Devon Clinical Commissioning Group £66 million in debt and heavily criticised

“One of England’s largest clinical commissioning groups has increased its planned deficit by nearly £40m.

Devon CCG, formerly part of a “success regime”, is now forecasting a £66m deficit in 2019-20, despite initially targeting ending the year £27m in the red.

The £1.2bn-income CCG broke even for the first time in its history in 2018-19, after it achieved a £25m deficit which unlocked £25m of commissioner sustainability funding.

Devon’s problems are compounded by the “increasing expectation” that several of the county’s providers are at risk of missing their control totals, according to the CCG’s latest finance report.

Additionally, Torbay and South Devon Foundation Trust, which was not part of the success regime, has expressed concern about a “top-down approach” by Devon’s sustainability and transformation partnership over the creation of a long-term financial plan.

It comes just two months after HSJ revealed external consultants reported a culture of “learned helplessness” and “crisis mentality” among Devon’s NHS leadership, with individual chiefs “retrenching” back into their organisations when faced with difficult decisions.

Savings plans

Devon’s STP initially forecast a deficit of £115m for 2019-20 against a control total of £43m. However, the area then went through an “intensive programme supported by NHS England/Improvement” to reach an “acceptable position”, according to Devon CCG’s board papers.

This resulted in the forecast deficit being reduced to £70m and was based on “accelerating” transformation programmes across Devon, with the CCG tasked with finding the extra £45m of savings required to hit it.

This meant the CCG’s savings plan rose from £36m to £81m.

The revised plan is yet to be approved by NHSE/I, but the CCG now says it cannot find savings worth £39.5m, leading to the rise in the deficit forecast.

Asked what transformation programmes the CCG had hoped would yield savings, a spokesman said this included:

Revising down the level of forecast demand growth so it was “more closely aligned” with national benchmarking;

Managing demand for hospital services by accelerating planned improvements in productivity; and

Updating “projected increases” in additional funding.

But, according to the CCG’s board papers, it will not be possible to deliver the proposed savings due to pressures within “continuing healthcare, prescribing and independent sector contracts”.

Control totals

The CCG’s finance report also warns Devon’s providers are increasingly at risk of missing their control totals.

Torbay and South Devon FT has moved its forecast deficit from £3.8m to £18.8m after missing out on expected income in relation to social care services provided to Torbay Council, failing to deliver savings schemes such as reducing outpatient follow-up appointments, and spending more money than planned on agency staff.

The trust also reported sickness levels in “key specialties” — such as emergency, respiratory and stroke — adversely affecting the organisation.

This autumn, the trust hired KPMG to review its finances, but the “draft” report has not yet been published.

Additionally, the trust’s finance committee has heard concerns from members about a “top-down approach” being adopted by STP chiefs in charge of preparing a long-term financial plan for the health economy.

According to the committee’s minutes, the approach “does not take account…of the unique position of Torbay and South Devon as an integrated trust which carries the risk of adult social care”.

The minutes went on to state that members felt it is “imperative” the trust “challenges the modelling approach” used by the STP to avoid financial targets which “lack credibility”.

The trust did not answer when HSJ asked it to clarify what the problem was with the STP’s modelling approach.

Asked for a response to the allegation of a top-down approach, Devon STP’s finance lead John Dowell said: “All partners across the Devon system… are fully focused on solving the performance and financial challenges we face.”

Elsewhere in Devon, University Hospitals Plymouth Trust did not comment when asked if it was on track to achieve its finance plan to break even. However, its latest board papers stated it faced a “forecast shortfall” against its £25m savings programme which — alongside other finance pressures — means the trust is facing a “significant challenge to deliver its financial plan”.

Both Northern Devon Healthcare Trust and Royal Devon and Exeter FT are on track to hit their targets (breakeven and £8.6m surplus respectively).

Devon Partnership Trust, which provides mental health services, is also reporting being on track to deliver its planned £1.6m surplus, according to its latest board papers.”

Source: Health Services Journal

Why does it matter if your free NHS treatment was at a private hospital?

From Facebook:

“Reflecting on what was an unusual weekend.

On Saturday morning I got a knock on the door from a stranger to say that my partner had come off his bike at the end of our road. The panic must have been visible on my face. “He’s ok”, she said. “But he’s got a nasty gash on the side of his face. My husband’s with him. He’s ok. But he’ll need to go to hospital.”

