“Social care postcode gap widens for older people”: EDDC tries to claw back its mistakes too late

Last week, desperate Tories put a much-too-little! much-too-late motion to East Devon District Council:

“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”


As Owl noted at the time, this is somewhat rich, as their Leader, Paul Diviani, voted at Devon County Council AGAINST sending the document to the Secretary of State for Health (where this could have been highlighted in the covering submission) against the instructions of his EDDC Tory Councillors and never having consulted other Devon Tory councils he was supposed to represent. He was ably assisted in this by former EDDC Chairman Sarah Randall Johnson, who as Chair of the DCC committee, railroaded their choice of action by effectively silencing any opposition (EDW passim)

This led to the accelerated closure of community beds in Honiton and Seaton, following on from earlier closures in Axminster and Ottery St Mary.

A subsequent vote of “No Confidence” in Diviani at EDDC (brought by non-Tory councillors) was defeated by the very Tory councillors he had defied!

Now we read that “Social care postcode gap widens for older people” and that social care is breaking down in deprived areas – many of which are inevitably rural.

… The knock-on effects for the NHS see elderly patients end up in hospital unnecessarily after accidents at home, while they cannot be discharged unless they have adequate community care in place. Among men, 30% in the poorest third of households needed help with an activity of daily living (ADL), compared with 14% in the highest income group. Among women, the need for such help was 30% among the poorest third and 20% in the highest third.

There is a growing army of unpaid helpers, such as family and friends, propping up the system. Around two-thirds of adults aged 65 and over, who had received help for daily activities in the past month, had only received this from unpaid helpers, the figures revealed.

Spending on adult social care by local authorities fell from £18.4bn in 2009-10 to just under £17bn in 2015-16, according to the respected King’s Fund. It represents a real-terms cut of 8%. It estimates there will be an estimated social care funding gap of £2.1bn by 2019-20.

While an extra £2bn was provided for social care over two years, a huge gap remains after the latest budget failed to address the issue. Theresa May was forced to abandon plans to ask the elderly to help pay for social care through the value of their homes, after it was blamed for contributing to her disastrous election result. The government has promised to bring forward some new proposals by the summer, but many Tory MPs and Conservative-run councils are desperate for faster action.

Ministers have dropped plans to put a cap on care costs by 2020 – a measure proposed by Sir Andrew Dilnot’s review of social care and backed by David Cameron when he was prime minister.

Izzi Seccombe, the Tory chair of the Local Government Association’s community wellbeing board, said: “Social care need is greater in more deprived areas and this, in turn, places those councils under significant financial pressures. Allowing councils to increase council tax to pay for social care, while helpful in some areas, is of limited use in poorer areas because their weaker tax base means they are less able to raise funds.

“In more deprived areas there is also likely to be a higher number of people who rely on councils to pay for their care. This, in turn, puts even more pressure on the local authority.

“If we are to bridge the inequality gap in social care, we need long-term sustainable funding for the sector. It was hugely disappointing that the chancellor found money for the NHS but nothing for adult social care in the autumn budget. We estimate adult social care faces an annual funding gap of £2.3bn by 2020.”

Simon Bottery, from the King’s Fund, said: “We know that need will be higher in the most deprived areas – people get ill earlier and have higher levels of disability, and carry that through into social care need.

“We also know that the councils that have the greater need to spend are, on average, raising less money through the precept [earmarked for funding social care].”


Accountable Care Organisations: angels or devils?

Owl says: if you believe that Accountable Care Organisations are a good thing you will believe anything. Back-door privatisation a la USA and a ruthless way of enforcing rationing and post code lotteries rather than proper funding.

“Accountable care organisations have many strengths but should be openly debated before being implemented.

The war over the future of the NHS is being fought on multiple fronts. Campaigners, the Labour party, the government, NHS England and even Stephen Hawking are locked in combat over the structure, funding, transparency, accountability and legality of the current wave of reforms, along with the never-ending fight about privatisation – real or imagined.

The famous physicist has joined campaigners in a high court bid to block the introduction of accountable care organisations to oversee local services without primary legislation, arguing they could lead to privatisation, rationing and charging.

Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a Commons early day motion after the government announced plans to amend regulations to support the operation of accountable care organisations. Ashworth argues that they are a profound change to the NHS that should be debated in parliament.

Accountable care – a term imported from the US, where it plays a key role in Obamacare – can take many forms, but it typically involves an alliance of providers with a fixed budget collaborating to manage the health needs of their local population. NHS England wants to see sustainability and transformation partnerships (STPs) evolving into accountable care systems in which integrated care supports good physical and mental health.

In June, NHS England announced that eight areas would be leading the accountable care drive. Greater Manchester is also adopting this approach, and many others are starting to use the accountable care language.

Accountable care has the potential to address many of the criticisms the most vociferous supporters of the NHS have made for many years. It goes a long way to replace competition with collaboration, and the NHS England chief executive, Simon Stevens, said it could mark the end of the infamous purchaser/provider split, which weighs down the health service with costly and often pointless bureaucracy.

