NEW Devon CCG

It seems likely CCG strategy director DID say that there would be no closures of East Devon community hospitals – but in a private meeting for councillors. Over to you again, @NEWDevonCCG: we need a definitive, detailed public statement

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Conservative councillor Phil Twiss has commented on East Devon Watch about my post yesterday. He says:

Happy to clarify that a discussion about provision of services in our local hospitals was raised at the Health Scrutiny Masterclass to improve knowledge (other Scrutiny committees hold similar cross party meetings as required), held on the 4th of October, which is open to all members of DCC. This particular one was attended by a broad cross party selection of Councillors, but not Martin Shaw or colleague Claire Wright who chose not take up the opportunity to hear from a variety of healthcare professionals at the Masterclass. My apologies to your reader for any confusion with the committee held on the same day.

I am delighted that local charity FORCE are now providing some chemotherapy treatments in Honiton, making it easier than travelling in to Exeter, with hopefully other services coming down the track; there is a clear ambition for healthcare hubs here and in the Axe Valley, where there is cross party work taking place to this end.

My reply on the same site:

Since Phil Twiss has clarified where Sonja Manton was speaking, but doesn’t comment on what she said, we must assume that he stands by his statement in the open Council meeting that she had confirmed there would be no closures of community hospitals in East Devon. If so, this is obviously very welcome, but the devil could be in the detail, and it is not good enough for such vital public information to be leaked to councillors in informal meetings. We need a public statement from the CCG, assuring us of the future of Axminster, Honiton, Ottery St. Mary and Seaton hospitals (as well as Okehampton which is part of the wider Eastern Locality).

Twiss’s comment that Claire Wright and I “chose not to take the opportunity” to attend the masterclass barely deserves a reply. However I have been dealing with a very difficult family situation over the last two months and this was one meeting which I had to pass up. I am not, in any case, a member of the Health Scrutiny committee, but since I was elected I have attended almost all its meetings, chiefly to support Claire in fighting for the community hospitals.

If the CCG now accept that the hospitals must stay, this will be a great victory for the campaigns in all the towns over the last few years, and for Claire, the Independent councillors at EDDC, and myself, who have supported local communities while the Conservatives have constantly left the door open for the CCGs to close them “where appropriate”, in the words of their most recent motion at the County Council.’

@philtwiss’claim that @SonjaManton said ‘there are no plans to close any community hospitals in our area’, not backed up by @NEWDevonCCG. What’s the explanation, Phil?

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Phil TwissConservative County Councillor for Honiton, Phil Twiss (right), told Devon County Council on 4th October that ‘Sonja Manton [Director of Strategy for the Devon Clinical Commissioning Groups] said at the Health and Adult Care Scrutiny Committee the other week that there no plans to close any community hospitals in our area. We were talking about Seaton, Honiton and Axminster at the time.’

I was surprised that he should give us this good news in passing, and that the CCG had made no announcement of something so obviously important. So eventually I watched the webcast of the Health Scrutiny meeting on September 20th. Although Sonja Manton spoke several times, I couldn’t find her saying anything like what Phil said – indeed anything about community hospitals at all.

So I emailed Sonja and she confirms she didn’t speak about the hospitals. As for the issue, all she would say was, ‘I can assure you that our continued focus remains on planning and commissioning services and support to meet the needs of the Devon population in the best possible way. We recognise how strongly communities feel about community hospital buildings and will continue to work with communities and stakeholders to modernise and evolve the way our services are delivered and where they are based to make sure we make best use of all our resources and public estate.

So was Sonja more forthcoming at another, presumably private, meeting, Phil? Or was what you said wishful thinking?

‘A wake-up call for East Devon … the threat is even more serious than the loss of beds last year’ – my letter in The Paper for Honiton on the fallout from Dr Kerr’s statement that Seaton and Honiton hospitals are ‘at risk’

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Published in this week’s issue:
The Paper for Honiton (17 May) was right to highlight the statement of Dr Simon Kerr of NEW Devon Clinical Commissioning Group (CCG) that Honiton and Seaton hospitals are ‘at risk’ of closure, which he has not denied making. This should be a wake-up call to everyone in East Devon that any of our community hospitals, including also Axminster, Ottery St Mary and Whipton, which have lost their beds could be closed after the CCG’s Local Estates Strategy is published around July. The CCG remains focused on cutting its deficit, mainly the result of the NHS being badly underfunded, and the Government has given it a ‘double your money’ incentive to sell off ‘surplus’ buildings.
This threat is even more serious than the loss of beds last year. In the face of it, I call on all East Devon county councillors and the leader of East Devon District Council to join me in pressing the CCG to continue funding a wide range of outpatient services in all our hospitals, keeping them as health and wellbeing hubs (in line with the policies supported by all parties in last year’s county elections), and turning the CCG’s idea of ‘place-based care’ into reality. We have an enviable system of community hospitals supported by local people over many decades. Let this remain the centre of our local health provision in every town – without exception.

