The overwhelming public rejection of the hospital cuts proposals counts for nothing, because it was based on people’s emotional response that shut down their ability to take on information in the consultation proposals.
This was the self-serving message from the Calderdale & Greater Huddersfield Clinical Commissioning Groups’ stakeholder engagement event on the public consultation findings, which was held on 13th September.
The stakeholder event info pack failed to mention that most of the consultation respondents rejected the proposals – even though 64% of people who responded to the consultation said they disagreed with the proposals and 60% said that the proposals would have a bad impact on them.
And in his presentation on the consultation findings, Dave Rowson from the Midlands and Lancashire Commissioning Support Unit only mentioned the overwhelming public rejection as an afterthought.
It was a big elephant in the room.
Complete waste of time or important session in deliberation process?
In his presentation to the stakeholder engagement event, Dave Rowson largely ignored the public’s rejection of the hospital cuts proposals in order to concentrate on six other key themes that the Commissioning Support Unit’s “independent” report on the consultation findings had identified. He said these were what Calderdale and Greater Huddersfield Clinical Commissioning Groups should “deliberate” upon.
The CCGs’ Head of Quality, Penny Woodhead, told the stakeholders,
“This is an important session in the deliberation process. It is uncommon to bring stakeholders into the deliberation process. Stakeholder input has been vital.”
Terry Hallworth, a Save the NHS campaigner who had taken an active part in the whole consultation process, disagreed,
“What a complete waste of time that was. Goodness knows how much money that cost.
I’m still trying to figure out what the purpose was.”
Commissioning Support Unit says public didn’t understand the consultation proposals
Dave Rowson’s purpose seemed to be to reassure the Clinical Commissioning Group’s stakeholders that members of the public, who had raised issues in the consultation that he said were key for the CCGs to deliberate on, had simply got the wrong end of the stick and failed to understand the proposals.
This was because:
- We – the public who opposed the proposals – were emotionally set against them, so unable to take on the information the Clinical Commissioning Groups (CCGs) provided
- Our perceptions of the proposals were wrong
- We are incapable of abstract thought and need things explaining to us in concrete terms
However, he went on:
- The CCGs “can win these people round”
- The CCGs should therefore ignore the fact that the majority of the public have rejected their proposals, he implied, and instead they should concentrate on better communicating the six key issues that the public have incorrect perceptions of.
Despite this crass spin, the CCGs’ Head of Quality, Penny Woodhead, announced that the Commissioning Support Unit’s report on the consultation findings was a factual report.
However Dave Rowson admitted in his presentation that some of the coding used to identify sub themes and themes in people’s consultation responses was a matter of interpretation.
The six main themes the CSU coding threw up were:
- Travel & transport
- Clinical safety and capacity
- Worries about the rationale for change
- Consultation process
- Understanding the proposals
- Public acceptance of need for change
Dismissive Interpretation of public’s perceptions
Dave Rowson’s presentation was rather heavily based on interpretation, not facts. For example, regarding issues people had raised about travel and transport, Dave Rawson said dismissively,
“It’s people’s perceptions a lot of the time. They may be incorrect. It’s people’s perceptions. It’s a communication challenge going forward.”
Of the consultation process, he said,
“If people are set against a proposal, it’s very difficult for them to take on the information.”
He reinforced his theme that we – the public who disagree with the proposals – are too closed-minded and thick to understand the proposals, by implying that we are incapable of abstract thought. Dave Rowson said,
“If they can’t see it or touch it, people can’t understand it. For example, if they are in urgent care and needed to transfer to emergency care, how would that work?”
However, Dave Rowson told the “stakeholders” that all was not lost:
“Despite what seems like a high level of opposition, there is a recognition that if you work through certain issues you can get people to accept the need for change. There is a recognition that things can’t stand still – people gave ideas for alternatives. People wanted to discuss with the CCGs how this could happen.”
‘Stakeholders’ regurgitate Rowson’s views
After dutifully swallowing what Dave Rowson told them in his presentation, the ‘stakeholders’ spent the next hour or so regurgitating his views.
Around 20 small “stakeholder” groups were asked to consider:
- Are you surprised by the findings?
- What do you think are the main issues?
- What can the CCGs do to mitigate these issues?
Table 11, where I was, agreed that we were not surprised by the consultation findings and that the main issue for the Clinical Commissioning Groups to deliberate on was the fact that 60% of respondents said the proposals would negatively affect them and 64% disagreed with the proposals.
But Table 11 baulked at the suggestion that the Clinical Commissioning Groups should reconsider the proposed clinical models, which most of the public had rejected, and should also address the fact that their proposals are untenable given the current NHS crisis and the new Sustainability and Transformation Plans, and this is what needs addressing now.
Table 11 also did not think that the Clinical Commissioning Groups should admit that their the proposed clinical models were a response to government policy to underfund and privatise the NHS, and were driven by NHS England’s plans for putting this policy into action. Or that the Clinical Commissioning Groups should face the fact that where these proposals have already been carried out, as in the massive North West London reconfiguration called Shaping a Healthier Future, it has proved disastrous and in December 2015 an independent commission called for its immediate halt.
