Health crisis: EDDC scrutiny committee grills NHS rep

01 December 2016
Scrutiny committee questions CCG representative
Councillors voice concerns over proposed East Devon in-patient bed provision within Your Future Care consultation

At a meeting on Thursday 24 November 2016, members of East Devon District Council’s Scrutiny committee listened to Rob Sainsbury, the Chief Operating Officer of the NHS North Eastern & Western Devon Clinical Commissioning Group (NHS NEW Devon CCG), give a talk about the NHS’s Your Future Care consultation.

Mr Sainsbury spoke about issues such as the financial pressure faced by the NHS, the changing way in which people are cared for, proposed models of care and the number of community inpatient beds in East Devon. He outlined the options set out in the consultation and reassured the committee that no changes to services would be made until tests created by local clinicians had been undertaken to ensure the changes are safe and reliable.

Consultation options
• Option A: Tiverton 32 beds, Seaton 24 beds, Exmouth 16 beds
• Option B: Tiverton 32 beds, Sidmouth 24 beds, Exmouth 16 beds
• Option C: Tiverton 32 beds, Seaton 24 beds, Exeter 16
• Option D: Tiverton 32 beds, Sidmouth 24 beds, Exeter 16 beds
The CCG’s preferred option is A, as this combination is considered by the CCG to result in the smallest changes in travel time and to have the greatest impact on the whole system.

Prior to councillors questioning Mr Sainsbury and debating a number of issues, the Scrutiny Chairman Councillor Roger Giles reminded the committee of recent comments made by Neil Parish MP who asked that action be taken to: “Fight all closures across East Devon.” Cllr Giles expressed a hope that the committee would adopt a unified front rather than focus on arguments between the towns where community hospitals are located.

Following a wide range of questions from councillors, which Mr Sainsbury answered, councillors voted in favour of the following comments being sent in a response from the Scrutiny committee to the NEW Devon CCG Your Future Care consultation:

1. Asks that the New Devon CCG presents an outline of how care delivery integrates health, social, and mental care, as well as physiotherapy, and how it is provided to patients

2. Consider that the comparison with Northern and Western Devon areas is unfair as the demographics were not the same as Eastern Devon

3. The committee considers that the models proposed in the consultation will not meet the needs of the District because of the local issues of social isolation, and the support that carers need

4. The NEW Devon CCG should review the expenditure on management and administration as a means to realise savings that could be used to provide care rather than divert funding from in-patient beds

5. The committee considers that the evidence presented to date by the NEW Devon CCG is not sufficient to convince them that the new model of care will be successful

6. The Committee does not accept Options A – D, but recommends that the NEW Devon CCG should retain the current level of in-patient beds in community hospitals in the Eastern Devon locality

7. Should a decision be made to close in-patients beds, the Committee insists that this is not undertaken until the replacement model of care is recognised as safe and in place; subject to the provision of evidence that the model of care has resulted in no bed blocking at acute hospitals, non occupancy of beds in community hospitals, and full care in the community

Commenting on the content and outcome of the meeting, Councillor Roger Giles said:

“The Scrutiny Committee were very far from convinced about the practicality of the CCG proposals to close beds in East Devon community hospitals and replace them with care in the community. There was also concern about the accuracy of the CCG costings used to justify closure of hospital beds. The committee felt strongly that East Devon hospitals provided an excellent and essential local service and that the existing hospital beds should be retained.”

ENDS

Devonwide NHS cuts rally Exeter 3 December midday – assembly arrangements

Dear Friends,

I wrote to you a few days ago giving you the suggested meeting places in Exeter on Saturday for those demonstrating who wished to march through the town to the area of our rally in Bedford Square, Princess Hays rather than going directly to the rally. The rally is from 12.00-14.00.

I have now been informed that at the final planning meeting it was considered that the suggested places were too many and too complicated.

So to Keep it Simple, individuals and any towns or communities that have not made their own arrangements to enter Exeter as a group could gather, at 11.30, at Bury Meadow at the Northern end of Queen Street (ten minutes walk up the hill from St Davids Station, near Exeter College) and walk south to High Street, and turn left to Bedford Square. If you do get lost, just join a group wearing red, particularly if they are waving placards!

Others may assemble as already planned, for instance, East Devon people will meet near the bus station by the civic centre on Paris Street, walk north to High Street and left to Bedford Square.

It looks as though we can expect a very active rally with some good speeches. This is not just about the hospital beds in East Devon. That is only the first of the NHS cuts planned here in Devon which are part of the NHS’s STP (Sustainable Transformation Plan). People throughout England are getting up to be counted, led and motivated to some extent by 38 Degrees who have revealed the secretive nature of this STP which will be applied in 44 areas, or footprints, in England. Cuts are also to be made in AE departments, major acute hospitals and GP surgeries.

See you on Saturday.

https://you.38degrees.org.uk/petitions/save-community-hospital-beds-in-east-devon

Thanks

Chris East

Chris East started this campaign on the 38 Degrees Campaigns by You website.

Most NHS Finance Managers don’t believe their own hype on Sustainability and Transformation plans

Finance chiefs in charge of implementing NHS sustainability and transformation plans are struggling with a “club versus country” dichotomy, according to the Healthcare Financial Management Association.

Meanwhile, 52% of trusts and 21% of clinical commissioning groups (CCGs) are forecasting a deficit in 2016/17.

These were the findings of the latest NHS Financial Temperature Check undertaken by the HFMA, which represents NHS finance directors and finance staff working in healthcare.

It draws on responses to a survey of over 200 finance directors and chief finance officers from 128 provider trusts (53%) and 72 (35%) clinical commissioning groups across England. The responses were received between 20 October to 3 November this year.

Feedback indicated that 22% of trusts and 35% of CCGs are forecasting a worse position than predicted in their financial plan for the year. The most common causes of deficits were under-achieving savings plans (61%), increased agency costs (34%) and an increase in non-pay costs (24%).

Most respondents do view the STPs as a cornerstone in plans to reduce deficits. However, an overwhelming majority also voiced concerns about the structure of the plans, with almost three-quarters (72%) concerned about their governance.

