Devon CCGs want to merge (but looks like they already did it!)

Owl says: anyone recallveing consulted about this? And surely, if it is for cost-sVing, all previous financial scenarios at the two CCGs must be recalculated. And shouldn’t this be rescrutinised by DCC?

“North East and West (NEW) Devon CCG is hoping to merge with South Devon and Torbay CCG in April next year. Both CCGs have expressed an interest to NHS England to merge the organisations, in what they say is the ‘next natural step’. In May last year, NEW Devon CCG refuted claims it had ‘gone bust’ – though it did have a defecit of £42million in 2016/17.

Last year (2017/18) NEW Devon CCG had a planned defecit just shy of £50million.

It is thought the merger would help both organisations face funding challenges in the years ahead; they have already made a saving of £4million working together in the last year. This has includinged merging the two executive teams and establishing a common governing body and committees.
Executive directors now sit in Devon-wide roles working across both CCGs.

Dr Sonja Manton, director of strategy at the two CCGs in Devon, said: “We have made significant progress working as a health and care system in Devon over the past two years.

“As commissioners (buyer) of health care services for our local population, our two CCGs have worked more closely together for over a year, and this has brought many improvements and benefits such as speeding up decision making and making cost savings and efficiencies of nearly £4million on running costs.

“We have achieved much more together than we would have working separately. “A merger of our two organisations is the natural next step, and we have expressed an interest to NHS England to merge our two organisations from April 2019. “We are working with staff, clinicians, partners and stakeholders to ensure that everyone is involved in the changes as they develop. “This is an important step in our journey to better integrate health and care services to benefit our local communities.

“In Devon, we have well-established joint working arrangements with our local government partners and this will be strengthened as we design a new more integrated approach.”

https://www.northdevongazette.co.uk/news/proposals-to-merge-two-devon-ccgs-1-5642433

“Virgin awarded almost £2bn of NHS contracts in the past five years”

“Virgin has been awarded almost £2bn worth of NHS contracts over the past five years as Richard Branson’s company has quietly become one of the UK’s leading healthcare providers, Guardian analysis has found.

In one year alone, the company’s health arm, Virgin Care, won deals potentially worth £1bn to provide services around England, making it the biggest winner among private companies bidding for NHS work over the period.

The company and its subsidiaries now hold at least 400 contracts across the public sector – ranging from healthcare in prisons to school immunisation programmes and dementia care for the elderly.

This aggressive expansion into the public sector means that around a third of the turnover for Virgin’s UK companies now appear to be from government contracts. …

Sara Gorton, the head of health at the trade union Unison, said: “The company has been so keen to get a foothold in healthcare, it’s even been prepared to go to court to win contracts, moves that have cost the NHS dearly.

“While the NHS remains dangerously short of funds, taxpayers’ money shouldn’t be wasted on these dangerous experiments in privatisation.”

One former surgery manager who spoke to the Guardian said Virgin appeared to be paid more for doing less in her area, although the company said “because the contracts are generally not directly comparable, we don’t believe it to be true”.

Guardian analysis reveals the way the company that began selling records in the early 1970s has diversified in a bewildering way over recent years. …

In March 2017, it had almost 1,200 staff – a five-old increase from the year before. Over the same period, its turnover increased from £133m to £204m and its operating profit rose from £7.3m to £8m.

Though healthcare is a growing part of the group, Virgin still appears to make most of its money from transport.

Virgin UK Holdings, the UK business which holds its rail and healthcare ventures, reported revenues of £1.5bn in 2016 and paid £22m in tax.

Earlier this year, Virgin Trains had its west coast line franchise extended for another year. …

Paul Evans, the director of the campaign group NHS Support Federation, said: “Virgin Care are the biggest private sector winner to emerge out of the NHS experiment with competition and outsourcing.

“We don’t know the final shape of it, but players like Virgin and Care UK clearly see a big opportunities for business to continue to deliver clinical services for the NHS.”

https://www.theguardian.com/society/2018/aug/05/virgin-awarded-almost-2bn-of-nhs-contracts-in-the-past-five-years

Very important case law on consultation

This has great relevance to NHS consultations, the wording of consultation comments, the treatment of those comments and the duties and respinsibility of the DCC Health and Wellbeing Scrutiny Committee to scrutinise evidence presented.

It is going to be much easier to challenge flawed consultations.

Those involved in these matters MUST read the full document (see source at end of post. Only a couple of the relevant sections are published here but should be read with the whole document.

“… “Commentary on
R (ex parte Kohler) v The Mayor’s Office for Policing and Crime
[2018] EWHC 1881

This Briefing Note considers the judgment handed down by Lord Justice Lindblom and Mr Justice Lewis on 20th July 2018. It details the circumstances of the case, its wider context and, in particular discusses practical issues which will be of concern to consultation practitioners.