Locally led, integrated systems are essential if we are going to shift the NHS from a 1970s-style hospital service to one that provides a community-based health and wellbeing service. Pooling budgets across the local area is not a ruse to disguise cuts. It is the most effective way to manage public money, irrespective of the level of funding.

The court case confuses the issue of how the NHS is organised with its funding and the role of the private sector. These are three different issues.

But the legal basis for accountable care is shaky. Faced with the wreckage left by Andrew Lansley’s infamous 2012 reforms, NHS England introduced STPs because trying to plan services through more than 200 clinical commissioning groups was never going to work.

As demand climbed, funding flatlined in the aftermath of the 2008 crash and managing long-term conditions became the dominant challenge; it was imperative to move from competition to collaboration and set a long-term goal of population health management. That is where accountable care comes in.

STPs and accountable care are operating under legislation meant for clinical commissioning groups – so collaborative systems typically serving 1.2 million people in which local government and all parts of the NHS have a say are underpinned by a legal framework for GP-managed competition overseeing populations of 250,000.

This is such a precarious legal balancing act that the 2017 Conservative manifesto promised to tidy up the legislation and regulations. But introducing an NHS bill now would be political harakiri for Theresa May, and most health service staff would prefer legal ambiguity to yet another round of organisational upheaval that would inevitably follow legislation.

So the choice is to either continue to find legal bodges to allow the NHS to collaborate and plan or – if the high court challenge succeeds – to return to the Lansley dream-turned-nightmare of full-blooded competition.

But although the thinking behind the legal challenge is muddled, that campaign and Labour’s early day motion highlight the major problem: a profound change in the management and leadership of the NHS is being introduced without informed public and parliamentary discussion.

The new approach has many strengths, but introducing it under the radar only serves to feed anxieties and misconceptions about the objective. NHS England needs to get the discussion about accountable care out in the open.”


Honiton Health Matters: a conversation with stakeholders 18 January 2018 9.30-13.30

What an excellent idea! Something for other towns to copy.

“Honiton’s Health Matters – Going Forward Together
Thursday 18th January 2018,
Beehive Main Hall,
9.30 for 10am start – 1.30pm

Book a place here:

Context: This event is the start of a community conversation with key stakeholder organisations around the future health and wellbeing of residents in response to the new landscape affecting Honiton and its environs as a result of NHS and Government policies advocating placed-based health provision and cross-sector collaborative working.

The aim: To discuss what we know, where there are gaps/challenges and how, as a community we will address these to ensure collaborative approaches to co-design and co-produce local health services/activities that meet the needs of all the people in our communities.

Invitees: Management and senior level employees / volunteers / trustees across the public, private, community, voluntary and social enterprise sector.

Ø Professor Em Wilkinson-Brice – Deputy Chief Executive / Chief Nurse RD&E
Ø Dr Simon Kerr – Chair, Eastern Locality New Devon CCG
Ø Julia Cutforth – Community Services Manager, Honiton and Ottery St Mary
Ø Ways2Wellbeing – Social Prescribing, Speaker to be confirmed
Ø Charlotte Hanson – Chief Officer, Action East Devon
Ø Heather Penwarden- Chair, Honiton Hospital League of Friends

Organised by Action East Devon.

Effect of Sustainability and Transformation plans on rural communities – East Devon Tories miss the boat then moan about it!

Motion at today’s EDDC full council meeting.

Recall that EDDC council leader voted AGAINST submitting the Sustainability and Transformation Partnership’s plan to the Secretary of State for Health at the meeting of Devon County Council’s Health Scrutiny Committee AGAINST the wishes of his own district council.

Now, that same district council, whose Tory members absolved him of blame for this act are making a TOKEN fuss about its consequences!

“Motion – The effects on Rural Communities of the Sustainability Transformation Partnership (STP) actions in East Devon

“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”.

Proposer Councillor Mike Allen Seconded by Councillor Ian Hall
Supported by:
Councillor Dean Barrow; Councillor Stuart Hughes; Councillor Brian Bailey; Councillor Mark Williamson; Councillor Mike Howe; Councillor Iain Chubb; Councillor Simon Grundy’; Councillor Graham Godbeer; Councillor Tom Wright; Councillor Jenny Brown”


NHS “Accountable Care Systems” – about money not people

Sustainability and transformation partnerships should tell NHS England if it is “getting in the way”, the HFMA annual conference heard yesterday.

Matthew Style, director of strategic finance at NHS England, encouraged local areas to adopt accountable care systems (ACSs) – which evolve from STPs – where possible.

But, speaking at the conference in London, he added: “I am conscious some things we [NHS England] do make local relationships at a local level more strained.

“We get in the way. You do and should keep us to account on that.”

NHS England was committed to ACSs, he said, and areas that did not have them – if they feel ready – should adopt the principles.

“The finance community has a pivotal role to play to drive forward this agenda,” he added. He advised the audience that any investments they made should “show demonstrably [they] are sustainable as a whole”.

Style also told the conference the Budget package “hasn’t taken away stark challenges we are facing” and that NHS England would not be changing the way fund was allocated next year.

Philip Hammond promised £10bn of capital investment to the health service by 2020 in the Budget last month.

