Guardian letters on regulation, health and safety and austerity

“• The elephant in the room not mentioned in Steven Poole’s excellent article on deregulation was the de facto deregulation facilitated by the government’s savage cuts in local authority spending. Councils were inevitably going to respond to these cuts by reducing the resources available for statutory duties where cuts would be less likely to create an immediate outcry, such as regulation enforcement. It would be naive to think that a government obsessed with deregulation would not have been fully aware of this. This week’s news of tower block cladding investigations provides grim evidence of the effects of this strategy, if any were needed.
Jim Hooker
Chichester, West Sussex

• As long ago as 1840, when rapid expansion forced government at least to consider some degree of regulation of buildings, Thomas Cubitt gave evidence to the select committee on the health of towns. He warned that, without rules and regulations, builders would put up houses crammed into smaller and smaller spaces. “I am afraid a house would become like a slave ship, with the decks too close for the people to stand upright.”

Polly Toynbee was right to insist on the need for regulation (They call it useless red tape, but without it people die, 20 June). And they couldn’t, in 1840, even imagine 24 storeys high.
Enid Gauldie
Invergowrie, Perthshire

• Steven Poole provides an excellent account of the right’s professed hatred of regulation and red tape, but this ideological hostility only seems to apply to big business and the private sector.

By contrast, the last three decades have seen the public sector crushed under regulatory burdens and tied up in red tape, often in a bizarre attempt at making schools, hospitals, the police, social services and universities more efficient, business-like and accountable. Talk to most doctors, nurses, police officers, probation officers, social workers and university lecturers, and one of their biggest complaints will be the relentless increase in bureaucracy imposed by Conservative (and New Labour) governments since the 1980s.

Instead of focusing on their core activities and providing a good professional service, many frontline public sector workers are compelled to devote much of their time and energy to countless strategies, statutory frameworks, regulations, codes of practice, quality assurance procedures, government targets, action plans, form-filling, box-ticking, monitoring exercises, and preparations for the next external inspection.

A major reason for public sector workers quitting their profession, taking early retirement or suffering from stress-related illnesses is the sheer volume of bureaucracy that Conservatives (and New Labour) have imposed during the last 35 years. This bureaucracy, almost as much as underfunding, is destroying the public sector, impeding efficiency and innovation, and driving frontline staff to despair.
Pete Dorey
Bath, Somerset”

Corbyn: is housing a right or a marketing opportunity?

” … Speaking to NME [New Musical Express] backstage at Glastonbury after his speech on the Pyramid Stage earlier this afternoon (June 23), the Labour leader said: “I think we have to recognise that what happened at Grenfell Tower is a game changer in our society. It’s a game changer about safety. it’s a game change about attitudes to housing – do we treat housing solely as a marketing opportunity or do we treat it as something that’s a human right and a necessity?

He continued: “I don’t think the fifth richest country in the world should see predominantly poor people burning to death in a towering inferno any more than it should tolerate people sleeping on the streets around stations. We can and should do a lot better. I hope this is a massive wake up call for the entire community and I’m calling on people to campaign like never before for housing justice. …”

Government is NOT making u-turns on safety but to desperately buy votes for the next election

Controversial government proposals to relax fire safety standards for new school buildings as a cost-cutting measure are to be dropped by ministers in a major policy U-turn following the Grenfell Tower fire. ...”

NO it isn’t about Grenfell Tower, or safety – it’s about saying and doing ANYTHING that might stop a Labour victory at the next election.

Should they regain a majority, they will U-turn on their U-turn just as fast as they can.

Claire Wright’s report on the disgraceful DCC NHS meeting and its disgraceful chairing by Sarah Randall-Johnson

“It is just as well I have left it almost a week to write this blog because I was very angry on Monday evening.

Before the meeting there was a public demonstration of angry residents mainly from Seaton and Honiton, which was attended by film crews from the BBC and ITV. The BBC and a reporter from the Western Morning News stayed for the whole meeting.

The committee had also received dozens if not, hundreds of emails from residents who were asking us to refer the decision to close 71 community hospital beds in Eastern Devon, to the Secretary of State for Health.

Devon County Council’s newly formed Health and Adult Care Scrutiny met for the first time last Monday (19 June) to review this decision.

