RDE rushes ahead with unaccountable “Accountable Care Organisation” plans

[By total coincidence, of course, Tiverton has the only local 24 bed PFI-funded community hospital which cannot therefore be closed].

Tuesday 5 December 2017

“Tiverton GP practice due to join hospital trust – pioneering the way for Devon’s first primary and secondary health care integration

On 2 January 2018, Tiverton’s Castle Place Practice and its 50 members of staff*, including GPs, plan to join the Royal Devon and Exeter NHS Foundation Trust (RD&E). This new venture will be the first of its kind in Devon and will provide locally-led seamless care for the Tiverton community
This move fits with the direction of the NHS Five Year Forward View and offers better integrated working by removing organisational barriers. Castle Place is already co-located with Tiverton Community Hospital and has an established close working relationship with the Trust’s community teams so it was a pragmatic option for the practice to approach the RD&E with the proposal to explore a fully integrated model. Whilst offering the opportunity to work differently for the benefit of all the local community, it will also help address some of the challenges faced by primary care, particularly the difficulty in recruiting new GP partners and balancing time for clinical care with the demands of running a business.

Dr James Squire, GP Partner at Castle Place, explains: “This is an exciting new venture for us and one in which our patients’ best interests are central to our rationale for pursuing this change. I’d like to reassure our patients that in the short-term there will be no changes to the services we offer and in the longer-term will only provide better care.

“The ever increasing challenges and pressures are resulting in necessary changes right across the healthcare system. Thankfully, due to our focus on person-centred, continuity of care we have managed to fare some of these challenges well but we know that to maintain this for our current patients and future generations we need to explore new ways of working. There are a number of different ways GPs could adapt but it was important for us that we secured a future which was true to our core values and principles. Joining the RD&E gives us an opportunity to concentrate our efforts on leading and providing excellent clinical care in a way that’s right for our community”.

“This is a bold step for us but the whole team here is motivated to test new ways of working, not only between the practice and the hospital but also with the community services for our population, and we are really keen to share our experiences and learning for the wider benefit.”

Suzanne Tracey, RD&E Chief Executive, said: “At the RD&E we are prioritising working more closely with local health and care partners to support a move towards ‘place-based care’. This is the future of healthcare and we want to help create the conditions which enable communities to take the lead. To achieve this, we envisage working with our partners in a number of exciting and different ways and this proposal initiated by the Castle Place Practice in Tiverton is a great opportunity to put this into practice.

“Whether in primary or secondary care, all of us want to do what’s right for the person and right for a community but sometimes competing demands, targets and finances can get in the way or slow the pace of change. The partnership with Castle Place Practice is a great opportunity for us to work together with GPs to develop more proactive care which keeps people well and independent in their own communities.”

Castle Place Practice’s 15,000 registered patients, which is around half of Tiverton’s population, will see no immediate changes. Staff will continue in their existing roles, patients’ named GP will not change and access to appointments and services will continue in exactly the same way. However, in the longer term it will enable and increase the opportunities for better management of long term conditions plus improve access to care at home and in the community.”

More bad news for ineffective Local Enterprise Partnerships!

The Industrial Strategy is also offering what it calls “Sector Deals”. Partnerships between Government and groups of industries and businesses focussed on specific industrial sectors such as Nuclear Power.

To unlock Government money here are the sort of things Government will require (page 210):

“Deal proposals should have a demonstrable and analytically rigorous impact on the productivity and earning power of the sector.

We expect credible analysis of the impact of any proposals to accompany each specific proposal showing expected increase in GVA, employment or increases in skilled workers, exports or specific investments (including foreign direct investment) resulting from the deal. Tangible commitments are likely to be the most convincing.

Sector Deal proposals need to be realistic and achievable. We are looking for evidence that industry commitments can be delivered and that clear governance arrangements will be set up. Any arrangements should be proportionate to the scale of ambition of the deal itself and designed to ensure commitments will endure. To be credible, deal proposals should include specific delivery plans covering each component of the proposal.”


Demonstrable and analytically rigorous impact on productivity; credible analysis; tangible commitments; realistic and achievable proposals; clear governance: specific delivery plans …

HotSW, our LEP, is going to have to up its game or we shall lose out on each and every one of these.

Government industrial strategy: Local Enterprise Partnerships have to pull up their socks

Unfortunately, we have heard this all before – words do not seem to get translated into actions:

Page 223:

“… We remain firmly committed to Local Enterprise Partnerships. From next year, the Prime Minister will chair a biannual ‘Council of Local Enterprise Partnership Chairs’. This will provide an opportunity for Local Enterprise Partnership leaders to inform national policy decisions.