CCG chair says Seaton and Honiton hospitals ‘at risk’ of closure in Local Estates Strategy

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It has been revealed that Dr Simon Kerr, Chair of NEW Devon CCG’s Eastern Locality, told a meeting with representatives of 38 Degrees on 5th April that Seaton and Honiton hospitals were ‘at risk’ in the CCG’s Local Estates Strategy due in July. His remarks were taken down by the 38 Degrees member who produced draft notes of the meeting, and have been confirmed by other participants, but have not yet been confirmed by the CCG.

Although the hospitals both lost their inpatient beds last summer, Seaton Hospital currently hosts over 50 outpatient services (and there are probably at least as many in Honiton). Both are vital community health resources, created with decades of financial and practical support from people all around the Seaton and Honiton areas.

As part of a move to promote ‘place-based care’, the CCG and RD&E are currently taking part in two ‘community health conversations’, Honiton’s Health Matters and Seaton and Area’s Health Matters, which local voluntary groups, town and parish councils etc. are involved in. However if place-based care means anything, it should mean that communities should keep their local hospitals as health hubs, with more rather than fewer services.

Together with Cllr Jack Rowland, who stood down as mayor of Seaton last week but remains the town council’s representative on the Health Matters organising group, have written to Dr Tim Burke, Chair of the CCG, to ask for an unequivocal assurance that the hospitals will remain open.

I am hoping to shortly announce a meeting of the hospital campaign group.

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.

Our pressure has led to Devon NHS joining a national retreat from privatising Accountable Care Organisations. However the Devon Integrated Care System will still cap care, with weak democratic control – we need time to rethink

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Regular readers will be aware that Devon has been following NHS England’s plan to get Sustainability and Transformation Plans or Partnerships (STPs: Devon’s is the successor to the ‘Success Regime’ which cut our community hospital beds) to ‘evolve’ into Accountable Care Systems (ACSs) which in turn will prepare to establish Accountable Care Organisations (ACOs).

Under ACOs, single organisations could be contracted to provide all services in an area for 10 years or more, and these organisations could – Jeremy Hunt has confirmed this to Sarah Wollaston – just as well be private companies as NHS bodies. So all of Devon’s NHS could have ended up being run by Virgin Care – or a US care conglomerate under Theresa May’s desired trade agreement with Donald Trump.

As recently as December 2017, Dr Tim Burke, Chair of Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group (CCG), endorsed a ‘route map‘ for Devon’s ACS which said that in the ACS, ‘The Accountable Care Delivery System will hold the capitated budget for the population covered’, and that the aim is ‘through bringing budgets together on a whole population and/or model of care basis, [to] provide signals to providers on how to organise. This will signal the number, shape and scope of accountable care organisations and how they will need to work together to deliver.’

Devon backs off ACOs

Devon’s CCGs still want to set up an ACS – now rebranded an Integrated Care System (ICS). However in February they said: ‘A few areas in England are on their way to establishing an Accountable Care Organisation (ACO), where a single organisation is responsible for planning and delivering services to the whole population. This is not being considered in Devon.’

They are not the only ones to back off ACOs – indeed this week Kernow CCG went further and rejected the option of setting up an ICS under the overall control of the Cornwall Council CEO. Instead they voted for S75 partnership agreements for integration of NHS and social care, which have the advantage of being lawful as they’re mandated by the NHS 2006 Act.  (Devon County Council already has a partnership agreement with the CCGs.)

Last Wednesday, the CCGs told Devon’s Health and Wellbeing Board that a ‘shadow’ ICS which will operate from 1st April, which they hope to be part of the next wave of formal ICSs to be recognised by NHS England. Within this, they aim to set up one Devon-wide ‘care partnership’ for mental health and four ‘local care partnerships‘ for Northern, Eastern, Southern and Western Devon. These will have boards with local government representatives (district and county councillors) as well as representatives of acute, primary care and mental health providers, and will engage with wider stakeholders such as the voluntary sector.

A victory for legal action and local pressure 

It appears the retreat is genuine – and national. A Northumberland County Council Cabinet paper says ‘it now seems clear that no ACOs will be created nationally in the near future, as a result in a shift of national policy.’ It also says, ‘The original plans for the ACO are not now proceeding. Discussions are ongoing with NHS England, NHS Improvement and local system leaders about how organisational relationships might now develop to support the integration of services, however the timetable for and nature of any new arrangements remains unclear.’

