Devon County Council | Wider Devon Sustainability and Transformation Plans

At its meeting held on 08 December 2016, Devon County Council debated the Wider Devon Sustainability and Transformation Plans.

Minute 63 of the meeting notes:

Public Participation: Petitions, Questions and Representations
Petitions, Questions or Representations from Members of the public in line with the Council’s Petitions and Public Participation Schemes.

In accordance with the Council’s Public Participation Rules, the Council received and acknowledged oral representations made by a Mr Wearne and a Ms Wood on a matter relating to the functions of the Council, specifically on the impact of the Clinical Commissioning Group’s Sustainability & Transformation Plans (STP) for NHS services in Devon.

Speech made by Phillip Wearne:
Councillors, one of the motions before you today calls the Success regime now directing our NHS services in Devon flawed and calls for it to be halted until its independence is determined. I agree and trust you will too. You should consider the Sustainability and Transformation Plan process, the STP, headed by the same person in Angela Pedder and operating with the same staff part of the same critique.

In the brief time allowed me I will try and illustrate why what is going on here is not only open to serious accusations of pre-determination but riddled with conflicts of interest and inherently unfair, especially for North Devon. In sum what is going on is an inside job.

Firstly how can a healthcare trust running an acute service district hospital like North Devon District actually defend services when it proclaims itself part of a Success Regime that has made it clear that its services will be cut? How can our chief Executive Alison Diamond stand up for us North Devonians and represent the Success Regime at the same time? She can’t and she doesn’t – as consultants, staff and the public who have challenged her on this in Barnstaple have discovered.

Secondly, since this is all about money who is Alison Diamond, NDDH’s Chief Executive accountable to? She is married to Andy Robinson, now, having left her employ, the Chief Financial officer of the Success regime. So is she accountable to him or us, the residents of North Devon, where, incidently, she does not even live.

Third, in the clinical cabinet meetings in Exeter and Plymouth who represents North Devon? How many practising as opposed to managing clinicians – it’s an important distinction councillors — from North Devon are involved in the current clinical reviews and decision making? If any, and to date there have been very few, very occasionally, what weight is their opinion ever given?

In the coming weeks and months you will told repeatedly that all decisions on service cuts are being made on clinical grounds. Ask who those clinicians are councillors, where they work, what credentials they hold, what motives might impact their opinions. Money follows patients councillors, particularly in the acute sector. Both Derriford and RD&E have much bigger deficits than NDDH.
The Success Regime’s mantra is clinical and financial sustainability. They don’t say it but I will, councillors. NDDH is today on the very edge of clinical viability. Vacancies in essential areas are rife, staff covering for ghosts are run off their feet, interim, temporary appointments are the norm.

The very threat to our hospital imposed by the Success Regime’s threats to the services provided there has encouraged some staff to leave, others to refuse to come, still others to seek other jobs. Irony of ironies, councillors, the structures are so incestuous that NDDH has even lost two executives to the Success Regime. They are reinforced. We are weakened.

So ask yourselves who has made our hospital less clinically sustainable? Who is already cutting services? Who is weakening, co-opting or even recruiting our management? Ask yourselves whose interests might that be in if the leadership of the Success/STP Regime are determined to make the case for closing more services at NDDH. I say more because ENT and vascular surgery have already gone along with forty acute beds. Facts on the ground are being created councillors. You need to know those facts.

Medicine is an evidence based discipline councillors, and the evidence, points in one direction. Many of you have said to many of us wait for the various service reviews. But we know from bitter experience in Torrington, Ilfracombe, Bideford that will be too late: by then pre-determination will have become determination, and consultation will in fact be foregone conclusion.

By then much of the deliberately manufactured evidence on the clinical and financial viability of our hospital will be in their favour. And guess what, it’ll all be the product of the ultimate inside job. Well paid Success for them, disastrous failure for us. They move on, we in North Devon remain to live, and die, from the consequences.

Speech made by Liz Wood:
Councillors, as an active member of Save our Hospital Services (SOHS) in North Devon I am one of those who have lobbied you asking for your support for the two motions on your agenda as Item 15 today. Some of those exchanges have made it clear that there is little real understanding of what is happening or what is at stake here as regards health service provision in Devon in general, and where I come from in North Devon in particular.