Respondents professed limited confidence in the simultaneous delivery of both STP and organisational financial objectives. Only 6% of trust finance directors and 17% of CCG finance chiefs believe they are both deliverable.

Of the finance directors that responded, 62% claimed they will prioritise organisational objectives rather than their STP objectives. On reflection, 82% believe the regulatory regime needs to change to support the delivery of the STPs, and 79% believe the financial regime needs to change too.

Moreover, only half (54%) of finance directors believe that risks associated with STPs have been recognised, and only 5% believe adequate risk management arrangements are currently in place. …

http://www.publicfinance.co.uk/news/2016/12/hfma-survey-reveals-divided-loyalties-nhs-finance-chiefs-implementing-stps

East Devon will be represented at NHS cuts rally in Exeter on Saturday 3 December

“Sidmouth campaigners will join with others across Devon to rally against hospital bed cuts in Exeter on Saturday, December 3.
Organisers are urging the public to join them in a united show of opposition to proposals under which the town could lose all of its inpatient beds.

People from East Devon will gather at 11.40am near the bus station, outside the Civic Centre in Paris Street, Exeter. The rally will take place from noon in Bedford Square, Princesshay.

Campaigner Robert Crick said Sidmouth can be proud of its leading role in the campaign.

Organisers coined the term ‘See Red Day’ to highlight the point lines should be drawn to stop essential services being cut.”

http://www.exmouthjournal.co.uk/news/sidmouth_campaigners_join_in_see_red_day_rally_against_hospital_bed_cuts_1_4791281

Sidmouth public meeting on health cuts 9 December – Swire invited

“Organisers of a public meeting to discuss proposed hospital bed cuts are calling on East Devon’s MP to join and help fight the cause.

Campaigners are inviting people from across the district to attend a gathering on Friday, December 9, from 7.30pm, in Sidmouth Parish Church, in response to plans that could see the town lose its 24-bed inpatient unit.

Several community hospital beds around the county are under threat as the Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) seeks to change to a more ‘home-based model of care’ and plug a predicted £384million deficit by 2020/21.

One of the organisers, Robert Crick, has issued a call for the community to join ‘urgent talks’ and East Devon MP Sir Hugo Swire – who has raised concerns about the cuts in Parliament has been invited.

Mr Crick said the idea to mobilise individuals and groups in a public meeting was born out of dissatisfaction with the CCG’s ongoing consultation into the proposals and a feeling that asking the public to choose one of four set options does not offer people enough choice.

He is calling on residents and Sir Hugo Swire to resist the CCG’s proposals and demand the Government restores funding levels for NHS and social care.

There is also a county-wide rally planned in Exeter on Saturday, December 3. For more information, call Robert on 01395 519292.”

http://www.midweekherald.co.uk/news/urgent_public_talk_in_sidmouth_on_hospital_bed_cuts_1_4791334

Has DCC Leader John Hart just killed off Devon and Somerset devolution plans?

Agenda item
Councillor John Hart, Leader of Devon County Council

Meeting of Exeter Board, Monday 21st November 2016 5.30 pm (Item 31)

Minutes:

The Chair welcomed Councillor John Hart, Leader of Devon County Council who spoke on the future direction and plans of the County Council in light of Government policy and continued cuts to local government funding – 2017/18 set to be the 8th consecutive year since 2009 of further restrictions, the precise nature of cuts to become clearer as part of the budget setting process in the New Year.

Having recently met Sajid Javid, the Communities Secretary, Councillor Hart expanded on latest developments in the Devolution debate.

A number of areas such as Norfolk and Suffolk had withdrawn interest and, whilst the Secretary had urged a joint Devon, Cornwall, Somerset and Dorset bid, Councillor Hart outlined the disparity of views across the region for this approach.

Quarterly meetings for the Leaders of Devon, Cornwall, Torbay and Plymouth councils continued to be held and, although Somerset now also participated, within that County the views of districts diverged.

Whilst funding of £15 million per year associated with the adoption of the Mayoral system would be available there was no enthusiasm for an extra tier of local government and this sum represented a fraction of the overall County Council budget.

With regard to two independent studies looking into potential local government reorganisation in county areas for the County Councils Network, he asserted that County/District relationships in Devon were much improved since the previous ruling on re-organisation as evidenced by various joint initiatives with the Districts, the National Parks and the LEP. However, he suggested that some Devon Districts would face increased financial challenges with changes in New Homes Bonus rules.

In his meeting with the Secretary he had urged greater funding commitment for training and skills given the gap of some 20% between the SE and the SW in productivity and he emphasised the value of apprenticeships, including for small businesses.

He thanked the voluntary/community sector for the role played in supporting the County in the delivery of many of its services referring to Senior Voice, Age Concern and CAB which were valued and supported by the authority. He also referred to ICE where again the input of this sector was invaluable, this initiative being a pilot for the rest of the UK. Community self-reliance was a growing theme and he referred to County initiatives encouraging collaboration between parishes.

Members referred to the impact of the reshaped County Council services on areas such as youth, libraries, reduced rural transport funding of 1.7 million, day care, closure of residential homes, the sale of old people’s homes as well as responsibilities under the Care Act legislation.

Responding, Councillor Hart stated that the old people/residential homes had no longer been fit for purpose and that this was also being reflected in the private sector, the County was retaining its overall £4million County wide bus service subsidy and that the transfer of the library service to Charitable Trusts would facilitate business rate relief.

Responding to the concerns of Members regarding the changes emerging from the Care Act legislation and the shift to community based service delivery, he advised that the County Council’s Health and Wellbeing Scrutiny Committee was leading on consultation and responses to the Wider Devon Sustainability and Transformation Plan which sought to achieve the NHS “Five Year Forward View”.

It was noted that the New Devon Clinical Commissioning Group had offered support towards the changes. The County Councils Network was reviewing changes at the national level. Devon’s older people population exceeded 170,000 – both over 65’s and over 85’s, with no specific Government funding for the latter.

