Was “smug” Swire responsible for the Seaton/Sidmouth switch?

Owl says: we all know he is a pal of Jeremy Hunt.

Seaton County Councillor Martin Shaw (Independent East Devon Alliance) Facebook page:

“Was Hugo Swire behind the Seaton-Sidmouth switch? A smug Swire told BBC’s Sunday Politics this morning that East Devon had more community hospitals than western Devon and than the national average. He failed to mention that it has many more over-85s too. He backed the NEW Devon CCG’s plans to replace community hospital beds with care at home, and said we must ’embrace change’.

Swire knows that beds in Exmouth and Sidmouth, in his constituency, are safe from closure. So he is happy to write off Seaton (which he no longer represents after boundary changes a few years back) and Honiton.
Swire’s self-satisfied comments raise the question of whether he played any role in the CCG’s bizarre, unexplained, last-minute switch of 24 beds from Seaton to Sidmouth. Clearly had the CCG stuck with its original preferred option of closing beds in Sidmouth, they would have given Claire Wright a huge issue – which might well have seen her taking Swire’s seat in the general election.

Readers will recall that during the consultation, Swire was already saying that if beds had to go, they should stay in Sidmouth. Did Sir Hugo, or Tories acting on his behalf, lobby the CCG? How did the CCG respond?
Swire’s colleague Neil Parish MP told me and other Seaton councillors that the decision ‘smells’. Whose smell was it?

I appeared on the same edition of Sunday Politics as Swire, but was not in the studio to respond to him. Here I am being interviewed! (YOU WILL BE ABLE WATCH THE FULL PROGRAMME ON BBC iPLAYER SOON.)”

“Staffing crisis leaves NHS on brink of another Mid Staffs disaster, nurses warn”

“Nurses are warning Theresa May that dire staffing shortages have left the NHS on the brink of another Mid Staffs hospital scandal, putting hundreds of lives at risk.

Royal College of Nursing chief executive Janet Davies said the Government has failed to respond to clear and alarming signals that the tragedy she called “inevitable” is about to happen again.

In an exclusive interview with The Independent, Ms Davies pointed to a perfect storm of collapsing foreign arrivals in the profession due to Brexit, plummeting domestic applications, and chronic low pay and high stress pushing people out.

NHS leak reveals ‘shocking’ secret plans for cuts in London hospitals
She said the RCN’s national day of action this week, kicking off a summer of lobbying, is a “final warning” to ministers to take action or face its nurses striking for the first time ever.

The Independent also revealed on Saturday how the number of GPs seeking specialist help for substance abuse and mental health problems is “increasing day on day”, amid fears the NHS is coming apart at the seams.

In the wake of the Conservatives’ failure to win a Commons majority in the election, even Tory backbenchers have been calling for a new approach to a public sector strangled by cuts.

Ms Davies said the long warned-of crisis in nursing, exacerbated by the Government’s approach, has now become so acute that the NHS is in grave danger of suffering another catastrophe on the scale of Mid Staffs.

She went on: “They are risking it again. They are aware of the problem, but their solutions are not working.”

A Government failure to properly heed warnings is already in the spotlight following the Grenfell Tower fire, with ministers having neglected to implement a long called-for safety review that experts say could have helped prevent the blaze that has so far claimed 79 lives.

The RCN reports that there should be 340,000 nurses in the system to make sure patients are safe according to official standards, but one in nine posts – some 40,000 – are unfilled. In some areas of the country it is one in three.

The shortage is likely to worsen as the foreign staffing the NHS depends on has fallen off a cliff since the country’s referendum to quit the European Union.

Official data shows an enormous 95 per cent drop in EU nurses registering since the vote. In July last year 1,304 came – in April this year, just 46.

Ms Davies said: “All around the country we have been very dependent on recruiting people from Europe, but also from the wider world. The NHS has never been without international recruitment.”

She points to the uncertainty created by Brexit and the poor conditions for nurses in the UK contributing to the collapse in numbers.

