At the meeting that took place on 20 September, my proposal for a review into the vast cuts the local NHS is making failed, partly because Cllr Randall Johnson insisted any such fact-finding should be carried out within the confines of a private meeting, and partly because very disappointingly, no councillor would second my proposal.
I have been asking for over half a year for information on what cuts the local NHS is making as part of the government’s plan to reduce the NHS £30bn shortfall by 2020. In Devon, this has translated into around £500m by 2020 and in Devon the NHS is working to achieve this.
At the June meeting (after I had asked for more information on the cuts as the local NHS reported its confidence to get back to zero by 2020) the health and adult care scrutiny committee received a paper, including one side of A4 of bullet points on what was being cut.
It was extremely vague and did not provide anything like the level of detail required for a proper scrutiny session.
I asked a further paper for our September meeting. This arrived by email two days before the meeting. The finance section was four pages of bullet points. Slightly less vague but fell very short of what I would have expected for councillors to carry out an effective scrutiny of what services are being cut in order to meet the government’s requirements for financial balance by 2020.
The paper simply raised dozens of further questions, for which there was not time to ask.
I told the representatives of Health and Social Care present (and the committee) that I believed that there was some obfuscation going on.
I proposed a spotlight review into the cuts.
I emphasised that there was little more important at the current time and residents were being kept in the dark about massive cuts, to the tune of over £100m across the county – and that’s in this financial year only!
Unfortunately, the chair, Sara Randall Johnson rejected my proposal, instead suggesting the issue is discussed by a group that meets in private. I objected to this and argued that both the NHS and Devon County Council were both publicly accountable organisations and this issue should be debated and reported to the official committee that meets in the public domain.
The health and adult care scrutiny committee is the right place for it. The chair simply refused to accept that this was an issue that needed properly investing and reporting back to the official committee that has a legal remit to investigate issues of concern relating to health services.
In the end, frustrated at her attitude, I simply asked for a seconder so there could be a vote.
I am very disappointed to report that no committee member seconded my proposal. I remain baffled and disappointed about this.
This programme of cuts, known as the sustainability and transformation plan (pushed on the NHS by this government), essentially underpins all the work the NHS is doing for the next two years (and has done for the previous two years) and I believe that people across the county have been let down by our committee, which failed to see the importance of our committee having access to this information.
The information we were presented with at the meeting on 20 September was as follows:
Savings overview – 2017/18
Integrated Care Model – £39m
• New care models implemented across the system, allowing the safe reduction of over 200 beds since 1 April 2016
• Focus on reducing delayed transfers of care
• Includes savings of £9.4m on improving continuing healthcare process and ensuring most cost effective packages are provided for patients
• £7m delivered from working collaboratively with local authorities on areas of joint investment through the Better Care Fund, providing for opportunities for reduction in hospital operating costs
Elective care – £20m
• Reduced the rate of growth in referrals for acute services
• Increased the available options of alternatives to invasive procedures and operations at an earlier stage
• Advice and guidance option implemented for GPs to access
• New pathways for hips and knee patients
Prescribing – £18m
• Work with GP practices to switch prescribing to more cost-effective brands
• Reduce unnecessary repeat prescriptions
• Review of high cost drug prescribing in acute trusts
Corporate Support services – £8m
• Efficiencies made in back office functions by moving towards national best practice
Workforce and staff development – £9m
• Collaborative working to agree a set of agency staff providers and significantly reduce the costs of agency staff
• Reduction in temporary staffing
• Improved processes around use of agency
• Reduced reliance on agency staff, including implementing use of a shared staff bank
Mental health – £8m
• £3.2m saved from improved processes around individual patient placements. Devon Partnership NHS Trust now commissions this directly – removing organisational barriers, increasing care plans and enhanced focus on admission/discharge
• Community mental health services consolidated into three geographical hubs
Strategic organisational development – £3m
• Reduction in administrative costs and reducing duplication by aligning the two clinical commissioning groups in Devon
• Joint working across the two clinical commissioning groups ,including joint committees and governing body
• Implemented a single executive team across two clinical commissioning groups
Internal cost improvement programmes/other – £52m
Each individual organisation made business as usual savings of £47m
Other programmes of work have delivered small savings in year of £5m (eg estates)
Total – £157m
NB. These figures are for 2017/18 only.
Why would anyone disagree that this massive issue needs a closer look at – transparently?!
Here’s the webcast. It is item 9. The webcast is slightly out of kilter. I have asked this to be fixed so it should be sorted shortly.
Pic: Arguing my case at the meeting on 20 September.