Background

In common with other police forces, the Metropolitan Police has needed to make huge savings in its budget. Unsurprisingly it has led to a review of what premises they occupy and whether they still need over-the-counter services at their police stations.

In July 2017, the Mayor’s Office for Policing and Crime (MOPAC) published a Public Access and Engagement Strategy, a dual-purpose document simultaneously consulting the public about the future direction of public engagement on policing and seeking views on proposals to close or ‘swap’ 37 police counters.

The consultation was heavily criticised, and at the Institute, we published a detailed critique under the provocative title Is this the worst consultation of 2017?

https://www.consultationinstitute.org/worst-consultation-2017/

Some of the complaints were heeded and a revised set of questions emerged three weeks after its original launch.

The legal challenge

Professor Paul Kohler lives in Wimbledon and in 2014, was subjected to a serious assault. He believes his life was possibly saved only thanks to the prompt response by police from Wimbledon Police Station.

The MOPAC proposal included a provision for that facility to be transferred elsewhere in the London Borough of Merton – to Mitcham, so that the site at Wimbledon could be sold and generate capital receipts. These in turn, according to the consultation document, would help the Met Police fund technology improvements needed to support the case for changing public access and reduce the traditional reliance on police counters. …

The Kohler case spells an end to the practice of sending decision-makers a summary report (or an unreadable tome) with a message ‘Don’t worry, there’s nothing here to stop you from going ahead!’. If a failure to consider a specific argument can spell illegality following a consultation, someone somewhere has to decide what might constitute such an argument. Who can be trusted to decide?

The Consultation Institute View [on the case]

• The Kohler case is a game-changer, placing the Gunning Four Principle of ‘conscientious consideration ‘ at centre stage. There have been few comparable cases, as flawed consultations have, in the past failed the pre-determination or the sufficient information tests. It remains to be seen if the judgment opens the door to more claims that decision-makers never properly studied consultee submissions. It could happen!

• One consequence is that campaigners and other smart stakeholders will structure their comments to ensure that they cannot easily be summarised, and may specifically seek assurances that their submissions will have been read by decision-makers.

• To respond to such pressures and to safeguard themselves, consultors will need to look again at their data analysis practices, possibly strengthening the independent element both in analysis and in reporting to decision-makers. They will also need to be better at political risk assessments. Independent Quality Assurance becomes even more attractive for controversial consultations.

• The case for Public consultation hearings is further strengthened, as decision-makers will be able to prove that they heard and understood particular arguments. …”

Full document here:

Click to access briefingnote21-mopac.pdf

Sky News claimed 55% of the NHS budget is spent on over 85s – the REAL amount is VERY different

A Sky News article claimed that 55% of all NHS spending went on people 85+:

https://news.sky.com/nhs-in-numbers

An independent fact-checking charity decided to research this claim.

Sky News told them it calculated the figures based on data published by the Institute for Fiscal Studies (IFS), but the IFS told us they don’t recognise these figures. They have asked Sky for more information.

Other figures the charity has seen from the IFS suggest that the proportion of health spending across the UK (rather than just the NHS budget) which goes to those aged 85 and over is likely to be around 10% by 2021/22.

The Institute for Fiscal Studies (IFS) told them it wasn’t familiar with the figures used by Sky News, but did provide them with other information.

When compared to a 30 year-old, spending across the UK on health (not just the NHS) for an 85 year-old is projected to be 5.6 times higher in 2021/22, and twice as much for a 65 year-old. That’s taking account of the fact that not all people of those ages will necessarily need to use health care.

But that doesn’t mean that 85 year-olds will require 5.6 times as much of the budget as 30 year-olds, because there are fewer people at that age.

Using population projections for 2021 we can see that those aged 85 and over are projected to make up just 3% of the population of the UK. Those aged between 65 and 84 made up 16% and those aged 30-64 made up 45%.

Based on this, 10% of health spending across the UK would go to those over the age of 85 by 2021/22, 32% would go to those aged 65 to 84 and 35% would go to those between the age of 30 and 64.

https://fullfact.org/health/how-much-nhs-budget-spent-people-over-85/

Claire Wright concerned about unpaid carers – asks for them to contact her

Could you imagine Swire being concerned about this – concerned, not just anodyne words.

“Some of Devon County Council’s Health and Adult Care Scrutiny Committee will visit Westbank League of Friends to hear from staff who support unpaid carers, later this month, following my proposal for a spotlight review into how unpaid carers who look after friends and family members are faring.

I have seen a confidential report of a focus group meeting that took place last year, which indicates that the 24 people in Devon who took part, are suffering from a lack of support, a lack of money and a lack of respite care….. many reported that their mental and physical health was suffering as a result.

I asked for the (anonymised) report to be published with the June health scrutiny papers, but this was refused as the focus group report was not ever intended to be made public and consent had not been given. Instead a rather more neutral version of the report was published, but as I told the committee, this did not reflect the original report and I don’t believe people’s voices have been heard.

