Our local health services: our last line of defence

From the Save Our Hospital Services Facebook site:

:… these guys are our last line of defence. They need to work harder at not being manipulated.

Health and Adult Care Scrutiny Committee, County Hall, 25 January 2018

“I take my Scrutiny duty very seriously,” declared Cllr Brian Greenslade (Barnstaple North) at the Devon County Council Health and Adult Care Scrutiny Committee meeting at County Hall on 25 January. Save our Hospital Services (SOHS) members from North Devon who attended this and many other such meetings know this to be only too true.

Indeed, were it not for Cllr Greenslade and his meticulous colleague, Cllr Claire Wright (Otter Valley) it is doubtful how much scrutiny by the Scrutiny Committee there would be at all. One thing is certain: given the scale, speed and scope of the changes now being pushed through in health and social care services in Devon, real information, real questions and real answers have never been so vital. It is literally a matter of life and death.

At a previous Scrutiny meeting, the Chair, Cllr Sara Randall Johnson, in clear cahoots with Cllr Rufus Gilbert, manipulated proceedings. The two managed to prevent Cllr Wright putting a motion she had already tabled, thus shutting down a debate that may have saved in-patient services at some community hospitals.

This so outraged some councillors and members of the public that their chorus of complaints and the consequent internal investigation prompted the county’s lawyers to lecture councillors as to their legal obligations to scrutinise. The investigation and warning came too late for the community hospitals, but could better behaviour be expected from now on?

Indeed, it could. But then, on 25 January, the Chair of the Standards Committee was sitting in. This time Cllr Wright was allowed to say quite a lot, pose many more questions, and state much more of the obvious in defence of our health and social care services.

However, far too many of our County Councillors still appear unwilling to spend time and effort educating themselves as to the issues, facts and figures, whilst being only too willing to swallow propaganda and projections put out by overpaid health bosses bent on making severe cuts to our NHS services.

No one, even councillors who have barely raised a whisper in opposition, is in any doubt as to the real motive for all these health service changes: cuts and cutbacks designed to save £557 million over the next five years. The aim is to ration, restrict and remove elements of care and treatment for however many people it takes to save that amount of money. Cost comes first, clinical need a poor second.

Dr Sonja Manton was again allowed to speak at great length. She is NHS Devon’s lead cost-cutter, qualified by means of a doctorate in Systems Dynamics, not qualified in Medicine or any form of clinical care. Which sort of gives the game away –as does her most obvious skill, talking for a very long time without saying anything at all.

When questioned by Councillor Wright, she appeared, as ever, not to have the required data or evidence to hand. Cue the now customary promise to look it up and pass it on. The pattern that follows has been obvious for more than 15 months now. The Scrutiny Committee ends up waiting a long time for what they have asked for – if they get it at all — making real scrutiny in public for the public impossible. The lack of real information, the failure to meet requests, the failure to resolve contradictions in presentations cause real difficulties for our County Councillors meeting after meeting – not least again on 25 January.

It has been reported that Devon’s Clinical Commissioning Groups are bent on steamrollering ‘Accountable Care Organisations’ into position from 1 April. To prove that the joke is on us for what is, after all, April Fool’s Day, they have given the Scrutiny Committee no information about them at all. This is particularly scandalous and frightening. As Brian Greenslade stated: “I want to know where we are…..we need to understand where we’ve got to and what this may mean.”

One faint beacon of light is the announcement, on the same day as the Scrutiny meeting was held, that NHS England will hold 12 week consultations on the implementation of ACOs https://www.england.nhs.uk/…/consultation-aco-contracts/ which puts a very slight delay in place. But the website does not elaborate on how much time after closure of consultation implementation could happen. The Consultation could well be the outcome of an exchange between Sarah Wollaston, Chair of the Health Select Committee, and Jeremy Hunt, Secretary of State for Health and Social Care, as well as an attempt to water down the possible impact of a Judicial Review, which is being filed by a group of Health Care professionals, to challenge the government’s attempt to circumvent Parliament and democratic scrutiny and allow ACOs to operate

ACOs are financially constrained, business-based American-style systems of healthcare purchasing and provision, which will pave the way for further privatisation and still more rationing and restriction of provision. Councillor Martin Shaw from Seaton had done a lot of research on ACOs and put his findings online. But, incredibly, he had to force the whole issue onto the Committee’s Agenda just to secure the very limited discussion that took place.

Until this announcement it was the case that ACOs (unless the Judicial Review has effect) were to be imposed without any debate, discussion or statute. So an ACO could be and, in many cases, will be, a private business, primarily accountable to shareholders and managers rather than patients and the public. And even now we don’t know how ‘public’ the consultation will be. As Jan Goffey, Mayor of Okehampton, declared, “Sick people should never be regarded as a profit-making opportunity.”

Eventually even the Chair, Sara Randall Johnson said, “We need more information.” We have heard her, and others, say this before. Is this a way of avoiding doing anything? Or is it something more cynical: a way of helping to destroy our NHS, but giving themselves the excuse that they just did not know?

If so, it will only be because they failed to find out – or scrutinise.”