It was noted that the Government had announced a £10 million investment to help strengthen the resilience of the railway line between Exeter and Dawlish and Teignmouth.

The Chair thanked Councillor Hart for attending.

http://committees.exeter.gov.uk/mgAi.aspx?ID=36263

Social care HAS collapsed

Readers are urged to read the full article, only part of which is reproduced below. Social care is NOT about to collapse – it HAS collapsed. In addition, the decision to hand health and social care budgets ( cut to the bone and beyond) means that, with what little help there is available, rich areas will get better care than poorer ones and there will be a postcode lottery for services – which will sometimes depend which side of a road you live on.

Theresa May is under intense pressure from senior doctors and a powerful cross-party alliance of politicians to avert a collapse in care for the elderly, as shocking new figures show the system close to meltdown.

The medical profession, together with Tory, Labour and Liberal Democrat leaders in local government, have demanded a funding U-turn, warning that the safety of millions of elderly people is at risk because of an acute financial crisis completely overlooked in chancellor Philip Hammond’s autumn statement.

New figures obtained by the Observer show that 77 of the 152 local authorities responsible for providing care for the elderly have seen at least one residential and nursing care provider close in the last six months, because cuts to council budgets meant there were insufficient funds to run adequate services.

In 48 councils, at least one company that provides care for the elderly in their own homes has ceased trading over the same period, placing councils under sudden and huge pressure to find alternative provision.

In addition, 59 councils have had to find new care arrangements after contracts were handed back by a provider who decided that they were unable to make ends meet on the money that councils were able to pay them.

The medical profession, council leaders and even the former Tory health secretary, Andrew Lansley, are appalled that the social care crisis – exacerbated by growing numbers of elderly people and the rising costs of paying staff – was not addressed in the autumn statement.

In a letter to the Observer, the leaders of the four main political groups in local government expressed their disquiet at the chancellor’s dismissing talk of a crisis despite calls from politicians, NHS leaders, doctors and others. …

See https://www.theguardian.com/society/2016/nov/26/nhs-elderly-care-close-to-collapse

Current bed cuts in Devon hospitals – the reality

“The number of beds at a Devon hospital trust have fallen by more than a quarter over the past six years.

In July to September 2010, the average number of general and acute beds open overnight at Torbay and South Devon

The occupancy rate for these beds has grown from 64.6% in July to September 2010, to 87.7% in 2016, an increase of 36%, one of the highest in England.

At Northern Devon, the number of beds has also dropped by 21%, from 370 to 294, with occupancy rates rising from 85.5% to 86.4% over the same period.

Across England, for general and acute beds open overnight, the occupancy rate between July and September was 89.1%, up from 87% over the same period in 2015.

The average daily number of beds open overnight was 129,458 in July to September 2016 compared with 130,774 in April to June. The average occupancy rate for all beds open overnight was 87.5%.

Health experts advise that occupancy levels should ideally be under 85%. Anything over this level is regarded as riskier for patients as this leads to bed shortages, periodic bed crises, and a rise in healthcare-acquired infections such as MRSA.

Commenting on the numbers, Mr Ian Eardley, a consultant urological surgeon and Vice President of the Royal College of Surgeons, said:

“The NHS has been able to reduce bed numbers as medical advances mean more modern surgery can take place without an overnight stay. However, these figures suggest bed reductions have now gone too far in the absence of sufficient social care or community care alternatives.

“We are now seeing increasing numbers of frail older patients in hospital because they have nowhere else to go. The lack of additional money in the Autumn Statement for social care and the NHS is only going to make this even harder.

“Today’s figures will come as no surprise to frontline staff who struggle every day to provide for their patients because of increasing demands and a shortage of hospital beds. I and too many of my colleagues all around the country are regularly having to cancel patients’ operations due to a lack of beds and delays in transferring patients back into the community.

“A number of sustainability and transformation plans are proposing further hospital bed reductions. Today’s figures suggest NHS leaders need to think carefully about whether this is a good idea without first putting in place better care in the community.”

The Royal College of Surgeons warned the figures almost certainly underestimate hospital bed shortages in the NHS. The Nuffield Trust think tank warned last month that NHS England’s bed occupancy statistics do not show the true scale of the problem, stating that “with a growing number of patients coming and going during the day, counting bed occupancy at midnight means that crunch times are often invisible”.

http://www.exeterexpressandecho.co.uk/number-of-hospital-beds-in-devon-falls-creating-potential-risk-for-patients/story-29936995-detail/story.html

The true cost of NHS cuts

“Hospitals have been told to discharge thousands of patients and pass some scheduled surgery to private organisations to reduce pressure ahead of a potential winter crisis, it was reported.

Leaked memos also revealed that managers have been banned from declaring black alerts, the highest level, when hospital services are unable to cope with demand, the Daily Telegraph said.

The newspaper claimed instructions were sent by NHS England and the regulator NHS Improvement last month to reduce the levels of bed occupancy in hospitals, which are the most crowded they have ever been ahead of winter.

In the three months to the end of September, 89.1% of acute and general beds were full, compared with 87% last year, prompting the order for hospital trusts to take the drastic measures.

The goal is to reduce occupancy levels down to the recommended safe limit of 85% from December 19 to January 16, the Telegraph said.

Dr Mark Porter, chairman of the British Medical Association, said: “This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand.”

Hospitals have been told to turn to the private sector to “maximise elective activity”, with operations such as knee and hip replacements likely to be among the outsourced procedures to help free up beds for urgent patients.

The measures are likely to have a significant cost to the NHS.

NHS England said plans to pace elective programmes and hospital discharges are put in place every year to maximise bed availability and reduce the possibility of cancelled operations.

A spokeswoman said: “Our ambition to reduce bed occupancy in hospitals over the festive period is about timely discharge and getting people to the most appropriate care setting ahead of the holidays, so there is capacity for early January when we know pressure is greatest.

“This is part of our well-rehearsed winter preparedness every year.”

A spokeswoman for both NHS England and NHS Improvement added there was a lack of a historic national protocol for hospitals when declaring alerts, leading to “a hotchpotch of confusing terminology”.