Clinical Commissioning Groups to “flex the details” where they “are able to”
Instead Table 11 said that the Clinical Commissioning Groups should do what Calderdale CCG’s Chief Officer had said all along they would do if the public consultation rejected their proposals: “flex the details” of the proposals in response to the public’s rejection of them.
Matt Walsh, Calderdale CCGs’ Chief Officer, said this in his Chief Officer’s Report to the 11th Feb 2016 Calderdale CCG Governing Body, when he announced that the Governing Body’s duty regarding the Consultation is to respond to the public’s views:
“by flexing our proposals where we are able to.”
In other words they were never going to take any notice of what comes out of the consultation except where it suits their purposes.
At the 29 January Joint Health Scrutiny Committee Matt Walsh also talked about “flexing” details of the development on both hospital sites. He said:
“Development will be required on both hospital sites. In terms of detail, we need to consult on the model and be prepared to flex and change in response to the consultation and then reflect on what that means for the estate and discuss this with the Treasury and we won’t have that info until out the other side of consultation.”
So putting 2 & 2 together, it looks as if the bit of their proposal they’re prepared to “flex” in response to the consultation is details of the hospital developments on both sites.
Doesn’t that amount to predetermination? Never mind their refusal to consult on all available options.
Calderdale Clinical Commissioners have abandoned consultation promise to double run hospital and community services during transition
At the next table, another member of the public reported that Dr Brook, the Calderdale Clinical Commissioning Group Governing Body Chair, said that Calderdale Clinical Commissioning Group would cut hospital services before setting up community services to replace them – which is the opposite of what Calderdale Clinical Commissioning Group has been saying for the last two years, including during the consultation this year.
The member of the public also noted that he and the handful of NHS campaigners present seemed to be the only people with no involvement or formal relationship with the Clinical Commissioning Groups, and that the Clinical Commissioning Groups and their “stakeholders” had their own language which he found peculiar.
For example, Dr Brook was talking about privatisation as if it was a way to provide NHS services more cheaply and to take the pressure off NHS providers. Which is clearly not the case, as a recent study shows.
Stakeholders’ recommendations: NHS Commissioners should go ahead regardless of majority public disagreement
The various tables proposed that in their deliberations, the Clinical Commissioning Groups should:
- Prioritise communicating the benefits of the proposals, emphasising Care Closer to Home
- Give a better explanation of the rationale for change
- Improve communication, particularly being honest about finance
- Work together for better quality and safety and improved outcomes
- Do joined up workforce planning for important services
- Win hearts and minds on the basis of the public’s recognition of the need for change; most issues are resolvable
- Communicate clearly and widely what the urgent/emergency care model is
- Clarify the impact on GP practices – a solution is to start with services that are closest to patients and have a phased approach to the introduction of community services
- Clinical case for change – figure out how to describe more clearly how it will affect people
- Explain patient pathways and clarify things practically
- Clinical safety – deal with travel concerns, explain what A&E is and isn’t, explain new ways of working between hospital and community services
- Given that 64% of people don’t agree with the proposals, the CCGs should say how they will flex the proposals and communicate them better
- Clarify urgent and emergency care through better communication and patient stories
- People need to understand the proposals, better communication is needed
- Need balance of specialist and community staff, can’t just transfer staff out of hospitals into the the community, need to retrain hospital staff for community services because not going to be able to recruit them from outside Calderdale on the salaries on offer.
Why did a big roomful of probably around 200 people spend two hours agreeing that the Clinical Commissioning Groups should go ahead and do what they had all along said they would do – despite most of the public who took part in the consultation telling them they disagree with the proposed clinical models and think they will have a bad impact on them? But hey ho. I think it’s called a rubber stamping exercise.
Not a consultation, a public relations exercise
Commenting on social media, Gerhard Lohmann-Bond wrote:
“Is it time to call for the dissolution of the CCG already? What mechanisms exist to replace a useless CCG? A consultation which refuses to consider the basis of a proposed clinical model is not a consultation, but a public relations exercise.”
Indeed, Dave Rowson is listed on Linked In as “Service Partner – Involvement, Midlands & Lancashire Commissioning Support Unit Stoke-on-Trent, United Kingdom – Public Relations and Communications”
Andrea English added
“A ridiculous waste of money to boot. How soon until we get a proper glimpse of the Footprint Sustainability and Transformation Plan, to see what is actually proposed across the whole area and how bad things really are?”
Paul Cooney from Huddersfield KONP, who also took part in the stakeholder engagement event, said,
“Dr Steve Ollerton, the Greater Huddersfield CCG Chair, told me that there were full elections to the CCGs in May this year but this didn’t seem to have been covered in the media and our GPs seem to have voted them all back in – despite Kirklees LMC rejecting their hospital cuts and community care proposals.”