Almost all the committee members are either new to the committee or new Devon County councillors.

At the last health scrutiny meeting in March before the elections, I proposed that there were 14 grounds that the committee needed assurances on or it would refer the decision to the Secretary of State for Health on the basis that it wasn’t in the interests of the health service in the area and that the consultation was flawed.

These are legal reasons for referral.

The new chair of the committee is East Devon Conservative member, Sara Randall Johnson, following the retirement of long-serving Labour councillor, Richard Westlake.

During the time between the March health scrutiny meeting and the meeting on 19 June, Richard Westlake had taken the time to instruct the scrutiny officer to draft two letters to the CCG one requesting further information and the second, dated 24 April, expressing concern about the availability of end of life care under the new model of care.

Cllr Westlake alluded to the Francis Report, which was published following deaths at Mid Staffordshire Hospital and which criticised the health scrutiny committee there for lack of challenge.

Points were also made relating to the committee having been told several times previously that the new model of care to be provided in people’s homes instead of in a community hospital, was actually cost neutral, despite claims to the contrary.

The cost of people being cared for at home surely will increase as many people have co-morbidities (multiple conditions), the former chair had pointed out.

His letter also made references to the lack of information relating to the future of bedless community hospitals, given the ownership of NHS Property Services, the exclusion of Honiton and Okehampton Hospitals from the consultation process and the small number of staff who responded to the consultation (less than 2 per cent).

The team for the NHS present at the meeting included Rob Sainsbury, director of operations for NEW Devon Clinical Commissioning Group (CCG), Adel Jones, integration director with the RD&E, Sonja Manton, director of strategy with NEW Devon CCG and Em Wilkinson-Brice, deputy chief executive of the RD&E.

I started my questions, but before I could ask anything the new chair interjected to tell me to ask all my questions at once to save time.

I was a bit surprised at this as it is poor scrutiny technique. Invariably any reply will miss out much information. I said I would ask them in sequence…

Question 1
This was one I asked in March which at the time could not be answered, despite a decision on the bed closures already having been made. What had been the number of objections compared with the number of responses of support for the bed losses?

Answer: We will get back to you (they said that last time).

Question 2
Finance: How much money would be saved given that mixed messages had been received. Even the information from the CCG in the scrutiny agenda papers was contradictory and referred to different levels of savings, which ranged from £2m to £7m. Given that a decision had already been made wasn’t this a bit vague? See pages 11 and 22 of the agenda papers – link at the bottom of this blog post.

Answer: There is a range of savings and this depends on staff and resources. A fixed amount cannot be set. Savings are based on workforce only.

Question 3
Was it true (as I had been informed by Tim Burke the CCG chair) that the numbers of staff had to double? Are the staff in place?

Answer: Yes the staff do need to double, there are 200 staff that are being consulted with. We don’t yet have the workforce in place because not possible to “double run” (services).

Question 4
What happens to community hospitals that lose their beds? Will they be sold off by NHS Property Services which has a remit for this?

There was an interjection by the chair at this point who asked the CCG to clarify whether this was true (NHS PS having a remit for selling off hospital buildings).

Sonja Manton replied selling off NHS property was a trend….

Answer: This was a piece of work not yet carried out. It will be carried out next. (I am afraid it is not credible that the CCG does not have a list of which hospitals they intend to declare surplus to requirements for selling off by NHS PS, even if there has been no formal decision made).

Question 5
An audit on people fit to leave Eastern Devon hospitals in March shows a marked increase compared with the 2015 acuity audit carried out by Public Health. The public health audit 2015 revealed that around 34 per cent of patients are ready for discharge in community hospitals across Devon and the March 2017 audit stated that 64 patients were ready for discharge. How is this doubling in two years, in the number of patients well enough for discharge possible?

And who carried out the survey?

Answer: Clinicians (mainly RD&E) carried out the survey and the results had changed partly because of a new at home palliative care service and hospital at home. (I am sceptical about this because my understanding is that these services are available only in limited places and were in existence previously anyway).

Other councillors asked questions and made their own points.

After a few councillors had spoken chair, Sara Randall Johnson, said she thought there should be a task group set up to obtain evidence on what the committee was being told.

