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

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

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

https://eastdevonwatch.org/2017/12/13/effect-of-sustainability-and-transformation-plans-on-rural-communities-east-devon-tories-miss-the-boat-then-moan-about-it/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

https://www.theguardian.com/society/2017/dec/16/social-care-for-elderly-postcode-gap-grows

DCC Health Scrutiny Committee – not fit for purpose

The DCC Health Scrutiny Committee lurches from poor practice to bad practice to utter chaos under the continued Chairmanship of Sarah Randall-Johnson

Can you imagine saying you will vote against questioning NHS Property Services about their intentions on the future of community hospitals which they now own “because they might not come”! And Randall-Johnson saying she is “not aware of any threat to any community hospital!!!

[CCGs have been offered match funding from the government for any properties sold in their areas]
http://www.mirror.co.uk/news/politics/naylor-plan-outline-sell-nhs-10544577
http://www.property.nhs.uk/asset-management/

Claire Wright’s Blog:

NHS Property Services will be invited to attend the next Health and Adult Care Scrutiny Committee in January.

But my simple request prompted a debate lasting over half an hour, at Tuesday’s meeting (21 November).

The lengthy and baffling discussion gave a poor impression of the committee in my view, with some Conservative councillors claiming confusion and dismissing the proposal several times as “premature.”

It all started off with a presentation to the committee by Independent councillor, Martin Shaw, under the final work plan agenda item.

Cllr Shaw rightly pointed out how many people were concerned about the potential loss of the hospital buildings, that they had put their own money into them and still there was no clarity over their future, yet NEW Devon CCG were (or at least would very soon be) paying large sums of money in rent each year when previously they owned the buildings outright.

NHS Property Services, a private company wholly owned by the Secretary of State for Health, set up under the Health and Social Care Act 2012, acquired the ownership of 12 community hospitals in Eastern Devon at the beginning of this year.

Given that the NEW Devon CCG is one of three most financially challenged health trusts in the country and must make huge cuts to try and stem a deficit of over £400m by 2020, people’s concerns about the future of the hospitals are very valid.

Following my proposal to invite NHS Property Services to the January meeting, chair, Sara Randall Johnson said there was a full agenda for the next meeting so it may not be possible to include it. She said that she was not aware that there was a threat to any community hospital.

Liberal Democrat, Brian Greenslade said NHS PS had been invited previously but questions had been remained unanswered and so should be invited again.

Conservative, Phil Twiss, who represents Honiton which has lost its own hospital beds, claimed in a number of long statements that it was “premature” to invite the company because the future of the buildings had not yet been decided.

He later added that they wouldn’t come anyway.

I replied that waiting until the March meeting was far too long and could mean that decisions were already made. Surely we need to talk to NHS PS and the CCG before their decisions?

I attempted to explain again why it was important we invited the company to the January meeting.

But apparently confusion reigned.

Conservative members became very fixated with the legacy issue, even though I had made it clear that it was about questioning NHS PS and the CCG about their plans on the future of community hospitals and the legacy issue was only part of that.

Chair, Sara Randall Johnson, suggested holding a meeting first to agree some questions to ask NHS PS. I have not seen this approach in my four and a half years as a member of the committee.

I had to make my proposal numerous times, while one or two persistent Conservative members continued to challenge it.

There was an amendment by Liberal Democrat, Nick Way, who wanted a spotlight review into the issue as well.

Phil Twiss then changed his tack and claimed there was no point in asking the company to attend as they wouldn’t come. He was in favour of a spotlight review instead (spotlight reviews are held in private).

But when the vote finally was taken, it was on the spotlight review amendment and not my original proposal to invite NHS PS to the next meeting …

I tried to intervene. Fortunately, the officers corrected matters… and then the majority of the committee voted in favour of my proposal. Finally.

My proposal couldn’t have been more straightforward or uncomplicated. It was entirely within the committee’s remit.

It was also within a couple of hours of hearing the county solicitor’s presentation about how scrutiny should do its job properly. Or be culpable. See this blogpost here – http://www.claire-wright.org/index.php/post/devon_county_council_solicitor_tells_health_scrutiny_committee_you_have_a_v

Here’s the webcast. It is the final item on the agenda – https://devoncc.public-i.tv/core/portal/webcast_interactive/302658

Pic: Me exasperated!”