The media reports today that unpaid carers save the economy a massive £60bn a year – https://www.bbc.co.uk/news/uk-40560827 – here’s the BBC story on the subject.

Anecdotally, my conversations with local people 100 per cent support the findings from Devon County Council’s focus group. Many unpaid carers are at their wits end.

I did propose a spotlight review into how unpaid carers are faring but this was not voted on unfortunately. There didn’t seem support from around the room. However, the issue will return to the agenda in September and I will pursue it then.

If you are an unpaid carer and wish to get in touch I would be very pleased to hear from you.

Email me at claire@claire-wright.org

http://www.claire-wright.org/index.php/post/unpaid_carers_are_they_getting_the_support_they_need

NHS bed blocking costs £550 per MINUTE says charity

“Bed blocking because of a lack of social care availability is costing the NHS an “eye-watering” £550 per minute, according to research by a charity released today. This equates to £290m a year, Age UK has estimated.

Analysis by the charity also showed that in just two years, the number of older people in England living with an unmet care need has risen by 19%, which translates to 1.4 million over 65s living with unmet care needs

More than 300,000 need help with three or more essential daily tasks like getting out of bed, going to the toilet or getting dressed, the charity found, and of this 165,000 receive no help whatsoever from paid carers, family members or friends.

Caroline Abrahams, Age UK’s charity director, said: “The numbers of delayed discharges to a lack of social care are actually going down, but a lack of social care still costs the NHS an eye-watering £500 every minute – not to mention undermining the chances of older people making a full recovery if they are unnecessarily stuck in hospital for weeks or longer.”

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said: “People’s unmet care needs will continue to increase and deepen the crisis in adult social care unless the sector receives a long-term funding settlement, like the NHS, and further funding is made available for council’s public health and prevention services.

“To prevent crises in the NHS, government needs to plug the £3.5bn funding gap facing adult social care by 2025 and reverse the £600m in reductions to councils’ public health grants between 2015-16 and 2019-20.”

Age UK noted that between 2009-10 and 2016-17 spending on adult social care in England fell by 8% in real terms. As a result, in the same period, the average spend per adult on social care fell by 13%, from £430 to £379.

Alex Khaldi, head of social care insights at Grant Thornton, said: “Funding is not the only answer, councils need to focus on monitoring the level of unmet need in their areas more effectively. “If we are to exercise place-based leadership in social care, better data insight that allows councils to identify where and why people have fallen between the cracks is urgently needed.”

The LGA has announced that it would be publishing its own adult social care green paper, after Jeremy Hunt announced the government green paper would be delayed until autumn.

A Department of Health and Social Care spokesperson said: “We expect the NHS to work closely with local authorities to ensure people are treated in the most suitable setting and when they are discharged from hospital they have a care plan in place.”

https://www.publicfinance.co.uk/news/2018/07/bed-blocking-costing-nhs-ps550-minute

What Shakespeare knew about Integrated Care Organisations and Local Enterprise Partnerships!

Reposting a comment by “The Bard” with apologies to Shakespeare!

“Meantime we shall express our darker purpose.
Give me the map there. Know that we have divided
Our kingdom divers ways: and ’tis our fast intent
To shake all cares and business from our age;
Conferring them on LEPs, they so enriched,
While we, unburthen’d crawl toward electoral death.

………………….Tell me, my Councillors,–
Since now we will divest us both of rule,
Interest of territory, cares of state,–
Which of you shall we say doth owe us most?
That we our largest bounty may extend
Where nature doth with merit challenge. Greg Clark,
Our business secretary, speak first.

King Lear: Act 1, Scene 1 (updated a tad)

The NHS at 70

“Only one hospital trust met all its main targets over the past year, with dozens failing on emergency treatment, cancer care and routine surgery waiting times, an investigation by The Times has found.

As the NHS prepared to mark its 70th anniversary today with services at Westminster Abbey and York Minster, doctors said the findings showed a system that was teetering “like a giant game of Jenga”.

The Times interactive project to uncover the best and worst of NHS hospitals found that in 2017-18, 25 out of 139 trusts failed to see 95 per cent of A&E patients within four hours, treat 85 per cent of cancer patients within 62 days and offer 92 per cent of non-emergency patients treatment within 18 weeks. Only the Chelsea and Westminster in London hit all three key targets. Inspectors have praised the trust’s leadership and desire to learn from problems.

Over the winter 49 hospital trusts said their beds were full at some point. Saffron Cordery, deputy chief executive of the hospitals’ group NHS Providers, acknowledged that this risked damaging “public faith in the NHS, if it is unable to meet the standards people rightly expect”. The analysis, which looked at data on three key targets plus cancelled urgent operations, Care Quality Commission ratings, ambulance delays, bed blocking and norovirus outbreaks, suggests that Worcestershire Acute Hospitals Trust is performing worst. The hospital, where two patients died on trolleys in A&E in one week in January last year, is rated inadequate and has the third worst casualty performance.

