Dr Tim Burke BM Clinical Chair NEW Devon CCG 19th March 2018

Dear Dr Burke,

Thank you for arranging to meet me and my erstwhile colleague David Jameson-Evans. And I also thank you for the letter which followed with the clear minutes made by Clare Doble.

I accept your apologies contained in the letter. I have learned, much too late in the day and with some anger, that there was a worthwhile electoral process for all NEW CCG medical officers. This extract of the minutes adds clarity -

Dr Halpin therefore sought evidence that this was an electedprocess and wrote to the CCG onMarch 3rd 2017, but the documents that Dr Halpinreceived did not give reassurance on the process, detail or clarity as to how theclinically elected membership of the CCG had arisen. (collected correspondence)

In the absence of a coherent response to my question re constitution, and 5 months after I wrote to Dr Jenner of the NEW CCG , I instructed Mr Selman Ansari of Bindmans. He wrote to you on the 22nd August (4), that being over 5 monthssince my brief and courteous letter to Dr Jenner. You replied 25th October.

Q1 (at the meeting): Some might think that CCG board members are ‘political appointees’ given, forinstance, that no dissent is reportedeven though what can be predicted as verydamaging policies are driven through. And there were no public reports of elections for board membership. However, in the attachments you sent to Bindman’s I dolearn that you were elected to the position of Chairman.

Response from TB: Confirmed that the election process of clinical members to the CCG is not in anyway political, but through an election process run by an independent body,in this event the LMC, and is overseen by a voting process as outlined in theattached documentation to this letter.

However, I learned this of at least one CCG, the South Devon and Torbay CCG -

As far as this CCG is concerned only the Chair and the Chief Clinical Officer are elected by the membership. Effectively there is a recruitment process that identifies candidates that could fulfil the role and then decisions are with the membership. Our CCG constitution is on the website http://www.southdevonandtorbayccg.nhs.uk/about-us/Documents/constitution-2015.pdf Page 65 sets out "The Clinical Commissioning Group: composition of Membership, Key Roles and Appointment Process"
Ray Chalmers    Head of Communications and Strategic Engagement


( DSH -but I could find the 'SD&T CCG recruitment policy' using the search engine. The process appears to have much less rigourthan that used for NEW CCG. I recall being told - verbally I think, that some members were selected and others put themselves forward, both varieties being subjected to the same process. Election did not appear to come into it.)

Given the rigour followed at central behest in the formation of the NEW CCG, it would appear that the SD&T CCG is not properly constituted.

The Tide.

The leader of the government that got the Health and Social Care Act of 1-04-12 passed with help from Labour's Health Act of 2006 said 'the NHS is safe in my hands' and 'there will be no top down re-organisation'. This act must be at least the eighth politically driven convulsion in OUR NHS. (I fought Mrs Thatcher's/Centre for Policy Studies' Internal Market proposal alone in Torbay. This ridiculous policy added about £1.3 billion in administrative costs to a budget of c. £30 billion – about 4% in its first year.I doubt few CCG board members nationally know this. “Those who fail to learn from history are doomed to repeat it.”George Santayana ) CCG members are toeing the line drawn by NHSE and the DoH as one policy after another is set, and often without pilot studies or wide professional consultation. Very few members of the public know what is happening or what the acronyms stand for as they move quickly from CCG to the final and fatal ACO/Integrated Care System. See 9 minute video from Keep Our St Helier Hospital

http://dailystarmovies.com/videomovies-Jeremy-Hunt-drops-a-clanger_f0HyL-riKqqc.html

The consultations regarding Community Hospital (CH) closure have been a sham in Devon and involved a small percentage of the public.

The Medical Services

The keystone of NHS medical services is primary care. I have known that since my training at St Mary's and I respect this arm of the service greatly. And yet 11% for GP funding has been shrunk to about 7% without protest from the CCGs I believe. Morale throughout all arms of the service has drained away, with GPs retiring before time, 35,000 nurse vacancies https://www.theguardian.com/society/2018/jan/23/nhs-england-recruitment-crisis-nursing-vacancies in a nation which previously retained them and respected them, 2,500 short in midwifery, and mental health services grossly inadequate especially “CAMHS”. These are vital priorities before yet more deckchairs are shuffled about. A nurse I know – 'Could morale be lower?'. She tells me that a friend in another hospital (Torbay) learned that non-medical staff now outnumber clinical staff. I can imagine that, with board minutes of 250 pages and 5 staff in the 'discharge team'. All this means many locum/agency staff with added costs, great stress in the staff, less efficiency and greater risk of accidents and otherwise sub-standard treatment. The teachers in our schools are suffering the same assault on their morale, and are leaving in droves.
Anecdotes re Risk/Negligence

I hear many people.  A very healthy 'primip' – a shiny London 'birthing centre'.  Fine baby girl. Mother re-admitted at 4 days with sepsis ie septicaemia the proper term in pathology.  Cause – the placenta had not been delivered. 80+ man > ?hemicolectomy for cancer.  Pack or swab left in. Removed at SIX months.  Much suffering until recent death. 
NHS: Clinical Negligence - Question 31 Jan 2018 Lord Ribiero past President RCS and chair of DoH Independent Reconfiguration Panel

 

My Lords, we need to do something to tackle this issue much more urgently as the total cost of the litigation in the pipeline is some £65 billion—half the NHS budget. Until and unless we do something about changing Section 2(4) of the relevant Act we will have a continuing problem with patients claiming for private care when they should have their care provided by the NHS.”
75% of cases that go to court (too many) end with compensation. Thus legal and other costs are added to the NHS Bill. (DSH - is £65 billion a fact? No national discussion followed.)

