News and views from Paul Bull, the Labour and Co-operative Councillor for the St THOMAS Ward of Exeter City Council. Promoted by Dom Collins on behalf of Paul Bull, both of 26b, Clifton Hill, Exeter, EX1 2DJ.
To follow up on my previous emails regarding the Your Future Care consultation, I now attach details of a series of roadshows that have been organised across North, East and West Devon.
The Your Future Care programme aims to bring about a consistent model of care across Northern, Eastern and Western Devon (NEW Devon).
In the Eastern locality of Devon there is a public consultation taking place about the number of inpatient beds required at hospitals in the area. Elsewhere, including in North Devon and West Devon, we are seeking views over how an integrated model could work in practice. We want to seek your views on the new model of care and hope will be able to come along to these roadshows, and we also need your help with publicising these events as widely as possible.
Everyone living in NEW Devon should be able to access great care. At present many of our most vulnerable groups and populations receive lower levels of support. We are continually looking to improve the services we provide to ensure that people have the maximum opportunity to retaining their well-being and independence.
We have to find a way to maximise the care we can provide, making the best use of our scarce resources.
Details of the roadshows can be found in the flyer below.
We have also added two additional dates to the list of public event meetings that we are holding in the Eastern locality of Devon. These will be in Honiton and Exeter. A flyer for this is also attached.
For information – The Eastern locality of Devon covers East Devon, Exeter and Mid Devon and parts of West Devon, including Okehampton.
Over the weekend I’ve received some e-mails from local residents linked to We Own It’s It’s our NHS: Don’t Slash, Trash and Privatise campaign
Dear Cllr Paul Bull.
You may be aware that the government is dividing the NHS in England into 44 areas or ‘footprints’, each of which has a ‘Sustainability and Transformation Plan’ (STP). I believe that these plans are intended to help the government to Slash, Trash and Privatise our NHS – leaving local areas to deal with the crisis that follows.
Jeremy Hunt wants to force councils to quietly sign up to an NHS that simply cannot meet people’s needs within the budget he has fixed.
Privatisation is already part of the waste problem causing this crisis – the market in the NHS costs at least £4.5 billion a year. But these cuts will also lead to more privatisation in turn as the NHS struggles to cope with the pressure.
This is all happening behind closed doors. Only 15 of the 44 plans have been published. The plans are due to be signed off completely by Christmas – yet the public still hasn’t seen most of them.
These plans are dangerous. I don’t want to see an NHS that says ‘sorry, this hospital is closing, you need to travel further to have your baby or deal with your emergency’. I don’t want to see more privatisation.
I am writing to ask you to do two things
1. Demand that the ‘Sustainability and Transformation Plan’ for our ‘footprint’ area is immediately released for public consultation. (The following plans have already been released but need scrutiny: Newcastle, Tyne & Wear • Durham, Darlington, Teesside, Hambleton, Richmondshire & Whitby (Footprint 3) • W Yorkshire • Birmingham & Solihull • Bedfordshire, Luton & Milton Keynes • N Central London • NW London • SE London • SW London • Gloucestershire • Somerset • Dorset • Devon • South Yorks and Bassetlaw • Lancashire and South Cumbria)
2. Oppose the local plan to Slash, Trash and Privatise and refuse to sign up to it. It is part of a bigger plan by government to undermine our NHS as a public service through cuts and privatisation. Some brave councils are already taking a stand for our NHS. Hammersmith and Fulham, Ealing and Sutton councils have refused to sign up to the plans. This is the right thing to do.
Steve Cowan, leader of Hammersmith & Fulham council said: “This is about closing hospitals and getting capital receipts. It’s a cynical rehash of earlier plans and is about the breaking up and selling off of the NHS. It will lead to a loss of vital services and will put lives at risk. Our job is to protect the NHS and this plan is about dismantling it.”