Nigel Edwards, chief executive of the Nuffield Trust think tank, said: “It’s perfectly possible to have a view that the NHS needs more money but being oversentimental about it doesn’t help . . . There is definitely scope for improvement.”

He warned that there was no end in sight to the need for budget rises. Britain spends twice as much of national income on the NHS as in 1948, despite a vastly larger economy.

Theresa May has promised a £20 billion boost over the next five years, which experts have estimated is not enough to allow it to start meeting targets while improving GP, mental health and cancer care.

Taj Hassan, president of the Royal College of Emergency Medicine, said the system had been starved of resources and was “like a giant game of Jenga”.

A national “brand” like the NHS does not exist anywhere else and it profoundly affects how we look at our health service (Chris Smyth writes).

It is common to hear “the NHS saved my life” but in no other country do people say “our universal taxpayer-funded healthcare financing system saved my life”.

The NHS brand encapsulates the promise of comprehensive treatment, free at the point of use for the richest and poorest.

Yet responsibility lies in Whitehall, which feels remote from the front line. The political control of the NHS is unique and damaging. In Europe regions take responsibility and often find it easier to get things done. It is striking that recent key NHS successes — bringing down death rates by publishing data, centralising stroke care and eliminating surgical inefficiencies — have been led by staff rather than top-down initiatives.”

Source: Times (paywall)

Celebrate 70 years of OUR NHS at Respect Festival Saturday 30 June, Exeter

KEEP OUR NHS PUBLIC (KONP)

The NHS is 70: celebrate and protest to preserve it

Saturday 30th June 2018
In Exeter

KONP will have a stall at the Respect festival (Belmont park, Exeter) to celebrate the NHS and spread the word about KONP campaigns.

This includes information on accountable care organisations, the Friends of the Sidwell Street Walk-in Centre, and others.

NHS and taxes – it doesn’t need special taxation

Gower Institute for Money:

“Yet again we have politicians saying that taxes need to be increased to “pay for” spending; this time it’s for social care.

In the UK, as many other nations, Government spending comes before taxation. The UK Government creates new money every time it spends and deletes it by taxation. We can spend the necessary money NOW, we do not have to tax first to pay for the spending.

As for borrowing, that is not borrowing at all, it is providing investment vehicles called gilts to investors. These defend the desired interest rate, the money saved in gilts does not pay for anything either. The interest paid on these accounts is a matter of choice too.

The Government should spend the money necessary to provide the service. Taxes collected will increase anyway as the people who do the work providing the service will pay tax and NI on their wages and taxes on their spending.

Of course the tax system needs sorting out; avoidance needs to be tackled. But we can do the spending needed now; the tax issue is an important, but separate, fight.”

Devon Tory GP MP pours cold water on “extra” NHS funding promise

Owl says: surely “extra” money for the NHS means ALL CCG costings have to be revised? And all the arguments about WHY services have to be cut must be revisited.

“Theresa May has come under fire for promising that a Brexit windfall will provide an extra £400m a week for the NHS. May – who will pledge an extra £20bn in annual real terms from 2023-24 in a major speech – has been ridiculed for linking the money to Brexit savings. “At the moment, as a member of the European Union, every year we spend significant amounts of money on our subscription, if you like, to the EU,” she said on BBC One’s Andrew Marr show. “When we leave we won’t be doing that.”

Two senior Tory MPs, who are also doctors, took aim at May: “The Brexit dividend tosh was expected but treats the public as fools. Sad to see Govt slide to populist arguments rather than evidence on such an important issues,” tweeted Sarah Wallaston, who chairs the Commons health and social care committee. Dr Philip Lee, MP for Bracknell, tweeted: “There is no evidence yet that there will be a ‘Brexit dividend’ – so it’s tax rises, more borrowing or both.”

The PM’s decision to frame extra spending specifically as a benefit of leaving the EU has been widely seen as a sop to hardline Brexiters in her cabinet, echoing Boris Johnson’s suggestion during the EU referendum that Brexit would free up £350m a week extra for the NHS.”

https://www.theguardian.com/world/2018/jun/18/monday-briefing-nhs-windfall-is-brexit-dividend-tosh-says-tory-mp

Ottery Health Matters! Meeting 29 June 2018, afternoon and evening

Ottery St Mary & District Health & Care Forum, in partnership with:
RD&E, Coleridge GP’s, NEWCCG, Devon County Council, East Devon District Council & Ottery St Mary Town Council

Ottery Health Matters!

Health and Wellbeing Community Information Event

Date: Friday 29th June 2018

Time: Two drop-in sessions
2pm – 5pm
6pm – 8pm

Venue: The Institute, Yonder Street, Ottery St Mary, EX11 1HD.

