NHS Commissioners avoid answering Councillors’ scrutiny questions about Phase 2 Care Closer to Home – what are they hiding?

At the 14 June 2016 Joint Health Scrutiny Committee meeting, Calderdale and Greater Huddersfield Clinical Commissioning Groups excelled themselves in avoiding answering Councillors’ entirely right and proper questions about strengthening community services, aka Phase 2 Care Closer to Home.

So please ask these questions in the consultation survey

That leaves it down to us, the public, to ask these questions in the consultation survey. Even if you’ve filled it in already, you can fill in a printed survey again and this time just answer question 9, about community services. Dr Brook said at the Hebden Bridge drop in that people could respond to the survey as often as they want, and this doesn’t matter because the consultation survey “isn’t a vote”.

So here are the Care Closer to Home/community services questions that the Clinical Commissioning Groups went to some lengths to avoid answering:

  • Can it really be true, that they haven’t designed the Phase 2 Care Closer to Home service model and identified the capacity it needs?
  • And if it is true, can they safely and thoroughly do this in the short time available before procuring the Phase 2 Care Closer to Home services in the autumn?

The Phase 2 Care Closer to Home services are those services for the frail elderly, people with chronic illnesses and children with complex needs, that they plan to take out of the hospital and provide in the “community”.

The range of these services are outlined on p 36 of the Consultation Document – Strengthening Community Services and the survey question 9 asks what we think of them.

Carol McKenna told the JHSC:

“The consultation is about getting people’s views about whether or not they agree that those services that we have set out in the consultation document are the sort of services that could be delivered in community settings.”

To which the only answer seems to be –

  • How can we tell, when you say you haven’t yet designed the community services model or identified its required capacity?
  • But almost certainly these services probably can’t be safely delivered in community settings, if it’s true that you don’t yet know what you’re doing but you’re going to do it this autumn, when you procure these services.
  • And since you’ve proved so evasive and patronising during the consultation, you must be hiding something or else there’s something collectively wrong with you and either way this makes you unfit to plan and commission our health services.

Is Phase 2 Care Closer to Home built on sand?

Joint Health Scrutiny Committee Councillors’ attempt to get to the bottom of whether the Phase 2 Care Closer to Home scheme is built on anything more than sand starts off with a question from Kirklees Councillor Elizabeth Smaje.

This is the scheme that aims to take services out of the hospital and put them in the community, so making it ok to cut hospital beds and staff.

Cllr Smaje asked – Calderdale Phase 2 is due to start in April 2017 – how are you going to model that you have the capacity in cc2h to reduce hospital beds?

Matt Walsh, Calderdale Clinical Commissioning Group Chief Officer said: We’ll need to design a clear service model that articulates not just bed capacity we want to commission from the hospital but we will also need to describe the community based capacity that we need to have in place to make all of that work … eg through the development of a clear specification… He said that in Calderdale that will be done by building through the methodologies  used in Vanguard value proposition, and

“that  will develop clarity about what community capacity needs to be, to enable the system to work in the way we’re describing. That’s my answer. I’m not sure if you like it.”

Cllr Smaje What are your timescales for developing that?

Matt Walsh:

There’s a clear note in the briefing to you that we need to go through this process in a way that will enable us to make a procurement decision later this year, yep? So we need to get through consultation, we need to deliberate on what we’ve heard and learned in consultation and reflect on what that means for the model that we want to put in place. And what we want to do in Calderdale is articulate a high level specification that our system will collaborate to deliver.

(Which begs the question : what is that “system”? What if the procurement process – that involves putting services out to competitive tender – pulls in a bid from a private provider like Virgin, that is currently bidding left right and centre for community services across England – and has successfully fought contract awards that go against them?)

NHS Commissioners’ practiced skill at avoiding answering questions

What happened next lays bare the Clinical Commissioning Groups’ practiced skill at ducking and weaving to avoid answering crucial questions.

Cllr Julie Stewart Turner then asked whether the Clinical Commissioning Groups have a range of proposals about how they’re going to carry out the procurement process this autumn for Phase 2 care closer to home, given that their briefing note to the JHSC says that they’ve not yet made any decisions about delivering these services.
She said,

“…I’m reading on page 67, “as such no decisions have been made about delivery of these services in the future.” So if you don’t have a decision but you’re on such tight timescales and you’re hoping for procurement process in the autumn, do you have a range of proposals then about how you might achieve this?”

There was a very, very long pause.

Then Matt Walsh, Calderdale Clinical Commissioning Group’s Chief Officer, said,

“I’m a little lost on page numbers there.”

Calderdale CCG’s head of service improvement, Debbie Graham, helped him out:

“67 I think is the Greater Huddersfield report, is that right?”

Clr Stewart Turner persisted:

“It’s a similar question for Calderdale as well, cos you’re on your consultation, you haven’t got a fixed decision yet on how you’re going to deliver these outcomes. But if you’ve got a tight timescale of autumn and you want to start implementing this in – you want a procurement process in autumn – in Huddersfield, I don’t know the timescales for Calderdale – do you have a range of proposals then?

Carol McKenna said:

“I actually think that on p 67 the dates that are there are the dates that applied to our procurement process that we ran last year. So the autumn date is 2015 which is when the contract went live. Is that what you’re referring to?”

(At this point the Calderdale 38 Degrees NHS Campaign Group secretary, Rosemary Hedges, whispered to me:

“They’re trying to pretend they haven’t made their decisions.”)

Cllr Stewart Turner refused to allow Carol McKenna to  fobb her off. She said:

“Last line of the first paragraph.”

Carol McKenna then embarked on a tour de force of simultaneous patronisation and evasiveness:

“Oh I see what you mean, in terms of the services that are currently in phase 2 that we’re consulting on. Um yes you’re right we haven’t actually…the consultation is about getting people’s views about whether or not they agree that those services that we have set out in the consultation document are the sort of services that could be delivered in community settings. So that’s the stage that we’re in at the moment. There will need to be a decision that will need to be taken at a point in time as to who is the most appropriate organisation to provide those services going forward but we haven’t had that conversation yet. We’re still at the point of consulting about the next phase in care closer to home.”

There was a very long pause after she finished speaking.

Time to remember that Cllr Stewart Turner had not asked who is the most appropriate organisation to provide those services. Why would she? That decision is made during the contract award process. She asked if the CCGs had a range of proposals, as the basis for their decision about how they were going to deliver the Phase 2 Car Closer to Home services, so they could meet the very tight timescale for procuring them in the autumn.

Time for the video to catch Matt Walsh shifting in his seat and looking worried. (01.09.51 ish)

Before this pregnant pause could give birth to a logical follow up question – like, please answer the question Cllr Stewart Turner asked you – Calderdale Cllr Marilyn Greenwood, co-chair of the JHSC, asked a question that was nothing to do with this fertile line of enquiry.

A question about whether the choose and book system within GP practices would be available for patients so they could have elective surgery nearer to home, that Matt Walsh met with a dismissive nod of his head, a grimace and whisper to Dr Steve Ollerton – who told Cllr Greenwood that her question was outdated since choose and book had been replaced by e-referrals.

Thus was an opportunity lost to nail the CCGs on exactly how they are going to make the decision on phase 2 care closer to home specifications in order to procure the services in the autumn, given that they say they have not yet designed a clear service model that includes the capacity they need for community services.

Can that really be true, that they haven’t designed the service model and identified the capacity? And if it is true, can they safely and thoroughly do this in the short time available?

String vest awards all around for CCGs’ holes in answers to Joint Health Scrutiny Committee.

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