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

Another council refers its hospital closure to Secretary of State

“The future of the inpatient ward at Rothbury Community Hospital is going to the top, after councillors voted to refer the matter to the Health Secretary.

After the joint executive board of the Northumberland Clinical Commissioning Group (CCG) last month voted unanimously in favour of permanently closing the inpatient ward and shaping the existing services around a Health and Wellbeing Centre at the hospital, the proposed closure of the 12 beds was discussed by Northumberland County Council’s health and wellbeing overview and scrutiny committee this morning.

And now that closure is on hold and the final decision rests with the Health Secretary Jeremy Hunt. The aim of today’s meeting was to decide if the consultation with the committee had been adequate; if the committee felt the proposal would not be in the best interests of the health service in Northumberland; and therefore it it had sufficient evidence of these concerns to make a referral to the Secretary of State for Health. And as part of her statement to members, Katie Scott, from the Save Rothbury Community Hospital campaign group, reflected on this first issue.

“Surely at all stages the scrutiny committee should have been consulted? It seems to us that you have been ignored,” she said. “I believe today is the first opportunity in over 14 months for the committee to fully examine the proposal to take away our beds.”

She also questioned the reasons put forward by the CCG for the proposed closure – the alleged savings, bed underuse and the drive to treat people in their own homes – claiming all are flawed, as well as saying the consultation has been ‘defective’.

However, Stephen Young, Northumberland CCG’s strategic head of corporate affairs, outlined the lengthy process of consultation, including with the committee, and explained that it was made clear to councillors that there was no local support for the proposed closure. He added: “We believe there’s alternative, suitable provision in the area.” His colleague, Dr Alistair Blair, the clinical chairman, set out the clinical reasons behind the proposed closure, which included the fall in bed occupancy and the wider national context around more care being provided at home and why this was beneficial.

He added that they had been monitoring the impact on healthcare services elsewhere in Northumberland for 12 months while the ward has been shut and there have been no adverse consequences. “We understand that this does not have local support but we have to look at the evidence base,” Dr Blair said. “We hope the Health and Wellbeing Centre will benefit more local people.”

One local who benefitted from the ward prior to its closure was Coun Steven Bridgett’s grandmother – the care she received at the hospital prior to her death in 2012 was the focus of an emotional address by the local ward member: “Gran was so well looked after and cared for that you would forget that she was 91 and had most of her body failing her.”

It was his statement which probably resonated most with the Rothbury residents who had filled the council chamber at County Hall in Morpeth. “We are no more than numbers on paper to the CCG,” he said. Turning their attention to the three questions mentioned above, a majority of the committee members considered that the consultation with the committee had not been adequate as the preferred option for consultation, ie, the closure of the ward and the creation of a Health and Wellbeing Centre, was decided and the consultation started before being brought to the scrutiny committee, albeit the CCG brought the matter to the first available meeting once that decision was taken.

A majority of the councillors also felt that whether the proposal was in the best interests of the health service in Northumberland could not be fully assessed as it had not been made clear exactly what the Health and Wellbeing Centre will be and there were also questions over the robustness of the data in relation to future-proofing and knock-on impacts in the rest of the county.

Therefore, following around half-an-hour spent thrashing out their reasons amid advice from the council’s senior legal officer, members voted to refer the matter to the Secretary of State. In each case, members voted by five votes to two with one abstention.”

http://www.northumberlandgazette.co.uk/news/future-of-rothbury-hospital-ward-goes-to-secretary-of-state-1-8808912

Referrals by councils to Secretary of State increase – but not in Devon where local Tories said it wasn’t worth doing

“2017 is shaping up to be a bumper year for NHS service change proposals in England being referred to the Secretary of State for Health by local politicians. And that means a bumper year for initial assessments by IRP, the independent body that advises the Secretary of State. [This is what would have happened – mandatory independent scrutiny – if the DCC adult care scrutiny committee had not had a block Tory vote to refuse it – spurred on by Diviani ignoring the wishes of his own council and some very dubious chairing by Sarah Randall-Johnson. What were DCC Tories afraid of, Owl wonders?

