What Swire’s mate Heffer thinks of local authorities

Just before the last general election, Swire made one of his very rare appearances at what he called a “hustings” in Exmouth. Except no other parties were invited to participate and his one guest was Telegraph journalist Simon Heffer.

In today’s Sunday Telegraph Heffer calls for privatisation of everything that currently makes any semblance of profit, or which might make profits in future, and hiving off the loss-making tasks to unitary authorities or, in our case, the unelected, unaccountable and opaque business-run Local Enterprise Partnership.

Oh to be a fly on the wall when Swire and Heffer have their fireside chats …

He says:

“… There is too much local government. Pointy-headed theorists have banged on about localism, but all that is missing is evidence that “local” people are either capable or motivated enough to deliver “local” services. The best way to deliver “localism” is to take councils out of the equation altogether, as has been done in many cases by removing schools from their control. …

But local government will not work well until it is stripped of duties that individuals or the private sector can provide for themselves: which brings us back to social care … the government must … develop an insurance scheme that will encourage private providers to take over what threatens to become a crippling state responsibility …”

Sunday Telegraph, Sunday Comment, page 16

Unfortunately Mr Heffer neglects to explain how private providers, with shareholders mouths to feed, will be able to do it more cheaply.

North Somerset grabs cash for care homes – London Borough of Westminster doesn’t

“F​amilies are facing a care funding lottery as new figures reveal wide variations in the lengths to which councils will go to stop people giving away assets in an attempt to make the state pay instead.

Local authorities means-test residents of care homes to check if they should pay towards their costs.

The cut off point is £23,250 – if you have assets above this figure you are expected to fund your own care. If your assets are worth less than £23,250 the council will help to meet the costs. Average nursing home costs reached £1,000 for “self-funders” earlier this year.

The spiralling cost of care has created an incentive for families to give away property, investments and savings to bring their assets below the £23,250 limit.

Councils have powers to claw back money from people it can prove to have “deliberately deprived” themselves of assets to claim state aid. Yet it has long been suspected that they find it nearly impossible to prove that someone has given assets away deliberately to dodge care costs.

Giving to children and grandchildren as a way to limit inheritance tax bills has become increasingly common. High house prices and buoyant stock markets have increased families’ wealth, while the headline amount you can pass on tax free has not been increased for nearly a decade.

A series of Freedom of Information requests submitted by Telegraph Money has uncovered how often councils use their powers and the amounts they have managed to claw back.

Of the eight local authorities approached, North Somerset council, whose jurisdiction includes Weston-super-Mare and the outskirts of Bristol, had used its powers the most. Since 2012 it recorded 64 “deprivation” cases in relation to care funding. The total value of assets involved in the cases was £1.3m.

By contrast, the London borough of Westminster had no recorded cases. This is despite the area having a similar population to North Somerset, at around 200,000, and a similar proportion of elderly residents.

Likewise Southwark, which covers a large part of south-east London, had not used its powers at all. The north London borough of Camden had the second-highest number of cases, at 14, with a total value of £158,000 over five years. Liverpool and Hertfordshire councils refused to provide figures on the grounds of cost, while Nottingham City Council said it did not keep relevant records.

Steven Cameron, a care expert at Aegon, the insurer, warned that greater scrutiny of the sector meant individuals who attempted to dodge care fees were increasingly likely to be caught by councils.

“A few years ago it was highly unlikely that a council would have paid much attention to people who gave away assets to avoid paying,” he said. “But with the care crisis getting worse daily and with more public interest in getting out of paying for care by giving away assets, the attention councils will pay is certain to increase considerably.”

Councils also take action that may not be reflected by official statistics, said Tracy Ashby a specialist legacy planner at Thursfields, the law firm.

She has seen cases in the West Midlands where instead of trying to claw back funds from families, councils simply cut off funding for care. Care homes are then left to pursue families themselves and in some cases have sought to evict patients, Ms Ashby said.

The “dementia tax” Telegraph Money has reported extensively on the anomalies of the care funding system.

Self-funding patients effectively subsidise those funded by councils, which set strict limits on the fees they are prepared to pay. This leaves homes in areas with few private customers battling to stay open.

The Conservatives’ radical plans for reforming the care system have been blamed for the party’s disastrous showing in the general election. Under the plan, councils would have started to pick up the tab for care costs once a person’s assets fell below £100,000, as opposed to the current level of £23,250 in England.

But, crucially, family homes would also have been included in the means-testing formula for “at home” care for the first time.

At the same time, the plan for a lifetime cap – which would have helped those who needed long periods of care – was dropped. The Tories quickly backtracked over the latter, which Labour called the “dementia tax”.

http://www.telegraph.co.uk/money/consumer-affairs/councils-failing-stop-people-giving-away-cash-dodge-care-home/

Doctors wake up to consequences of STP plans which have already closed most East Devon community hospitals

BUT DOCTORS – IT’S BEEN HAPPENING UNDER YOUR NOSES FOR MONTHS AND MONTHS!

Almost two in three senior doctors fear a controversial NHS shake-up that will downgrade or close dozens of hospital units will damage the care patients receive. The hospital consultants fear the sustainability and transformation plans (STPs) will lead to staff losing their jobs, will exacerbate workforce shortages and will act as a cover for cuts to services.

Of 450 hospital clinicians surveyed by the Hospital Consultants and Specialists Association (HCSA), 42% believe that STPs will have a “negative impact” on patient care. Barely one in 10 consultants who belong to the union expect a “positive impact”.

Three in four (77%) fear STPs are a way of making cuts to the NHS, while just over half (56%) fear they will lead to job losses and worse understaffing. …

“Many hospital doctors see STPs as a managerially driven process with no real clinical basis, and fear that a mix of underfunding, under-resourcing and service rationalisation can only damage patient care,” said Eddie Saville, the HCSA’s chief executive.