She said: “This has led to confusion between hospitals, ambulances and the public over what is happening, how to respond or how they can help.

“The new NHS guidelines are for hospitals to use when managing local operational pressures in order to deliver a consistent approach across the country.”

https://www.theguardian.com/society/2016/nov/26/send-patients-to-private-sector-to-avert-winter-crisis-hospitals-told

Big rise in hospital admissions for malnutrition

The number of hospital beds in England taken up by patients being treated for malnutrition has almost trebled over the last 10 years, in what charities say shows the “genuinely shocking” extent of hunger and poor diet.

Official figures reveal that people with malnutrition accounted for 184,528 hospital bed days last year, a huge rise on 65,048 in 2006-07. The sharp increase is adding to the pressures on hospitals, which are already struggling with record levels of overcrowding.

Critics have said the upward trend is a result of rising poverty, deep cutbacks in recent years to meals on wheels services for the elderly and inadequate social care support, especially for older people. …”

… The Department of Health figures showed that the number of bed days accounted for by someone with a primary or secondary diagnosis of malnutrition rose from 128,361 in 2010-11, the year the coalition came to power, to 184,528 last year – a 61% rise over five years.

Such patients only account for one in 256 of all hospital bed days, or 0.4% of the 47.3m total, but the financial cost is considerable as each bed costs the NHS an average of £400 a day to staff and given the condition each spell in hospital because lasts an average of 22 to 23 days.”

https://www.theguardian.com/society/2016/nov/25/huge-rise-in-hospital-beds-in-england-taken-up-by-people-with-malnutrition

Now the well-regarded Institute of Fiscal Studies joins health row

Institute of Fiscal Studies”

Chancellor Philip Hammond will not be able to resist calls for extra funding for health and social care for much longer, the head of the Institute for Fiscal Studies has predicted. …

http://www.publicfinance.co.uk/news/2016/11/pressure-will-mount-health-and-care-funding-boost-says-ifs

They join:

The King’s Fund:

Which reported that changes were kept secret from doctors and the public:

http://www.independent.co.uk/life-style/health-and-families/health-news/hospital-closures-stps-secret-kept-nhs-ae-public-kings-fund-england-chris-ham-stp-a7415836.html

The National Audit Office:

Which reports that the NHS is underfunded:
https://www.theguardian.com/society/2016/nov/22/nhs-financial-problems-endemic-and-no-longer-sustainable-national-audit-office-deficit

and

The UK Statistics Agency:

which says numbers simply don’t add up including the purported £10 billion extra cash:

https://eastdevonwatch.org/2016/11/23/and-now-the-uk-statistics-agency-criticises-nhs-funding-figures/

Who disagree? Theresa May and Jeremy Hunt. Their plan? Cut, cut, cut – then privatise what makes money and keep cutting essential services don’t show a profit.

Moral of this story: Don’t get sick but do get angry!

East Devon Alliance invites local politicians to Exeter health crisis rally

“To: Hugo Swire MP, Neil Parish MP, Mel Stride MP, Sarah Wollaston MP, Anne‑marie Morris MP, Peter Heaton‑jones MP, Gary Streeter MP, Geoffrey Cox MP, Kevin Foster MP, Oliver Colvile MP, Johnny Mercer MP

Cc: Jon Ashworth MP, Jeremy Hunt MP, Ben Bradshaw MP

Dear all,

As a representative of residents in East Devon I am addressing this to Devon MP’s but also to those in senior positions in parliament.

Will you be there when the National Health Service Bill (Margaret Greenwood MP) has its second reading? (By the way, that will be on 24th February 2017)

Will you back this bill? If not, why not?

Be aware: your electorate are watching. We in the East Devon Alliance are doing all we can to let them know how you vote on NHS and other healthcare issues, to counter the messages you try to get out down here that you are ‘against’ the current proposals to close community hospital beds. We know this issue is far bigger than that. We know that the 2012 Health and Social Care Act paved the way for the dismantling of the NHS. It’s taking a while for the public to wake up to what is being done, but they will.

And where is Labour? I am afraid a media blackout might be stopping us from hearing from the ‘opposition’. If you can mobilise your supporters all over the country, we will hit the headlines. Come the next election you might find there are new candidates opposing you in your previously safe seats. Or the person who gave you a run last time is out in front.

Are you prepared to continue with this programme to dismantle the NHS? Or do you have the courage to speak out and vote to reverse the changes?

Will you join us in Exeter on 3rd December to parade your support for the NHS as it was?

Please do let me know your position.

Yours sincerely,

Cllr Dr Cathy Gardner
Leader
East Devon Alliance

http://www.eastdevonalliance.org.uk/cathy-gardner/20161124/open-letter-mps-ministers-nhs-reinstatement-bill/

Devolution: “flawed fiscal ‘power’, an unjust system, unfulfilled potential”

“… local authority funding (for services) will become far more volatile as year to year income will be intrinsically linked to those who pay rates locally and those who choose to appeal. So, in sum business rates devolution in its current guise is less about devolved power and more about the devolution of risk and the associated, potentially negative, effect on services. …

… In 2016, there is no such thing as the UK housing market, rather a polarised collection of divergent, individual markets (hyper-dynamic price inflation in London versus low demand and price stagnation in parts of Liverpool & East Lancashire, for example) bearing little or no resemblance to the situation at the time of the last revaluation some 25 years ago.
The effect of this is an increasingly unfair council tax banding where a resident in Blackpool in a Band A property currently pays 35% more in council tax than a resident in a Band A property in Kensington and Chelsea, where average gross earnings are more than double that of those living beside the Pleasure Beach. …

… So far, devolution has only served to deflect risk and responsibility for the local effect of national cuts and add a further layer of complexity to an already intractable local government governance system. The lack of real power in devolution deals to date does not fully equip places or the incoming City Mayors to effectively deal with the challenges of the modern economy whilst driving tax revenue.