I disliked this pre-empting of the end of the debate by the chair, especially when she knew I wanted to add to my earlier points.

When I was called to speak I made a proposal to refer the decision to the Secretary of State for Health on the basis that this was the committee’s prerogative at this meeting based on 14 grounds. These questions remained unanswered I said. And out of all the bed closure decisions that I had scrutinised over four years, this was the decision that caused me more anxiety than any other.

LibDem and former fellow committee member, Brian Greenslade, seconded my proposal.

But the chair refused to take a vote.

She said the committee was new and needed to be clear about evidence before any such action was taken. She suggested leaving it to the September meeting.

This was unbelievable! A refusal to take a vote on a seconded proposal is very unusual in council committees.

I pushed the chair to take a vote. The CCG had already admitted they would be closing the beds by then. The suggestion appeared to be to me, an attempt to kick the issue into the long grass.

She refused.

There was significant heckling from the public who were understandably very angry at not being listened to.

A range of other councillors (mainly Conservative) then spoke to back her up claiming that there was not enough evidence to refer and what was the point anyway because the Secretary of State would just “throw it out.”

There were other suggestions that we simply work with the CCG to get a better deal. This was immediately dismissed by the CCG as they had already made the decision to close the beds some months ago.

Responding to this, I explained the process and how we had done this before as a previous committee and it was a very worthwhile exercise for guidance and feedback from the Independent Reconfiguration Panel, which looks at the process in fine detail before commenting and/or advising.

Without a referral we simply lie down and acquiesce to the worst decision I have ever witnessed as a health scrutiny committee member. And we let down every single resident who is opposed to the plans.

I also reminded the committee that we were there to provide a legal check (the only legal check) on health services in Devon and it was our duty to represent local people’s views. The evidence that a large number of local people were deeply unhappy with the decision, was overwhelming.

The scepticism among new members was extremely disappointing because the Referral is the ultimate in our powers and of course we had the grounds to do it. It had been already established from the previous meeting that we had the grounds to do it! And it had the full support of the previous chair.

We were told by the new chair that that this was the position of the old committee and the new committee could choose to take an entirely different view if it so wished.

This was also extremely disappointing and members of the public were clearly furious.

I then suggested we have an additional health scrutiny meeting in July to re-examine this issue. I suggested it be held on the day of the full council meeting but this was dismissed by the chair who said there wasn’t time. I asked for a different date but this was also glossed over….

… until Conservative leader of EDDC, Paul Diviani, also proposed a standalone meeting sometime soon about the issue.

Was there a seconder for this proposal, the chair wanted to know?!

I reminded the chair that I had already proposed this. It fell on deaf ears.

The debate continued and appeared to go around and around, with interspersed heckling from angry members of the public.

Eventually, I was asked if I would accept an amendment to my proposal of a standalone meeting of the committee in July. I agreed.

The committee voted in favour.

The meeting has now been booked for Tuesday 25 July at 2.15pm, at County Hall.

Here’s the webcast –

Here are the agenda papers –

The 14 grounds for referral to the Secretary of State for Health can be found on page 34.

Below is an extract from a letter to the chair after Monday’s meeting from one of the angry members of the public who was present

“Dr Sonja Manton offered for you to attend a meeting to see how the CCG works. Why didn’t one of you ask them to simply save everyone’s time and respond fully and completely to the requests for information made in March? Aside from which how can you both scrutinise and also collaborate – surely you have to be independent?

Meanwhile – the CCG are negotiating with nursing staff and nursing staff are leaving the hospital in Honiton. The RD &E is reducing or even not making admissions. By the time you get to your extraordinary meeting it will too late to do anything useful at all.

I expect members of the committee to have the will to ensure that residents in the county they represent have easy access to adequate and safe healthcare.

Why is it that the only member of the committee who consistently and unfailingly has the energy and the will to carry out their role efficiently and as effectively as the constraints of being on a committee permit is Claire Wright? Why do councillors agree to be on the committee if they’re just going to let the CCG do what they like?