Her husband, it turns out, is a firefighter. So fortunately knew what to do when he saw the head injury.

By the time I got to him, Kev was sitting on a chair outside their house, with kitchen paper held over the left side of his face. There was a lot of blood. He was conscious, but in shock. They told me it was probably best not to look at his wound.

The paramedics arrived within minutes and took us to Kings, where they have a specialist facial trauma unit.

Although he was wearing a helmet his face smashed into the edge of a sharp curb. So, as well as the deep lacerations around his eye socket, he’d broken his cheekbone in three places.

From the moment we stepped into the ambulance around 1030am to when that we left the hospital around 9pm, we were in the hands of the most amazing individuals.

In total, at least 20 different people were involved in caring for him: 2 paramedics, an A&E receptionist, 3 different A&E nurses, 1 X-ray receptionist, 1 radiologist, 1 A&E doctor, 3 facial trauma specialists, 1 facial surgeon, 2 porters, 1 neuro radiology receptionist, 1 neuro radiologist, 1 ophthalmic consultant, 1 head injury specialist, and an A&E discharge nurse. And these were just the people we met. There were probably countless others contributing behind the scenes.

We were so well looked after. Every single one of those people were calm, caring, cheerful, patient, professional, focussed and committed. They explained what was happening at every stage. They cared about doing the best for us.

Many of these medical professionals were working 12-hour shifts. Several of them worked beyond the end of their shift to care for us, including one facial trauma doctor who, although his cover had arrived, stayed to help her with the complex stitching that Kev needed, and chatted cheerfully to us as he worked.

Many of these NHS professionals were from other countries – Australia, Cyprus, Nigeria, Philippines and Poland, to name a few – working in what is the busiest A&E department in the whole of the EU.

Their expertise was incredible. We were seen by three different specialist teams – facial trauma, neurology and ophthalmology – all working together, seamlessly, under the same roof.

This is the NHS is all its magnificent glory.

At no point did we worry about the cost of this care. At no point did anyone ask us for an insurance number. At no point were we offered optional treatments with different price tags. Everything they did was the very best available treatment for that patient with that specific problem, no matter their background, or circumstances, or means. From my partner, to the elderly woman who‘d had a fall, to the young lad with a sports injury, and the chirpy flat capped guy with a suspected broken hip, and the loveable and slightly drunk homeless woman with a fractured wrist. They were all treated equally. They were all given the very best medical care available.

I am a huge supporter of the NHS. I marched to save Lewisham Hospital, where I gave birth. I was one of the people who swelled with pride and wept watching nurses bouncing on beds at the opening ceremony of the London 2012 Olympics. And on Saturday I witnessed first-hand how brilliant and precious it really is.

But there are those in government who are keen to see market forces play a bigger role in our NHS, or who are at best extremely relaxed about it. They’ve already introduced a lot more private providers into the system.

You might think, “what does it matter if my routine surgery, my cataract operation or my knee replacement, gets done by a private health care company? So long as I’m not paying for it.” It matters because as the private sector cherry-picks the straight forward and more lucrative areas of care, it gets more and more difficult for NHS hospitals to function well.

There is something about the way hospitals are funded that means that, when money is diverted to private providers for routine treatments or elective surgery, it becomes more challenging for hospitals to provide emergency care and the more complex higher risk medical treatments.

So, this is to say that the concerns around private sector involvement in the NHS are multifaceted.

It’s not just a question of “well, as long as medical treatment is still free, it doesn’t matter who is providing it”. Gradual and almost invisible changes are already undermining and eroding the system. And if we aren’t careful, they’ll have such a seismic impact that we risk losing the NHS as we know it.

There are other people that have a much greater insight into all this than I do. And if you’re interested in finding out more more, a good starting point is to watch this video of Allyson Pollock’s TED talk on the privatisation of the NHS, or to visit the website Public Matters.

The NHS is at risk as never before. I knew that already, but this week I was reminded just how very precious it is, and how fortunate we are to have it.

Our family’s experience this weekend was stressful, but our worries were only for Kev’s health, well-being and medical prognosis. I dread to think how it would have been if we’d been worrying about whether we’d be able to access the specialist care he needed, or whether that care was available close to home. Or if we had been fretting about whether we’d be able to afford the treatment on offer. Or wondering if our insurance would cover it.