Without true devolution of power, the potential contribution of local government towards a prosperous future for people and place is in danger of drowning in a mire of unnecessary fiscal constraints and excessive levels of localised risk.”

http://www.cles.org.uk/wp-content/uploads/2016/11/CLES-Think_Devolution-Beyond-the-rhetoric_Nov-2016.pdf

Why is Tiverton Community Hospital retaining 32 beds when some other community hospitals are being closed?

Apparently, as explained at a recent consultation, it is run as a Private Finance Hospital (PFI) and its contract cannot be broken.

So the rest of our district has to lose beds to keep it at its full capacity, even if that is too high.

Not what we want to hear.

Here is a Daily Telegraph article from 2015 explaining the situation:
http://www.telegraph.co.uk/news/nhs/11748960/The-PFI-hospitals-costing-NHS-2bn-every-year.html

Budget reality check: housing and infrastructure

Interesting that when talking about geographical inequities in the budget, the writer speaks only of the north and not the south-west.

“… As for housing, Whitehall policies remain dictated by the all-powerful builders’ lobby, craving state subsidies to increase demand and push up prices in the south-east. Hammond pledged £1.4bn for 40,000 “affordable” homes, which appears to be just £35,000 each. This is despite overwhelming evidence that Britain’s key housing resource is buried in the inefficient distribution of what is already built. The need is for smarter regulation of the existing housing stock, not more subsidy. On that, the modest new controls on rental fees are at least welcome.

Hammond had sadly inherited his predecessor’s infatuation with the great god, infrastructure. To George Osborne it was nothing short of Stalin’s “electrification of the Soviet Union”. This is despite the fact that most infrastructure is code for investment demanded by the private sector from the public sector. It is a welfare state for capitalist fast-learners.

To any chancellor, infrastructure is a gift. It is headlines today, and postpones payment until tomorrow – if not the day after. A Centre for Policy Studies report excoriates the wildness of this spending. It points out that half of China’s boom in infrastructure is now reckoned to harm growth. In Britain state capital spending is virtually uncontrolled, because it is buried in future debt. Hospital PFIs have saddled the nation with a staggering £200bn in debt. The McKinsey consultancy estimates rail projects on average go 44% over budget, and exaggerate their benefits by 50%.

Hammond this week boasted he would spend £1.1bn on roads, a genuinely pressing need. But it is ludicrously paltry, at one fiftieth of what he is about to spend on a single, upmarket railway line, the glamorous HS2. There are a dozen more worthwhile rail projects languishing. How can Hammond possibly tell health carers or the poor he is penniless? Infrastructure is political eye candy.

In his speech the chancellor rightly drew attention to the “damaging imbalance in economic growth across the whole country”. He went further, adding that “no developed economy has such a gap between its capital city and its second and third cities”. So what does he mean to do about it?

The latest Legatum prosperity index puts Britain near the top at creating prosperity, but not so good at sharing it. This is despite a not ungenerous welfare state. The reason is that sharing is not just about fiscal transfers. It reflects a deep imbalance of the country’s economic geography.

Nothing the government does is relieving this imbalance. Cities in the north of England are among the most poverty-stricken in western Europe. Their jobs flee to the south-east, followed by their young. Their local government is as indigent as their population. Media hysteria about housing and health is in reality about housing and health in the capital.

If the northern economy is depressed, London’s must be the most overheated in Europe. Yet Hammond heats it even more. He tips housing subsidies into the south-east. He spends ever more on transport in the south-east. He does nothing to decentralise public sector employment to the north. Subsidies for universities, charities and the arts are concentrated on London.

The government’s four megaprojects – Heathrow, HS2, the Oxford-Cambridge expressway and the forthcoming Crossrail 2 – are massive, and all in the south-east. They hurl public money at the wealthiest parts of the country. This merely piles pressure on housing, schools and welfare in the south-east. As for HS2, every study of high-speed rail indicates that it benefits the richer end of the corridor.

Britain’s greatest historical investment in housing and welfare is in the towns and cities of the north of England, Wales and Scotland. Houses lie empty, schools unused. Unless the government intends this to go to waste, rotting into a dependency culture and dragging down the rest of the economy, it must find ways to revive it.

Making it easier for Birmingham to get to London is not a national priority, getting fast from Manchester to Leeds is. Crossrail is not a priority, cross-Pennines is. Boosting London’s outbound tourism with more runways is not a priority, boosting northern tourism is. London does not need more bridges, the north’s ports most certainly do.

Hammond should tax London more heavily and the north more lightly. He should move London’s universities and research institutes to the provinces. He should beautify northern cities. This has nothing to do with Brexit, except that rebalancing the economy is an essential response to Brexit’s challenge. Relying on London as the nation’s workhorse is fair neither on London nor on the provinces. It is certainly not sensible.

https://www.theguardian.com/commentisfree/2016/nov/24/philip-hammond-britain-regional-imbalance-risky-autumn-statement

Corbyn finds his voice on NHS and Social Care

Vox Political blog:

“Theresa May consolidated her position as the UK’s most pathetic excuse for a prime minister yet, with a crushing defeat at the Dispatch Box under the questioning of Labour leader Jeremy Corbyn.

(Wasn’t he supposed to be the inept one?)

Mr Corbyn made strong points and supported them with solid facts. Mrs May provided no answers and seemed utterly lost.

Mr Corbyn began: “The government’s sustainability and transformation plans for the National Health Service hide £22 billion of cuts from our service, according to research by the BMA. That risks ‘starving services of resources and patients of vital care’. That comes from Dr Mark Porter of the BMA. When he calls this process a mess, where is he wrong?”

Mrs May ventured this reply: “The National Health Service is indeed looking for savings within the NHS which will be reinvested in the NHS. It is this government which is providing not just the £8 billion which the NHS requested, but £10 billion of extra funding… and sustainability and transformation plans are being developed at local level, in the interests of local people, by local clinicians.”

Oh really?

“It’s very strange the prime minister should say that,” mused Mr Corbyn. “Because the Health Select Committee… says it is actually £4.5 billion, not £10 billion. There’s quite a big difference there.”

