Formal titles -“INTO THE FUTURE Re-shaping community based health services”

'Driving quality, delivering value, improving services'

In fact – closing four Community Hospitals (CHs), including Ashburton/Buckfastleigh and substituting 'Care at Home'

The consultation extended from 1st of September 2016 to 23rd of November

21 December 2016

PREAMBLE

This briefing paper has been written in the event of the committee of the League of Friends of the Ashburton and Buckfastleigh Community Hospital (A&BL LoF) deciding that an application should be sought for a Judicial Review about elements of the consultation conducted by the South Devon and Torbay Clinical Commissioning Group (SD&T CCG)

I made detailed responses to the 'consultation' 21st November but 'interacted' with the CCG many times before. The document provides useful context and contains two, or possibly three elements which a barrister might consider justiciable. (1)

The SD&T CCG, like all others, was set up by the Health and Social Care Act of 1st April 2012. It was charged with commissioning medical services and, presumably, in pursuing efficiency, economy and safety in those services. The South Devon Care Trust, which had direct reponsibility for the Community Hospitals, launched the first consultation on the proposal to close CHs and substitute 'care at home' in the autumn of 2012. That ran into the sand. SD&T CCG has been consulting (wearing down) about these proposals throughout 2014 – 2016, with the formal period as noted above.

A large amount of material has been dispersed but traditional notices like posters have seldom been used. A large majority of the population does not know what the 'CCG' stands for or does. They would not be helped if they read, say, the Formal Governing Body meeting of April 2016 and its 263 pages.

The A&BL LoF is aware of these government rules - "which require all local reconfiguration plans to demonstrate support from GP commissioners, strong public and patient engagement, clarity on the clinical evidence base, and support for patient choice.”

It is also aware of the Gunning principles and especially the two added by the Supreme Court. These were laid out in a critique prepared by the President of the LoF.

i) Consult when the Proposals are at a formative stage

ii) Sufficient reasons for Proposals to permit Intelligent Consideration

iii) Adequate time for consideration and response

iv. Must be conscientiously taken into account

In a recent case “Moseley v Haringey the Supreme Court also endorsed the Gunning Principles and added two further general Principles

a) The degree of specificity regarding the Consultationshould be influenced by those who are being Consulted

b) The demands of fairness are likely to be higher when theConsultation relates to a decision which is likely to deprivesomeone of an existing benefit.

1. EVIDENCE FROM A CH NURSE SHOWS CONSULTATION TO BE A PRETENCE/SHAM

That there is openness in the relations between the CCG and the public has been claimed by Dr N Roberts Chief Clinical Officer. Truthfulness has not been mentioned. It is accepted that openness and truthfulness should be at the bottom of any consultation about vital medical services. A nurse wrote to me in the week before the consultation started. And she wrote on 7 further occasions

(Attachment 2). This is her first e-mail -

E-mail from nurse in a Community Hospital 23-08-16 earmarked for closure

Dear Mr Halpin,

“At the weekend I worked in one of the community hospitals earmarked for closure. Staff working there were angry and upset . A recent meeting with staff informed them that intermediate care vacancies ** would be offered to the staff and it was suggested that they start and apply for them. Obviously it shows that closure is going ahead despite the so called consultation with the public and staff.

Most have no alternative but to accept the jobs on offer as work is the only way to pay the bills. The intermediate care will only provide for patients who are able to see an improvement in their health and no provision is being made for patients with progressive deterioration of their health. Only one of the patients I cared for on my shift fell into the 'intermediate' category the rest were either awaiting placement in a home or were terminal. …..”

DSH commented -

This confirms the 'consultation', starting next week, is a sham. The CCG, a public body, is being grossly dishonest and thusunlawful.

David Halpin MB BS FRCS Formerly orthopaedic and trauma consultant at Torbay and Exeter.

Quote from Stakeholder briefing 11th August 2016

No decisions will be made on thefuture shape of services until after consultation has closed and all feedback and alternativeproposals been thoroughly evaluated.”

(Decision to be made by SD&T CCG, a board of GPs, due January/February 2017)

**'Intermediate care' has been applied to care within the CH. I opposed this because it inferred a lower level of care compared with the DGH, when often the care is better, or excellent in the CH. As quoted here 'intermediate care' should instead be defined as nursing care in the patients home or care in the community ie a care home.

31-08-16 DSH to Mr Chalmers Please reassure me by return that  "Final decisions will not be made until after all feedback and viable alternative proposals have been fully considered by the CCG governing body" is set in tablets of stone.