The plans will mean reducing the number of A&E hospitals from 140 to less than 70 across England and cutting hospital beds – while hoping that care in the community (also being cut) will pick up the slack. The plans also include selling off land and assets that belong to the NHS. They include huge shortfalls of millions of pounds – patients just can’t be cared for properly without more funding. The plans may include some good ideas, but overall they are unrealistic about funding and include untested assumptions.
The former head of NHS commissioning Julia Simon has denounced the STP process as ‘shameful’, ‘mad’, ‘ridiculous’ and the plans as full of lies. Only 16% of NHS finance directors believe they can deliver on STP plans.
NHS England health plans assume partnership with local authorities and they imply shared responsibility for the (potentially very serious) consequences. That means you can play a crucial role by refusing to sign up to these plans. This is about local democracy – councils should not allow themselves to be forced into signing these plans.
Please don’t sign up to Slashing, Trashing and Privatising our local NHS.
Thank you for your time.
My reply to them is here:
Thank you for contacting me about the Government’s plans for our National Health Service, and your fears that they are using their Sustainability and Transformation Plans to Slash, Trash and Privatise the NHS.
It is e-mails such as yours that give me hope that Nye Bevan was right: “The NHS will last as long as there are folk left with the faith to fight for it.”
You say you are writing to me to ask me to do two things: 1) Demand that the STP for our footprint area is immediately released for public consultation.
The Wider Devon STP was originally leaked in the summer, and the latest draft was published on Friday 04 November 2016.
2) Oppose the local plans to Slash, Trash and Privatie, and refuse to sign up to the STP.
The local authority responsible for public health and well-being for Exeter is Devon County Council, and so I – and my co-councillors on Exeter City Council – will not be asked to sign-up to the STP.
However, with that said I will continue to lobby my County colleagues to oppose STP unless it works for the residents of Exeter and Devon.
And I hope that you have contacted your local County Councillor – Cllr Roy Hill [for Alphington and Cowick] or Cllr Rob Hannaford [for Exwick and St Thomas].
The DCC Health and Wellbeing Scrutiny Committee met on Tuesday 08 November 2016 and considered a report by Jenny McNeill, Associate, NEW Devon CCG.
The Scutiny Committee were concerned that they had no time to read the full STP document before considering the report, so It was MOVED by Labour’s Chair of the Committee, Cllr Westlake, SECONDED by Councillor Sellis and
RESOLVED that a special meeting of the Committee be arranged (for early December) to consider in detail the recently published Sustainability and Transformation Plan for wider Devon.
I believe this special meeting has so been arranged be held on Thursday 15 December.
The report suggests that the STPs offer the best chance for health and social care leaders to work together to improve care and manage limited resources. But will the report also questions whether the plans will succeed where other initiatives have failed?
In particular, the Kings Fund is concerned that little is known about the process of developing the plans and how the initiative has worked in practice.
– Despite the focus on local ownership, key elements of the process have been ‘top-down’;
– National requirements and deadlines for the plans have changed over time, and guidance for STP leaders has sometimes been inconsistent and often arrived late;
– The approaches of national NHS bodies and their regional teams have not always been aligned;
– Tight deadlines have made it difficult to secure meaningful involvement in the plans from key stakeholders, including patients and the public, local authorities, clinicians and other frontline staff; and
– Organisations face fundamental policy barriers to working together on STPs; existing accountability arrangements focus on individual rather than collective performance.
Based on these findings, the report makes a number of recommendations for the future of the STP process. There is a need to:
– secure the meaningful involvement of patients and the public in the plans, alongside clinicians, other frontline staff and local authorities;
– develop governance arrangements that allow organisations to make collective decisions and share accountability
– improve national co-ordination and leadership of the STP process;
– ‘stress-test’ STPs to ensure that the assumptions underpinning them are credible and the changes they describe can be delivered; and
– focus on the skills and resources needed to implement STPs, as well as the cultural aspects of making change happen.
If you need more information on the local situation, this guide – published by Save Our Hospital Services in North Devon – provides a good grounding in what the STP means for Devon.