I am authoritatively informed that this shift results from the impossibility of new legislation to allow ACOs to be created (a result of the hung parliament!). This is very interesting: it implies that while currently NHS England is still defending the crowdfunded judicial review of its draft ACO contract, it is already recognising that ACOs cannot be introduced in England under present legislation. It seems likely that full ACOs may only happen if the Tories regain a parliamentary majority. We shall have to see how precisely the legal challenge develops, but the retreat is already a significant victory for the legal action – and for the local pressure which I, other councillors and Save Our Hospital Services campaigners have mounted in Devon. 

Lack of democracy in the development of the ICS

This leaves us with the proposed Devon ICS – and the undemocratic process of its introduction. A proposal is finally being put to DCC’s Cabinet this Wednesday, but since the Council itself will not meet until after 1st April, the CCGs will introduce the ICS without the approval of DCC, whose logo they have been using to advertise the idea since September. The Health and Adult Care Scrutiny Committee, which is supposed to examine important developments in the local NHS, is only discussing it on 22nd March, nine days before the ICS starts, its chair having disregarded the agreement that a special meeting should be held if the ICS was going ahead on 1st April!

This is the result of the lamentable failure of the Council’s Conservative leadership to bring the proposals to Council over the last 6 months. Would they even have been discussing it now, if I – a backbench councillor from the smallest opposition group – had not put it on the agenda of Health Scrutiny on 25th January? Or would they just have joined it without direct authority, as they did with the STP – after the Council rejected the Success Regime in December 2016, DCC officers (presumably with informal Cabinet authorisation) simply participated in the STP following the general duty of the Council to cooperate with the CCGs as statutory NHS organisations?

Problems with the proposed ICS

On 1st April, the CCGs will introduce a ‘shadow’ ICS, which they hope will then be part of the next wave of official ICSs approved by NHSE. There are a number of concerns about what is being proposed:
  1. The ICS will be based on capitated funding, which means that Devon NHS patients will be entitled only to the services which the CCGs decide they can have within their financial envelope. This is embedding the existing postcode lottery in the NHS, and another major step away from a universal national service.
  2. In the current situation, capitated funding is capitated underfunding, and threatens to further embed current dire shortfalls in service – as I pointed out at the last Health Scrutiny, all Devon’s four acute trusts were further away from meeting official targets for A&E, cancer care and routine operations in January 2018 than 12 months previously. Better-off patients will continue to be pushed towards private practice leaving the rest with a second-class NHS.
  3. The CCGs intend to apply capitation to each of Devon’s four areas, calling it ‘fair funding’ which is really equality of misery. Since Eastern Devon is ‘overfunded’ compared to Western Devon, watch out for a sharper deterioration in the east.
  4. Since the CCGs intend to apply for formal recognition as an ICS, which will bring them greater local financial flexibility, we need to know how they will use this.
  5. Commissioning power for all Devon’s NHS will be concentrated in the hands of a single Strategic Commissioner, who will be responsible only to the combined boards of the two CCGs. The CCGs say they don’t want to set up an ‘undemocratic organisation’ – but they are undemocratic organisations, with power concentrated in the hands of a few professional managers and selected doctors, and a single commissioner will concentrate undemocratic power further.
  6. There is no clarity on how NHS and DCC funding will be combined. There is a danger that adult social care, which is currently run by DCC, will increasingly be taken over by the CCGs, diminishing democratic control.
  7. Local care partnerships have been a fundamental part of the new system since it was first agreed by the CCGs in September, but despite this no paper has yet been published to elaborate this element, so we are being asked to approve a vague idea.

What needs to happen now

  • DCC’s Cabinet cannot approve these proposals at this stage.
  • Full proposals – including proper details of the Local Care Partnerships – should go to Health Scrutiny first, and then back to Cabinet at its next meeting, and finally to Council later in the summer.
  • We need an explanation of how Devon patients can regain national standards of care while introducing this system.
  • Proposals for strengthening democratic control, including the role of DCC and other councils, in the ICS should be brought forward first.
  • Meanwhile, DCC officers can cooperate under their existing S75 partnership with the NHS.
  • Nothing will be lost by a delay in bringing these proposals to Council, but that will not only enable proper scrutiny by Council, but will also allow the public to join the discussion.
  • After Scrutiny and Cabinet have further considered the proposals, DCC and the CCGs should produce a document explaining these developments to the public and invite public debate on them.