“This is, in effect, yet again an NHS reorganisation, but region by region, with management trying to plug the financial gaps rather than putting high-quality care of patients at the forefront. The fact that STPs are being planned against a backdrop of underfunding and cuts has led many doctors to conclude that this transformation programme is purely an attempt to mask further cutbacks.”

The Local Government Association, which represents local councils, criticised STPs as “secretive, opaque and top-down” reforms that would fail patients. …”

https://www.theguardian.com/society/2017/sep/09/nhs-hospital-reforms-closures-job-losses

DUH – where have some of these doctors been this last 2 years?

Budleigh “well being” hub has to have minibus to collect patients – but only from the “nine parishes” that contributed to it

Good for those people who have raised their own money for this service. Perhaps the CCG can now provide dedicated buses from the proceeds of the sale of assets from rest of East Devon, where Leagues of Friends also tirelessly continue to raise funds for their bedless hospitals, for similar buses to other “health hubs” or to the two remaining community hospitals in Sidmouth and Exmouth – otherwise those people outside the “nine parishes” will have an inequality of service.

And Owl loves the optimism of the last sentence: “When phone lines are established at the hub, residents will be able to ring up and arrange for the bus to collect them.” Anyone who has ever tried to maintain a rota for such a service and who has had to prioritise how such a service is funded, maintained and accessed will understand Owl’s qualms when the private company running the hub starts to make the executive decisions about who uses it and when.

“New community mini bus will help transport people to new health and wellbeing hub

A ‘ring and ride’ bus which will transport residents to the new Budleigh Salterton Health and Wellbeing Hub has officially been handed over.

The bus was purchased two years ago following an cash injection of more than £20,000 from the Parishes Together Fund.

Now, the bus will give residents in the nine parishes that contributed towards that initial cost transport, a form of transport to the former hospital. It will also allow people in the Budleigh area to get transport to Exmouth Hospital for appointments.

That includes Budleigh Salterton, Colaton Raleigh, Otterton, East Budleigh with Bicton, Exmouth and Lympstone.

Dr David Evans, chairman of Budleigh Salterton Hospital League of Friends, said: “The Hub Bus and local transport is of immense importance to the Budleigh Salterton Community Hospital Health and Wellbeing Hub.”

The tail-lift minibus will be kept at the hub in what used to an ambulance bay.

The running costs of the bus will be shared between Budleigh Hospital League of Friends and their Exmouth counterparts and the bus will be managed by Westbank Community Health, which has the lease of the new hub.

Hub project manager Rob Jones added: “What we wanted to try and do is to reduce worry about not being able to get to the hub.”

Dr Evans also revealed that a grand opening of the new health and wellbeing hub is due to take place this November.

He added: “The contractors have now finished the refurbishment of the hospital and moved out last week.

“They have completed an excellent assignment and the result is absolutely superb.

“It is desirable that the hub is fully functional for the grand opening in very early November.

“This will show what can be done when a community hospital faces closure.”

Furniture and fittings funded by the League of Friends are due to be introduced in the next month with services being phased in during September and October.

Royal Devon and Exeter Hospital is due to move some its services into the hub next month.

When phone lines are established at the hub, residents will be able to ring up and arrange for the bus to collect them.”

http://www.exmouthjournal.co.uk/news/budleigh-salterton-hub-bus-handed-over-1-5183505

“The Conservatives’ solution for unaffordable care? No care”

“Seventy thousand older people with complex needs left to fend for themselves: Tory apathy on social care funding could turn a crisis into a catastrophe

• Barbara Keeley, Labour MP for Worsley and Eccles South, is shadow minister for social care and mental health

“Despite evidence that life expectancy may be stagnating, the century-long rise should be a cause for celebration. However, for too many people – unsure whether they will be able to afford the care they may need or to plan for the future – their later years are proving to be a time of fear and uncertainty.

Now we learn there will be insufficient care home places, even if people could afford them: 71,000 more care home beds will be required within eight years – according to a Newcastle University study – to meet the demands of an ageing population living longer, with complex care needs. But there is little hope that these places will materialise.

Residential and nursing homes are already under unprecedented pressure. By the end of this financial year, £6.3bn will have been cut from social care budgets since 2010, with local authorities facing a £2.3bn care funding gap by 2020. These severe cuts, along with rising costs and problems of retaining and recruiting staff, mean that one in six care homes is now displaying signs of financial stress, and across England residential homes are closing.

And in the coming months, the signs are that things will get worse. The Association of Directors of Adult Social Services has reported that councils will have to cut social care budgets by a further £824m this financial year alone – meaning fewer older people getting the help they need with basic tasks such as washing, dressing and eating.

The Conservatives’ policy of cutting funding and leaving people to fend for themselves is simply not working. It has left us with 1.2 million older people living with unmet care needs, one in 10 facing catastrophic costs, and relatives forced to give up work to look after them. Although the Tories backed down from their “dementia tax” plans, more than 70% of people in residential care have dementia, and they face the highest care costs.

These harsh realities are brought home through the many cases I hear about, both in my constituency and in parliament. Cases like the woman whose homecare was cut suddenly from 10 hours a week to nothing. Her son had to step in to care for her, risking his job, which financially supported them both. Or the elderly people left without food or help with bathing when care staff did not turn up.

If this apathy towards the social care crisis continues, there is a risk not only of insufficient care beds, but of serious care failures.

In Labour’s manifesto, we set out comprehensive plans to tackle the short-term funding gap in social care, promising £1bn this year and £8bn over this parliament to stabilise the sector. This would enable us to close the funding gap, implement a living wage for care workers and enable an extra 36,000 people with high levels of need to receive publicly funded social care.