This weekend the NHS was there for my family and is going to be hugely important to us over the coming weeks as Kev continues his treatment on the road to recovery.

If the NHS is important to you, then fight for it. I will be.”

What can you use a closed community hospital for? A holiday let!

https://www.theguardian.com/travel/2019/nov/08/healthy-break-devon-stay-restored-landmark-trust-winsford-cottage-hospital?CMP=Share_iOSApp_Other

“Don’t sign pledges on NHS or climate, Tory HQ tells candidates” (but shooting ok)

“Conservative candidates in the general election will be told not to sign up to specific pledges on protecting the NHS from privatisation and trade deals or tackling climate change, according to a leaked internal document from party headquarters.

The 11-page briefing note explains the party’s position on nine key areas and “strongly advises” prospective Tory MPs “against signing up to any pledges” unless they have been agreed from the centre.

However, supporting shooting is allowed “as an important part of rural life”, the document says. …

The issues on which candidates have been told to avoid signing up to pledges include:

Trade deals with the NHS.

The memo warns candidates to avoid signing any pledges to “protect our NHS from trade deals with new legislation which ends privatisation”. It says this kind of pledge would “give credence to factually inaccurate smears … The NHS is not for sale.” It says candidates should focus instead on “Jeremy Corbyn’s attempt to override the British people on Brexit”.

Climate change.

Tory candidates are told that many campaigns to tackle climate change “contain unrealistic targets that would be impossible to achieve” and that it would be better to focus on “practical, reasonable steps to protect our planet while keeping bills down”. The memo claims Labour does not have a credible approach to the problem.

Women’s state pension age.

This highly charged issue could be a significant factor for women in the general election as the age for receiving a state pension rises from 60 to 65. Boris Johnson has promised to review the change, but the memo urges candidates not to engage on the issue. “Avoid signing [pledges],” it says.

“Changes to the state pension age are part of a long overdue move towards gender equality and will put the pensions system on a more sustainable footing for future generations.”

Standing up for Brexit.

The memo says it is unnecessary to pledge to stand up for Brexit because “a Conservative government with a functioning majority will immediately get Brexit done”.

Other pledges to avoid relate to private schools. Tory hopefuls are told they could say: “Labour’s plans to abolish private schools … would dramatically increase class sizes and do nothing for our children’s education.” …”

https://www.theguardian.com/politics/2019/nov/05/dont-sign-pledges-on-nhs-or-climate-tory-hq-tells-candidates?CMP=Share_iOSApp_Other

“Boris Johnson criticised for selective quotes about NHS in letter to voters”

“Boris Johnson has been criticised for misleading voters over the Tories’ record on the NHS, after he sent letters to voters in swing seats that selectively quoted a charity.

The letter, sent out across marginal seats such as High Peak and Reading West, highlighted comments from various media sources and charities praising the long-term plan for the NHS, which was set out before Johnson took office.

One of the highlighted quotes, from Sarb Bajwa, the chief executive of the British Psychological Society, lauded the plan for a “clear commitment to mental health through increased spending and introducing access standards”.

But Johnson’s letter missed off subsequent parts of the quote saying that there was “still a long way to go”, though the plan showed the NHS was listening to concerns about mental health provision. It also highlighted the need for “immediate action for children and young people’s services as they have become woefully underfunded and overstretched” and for mental health provision outside the NHS to be resourced effectively. …”

https://www.theguardian.com/politics/2019/nov/04/boris-johnson-criticised-for-selective-quotes-about-nhs-in-letter-to-voters?CMP=Share_iOSApp_Other

If you don’t want the NHS to be a political weapon – depoliticise it!

NHS bosses have said that the NHS should not be used as a political weapon in the forthcoming general election:

https://www.bbc.co.uk/news/election-2019-50282333

But it will ALWAYS be used as a political weapon if it is given annual sums of money or has very short-term plans made by the political party currently in power, as is the case now.

The solution is to make the NHS independent of politics, have a long-term funding plan and have it run by non-politically appointed staff.

You can’t have it both ways.