So she was being economical with the truth about the amount of money being put into the NHS – and, by the way, is that NHS England or the health service across the whole of the UK? Mrs May doesn’t seem clear about that and the UK Statistics Authority certainly seems confused.

Mr Corbyn continued: “Part of the reason for the strain on our National Health Service is that more than one million people are not receiving the social care that they need. As a result of this there has been an increase in emergency admissions for older patients. What action will the prime minister take to stop the neglect of older people, which ends up forcing them to take A&E admissions when they should be cared for at home or in a care home?”

Mrs May: “The government has introduced the Better Care Fund… the Social Care Precept for local authorities, and we’re encouraging the working together of the health service and local authorities, to deal with precisely the issues he’s raised on social care and bed-blocking,” Mrs May blustered, unaware of the hammer-blow that would shatter her protestations very shortly.

She blundered on: “But I will just say this to the Right Honourable gentleman: Er, we’ve introduced the Better Care Fund and the Social Care Precept. Let’s just look at what Labour did in their 13 years. They said they’d deal with social care in the 97 manifesto, introduced a Royal Commission in 1999, a Green Paper in 2005, the Wanless Review in 2006, said they’d sort it in the CSR of 2007, and another Green Paper in 2009. Thirteen years and they did nothing.”

Here comes the hammer: “As the prime minister well knows, health spending trebled under the last Labour government – and the levels of satisfaction with the National Health Service were at their highest ever in 2010. This government’s choice was to cut social care by £4.6 billion in the last Parliament, at the same time as they found the space, shall we say, to cut billions in corporate taxation bills. That means it’s affecting patients leaving hospital as well. In the last four years, the number of patients unable to be transferred from hospital due to the lack of adequate social care has increased by one-third.”

So it doesn’t matter what Theresa May says her government has introduced; the service it provides is much, much worse than that offered under the last Labour government. That is unquestionable.

Mr Corbyn pressed on: “Will the prime minister ensure her government guarantees all of our elderly people the dignity they deserve?”

“I recognise the importance of caring for elderly people and providing them with the dignity they deserve,” said the prime minister, immediately prior to evading the question completely, going back over her previous assertion and changing the subject (which, as we all know, is a false argument).

“He says this government has done nothing on social care. I repeat, this government has introduced the Social Care Precept, that is being used by my local authorities and by his local authority, and we’ve also introduced the Better Care Fund.” That’s the recapitulation of what she had already said.

Let’s look at that Social Care Precept. It allows local authorities to increase council tax by up to two per cent in order to fund adult social care, meaning that this service has now become a postcode lottery.

Oh, and the Social Care Precept was announced at the same time the Conservative Government said the local government central grant is to be cut by more than half, from £11.5bn in 2015/16 to £5.4bn in 2019/20, a drop of 56 per cent. Meanwhile, councils were expected to increase self-financed expenditure (from revenue and business rates) by 13.1 per cent over the same period, making council services another postcode lottery.

Was it wise of Theresa May to draw attention to this monumental increase in unfairness across the UK?

The Better Care Fund is a pooled budget, initially £5.3 billion, announced in the June 2013 Spending Round and intended to save £1 billion by keeping patients out of hospital. As the number of patients who could not be transferred from hospital due to inadequate social care has increased by one-third in the last four years, it is clear that the Better Care Fund has failed.

In fact, the Chartered Institute of Public Finance and Accountancy and the Healthcare Financial Managers Association surveyed the plans for saving money through integration financed by the BCF in December 2015 and concluded that 80 per cent were likely to fail and that many were hampering progress, “giving integration a bad name”.

Mrs May continued: “But if he talks about support for elderly people I would remind him: Which government is it that has put the triple-lock in place for pensioners, that ensured the largest increase in pensions for elderly people?” And that’s the change-of-subject. Mr Corbyn was not discussing increases in pensions for senior citizens who may be perfectly healthy.

Our verdict can only be that, even though Mr Corbyn didn’t actually say the Conservatives have done “nothing” on social care, the result of their efforts is in fact worse. His response – “The precept is a drop in the ocean compared to what’s necessary for social care” – is mild, in that context.

Moving on to specifics, Mr Corbyn said: “I’m sure the whole House will have been appalled by the revelations in the BBC Panorama this week, showing older people systematically mistreated. The Care Quality Commission’s assessment is that care homes run by the Morleigh Group require improvement and has issued warning notices. The commission goes on to say that the owner has allowed services to deteriorate further, and has ‘utterly neglected the duty of care to the residents of these homes’. What action is her government going to take to protect the residents of those homes?”

Look at this stuttered, barely-intelligible response:

“The- the- Right Honourable gentleman mentioned-raises the issue of the quality of care that is provided in homes and the way that elderly people are treated. I’m sure everybody is appalled when we see examples of poor and uh, uh terrible treatment that is given to elderly and vulnerable people in care homes.

“What we do about it is ensure that we have the CQC which is able to step in, which takes action, which has powers to make sure that nobody-nobody in the chain of responsibility is immune from legal accountability. But we know that there’s more that can be done, and that’s why the CQC is looking into ways in which it can improve its processes, increase its efficiency.

“The, er, my-my honourable friend Minister for Community Health and Care is going to be writing to the CQC shortly, to look at how we can improve, to see what they do. It’s the CQC that deals with these issues. Is there more we can do? Yes, and we’re doing it.”

In other words, her government is taking no action at all.

Oh, and the CQC? It deliberately suppressed an internal review that meant it was found unfit for purpose in 2013. Are we sure we want to trust this organisation now?

“Yesterday, the government proposed that patients may have to show passports or other ID to access non-emergency healthcare,” said Mr Corbyn. “Has the government considered the impact of this on elderly people?

“The last census showed that nine-and-a-half million people in this country don’t have passports. Rather than distracting people with divisive and impractical policies, could the prime minister provide the NHS and social care with the money that it needs, to care for the people who need the support?”

Mrs May’s response was very silly indeed: “Over the course of this Parliament, the government will be spending half a trillion pounds on the National Health Service.”

And it is clearly not enough! How much goes into the pockets of private health bosses?