But we also recognised the need for a long-term funding solution to meet the needs of an ageing population. Labour’s national care service would be based on the principle of pooling risks, so that no one is left to face catastrophic care costs alone. A care cap would ensure those unlucky enough to develop conditions like dementia would not be penalised for doing so. And we would raise the asset threshold, so that no one loses everything they own, as well as introducing free end of life care.

Enough is enough. This government has had ample wake-up calls. Now it must give social care the funding it needs and develop a long-term plan to put the sector on a sustainable footing – so that today’s generation of older people and those to come get the care they need and deserve.”

https://www.theguardian.com/commentisfree/2017/aug/17/conservative-solution-unaffordable-care-crisis

Oxfordshire unites to fight for its community beds services – unlike Diviani and Randall-Johnson in Devon

Owl says: alas it doesn’t matter one jot what our district, town or parish councils think about the removal of community hospitals in general and removal of Honiton’s maternity services specifically, since the majority party cannot even trust their own Leader of our district council – Paul Diviani – to represent them.

(One more reason to turn up at Knowle on 13 September 2017 and watch those cowardly Tory councillors rally round him and turn out in numbers to overturn a vote of no confidence in him – even though it was THEIR confidence that he sabotaged at DCC when he voted against their instructions to refer bed closures to the Secretary of State- at the notorious scrutiny meeting where Sarah Randall-Johnson ensured that no contrary voices would be heard – only those echoing their Tory masters. Diviani being one of those enthusiastic voices.

“Campaigners backed by four councils have won the first round of their legal action over a claim that a consultation over changes at Horton General Hospital was flawed.

They want to prevent plans by Oxfordshire Clinical Commissioning Group (CCG) to downgrade maternity and critical care services at the hospital in Banbury.

Their campaign has been supported by nearby councils: Cherwell District Council, South Northamptonshire Council, Stratford-on-Avon District Council and Banbury Town Council.

A statement from barristers at Landmark Chambers said: “Campaign group Keep the Horton General has won an important first step in the battle against the downgrading of Horton Hospital.

“Fraser J today granted permission to apply for judicial review of the consultation process.”

The Administrative Court in July refused on the papers permission for a full hearing, but Cherwell successfully challenged that decision this week.
Oxfordshire CCG said last month that its proposed changes would “ensure safety, quality and better outcomes for patients”.

It said the critical care unit at Horton would be downgraded to cater only for less seriously ill patients and it would also lose some beds.

A single specialist obstetric unit would be created at Oxford’s John Radcliffe Hospital and only a midwife service would remain at Horton, though it would gain an improved diagnostic and outpatient service.

A CCG spokesperson said: “We are fully aware of the outcome of today’s oral hearing seeking permission for a judicial review and will co-operate with the process as appropriate.”

“NHS warns of ‘dangerous’ beds shortage this winter”

“Patients could die this winter because the NHS is alarmingly unprepared to deal with the surge of people who fall ill during the cold weather, hospital bosses warn today.

NHS Providers, which represents hospital trusts in England, fears lives could be lost because patients are being forced to spend long periods waiting in ambulances outside A&E, or on trolleys.

Hospitals are so “dangerously short” of beds that they may be unable to cope with the coming winter, Chris Hopson, the organisation’s chief executive, told the Observer. They will struggle even more than last winter – when chaotic scenes led the Red Cross to call the situation “a humanitarian crisis” – because a £1bn government initiative intended to free 2,000-3,000 beds by September has failed, he added.

That scheme aimed to reduce the proportion of beds occupied by patients who are fit to be discharged but cannot leave – called “delayed transfers of care” – to 3.5% of all beds by this month. It was 5.6% of beds at the end of 2016 and still 5.2% at the end of June, NHS figures show.

“That 3.5% target is going to be missed,” Hopson said. “Therefore, hospitals this winter will still be too full of people whom we can’t discharge, even though they are medically fit to leave, because of problems with social care. Failure to do so leaves us dangerously short of capacity.

“That means that it could be even worse than last year, when there were far too many patients waiting more than 12 hours on a trolley or in the back of an ambulance to be seen. We were running much greater levels of risk to patient safety than we had had for at least a decade and we don’t want to see that level of risk again.”

Hopson added: “If that does happen, it could result in patients having dreadful experiences. If people are ill, they need to be seen quickly or their condition gets worse or ultimately they die prematurely. Waiting unduly long can mean patients getting much iller than they should be and dying when they don’t need to.”

A new NHS Providers report details its concerns about winter.

In an online commentary for the Observer, Hopson writes that, despite efforts by the NHS nationally to plan for the cold spell ahead, “NHS trusts are worried that they do not have enough staff, beds and other services to manage the risk to patient safety this winter”.

The warning comes as some hospitals continue to struggle with the number of patients seeking help, even though winter is months away. Last Thursday the NHS trust which runs Royal Stoke University Hospital and County Hospital in Stafford asked people to stay away from their A&E units, except in a genuine emergency, to help reduce the “extreme pressures” on the units.

“Currently, both sites are experiencing the type of demand usually only see in the middle of winter, so people are experiencing long waits and our staff are exceptionally busy. Please only attend A&E Departments for anything classed as an emergency including choking, chest pain, loss of consciousness, severe blood loss, broken bones, difficulty breathing, deep wounds or a suspected stroke,” it said.

On Friday, Gavin Boyle, the chief executive of Derby Teaching Hospitals NHS Foundation Trust, wrote in his blog: “Without wanting to come over all Game of Thrones, winter is coming! For many working in our hospitals, it feels as though winter never went away and indeed August was one of our busiest months for emergency admissions.”