We saw just two initial assessment letters in 2016. The assessment letter IRP published on 18 October responding to concerns raised by Thurrock Council about the location for a specialist scanner, is the fifth IRP has published this year and we’re waiting for more to progress through the system.

Local councillors are uniquely placed to understand public sensitivities around changes to local health services, so it’s no surprise that NHS legislation gives them a crucial role in overseeing health service change programmes. The role is important and the legislation sets out responsibilities for NHS and council leaders to make sure the process is effective.

The IRP’s assessment of the Thurrock referral is a timely reminder of the requirement for councils to formally join together to scrutinise proposals that affect more than one local authority area. In this case it seems Thurrock councillors declined to take part in a joint scrutiny committee and instead dealt with the matter on its own. The process is there for good reason and not following it risks weakening whatever good case a council has for making the referral.

The regulations allow councils to come together to form joint scrutiny committees whenever they see fit. The same regulations require councils to form a joint committee when “a relevant NHS body or health service provider consults more than one local authority’s health scrutiny function about substantial reconfiguration proposals”. The rules mean where a section 30 ‘mandatory joint health scrutiny committee’ is in place, only the mandatory committee is allowed to respond to the consultation; exercise the power to require information about the proposals to be provided to it; and require people from the relevant body to appear before it to answer questions relevant to the proposals.

The power to make referrals to the Secretary of State for Health is different. Councils can choose to delegate that to a mandatory joint scrutiny committee, or retain it. So the rules would have allowed Thurrock to participate in the mandatory committee and still consider the matter of referral alone. Would it have strengthened their case to have done that? It’s hard to envisage that following the required process would have weakened it.”

https://www.consultationinstitute.org/focus-health-scrutiny-irp-essex-cancer-scanner-review/

Q: who does Diviani represent on the NHS? A: Jeremy Hunt

How does Owl know?

Well, he DOESN’T represent East Devon District Council – they told him to vote to keep local community hospital beds and maternity services open. He went to a DCC scrutiny meeting and voted to close them.

He DOESN’T represent the eight district councils he is supposed to represent at DCC [as a co-optee NOT a full member of the committee – and he was only allowed to vote because the badly-worded DCC constitution does not make the voting power of a co-optee clear] because he admitted in public that he did not consult any of the other councils before voting.

He DOESN’T represent DCC because he has not stood for election to that council and been successful.

WHAT was his reason/excuse/pathetic flim flam for his vote then?

That other attempts to refer the closure to the Secretary of State had failed, so this one would also fail.

How did he know that? Does he have a direct line to Hunt’s office or what passes for Hunt’s brain? He must have one or the other because he KNEW in advance what would happen and chose to vote on what he says he KNEW.

But if he KNEW what would happen (and he says he did) then why not vote as EDDC told him to do? The letter would have failed and he could still say he had voted as instructed at EDDC (though not as other councils wanted as he had no idea about that.

BUT – as he again admitted – it would have slowed down the closure. It would have given councils, the staff and supporters of the hospitals, the patients and their carers, more time to put alternative plans into action. More home care staff, more suitable plans for hospital buildings, better care for patients at home.

He did none of these things. He and Sarah Randall-Johnson consigned community hospitals to the rubbish heap.

And all because, he says, he knew what Jeremy Hunt would do.

So, now we know, he has a direct line to Jeremy Hunt and does what Jeremy Hunt wants him to do.

But why? Owl can only guess that he wants a gong from this despicable government to add to his only other qualification – an innkeepers certificate.

And the only way to do that is do the bidding of those who hand them out.

And if that isn”t his rationale, Owl would welcome a comment from him which would be published on the blog in full.

And what of his “representation” of the other councils? Who voted for him to be their representative? Was there a vote at all?

Or conversations in dark corners of County Hall?

“Tories block recording concerns over biggest ever planned health service cuts in Devon”

Oh, how different it will be if (when) Tories lose control of DCC. We will then hear Twiss and his party colleagues saying EXACTLY what Claire Wright is saying!