“The Right Honourable gentleman asks about a process to ensure that people who are receiving NHS treatment are entitled to receive NHS treatment. For many years there has been a concern about health tourism, about people turning up in the UK, accessing health services, and not paying for them.”

No, there hasn’t!

Beggars belief! Local Tories implicitly defend local bed cuts then put out a press release saying the total opposite!

EDDC Tories have released the following statement and press release below.

The wording of this statement seems to imply to Owl that our local Tories are 100% behind the cutting of beds and the closure of our community hospitals. Note that it takes no account of the warning bells from the King’s Fund (plans are vague, poorly costed and badly evidenced) and the UK Statistics Agency (the NHS is underfunded) – it simply offers knee-jerk pandering to a CCG shown to be not fit for purpose and (much as usual in Devon these days) with people at the top with glaring conflicts of interest.

THE STATEMENT

We have decided as a group to issue this statement on the proposed bed closures throughout Devon which we will continue to oppose in their current form. Those wishing to cause mischief are doing a great disservice to our residents as they do not offer a sustainable solution to the endemic problems the NHS faces and tinkering with the process is no solution to the root and branch reform needed. The process is being piloted in Devon and Sir Hugo Swire and Neil Parish, our MPs, are continuing the fight in Westminster as do I as the South West Board Member for the District Councils Network nationally and as a Member of Devon County Council’s Health and Wellbeing Scrutiny Committee.”

Readers will recall that Councillor Leader Diviani voted against DCC Councillor Claire Wright’s motion to “stop the clock” on the closure of Honiton hospital until its viability had been reassessed and rechecked. Councillor Leader Diviani and his fellow Tories can hardly claim to be defending our services – indeed they seem anxious for the process to be concluded as quickly as possible, including the closure of Honiton hospital.

They also state that our MPs are “fighting for us” when their voting records, lack of speeches on our behalf and watering down of a parliamentary motion shows that they are doing nothing of the sort.

To all those vulnerable people out there who will suffer from these cuts: use your vote much more wisely in council by-elections, elections and general elections.

Now, compare what they say in the paragraph above to the press release sent out below. REMEMBER, when they say THEY – they mean their own party!

THE PRESS RELEASE

STARTS

Conservatives call for second opinion on Devon NHS funding crisis treatment
ENSURE THAT BED-CUT ‘CURE’ DOESN’T DAMAGE PATIENTS

East Devon Conservatives are deeply worried about proposals from the NEW* Devon Clinical Commissioning Group to restructure hospital care in the North, East and West of the county in a bid to plug a £400 million budget shortfall over the next three years.

They believe the hospital bed closures proposed by the Devon health provider as the cure for a funding crisis may be the wrong treatment – and could have harmful side-effects for patients.

So the 37 Conservative members of East Devon District Council are sending a collective response to the CCG’s current consultation in the hope of persuading the NHS commissioning group to change its approach to tackling the immediate £100m funding gap, expected to rise to £400m by 2020.

The Conservative councillors are advising the CCG that it would be dangerous to move from a system of mostly inpatient treatment to care at home until a robust structure is in place to provide the alternative cover. Taking this step without the necessary resources in place and with no vital transition budget to call upon, could put patients at risk, they say.

Dangerous

Having studied the CCG’s report, Conservative group members were unimpressed with the strength of the argument in favour of bed closures and home care, especially because the CCG has not been able to provide accurate and meaningful financial detail or convincing trial evidence to back up its proposed Community Care Package.

They also wonder if the massive funding gap could not be closed by greater attention to efficiency savings.

And they are counselling the commissioning group not to adopt a “one-size-fits-all” approach to tackling the area’s financial ills, bearing in mind the differing demographics and age profiles of each local authority area in Devon, especially remote rural communities. Patient vulnerability and loneliness must also be addressed.

The CCG appears to favour a new model of care that has been subject to limited testing, with little hard evidence that it improves the service to patients.

The Conservative group are not convinced by the scant evidence provided after their requests for more detail and are nervous of the CCG’s reliance on a notional target of county hospital beds, regardless of variations in proven need.

Blunt instrument

They want to know more about the 80 clinicians the CCG claims to be in support of the new model. And they are sceptical of a ‘blunt instrument’ approach to treatment, especially when many elderly patients have dementia in addition to multiple clinical problems.

Finally, the Conservative members contest that many areas in East Devon appear to have a reducing stock of nursing and residential home beds. This only aggravates the situation, because these beds are often required in the short or long-term for patients stuck in hospital.

Phil Twiss, Conservative Group Secretary, said: “Some people want to boycott this consultation process – but that won’t help anyone. We believe constructive feedback is the best way.

“We all agree that bed-blocking is a serious issue and we also accept that the clinical commissioning group need to save money. The question is how should they go about it so as to deliver results without making the situation worse.

“We feel that they have the solution the wrong way round. They want to move to a care-in-the-home model at a time when the resources just aren’t there to support that model. It might be the right approach in theory, but it will only work in practice if the social care infrastructure is robust enough to take the strain – and it is not.

Panic measures

“We’re not convinced that the new model has delivered the right standard of success in trial areas and we don’t believe it can be rolled out across other parts of the county until the necessary support structure is in place. And we should not be moving to a new model as a panic measure to solve a funding shortfall that could be tackled by other means.

“For example, a lot of money can be wasted on high-cost agency staff who appear to be a short-term emergency man-power fix but all too often are relied upon as part of the workforce establishment.

“We don’t know whether the budget shortfall was perhaps caused by wasteful practices that are still in place, and so we don’t know whether the CCG could find alternative ways to save money. What we do know is that their current proposals are unconvincing and ill-advised”.

East Devon Conservatives will be responding to the CCG consultation with their views and will be calling on the commissioning group to think again.

ENDS

SO, are they for cuts or against them? A dangerous business deciding which bit is truth and which bit is post-truth!