“We do know that people aren’t applying, the figures just aren’t there. There has been a 95 per cent reduction,” she said.

“People are not applying to come to the UK, because when they did apply they were not coming just for a job, they were coming for a career.

“Nursing is not just a fill-in job.”

The other source of new talent, people coming through UK nursing courses, has also been hit as 2017 marks the first year undergraduates will have to pay tuition fees rising to £9,000.

Official figures are yet to confirm the exact number of would-be nurses starting in September, but data from UCAS points to a 23 per cent reduction on last year.

In new applicants above the age of 25, who bring vital life experience and more often work in the community, where ministers want more care to take place, it is a 26 per cent drop.

Ms Davies said: “My conversation with some universities show a significant drop in applications in some areas.

“I’ve heard from individual universities that in some places they have as few as three people applying. It is pretty dramatic.”

With a tightening on the number of new nurses ahead, it is vital to hold on to those already in a system that Ms Davies says is at breaking point.

Nurses have not seen any sort of pay rise for the best part of a decade, with wages first frozen and then capped at a below-inflation 1 per cent. This year the cap will mean nurses losing £3,000 in real terms, she says.

The RCN reports its members taking on second jobs to make ends meet, including a window-cleaning round and working shifts in a supermarket.

Those who continue are on understaffed shifts, tired, facing more work than they can handle, and with their mental health under pressure, Ms Davies explains.

The strain is showing elsewhere in the NHS too, with referrals to the GP Health Service surpassing expectations since its launch in late January, while medics in all fields are seeking help “in escalating numbers” according to Clare Gerada, former chair of the Royal College of GPs.

Dr Gerada told The Independent stress and burn-out faced by family doctors with increasingly heavy workloads means GPs developing severe depression and anxiety, with some turning to alcohol and substance misuse to cope with the pressure.

The BMA warned earlier this year that two in every five GPs are planning to quit the NHS amid a crisis of “perilously” low morale.

Ms Davies went on: “It’s not being able to do the things that they know they would want to do in their heart, that makes nurses go off their shift crying.

“Lifting a cap on pay and paying people a living pay rise, would make a huge difference.”

In criticism aimed directly at the Prime Minister, she said a “shockwave” had coursed through the profession when Ms May responded to a nurse worried about making ends meet, not with a thought-out answer, but with a campaign slogan, telling her there is “no magic money tree”.

She said: “It was the most insulting thing I have heard for a long time – the idea that the nurse doesn’t understand economics.

She added: “We understand the problem. The question that has to be asked is how much do we want to fund our health service?”

The day of action will see protests across the country on Tuesday aimed at raising awareness of the crisis, with the specific message to Ms May’s government that it is a “final warning”.

Ms Davies said: “This is nurses saying I’m going to leave this profession if nothing changes. This is a last chance. No matter what we’ve been saying, no matter what our organisation has been doing, it hasn’t made any difference.

“We are really going to try and get this cap lifted and try get them to see the effect this is having. If they don’t then that is when we have said we will go to a ballot.

“It’s the last thing that nurses want to do – go on strike. Our members have never been on strike, but they are stuck for what more they can do.”

She explained that a strike would not mean a mass walkout and that the RCN’s constitution does not allow the body to do anything that would harm patients.

It is more likely that action would target specific settings and could cause delays in non-emergency care. When junior doctors first went on strike they continued to provide cover in settings that provide life or death care, such as A&E, intensive care, maternity services, acute medicine and emergency surgery.

A Department of Health spokesperson said: “NHS nurses do a fantastic job in delivering world class patient care and their welfare is a top priority for this Government.

“That’s why we have 12,100 more on our wards since 2010 and 52,000 in training. The Prime Minister also said last week that we want to give EU nationals the same rights as British citizens going forward.”