Come along to this informal drop-in event to find out about the care and support available in Ottery and the surrounding areas. It will be a great opportunity to talk to health and care experts plus volunteers about the local services and activities to help people live well.

We need to hear from you about what’s important to you, what you think the challenges and priorities are to improve health and care for people in our community now and in the future.

Refreshments will be provided. Transport to and from may also be available. For any queries or feedback please contact:

Elli Pang via e-mail: ellipang@btinternet.com or Tel: 01404 812268 or Leigh Edwards via e-mail: leighp3@sourcemode.com or Tel: 01404 814889

Adult social care on its last wobbly, fragile knees

“Social care services for vulnerable adults are on the verge of collapse in some areas of England, despite the provision of extra government funding, senior council officials have warned.

The fragile state of many council social care budgets – coupled with growing demand for services, increasing NHS pressure, and spiralling staff costs – is highlighted in research by the Association of Directors of Adult Social Services(Adass).

It says councils “cannot go on” without a sustainable long-term funding strategy to underpin social care and warns that continuing cuts to budgets risk leaving thousands of people who need care being left without services.

“The overall picture is of a sector struggling to meet need and maintain quality in the context of rising costs, increasingly complex care needs, a fragile provider market and pressures from an NHS which itself is in critical need of more funding,” the annual “state of the nation” survey says.

It reveals English councils plan to push through social care cuts of £700m in 2018-19, equivalent to nearly 5% of the total £14.5bn budget. Since 2010, social care spending in England has shrunk by £7bn.

A government green paper on adult social care funding is expected in the next few weeks, and while councils are hopeful this could put budgets on a firmer footing over time, they warn that extra funding is needed to shore up services in the short term.

“Social care is essentially about making sure we not only look after people with profound and increasingly complex needs, but also help many transform their lives. Sadly, however, this budget survey reveals, once again this essential care and support is just not being given the resources it needs,” said the president of Adass, Glen Garrod.

He added: “We cannot go on like this. How we help people live the life they want, how we care and support people in our families and communities, and how we ensure carers get the support they need is at stake – it’s time for us to deliver the secure future that so very many people in need of social care urgently need.”

A government spokesperson said: “We know the social care system is under pressure — that’s why we’ve provided an extra £9.4bn over three years. We will shortly set out our plans to reform the system, which will include the workforce and a sustainable funding model supported by a diverse, vibrant and stable market.”

The Adass survey says the social care market is “increasingly fragile and failing” in some parts of the country, with almost a third of councils reporting that residential and nursing home care providers have closed down or handed back contracts.

Although councils are spending an increasing proportion of their total budget on adult social care – almost 38p in every pound in 2018-19, compared with 34p in 2010 – social care directors admit they will have to continue to reduce the number of people in receipt of care packages.

The survey reveals councils are increasingly reliant on so-called “self help” or “asset-based” approaches to care – in effect using networks of family and neighbourhood groups to provide volunteer support for some social care recipients.

Half of local authorities overspent on adult social care budgets in 2017-18, the survey finds, with half of these drawing on council reserves to meet the overspend.

The National Audit Office has warned that about 10% of councils will exhaust reserves in three years at current rates of deployment, putting them at risk of insolvency.

Ministers acknowledged the financial crisis facing council adult social care services last year, when they provided £2.6 billion, enabling councils to raise extra social care funds locally through a council tax precept.

Adass says this injection of cash helped stave off financial collapse in some council areas. But it warns that the additional funding has “temporarily relieved, rather than resolved” the long-term funding needs of the sector and there is a danger council services could collapse before any new arrangements are in place.

Although councils have a legal duty to ensure there is a functioning care market in their area, nearly four in five say they are concerned that they are unable to guarantee this because of the fragility of many care firm balance sheets and rising care staff wage bills.

Councillor Izzi Seccombe, the chair of the Local Government Association’s community wellbeing board, said: “Councils and providers are doing all they can to help ensure older and disabled people receive high quality care, but unless immediate action is taken to tackle increasingly overstretched council budgets, the adult social care tipping point, which we have long warned about, will be breached and councils risk not being able to fulfil their statutory duty under the Care Act.”

Richard Murray, the director of policy at The King’s Fund, said: “This latest evidence, from every council in England, lays bare once again the need for, as the prime minister put it herself, a proper plan to pay for and provide social care.

“Older and disabled people and their families and carers continue to be let down by a system that is on its knees.”

https://www.theguardian.com/society/2018/jun/12/adult-social-care-services-collapse-survey-england-council

Devon CCG refuses to reveal crucial figures to independent county councillor

“Beds, beds, beds – Devon’s NHS couldn’t or wouldn’t give me their overall occupancy figure for the recent winter: but they were forced to buy in more capacity and there were ’12-hour trolley breaches’

Devon NHS’s Sustainability and Transformation Partnership (STP) admitted in a report to Health Scrutiny yesterday that they had been desperately short of beds during the recent winter. They had to buy in extra beds to keep up with more patients staying longer, because of complex conditions. There were ’12-hour trolley breaches’, where patients had to wait more than 12 hours to be seen.

