Thursday, October 26, 2017

The Impecunious Council scrutnises the Peniless CCG about its plans






Went to Weston Town Hall (above) today to observe a 2-hour meeting between North Somerset Council's Heath Overview and Scrutiny Panel (NSC HOSP) and the North Somerset Clinical Commissioning Group (NS CCG).

It was all about the NSCCG's 115 page paper called Healthy Weston which is here.

Mercifully, it is summarised here: 

"Healthy Weston" is part of Sustainability and Tansformation Plan, but would have been needed to have been written anyway because of the change in the circumstances of NSCCG, because Weston is going to have to team up with United Bristol Hospitals. Again. The document is "the new vision of NSCCG to improve the health of  Weston and the surrounding villages".

The main tangible idea is to have a Health Campus and Primary Care Led Community Hub on the grounds of Weston Hospital. There is no new money for this, so the rest of the service is going to have to shrink. It might (or might not) be in existence by March/April 2018.

Forgive me for sounding jaded, but I have heard this kind of planning over and over again in the thirty eight years I have been involved in this area.


When I arrived, the Clinical Director, Dr Malcolm, said "Weston is the damp corner of the forest that nobody will spend money on". The only thing that has changed is that his 15 words have been replaced by hundreds of thousands of words from scores of highly placed managers who have replaced the good, but sad Dr Malcolm. His replacements are not sad: they are full of bounce and total acceptance of the situation, because their job depends on not saying a word against the situation that they find themselves in.


The two hours consisted of the Councillors on the panel asking vague questions, and the NHS officers giving even vaguer answers.


This in a nutshell is what they talked about:

integrationmodelscommunicationcategorydocumentpopulationbalancingactbenefit
forpatientscareplansafeandeffectiveserviceselderlyunderstandwhatisgoingonpatientjourney
freeupcomplexcurrentpathwaymaximiseassetsdelivercarecampusdrugbill.careinthecommunity

These are the same words that I have heard plopped out time and again in health planning meetings over the past four decades. Not necessarily in the same order, but the meaning is the same. "There is no more money. You are just going to do the same you have always done, but with less money".


Hereare the two words were not used: Deckchairs. Titanic.

Cllr Tom Leimdorfer, (Green Party) was the only one to mention  underfunding. The NS budget, he said,  is going to have to drop from £284m to £269m. We expect to be funded less per capita than Germany etc, but why, he asked do we have to be funded 20% less per capita than Ireland? And what, he said, can the Council do to empower the CCG to bring about change?
I took careful notes of the answer from the CCG. This is what I got: "Perverse incentives...contracts...alter the care package".

I did not notice any questions about the A&E closure, but that may have taken place in the 20 minutes I had to take out to buy a new parking ticket for my car.


They did touch on the bed-blocking problem. The answer for this is of course, for the Council to improve Social Care, and designate or build a few convalescent homes (as they used to be called. God know what they are called today, or how many management hours went into deciding what to call them). NSC cannot do this, because it has no money. The Care Campus is going to do it because it is going to Suck the patients out of hospital, which is much better because they used to be Pushed out of hospital. Sucking is better than Pushing.


Clevedon Hospital has been lost. What, asked Tom, about the excellent physio services that have been lost with it?

Care in the community is the answer to that. The physio will come to your door. Nobody asked who will help to get her couch and kit in the door, or how much of her time will be spent in travel. No. Care in the Community are Good Words. Don't sup with the Devil who lives in The Detail.


And so it went on. Anecdotes were shared. Questions were put, answers were given. One Tory councillor whose first name was Ann, opined, in passing, that "the NHS was not fit for purpose".


So there we have it. A terminally underfunded Health Service taking  questions from a terminally underfunded local Council.


The pauper talking to the penniless about their plans to rearrange their cardboard boxes into a nice semi-detatched house.



3 comments:

Anonymous said...

I work at one of the institutions mentioned . I could not have put it better myself

Anonymous said...

Our MP's hands are now tied as his wife is now the chair of NHSi, so who is going to speak up for us?
By downgrading Weston, it makes a small hospital even less sustainable and for many of us, getting to Bristol is difficult and expensive....what we are getting is a second class solution....and no one is challenging....we are all just numbers in the CCG's experiment as they promote their careers.

Richard Lawson said...

Thanks, Anon! I worried that I was being unnecessarily nihilistic, so it is reassuring to get confirmation from someone inside the system.

There is a balance to be struck between the shorter travel time of the smaller hospital, and the more specialised treatment available in bigger units, but ambulance personnel are able to make that decision. All they want is enough resources so they are not rushed all the time. So it is all down to resources, as I will show in my speech at the Save Weston's A&E rally at 12:00 hr Saturday 4th November at the Italian Gardens, WsM. https://www.facebook.com/events/133221923981180/