Friday 12 May - I feel whacked ....

4pm: Woke far too early - tried unsuccessfully to get back to sleep - so started drafting report of yesterday's JCPB meeting. By 11.30 I was stuck half way up a gum tree and walked the dog down the town for lunch. Combination of a good meal, the heat, the hill and general tiredness meant I stopped off at every public seat for a breather on the way back.

On my return I took one look at what I had done and junked it - and have started again - but don't expect it to appear here until tomorrow. However it will include my initial comments (on earlier blog) as an appendix, and look at the overall conduct of the meeting - and a number of specific topics.

One topic it will look at is the use of the "Quality and Outcomes Framework" (QOF) on page 30 of the response document. We were told QOF will solve the problem of getting the GPs to provide for patients when HPT services are shut down. But the QOF specifically relates to the GPs having the choice as to whether provide the extra service themselves (for which they get paid) or to get the service elsewhere. As they are now so well paid they may not want to take on extra work - particularly of the more time consuming mental health patients. But the "service elsewhere" is being withdrawn - so either the GPs are conscripted into QOF whether they want to or not - or the patients don't get treated.

I have also used my current period of being awake to dabble in a few emails. Now off to sit in the garden with the newspaper - and probably fall asleep.

And as an afterthought - I gather there could be some relevant information on finances at the SHA Board Meeting on Tuesday.

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Off to bed - having recently sent an email to "the list" commenting on Heather's email , which contained the following view of the situation:

Further to what Heather says I have a number of observations.

On her last point I am glad I have not got a vote - apart from anything else I am the only person who is entitled to sit on both the JCPB and the Scrutiny Committee because I don't have a vote. If I had a vote there would be a conflict of interest and it is very useful to have someone on the Scrutiny Committee (apart from NHS employees who are there to give evidence) who actually knows what was said at JCPB. For instance neither David Lloyd, Ken Coleman or Bob Mays will be able to speak at the Scrutiny Committee.

I think it is important to realise that there were implied options in the current consultation. It would be foolish to proceed with a "cut" if it is shown to be inappropriate because the risks to patient safety are too high, or because it was not cost effective. The consultation specifically asked to be notified of any risks associated with each cut. This is what happened in the case of Seward Lodge.

I am sure that there are two areas which will be of particular interest to the Scrutiny Committee.

One relates to the Response Document itself. This document is fatally flawed (see earlier blog) because it asks for comments on risk assessment, includes no risk assessment of the findings, and most importantly ignores all statements of possible risk made by organisations (many with very good specialist knowledge of what is going on) which made written recommendations. There is almost no honourable way that the scrutiny committee could say that the "response document" represents a properly conducted consultation.

The 5% cut issue is, in one sense completely different. The evidence given by Bob Mays at the JCPB comes from an agenda paper for the SHA relating to the current Recovery position. I have not downloaded it yet but I gather it show that the Herts Health Economy has been given a large "Control Total" (i.e. overdraft) and HPT is the only Trust not to benefit. This will be considered by the SHA Board on the 16th. I also hear that there may be a last minute AOB item "of interest". (One must remember that Professor Louis Appleby is concerned - and maybe he has found a way to pull strings.) It is not impossible that the cuts will be cancelled by the SHA on the 16th - so there will be nothing for the Scrutiny Committee to discuss on the 17th!

However, if the consultation is still on the agenda, the Scrutiny Committee will have a lot to say, especially because of the way that their request to meet the Secretary of State over the state of the Hertfordshire Health economy has been repeatedly stubbed - they would love the opportunity to formally refer a matter to her so she could not refuse taking action.