Councillors and NHS bureaucrats talking without listening

Councillors gave no sign that they’d heard nine members of the public give heartfelt, closely argued and evidenced statements to the Calderdale and Kirklees Joint Health Scrutiny Committee on 23rd February 2017.

The public opposed the hospital cuts plans and most called on the Councillors to immediately refer them  to the Secretary of State on the grounds that – if carried out – they would damage the public.

Entirely ignoring them, Councillors launched into their scripted questions and comments about the Full Business Case for the hospital cuts plans.

They didn’t acknowledge the public’s contribution to the meeting or reflect for a single moment on the powerful information the public had brought to their attention.

It was as if the public were invisible and inaudible.

We shall clearly have to shout louder and longer in future.

It wasn’t just Councillors who performed from a script. Carol McKenna, the Greater Huddersfield Clinical Commissioning Group Chief Officer did too.

Carol McKenna misinforms the meeting about Sustainability and Transformation Plan powers

Councillor Smaje asked whether the Sustainability and Transformation Plan board, which is responsible for imposing over £1bn worth of NHS and social care cuts on West Yorkshire and Harrogate by 2020, could overrule Clinical Commissioning Groups.

Carol McKenna replied that the Sustainability and Transformation Plan has no power over the various organisations involved in it – Clinical Commisioning Groups, NHS Trusts etc –  but Simon Stevens, the NHS England Chief Executive, had only a couple of days before said that Sustainability and Transformation Plans would have such powers.

She must have known about this, because it was widely reported  – and I bet it would have come through in an internal communication from NHS England as well.

Simon Stevens has since confirmed this in his evidence to the Public Accounts Committee on 27 Feb, where he said that

“The STP process is simply saying that the best way of resolving a shared and unified plan of action is to ensure that there is no bickering locally as to what that should be. Instead people should unite around a plan to make the best of the funding envelope that they have got. That is what we are supporting them to do. There are certain changes that we have got to make to help them get that right, and we are going to be setting those out at the end of March as well… We are going to formally appoint leads to the 44 STPs. We are going to give them a range of governance rights over the organisations that are within their geographical areas, including the ability to marshal the forces of the CCGs and the local NHS England staff.”

Councillors did not challenge Carol McKenna’s statement although members of the public attending the meeting were clearly outraged by her misinformation.

We should have spoken out instead of muttering amongst ourselves and shaking our heads.

Public statements that the Scrutiny Committee ignored

Christine Hyde’s statement cited evidence from the recent Office of National Statistics report on the (in)effectiveness of the Better Care Fund. This found there’s no evidence that integrating health and social care to reduce hospital admissions of people with chronic illnesses/continuing care needs. Since this is the basis of Care Closer to Home, this evidence is vital.

Rosemary Hedges, Secretary of Calderdale 38 Degrees NHS Campaign, drew Councillors’ attention to the recent Journal of the Royal Society of Medicine report that failures in the health and social care system linked to disinvestment are likely to be the main cause of the 30,000 “excess deaths: recorded in England and Wales in 2015 – with a spike in January. This is the largest increase in deaths in the post-war period and these deaths were largely in the older population who are most dependent on health and social care.

Jenny Shepherd, Chair of Calderdale and Kirklees 999 Call for the NHS, pointed out that  both clinical and bureaucratic NHS staff are unable to carry out their duty of care for patients – but can’t speak out because they have no whistle blowing protection.  She recounted some of what they say in private – with their permission, although they’re scared in case it comes back to them.

Paul Cooney, Chair of Huddersfield Keep Our NHS Public told the Councillors that the NHS in our region has “absolute contempt” for the people it is supposed to serve, and for our elected representatives – who have the responsibility to challenge such views on our behalf.

In reply to his request for the Sustainability and Transformation Plan appendices and other key supporting documents,  the Sustainability and Transformation Plan team had  agreed that it would be in the public interest to release them – but refused to do so because this would inhibit “free and frank discussion”.  If  the Clinical Commissioning Groups, NHS England and NHS Improvement knew that their discussions were going to be made public, they would not be able to speak their minds. The release of the information would also prejudice Councillors’ scrutiny of the Sustainability and Transformation Plan.

Terry Hallworth pointed out the risk that the £290m capital costs for the hospitals’ “reconfiguration” might well come from PFI 2.

There were three more public statements, opposing the hospital cuts proposals.

Scrutiny Committee may refer the proposals to the Secretary of State by the end of July

The Scrutiny Committee concluded by weakly agreeing that they were “content” to receive information from the Clinical Commissioning Groups on all the Scrutiny Committee’s recommendations – which to date the Clinical Commissioning Groups have ridden roughshod over – and they expect the hospital Trust’s Full Business Case for the hospital cuts plans and associated documents by the end of June.

The Committee will scrutinise the hospitals Trust’s Full Business Case (about the capital funding for the hospitals) and associated documents when they are available.  In the meantime they will receive updates from the Clinical Commissioning Groups and hospitals Trust.

Cllr Smaje, the co-chair, added that the Scrutiny Committee also required to see the Clinical Senate review.

Carol McKenna clearly told the Committee that the Clinical Commissioning Group have no date to send the proposals back to the Clinical Senate – which last year reported that the plans were so vague that they couldn’t tell if they would deliver an appropriate standard of patient care.

Cllr Smaje said,

“Consideration will be given to refer the proposals to the Secretary of State by the end of July, including the Clinical Senate review?

More info:

Four ckJHSC deputation statements feb 23rd – links to pdf document.

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