However, that’s not the end of it – the plans for the NHS here in Devon go deeper that the Wider Devon STP.
It must be stated that what’s currently happening to the NHS nationally is a political decision, not an economic necessity – and the changes we’re seeing are a result of Tory dogma.
During Labour Governments up to 2009-10, UK NHS spending rose to near the average of comparable economies – but since 2010 it has fallen sharply.
UK spending on healthcare is significantly below the average of major European economies. If the UK were to increase its spend to 10.7% of GDP, this would equate to an extra £15bn of funding.
The table below shows the current status after 5 years of Tory Government:
NHS Funding was the subject of an Opposition Day debate in the House of Commons recently, when Ben Bradshaw challenged the Secretary of State for Health, Jeremy Hunt:
Ben Bradshaw [Labour] [Exeter]
The Government have been well and truly found out on this issue. Rather than quote selectively from Simon Stevens, the head of the NHS, will the Secretary of Stateconfirm that among the conditions that Mr Stevens put down to the Government as part of the five-year review was an increase in public health spending, not a 20% cut, and a policy of maintaining spending on social care? Will he also confirm—he was there in Simon Stevens’ presence before the Select Committee—that Mr Stevens made it quite clear that those conditions and others had not been met?
Jeremy Hunt The Secretary of State for Health
Mr Stevens said—I was there—was that social care and, indeed, public health provision needed to be maintained. We are increasing the social care budget by £3.5 billion over this Parliament. Although I accept that difficult cuts are being made to the public health budget, we are doing other things that do not cost money to make sure that we continue to improve this country’s excellent record on public health.
So, although its Tory dogma, it wasn’t what they promised, was it? I remember well, those Tory promises.
Before the 2010 general election David Cameron repeatedly promised that there would be no more top down reorganisations of the NHS.
“So I make this commitment to the NHS and all who work in it.
“No more pointless reorganisations.”
David Cameron, speech to Conservative Party conference, 4 October 2006
“The NHS needs no more pointless organisational upheaval. It needs no more top-down reorganisations.”
Andrew Lansley, Conservative Party press release, 11 July 2007
In their 2010 manifesto , the Conservatives promised that they would cut bureaucracy in the NHS.
“We will decentralise power, so that patients have a real choice. We will make doctors and nurses accountable to patients, not to endless layers of bureaucracy and management.”
Conservative Party manifesto, April 2010, p. 45
These promises were repeated in was repeated in the Coalition Agreement.
“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”
Coalition Agreement, 20 May 2010, p. 24
Despite these promises, what we did see was that the Tory-led Coalition Government – with the support of their Liberal Democrat allies – imposed the biggest top-down reorganisation in NHS history.
Yet under Andrew Lansley, all those promises were broken.
The Health and Social Care Act introduce new layers of bureaucracy into the NHS. New quangos created by the Tories include: Public Health England, Health Education England, Clinical Commissioning Groups, National Commissioning Board, SHA Clusters, PCT Clusters, Healthwatch England, NHS Property Services and Commissioning Support Services. According to the Royal College of GPs,the reorganisation moves the NHS from having 163 statutory organisations to 521.
The cynic in me was always sceptical when the Government set up the CCGs – especially here in Devon. I believe they were set up to fail.NEW Devon CCG, which covers Exeter, is the biggest CCG in the country. Yet when it was set up by Lansley’s Health and Social Care Act, was NEW DevonCCG funded to cope with the demands of local patients? I maintain not.
And now, according the BBC [12 February 2016], it faces an anticipated deficit of £430m by 2019 – and despite cost-saving measures of £239m, under current plans the CCG would still be short by £191m in five years.
So what has happened it that central Government has been able to absolve itself for the responsibililty of any cuts – with the added bonus being that hey can claim it was made by local people – including local clinicians and GPs!
As a result, NEW Devon CCG has been put into “special measures”, the Success Regime.
