Scrutiny Committee June 8th - My Report (also covers Foundation Status, the PCT budgets and Hospital plans)

Notes and Observations on the
Hertfordshire County Council
Health Scrutiny Committee Meeting
held at County Hall
8th June 2006

Agenda Papers – on line at
http://www.hertsdirect.org/portal/eDemocracy/Civic%20Calendar/HCC/archive/Health%20Scrutiny%20Committee_5

HPT – Letter to the Secretary of State.

Letter to Secretary of State: (and related documents) http://www.hertsdirect.org/havesay/scrutiny/scrutinycomm/scrutcomm/healthscrutiny/

This relates to the decision at the last meeting of the committee to refer a number of proposed cuts in the mental health services provided by the Hertfordshire Partnership Trust to the Secretary of State.

It was the first time such a letter had been sent by the County and because of the need to check the text with the county's legal advisers, etc. there was some delay in sending it off. Confirmation of its receipt has been received. The service changes objected to in the letter cannot (in theory at least, see below) be made.

It is far from clear how long it will take to resolve the issue – and it is worth noting that a similar objection to changes affecting mental health services in Cambridgeshire was referred to the Secretary of State in March and has still not been resolved.

HPT – Application for Foundation Status
Links: See Agenda Papers

Because the change is purely a management change that does not directly affect services the Scrutiny Committee is not directly involved – but is kept informed – and was asked for its opinion relating to the Governance arrangements. The aim is to have a membership of some 5-10,000 who will elect a Board of Governors who would influence stratecy and appoint the Chair and non-executive directors, The Board of Governors would consist of 19 public, 5 staff, and 13 representative of relevant organisations.

Because of the arrangements with adult care services some of the later positions would need to represent the County Council.

Timetable: Consultation starts for full period starting 5 July – result to Secretary of State on 3 November

All trusts are required to move to Foundation status so the key question is “When” rather than “whether”. The following seem to be the key issues:

➢ One of the problems is the definition of the boundary between the primary and secondary care trusts.
➢ Would it not be better to leave this matter until the new PCT arrangements had had a chance to settle in.
➢ While funding would be on three year contracts, giving more stability – it might be disadvantageous to sign up the contracts at a time of significant financial problems.

HPT – Closure of St Julian's Ward

Bill Macintyre, CEO of HPT, informed the Scrutiny Committee that St Julian's Ward had been closed on safety grounds, although it could be re-opened if money became available. He reported that even with St Julian's being closed there were currently 10 empty acute beds in Hertfordshire. This was anticipating the cuts which were technically “on hold” and he was given a stiff questioning about it.

The Scrutiny Committee missed the real significance of this. The nature on mental illness id that it is inadvisable to start a treatment and then, perhaps only a week or two later, withdraw it on financial grounds. Change has to be phased in gradually and if the Scrutiny Committee had not taken the action they did on 17th May most of the changes would have been completed in June. The decision was taken some time back to stop new admissions so that patients' treatments would not be disrupted by the closure – and in addition staff had been transferring elsewhere. The greatly reduced numbers of both patients and staff raised important safety issues ...

By concentrating on “the building” issue, the key question was not asked. This would have asked about the possible run-down in the other services in anticipation of the cuts. For instance are GPs referring less patients to the CMHT, and are the 10 empty beds (plus those from St Julian's) empty because new tougher acute bed admission standards are already being applied.

SHA – Financial Recovery
Links: See Agenda Papers

The SHA was asked if the 2006/7 figures were any more reliable than those which were so disastrously wrong in their predictions for 2005/6. I thin it would be fair to say the Scrutiny Committee was not convinced.

I suspect that there are many people in the SHA and the PCTs who are also not convinced that the changes will actually succeed in balancing the books and the much of the exercise is to make the budgets look “acceptable” to the Secretary of State – and the SHA and the PCTs will not longer be here when the silliness of some of the predictions, and increased levels of ill-health in the community, becomes apparent.

PCTs – Arrangements from October

While it has been agreed that there will be two PCTs for Hertfordshire the plan is for them to share a management team under Anne Walker who is currently heading up the “new” management team in Bedfordshire Heartlands PCT which had major financial problems.

PCTs – Recovery Plans
Links: See Agenda Papers

Eight recovery plans were presented in four groups of two. In general each plan (but see next section) was a long list of “efficiency savings” worded in such a way that it was impossible to really know how the changes might affect patient services. Several councillors queried whether they were really efficiency savings, in a way that implied that if they really where there must serious management shortcomings. (One councillor referred to “launching the lifeboat after the ship had sunk.”) In some cases there were large “savings” which had not yet been identified.
Adult Care Services made it clear that the proposals said nothing about the implicalions of the changes. It was far from clear that there were enough resources to cope with the existing demand – even before the proposed cuts begin to bite.

I was very disappointed that the Scrutiny Committee was not more questioning on these plans – although it would be impossible to have gone through them in details – especially as the documents were late in being made available – so it was not really possible to make comparisons between PCTs. From the point of view of mental health this could be an advantage. If all the PCTs need to do is make “efficiency savings” and the cuts on mental health cut hard into real services one can reasonable claim that the cuts on mental health are unduly savage.

When there are 8 PCTs, each with a separate deficit, working in pairs, and which will, in October be working as two boards but one management team it seems rather silly to have eight different plans when the first thing the new PCT(s) will want to do is to get some kind of unified policy in their area.

PCTs – Consultations

Two particular items were separated out for consultation. These relate to the closure of the Intermediate Care Beds at Harpenden Memorial Hospital and changes at the Elms Clinic, Potters Bar. It was agreed that 30 day consultations would be adequate.

West Herts Hospital – Consultation
Links: See Agenda Papers

The document presented to the Scrutiny Committee had three options, two of which appeared comparable, and the other much weaker. The Scrutiny Committee pointed out that there was little point in including a non-viable option and suggested that the only option which would have kept Hemel Hempstead Hospital open should be dropped.

There will be a pre-consultation event on 22nd June, the consultation will start on 10th July for three months . There will be an overall loss of 120 beds. It was stated that the medical staff committee fully supported the proposals.

David Law (CEO) admitted if financial balance was not achieved this could put at risk a new hospital on the Watford site. We could end up with no Hospital at Hemel, an overcrowded hospital in ageing and temporary buildings at Watford (with more patients and less parking?). My own view is that we can thank those who campaigned to stop us having a new hospital at Langleybury some 10 years ago for the current mess.

Could this help the Dacorum Mental Health mess – if the plans go ahead the Watford Hospital will want to get rid of the mental health wards A.S.A.P. And there could be space available on the Hemel Hospital site. ....

North & East Herts Hospital – Consultation
Links: See Agenda Papers

This was keeping the Scrutiny Committee advised on progress to a consultation to be held later.

Chris Reynolds
14 June 2006