Party politics sucks. More Independents needed – urgently.

From the blog of Claire Wright:

“.. And the County Solicitor will be called to address the committee to remind it of its responsibilities.

Devon County Council conservatives blocked my proposal yesterday to record significant concerns over the biggest cuts facing Devon’s health service in living memory.

Sonja Manton from NEW Devon Clinical Commissioning Group gave an update on the plans to slash around £500m by 2020, as part of Devon’s Sustainability and Transformation Plan (STP).

The county’s STP is one of 44 across the country and is the government’s main programme of major cost cutting and centralisation in the NHS, to stem a £30bn shortfall by 2020.

I asked a number of questions mainly on staffing, budgets and buildings, along the following lines:

What are the vacancies and how do you plan to fill them and when do you plan to make redundancies (which has been previously hinted at)?

The answer was woolly (and no amount of pushing would encourage Dr Manton to reveal more). It contained no information on numbers, but she did mention that there is a 30 per cent turnover rate across Devon, in home care staff and that 75 per cent of the NHS budget is spent on staffing.

Next I asked whether pregnant women would still have a genuine choice where to give birth, as three community maternity units at Okehampton, Tiverton and Honiton were set to close (two have already closed temporarily due to staffing issues).

The answer was that the new service would meet national guidelines, so I pushed and asked whether pregnant women would be able to have a choice of a midwife led unit and how far they would have to travel. The answer was that there will be a new midwife led unit at the RD&E, adjacent to the consultant led unit.

So essentially women from all over Devon will soon have to either have a home birth, or travel to Exeter to give birth, whether that’s at a midwife led unit or a consultant led unit. There was a bit of a disagreement about me saying the current midwife led units were closed, despite the announcement having already been announced that this was the intention and two being temporarily closed due to staffing pressures.

Next I asked how many more beds were planned to be cut.

More prevarication.

I pushed. Was the figure of 600 bed cuts recognised, which was the broad figure in the first draft of the STP?

Yes this figure was recognised but it depended on a raft of issues.

Finally, I asked about the selling off of redundant estate. How many, where and when? Another non answer ensued. It was the next piece of work.

Entirely frustrated at the refusal to answer questions, not because I believe, the answers are not known but because there is a total refusal to get into any detail whatsoever, I expressed my complete frustration and disappointment at the answers. It made no difference.

Other councillors asked other questions.

At the end of the debate I proposed a resolution that the committee express significant concerns over the STP, its potential effect on patient care and the lack of transparency so far.

I called for urgent information on staffing, beds, buildings and budgets, in particular.

The proposal was seconded by Chair, Sara Randall Johnson, who added that a piece of work would be done on this.

Unfortunately, my wording appeared to upset the conservative group. Cllr Philip Sanders said he didn’t like that I had said the process appeared not to be transparent and wanted this word deleted. I replied that that it was entirely justified and refused to amend my proposal.

But fellow Conservative, Phil Twiss, wanted ANY mention of concerns deleted.

He said: “We don’t need the emotional language.”

Three years ago, Cllr Twiss reported me and this blog to the police cyber crime unit. You can read about it here, if you like – http://www.claire-wright.org/index.php/post/eddc_tory_whip_reports_me_to_the_police_for_a_comment_on_this_blog

Cllr Twiss then proposed that ALL my words were deleted, simply retaining the section that relating to a task group being set up.

This was voted through by the vast majority of the Conservative group.

Letting down every single resident in Devon who relies on the NHS.

Yes, I think that’s everyone.

Ambulance Trust response targets are failing and RD&E unable to discharge its patients in good time

Later in the meeting we were examining the performance review.

The South West Ambulance Trust which used to meet the national target of eight minutes largely without a difficulty, are now significantly under target. Only 59 per cent of calls were answered within eight minutes, across Northern, Eastern and Western Devon, in July of this year. The target is 75 per cent.

Lives are surely being put at risk. Certainly news of the failures are hitting the local media.