Also last week, University Hospitals of Leicester Trust put in place plans to improve its poor performance against the four-hour A&E target before the start of winter. These include increasing the number of doctors working overnight in A&E, a daily “safety huddle” of senior doctors, ensuring full staffing and managers monitoring how quickly the emergency department is processing patients.

Two trust bosses said that their hospitals are already facing major problems, especially because of staff shortages. “The first quarter of this year [2017-18] has been as challenging as any I can remember; there has been no let-up. Acuity, attendances and admissions have all stayed high,” said Nick Hulme, chief executive of Colchester Hospital University Foundation NHS Trust. “Our major concern going into this winter is staffing. Going into August we are 50 junior doctors short on our rotas across the hospital. Every day is a constant struggle for junior doctors and registered nurses.”

John Lawlor, his counterpart at the Northumberland, Tyne and Wear Mental Health Trust, said itsinability to arrange packages of care to enable patients to be discharged, resulting in beds being occupied unnecessarily, was “a significant concern. [In addition] pressures on staffing, especially in psychiatry, are beginning to impact on services and these will become more intense until the new people trained begin to come on stream over the next five to 10 years.”

The health service regulator NHS Improvement warned that hospitals had experienced “extremely high levels of bed occupancy” during April, May and June, despite those usually being the service’s quietest months. The regulator said it doubted that the plan for hospitals to return to treating the required 95% of A&E patients within four hours by the end of 2017 would succeed.

NHS England admitted that this winter would be tough, and revealed that hospitals were already planning to open at least 3,000 beds, which should help manage demand and minimise the risks to patients.

“The NHS will face challenges this winter, as it does every year, but NHS Providers have stated that winter planning is more advanced than it was last year and – as they argue – special attention is being paid to areas where pressures are likely to be greatest,” said Pauline Philip, NHSE’s national urgent and emergency care director.

“We are currently in the process of assessing how many extra beds trusts are planning to open over winter and early returns indicate that this will be more than 3,000. This is something we will continue to review on the basis of evidence rather than arbitrary estimates. If the expectations for reduced delayed transfers of care outlined by the government are achieved, this would free up a further 2,000 to 3,000 beds over the winter period, on top of the extra 3,000 plus beds that hospitals now say they’re going to open.”

The Department of Health was more upbeat about winter. “Thanks to the hard work and dedication of staff, alongside record levels of funding to ease pressure on A&E departments, the NHS has prepared for winter more this year than ever before, ensuring patients continue to receive safe and efficient care as demand increases,” a spokesperson said.

“As new expert analysis shows, spending on the NHS is in line with other European countries, and once again our health service was independently judged to be the best and most efficient health system in the world.”

https://www.theguardian.com/society/2017/sep/02/nhs-warns-of-dangerous-beds-shortage-this-winter

Councillor calls for Randall-Johnson resignation

PRESS RELEASE

Devon County Council’s Health and Adult Care Scrutiny Chair, Councillor Sara Randall Johnson, should immediately consider her position following the stinging rebuke issued to her by the Council’s Standards Committee. The Council should also act to restore the credibility of Health Scrutiny, since its failure to fully scrutinise the removal community hospital beds in Honiton, Okehampton and Seaton has destroyed public confidence in its activities across a large swathe of Devon.

At its meeting on 29 August, minutes of which are published today, the Standards Committee agreed that while Cllr Randall Johnson had not broken the Members’ Code of Conduct, she should ‘be strongly reminded of the importance of the work of scrutiny committees – reinforcing the value of neutrality in scrutiny both generally and in calling the “health service” to account – and the need to be seen to be even handed and scrupulously fair, recognising that failure to do so may be perceived as a deliberate act.’

The call for a Scrutiny Chair to ‘be strongly reminded of the importance of the work’ of her committee, and of the value of neutrality and being seen to be even-handed and fair, is unprecedented and should lead Cllr Randall Johnson to immediately consider her position. There is no public confidence that she will lead the committee to carry out full and impartial scrutiny of NHS decision-making.

The Standards Committee also ‘accepts that the events of the Health and Adult Care Scrutiny Committee meeting on 25 July 2017 may not reflect well on individual Members or upon the Council as a whole, and further recognises that the perception gained by persons present at the meeting or subsequently viewing the webcast is not that which would have been desired’.

This stark acknowledgement of the damage done to Devon County Council’s reputation also requires early action by the Council to reassure the public that the Committee will do its job properly in future and protect the NHS in Devon.

The Scrutiny Committee ignored the views of local communities and their representatives and has allowed the CCG to get away with damaging cuts. The Council must now consider how to restore people’s faith that it will protect all our community hospitals in the future. I shall ensure that this is discussed when the Council meets on 5th October.

Martin Shaw
Independent East Devon Alliance County Councillor for Seaton & Colyton”

“Nine in 10 MPs don’t believe UK’s social care system is fit for purpose”

And Owl thinks the other 1 in 10 are self-serving idiots – one of whom is Jeremy Hunt.

“Only 10 per cent believe pensioners needing help to stay living in their own homes are well served, found the poll of 101 English parliamentarians.

Just 13 per cent of Labour MPs and 35 per cent of Conservative MPs say social care services in their constituencies are up to scratch.

“Confidence that the social care system can deal with the UK’s ageing population has virtually evaporated among parliamentarians,” said Janet Morrison, chief executive of Independent Age, which carried out the research.

“The crisis in social care was front and centre in the election earlier this year, and it is clear from this poll that there is an overwhelming desire from politicians on all sides for the Government to work towards a cross-party consensus on a solution.”

Former Lib Dem health minister in the coalition government Norman Lamb said: “The health and care system in England is creaking at the seams.