Despite my asking them directly, they did not give a figure for overall occupancy levels, although they did not deny my suggestion that they had been as bad as or worse than the nationally reported level of 95 per cent. (The nationally recommended safe level is 85 per cent.)

Jo Tearle, Deputy Chief Operating Officer for the Devon CCGs, rebutted my suggestion that cutting community beds had contributed to this crisis, saying that these were not the kind of beds they had needed, and that there had been capacity in community hospitals most of the time. However this suggests that there was no capacity some of the time. It is difficult not to believe that extra community beds wouldn’t have given them more leeway.

Meanwhile, Kerry Storey of Devon County Council indicated the strains that the ‘new model of care’ at home had been under. She said that maintaining personal care at home during the winter had been ‘a real challenge’, requiring ‘creativity and innovation’ – you don’t need much imagination to see that it will have been a real crisis time with frail people at home in isolated areas, care workers and nurses struggling to get through the snow, and staff themselves suffering higher levels of illness.

I and others predicted that because of the closure of community beds, there would be severe pressure on beds in a bad winter or a flu epidemic (and actually, this was not overall a bad winter and the snow episodes were late and short; despite higher levels of flu, there was no epidemic this winter).”

Beds, beds, beds – Devon’s NHS couldn’t or wouldn’t give me their overall occupancy figure for the recent winter: but they were forced to buy in more capacity and there were ’12-hour trolley breaches’

Shock revelation suggests the NHS’s ‘new model of care’ is more about switching intermediate care from community hospitals to ‘block bookings’ in private nursing homes – saving costs and freeing up assets

Martin Shaw, East Devon Alliance councillor for Seaton and Colyton, Devon County Council:

Press release:

“There was a staggering revelation yesterday at Health Scrutiny from Liz Davenport, Chief Executive of South Devon and Torbay NHS Foundation Trust, that they had made ‘block bookings of intermediate care beds in nursing homes’ when they introduced the ‘new model of care’. South Devon has closed community hospitals in Ashburton, Bovey Tracey, Paignton and Dartmouth and is currently consulting on the closure of Teignmouth – where I spoke at a rally last Saturday.

The ‘new model of care’ is supposed to mean more patients treated in their own homes, and there does seem to have been an increase in the numbers of patients sent straight home from the main hospitals.

But the idea that all patients can be transferred directly from acute hospitals to home is untrue. There is still a need for the stepping-down ‘intermediate care’ traditionally provided by community hospitals – the only difference is that now it’s being provided in private nursing homes instead.

It’s likely to be cheaper to use private homes, because staff don’t get NHS conditions, and crucially it frees up space in the hospitals so that the CCGs can declare buildings ‘surplus to requirements’ and claim the Government’s ‘double your money’ bonus for asset sales. It seems NEW Devon CCG has also made extensive use of nursing home beds, but we don’t yet know if there were ‘block bookings’.

However the private nursing home solution may not last – DCC’s chief social care officer, Tim Golby, reported that nursing homes are finding it difficult to keep the registered nurses they need to operate, and some are considering reversion to residential care homes.

This may be where the South Devon trust’s long term solution comes in – it had already been reported that it is looking to partner with a private company in a potential £100m dealwhich will include creating community hubs that contain inpatient beds.

The new model of care is also about privatisation.”

A surgeon speaks on community hospitals and NHS privatisation

David Halpin FELLOW OF THE ROYAL COLLEGE OF SURGEONS knows what is needed – see his letter………

LETTER sent by DAVID HALPIN FRCS to the WESTERN MORNING NEWS

Dear Letters Editor, 25th April 2018

I reply to the letter from B Gelder (WMN April 23rd) entitled ‘Cottage Hospitals ease strain on the NHS.’ I have written before on this vital subject and listed their functions.

Recovery from serious illness or major operations requires loving and professional care, good nutrition and sound sleep. These were provided in good Community Hospitals. The last thing patients might get in the District General Hospital is a good night’s sleep. The noise, the moving of beds and the distress of disorientated patients do not allow sleep.

This retreat, supposedly for economy, from past high standards is part of what I call the ‘atomising’ of all that we hold dear. The dogmas of capitalism win out all the time. ‘Private good, public bad’. So with the privatisation of OUR railways under the Major government, the wheels were stupidly separated from the tracks to meet EU competition rules. There are about 3000 separate contractors working on the permanent way. There are probably more ‘contractors’ working in OUR NHS.