Style also predicted there would be clinical commissioning group mergers in the future.

Bob Alexander, the deputy chief executive and director of resources at NHS Improvement, also addressed the conference. He told delegates they were doing a “tremendous job” but warned there was still a reliance on “non-recurrent stuff”. The Treasury stipulates NHS commissioners set aside 1% uncommitted spending at the start of a financial year as a buffer for ‘non-recurrent’ health economic priorities.

Alexander also warned NHS finance managers not to let “risks hang in the air” and advised: “Some of the best help comes from those colleagues who are a little bit removed from the day to day”.

This was Alexander’s last speech to the conference as he is leaving his role to become chair of Sussex and East Surrey STP next year.”


“Labour demands Commons vote on ‘secret’ plan for NHS”

This is the most dangerous thing to happen to our NHS since the Health and Social Care Act 2012 paved the way for wholesale privatisation. Once this goes through (on the nod as it will with this government) our NHS ceases to exist.

Currently, money in the true NHS stays in it and recirculates. With ACOs first big salaries for ACO staff are creamed off, then boardroom and shareholder dividends of the companies concerned and then the NHS gets cut and rationed – with only high-profit interventions (usually things such as elective surgery which can be costed to the penny) made available.

“Party says ministers are trying to push through changes that could lead to greater privatisation and rationing of care

Denis Campbell Health policy editor

Labour is demanding that MPs be allowed to debate and vote on “secret” plans for the NHS that they claim could lead to greater rationing of care and privatisation of health services.

The party says ministers are trying to push through the creation of “accountable care organisations” (ACOs) without proper parliamentary scrutiny.

Jonathan Ashworth, the shadow health secretary, has written to Andrea Leadsom, the leader of the House of Commons, urging her not to let “the biggest change to our NHS in a decade” go ahead without MPs’ involvement.

NHS England’s chief executive, Simon Stevens, and the government see ACOs as central to far-reaching modernisation plans that they hope will improve patient care, reduce pressure on hospitals and help the NHS stick to its budget.

ACOs involve NHS hospital, mental health, ambulance and community services trusts working much more closely with local councils, using new organisational structures, to improve the health of the population of a wide area. The first ACOs are due to become operational in April in eight areas of England and cover almost 7 million people.

Labour has seized on the fact that the Department of Health plans to amend 10 separate sets of parliamentary regulations that relate to the NHS in order to pave the way legally for the eight ACOs.

In his letter, Ashworth demands that Leadsom grant a debate on the plans before the amended regulations acquire legal force in February.

“Accountable care organisations are potentially the biggest change which will be made to our NHS for a decade. Yet the government have been reluctant to put details of the new arrangements into the public domain. It’s essential that the decision around whether to introduce ACOs into the NHS is taken in public, with a full debate and vote in parliament,” he writes.

A number of “big, unanswered questons” about ACOs remain, despite their imminent arrival in the NHS, he adds. They include how the new organisations will be accountable to the public, what the role of private sector health firms will be and how they will affect NHS staff.

Ashworth also says “the unacceptable secrecy in which these ACOs have been conceived and are being pushed forward is totally contrary to the NHS’s duty to be open, transparent and accountable in its decision-making. The manner in which the government are approaching ACOs, as with sustainability and transformation plans before them, fails that test.”

Stevens’s determination to introduce ACOs has aroused suspicion because they are based on how healthcare is organised in the United States. They came in there in the wake of Obamacare as an attempt to integrate providers of different sorts of healthcare in order to keep patients healthier and avoid them spending time in hospital unnecessarily.

A Commons early day motion (EDM) on ACOs also being tabled by Labour on Thursday, signed by its leader, Jeremy Corbyn, and other frontbenchers, notes that “concerns have been raised that ACOs will encourage and facilitate further private sector involvement in the NHS”.

In his letter Ashworth adds: “There is widespread suspicion that the government are forcing these new changes through in order to fit NHS services to the shrinking budgets imposed from Whitehall.” The EDM also notes “concerns that ACOs could be used as a vehicle for greater rationing”.

The King’s Fund, an influential health thinktank, denied that ACOs would open up NHS services to privatisation. “This is not about privatisation; it is about integration,” said Prof Chris Ham, its chief executive.

“There is a groundswell of support among local health and care leaders for the principle of looking beyond individual services and focusing instead on whatever will have the biggest impact in enabling people to live long, healthy and fulfilling lives,” added Ham.

Dr Chaand Nagpaul, the chair of the British Medical Association, backed Labour’s call for greater transparency but said care services should be integrated.

However, he added: “ACOs will not in themselves address the desperate underfunding of the NHS and may divert more money into processes of reorganisation. Current procurement and competition regulations create the potential for ACOs to be opened up to global private providers within a fixed-term contract and with significant implications for patient services and staff.”

The Department of Health refused to say if MPs would be able to debate ACOs. “It is right that local NHS leaders and clinicians have the autonomy to decide the best solutions to improve care for the patients they know best – but significant local changes must always be subject to public consultation and due legal process.

“It is important to note that ACOs have nothing to do with funding – the NHS will always remain free at the point of use,” a spokesman said.”