“An unprecedented number of older people need support in later life but are finding high-quality care is hard to come by.

“Without lasting reform, the most vulnerable frail and elderly people are at real risk of falling through the gaps and not getting the support they expect and deserve.”

The Government has pledged an extra £2bn for social care over the next few years but it is only one-off funding which reduces each year.

Vital services caring for elderly and disabled people still face an annual £2.3bn funding gap by 2020, which will continue to grow, according to the Local Government Association.

Izzi Seccombe, chairwoman of the LGA’s community wellbeing board, said: “It’s encouraging to see so many MPs across all political parties recognising the need for action to find a sustainable solution to the adult social care funding crisis.”

Margaret Willcox, of the Association of Directors of Adult Social Services, said: “Older and disabled people and their families need and deserve high quality, reliable and personal care.

“For this to happen, and with MPs returning to Parliament next week, government needs to address adult social care as a priority so it can be future-proofed for people who will continue to need care and support in increasing numbers.”

The poll of more than 2,000 British adults also found that many under-estimate the cost of social care.

On average, UK adults estimate that residential care would cost £549 a week – when in reality it costs on average £866 for a place in a nursing home, the Centre said.

Meanwhile, another poll carried out by carehome.co.uk found that four in 10 of care home residents do not receive regular visits from friends and family.

A total of 1,154 care home owners, managers and staff were asked to estimate the percentage of residents that do not receive regular visits, with 42 per cent being the average figure given.

A Department of Health spokeswoman said: “This Government is absolutely committed to improving social care in this country, which is why we have provided an additional £2bn for the sector, introduced tougher inspections to keep driving up standards and committed to consult on the future of social care to ensure sustainability in the long term.”

http://www.express.co.uk/news/uk/847814/MPs-dont-believe-UKs-social-care-system-fit-purpose

More on that Diviani “No Confidence” vote

http://www.devonlive.com/news/devon-news/calls-made-east-devon-council-399289

REMEMBER:

A vote AGAINST means the councillor involved supports the decision to close community hospital beds and agrees that the EDDC vote to keep them open counted for nothing – party before people.

An ABSTENTION is as good as a vote AGAINST but means that the councillor involved wants to pretend it doesn’t – still party before people.

A councillor ducking the meeting without a very good reason is AGAINST the motion AND a coward and a disgrace to his or her community.

And remember too their votes in subsequent elections when YOU vote for what is important in East Devon.

A chance to show Diviani exactly what you think of him for destroying our community hospital beds

Remember, anyone who votes AGAINST this motion, or ABSTAINS or is not at the meeting for spurious reasons, is guilty of destroying our local health service and killing off Axminster, Ottery, Seaton, Budleigh and Honiton community hospital beds – and cares not one jot what you may think.

“13 September 6pm, EDDC extraordinary meeting:

Motion – Vote of no confidence in the Leader

“On Tuesday 25th July 2017, Cllr Diviani chose not to represent the opinions of this Council or the people we represent at the DCC Health and Adult Care Scrutiny Committee meeting when he was clearly expected to do so. This Council no longer has confidence in Cllr Diviani’s commitment to represent our collective interests nor lead our East Devon communities as the figurehead for local government. We call for his resignation.’

Proposed by Councillor Ben Ingham, seconded by Councillor Val Ranger and supported by Councillors Cathy Gardner, Matt Coppell, Marianne Rixson, Rob Longhurst, Dawn Manley, Geoff Jung, Peter Faithfull, Susie Bond, Roger Giles, Matt Booth, Peter Burrows, Steve Gazzard, Megan Armstrong and Douglas Hull.”

Please attend to show how you feel and speak if you want to.”

Source: East Devon Alliance, Facebook

Honiton Hospital beds closed – motion of “no confidence” in EDDC Leader 13 September 2017 6pm

Susie Bond, EDDC Independent Councillor, Feniton reports”

“This morning I attended a vigil outside Honiton Community Hospital. It was called to mark the end of inpatient care in the town. It was a sad day, as it now means that there are no inpatient beds in the hospitals in Seaton, Axminster, Honiton and Ottery St Mary.

I wasn’t sure what to expect … it’s a Bank Holiday and the weather was glorious … so I half expected to be there with just a handful of people.

I was wrong.

The event had been organised by Honiton Patients’ Action Group … a well-organised and furious bunch of people.

A group of about 50 turned up, armed to the teeth with placards, happy to vent their feelings to the local press about the parlous state of future community health provision.

Among those present this morning was Cllr Martin Shaw (county councillor for Seaton and Colyton) who spoke about his grave concerns for health provision. He had also addressed Devon County Council’s Scrutiny Committee meeting in July (https://seatonmatters.org/2017/07/26/the-health-scrutiny-committee-which-didnt-scrutinise/).

The decision to close the inpatient beds in Honiton had not been the subject of public consultation, so those present felt that this was sufficient cause for Devon County Council’s Health and Adult Care Scrutiny Committee to refer the decision to close the hospital beds to the Secretary of State, Jeremy Hunt. In turn, he would have had to refer the decision to the Independent Reconfiguration Panel (which describes itself as ‘the independent expert on NHS service change’).

Had that decision been made at their July meeting (https://devoncc.public-i.tv/core/portal/webcast_interactive/293466), those present at the vigil today would probably have still been worried about their future health care, but at least they would have felt that every avenue open to them had been explored.

Instead they were denied this last opportunity by political shenanigans of epic proportion.

I watched the webcast of the July meeting of DCC Health Scrutiny Committee (http://www.devonlive.com/news/devon-news/conduct-committee-members-investigated-devon-312213) and was frankly appalled at the charade being played out before my eyes.

Questions have been raised about how the meeting was conducted and the Standards Committee at DCC meets tomorrow to decide if the complaints are well founded.