Tory”attack lines” document leaked

“The 22-page briefing document is likely to embarrass Conservative HQ as it exposes the party’s strategy for the 12 December poll. …”

A few pages – note fake news like “we are not privatising the NHS … continuing to [de]fund publuc services … the prime Minister’s “Great New Deal” (shades of Trump there and really pretty much May’s old deal – but worse!).

https://news.sky.com/story/general-election-leaked-tory-dossier-details-attack-lines-for-candidates-11852076

Swire says NHS is safe in Tory hands – do you agree

Owl finds nothing in this response on Facebook that is reassuring.

Reply to constituent:

“SWIRE, Hugo
Thu 31/10/2019 12:02
Dear Mrs Hadley
Thank you for contacting me about the NHS and international trade and Jonathan Ashworth MP’s amendment on the Queen’s Speech.

As I have stated before, like you, I cherish our National Health Service and the role it plays in ensuring that no-one is denied medical treatment because they cannot afford it. However, I did not vote for the amendment because I believe it was un-necessary as the Government has been repeatedly clear that our NHS will never be on the table in any trade negotiations, a position I fully support.

Free trade is a driver of economic growth which can raise incomes, create jobs, and lift people out of poverty, which is why I am glad that outside of the EU the UK will be able to strike new trade agreements with countries across the globe. But more trade should not come at the expense of the high levels of quality and protection enjoyed in our country.

In the EU trade agreements to which our country is currently party, our NHS is protected by specific exceptions and reservations. Outside of the EU, rigorous protections for our NHS will be maintained and included in any future trade agreement to which our country is party.

I hope this reassures you that all future trade agreements will continue to protect our vital NHS.

Thank you again for taking the time to contact me.

Yours sincerely
Hugo Swire”

Medical student challenges Johnson on NHS

“An angry medical student confronted Boris Johnson over his “PR stunt” visit to a hospital today.

The trip was paid for by the taxpayer – despite kicking off the Tories’ election campaign where the NHS will be a key battleground.

The Prime Minister visited Addenbrooke’s Hospital, Cambs, to meet staff and patients – despite mounting fears the Conservatives will do a deal to open the health service to the US in a post-Brexit trade deal with Donald Tump.

Julia Simons, 23, who is training in the hospital tried to challenge her fears about the future of the NHS if such a deal takes place.

She told the Mirror: “I want him to recognise that, for example insulin is incredibly expensive in the United States because of the monopoly that three companies have.

“And we don’t have that system here at the moment and Brexit threatens the reality that patients here won’t be able to access those drugs. …”

“One of the really expensive things to the NHS is drug purchasing and if we don’t have any guarantees about that being protected then how can I possibly consider voting for someone who is going to possibly detrimentally affect the death of my patients?”

Boris Johnson , Matt Hancock the health secretary and Liz Truss, the international trade secretary have all insisted that the NHS is “off the table” in talks with the US.

But reports of meetings where the relationship between the deal and health service remained open and reported by Channel 4’s Dispatches have ramped up fears. …”

https://www.mirror.co.uk/news/politics/angry-medical-student-slams-boris-20765714

Screwed NHS more screwed: Tory bed cuts cause chaos

“The NHS needs thousands of extra beds to prevent patients being subjected to “corridor care” this winter, doctors have said.

The Royal College of Emergency Medicine (RCEM) analysed NHS data and found that 4,000 to 6,000 extra beds were needed to “keep emergency departments moving” by ensuring that patients could be accommodated.

Katherine Henderson, president of the college, said: “Our number one priority is to put an end to ‘corridor care’ this winter. To do this we will need at least 4,000 extra staffed beds.

“Emergency departments aim to have most patients treated and back home on the same day, but nearly a third of all patients who go to major A&Es needed to be admitted to a bed.

“A lack of beds means that many patients have to wait long times in undignified conditions, often on a trolley in a corridor. Last year nearly a third of a million people waited for over 12 hours. No patient should have to experience this for even a couple of hours, let alone for over half a day as some do.”

It is deemed unsafe if more than 85 per cent of available beds are occupied at any one time because this would leave hospitals unable to cope with surges in demand. Last winter occupancy rates hit an average of 93.5 per cent, Dr Henderson said, adding that more than 15,000 beds, or about one in ten, had been lost since 2010.

This summer was the worst ever in terms of the number of patients waiting more than 12 hours for a hospital bed, she said.