 

Capacity

In South Devon 50% of CH beds have been erased, and 71% in North, East and South Devon in favour of 'Care at Home'.  Analysis of the delayed discharges resulting from this is yet to be completed.  The fact is that the ward sister was able to pick up the 'phone when a patient was fit to leave the DGH and often arrange prompt discharge to a CH near home.  Arranging packages of care etc takes days, and sometimes weeks. 8 orthopaedic lists were cancelled over a weekend in the Spring of 2016 at the RD&E (before any CHs in its catchment were closed) due to 'overflows', and Norovirus on one ward.  Very recently (this from the husband of a patient whose THR for a very painful hip has been delayed) there were 92 medical outliers, and this in spite of the RD&E building two wards, one for rehabilitation of the elderly.  Furthermore, although the beds in the orthopaedic ward are ring fenced, only 12 were available for elective orthopaedic operations. There are 33 consultants in this specialism with four operating theatres available!  The waste of staff and physical resources is scandalous and this is due in large part to CH and the PEOH (see below) closure.  Note that whereas the RD&E has opened beds (care at home!), CH beds have been cut drastically, and Torbay hospital has reduced beds – numbers vary.

David Jameson-Evans and I spoke of our great regret that the very good Princess Elizabeth Orthopaedic Hospital was turned into a housing estate by political direction and local jealousy. High standards could be maintained in it and the esprit de corps was of the highest.  Operating lists could be filled with all efficiency because there were no overflows of 'medical' patients.  The idiocy of thought and analysis is revealed by current discussion about a free standing elective orthopaedic unit at the Science Park, as I am told!

Accountability in the Commissioning/Provider 'system'
http://dhalpin.infoaction.org.uk/37-articles/nhs/177-ref-read-the-suppressed-report-into-botched-nhs-operations-by-private-company.   (absent link now re donations to a political party)

I know of two series of harm at Mt Stuart, a private 24 bedded hospital at Torbay.  Ramsay Health has received 80% of its income from the NHS. No bed closures there but there are at Torbay which had 13 theatres when I left.
First the cataracts.  10x concentration of an antibiotic injected into the globes of 6+ patients.  An assistant nurse, drafted from Torbay and unfamiliar with the concentrations.  Misty vision reported.

Another - 90 basal cell cancers fielded to Mt Stuart.  12 to a surgeon whom no one knew.  Inadequate margin in  each case - each had to be re-done.  Very incompetent surgeon.  Instructed for an hour, a good nurse could do it well.  I mentioned both to the chairman of the CCG, Dr Greatorex.   I do not think he knew of these cases.  Was this the response?  That it was the trust that had outsourced both sets of patients so not the CCG pigeon.  BUT the money came from the CCG and 'quality' of care was its central responsibility.  Complex and I would say evil – coming out of the damned H&SC Act.  Was there any litigation to follow?  Likely, but it would be the NHS paying.  (as above - Ribiero)  Had the 'commissioners' been told about these two series of harm?  It did not seem so. If they had, how would they have acted?  Only one local DGH – Hobson's choice. 

Conclusions

I taught young surgeons to 'keep it simple'.  Running an NHS, especially with burgeoning techniques and increasing 'pathologies' (take cancers alone) is not simple, but this aim should be central.  Instead, complexity is grafted upon complexity.  The commissioner/provider set up is the latter.  I cannot recall which quango thought it up.  And now the CCGs are directed to canter along the ICS course.  Many of us know that Mr Hunt et al have gone at our expense to the Kaiser Permanente Foundation but not seen Michael Moore's Sicko.

Susan Matthews, a senior nurse from North Devon asks -  “will this result in another expensive restructuring of services, management and redundancies? The answer will be yes. Do the formal NHS bodies take any notice of experience and evidence gathered over many years by servants of the NHS? No. This letter focused on the CHs, and was ignored completely by Dr Diamond, the CE at the NDDH, the 'provider' and closer. This careful analysis of CH function was cast aside including this. 'About 20% of acute illness can be dealt with by GPs in their local hospitals.'  This is relevant to the crammed A&Es.

Devon County Council did have a first class care system.  There should be no need to amalgamate 'social care' with the NHS.  The mantra for integration, though oft repeated, is hollow.

These were three of the rules set by Mr David Nicholson NHS CE in 2010

  • strengthened public and patient engagement

  • clarity on the clinical evidence base

  • andconsistency with current and prospective patient choice.

The present course ignores all three. It is likely to be the coup de gracefor OUR NHS. The doctors holding the reins will be responsible for it. As doctors they have the power to resist these destructive policies.

A symptom of a diseased and politically inspired set-up - a man on his way up the ladder in one of the 'big four' accountancy firms sucking blood from OUR NHS, PwC, was asked by his seniors 'to find ways of closing Community Hospitals'.

for truth

and yours sincerely

David Halpin FRCS Retired orthopaedic and trauma surgeon Torbay and the PEOH