Ray Chalmers The CCG has said on many occasions that final decisions will only be made after consultation has completed and after feedback and alternative proposals have been considered.  It is why in the stakeholder update you referenced in your letter to me, we indicated that a decision was likely to be made in January/February.

It is fair to conclude therefore, that closure of the CHs is cut and dried. The two more recent e-mail supports that conclusion -

9-12-16 Just opened an email from the 'trust'.  MARS is on offer again - a mutually agreed resignation scheme.  If you are accepted by the trust for the scheme you are paid to leave.  It used to be 12 months pay but its been reduced to 6 months. You are invited to apply - closing date 6 January - only 4 weeks away. A big temptation to cash strapped staff after Christmas spending. It isn't open to the temporary staffing bank, but if you leave the NHS I understand that you cannot be employed by NHS again. At a time when there are serious problems with staffing and retaining staff, one has to assume this is another attempt to downsize leading to eventual privatization.

9-12-16 The MARS scheme has been around for several years but in the past it was offered by the trust in March, presumably to allow payments to made before the next financial year. In recent years there has only occasionally been an offer in September. This new approach to offering payment for leaving the job just before Christmas and the payment for leaving arriving post Christmas bills and credit card bills will no doubt appeal to those in debt. As you know nurses and ancillary staff have been subjected to a four year pay freeze before a 1% rise last year, pegged at 1% for the future. Families who work hard in the NHS are being worked harder and paid poorly for their efforts. With the minimal wage rise it is making a lot of jobs in the NHS very unattractive as the gap gets smaller. Without the prospect of a decent pay rise I'm sure lots will grab the opportunity for some cash. Unfortunately the team spirit is broken. I had a girls day out last week with ex-colleagues and 50% had already found another job, of the remaining 50% about half were seriously looking for alternative work. Those in the position to retire soon were sitting it out, but with MARS on offer who knows? There is a constant pressure to work harder while being held more and more responsible/accountable for the care of patients.

Although difficulty in recruiting nurses has been one of the reasons given for closing the CHs, it is clear that the 'Trust' will 'shed' nurses in the CHs earmarked for closure even though the SD&T CCG assures us that 'no decision will be taken until January/February 2017. Neither openness nor truthfulness are evident.

2. COSTING OF CARE IN THE DGH, CH or WITH CARE AT HOME

The need to cut costs is a recurrent, central theme in the meetings arranged by the SD&T CCG, and in the large volume of documents. Given that taxpayers, NI payers, and potential patients value the CHs, it was necessary for explicit costings to be given, including breakdowns. The SD&T CCG have had over three years to research these and then to bring them forward.NO competent costings have been published. In fact, at a national level, it is hard to find any reference to cost per bed per day in the mountainous NHS publications. This is too round and there are no workings - £400 given for DGHs (3). Costs vary greatly, of course. from hospital to hospital.

About a year ago some raw figures were given to us. The e-mail cannot be located. They are clear in my memory - DGH cpbpd £250 CHs £275, with one or two just over £300. No costing.

An FOI made by me in September this year produced this (attached 3). The cpbpd for the CHs is now given as £388, an increase of 44% on the former. There is no analysis. The cpbpd for Torbay hospital, the DGH, is £277. This is very likely to be much lower than the reality. The analysis is scanty and manipulated eg the large Critical Care Unit cost is subtracted whereas it is a standard part of the service that a DGH provides. Exclusion of the cost of the Special Care Baby Unit is valid. But this is not – radiology, pathology, endoscopy and theatres!!

Domiciliary Care (Cost Per week)South Devon & Torbay CHC (exclude Torbay ASC) Average £897 Maximum £ 4113 Minimum £25

The total number of patients (clients) is not given. The maximum (£4113) equates with the cost of 10.6 bed days at the £388 figure. It is possible that 6 patients being cared for at home cost as much as 9 patients being cared for in a CH.

Costs have only been given in response to an FOI. They are grossly inadequate. There are plenty of auditors in the DGH and CCG. Rational and accurate figures should have played a central part in this consultation from the start since cost has been one of the main drivers for the CCG, as well as alleged improvement in access to and in quality of care.

3. A LEADING QUESTIONNAIRE – DESIGNED FOR THE RIGHT ANSWER

Mr David Prince, of Ashburton, has made a cogent criticism of this (attached 4). It is bound into the back of the consultation brochure – title at the head of this briefing. Councillors Rines and Stokes of Buckfastleigh have made similar criticisms.