Meanwhile, members of East Devon District Council have expressed dismay about the way an almost unanimous vote on a Motion expressing real concern about the conduct of the Clinical Commissioning Group was ignored and have called an Extra Ordinary Meeting of full Council to discuss a Motion of No Confidence in the leader, Cllr Paul Diviani, who sat on Devon County Council’s Health and Adult Care Scrutiny Committee as a representative of the leaders of all the district councils in Devon.

Cllr Diviani effectively voted against referring the decision to close inpatients beds in Honiton to the Secretary of State and later admitted under robust questioning that he had not canvassed the views of the other leaders.

The Extra Ordinary Council meeting will be held on

Wednesday 13 September
at EDDC’s headquarters at the
Knowle, Sidmouth,
starting at
6 p.m.

Honiton hospital beds close today; Seaton hospital Friends express dismay

“Seaton and District Hospital League of Friends has expressed its dismay at the loss of all its inpatient beds.

Speaking after the closure plans began last week chairman Dr. Mark Welland told the Herald: “We would like to express our deep gratitude to the many dedicated staff who have provided such a high quality of care to patients over the past 29 years, and also our sincere thanks to the numerous volunteers who have worked on the wards to support the patients and nurses.

“The League remains steadfast in its belief that beds are a necessary resource in Seaton, and will continue to explore every avenue that might lead to the reopening of the inpatient service in Seaton Hospital.

“At the same time, we would like to emphasise the ongoing work that will be taking place in Seaton Hospital – whilst it is true that no inpatient beds will be open, there are many more activities carried out at our hospital.

“These include the out-patient clinics which will continue to run, including rheumatology, ear nose and throat, audiology, spinal assessment, and general medicine clinics.

“The ever busy Seaton Hospital physiotherapy department will be continuing at full speed.

“Alongside these the hospital will continue to function as a base for community teams, including the rehabilitation team, speech and language therapy, community nursing, school nurse and health visitor teams, and the complex care team.

“There is now an opportunity for those hospital resources left under utilised by the bed closures to be put to new uses, and the Seaton and District Hospital League of Friends is currently active in establishing which services might be added to the above list to best serve the local community.

“The League continues to support the Seaton Friends Hospiscare at Home service, which will now be more vital than ever, with no opportunity to use hospital beds for end of life care. The Seaton Friends Hospiscare@Home service is entirely funded by the league, and receives no funding from NHS sources, even as the NHS support for end of life care locally is pared back. The League is very thankful to everyone who continues to support us, and to allow our work to continue.”

http://www.midweekherald.co.uk/news/dismay-over-seaton-hospital-bed-closures-1-5166084

And no thanks to our two MPs who simply turned up for photo opportunities and mouthed platitudes whilst voting in Parliament for these closures.

Hawking totally skewers Hunt on NHS!

The NHS is facing severe crises, from staffing to funding. Hunt misquoting me and misrepresenting research doesn’t help.

The secretary of state for health, Jeremy Hunt, has challenged me on Twitter and in an article for the Sunday Telegraph over a talk I gave recently to the Royal Society of Medicine in defence of the NHS. Having been accused by Hunt of spreading “pernicious falsehoods”, I feel the need to respond.

Hunt doesn’t deny that he dismissed research contradicting his claim of excess deaths due to poorer hospital care and staffing at the weekend. He admits he relied on one paper by Professor Nick Freemantle and colleagues. But even if one accepts its disputed findings, the authors explicitly warn that “to assume these excess deaths are avoidable would be rash and misleading”. The editor-in-chief of the British Medical Journal, Fiona Godlee, wrote to Hunt to reprimand him for publicly misrepresenting the Freemantle et al paper. As a patient who has spent a lot of time in hospital, I would welcome improved services at the weekend. For this, we need a scientific assessment of the benefits of a seven-day service and of the resources required, not misrepresentation of research.

Hunt’s statement that funding and the number of doctors and nurses are at an all-time high is a distraction. Record funding is not the same thing as adequate funding. There is overwhelming evidence that NHS funding and the numbers of doctors and nurses are inadequate, and it is getting worse. The NHS had a £2.4bn shortfall in funding in 2015-16, bigger than ever before. NHS spending per person will go down in 2018-19. According to the Red Cross, the NHS is facing a humanitarian crisis. There is a staff recruitment crisis. The BBC reported that on 1 December 2015 there were 23,443 nursing vacancies, and a 50% increase in vacancies from 2013 to 2015. The Guardian reported in May that the number of nursing vacancies had risen further to 40,000. There are increasing numbers of doctor vacancies and increasing waiting times for GP appointments, treatment and surgery.

Hunt misquoted me, saying that I claimed the government wants a US-style insurance system. What I said was that the direction is towards a US-style insurance system, run by private companies. The increasing involvement of private health companies in the NHS is evidence for this. Hunt chose to highlight – dare I say, cherry-pick – the fact that private companies’ share of NHS contracts rose 0.1% over the last year. This is an anomaly among the data since 2006. The NHS private providers’ share was 2.8% in 2006-7 and rose steadily to 7.6% in 2015/16. The amount of private health insurance has fallen since 2009 as Hunt said, but that is because of the financial crash. We can conclude nothing about health policy from this and in any case, it is now increasing again. As waiting times increase, private companies report an increase in self-pay where patients pay directly for care such as hip and knee replacements.

Further evidence that the direction is towards a US-style system is that the NHS in England is undergoing a complete reorganisation into 44 regions with the aim of each being run as an “accountable care organisation” (Aco). An Aco is a variant of a type of US system called a health maintenance organisation in which all services are provided in a network of hospitals and clinics all run by the HMO company. It is reasonable to expect the powerful US HMO companies such as Kaiser Permanente and UnitedHealth will be bidding for the huge contracts to run these ACOs when they go out to international tender. Hunt referenced Kaiser Permanente as a model for the future budgetary arrangements in the NHS at the Commons health select committee in May 2016.