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 – https://devoncc.public-i.tv/core/portal/webcast_interactive/288543

Here are the agenda papers – http://democracy.devon.gov.uk/documents/g2581/Public%20reports%20pack%2019th-Jun-2017%2014.15%20Health%20and%20Adult%20Care%20Scrutiny%20Committee.pdf?T=10

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.”


STPs may not be introduced till after Brexit – but are ‘Success Regimes’ similarly doomed or not?

Owl has had to resort to CAPITALS it is so mad!







What Hunt said yesterday:

“Given the result of the latest general election and with the negotiations around Brexit due to start later this month, it is now unlikely that the government will be able to introduce legislation for sustainability and transformation plans (STPs) in the next few years – if at all.

Speaking at NHS Confederation yesterday, health secretary Jeremy Hunt argued that the legislative landscape has changed after a hung Parliament was declared last week. Because of this, it is unrealistic to expect the government to enact legislative health changes before the Brexit process is finished.

“We said [in our manifesto] that we would legislate to give STPs a statutory underpinning if that was felt to be necessary,” he said. “To be clear, we’re expecting to be in power until 2022 and deliver a stable government to make that possible.

“But obviously, the legislative landscape has changed, and that means that legislation of this nature is only going to be possible if there is a consensus across all political parties that it’s necessary. I don’t think that is in any way impossible, but it’s realistically not something we would do while the Brexit process was carrying on.”

Post-Brexit, he added, the government will have “a lot better understanding” of the legislative changes required by STPs. But even then, changing the law would require cross-party support – a much greater challenge now that the Conservatives no longer hold the majority in the House of Commons.

Responding to audience questions after his keynote speech, Hunt – who survived Theresa May’s recent political reshuffle – also hinted that the NHS could be in line to receive some more transformation funding.

Asked by a West Hampshire GP about the possibility of supporting transformation with ringfenced investment in order to enable new models of care elsewhere in the country, the health secretary argued “that is what the STP plans are about”.

But the biggest risk to pouring in more capital funding, he noted, is “if we don’t maintain the financial rigour and discipline that we started to see coming back into the system in the last year”.

“That was really what slowed down this process in the 2015-16 financial year, when we would’ve liked to put a lot more money into transformation,” the health secretary said. “But I think now we’re in a much, much better position to do that. We absolutely want to make sure that money is not an impediment to the rolling out of the STPs, because they are central to our vision.”

In fact, the recent NHS response to the horrific terrorist attack in Manchester, which saw staff working around the clock to cope with the unexpected demand, is a “very good reason for exactly what we’re trying to achieve with the STP process”, Hunt argued.

“The interesting lesson for me about the response in Manchester was how joined-up it was as a result of the terrific progress, under Jon Rouse’s leadership, that trusts have made in coming together as part of their STP,” he added. “I think they’ve probably gone further and faster than anywhere else in the country. I know it’s not been easy to do that, but it was extremely streamlined and effective.”

He also suggested that the government would be prepared to boost the region’s cash pot “if there are specific aspects of the response to those terrible events where there have been unexpected costs that the NHS incurred that wouldn’t be part of its normal response to emergency situations”.

STPs need local support
Asked by another audience member to explain the importance of bringing all local communities together into designing and delivering change, Hunt emphasised that the reasoning behind STPs is to bring about “fantastically beneficial” changes for patients.

“It’s a transformation that is wholly positive for the public,” the secretary of state said. “But people are passionate about their NHS and they obviously worry about any change that happens, and that’s why we have a responsibility to communicate that change. And that change is usually best not communicated by politicians, but by clinicians, because frankly you guys are trusted a lot more than we are.

“That’s why I think it’s really important to have that local engagement, and that’s why, when it comes to the big transformation plans, Simon Stevens and I are supporting them with every fibre in our bodies at a national level.
“But at a local level, we need you to be making the arguments. The evidence is that when you do that, even with potentially controversial changes, it’s quite possible to win the case to do them. But it does involve a lot of local engagement and I think that’s going to be one of the central challenges for the next few years.”