Please take the time to reflect on yesterdays meeting and consider whether you and/or some of your colleagues were found wanting and then take steps to ensure that the committee becomes an effective scrutiny committee for the benefit of all the people who depend on it to safeguard them. The public may have the voice but it is the committee that has the power. Please use that power for the benefit of us all.”

Pic (on blog) : I was sent this pic of the demo before the meeting, by Honiton campaigner Gill Pritchett. The quote is by the founder of the NHS and says it all.”

The latest “under the radar” NHS sell-off plans

“All health and social care organisations that drew up plans to overhaul care in England will eventually become accountable care systems, according to new plans released by NHS England.

[Here is a post on these devious plans]:

Regional organisations that created sustainability and transformation plans (STPs) will ‘evolve’ into accountable care systems (ACSs), with some acquiring the status as early as April this year.

NHS England’s Five Year Forward View delivery plan has said that hospital trusts, CCGs and local authorities in the new ACSs will ‘take on clear collective responsibility for resources and population health’.

However, the report notes that CCGs alone will be responsible for improving emergency admission rates, which will be measured and managed on an STP or ACS level from April.

To do this, NHS England has committed to working with ‘upper quartile higher referring GP practices and CCGs’ to standardise the ‘clinical appropriateness’ of hospital referrals, using CCG data and ‘a new tool from NHS Digital’.

Simon Stevens, head of NHS England, announced at a Parliamentary Accounts Committee meeting last month that between six and ten STP areas would be launching as so-called accountable care organisations (ACOs).

However, the delivery plan says that ACOs are the next step after becoming an ACS, with some becoming an accountable care organisation ‘in time’.

In return for becoming an ACS, NHS England has promised the organisations ‘more control and freedom’ over their regional health system including receiving devolved national GP Forward View, mental health and cancer funding from 2018.

The healthcare systems will be set up in stages with the first to be implemented from April this year.

NHS England noted nine STP areas that are ‘likely candidates’ to become the first ACSs, including:

Frimley Health
Greater Manchester
South Yorkshire & Bassetlaw
Nottinghamshire, with an early focus on Greater Nottingham and the southern part of the STP
Blackpool & Fylde Coast, with the potential to spread to other parts of the Lancashire and South Cumbria STP at a later stage.
Luton, with Milton Keynes and Bedfordshire
West Berkshire
The delivery plan added that areas applying for ACS status should have ‘successful vanguards, ‘devolution’ areas, and STPs that have been working towards the ACS goal’.

Chris Hopson, chief executive of NHS Providers, said NHS England’s new plans recognisethat the Health and Social Care Act 2012 ‘prevents the creation of a formal ‘mid level STP tier’ with statutory powers’.

He said: ‘The plan also recognises the importance of existing governance and accountability structures focused on trusts, but also the opportunity for shared decision making at the STP level.

‘Finally, it allows different STPs to move at different speeds: enabling the fastest to progress without delay but not forcing others to adopt a single uniform approach they neither want nor are ready for.’”

“Be prepared to defend hospital closures in court”

“NHS leaders looking to deliver change and transformation in their local health economy should be prepared to defend their plans in court, rather than pretending that the likelihood of legal action will never happen, Rob Webster, CEO at South West Yorkshire Partnership NHS FT, has warned.

Chairing a session entitled ‘Saving Our Services – Why are local campaigns fighting to save the NHS from transformation?’, at last week’s NHS Confed17, Webster, who is also the lead for West Yorkshire and Harrogate STP, said that even if the health service does “harness the power of communities, you can bet we will still have a fight with some people about change”.

“One of the lessons I’ve learnt,” said the former NHS Confed boss, “is so long as you have engaged with people throughout the process and have done it in the right way, and so long as you have some clinical and public voices behind the changes you want to make, and as long as you’re prepared to go to court, if and when you have to, and win, then the change will happen.

“Somebody will refer you either to the secretary of state or to a judicial review. Get ready for it, and work through it, rather than pretending it’ll never happen or thinking that if it happens it is the worst thing in the world. Get yourself ready and it will work.”

During the session, Webster asked panel members what they thought should be the priorities with regards to the STP and change agenda for the new government.

David Lock QC, former MP and legal advisor to the NHS, said: “STPs were an object lesson in how not to do public engagement.”

