Dear Dr Johnson, Sent 30-07-19

It does not appear that I have had an acknowledgment of my e-mail below.  In it you will read that I was to write to the Torbay 'Trust' to find the costs of the visits of Trust board members to the headquarters of Kaiser Permanente in the USA.  I have not done that for lack of time, partly due to resolution of factors in my own health. 

Another reason is Trust tardiness in grasping nettles -
 a.  Admiral Sir Richard Ibbotson
https://dhalpin.infoaction.org.uk/37-articles/nhs/216-an-example-of-the-low-standards-of-ethical-principle-and-thought-in-our-nhs
Another -
b. is the failure of board member Leslie Darke Executive Director of Estates and Commercial Development at TSDFT, to tell me in October 2018 whether staff leaving before retirement were asked in a kindly way their reasons for leaving.  She was obliged. as you know, under the Freedom of Information Act to reply to my simple question within 20 days, and without a need for me to cite this STATUTE and her obligations under it.  I asked her twice.  The ICO (the overwhelmed Information Commissioners Office) was contacted and after delay, prised the following out of the Trust this month, at least 9 months after my question. See twin posting: Retention of Nursing Staff: Failure of Leslie Darke, Torbay Trust Board Member to Answer a Key Question asked October 2018

I am therefore asking you, on behalf of the CCG to answer these four questions given that the budget which CCG-Corporate Services holds of £1.6 billion funds the 'Torbay' Trust.  That is, it commissions services, planning, policy etc within the Trust.

ONE   What was the total cost of the visit/s made by Trust board members to the headquarters of Kaiser-Permanente in the USA?

TWO  If the budget which the CCG disburses was not the source of this funding, in whole or in part, was the CCG told of this unusual visit to a leading private health insurer before it took place?

THREE Did the Trust report what it learned in this visit or plural - visits?  Is that available to the tax/national health insurance paying public?

FOUR  Were they funded instead by private sponsors?  If so, which?

I look forward to a reply within the statutory limit of 20 days

yours sincerely

David Halpin FRCS

Header: Information re Teignmouth Community Hospital and wider

FAO   Dr Paul Johnson   Clinical Chair of NHS Devon Clinical Commissioning Group (Devon CCG)   Sent   12-07-19  1.57 pm

Dear Dr Johnson,

Background

You probably know that I opposed the closure of the many CHs in North Devon, and more recently the Ashburton and BFL Community Hospital,  based on my experience as a  conscientious Consultant Orthopaedic and Trauma Surgeon concerned with treating patients to the highest standard and with the greatest efficiency.

I was appointed to this post at Torbay in 1975 with another.  The two of us were responsible for caring for a resident population in Torbay and South Devon of about 180,000 people with a
larger holiday 'surge' than today.  Almost all elective operations were done at the world renowned Princess Elizabeth Orthopaedic Hospital where I trained mostly in the previous five years.  That hospital had 120 beds including a children's ward.  There were 4 modern operating theatres.  The hospital had been re-engineered to a high standard, had a spacious physiotherapy department with a most excellent staff, a large hydrotherapy pool and one new ward with bays.   (I cared in this area for the babies and children eg club foot, congenital dislocation of the hip, cerebral palsy etc.)  We had no 'overflows' from medical wards - of course, there was a high esprit de corps with excellent collegiality from surgeon to porter to the one admissions officer across all staff.  In say 1992, there were 4 Torbay based surgeons, 5 in Exeter and 3 in North Devon.  It was bulldozed for a housing estate by political diktat against the concerted opposition by all but one surgeons. 

As we feared and forecast, the removal of the PEOH service to 3 PEOC wards at the RD&E proved steadily disastrous for the service although the standards of care were maintained I am told.  For instance, last year in February, with norovirus (Norwalk) in a ward and the usual overflow of patients with acute medical diagnoses, there were 12 beds available for major operations by 33 surgeons.  8 weekend lists had been arranged for elective operations as requested by Mr Hunt.  Only 2 went ahead for lack of beds - trauma cases that had been admitted as emergencies.  The other day, a surgeon who I helped train, told me that his list was cancelled and theatres empty for lack of beds.  I have heard such stories often and would weep but feel intense anger instead, both for patients, the majority of which are in pain, and for the morale of all staff who serve.  There are about 56 such surgeons in Devon now and about half the beds.   You can imagine the waste of resources, both human and material, and how morale is affected.  Day case surgery, and short in-patients stays have increased somewhat in mitigation, but the PEOH had a daily, busy day case throughput, before it was standard in general hospitals.

I spent many thousands of hours in my efforts, with lay people, in attempting to warn the CCG's and 'trusts' that the closures would hamstring the medical services.  This was in the way of analysing the profuse output from the CCGs, attending meetings, writing to Dr Nick Roberts MBE and Dr Greatorex the Chairman and much else.  Most of my letters to the CCGs are on my web site    https://dhalpin.infoaction.org.uk/  The link to the last letter is via   https://dhalpin.infoaction.org.uk/37-articles/nhs   to 

https://dhalpin.infoaction.org.uk/37-articles/nhs/229-delayed-and-unclear-responses-to-my-request-re-ccg-constitution-integrated-care-system-likely-coup-de-grace-for-our-nhs    NOTE -

avoid the link 'See 9 minute video from Keep Our St Helier Hospital -'  It has been contaminated with pornographic images.  The posting will be edited after the week end. 

long, but I ask you with respect to read it.  As for 'trusts' I composed a letter to Dr Diamond, CEO of the North Devon District Hospital Trust on behalf of 10 senior GPs and specialists with a combined service experience of about 300 years

https://dhalpin.infoaction.org.uk/pdf/Joint%20letter%20to%20Dr%20Diamond7-09-15.pdf  She did not even reply to fellow doctors- a sign of the times.

All the indicators of performance in our local and national medical services are getting worse; the media tells of them almost daily.  Currently it is the overwhelmed A&E dept at the Royal Cornwall, and the record numbers (>4 million) waiting for elective surgery.

I noted this and will write to the chairman of the Torbay Trust to inquire of the cost and purpose, and did the funding come from the CCG budget of £1.6 billion.  The CCG could help me with the latter question.      

https://tompride.wordpress.com/2017/04/23/theresa-mays-secret-plans-to-replace-nhs-england-with-private-us-healthcare-system-kaiser-permanente/

Finally, I come to this - the response of the Royal College of Surgeons to the Public Accounts Committee re waiting times

http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/public-accounts-committee/nhs-waiting-times-for-elective-and-cancer-care/written/101446.html?utm_campaign=994153_14%20Jun%2019%20Political%20Update&utm_medium=dotmailer&utm_source=emailmarketing&dm_i=4D4N,LB3D,117TVJ,2HLBH,1

The second of three main points  "The RCS is calling for a 5-year plan to tackle this backlog, including a commitment to increase hospital bed capacity."

How can you justify closing one CH bed in addition to the 50% + that have been closed already, and not re-opening those close?  'Care at Home' and 'Intermediate Care' is no safe and efficient substitute for professional care with local knowledge and accountability in a CH.  ( I have noted that the inadequate substitute that you fund via the provider - the Trust', is given the same name the CCG gave to the Community Hospitals.  Chalk and cheese.  I will instance some recent close at home examples in a letter to the Trust Chairman with a copy to yourself.)

Bed capacity = More actual beds and significant lessening of 'delayed discharges of care.'  Nothing could be less relevant than flights + accommodation to hear the Kaiser-Permanente propaganda.  Those in control should see 'Sicko' by Michael Moore instead

https://vimeo.com/76646445    K-P is dealt with very well.

yours sincerely

David Halpin FRCS