The reasons given for why NEW Devon was selected include:
–– Increasing health community deficit forecasts;
–– A lack of working together to develop a system wide service and financial strategy.
In September 2015 , Judith Dean, a former nurse who more recently has worked in transformation at Wiltshire CCG, was appointed as programme director. Carnall Farrar, a healthcare and public services management consultancy, were selected to provide consultancy support following a competitive tender. Dame Ruth Carnall, former chief executive of NHS London (and co-founder of Carnall Farrar), will take on the role of chair.
In February 2016, Devon success regime published the Case for Change, which outlines the financial and quality challenges to delivering care locally.
But even now, the Success Regime has been redefined with the publication of the STP.
It appears to me that the STP can only succeed if costs are reduced. And there is only one way to do that – refine need.
One of the proposed ways of doing that seems to be to close hospital services in North Devon. Not only will this be disasterous for the people of North Devon, this will place additional burdens on out own RD&E Hospital.
In addition, NEW Devon CCG is proposing a series of reductions to community beds across Devon – these proposals are outlined in the Your Future Care consultation document
Apparently, it is all about deciding the location of community hospital inpatient beds in the Eastern locality while giving people reassurance as to the improved care they can expect instead, in their own homes.
The proposals have been expressed as four options, outlined in full below. In addition to the consistent and enhanced provision of community health and social care delivered in people’s homes, the services will be supported by consolidated community in-patient beds in the following possible configurations:
Option A Beds at Tiverton (32), Seaton (24) and Exmouth (16)
Option B Beds at Tiverton (32), Sidmouth (24) and Exmouth (16)
Option C Beds at Tiverton (32), Seaton (24) and Exeter (16)
Option D Beds at Tiverton (32), Sidmouth (24) and Exeter (16)
Option A is the preferred option of the CCG – it thinks this combination results in the smallest impact in travel time and has the greatest benefit to the whole pathways of care
In conclusion I would like to echo some of the themes being promoted by the People’s Red Line campaign, which calls on the Government to implement 3 simple reforms:
1. Fix NHS funding as a proportion of GDP, equal to the average for developed nations;
2. Remove parasitic privatisations; and
3. End the internal market that has more than doubled management costs in the NHS
The People’s Red Line Campaign aim to do this by calling for:
1. The building of a movement to bring back a state funded, a
state provided and democratically accountable NHS; and
2. Taking part in collective action for lasting change.
Northern, Eastern and Western Devon Clinical Commissioning Group [NEWDevonCCG] is launching a formal consultation, on community health services in Eastern Devon.
The consultation, called Your Future Care”, will run from the 7th October 2016 to the 6th January 2017. There will be roadshow events, where people can find out more, and public meetings, where proposed service changes will be discussed.
Devon is not alone in looking at changes to how health and care services are provided. Right across England, the NHS has been required to put together “Sustainability and Transformation Plans”. These will pave the way for greater joining-up of health and care services, across organisational and geographical boundaries.
The changes are being driven by multiple pressures on health and care services. We have an ageing population, with more people having long term and complex health conditions. Money is of course a factor, with continuing financial pressures on public services. “Workforce development” matters too, with concerns about how the NHS might be staffed post-Brexit. Other considerations include the physical condition of older NHS buildings, transport issues and so on.
It’s a complex picture, and health service managers will have to juggle many competing priorities. Among all of this, it is important that they hear what patients and the general public have to say. We will continue to publicise and support the public meetings and surveys so that as many people as possible can be involved in the debate.
NHS Northern, Eastern and Western Devon Clinical Commissioning Group’s [NEWDevonCCG] Governing Body met in public on Wednesday 28 September to discuss the Your Future Care consultation on community services in the Eastern* locality of Devon.
* The Eastern locality refers to the area of Exeter, East Devon, Mid Devon and parts of West Devon, including Okehampton.
Following agreement by the CCG’s Governing Body to proceed with a public consultation on community services, people will now be given the opportunity to find out more about the Your Future Care consultation and to have their say.