While Local Enterprise Partnerships across the country have played an important role in supporting local growth, feedback suggests that their performance has varied.

We are reviewing the roles and responsibilities of Local Enterprise Partnerships and will bring forward reforms to leadership, governance, accountability, financial reporting and geographical boundaries. We will work with Local Enterprise Partnerships to set out a more clearly defined set of activities and objectives in early 2018. These will be driven by influential local leaders, acting as figureheads for their area’s economic success, and a clear strategy for local and national partnership.

We will agree and implement appropriate structures for holding Local Enterprise Partnerships to account. We will work with Local Enterprise Partnerships to review overlapping geographies and ensure people are clear as to who is responsible for driving growth in their area. We recognise that in order to deliver their role effectively, Local Enterprise Partnerships need financial support. We will make additional financial resources available to Local Enterprise Partnerships that demonstrate ambitious levels of reform following the review. …”


Tory Minister refuses to give straight answer when asked to confirm his name!

A Tory minister was so reluctant to give straight answers to questions this morning that he wouldn’t even answer ‘yes or no’ to confirm his own name.

Business Secretary Greg Clark was given a thorough going over by Piers Morgan on this morning’s edition of Good Morning Britain.

He was doing a round of TV studios pushing the Government’s new industrial strategy, which he is launching today. But the minister became stuck in a series of Brexit questions – and his evasive answers appeared to frustrate Morgan.

Clark refused to answer whether he would vote for Brexit if there was another referendum, saying it was a “hypothetical question that I haven’t given a moment’s thought to.”

Host Susanna Reid asked him if Brexit was the best thing for the UK, he again failed to give a straight answer, saying: “I believe that we have to get the best deal through these negotiations and I think it’s possible to do that.”

Morgan asked him if that was a ‘yes’, to which he repeated: “I think we can get a good deal. It’s in everyone’s interests to get a good deal.”

Finally, Morgan challenged the Tory minister to give a straight, yes or no answer to one question – “the allegation that you are named Greg Clark.”

After some laughter, and a long, uncomfortable pause, Clark said: “Well, I think you’ve got that.”

Morgan seemed satisfied with his answer, saying: “We’ve established at least one convincing answer.”

But Reid was left unconvinced, adding: “I’m not sure we did. I think there was room for doubt there.” …”


Swire’s blog: is this satire?

“ … Despite all this [negative news for Tories – he mentions sexual harassment, Paradise Papers, Brexit shambles] A You Gov poll for the Times found 34% of voters want Theresa May to stay as Prime Minister, up one point from a month a go. It seems middle England, at least at the moment, cannot bear to contemplate the alternative!”


Er, doesn’t that mean that up to 66% of people (he doesn’t specify what the choices were which might include “don’t knows”) DON’T want May as PM?

Grenfell Tower resident blogged that fire would be result of council’s deliberate neglect – local media refused to take up the story

Local media knew about this for YEARS but refused to take it up or investigate, leaving a lone Grenfell Tower blogger to document the unfolding disaster. One so-called “local” journalist was actually filing copy from Dorset!

“[Edward] Daffarn [a social worker who had lived in Grenfell Tower for 15 years] is understandably emotional when reflecting on the last few months, but more than that he is angry. Angry with the way he feels Grenfell residents were treated by the Kensington and Chelsea Tenant Management Organisation – the people who were entrusted to maintain the estate and keep its residents safe. Angry with the Royal Borough of Kensington and Chelsea Council, which was meant to scrutinise the KCTMO. Angry with a society which didn’t seem to care about people like him – people who live on housing estates – until it was too late.

“The reality is if you’re on a housing estate it’s indifference and neglect, two words that sum up everything about the way we were treated,” he says. “They weren’t interested in providing housing services, keeping us safe, maintaining the estate. They were just interested in themselves.”
It wasn’t for us to tell the council what they should be doing we were just trying to raise an alarm.

Edward Daffarn, Grenfell Action Group blog

Daffarn and fellow Grenfell resident Francis O’Connor had been blogging on behalf of the Grenfell Action Group since 2012. They wrote about issues that concerned their tight-knit community – air pollution, the closure of the local public library, and their fears that corners were being cut during the refurbishment of the tower.

“We wanted to record for history how a community on a housing estate in the fifth richest country in the world could be ignored, neglected, treated with indifference. We never thought we could make change. We just wanted to record what was happening,” he says.

Daffarn and O’Connor shared a theory that Kensington and Chelsea – a London borough more widely known for its museums, designer shops and flower shows – actually wanted its council estates to go into decline, so that the residents would leave and expensive flats could be built in this sought-after location. For this they were described as fantasists.

“We weren’t fantasists,” he says, visibly hurt. “We were trying to raise genuine concerns about how our community was being run down.”

