Frustrating meeting sees bed closures secretary of state scrutiny referral pushed back
Saturday, 24 June 2017 2 Comments by Claire
It is just as well I have left it almost a week to write this blog because I was very angry on Monday evening.
Before the meeting there was a public demonstration of angry residents mainly from Seaton and Honiton, which was attended by film crews from the BBC and ITV. The BBC and a reporter from the Western Morning News stayed for the whole meeting.
The committee had also received dozens if not, hundreds of emails from residents who were asking us to refer the decision to close 71 community hospital beds in Eastern Devon, to the Secretary of State for Health.
Devon County Council’s newly formed Health and Adult Care Scrutiny met for the first time last Monday (19 June) to review this decision.
Almost all the committee members are either new to the committee or new Devon County councillors.
At the last health scrutiny meeting in March before the elections, I proposed that there were 14 grounds that the committee needed assurances on or it would refer the decision to the Secretary of State for Health on the basis that it wasn’t in the interests of the health service in the area and that the consultation was flawed.
These are legal reasons for referral.
The new chair of the committee is East Devon Conservative member, Sara Randall Johnson, following the retirement of long-serving Labour councillor, Richard Westlake.
During the time between the March health scrutiny meeting and the meeting on 19 June, Richard Westlake had taken the time to instruct the scrutiny officer to draft two letters to the CCG one requesting further information and the second, dated 24 April, expressing concern about the availability of end of life care under the new model of care.
Cllr Westlake alluded to the Francis Report, which was published following deaths at Mid Staffordshire Hospital and which criticised the health scrutiny committee there for lack of challenge.
Points were also made relating to the committee having been told several times previously that the new model of care to be provided in people’s homes instead of in a community hospital, was actually cost neutral, despite claims to the contrary.
The cost of people being cared for at home surely will increase as many people have co-morbidities (multiple conditions), the former chair had pointed out.
His letter also made references to the lack of information relating to the future of bedless community hospitals, given the ownership of NHS Property Services, the exclusion of Honiton and Okehampton Hospitals from the consultation process and the small number of staff who responded to the consultation (less than 2 per cent).
The team for the NHS present at the meeting included Rob Sainsbury, director of operations for NEW Devon Clinical Commissioning Group (CCG), Adel Jones, integration director with the RD&E, Sonja Manton, director of strategy with NEW Devon CCG and Em Wilkinson-Brice, deputy chief executive of the RD&E.
I started my questions, but before I could ask anything the new chair interjected to tell me to ask all my questions at once to save time.
I was a bit surprised at this as it is poor scrutiny technique. Invariably any reply will miss out much information. I said I would ask them in sequence…
This was one I asked in March which at the time could not be answered, despite a decision on the bed closures already having been made. What had been the number of objections compared with the number of responses of support for the bed losses?
Answer: We will get back to you (they said that last time).
Finance: How much money would be saved given that mixed messages had been received. Even the information from the CCG in the scrutiny agenda papers was contradictory and referred to different levels of savings, which ranged from £2m to £7m. Given that a decision had already been made wasn’t this a bit vague? See pages 11 and 22 of the agenda papers – link at the bottom of this blog post.
Answer: There is a range of savings and this depends on staff and resources. A fixed amount cannot be set. Savings are based on workforce only.
Was it true (as I had been informed by Tim Burke the CCG chair) that the numbers of staff had to double? Are the staff in place?
Answer: Yes the staff do need to double, there are 200 staff that are being consulted with. We don’t yet have the workforce in place because not possible to “double run” (services).
What happens to community hospitals that lose their beds? Will they be sold off by NHS Property Services which has a remit for this?
There was an interjection by the chair at this point who asked the CCG to clarify whether this was true (NHS PS having a remit for selling off hospital buildings).
Sonja Manton replied selling off NHS property was a trend….
Answer: This was a piece of work not yet carried out. It will be carried out next. (I am afraid it is not credible that the CCG does not have a list of which hospitals they intend to declare surplus to requirements for selling off by NHS PS, even if there has been no formal decision made).
An audit on people fit to leave Eastern Devon hospitals in March shows a marked increase compared with the 2015 acuity audit carried out by Public Health. The public health audit 2015 revealed that around 34 per cent of patients are ready for discharge in community hospitals across Devon and the March 2017 audit stated that 64 patients were ready for discharge. How is this doubling in two years, in the number of patients well enough for discharge possible?
And who carried out the survey?
Answer: Clinicians (mainly RD&E) carried out the survey and the results had changed partly because of a new at home palliative care service and hospital at home. (I am sceptical about this because my understanding is that these services are available only in limited places and were in existence previously anyway).