Firstly, please understand that the Success Regime and the Sustainability and Transformation Plan process are now essentially one and the same. Both Ruth Carnall and Angela Pedder have made that clear in public and in private. Of course the latter includes Torbay and South Devon, the former did not, but the objectives of both, a reconfiguration and relocation of services to eliminate deficits based on the underfunding and defunding of our NHS — the subject of the motions before you today — are the same. For “Success Regime” in Cllr. Greenslade’s motion before you today you could and should read Success/STP Regime.

Secondly, many of you seem to think there is no defined threat to acute service provision at North Devon District Hospital. I do not understand how anyone following this issue can believe that. In June Ruth Carnall came to Barnstaple armed with her contradictory and contestable Case for Change document – the product of her own independent healthcare consultancy. Then and since then, she and her Success/STP Regime colleagues have stressed one thing: there are no red lines around any hospital services in Barnstaple. Anything could go, we should expect change, nothing is ruled out they warn in concert. That “nothing” includes all our acute services – consultant led maternity, paediatrics, neonatology, stroke.

You really need to understand one thing councillors. The basic STP template from NHS England allows for only two full service acute centers in each footprint, so technically just two in Wider Devon. As the acute service hospital catering to the smallest catchment population in Devon that makes NDDH particularly vulnerable. As the remotest acute service hospital in mainland England, that makes us, the people of North Devon, uniquely exposed to any acute service cuts.

Please read page 40 of the first draft of the STP, the one dated June 30th and leaked in mid-September, the one they did not expect the public or the politicians to see. It contrasts sharply with the second draft of the STP, the one sanitized for public and political consumption and published in October.

In the context of Derriford Hospital being the accepted primary fixed point for emergency care in Devon, the STP Draft One states: “Under a two site-option for maternity, paediatrics, neonatology and stroke, Royal Devon and Exeter Hospital would most probably be the second site rather than North Devon District Hospital….”

STP/Success Regime proponents and protagonists are not accountable to us councillors. But they are accountable to you and you are accountable to us, the residents and electors of this county. Please read what I have referred to, please listen to what they say, please question them, their assumptions, their statistics, and their evidence much more comprehensively than to date.

Above all please understand what is being proposed here – real, substantial cuts in provision and accessibility under the pretence of better care. Passing these motions today as I trust you will is just a start. The real work begins when you give them effect in both practice and spirit. Please ensure you do. Please make today a beginning, not an end.

The Chairman responded, thanking Mr Wearne and Ms Wood for their attendance and presentations, acknowledging representations made by them had been heard by the Members of the Council and would be taken into account, as necessary, at the appropriate stage of the Council’s proceedings (Minute 73 below refers).

Minute 73 of the meeting notes:

Cuts to Devon Health Services and the Success Regime (Minutes 55 and 56 of 6 October 2016)

To receive and consider the recommendations of the Cabinet relating to Councillors Biederman and Greenslade’s Notice of Motions.

The text of the original Notices of Motion, the Cabinet’s recommendations and any reasons therefor may be seen in full at Minute 104(e) of the Cabinet held on 9 November 2016 (Page 10 of 9 November 2016, Green Pages).

Pursuant to County Council Minutes 55 and 56 relating to the two Notices of Motion set out below as originally submitted and then formally moved and seconded by Councillors Biederman and Greenslade that:

Proposed Cuts to Devon Health Services and Impacts on Patients (Councillor Biederman)
‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.

This Council also recognises that Governments have deliberately not provided the NHS with the adequate level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations’.

NHS Success Regime  (Councillor Greenslade)
County Council believes that the NHS Success Regime project for Devon is now seriously flawed and accordingly calls on the Secretary of State for Health and NHS England to cancel it forthwith. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services.

Until funding issues are addressed it is not possible to decide whether or not there is a local NHS budget deficit to be addressed. Unnecessary cuts to local NHS budgets must be avoided!

