Direction Of Travel
The following blog post is my personal view only, based on my anecdotes as previous Cabinet Member for Health & Wellbeing at County Council many years ago, as (briefly) the Chairman of the Health and Wellbeing Board, and based on the alleged leaks brought to public attention by Steve Barclay MP. They are strictly my personal view and not the view of any Council or other body – and they are based on the emerging picture and my observations only.
A few years ago when the County Council first went to “no overall control” and the Rainbow Alliance of UKIP, Labour, the Lib Dems and the Independents set about their act of turning it into a Committee System rather than a Cabinet System I warned what the consequences would be. I said that it was a recipe for stagnation and weakness and that we would be feeling the consequences for years to come. We have been and we still are. Trouble is, when some bad policy appears it can be hard to trace the roots back and note the cause. Such is always the way with these things.
Our current problem with the C.C.G.’s apparent desire to close our Minor Injuries Unit is one of those consequences. But how? It certainly is hard to see and you have to understand some of what went on, and why, to follow it. Defenders of the Committee System, who really should be hanging their heads in shame by now, will deny deny deny as they always do. Which is a shame because the ongoing local costs of this farce will continue to reverberate until the whole useless shambles of a system is wiped away.
Back when the Coalition Government decided to controversially shake up the NHS one of the aims was to localise the NHS service. To make it more flexible and driven by local needs. To make it more answerable to local demand. To give it local strategic and democratic insight instead of being run by very remote and distant bureaucratic grey-suited bean counters. It was a laudable aim. Although there was a lot of political saber-rattling about it, many senior NHS people I spoke to would privately admit that they saw the sense in it.
The senior body which would provide the strategic links and the democratic oversight was a new County-Wide body called the Health & Wellbeing Board. That Committee would comprise of senior people from County Council, District Councils, health partners, Public Health and the NHS.
The County Council Leader at the time was Nick Clarke and he understood very quickly the importance of this Committee to make the whole thing work. He determined to keep the Committee small, with only “senior players” at the table, in order to make it a place where meaningful decisions could be quickly taken and carried through. He also chose to be the Chairman himself. At the time some thought this a bit of a “power grab” given that he was already Leader of the County Council, but I believe that was not a fair view of his motivations. Indeed, the Senior NHS people and County Officers told me at the time that they thought this a strong move and they supported it. “It shows we are serious about the remit and breadth of this Committee and its role,” I was told by more than one senior official.
After a time, Nick Clarke handed the Chairmanship to me as the appropriate Cabinet Member – once he was confident that I understood his vision for it. I did. It had to be dynamic, flexible and provide an opportunity for all the parties involved to become greater than the sum of their parts. If something controversial, like the closing of a Minor Injuries Unit, were to emerge it was the Health & Wellbeing Board who would be on it in a flash, calling the C.C.G. to account, able to get to the bottom and look at alternatives very quickly because everybody who needed to make a decision was already connected to the Board. The results of the County Election meant that I never got to continue as Chair the Health & Wellbeing Board, but I certainly hoped it would be well-placed to continue its important role.
Unfortunately, that was when the Council fell to “no overall control” and the Rainbow Alliance immediately set to work dismantling a system that had worked well, replacing it with the toothless shadow that has emerged. They will tell you they did this to “reflect the changes in the political make up” and to be “more democratic.” I don’t believe a word of that. In my opinion, they did it partly out of spite – they didn’t want Conservatives in “control” anymore. And partly to give themselves the trappings of “power” without the responsibility that should come with it.
They created, in one short year, a system where the buck stops nowhere. Where decisions can be taken and apparently everybody can say: “Nothing to do with me Guv.” Where everything is quietly run by Officers and democratic oversight only happens when the dirt really badly hits the fan and creates enough waves to force the warring parties to briefly align in their position. Though not even then, sometimes. Watchers of County Council have noticed that the whole place has become disfunctional with some County Councillors openly calling for their own Council’s dissolution. Recently, they voted for “devolution” which most people I’ve spoken to are confident will ultimately mean the end of County Council (if they are prepared to give you a candid answer.) Yep. It could well be that indirectly, they voted for their own demise.
The effect on the Health & Wellbeing Board was apparent. The first thing they did was stuff it full of loads more members. The argument that this was “more democratic” didn’t mention that it was also taking a streamlined and effective Committee and changing its very nature. A bunch more Councillors from all different parties joined, creating an adversarial and political backdrop that had previously been absent. Its not that any of those individuals had anything but the best intentions. It’s not a failing of the Chairman or any other specific individual. Only that they were now one voice in a throng, lost in the hubbub of competing views. The power of the Committee was now diluted, in my view. I suspect this was deliberate. Some people take a very ideological view of the NHS and don’t want to see any democratic oversight on it.