The idea that the NHS needed space to have honest conversations with itself before going out to the public created a huge deficit in public trust, he argued.

“The process and the constraints put on those running the process, and not to be public about what they were doing, was enormously damaging,” stated Lock. “If the ministers want to keep the STP process going on, they are going to have to do an awful lot more emphasis on bringing the public with them. In the end, you cannot deliver public services in the face of public opposition.”

Cllr Robert Smart, an advisor to the ‘Save the DGH campaign’ in Eastbourne, stated that the health secretary needs to slow down the process of the STPs “and make them into a proper 10-year strategic view”.

“And if that takes a couple of years to produce, then it takes a couple of years to produce,” he told the audience of delegates. “It isn’t a question of suddenly saying, ‘in three months’ time, we’re going to convert 40% of acute spending into community spending’.”

The following day, Jeremy Hunt admitted that, given the result of the latest general election and with the negotiations around Brexit starting just a couple of days ago, it is now unlikely that the government will be able to introduce legislation for STPs in the next few years – if at all.

Imelda Redmond, national director of Healthwatch England, also called on Hunt to “reward, and encourage, engagement with the public” on the STPs.
“It is number one on people’s agenda of what they love about the country, and what they care about,” she said. “Why would you not harness that, and get the best care we can?”

And Jeremy Taylor, CEO of National Voices, stated that the government must give the health and care system the resources it needs, and give it the time it needs to make change.

“There may be legal requirements on consultation, but there are also psychological requirements: you need time to build trust and relationships,” he reflected. “If you are doing this at breakneck speed it is just not possible to do it.”

However, NHS Improvement boss Jim Mackey also told the conference that it is possible to get “90% of the way there” with accountable care systems and accountable care organisations within the current legislative framework – “but we need to prove it”.

NHS England’s Simon Stevens later confirmed the nine areas that will officially form part of the first wave of ACSs.

Webster concluded by agreeing that time and resources are really important. “It sounds like you need to plan in the medium term and understand the money you have to do that. You could call it a sustainability and transformation partnership trying to bring everyone together,” he joked.

“I think it’s good that we have an audience that thinks it is not right to be dishonest or patronising. What we need to do is be honest and get alongside people and harness the power of communities.”

Clinton Devon Estates and Budleigh Salterton “health hub” have an unhealthy relationship

Readers will recall an earlier Owl story of landowners Clinton Devon Estates grabbing a large part of the garden to Budleigh Hospital for development, considering the garden surplus to the requirements of the new “health hub” and much more suitable for their plans for two houses:

The Budleigh Neighbourhood Plan designated the Hospital garden as open green space. Neighbourhood plans can do this and this space ticks all the NPPF criteria boxes. The garden was considered an essential part of the psychological and therapeutic welfare of patients at the “health hub”.

Bell Cornwell for CDE only commented at the very last minute of the very last stage. They made a number of general comments to EDDC on 16 February 2017 suggesting a loosening of a number of policy phrases and a general comment that too many green spaces were being designated. No mention of Hospital Hubs or development of that site at all.

An application to build two houses on the hospital garden was then submitted and validated on 27 February 2017 It takes about two-thirds of the garden, rather than the half suggested.

The Plan Inspector asked the steering group for clarification of criteria used in each green space case on 18 April 2017. The steering group responded, and its response was published on the internet.

The Inspector in her report sided with CDE.

The Neighbourhood Plan steering group unanimously agreed to accept all the Inspector’s recommendations except the one where she agreed with Bell Cornwell who, of course, had no medical evidence to draw on!

The decision to accept or reject Inspector’s recommendations now lies with EDDC.

The question now is – how brave will EDDC councillors they be? There is a track record of rolling over for tummy tickles when CDE engages with them. CDE has fingers in many East Devon pies and held restrictive covenants on the seafront at Exmouth that it relinquished to allow EDDC to approve the Grenadier development and has everything from large landholdings to small ransom strips all over the district.

Strong administrative pressure will be to do the easy thing and to get the plan to Cabinet in July with no controversy and no action against CDE.

Local opinion is running strongly against “droit de seigneur” ( medeival feudal rights) in this case.

If it looks like everyone is rolling over without a fight, the plan may well be rejected at referendum.