This is a sign of these shabby and confused times. Walking to Paddington Station past St Mary’s Hospital where I qualified as a doctor in 1964, I saw an ambulance – ‘NHS working in partnership with DHL.’

I understand that Teignmouth Community Hospital is likely to be closed completely. That catch phrase ‘not fit for purpose’ is being applied – ‘going forward’. The Philistines who order this will know that the original hospital was bombed by the Luftwaffe. Seven patients and three nurses were killed. They do not ‘remember them’. The first hospital to be built by the NHS, when the UK was on its uppers, was Teignmouth Hospital. Patients were treated for acute illness there by good GPs, nurses and physiotherapists, and others taken for further care from the big hospitals. It is being bombed again.

When this good hospital, with its views over Lyme Bay, becomes a 5 storey block of ‘luxury’ flats and second homes, the capital from the sale of the site will disappear in a puff of smoke. Taxpayers money is being burned in the NHS. The non-clinical staff in one Devon hospital now outnumber the clinical staff – nurses, physios, doctors etc. Watch BBC’s ‘Hospital’ from Nottingham as a quart fails to be squeezed into a pint pot. The proliferation of managerial personnel with unusual titles is excruciating and the distress of patients likewise.”

DCC Health and Social Care “Scrutiny” – Claire Wright continues her battle

“Health and Adult Care Scrutiny Committee meeting: A PACKED AGENDA….

I asked for several items, including the future of our community hospitals, the plight of local carers, the local NHS deficit and what is being done to reduce it.

Also, on the agenda is how the local NHS coped with winter pressures (something I have asked for, for months and even resorted to a Freedom Of Information request on – it was refused, I have issued a formal complaint)……..

I have been really disappointed in recent months and years at what I see as a systemic lack of accountability in the NHS. As a Health Scrutiny Committee member, I would expect to get straight answers to straight questions at meetings, but unfortunately this rarely happens, which is why I was forced to submit a Freedom of Information request about a basic set of data tables relating to winter pressures.

I will not hesitate to do this again.

The report on carers starts on page 55 of the link below. This came about after I read a detailed survey and saw that local people who are caring for loved ones may not feel very supported.

I subsequently had a meeting with senior officers and saw the raw (anonymised) data from local focus groups. It was disturbing and it appeared to me that many local carers are having a really hard time managing, because of the government’s austerity agenda. I asked for the report to be referred to the Health Scrutiny Committee, but was told this wasn’t possible as consent had not been given by the participants of the focus group.

A version of the report has been submitted instead. I am pleased that a number of measures have been put in place by officers to try and improve matters, however, I have already told senior officers that leaving out the comments has meant that the voice of carers has been lost, in my view.

I believe that there should have been an attempt to secure retrospective consent for the publication of the report, as without a proper voice, the government will simply carry on ignoring carers’ plight – and they deserve better.

If you want to read the reports – and if you care about our NHS I would urge you to! The link is here
http://democracy.devon.gov.uk/ieListDocuments.aspx

Members of the public are permitted to address the committee in the 15 minute slot at the beginning of the meeting, but need to register four days ahead to do so. Email Gerry.rufolo@devon.gov.uk

The meeting starts at 2.15pm on Thursday 7 June. It will be webcast from this link:

https://devoncc.public-i.tv/core/portal/home

and archived afterwards.

“8,900 checks on NHS ‘health tourists’ find just 50 liable to pay”

It almost certainly cost more to find the 50 than to leave this alone.

So, knock on the head – it is underfunding to speed privatisation that is bringing our NHS to its knees NOT health tourism!!!

https://www.standard.co.uk/news/health/8900-checks-on-nhs-health-tourists-find-just-50-liable-to-pay-a3850121.html

“NHS England and Capita misunderstood the risks in outsourcing primary care support services …” says hard-hitting report

Summary:

NHS England and Capita misunderstood the risks in outsourcing primary care support services resulting in services to 39,000 GPs, dentists, opticians and pharmacists that were a long way below an acceptable standard. Capita’s performance against the contract has improved but widespread failures are still being experienced by primary care practitioners, says today’s report by the National Audit Office (NAO).

In August 2015, NHS England entered into a seven-year, £330 million contract with Capita to deliver primary care support services. NHS England aimed to reduce its costs by 35% from the first year of the contract and provide a high-quality and standardised service. Capita expected to make a loss of £64 million in the first two years of the contract, which it planned to recoup in later years.

NHS England’s decision to contract with Capita both to run existing services but also simultaneously to transform those services, was high risk. Capita was incentivised through the contract to close existing services to minimise its losses but the interaction between running, closing and transforming services was more complex than Capita or NHS England had anticipated.

Performance issues emerged in 2016 shortly after Capita started closing primary care support offices and making other changes to the service. Capita acknowledges that it made performance issues worse by continuing to close support offices in summer 2016 even though it was aware the customer service centre was struggling to meet demand at that time. NHS England was contractually unable to stop Capita’s aggressive office closure programme, even though it was having a harmful impact on service delivery.