The proper construction of a text designed to establish opinion is well known, and two of the above have professional knowledge of it. Given a. the importance of this questionnaire to the CCG and the public being consulted b. the likely cost of producing thousands of brochures, expert advice should have been sought. Was it?

(The opinion of a leading opinion seeking firm might be sought - ORB)

4. CLARITY OF THE CLINICAL EVIDENCE BASE– see Government rules above.

No research based evidence for the possible benefit of care at home has been presented by the CCG, nor pilot studies carried out by it. It has been asserted that people will be kept fitter in their homes under this regime and thus they will require admission to the DGH less often. Most acute illness in the elderly is 'predestined' – cancer, stroke, acute cardiovascular events including dysrrhythmia and will not be influenced by the attendance of doctors and nurses in the home.


References

  1. http://dhalpin.infoaction.org.uk/37-articles/nhs

  2. http://www.southdevonandtorbayccg.nhs.uk/about-us/our-governing-body/meetings/Documents/governing-body-2016-04-apr.pdf

  3. https://data.gov.uk/data-request/nhs-hospital-stay


RESPONSE

 Dear David, many thanks from myself and the HAG for your research and preparation for mounting a possible Judicial Review. Unfortunately after due consideration and after studying the paperwork that you have presented we cannot see that there is a strong enough case to bring to court. I know this will be a great disappointment to you as it is to us.
Best Wishes dated 8-01-17


Dear Elaine,

Thank you.  I think there is a strong enough case but there was 'no harm' anyway in seeking another legal opinion.  I think the LoF has been swayed too much by David Locke's opinion.  OUR NHS is in crisis as I have been saying for some years.  Closure of half the CH beds in South Devon will add to the crisis in the several ways I have outlined.

What has the LoF to lose when we are losing our NHS?  You will have a balance of about £129,000.  What will happen to that?  Food boxes for the poor, frail elderly until the money runs out?

I might speak at the 'Governor's meeting' - about 20th, and I hope others do too (notification required). Not one part of my submission to the CCG > Torbay 'Healthwatch' is contained in its report to the CCG even though it was the result of much thought and came out of devoted service.

I would like to see the written submission to the CCG from the Ashburton and Buckfastleigh League of Friends.  The sham consultation has depended a lot on the biased questionnaire - one of the elements I put in the briefing for a potential legal opinion.  It figures large in the HW report - and I note that about 30% of nitwit respondents were happy to see the CH closed.

I am not sure that the great British public knows what is happening to OUR NHS and what will not replace it.  You will recall my saying that I set up a meeting in Totnes in 2007.  'Your NHS: going going gone.'  John Lister PhD, a good health economist and on the left (writes in the Morning Star as I used to) kindly motored down from Oxford.  I invited the councillors from all the towns with CHs.  NOT ONE CAME.  30 in the audience - mostly GPs and their nurse wives who like me had qualified at St Mary's.  I was coming to the view that the GBP did not want a comprehensive NHS but I soldiered on, as I did with the plan to close Community Hospitals.

Yes, I am disappointed.  Bitterly.  You should still consider that action when the traitor doctors, all trained at State expense as I have said, do as NHSE has told them to do ie close precious beds.

When it starts hurting ones' own families, then the loss will sink in.

You had my e-mail re the report from Derriford. 12 hours on a trolley for a man with a PE with frail elderly women suffering the same along side him.
Royal Worcester - 35 hours on a trolley  Not third world - fifth world.
This just in from a friend up north. 

I have come to a full realisation of the state of the health service over the last 10 days-

My friend's 80 year old aunt had a fall whilst homecarer in the house- ambulance phoned at 5pm-finally arrived at 12.15am.Pneumonia had set in by the time she was brought to hospital as she had been lying on the floor in agony for hours-hip broken-cant operate- now receiving end of life care.

My Niece's boyfriend- ankle injury from football very swollen and possible break waited 7 hours in A and E. Ankle scanned and the Dr on duty could not interpret so he was sent away with a directive to elevate and see Dr if it got worse. No instructionsre what to do- (  tubular bandage, changes in skin colour relating to possible impaired circulation etc).

I have a chest infection and its 3 weeks wait for antibiotics.

Humanitarian crisis? Yes.

There should be a revolution, and of the mind, but Britain is flabby in spite of all the Lycra.

David