The Your Future Care consultation will launch on Friday 7 October 2016, and will run until Friday 6 January 2017.
At the Governing Body meeting, a comprehensive model of care for people who are frail or elderly was discussed by health commissioners from Northern, Eastern and Western Devon.
This includes changes to the way community services are provided and could result in a reduction of inpatient beds at some locations. The CCG’s Governing Body were presented with four options for a public consultation process.The model responds to the views of patients and clinical staff about what they wish to see provided in future.
More than 80 clinicians have worked on the model, which could see a much more responsive service in people’s homes – where it is safe and appropriate to do so.
Now we have agreed to go ahead with public consultation with a set of clear options for local people to consider, we want to encourage people to get involved and have their say on how community services should be provided in the future.
The proposals have been expressed as four options, outlined in full below.
In addition to the consistent and enhanced provision of community health and social care delivered in people’s homes, the services will be supported by consolidated community inpatient beds in the following possible configurations:
Option A Beds at Tiverton (32), Seaton (24) and Exmouth (16)
Option B Beds at Tiverton (32), Sidmouth (24) and Exmouth (16)
Option C Beds at Tiverton (32), Seaton (24) and Exeter (16)
Option D Beds at Tiverton (32), Sidmouth (24) and Exeter (16)
The preferred option is A, as this combination results in the smallest changes in travel time and has greatest whole system impact.
Honiton Hospital and Okehampton Hospital do not appear in any of the shortlisted options. Subject to consultation, the proposal would mean that there will be no inpatient beds on either of these sites and the new model of care would be implemented.
Once the consultation starts, a series of roadshows will provide a drop-in environment for people to come along to and speak with clinicians and other NHS staff about the proposed changes and find out more about the new models of care.
These will be followed with public meetings throughout November and December – where clinicians and managers will present information about the proposed changes. A full programme of events will be published shortly and this will be shared widely.
Information about the consultation will be available on the NEW Devon CCG website, under Your Future Care here.
We will be in touch with further detail in the coming days and weeks, including details of planned events, information about how the consultation document will be made available and more detail about how people will have their opportunity to get involved in the consultation.
We would like this communication to be two-way, so any feedback or comments are very welcome, either on email to: d-ccg.YourFutureCare@nhs.net by phone on 01392 356197, or by post to Success Regime, NHS NEW Devon CCG, Newcourt House, Newcourt Drive, Old Rydon Lane, Exeter EX2 7JQ.
As the clinical commissioner for services in most of Devon, we acknowledge the public support for the Walk-in Centre (WIC) facilities in Exeter and the paper’s intention to run a campaign. It is important to note, however that no decision has been made about the future of either WICs in Exeter at the Royal Devon and Exeter Hospital or at Sidwell Street. Indeed, the current review of these services is on hold.
Last year Professor Sir Bruce Keogh, NHS England Medical Director, led a national review of urgent and emergency care. This review emphasised the need for services that were clear and of high quality so that people with urgent care needs would be treated in the most appropriate setting.
In future, we should expect that patients with urgent, but not life threatening injuries or illnesses, will be treated in Urgent Care Centres, rather than Walk-in Centres.
Urgent Care Centres will provide high quality care, with consistent opening hours and clearly specified roles. This will be an improved level of service that will hugely benefit patients in Exeter and surrounding areas.
At this early stage in the process, we don’t have all the answers and we are awaiting further national guidance, which will help us make decisions locally.
What we do know is that we will commission these services through what is known as a procurement process, with times and dates yet to be agreed. This is also dependent on national guidance that is not yet finalised. Further public information will follow once this national guidance is received.
Should the guidance and associated local reviews lead to a proposal for a different model of care to that presently in place in Exeter, or one that differs to the proposal that NHS NEW Devon CCG recently consulted on, then further consultation would take place.
In the meantime, we expect the urgent care services currently available at the two Walk In Centre’s in Exeter to continue in the present form for the foreseeable future.