“This is a difficult position to be going into winter in. Without more beds, with appropriate nursing staffing, we fear we may be in for another record-breaking winter,” she added.

An NHS spokesman said: “The NHS will indeed be opening up thousands of beds over the next few months, based on the local availability of nurses and other staff. Hospitals will also be working closely with community health services and local authorities’ home care and care home services.”

A Department of Health and Social Care spokesman said: “We have invested £240 million in adult social care to ease pressures this winter by getting patients home quicker and freeing up hospital beds across England.”

Source:Times (paywall)

“Trump’s Plan for the NHS” on TV tonight, Channel 4, 8 pm

Tonight Channel 4 Dispatches, 8 pm:

“Antony Barnett investigates how a future trade deal with President Trump’s America might leave the NHS footing a bill for billions, with less money for UK healthcare. US drug giants are lobbying negotiators to make the NHS pay more for medicines.”

Sick people in Budleigh area can’t get to medical appointments due to lack of voluntary drivers

“People across Budleigh Salterton are missing vital medical appointments due to of a severe lack of voluntary car drivers.

Transport charity TRIP, which runs Budleigh Voluntary Car Service, has eleven drivers helping out, but most can only do limited times and days.

Neil Hurlock, office manager for the charity, said: “We desperately need more drivers.

“We are turning away several people a week because we have not got drivers.

“We had a case where we had no drivers available one day – this happened two weeks on the trot.”

The car service was created to provide transport by car for disabled people or frail elderly people who struggle to use public transport – either because there is no transport available or because they cannot walk to a bus stop or easily climb on and off a bus.

As well as covering Budleigh, the service extends to residents living in Colaton Raleigh, East Budleigh, Otterton, Woodbury, Woodbury Salterton and Yettington.

Mr Hurlock said a lack of on-call drivers could have serious implications to those relying on the service to get to appointments.

He said: “It means some of our users will not be able to attend medical appointments. If we do not get more drivers, then people are unfortunately going to be continuing to miss appointments.

“That is going to have a knock-on effect on their health because they will not be getting to their appointments at Royal Devon and Exeter Hospital.

“We want to make sure these people are attending their appointments.”

The voluntary car scheme sees people utilise their own vehicles to help people visit hospitals and go shopping.

Anyone can become a voluntary driver and full training is provided by TRIP.

The charity also offers the opportunity for those interested to attend a ride-along to see if they are suited for the role.

The charity offers 45p a mile in fuel expenses.

For more information, drop into the TRIP offices in New Street, Honiton, or call 01404 46529.”

https://www.exmouthjournal.co.uk/news/voluntary-drivers-needed-in-budleigh-devon-1-6329908

“New report reveals alarming shortage of country doctors”

“Hospitals in rural and coastal Britain are struggling to recruit senior medical staff, leaving many worryingly “under-doctored”, a major new report seen exclusively by the Observer reveals. Some hospitals in those areas appointed no consultants last year, raising fears that the NHS may become a two-tier service across the UK with care dependent on where people live.

Disclosure of the stark urban-rural split emerged in a census of consultant posts across the UK undertaken by the Royal College of Physicians (RCP), whose president, Andrew Goddard, has warned that patients’ lives may be at risk because some hospitals do not have enough senior doctors.

Just 13% of consultants appointed in England last year went to hospitals serving mainly rural or coastal areas, with the other 87% being hired by those with mainly urban populations.
…”

https://www.theguardian.com/society/2019/oct/13/nhs-consultant-shortage-rural-coastal-areas?CMP=Share_iOSApp_Other

“Doctors fear winter crisis chaos is looming in Devon”

“Fears of a winter crisis chaos across hospitals have been raised after new figures have shown A&E waiting times in parts of Devon are already worse than would be expected during the hardest months of the year.

NHS figures show 72.8 per cent of people arriving at Royal Devon and Exeter NHS trust’s major A&Es waited less than four hours before being admitted, discharged or transferred.

It is the trust’s worst performance since A&E waiting times began to be measured on a monthly basis in June 2015. Performance has been deteriorating at the trust since March this year. The target is 95 per cent.

The RD&E says the reason is due to ‘very high’ patient demand, staffing pressures and shortages in the care sector.

The British Medical Association (BMA) has warned poor A&E performance in September meant the NHS was on a “collision course” for what is likely to be the worst winter ever.