At a Health & Wellbeing Board meeting in May one of the Agenda Items was called “Sustainability And Transformation Programme Update.” This from the minutes of the meeting:-
The Board received a report updating it on the progress of the Fit for the Future, Sustainability and Transformation programme for the Cambridgeshire and Peterborough area, since the last report on 17 March 2016. The report was presented by Catherine Pollard, Programme Director, NHS Improvement (NHSI) and Matthew Smith, CCG Assistant Director, Improving Outcomes. It was explained that the Programme Director was attending to mark the importance NHSI and NHS England (NHSE) attached to supporting the work being done in partnership with local colleagues to establish a long-term plan to bring the health economy back to financial balance, and more importantly, to address and deliver improvements in healthcare.
Introducing discussion of the report, the Chairman drew attention to its statements that a further update would be provided at the Board development day, and that early engagement with the public was planned from July 2016. Points made in the course of discussion included
(1) one of the themes of the Sustainability and Transformation Plan spoke of the importance of avoiding the need for acute care, yet under the Action Log item earlier in the meeting, the question of withdrawal and closure of services from communities had been raised; such actions (or rumoured actions) ran counter to the direction of travel, which was to extend services rather than withdraw them
(2) the Plan was about making resources work best for patients; it was necessary for the CCG and partner providers to take a broad and objective look at what patients wanted and needed, and avoid piecemeal discussion about closure in isolation from the Plan, particularly if older people were to get the services they needed within their communities
as part of efforts to make the Sustainability and Transformation work more publicly useful, and to support more positive wider public engagement, Healthwatch had been working with the CCG on the question of patient and public involvement within each organisation
(3) it was not entirely clear where leadership of the system resided
the financial situation of the NHS and last year’s significant overspend had created anxiety which was raising questions about future structures
(4) working together in the course of developing the Older People and Adult Community Services contract with UnitingCare had brought local health partners closer together
local councillor members of the HWB and NHS members needed to work together to improve the way the NHS functioned locally.
So first (1) they are challenged about closure of local services and they declare that this runs “counter to the direction of travel.” Notice that they don’t actually say they aren’t going to do it. But they certainly intimate that. “Move along now, nothing to see here.” Except, since our local MP has received leaked information we now know this was, it certainly appears, completely false. It would seem that at that point, while telling the Health & Wellbeing Board that they weren’t aiming to close local services, they have already decided that was exactly what they wanted to do.
The second paragraph (2) is a bit weasely, don’t you think? “Making resources work for patients” doesn’t sound like it means closing them down. But when you start hearing that people want to take a “broad objective look” and “avoid piecemeal discussion about closure” alarm bells should start to ring.
Particularly shocking is the idea that (3) “it was not entirely clear where leadership of the system resided.” Not because I’m actually surprised about that, only that it’s an outright admission of exactly what I predicted from the outset. Leadership should very clearly originate with the collective Senior People on the Health & Wellbeing Board, or at least with one of them answerable to the others, all working together to get the best outcome for the people of Cambridgeshire. But apparently that’s “not clear.” I guess, hypothetically, if you’ve cocked up a massive contract, lost millions and are looking to close vital services to pay for those mistakes, not being “entirely clear” where Leadership lies is quite useful.
Finally, the meeting apparently reminded “local Councillor members” of the Boards duty to “work together to improve the way the NHS functioned locally.” It’s a shame they felt the need to remind them. The only Wisbech Councillor on the Health & Wellbeing Board is Cllr. Paul Clapp, who was present at the meeting. I would have hoped he might double down on the claim that the Minor Injuries Unit was not going to be closed and get it in the minutes for posterity. It doesn’t appear that he did, sadly. But it’s hard to really blame the guy – after all, you heard what the NHS said: “Closing stuff? Nah. Don’t be ridiculous. That’s counter to the direction of travel.” Or words to that effect.
It is not unreasonable to suggest that we are now subject to the arbitrary decisions of remote, unelected bureaucrats again. The exact situation the new system was supposed to cure. That the new “working towards the services communities need” approach appears to mean closing them down.
That the signing of major contracts can lead to disaster and millions lost, and that this absolute disaster can be spun to sound like (4) a good thing “working together in the course of developing the Older People and Adult Community Services contract with UnitingCare had brought local health partners closer together”. Unbelievable. Essentially: “Our massive multi-million pound disaster has made us work well together.” As team-building exercises go, I’d stick with paintball. And isn’t “making health partners work well together” supposed to be the role of the Health & Wellbeing Board. Isn’t that its entire original remit, in short summary?
If the leaked information is correct that would seem to mean that the senior body covering Health & Wellbeing for our County, the better part of a million people, can now be openly deceived by the NHS with no consequences whatsoever. Except the consequences to the thousands of Fenland people who face the potential closure of their Minor Injuries Units. But it is not too late. The Health & Wellbeing Board can prove themselves as strong as ever. They can do so by making it quite clear, at their next meeting, that there will be no closures. That there will be no change in the “direction of travel.” And that the people of Fenland will not pay the price for the bad contractual management of the CCG or its lack of “clear leadership.”