Judy Terry is a marketing professional and a former councillor in Suffolk.
Much has been said about productivity, and the lack of it, in recent weeks.
Don’t blame the private sector, which is pretty effective in delivering value for money; it is the public sector which is sclerotic, bureaucratic, frequently working in silos, wasting public money.
For example, what is the point of Health & Wellbeing Boards? Part of Andrew Lansley’s NHS reforms, which also created the 211 Clinical Commissioning Groups (CCGs) and 148 regional Healthwatch groups (which duplicate much of the consumer champion work done by the Patients Association).
Suffolk’s Health & Wellbeing Board has 21 members, including representatives of local councils, CCGs, Healthwatch, Police and the NHS regional office, but no-one from the hospitals. It meets for half a day six times a year to develop strategies and discuss reports, receiving presentations on new initiatives, but there is no evidence of actually holding any service to account. In fact it appears that Suffolk’s Board is questioning its own role, with a recent report stating “action to be taken on how to make time spent in Board meetings more efficient and effective”.
Although Mental Health features in a range of Suffolk initiatives (each programme with a different title: Mental Health Manifesto, Time to Change pilot, Integrated Work & Health pilot, to name just three), neither Suffolk’s nor Norfolk’s Boards appear to have formally discussed the Care Quality Commission’s latest report into their local mental health services.
I became increasingly disturbed as I read it, remembering a young neighbour who took his life whilst a resident in the Trust’s care some years ago; his parents were rebuffed when they requested an investigation, as was I when I took up their case, and it is apparent that others have suffered similar insensitivity.
Despite praise for staff’s caring culture, the Norfolk & Suffolk NHS Foundation Trust is officially the worst in England, and the only Trust to be put into special measures twice. Following CQC (Care Quality Commission) inspections in 2014 and 2016 the latest report was published in October 2017 and is excruciating in its condemnation.
It notes that services are inadequate, and inadequately led; the Board ‘failed to address all the previous concerns reported to them since rated inadequate in 2014’ and identified “breaches of regulations that had not been resolved”.
The Trust was ‘not safe, effective or responsive in all services, and leadership did not demonstrate a safety narrative running through the organisation’; training was inadequate. Local MP, Norman Lamb, noted “it’s disturbing that ligature points were not addressed as it was raised before”. (1,004 were identified for work.)
Between 1st April 2016 and 31 March 2017, Trust data showed 242 incidents requiring further investigation, including 184 ‘unexplained or avoidable deaths’. A further 27 deaths occurred between 1st April 2017 and 31st May 2017, and were reported to the CQC during their latest inspection; these are being investigated.
The Chief Executive, who oversaw this disastrous outcome, took early retirement shortly before the report’s official publication in October, replaced by the Deputy CEO/Finance Director. The Trust continues to pay two other directors who also resigned and will be “working their contracted six months notice periods in the wider NHS”.
The Chairman, who took up his appointment in 2013, after a year as a Non-Exec director, remains in place, alongside other Non-Execs, and three new recruits to the Board. The Council of Governors, whose role is to ‘hold the Non-Exec Board to account, and help the Trust decide its future direction’ appears unchanged. There is no mention of their remuneration on the website.
Belatedly acting on the CQC’s recommendations, a Transformation Team now meets weekly, holding monthly meetings with NHS Improvement. It admits to significant challenges, with the scale of change equating to 400 actions. East London NHS Foundation Trust is a ‘buddy’, conducting comprehensive reviews of governance and management, to support improvement priorities.
So, I go back to my original question: What is the purpose of Health & Wellbeing Boards if they don’t challenge service providers? Board members in Norfolk and Suffolk were evidently unaware of the ‘unexplained or avoidable deaths’, although campaigners’ concerns received extensive local media coverage in recent years.
As elected representatives, senior Councillors should have been on the Trust Board monitoring progress after the original 2014 CQC report, making regular reports to both Health & Wellbeing Boards and both Full Councils, with campaigners invited to share their concerns, providing assurance to the public that the key issues were being addressed.
It would also have been helpful to convene a joint emergency meeting to review the latest CQC report, agreeing a strategic plan for supporting the Trust and monitoring its progress towards compliance with the latest recommendations.
Also presumably in ignorance of how poorly the Trust was managed, what is the purpose of the Clinical Commissioning Groups (3 in Suffolk), which seem to spend their time controlling local budgets and rationing services? Councillors are not on their boards; they cost millions of pounds, with expensive offices and employing thousands of people.
Predictably, immediately after the Budget, the NHS was pleading poverty, yet it had never even noticed that the cost of a drug rose from £4.50 to a staggering £250 in the space of just a few years, adding billions to the NHS drug bill! So, surely it’s time to rationalise all the tiers of NHS bureaucracy, including Healthwatch, saving billions and focusing accountability. Ask anyone serving their communities in hospitals, dental and GP practices (apart from those GPs paid an extra fee to chair – at £60,000 a year for Ipswich & East Suffolk – or sit on a CCG board); they would welcome the abolition of CCGs, which simply interfere and add to their paperwork. They also have oversight of the Ambulance Service – why, when it is an emergency service?
It’s a fact that short lines of communication lead to greater efficiency, accountability and higher wages – productivity increases and those delivering services are happier, less stressed and more confident because they are making the decisions, instead of someone with a clipboard.
Give the money directly to those delivering frontline services, allowing medical professionals to do what they spend decades training to do – save and improve lives, which is what the taxpayer actually wants. Redirecting funding could even restore what used to be called ‘convalescent homes’, to prevent bed blocking…
Perhaps someone should tell Jeremy Hunt.