Health Scrutiny Committee
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
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.
Scandal of fundamental changes to Devon’s NHS, which open door to large-scale privatisation, pushed through without public discussion – I have put them on the agenda of next week’s Health Scrutiny Committee
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.
Devon’s CCGs have pushed the change through without publicity, and it is only because I have put it on the agenda that Health Scrutiny will have a chance to discuss in advance of April 1st. I have written a 7-page paper for the Committee outlining what we know about the ACS and posing eight questions which they should ask about it.
Devon Conservative machine backs Health Scrutiny travesty, blocks my last-ditch attempt to defend our hospital beds
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 ‘extensively considered 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 ‘may not reflect well on the Council as a whole’. 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.
There WILL be a debate at the County Council on Thursday on my motion calling for Health Scrutiny to look again at the issues it failed to scrutinise properly
There WILL be a debate at the County Council on Thursday on my motion calling for Health Scrutiny to look again at the issues it failed to scrutinise properly in July, and for the County to let the Secretary of State know of the concerns about the CCG’s decisions and the process. The Leader, Cllr John Hart, has told me that they will agree to a debate rather than having the motion forwarded first to Cabinet, as is the normal procedure.
The agenda for the meeting is here.
After the failure of the July Scrutiny meeting, I am asking Devon County Council to look again at hospital bed closures on 5th October
After the failed Health Scrutiny Committee meeting in July – which has led to repercussions in the County’s Standards and Procedures Committees as well as at EDDC – the full Devon County Council will be asked to look again at the issues on Thursday 5th October. I have proposed the following motion, which Claire Wright will second:
The County Council regrets the failure of the Health and Adult Care Scrutiny Committee on 25 July 2017 to be seen to scrutinise the decision of NEW Devon Clinical Commissioning Group to close community hospital beds in Honiton, Okehampton, Seaton and Whipton, especially in the light of the subsequent urgent recommendation by the head of the NHS in England, Simon Stevens, which is supported by evidence from the Royal College of Emergency Medicine and the King’s Fund, that more beds need be made available for the coming winter.
Noting also the Standards Committee’s conclusion that events at the Scrutiny Committee meeting ‘may not reflect well on individual members of the Council or upon the Council as a whole’, its recommendations for the Committee’s Chair and its general recommendations to both members and chairs of Scrutiny Committees, the County Council therefore
- requests the Health and Adult Care Scrutiny Committee to scrutinise those issues identified by the County Solicitor in her paper for 25 July which were not directly and fully addressed at the Scrutiny Committee in that meeting;
- consistent with the Council’s ‘community champion’ role, alerts the Secretary of State to the strength of feeling in the locality at the overall STP process throughout the County and the significant numbers of objections made by the public to the CCG’sproposals and that in the interests of democracy and democratic accountability he might wish to satisfy himself that all relevant process were properly undertaken and assessed and that the CCGs subsequent decisions are supported by the evidence; and
- welcomes the agreement of the Health and Adult Care Scrutiny Committee to examine, subject to the advice of the County Solicitor, means of safeguarding community hospital buildings throughout Devon as facilities for the provision of place-based health services.
Seaton and Axminster – combined health hub?
As I have reported before, Seaton Town Council, the League of Friends and I have been discussing the future of Seaton Hospital in the light of the removal of the beds. Full details of the proposals have not been finalised, so I can only quote the report of Councillor Jack Rowland, Mayor of Seaton, to next Monday’s Town Council:
‘The next campaign is to ensure that the site is retained with a compelling case for retaining the existing services and extending these. To this end I attended a meeting on 6 September to discuss the next steps. I cannot give fuller details at this stage, but broadly the idea is to set up a Steering Committee for an Axe Valley Health Hub and to work in conjunction with Axminster to build a case for retaining both sites with complementary services.’
EDDC Leader, Cllr Paul Diviani, will face a vote of ‘no confidence’ next Wednesday, 13 September at a special meeting of the Council, over his vote to block the referral of the CCG’s hospital beds closures to the Secretary of State – which effectively condemned the beds in Seaton, Honiton, Okehampton and Whipton:
- ‘On Tuesday 25th July 2017, Cllr Diviani chose not to represent the opinions of this Council or the people we represent at the DCC Health and Adult Care Scrutiny Committee meeting when he was clearly expected to do so. This Council no longer has confidence in Cllr Diviani’s commitment to represent our collective interests nor lead our East Devon communities as the figurehead for local government. We call for his resignation.’
Proposed by Councillor Ben Ingham, seconded by Councillor Val Ranger and supported by Councillors Cathy Gardner, Matt Coppell, Marianne Rixson, Rob Longhurst, Dawn Manley, Geoff Jung, Peter Faithfull, Susie Bond, Roger Giles, Matt Booth, Peter Burrows, Steve Gazzard, Megan Armstrong and Douglas Hull.
Members of the public can speak for up to 3 minutes each at the beginning of the meeting.
A slightly abridged version of my reply to Cllr Diviani is published in today’s Midweek Herald (below).
Health Scrutiny Chair should consider her position after rebuke and the County must act to restore confidence in scrutiny of NHS
My press release:
Devon County Council’s Health and Adult Care Scrutiny Chair, Councillor Sara Randall Johnson (right), should immediately consider her position following the stinging rebuke issued to her by the Council’s Standards Committee. The Council should also act to restore the credibility of Health Scrutiny, since its failure to fully scrutinise the removal community hospital beds in Honiton, Okehampton and Seaton has destroyed public confidence in its activities across a large swathe of Devon.
At its meeting on 29 August, minutes of which are published today, the Standards Committee agreed that while Cllr Randall Johnson had not broken the Members’ Code of Conduct, she should ‘be strongly reminded of the importance of the work of scrutiny committees – reinforcing the value of neutrality in scrutiny both generally and in calling the “health service” to account – and the need to be seen to be even handed and scrupulously fair, recognising that failure to do so may be perceived as a deliberate act.’
The call for a Scrutiny Chair to ‘be strongly reminded of the importance of the work’ of her committee, and of the value of neutrality and being seen to be even-handed and fair, is unprecedented and should lead Cllr Randall Johnson to immediately consider her position. There is no public confidence that she will lead the committee to carry out full and impartial scrutiny of NHS decision-making.
Effects on the Council’s reputation
The Standards Committee also ‘accepts that the events of the Health and Adult Care Scrutiny Committee meeting on 25 July 2017 may not reflect well on individual Members or upon the Council as a whole, and further recognises that the perception gained by persons present at the meeting or subsequently viewing the webcast is not that which would have been desired’.
This stark acknowledgement of the damage done to Devon County Council’s reputation also requires early action by the Council to reassure the public that the Committee will do its job properly in future and protect the NHS in Devon.
The Scrutiny Committee ignored the views of local communities and their representatives and has allowed the CCG to get away with damaging cuts. The Council must now consider how to restore people’s faith that it will protect all our community hospitals in the future. I shall ensure that this is discussed when the Council meets on 5th October.