Other councillors asked questions and made their own points.
After a few councillors had spoken chair, Sara Randall Johnson, said she thought there should be a task group set up to obtain evidence on what the committee was being told.
I disliked this pre-empting of the end of the debate by the chair, especially when she knew I wanted to add to my earlier points.
When I was called to speak I made a proposal to refer the decision to the Secretary of State for Health on the basis that this was the committee’s prerogative at this meeting based on 14 grounds. These questions remained unanswered I said. And out of all the bed closure decisions that I had scrutinised over four years, this was the decision that caused me more anxiety than any other.
LibDem and former fellow committee member, Brian Greenslade, seconded my proposal.
But the chair refused to take a vote.
She said the committee was new and needed to be clear about evidence before any such action was taken. She suggested leaving it to the September meeting.
This was unbelievable! A refusal to take a vote on a seconded proposal is very unusual in council committees.
I pushed the chair to take a vote. The CCG had already admitted they would be closing the beds by then. The suggestion appeared to be to me, an attempt to kick the issue into the long grass.
There was significant heckling from the public who were understandably very angry at not being listened to.
A range of other councillors (mainly Conservative) then spoke to back her up claiming that there was not enough evidence to refer and what was the point anyway because the Secretary of State would just “throw it out.”
There were other suggestions that we simply work with the CCG to get a better deal. This was immediately dismissed by the CCG as they had already made the decision to close the beds some months ago.
Responding to this, I explained the process and how we had done this before as a previous committee and it was a very worthwhile exercise for guidance and feedback from the Independent Reconfiguration Panel, which looks at the process in fine detail before commenting and/or advising.
Without a referral we simply lie down and acquiesce to the worst decision I have ever witnessed as a health scrutiny committee member. And we let down every single resident who is opposed to the plans.
I also reminded the committee that we were there to provide a legal check (the only legal check) on health services in Devon and it was our duty to represent local people’s views. The evidence that a large number of local people were deeply unhappy with the decision, was overwhelming.
The scepticism among new members was extremely disappointing because the Referral is the ultimate in our powers and of course we had the grounds to do it. It had been already established from the previous meeting that we had the grounds to do it! And it had the full support of the previous chair.
We were told by the new chair that that this was the position of the old committee and the new committee could choose to take an entirely different view if it so wished.
This was also extremely disappointing and members of the public were clearly furious.
I then suggested we have an additional health scrutiny meeting in July to re-examine this issue. I suggested it be held on the day of the full council meeting but this was dismissed by the chair who said there wasn’t time. I asked for a different date but this was also glossed over….
… until Conservative leader of EDDC, Paul Diviani, also proposed a standalone meeting sometime soon about the issue.
Was there a seconder for this proposal, the chair wanted to know?!
I reminded the chair that I had already proposed this. It fell on deaf ears.
The debate continued and appeared to go around and around, with interspersed heckling from angry members of the public.
Eventually, I was asked if I would accept an amendment to my proposal of a standalone meeting of the committee in July. I agreed.
The committee voted in favour.
The meeting has now been booked for Tuesday 25 July at 2.15pm, at County Hall.
Here’s the webcast - https://devoncc.public-i.tv/core/portal/webcast_interactive/288543
The 14 grounds for referral to the Secretary of State for Health can be found on page 34.
Below is an extract from a letter to the chair after Monday’s meeting from one of the angry members of the public who was present
Dr Sonja Manton offered for you to attend a meeting to see how the CCG works. Why didn’t one of you ask them to simply save everyone’s time and respond fully and completely to the requests for information made in March? Aside from which how can you both scrutinise and also collaborate - surely you have to be independent?
Meanwhile – the CCG are negotiating with nursing staff and nursing staff are leaving the hospital in Honiton. The RD &E is reducing or even not making admissions. By the time you get to your extraordinary meeting it will too late to do anything useful at all.
I expect members of the committee to have the will to ensure that residents in the county they represent have easy access to adequate and safe healthcare.
Why is it that the only member of the committee who consistently and unfailingly has the energy and the will to carry out their role efficiently and as effectively as the constraints of being on a committee permit is Claire Wright? Why do councillors agree to be on the committee if they’re just going to let the CCG do what they like?
Please take the time to reflect on yesterdays meeting and consider whether you and/or some of your colleagues were found wanting and then take steps to ensure that the committee becomes an effective scrutiny committee for the benefit of all the people who depend on it to safeguard them. The public may have the voice but it is the committee that has the power. Please use that power for the benefit of us all.
Pic: I was sent this pic of the demo before the meeting, by Honiton campaigner Gill Pritchett. The quote is by the founder of the NHS and says it all.