Overall, 81.9 per cent of patients waited less than four hours at all A&Es and minor injury units run by the RD&E in September.

Across England, 77 per cent of people waited less than four hours in major A&Es in September before being admitted, discharged or transferred.

BMA council chair Dr Chaand Nagpaul said: “The NHS has just experienced its worst-ever summer. This is incredibly alarming and should be taken as a serious warning sign of the chaos that is likely to unfold in the NHS this coming winter.

“With summer performance now as bad as recent winters, we have reached a point of year-round crisis and the Government cannot continue to let this happen.

“September A&E waits were the worst performance record outside of winter since 2010 and trolley waits and referrals to treatment are worse than we have seen in the last decade.

“Patient care is suffering, NHS staff working tirelessly around the clock are suffering, and with Brexit on the horizon and early indicators of an extremely cold winter, we are on a collision course for what is likely to be the worst winter ever.

“This is a serious plea – we need to see investment across the board including community and social care, and resources such as more beds, reaching the frontline now.”

https://www.devonlive.com/news/devon-news/doctors-fear-winter-crisis-chaos-3419929

Nurse shortage now a serious Health and Safety issue for patients and nurses

“The Royal College of Nursing (RCN) has published a report today, called ‘Standing up for patient and public safety’, outlining the serious staffing crisis and its potential causes.

The report warns of the need for legal responsibilities regarding the supply and planning of the health and care workforce. It says they need ‘Investment, long-term solutions and legislation to futureproof the workforce’.

This comes after current NHS figures show that there are now a record 43,671 empty nursing positions in the NHS in England alone, with 12% of posts are now without a full time Registered Nurse (RN).

RCN have stated in the report that there must be clearer roles, responsibility and accountability with workforce planning and supply, clearly defined in law.

Since 2017, the number of nurses in England joining the professional register for the first time has consistently been lower than the number of people leaving the register,
Recent polling for the RCN pointed out that 80% of the public agrees that the Government should have a legal responsibility for ensuring there are enough nursing staff.

This issue is having a knock-on effect on patient care, with new analysis showing that wards working with less than 50% of the expected registered nurses were twice as likely to admit they had to compromise on care.

This is why RCN have said, it is no longer the time to be discussing whether we need law, but rather how we secure these vital changes in legislation.

Despite the fact that The Health and Social Care Act (2012) devolved many of the roles and responsibilities on this issue, the RCN report shows that the subsequent poor clarity across all parts of the health system has left parts of it in ‘limbo’ and limited any potential progress on the staffing the crisis.

Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing said:

“Nurses are working harder than ever to deliver safe patient care but are being held back by a system that is legally lacking teeth. Despite the public, patients and nurses all agreeing that clarity is needed on responsibilities for delivering enough nurses, we have yet to see any government pledge anything of the like, and as a result are staring down the barrel at a record 43k empty nursing posts.

“We know how dangerous it can be when there aren’t enough nurses to provide care, but at present, almost all accountability rests with the frontline nurse working on the understaffed ward, rather than those responsible for the system they work in. We believe the time has come for change and that patient care was future-proofed by law, and that from the government down, decision makers are held to account.

“Without these bold changes, the public and staff within health and care services cannot be confident that safe and effective care can be delivered, risking the health of patients now and in the future.”

In September, after pressure from RCN members, NHS England and NHS Improvement stated that the issue of accountability for workforce planning and supply remains an area that needs be resolved.

The alarming new report indicates clearly why action is needed to tackle the current workforce crisis but also to ensure there is a sustained investment in the future workforce, at least £1bn per year, according to the RCN.”

http://www.nationalhealthexecutive.com/Health-Service-Focus/nursing-workforce-have-shrunk-at-an-alarming-rate-says-rcn-as-nursing-vacancies-rise-to-record-highs

Swire making promises he can’t keep before he exits

Swire says the only community beds in his constituency that have closed may have a brighter future ahead.

This comes from a speech made by the Health Secretary at the Tory Party Conference about ALL community hospital beds in England, not just the one in his constituency. It was a very vague statement about cons “no further cuts”.

That’s as much as Owl will report on this except to say: seeing is believing, don’t believe any promises made at any party conference just before a possible election – and especially don’t take any notice of Swire, whose only job now is to sabotage the (excellent) chance of Claire Wright replacing him …