Diviani and Randall-Johnson are satisfied these questions have been answered on bed closures – do you agree?

30 [plus] questions” that must be asked BEFORE care at home can be implemented:


The model of care:

• Does the new model of care align with our overriding ambition to promote independence?
• Is there clinical and operational consensus by place on the functions of the model and configuration of community health and care teams incorporating primary care, personal care providers and the voluntary care sector?
• Is there a short term offer that promotes independence and community resilience?
• Is there a method for identifying people at highest risk based on risk stratification tool?
• Are the needs of people requiring palliative and terminal care identified and planned for?
• Are the needs of people with dementia identified and planned for?
• Is support to care homes and personal care providers, built into the community services specification?
• Is support for carers enhanced through community sector development support in each community?
• Has the health and care role of each part of the system been described?
• Have key performance indicators been identified, and is performance being tracked now to support post implementation evaluation, including impact on primary care and social care?

• Is there a clear understanding of the capacity and gaps in the locality and a baseline agreed for current levels and required levels to meet the expected outputs of the changed model of care?
• Is there a clear understanding of and plan for any changes required in ways of working:
o thinking
o behaviours
o risk tolerance
o promotion of independence, personal goal orientation

• Have the training needs of people undertaking new roles been identified, including ensuring they are able to meet the needs of patients with dementia?
• Do we have detailed knowledge with regards to investment, WTE and skill mix across the locality and a plan for achieving this?
• Are system-wide staff recruitment and retention issues adequately addressed with a comprehensive plan, and where there are known or expected difficulties have innovative staffing models been explored?

Governance, communications and engagement:
• Is there a robust operational managerial model and leadership to support the implementation?
• Has Council member engagement and appropriate scrutiny taken place?
• Is there an oversight and steering group in place and the process for readiness assessment agreed?
• Have providers, commissioners and service users and carers or their representative groups such as Healthwatch agreed a set of key outcome measures and described how these will be recorded and monitored?
• Is there a shared dashboard which describes outcomes, activity and productivity measures and provides evaluation measures?
• Is there an agreed roll out plan for implementation, which has due regard to the operational issues of managing change?
• Is there a comprehensive & joint communications and engagement plan agreed?
• Is there a need for a further Quality or Equality Impact Assessment?

• Is there a clinical and operational consensus on the roles of each sector during the implementation phase including acute care, community health and care teams, mental health, primary care, social care, the voluntary care sector and independent sector care providers?
• Is there an implementation plan at individual patient level describing their new pathway, mapping affected patients into new services?
• Are the operational conditions necessary for safe implementation met?
• Have the risks of not implementing the change at this point been described and balanced against any residual risk of doing so?

Post Implementation
• Is there a description of the outcomes for individuals, their carers and communities?
• Are the mechanisms for engagement with staff, users of services and carers in place and any findings being addressed appropriately?
• Is there a process in place for immediate post implementation tracking of service performance including financial impact to all organisations?
• Is longer term performance and impact being tracked for comparison against pre-implementation performance?
• Have we captured user experience as part of the process, and have findings been addressed and recorded to inform the planning of future changes?
• Are there unintended consequences or impacts (e.g. on primary care or social care) which need to be addressed before any further change occurs?
• Is there a clear communication plan for providers and the Public describing the new system and retaining their involvement in community development?”

Source: http://www.newdevonccg.nhs.uk/about-us/your-

One thought on “Diviani and Randall-Johnson are satisfied these questions have been answered on bed closures – do you agree?

  1. This is the easiest EDW post to comment on. If these questions have been answered, then the following evidence should be available, ideally already published, but if not then using an FoI request:

    1. Agenda, reports and evidence base, and minutes of a formal CCG meeting at which these questions and the evidence to answer them was assessed, with records of the key points of debate amongst the committee, and records of how each member voted. Without such records, it has the appearance of a sham.

    2. Similar DCC agendas, reports / evidence base and minutes of a formal DCC meeting at which members, especially Cllrs Diviani and Randall-Johnson, reviewed the evidence themselves and formed an independent judgement that the CCG was correct in saying that they were ready for “hospital at home”. Without such records, there is no evidence of real scrutiny, and an appearance of Party cronyism (and perhaps dereliction of duty) of the worst type.

    If neither sets of evidence are available, the only conclusions you can come to are:

    a. That the whole deal is a stitch up to save money, with the likelihood of extensive suffering and avoidable deaths to come; and / or

    b. That there is no transparency, and without transparency there can be no accountability, and without accountability there is no democracy.

    So I therefore challenge:

    I. Paul Diviani and Sara Randall-Johnson both confirm that they personally reviewed in detail the evidence that the CCG is ready for “hospital-at-home” and were not simply relying on the verbal assurances from the CCG?

    II. Anyone to provide the Owl (and her followers) the mass of evidence needed to answer the 30 questions so that they can review the evidence themselves?


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