The natural consequence, he concluded, would be loss of life. Which is why on 20 November 2016, frustrated and desperate, Edward wrote the blog post KCTMO – Playing with fire!

“It is a truly terrifying thought but the Grenfell Action Group firmly believe that only a catastrophic event will expose the ineptitude and incompetence of our landlord.”

A few months earlier a fire had ripped through five floors of a tower block in Shepherd’s Bush, just down the road. Edward was worried that if a fire broke out in his tower block residents wouldn’t know what to do. They had been given no proper fire safety instructions from the KCTMO. There were no instructions on individual floors on how residents should act in the event of a fire, there was only a recent newsletter saying residents should remain in their flats – advice which in the case of the Shepherd’s Bush fire would have led to fatalities.

There’s a lot of abusive behaviour evidenced forensically about what was happening to our community, but it wasn’t sexy so it never got picked up.

In March 2017 the KCTMO installed fire safety instruction notices in the entrance hallway to Grenfell Tower and outside the lifts on every floor of the building, again urging residents to “stay put” unless the fire was “in or affecting your flat”.

It wasn’t the first time the Grenfell blog’s authors had raised concerns about fire safety.

Before the blog began, when a school was built on the only green space the residents had, they wrote to the borough pointing out that access for fire and emergency vehicles had been compromised.

Later they blogged about the blocking of a fire exit with mattresses during the refurbishment and the power surges in 2013 that manifested in flickering lights, computers and stereos blowing up, and entire rooms filling with smoke. These continued for three weeks, Daffarn says.

“We were tenants we weren’t fire safety specialists but we were switched on enough to feel this was important and it was not being dealt with on our estate and that’s why we were blogging. It wasn’t for us to tell the council what they should be doing., We were just trying to raise an alarm.”

An alarm that went unanswered. The November 2016 blog post represented the last moment at which something might have been done to avert the disaster which followed six months later. But why didn’t anyone heed or investigate Daffarn’s claims?

Hidden within the story of the Grenfell blog is another story of the decline of local media. There simply was no local press on the ground in the borough of Kensington and Chelsea scrutinising the authorities and helping to amplify the voice of people like Edward Daffarn.

The last time he had the attention of a local journalist was in 2014 when Camilla Horrox, the reporter for the Kensington and Chelsea Chronicle ran front page stories about Grenfell residents’ concerns regarding the possible presence of asbestos on the site of the new school and about the power surges.

She had met Daffarn several times, and had been concerned about KCTMO’s dealings with the residents of the properties it managed.

But when the newspaper was closed down later that year Horrox was made redundant and all her Grenfell articles disappeared from the web. The Kensington and Chelsea Chronicle was incorporated into a website that reports on 29 west London districts.

Horrox’s replacement was expected to report on three boroughs – Kensington and Chelsea, Westminster and Hammersmith and Fulham – while based in Surrey, an hour’s drive away.

Some residents of the borough might have been under the mistaken impression that they did have a local newspaper. In 2015 a free paper, The Kensington and Chelsea News, was established to fill the gap left by the closing of the Chronicle.

But when I tracked down its reporter he explained that he was the sole reporter working on the paper, and on two other local newspapers – his salary was £500 a week and he did almost all his reporting from home in Dorset, 150 miles away. He made it to the borough only twice in two-and-a-half years, and the one story he ever published about Grenfell was from a council press release about the installation of the new cladding.

Though he always searched for a “good front page splash” for each of the three editions, he also made sure to find two pages of royal stories and two pages of entertainment stories.

Edward Daffarn didn’t take his concerns to the media in November 2016 because he no longer thought anyone would listen. But the blog was out there for everyone to see, he points out, if only they had been looking.

“We’d been blogging for three or four years and you go back over that time there’s a lot of abusive behaviour evidenced forensically about what was happening to our community, but it wasn’t sexy so it never got picked up.”
For Edward, what was going on at Grenfell wasn’t just a local story, but a national one. A story about invisible people in a society that cared more about celebrity and wealth than its most vulnerable residents.

Close to tears, he admonishes the nation’s journalists.

“If you look back now our whole community of North Kensington, the policy that the local authority was taking every public space and privatising it, that that could be missed by the BBC, by Channel Four, by these wider news agencies… The question should be for you, why did you miss it?
“Why aren’t our lives important enough for you?”


When is government funding not government funding?

… When you announce a fund of £1.7 billion and, in the same press release, announce that you have only agreed to spend £250 million!

“… The Transforming Cities fund aims to improve connectivity, reduce congestion and bring in new technology to create high-quality jobs and spread wealth around the country.

Some £250m has already been allocated to the West Midlands. …”