The NHS is political, but not necessarily party political. I am a Labour supporter but acknowledge that privatisation increased under Labour governments in the past. The question is whether democracy can prevail and the public can make its demands for proper funding and public provision undeniable by any government.

• Stephen Hawking, the author of A Brief History of Time, is director of research at the Centre for Theoretical Cosmology at the University of Cambridge, where he was Lucasian professor of mathematics”

https://www.theguardian.com/commentisfree/2017/aug/25/jeremy-hunt-attack-nhs-stephen-hawking-crisis

Diviani and Randall-Johnson are satisfied these questions have been answered on bed closures – do you agree?

30 [plus] questions” that must be asked BEFORE care at home can be implemented:

Pre-implementation

The model of care:

• Does the new model of care align with our overriding ambition to promote independence?
• Is there clinical and operational consensus by place on the functions of the model and configuration of community health and care teams incorporating primary care, personal care providers and the voluntary care sector?
• Is there a short term offer that promotes independence and community resilience?
• Is there a method for identifying people at highest risk based on risk stratification tool?
• Are the needs of people requiring palliative and terminal care identified and planned for?
• Are the needs of people with dementia identified and planned for?
• Is support to care homes and personal care providers, built into the community services specification?
• Is support for carers enhanced through community sector development support in each community?
• Has the health and care role of each part of the system been described?
• Have key performance indicators been identified, and is performance being tracked now to support post implementation evaluation, including impact on primary care and social care?

Workforce:
• Is there a clear understanding of the capacity and gaps in the locality and a baseline agreed for current levels and required levels to meet the expected outputs of the changed model of care?
• Is there a clear understanding of and plan for any changes required in ways of working:
o thinking
o behaviours
o risk tolerance
o promotion of independence, personal goal orientation

• Have the training needs of people undertaking new roles been identified, including ensuring they are able to meet the needs of patients with dementia?
• Do we have detailed knowledge with regards to investment, WTE and skill mix across the locality and a plan for achieving this?
• Are system-wide staff recruitment and retention issues adequately addressed with a comprehensive plan, and where there are known or expected difficulties have innovative staffing models been explored?

Governance, communications and engagement:
• Is there a robust operational managerial model and leadership to support the implementation?
• Has Council member engagement and appropriate scrutiny taken place?
• Is there an oversight and steering group in place and the process for readiness assessment agreed?
• Have providers, commissioners and service users and carers or their representative groups such as Healthwatch agreed a set of key outcome measures and described how these will be recorded and monitored?
• Is there a shared dashboard which describes outcomes, activity and productivity measures and provides evaluation measures?
• Is there an agreed roll out plan for implementation, which has due regard to the operational issues of managing change?
• Is there a comprehensive & joint communications and engagement plan agreed?
• Is there a need for a further Quality or Equality Impact Assessment?

Implementation
• Is there a clinical and operational consensus on the roles of each sector during the implementation phase including acute care, community health and care teams, mental health, primary care, social care, the voluntary care sector and independent sector care providers?
• Is there an implementation plan at individual patient level describing their new pathway, mapping affected patients into new services?
• Are the operational conditions necessary for safe implementation met?
• Have the risks of not implementing the change at this point been described and balanced against any residual risk of doing so?

Post Implementation
• Is there a description of the outcomes for individuals, their carers and communities?
• Are the mechanisms for engagement with staff, users of services and carers in place and any findings being addressed appropriately?
• Is there a process in place for immediate post implementation tracking of service performance including financial impact to all organisations?
• Is longer term performance and impact being tracked for comparison against pre-implementation performance?
• Have we captured user experience as part of the process, and have findings been addressed and recorded to inform the planning of future changes?
• Are there unintended consequences or impacts (e.g. on primary care or social care) which need to be addressed before any further change occurs?
• Is there a clear communication plan for providers and the Public describing the new system and retaining their involvement in community development?”

Source: http://www.newdevonccg.nhs.uk/about-us/your-

Now Seaton and Honiton hospital beds are closed, here’s something to look forward to

Better keep fingers crossed that you or your loved ones are not in a similar position to some of the people mentioned here.

But if you are one of the unfortunate ones, remember Paul Diviani (EDDC), Sarah Randall Johnson (DCC), Neil Parish MP, Hugo Swire MP, Minister Jeremy Hunt and Prime Minister Theresa May all put you there. They all have one thing in common: they are Conservative politicians whose decisions led to this situation – and think carefully about whether you would vote for them now or in the future knowing what you know now.

People who receive care at home have told a health watchdog that a lacklustre service has meant they have had to go two weeks without a shower, eat their dinner at 3.30 in the afternoon and be cared for by workers who can’t make a bed.

The failings highlighted in a report by Healthwatch England drew on the experiences of more than 3,000 people who receive care at home. Other problems described in the document include care workers coming at different times to those scheduled, not having enough time to fulfil all their duties and some missing appointments altogether.

Across England there are more than 8,500 home care providers, collectively helping an estimated 673,000 people with tasks such as washing, cooking, dressing and taking medication. The report suggested that home care was “in a fragile state” and that care packages were being “designed to meet the needs of the service provider rather than the service user”.

One home care user in Redcar and Cleveland said: “Sometimes they give me a shower but they go over their time. Most of the time they haven’t got the time to give me one so I go a couple of weeks without one and that is not right. I feel dirty.”

A woman in her 80s told Healthwatch Bradford her care workers were unable to boil an egg or make the bed, while another said staff needed to be taught “home care common sense”.