Thank you for allowing us to make this clear. Anyone who wishes to contact the CCG should direct their correspondence to email@example.com or write to myself at NEW Devon CCG, Newcourt House, Old Rydon Lane, Exeter EX2 7JQ.
Dr Alex Degan GP and clinical lead for Transforming Community Services, Eastern locality NHS Northern, Eastern and Western Devon Clinical Commissioning Group
For more information contact Keri Ross, Community Relations Manager, on 01392 267680 or email firstname.lastname@example.org
Earlier today, I joined campaigners from Keep Our NHS Public (South West) to hand over the 38 Degrees petition against the planned closure of the Sidwell Street Walk-in Centre in Exeter to NEW Devon CCG
The petition was launched at Exeter Respect and KONP (South West) managed to get well over 6,000 signatures in just over three weeks.
We met in the grounds of Newcourt House on the edge of Exeter, where the Eastern Locality Board were due to have a meeting.
Geoff Barr, Chair of KONP (South West), attended the meeting and afterwards he told me that the Clinical Commissioning Group Chair seemed unmoved by reason.
It seems that more pressure may be needed.
Some notes from Geoff Barr
Why keep the walk-in centre open?
Thousands of people want it open. We have collected well over 6,000 signatures on the petition to keep it open.
Where do the signatures come from?
– Respect Festival. The petition was launched here on 6th June.
– Anti-Austerity event on 13th June in Exeter
– Sidwell Street outside the Walk-in Centre – thanks to our team who spent many lunch hours attracting signatures. It was not difficult as the results show.
– Churches across the city from several denominations.
– Doctors waiting rooms.
– Community centres.
– Other places too numerous to mention.
– On-line collection thanks to 38 degrees and thanks to Andrew for organising this.
Behind this lies the feeling of the people of Exeter. We had less than 4 weeks to accumulate the names. We could not reach most of the population of our city.
Why should we keep the Walk-in Centre open?
This is not some conservative instinct to preserve an old service just because it is familiar. It is a service that has proved its worth in the many people we approached who told their own stories. One was the person working with people dependant on drugs and homeless people. He pointed to the need for a place that these hard to reach people could find health services. The Walk-in Centre is vital. The busy workers from out of town who cannot access their GP. The mums who find that a fortnight’s wait for a GP appointment is intolerable were another group. Then we saw some of poorest people in Exeter. They often had disabilities and the thought of going to the hospital meant a long trudge or an excessive bus fare. Several people needed dressings replaced. Their GPs were simply overwhelmed and could not do this work in time. Again and again we found that this centre offered a quick and efficient service.
Healthwatch Devon is the official voice of health service users in the county. It undertook an assessment of the two Exeter Walk-in Centres. It used a questionnaire and interviewed a number of users of the service in some depth. The result is the same as our less systematic finding. People value the service.
We note that the hospital has faced enormous pressures on its accident and emergency services. Indeed it has had periods when it failed to see every patient within the four hour target. Closing this Walk-in centre will pile more pressure on the hospital.
The service is popular; it is needed by patients and the health system of Exeter and east Devon. In a time when government NHS England and health professionals say that the voice of patients must be heard we insist that you listen and drop the plans to close this valued service.
Some responses to the petition against the closure of the Sidwell Street Walk-In Centre.
“It’s the finest thing – the staff have all been very good to me with my troubles.”
“It’s such a good place, really helpful people.”
“It’s disgusting, they shouldn’t cut down on people’s health. It’s accessible to all – young girls wanting help – the GU clinic – they don’t want an appointment with the GP which would take weeks, they can just walk in.”
“Even if the GU clinic stays it won’t be used as much because it’s stigmatising to be seen walking into one, whereas you can go into the Walk-In Centre and nobody knows what service you’re going to.”
“It’s really good, it’s really handy having it here. I can use it from work whereas I couldn’t get to the GP without losing time off work.”