Update 12 Oct 2020 Despite the best efforts of Councillors and campaigners to protect the NHS in Devon, the Devon Integrated Care System is to start in April 2021, under the name Together for Devon.
Devon Councillors put their heads above the parapet in defence of NHS and social care services, when the Chair of the Devon Overview and Scrutiny Committee, Cllr Brian Greenslade, called in the Cabinet’s decision to approve the set up of a Devon Integrated Care System.
A call in is where a Scrutiny Committee decides to summon any of the public bodies it is tasked with scrutinising, in order to challenge and review decisions they have made. It has to be done according Overview and Scrutiny Procedure rules. These can be found on Councils’ websites.
At their 22nd March meeting, Devon Scrutiny Committee refuted claims by the Cabinet that the Integrated Care System was just an evolution of previous changes to NHS and social care services, without any changes to Council and Clinical Commissioning Groups’ governance structure.
It rejected the Cabinet’s decision on grounds of prematurity, since Cabinet had approved the creation of a shadow Integrated Care System from April 2018 without knowing what the Integrated Care System is, how it is to be governed and funded, and how it would be democratically accountable. In addition, there are issues with care closer to home proposals in a rural area and issues of lack of consultation.
The Scrutiny Committee told Cabinet not to go ahead with their ICS proposals until a number of rather stringent conditions have been met.
Successful public campaign for call in
The Devon Scrutiny Committee call in of the Cabinet decision on 22nd March was largely down to the organising powers of Devon Save Our Hospital Services.
Devon SOHS member Ian Williams explained,
“The Chief Exec of Devon County Council had submitted a report to the Cabinet which waxed lyrical about the Integrated Care System proposals, said that it wasn’t a fast track to dismantling the NHS or privatising, but did not say what it was!!!!”
As a result Cllr Brian Greenslade, Chair of Devon Overview and Scrutiny Committee and a leading supporter of the Devon Save Our Hospital cause, called the report (p 159-166) in for Scrutiny.
In the normal way this would have delayed things for at least 5/6 weeks however it was shoehorned for Scrutiny within 7 days.
At the Scrutiny meeting Devon Save Our NHS were able to provide 4 speakers to challenge the report. There was a strong level of opposition support among Councillors. One key comment by a Councillor was that the Clinical Commissioning Group were telling the County Council how to spend their budget, the tail wagging the dog. Ultimately, the Devon County Council Chief Exec’s paper provided no details of Governance, Structure or indeed appropriate budget.
One Councillor said that in approving the paper and its vague proposals, Cabinet was signing a blank cheque before anyone knows what the amount’s going to be. Members of the public, Councillors and Scrutiny should have information in front of them before they come to any decision about any Integrated Care System that is being foisted upon them.
The Scrutiny Committee questioned the Council’s Director of Adult Social Services and the Chief Officer of South Devon Clinical Commissioning Group.
Both protested that no change was proposed to the governance structure of how Clinical Commissioning Groups and the Council work. This was supported by Cllr Andrew Leadbetter, the Cabinet member for Adult Social Care and Health Services.
That claim was refuted as disingenuous by Cllr Martin Shaw. He pointed to key elements that the Integrated Care System will bring in from 1st April without Councillors’ or the public’s awareness:
- Integrated Strategic Commissioning
- Capitated (whole population) funding – currently the subject of a Judicial Review to be held in Leeds High Court on 24th April
- Local care partnerships – four area-based and one for mental health – without a single paper describing how they work
He said the Scrutiny Committee could not approve the Cabinet’s decision without knowing about these issues. And that Cabinet had approved the paper and its proposals despite having all these absences pointed out to them. Cllr Shaw described this as a rush to make a half baked decision and added:
“This committee therefore needs to take it seriously as a big change, not as an evolution of what already existed, and to get information which is missing, to bring the proposal to a stage when we can make a proper judgement on it.”
Accordingly, after further debate and discussion by Councillors, the Overview and Scrutiny Committee referred the report back to Cabinet until such details were available.
Flood Councillors with expressions of concern and a list of questions for Scrutiny
Devon Save Our Hospital Services flooded all councillors with a letter/email expressing concern and a list of questions that needed to be asked by Scrutiny. They provided a sample email which people could use or tailor which included the questions – downloadable here. The group also produced a more more detailed summary with questions .
The email with questions was easy to send to all of the councillors because their email addresses were also listed in the email that SOHS sent out to their subscribers. These can be included in a FB post if you don’t have such a list. The number of emails received by all councillors was mentioned by the Chair of Scrutiny, so it’s a worthwhile exercise.
Devon SOHS suggest that any other campaign groups lobbying for a Scrutiny call in of Cabinet decisions approving Accountable/integrated Care Systems should also highlight the Health and Social Care Select committee inquiry into Integrated Care Systems and the 2 Judicial reviews of NHS England’s Accountable Care Organisation contract that are shortly coming to court.
Also the NHSE 2018/19 Planning Guidance on public engagement, so it’s not just Scrutiny that get to ask questions directly.
NHSE 2018/19 Planning Guidance – Public Engagement on Integrated Care Systems
“As systems make shifts toward more integrated care, we expect them to involve and engage with patients and the public, their democratic representatives and other community partners. Engagement plans should reflect the five principles for public engagement identified by Healthwatch and highlighted in the Next Steps on the Five Year Forward View”