4 thoughts on “Our local health services: our last line of defence

  1. I watched the proceedings on web cam and totally agree. The responses, even to the astute and clear questioning of Claire Wright, were waffly and heavy with jargon. I heard no question answered in a way that was clear and factual. Even the two ambulance service staff relied on jargon and unclear language. The word ‘acuity’ cropped up way too often !

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  2. According to The Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 ( http://www.legislation.gov.uk/uksi/2013/218/pdfs/uksi_20130218_en.pdf ) Regulation 26 on page 12:

    NHS bodies “must provide a local authority with such information about the planning, provision and operation of health services in the area of that authority as the authority may reasonably require in order to discharge its relevant functions.”

    This would seem to have applied both to previous situations and the latest scrutiny.

    As far as I can understand (given the legalistic and convoluted way in which these regulations are written) the Health and Wellbeing Board (which in Devon’s case is the Health and Wellbeing Scrutiny Committee) needs to make a formal response to the CCG about their proposals in which they may formally “disagree” with the CCG’s proposals (Regulation 23 paragraph (5)), in which case the CCG and Scrutiny Committee need to try to reach agreement and if not then the council needs to inform the CCG that they will be reporting to the Secretary of State (for Health i.e. Jeremy “Thick” Hunt) that:

    (a) the authority is not satisfied that consultation on any proposal referred to in paragraph (1) has been adequate in relation to content or time allowed;
    (b) in a case where paragraph (2) applies, the authority is not satisfied that the reasons given by R are adequate; or
    (c) the authority considers that the proposal would not be in the interests of the health service in its area.

    But if you read the language, the onus is upon the council to jump through all the hoops and make a case in order to be able to make a report to the SoSfH and not upon the CCG to prove to the council that what they are doing is sound.

    And in particular the onus is on the council to prove that:

    a. The evidence provides was insufficient – how do you prove the existence of evidence that has never been disclosed to you, and since you have to prove that it was (grossly?) inadequate, this is inherently biased towards the CCG who can provide just enough evidence to avoid it being grossly inadequate. There is no requirement on the CCG for full disclosure, no definition of the standard of evidence that should be expected, and certainly no standards that the CCG need to meet; or

    b. That the reasons given for the change are inadequate – again, the onus is on the council to show (without access to the evidence base) that the reasons are invalid, rather than on the CCG to prove that they are valid; or

    c. That the changes are not in the interests of the local population – again, without access to the evidence base and the resources needed to undertake independent analysis, this is extremely difficult if not impossible for the council committee to do.

    In other words, the legislation is very heavily weighted in favour of the CCGs and against local Health and Wellbeing Boards. I have not researched it, but I suspect that these 2013 Regulations created by Jeremy “Thick” Hunt are a watering down of the powers of the local H&W Boards, presumably with the intent of allowing CCGs to get away with exactly these sorts of dodgy tactics in order to push changes through regardless of the feelings of the local community and regardless of the impact on the quality of Healthcare provision i.e. in other words to support the austerity cost cutting regardless of the consequences.

    After all, how could the Conservatives afford to make tax cuts for the ultra-rich and corporations owned and run by the ultra-rich (and who make entirely coincidentally are the same people / companies make the donations to the Conservative Party that enable it to spent millions on targeted social media campaigns during elections) if it can’t push through it’s austerity cuts using mechanisms like this.

    Conservatives – for the wealthy not the many.

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  3. There are 2 Judicial Review being brought against Accountable Care Organisations. As well as the one mentioned in this blog post, there is the 999 Call for the NHS Judicial Review of NHS England’s Accountable Care Organisation contract, on the grounds that its lump sum payment mechanism for a whole population is unlawful. Info here: https://www.crowdjustice.com/case/healthcare4all-stage3/. The Judicial Reviews have brought delays to the imposition of Accountable Care Organisations and it may be that this is the case in Devon too? The S Devon and Torbay CCG website says “NHS England intends to run a public consultation on the draft contract that will be implemented for Accountable Care Organisations – more here . The consultation will set out how the contract fits with the NHS as a whole and how public accountability and patient choice will be preserved.
    Planning for an Accountable Care System for Devon is still in the very early planning stage, building on the good work that already takes place across Devon.”
    Is that last sentence true does any one know?
    In any case, NHS England’s planning guidance on updating the 2 year operational STP plans calls for “full speed ahead” on setting up Accountable Care Systems (except they’ve rebranded them as Integrated Care Systems, as if changing the name means anything): https://calderdaleandkirklees999callforthenhs.wordpress.com/2018/02/08/full-speed-ahead-for-renamed-accountable-care-systems-and-more-harsh-sustainability-and-transformation-plan-financial-controls/

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    • I am confused. If “Planning for an Accountable Care System for Devon is still in the very early planning stage” then how can its implementation be planned for April?

      As for “building on the good work that already takes place across Devon”, presumably they are referring to the care at home scheme, where they promised several times over (during the Your Future Care “consultation”) that “care at home” would not be implemented until they were 100% certain that the resources were available, yet we find that they have implemented it and the home care resources are not available.

      Does CCG stand for Casuistry, Calumny & Guile – which in common English means lies by over-generalisation, slander and slyness?

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