question the CCG’s plans.
This motion therefore proposes that
The Scrutiny Committee should look again at the issues which were not satisfactorily addressed.
The Council should tell the Secretary of State that the CCG’s decisions and the wider STP process have aroused great feeling in Devon, that people are not happy with either the decisions or the way they were made , and we are worried that we simply won’t have enough beds for the coming winter.
Finally, following a more constructive Health Scrutiny meeting on 21st September, this motion welcomes the Committee’s help in securing community hospital buildings.
Some of you may still wonder if Cllr Diviani was right, and all these proposals will be a waste of time. The answer to this is given in a recent letter from the Secretary’s own office: ‘As you may know,’ it says, ‘contested service changes can be referred to the Secretary of State, who then takes advice from the Independent Reconfiguration Panel.’ So a referral is not something the minister deals with personally; it is a legally defined procedure.
The letter continues, ‘However, as you are aware, Devon’s Health Scrutiny Committee … passed a motion … in favour of not referring the CCG’s decision to the Secretary of State.’Cllr Diviani suggested that referral was pointless because of the minister’s opinions: the minister’s office implies it WOULD be meaningful, if only Devon would take action.
I ask you to restore this Council’s reputation and take the action which it is within your power to take, even at this late date, to save our community hospital beds.