A care user in Barnet, north London, said: “I am diabetic and sometimes carers are late or don’t show up and that really affects my medications and insulin administration.”

However, Healthwatch, the health and care consumer champion, stressed that most people had positive things to say about their domiciliary care – with many older people praising the service because it enables them to remain in their own home and to maintain as much independence as possible.

Neil Tester, the deputy director of Healthwatch England, said: “We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards. Given the challenges facing the social care sector, it is more important than ever that people’s voices are heard.”

Izzi Seccombe, the chairwoman of the Local Government Association’s community wellbeing board, said: “This report shows that while most people report that their services are good there is a need to improve services.

“The financial pressure facing services is having an impact and even the very best efforts of councils are not enough to avert the real and growing crisis we are facing in ensuring older people receive the care they deserve.

“The continuing underfunding of adult social care, the significant pressures of an ageing population and the ‘national living wage’ are combining to heap pressure on the home care provider market.”

She added: “This study shows the strain providers are under, and emphasises the urgent need for a long-term, sustainable solution to the social care funding crisis.

“While the £2bn announced in the spring budget for social care was a step in the right direction, it is only one-off funding and social care services still face an annual £2.3bn funding gap by 2020.”

A Department of Health spokesman said: “Everyone deserves access to high-quality care, including those who receive it in their home. This is why we have introduced tougher inspections of care services to drive up standards, provided an additional £2bn for adult social care, and have committed to consult on the future of social care to ensure sustainability in the long term.”

https://www.theguardian.com/society/2017/aug/24/report-highlights-failings-of-home-care-services-in-england

Hunt v Hawking – no contest!

Guardian letters:

“• Jeremy Hunt’s tweeted dismissal of Hawking’s article (How to solve the NHS crisis – scientifically, 19 August) is revealing: “Stephen Hawking is brilliant physicist but wrong on lack of evidence 4 weekend effect.2015 Fremantle [sic] study most comprehensive ever”.

If Hunt bases policy on a single publication (which no serious observer would do) then he should read it, and he would see Freemantle’s warning: “It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

Freemantle found that patients admitted over the weekend are more seriously ill and more likely to die. Nobody denies that the “weekend effect” exists, but one must not jump to the facile and unsubstantiated conclusion that it reflects quality of care.

Hunt cherrypicks not only the evidence but even the authors’ interpretation.
Dr Richard O’Brien
Highbridge, Somerset

Jeremy Hunt accuses Stephen Hawking of ‘pernicious falsehood’ in NHS row

• Privately provided services, with their bank loan costs, dividend payments and management add-ons, cost far more than state-funded ones. The administration of privatisation, with the consultants, lawyers, accountants, billing agents etc involved in franchising NHS services, also add substantial costs. Hospital PFIs (private finance initiatives) have evidenced the billions that privatisation is costing the NHS and taxpayer.

Yet the government’s and NHS England’s “reconfiguring” of the NHS is using regional accountable care organisations (ACOs) which allow for extended involvement of the private sector in the running and provisioning of NHS services. This not only accepts the continuing financial burden of privatisation to the taxpayer, but allows further costs to that burden.

ACOs, and other NHS England plans such as the move from the family GP practice model to a system of commercially driven super-clinics called multi-speciality community providers, originate from the US’s notoriously costly and flawed healthcare system. The plans have been drawn up by business consultants with extensive US interests like McKinsey and Optum, a subsidiary of US private health provider/private health insurer United Health. NHS England’s CEO Simon Stevens is a former UnitedHealth senior executive.

Professor Hawking’s concerns about the privatisation and Americanisation of the NHS are therefore unsurprising. Removing all the privatisation apparatus from the NHS would allay such concerns, which are shared by many. The savings that this would make would cover the lion’s share of the costs of the extra demands facing the NHS (the ageing population etc) which are blamed for making the NHS “unaffordable”.
John Furse
London

• I am 100% behind Stephen Hawking’s attack on the Tories over the plight of the NHS. As a nurse for the last 40 years, I think that the NHS is by far the best health system in the world and it is only surviving because of the deep commitment of thousands of medical and admin staff to a worthy cause. I know for a fact that after the referendum results, scores of foreign doctors and nurses started to leave our large local hospital, for fear that they would not be allowed the freedom to stay. This has left our hospital grossly understaffed and under tremendous pressure. Others have gone off sick with severe stress after all the extra hours they are expected to put in to care for patients.

The Tories’ recent promise to provide training for thousands of medical students and nurses in a few years’ time is of no use whatsoever. Something drastic is needed now and that is to give the nurses the pay rise that others are getting. With conditions and pay at such an all-time low, how else are they going to recruit any new nurses?
Sue Ingleby
Gloucester

• What wise words from Prof Hawking and what a pathetic response from Jeremy Hunt. Hawking is right to draw attention to the vast amounts of public money going into the coffers of private organisations for services that could be handled better and cheaper in-house. The question of agencies providing nurses to fill gaps is analogous with those providing supply teachers. Previously hospitals relied on their own “banks” to provide cover for absentees, usually drawn from any of their own staff who requested extra shifts. The advantage of employing their known staff is obvious. Schools requiring temporary help could contact their local education authority (now sadly almost defunct) which kept a list of qualified teachers requesting temporary work. No money was exchanged, unlike today where in many cases the agency charges both the professional worker and the employer. How did we allow this to happen?
Ruth Lewis
Potters Bar, Hertfordshire

• Stephen Hawking’s article is so wonderfully simple and beautiful it made me want to cry. How precious the NHS is and how much it means to us. Thanks to him for writing it and to the Guardian for printing it. It should be printed in all the newspapers.
Jenny Bushell
London”