And now the UK Statistics Agency criticises NHS funding figures

“The UK Statistics Authority looked into the prime minister’s repeated use of the £10bn claim after Labour and the British Medical Association complained that the figure was misleading and wrong. It has asked the Treasury to overhaul how government spending on both the NHS and health more widely is presented in order to minimise the risk of further “confusion” about the size of budget rises.

The UKSA’s intervention followed an increasingly public disagreement between May and Simon Stevens, the chief executive of NHS England, over how much extra funding the government had pledged to give the health service over the course of this parliament. May has put the figure at £10bn in the House Commons, a newspaper interview and at the Conservative party conference. She said that sum meant her administration was giving the NHS more money than the £8bn it had asked for in 2014 in order to transform how it works and close a £30bn budget gap by 2020.

Jon Ashworth, the shadow health secretary, accused the prime minister of exaggerating the true sum and using “spin” to try to present the government in a better light over the NHS. Dr Mark Porter, chair of the BMA’s ruling council, had also asked the UKSA to look into May’s claim. …

… The UKSA intends to ask the Treasury to “investigate whether in future they can present estimates for NHS England and total health sending separately. I will also explore with officials producing these figures other ways in which they might ensure clarity around sources, time periods and what is being measured, and in what context, when reporting on the level of increase in real budget allocations to NHS England.”

While Hunt has acknowledged that the £10bn was the budget increases over a six-year period, May has yet to do the same.”

https://www.theguardian.com/society/2016/nov/23/government-scolded-by-watchdog-over-theresa-may-nhs-funding-claims?CMP=Share_iOSApp_Other

National Audit Office slams NHS ” transformation” plans

Owl’s summary: you haven’t done your homework, your models are untested, you don’t understand what you are doing and the NHS is underfunded NOT overspent!

Some quotes:

17. Plans to close the estimated £22 billion gap have not been fully tested.

“The Department, NHS England and NHS Improvement used a financial model to estimate the gap between patients’ needs and resources by 2020-21, and the savings their programmes need to achieve to close this gap. We found limited testing by the Department, NHS England and NHS Improvement of their estimates of how much they expect to generate from their savings programmes.

This raises concerns about whether planned savings can be achieved. For example, plans assume that growth in trusts’ acute activity (including specialised acute services) will be reduced from 2.9% to 1.3% through transformation and efficiency programmes such as Right Care, new care models and the Urgent and Emergency Care programme. However, NHS statistics show this will be challenging as hospital admissions, a key driver of activity, grew by 2.8% a year between 2013-14 and 2014-15 (paragraphs 2.4 to 2.7).”

18. The NHS is implementing its plans to make the NHS financially sustainable from a worse than expected starting point.

Plans to achieve financial sustainability were based on trusts ending 2015-16 with a combined deficit of £1.8 billion. The fact that trusts ended the year with an even larger deficit means that the level of deficit to be recovered is significantly greater than expected. This means that the trusts affected will need to catch-up by making more savings than planned to reach the intended starting position. For example, trusts with deficits greater than expected at the end of 2015-16 will need to make operational efficiencies above the 2% savings level applied to all providers of healthcare services in 2016-17 or subsequent years (paragraphs 1.8 and 2.8).

19. National bodies have not assessed the impact of all the wider cost pressures faced by local NHS organisations in plans for achieving financial sustainability.

The Department, NHS England and NHS Improvement expect trusts and commissioners to invest in transformation programmes. But they do not yet know what level of investment is required or whether local bodies will be able to make the changes at the scale and pace needed.

Furthermore, the government has made a commitment that the health and social care system in England will be fully joined together by 2020. We have previously reported that local authority spending on adult social care fell by 10% in real terms between 2009-10 (£16.3 billion) and 2014-15 (£14.6 billion). The accounting officer for NHS England told the Committee of Public Accounts that “over the next two or three years, there is likely to be a widening gap between the availability of adult social care and the need for social care. That, will, inevitably show up as delayed discharges and extra pressure on hospitals.” However, in our review of the plans for financial sustainability, we did not see any estimate of the impact of pressures on social care spending on NHS bodies (paragraphs 2.6 to 2.13).

24. The National Audit Office (NAO) perceives differences in the position articulated by the Department – which views the funding for the NHS as having been adequate over the last few years, and in line with what NHS England set out it would need to deliver the NHS Five Year Forward View – and NHS England itself. Confronted as NHS England is by the pressures of rising demand for services, these signs of differences do not help build a confident feel about the future of the NHS.

https://www.nao.org.uk/report/financial-sustainability-of-the-nhs/

About ….. turn! Councillors doing contortions?

With the proposal to severely cut community hospital beds and totally close some community hospitals (Owl STILL insists a ” community health hub” with no beds is NOT a hospital) comes some interesting behaviour from majority party councillors in East Devon.

For example”

Suddenly, they have become “experts” on consultation, loudly stating that the CCG consultation is “flawed” because users of NHS services were not consulted.

They check numbers and find some don’t add up and some are missing.

They ask for “more evidence” on some of the CCG’s wilder claims.

They suddenly discover their voices and some, who have been mute for many a long month or even years, decry the whole project – even though their own party is 100% responsible for it.

They complain bitterly about the amount of money spent on so-called consultants who seem ready to tell the CCG what it wants to hear – for a price.

Well, councillors, welcome to our world – the world of residents battling some of YOUR sillier decisions (so many of them) and profligate spending. Now YOU know how WE feel – if only for a fleeting moment and because it is YOUR health and YOUR families that will suffer from these decisions. Especially as so many of our majority councillors are of the age and lifestyle that often makes most demand on community hospital services.

Just one caveat: Councillor Leader Diviani HAS stayed true to his principles and has tacitly agreed to CCG proposals to close Honiton hospital – having not spoken out AND voting against the motion from Councillor Claire Wright at DCC to “stop the clock” on the plans until Honiton and Okehampton hospitals (both due to close under CCG proposals) could have their viability assessments checked and included in the plans.

Expect some rousing speeches when the head of the CCG comes before the EDDC Scrutiny Committee on Thursday this week at 6 pm. But do watch out for any majority councillors crossing their fingers behind their backs.

Yes, welcome to our world indeed – if only for a very short time.