The narrative attached to the graph claimed that the reason was the rural nature of the South West. Yet the South West has been rural for years and this wasn’t a problem previously. Of course there have been cuts to budgets, and reductions in the number of ambulances so that is more likely to be the cause of the failure.

Problem with delayed discharges at the RD&E

Similarly, the RD&E was shown to have a significant problem with delayed discharges.

In June this year a daily average of 66 beds were occupied by patients who were well enough to go home.

It was obvious from the graph that the problem was clearly way out of kilter with other local NHS trusts.

This was largely to do with major staffing problems in the care sector, an officer confirmed.

of course it is these staff among others that we will rely on, to look after people in their own homes following community hospital bed cuts.

I proposed a resolution that the committee record its concerns at the ambulance response rates and the high level of delayed discharges at the RD&E and invite both trusts to the next committee meeting.

I had to argue with the chair that the proposal should retain the bit about recording concerns, before it was seconded by Cllr Brian Greenslade.

One of the Labour councillors was unhappy with me mentioning the RD&E at all in my resolution because she was chairing a piece of work looking at delayed discharges. I tried to point out that the resolution supported her work but she was adamant …

Then Cllr Twiss started up again. He said he didn’t like my wording and that I was simply making a statement that “looks good in the press.”

I reminded Cllr Twiss that the committee is legally constituted to scrutinise health services on behalf of the people and our job is to hold the health service to account. In fact such words had been used recently in a standards committee hearing minutes.

Anyone who is familiar with the basic requirements of an audit trail will recognise the importance of the committee recording concerns about service failures in this way.

I told Cllr Twiss that I intended to ask in the work programme agenda item, that the county solicitor attends the next committee meeting and outlines our responsibilities.

The final amendment removed my words about concerns about the RD&E’s delayed discharges but retained the words about the ambulance trust target failure.

So Ambulance Trust representatives will be invited to the next meeting.

I have certainly heard anecdotally that things are very challenging indeed within the Trust, with too few ambulances and low staff morale.

I duly asked in the final agenda item for the County Solicitor to attend the next meeting to remind the committee of its remit.

Some councillors appear to be in sore need of training.

Playing political games with health scrutiny resolutions is a dirty and unacceptable game.

NHS Property Services and buildings

Cllr Martin Shaw spoke to a report he submitted to the committee on this. The upshot will be that a sub group will examine the future of community hospital buildings.

The speaker itemised webcast can be viewed here – https://devoncc.public-i.tv/core/portal/webcast_interactive/301904”

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

NHS given 6 weeks to EMPTY beds – not CLOSE them. If we don’t have enough beds, blame Diviani

Diviani’s excuse for not (at least) buying time for our closed community hospitals was that 14 such pleas had been refused so ours was unlikely to succeed. Not CERTAIN to succeed – unlikely. BUT the referral would have

(a) bought us time and ensured our beds stayed open over winter, and
(b) forced the CCG to give us MUCH more information about their numbers.

IF/WHEN we run out of winter beds the BLAME will lie fairly and squarely on Diviani, Randall-Johnson and all those Tories who voted for bed cuts at DCC – PLUS Twiss – who although he voted for referral at DCC, according to news reports, supported his Leader at EDDC last night.

“Hospitals and GP surgeries will struggle to cope this winter as a severe flu outbreak heads towards Britain, the head of the NHS has warned.

Simon Stevens, chief executive of NHS England, has given the health service six weeks to empty beds in order to avoid chaos in A&E as more elderly people than usual get sick.

He also told NHS leaders that he would have a “hard look” at why life expectancy growth is slowing, after The Times revealed this week that progress in Britain has stalled while people in other countries live ever longer.

Theresa May has been briefed about health chiefs’ fears of a winter crisis after hospital wards ended the quieter summer months already dangerously full. Now Mr Stevens has warned that after Australia experienced its worst flu season for many years during the southern hemisphere winter, the virus is likely to strike Britain hard.

NHS flu vaccination will shortly get under way and while it will include the H3 strain dominant in Australia, health chiefs never know in advance how well the jab will protect patients. Last year the vaccine did not work in the elderly but protected children.”

Source: Times (pay wall)