Trench Warfare

We had another small but important victory on Monday. We’re winning a lot of the individual skirmishes just now, but it’s overwhelmingly clear that the war goes on.

Tuesday was the Governing Board meeting of Telford and Wrekin CCG. You’ll probably have seen the anger that preceded this. The meeting was not listed on the Meetings page of the CCG website, which meant it was almost impossible for members of the public to know that it was taking place. This was for a meeting that was intended to sign off the Future Fit Strategic Outline Case, the blueprint for closing an A&E and downgrading a hospital (either the Royal Shrewsbury or Telford’s Princess Royal). Senior managers of the CCG will have known how contentious this decision was going to be.

The history

The CCG’s Constitution requires the Board and the organisation as a whole to behave with utmost transparency at all times. Specific responsibilities are placed on the Chair to ensure this. The Constitution also requires that meeting details appear on the CCG website, including details about meeting dates, times and venues. The Constitution has a statutory basis, and is a requirement of the Health and Social Care act 2012. When we found out on Saturday that the meeting was taking place, we raised the strongest possible concerns; we argued that the meeting was unconstitutional; and we called for the meeting to be postponed.

The response from the Chief Officer and Chair of the CCG was a robust one. They said that the meeting had appeared on the website. Up to a point, they were right. Unfortunately, it wasn’t listed on the ‘Governance Board Meetings’ page, where other CCG meetings are publicised. It was much better hidden than that. This time, the meeting agenda was tucked away on the ‘Board Papers’ page. The problem is that you would typically get to that page by clicking on a link from the Board page that is labelled ‘Past agendas can be found here’. You would need to be a very, very persistent member of the public to track down the details of a meeting you had no way of knowing was happening by linking to a page labelled ‘Past agendas’ for a meeting that hadn’t taken place yet… In a constitutional requirement to have meeting details on your website, it is surely implicit that the meeting details are placed somewhere that people might find them. It takes a particular kind of arrogance for NHS leaders to argue that this is a transparent way for public organisations to do business.

On Sunday afternoon, we asked our supporters to email the CCG Chair asking for the meeting to be postponed. One of our supporters is an expert user of twitter, and he also circulated information on a very wide scale about the unconstitutional basis of the meeting. We’re confident that the Chair will have received a large number of requests from members of the public for the meeting to be postponed. We believe this affected the outcome.

The meeting

We argued at the start of the meeting that the meeting was unconstitutional. We quoted the relevant sections of the CCG Constitution. We argued that putting meeting details in an area of the website where no one was likely to discover them did not comply with the constitutional requirement for transparency.

The Chair rejected this, repeatedly interrupted members of the public, told us be quiet, and threatened to remove people from the meeting. It was an abrasive and unnecessarily confrontational approach.

After that, things rather unexpectedly got better. The plan a week before the meeting had been for the A&E closure document to be signed off. We know this. We also know of the considerable pressure that we were able to bring to bear in less than 48 hours, through emails and tweets. We were also talking to lawyers, and we would have explored with them the possibility of overturning a decision made in such a shoddy way. As it happened, this was unnecessary. There was a U-turn from the Chief Officer of the CCG, David Evans. He proposed that the Board should defer any decision, that further work should be done on the ‘Strategic Outline Case’ (that A&E closure blueprint), and that the matter should be brought back to a joint meeting of Telford and Wrekin CCG and Shropshire CCG in the future.

There was very little discussion. One Board member said ‘the status quo is not an option’ – which is one of the few remaining justifications for the collapsing Future Fit project! Another talked about some of the problems, and said that more work was needed before the next set of decisions. In particular, she focused on the Strategic Outline Case being only about hospital services, and not covering the integration of NHS services that is needed (i.e. including community NHS services and GP care). The Chief Officer tried to limit the scope of any future work before the A&E closure plan is signed off, saying that previous delay had led to political and public criticism, and that he thought there was a need for ‘a bit more modelling’ about the viability of acute hospital plans at this stage, and other problems could be dealt with later on. The main part of the meeting was done and dusted in less than half an hour.

Given the situation we were in, this is a victory. We expected the Strategic Outline Case to be signed off, and for Telford and Wrekin CCG’s agreement to be used as ammunition against Shropshire CCG’s reluctance to agree the plans. In the event, the decision was deferred – just as it was deferred on 12^th April, at Telford and Wrekin’s last Board meeting, and on 13^th April by the Governing Body of Shropshire CCG. We’re doing OK.

The big challenges still lie ahead. Our local NHS leaders now know that the modelling work behind Future Fit is catastrophically flawed, and that the plans are based on all sorts of bizarre and invented predictions about people not getting ill anymore and not needing hospital care in the future. They know that having a single A&E would go against national guidance, and would not meet the needs of a widely dispersed and largely rural population. They know that the public is overwhelmingly opposed to what they’re trying to do. Sadly, they won’t accept that there might be an alternative to continuing down this blind alley. This – together with the fight for adequate funding for local healthcare – will be our priorities for the future.