Devon MP’s be asked to support this approach to protecting Devon NHS services and having had regard to the advice of the Health & Wellbeing  Scrutiny Committee and the subsequent views of the Cabinet set out in Minutes 29 and 104(e) of 8 and 9 November  2016, respectively, to accept the Notice of Motions in the name of Councillors Biederman and Greenslade as amended [highlighted below] for consideration by the County Council at its next meeting and to the further representations received (Minute 63 above refers).

Proposed Cuts to Devon Health Services and Impacts on Patients (Councillor Biederman)
‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.

This Council also recognises that Governments have [deliberately] not provided the NHS with a fair [the adequate]level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations’.

NHS Success Regime  (Councillor Greenslade)

County Council believes that the NHS Success Regime project for Devon is now [seriously] flawed and accordingly asks [calls on] the Secretary of State for Health and NHS England toput the process on hold, until issues relating to the ‘independence’ of the Success Regime are investigated and for fair funding to be considered [cancel it forthwith]. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services. Until funding issues are addressed it is not possible to decide whether or not there is a local NHS budget deficit to be addressed. Unnecessary cuts to local NHS budgets must be avoided! Devon MP’s be asked to support this approach to protecting Devon NHS services”

Members then formally moved and duly seconded the amendment(s) shown below and thereafter subsequently debated and determined.

Councillor Hart then MOVED and Councillor Clatworthy SECONDED that the Cabinet’s advice be accepted and in accordance with the views of the Health & Wellbeing Scrutiny Committee the Notices of Motion as set out hereunder be accepted:

Proposed Cuts to Devon Health Services and Impacts on Patients (Councillor Biederman)
‘This Council is deeply concerned about the impact the proposed cuts to Devon health services will have on patients – especially the loss of whole departments including maternity services at North Devon District Hospital – and massive reduction in acute and community hospital beds across Devon, as set out in the sustainable transformation plan.

This Council also recognises that Governments have not provided the NHS with a fair  level of funding and now calls on local MPs to lobby government ministers to urgently and significantly increase the level of funding to the NHS, in order to protect our precious health services for current and future generations’.

NHS Success Regime  (Councillor Greenslade)
County Council believes that the NHS Success Regime project for Devon is now flawed and accordingly asks the Secretary of State for Health and NHS England to put the process on hold, until issues relating to the ‘independence’ of the Success Regime are investigated and for fair funding to be considered]. County Council further calls on Government and NHS England to firstly address the issue of fair funding for our area and to ensure the general election promise of an extra £8 billion of funding for the NHS is taken into account when assessing the claimed deficit for Devon NHS services. Until funding issues are addressed it is not possible to decide whether or not there is a local NHS budget deficit to be addressed. Unnecessary cuts to local NHS budgets must be avoided! Devon MP’s be asked to support this approach to protecting Devon NHS services”

Councillor Boyd MOVED and Councillor Chugg SECONDED that in accordance with Standing Order 14(11) ‘The Question be Now Put’.

The Motion was put to the vote and declared CARRIED and immediately thereafter the mover of the amendment (Councillor Hart) and the movers of the original Notices of Motion (Councillors Biederman and Greenslade) exercised their right of reply to the debate.

Councillor Hart then MOVED and Councillor Hughes SECONDED that in accordance with Standing Order 32) the vote on the amendment in his name shall be by roll call.

The Motion was put to the vote and declared CARRIED.

The amendment in the name of Councillor Hart was then put to the vote and there being:
for the amendment, Councillors Ball, Barker, Berry, Biederman, Bowden, Boyd, Brazil, Channon, Chugg, Clarance, Clatworthy, Colthorpe, Connett, Croad, Davis, Dempster, Dewhirst, Dezart, Diviani, Eastman, Edgell, Edmunds, Foggin, Gilbert, Greenslade, Gribble, Hannan, Hannon, Hart, Hill, Hook, B Hughes, S Hughes, Julian, Knight, Leadbetter, McInnes, Mathews, Moulding, Owen, Parsons, Prowse, Radford, Randall Johnson, Rowe, Sanders, Sellis, Squires, Vint,  Way, Westlake, Wragg, Wright, against, or in abstention of, the amendment, none (Total: 0),
the amendment was declared CARRIED and subsequently thereafter also CARRIED as the substantive motion.

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