Failure to deliver key aspects of the end-to-end service, delivered by Capita and other organisations, impacted primary care services and, potentially, put patients at risk of serious harm. For example, 87 women were notified incorrectly that they were no longer part of the cervical screening programme; processing issues led to an estimated 1,000 GPs, dentists and opticians being delayed from working with patients and some of these practitioners lost earnings. No actual harm to patients has been identified.

Users continue to experience poor delivery with seven severe service failures in February 2018. A number of organisations have contributed to underperformance as Capita relies on other organisations to provide some services.

NHS England has made savings, in line with expectations, of £60 million in the first two years of the contract, as the financial risk of increased costs sits with Capita who have made a £125 million loss over this period. To date, NHS England has deducted £5.3 million from payments to Capita as penalties for poor performance but it expects it may have to pay up to £3 million in compensation to primary care providers.

NHS England has not yet secured all the benefits it wanted to achieve as Capita’s transformation programme was halted while it focused on operational issues. NHS England remain concerned about three of the services – the national performers lists, payments to opticians and GP payments and pensions but recognises that some of the issues with them pre-date the contract with Capita.

Two and a half years into the contract basic principles are still not agreed, which limits NHS England’s ability to hold Capita to account. NHS England and Capita have still not agreed how to calculate 11 performance measures, and how these data should be used to calculate payments owed to Capita for delivering the services.

The NAO recommends that NHS England should determine whether all current services within the contract are best delivered through that contract or be should taken in-house by NHS England.

“Neither NHS England nor Capita fully understood the complexity and variation of the services being outsourced. As a result, both parties misjudged the scale and nature of the risk in outsourcing these services. “While NHS England has achieved financial savings and some services have now improved, value for money is about more than just cost reduction. It is deeply unsatisfactory that, two and a half years into the contract, NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively.”

Amyas Morse, the head of the NAO, 17 May 2018″

https://www.nao.org.uk/press-release/nhs-englands-management-of-the-primary-care-support-services-contract-with-capita/

Full report here:

“Inpatients at Exmouth Hospital to be temporarily relocated during fire safety improvement project”

Owl adds: Did you know there were closed wards at Exmouth Hospital?

“News Release 16 May 2018

Inpatients at Exmouth Hospital are being temporarily relocated to another ward on the site while building owner NHS Property Services invests in fire safety improvements.

Beds on Doris Heard Ward are being moved to the vacant Geoffrey Willoughby Ward while a £50,000 project to safely remove asbestos and improve fire resistance takes place. A deep clean and air testing will also take place.

The works, carried out by Integral, will be undertaken from 21 May with the ward planned to be fully reopened during the week commencing 11 June 2018.
Due to the constraints of Geoffrey Willoughby Ward, the number of available beds will be temporarily reduced from 16 to 12 during this period.

Rosemary Kearney, Senior Facilities Management Business Manager for NHS Property Services (NHSPS) in the South West, said: “We’re working closely with our partners at the hospital to ensure services can, as far as possible, continue as normal.

“We’re sorry for any inconvenience but this is an essential project that will ultimately improve the fabric of Exmouth Hospital for patients for years to come.”

Donna Robson, Royal Devon and Exeter NHS Foundation Trust’s Matron at Exmouth Hospital, added: “Maintaining continuity of care for patients is our top priority. We’ve been working with NHSPS to ensure that any disruption is kept to a minimum during these necessary maintenance works. We’d like to thank our patients and visitors for their understanding during this time.”

All other services at the hospital are unaffected and patients should continue to attend their appointments as normal.

The need for the work was identified as part of a survey undertaken by NHSPS.”

The press release also includes background information for editors on NHSPS. This is not usually published with the press release but is information in the public domain, so Owl reproduces it here:

“NHS Property Services brings property and facilities management expertise to thousands of sites across the NHS estate.

At a time of major change and increasing demand for the NHS, NHS Property Services is reducing costs, creating a more fit for purpose estate and generating vital funds that are being reinvested to support improvements in frontline patient care.

The company’s portfolio consists of 3,500 properties – worth over £3 billion – which represents around 10 percent of the entire NHS estate. The vast majority of our sites are used for clinical, local healthcare and fall into one of three categories:

Health centres and GP surgeries; Hospitals/hospital- related properties; or Offices.

The company has a major role as both landlord and service provider for its NHS customers. Services fall into four main business areas:

1. Strategic estates planning – supporting our customers to deliver healthcare premises that meet future needs for patient services

2. Asset management – proactive asset management to create value and reduce overall costs of property

3. Construction project management – managing the development of new buildings and refurbishment of existing buildings, along with investment in our estate

4. Facilities management services – including health and safety, maintenance, electrical services, cleaning and catering.”