Terry Hallworth said that at his table he pointed out that the report said nothing about how the proposal was going to be financed and that Owen Williams had mentioned Private Finance 2 and that this was relevant. He went on,
“Jen Mulcahy, the Right Care Right Time Right Place Programme Officer, said we were not going to discuss the consultation but the report. I said this was relevant to the report, as it was a glaring omission. She refused to discuss it further.
I thought this was a bit odd, since Dave Rowson said in his presentation that the CCGs need to deliberate on issues about the rationale for change – this included people’s lack of confidence in accepting that the reasons given are the real reasons, worries about PFI and the proposals for change being financially driven.
I also pointed out that during the consultation drop ins the public questions were not written down and so those and the answers could not have been given to the CSU for inclusion in the report. I was given the same answer as before.
Someone asked how the effect of ambulance travel times would be monitored. Mark Davis, the CHFT A&E consultant, said there was no information on how many people were dying with the current A&E services so it would not be possible to compare.
I asked Mark Davis what would happen if these proposals didn’t go ahead and he stated that in that case he would prefer to see no A&E at either hospital.
I suggested that these proposals may not go ahead because of the Sustainability and Transformation Plan. Mark Davis asked what STP was. When told, he said he was too far down the food chain to know what they were as he was only a clinician.”
Untroubled by such concerns, Penny Woodhead described the stakeholders’ feedback as a
“suite of information for the CCGs to include in their deliberation process.”
She said this deliberation process will end on October 20th, when the CCGs will announce their decision on the outcome of the consultation at a joint meeting in public.
The output from the stakeholder engagement event will be published in a report on the consultation findings in four weeks time.
The slides from the presentations are on the Right Care Right Time Right Place website.
“Independent” Commissioning Support Unit is a privatised business that provides services through a consortium headed by United Health – Simon Stevens’ previous employer
Although the Commissioning Support Unit’s report on the consultation findings is described as “independent”, Midlands and Lancashire Commissioning Support Unit was privatised from 1 April 2016. Now Clinical Commissioning Groups that use its services have to hire them from a consortium of private companies that are on the Lead Provider Framework supply chain. Update 3.8.2019 The Lead Provider Framework has expired and been replaced by the Health Systems Support Framework:
“The Health Systems Support (HSS) Framework provides a quick and easy route to access support services from innovative third party suppliers at the leading edge of health and care system reform, including advanced analytics, population health management, digital and service transformation.”
Under the Lead Provider Framework, the key “supply chain partner” in the Midlands and Lancashire Commissioning Support Unit consortium was United Health aka Optum: the American private health insurance company that the head of NHS England, Simon Stevens, previously worked for. Optum is on the Health Systems Supply Framework as a supplier for 7 out of the 10 “lots”:
- 2A – Local health and care record strategy and implementation support
- Lot 4 – Informatics, analytics, digital tools to support system planning, assurance and evaluation
- Lot 5 – Informatics, analytics, digital tools to support care coordination, risk stratification and decision support
- Lot 6 – Transformation and change support
- Lot 7 – Patient empowerment and activation
- Lot 8 – Demand management and capacity planning support
- Lot 9 – System assurance support
As Dr Brook, the Calderdale Clinical Commissioning Group Chair, has never tired of trumpeting over the last year or so, the Calderdale and Kirklees proposals for hospital cuts and care closer to home are taken straight out of Simon Stevens’ Five Year Forward View.
The full list of the Midlands and Lancashire Commissioning Support Unit consortium supply chain partners was on the NHS England website here (p 4- 7) Update 3.8.2019 However, as noted above, NHS England has discontinued the Commissioning Support Unit Lead Provider Framework and replaced it by the Health Systems Support Framework. The Midlands and Lancashire Commissioning Support Unit website now says it has 28 supply chain partners. CK999 is submitting an FOI request to find out who they are.
The effective privatisation of Commissioning Support Units (by making them little more than shell organisations which act as a front for the private companies behind them) not only hands the private sector more power, more influence and potentially a lot more of the NHS budget; it also presents potentially huge conflicts of interest, with private companies like Optum/United Health bidding to do work for commissioners at the same time as it is increasingly looking to provide the healthcare that commissioners pay for.
Follow the money.
The independence of the Midlands and Lancashire CSU is further thrown into doubt by the fact that its Senior Programme Manager, David Frith, is Programme Manager for Future Fit, the reconfiguration proposal for acute, emergency, primary and community services in Shropshire that is almost identical to the Right Care Right Time Right Place proposal and that is meeting with huge public opposition from Shropshire Defend Our NHS and a wide range of supporting groups and individuals, as well as opposition from the Shropshire GPs’ Local Medical Committee.
Midlands and Lancashire Commissioning Support Unit is not going to want to see our hospital cuts reconfiguration proposals sent back to the drawing board as a result of public rejection. That would not bode well for their success in forcing through Future Fit in Shropshire.