On Wednesday 10th August, the Governing Board of Shropshire Clinical Commissioning Group (CCG) took some shocking decisions. They nodded through NHS cuts that will harm frail elderly people, people with mental health problems, people with profound disabilities, and children with cerebral palsy. They didn’t say ‘cuts’, of course. They’re just ‘realising the potential for disinvestment’.
The planned cuts for this year include axing a voluntary worker who worked on integrating services from health, social care and the voluntary sector; closing a crisis house in Ludlow for people with mental health problems; withdrawing funding from the handful of children with cerebral palsy who have intensive therapy at the Movement Centre in Oswestry (a recognised centre of excellence); closing Enable, a high quality specialist service helping people with mental health problems remain in employment; closing beds in a Much Wenlock care home that have been used to avoid hospital admissions; ending a service that provides proactive care to frail elderly people in care homes who are most at risk of hospital admission; ending a lifestyle physiotherapy service that has run for 8 years, is cost effective and well-used; stopping a Home from Hospital service that provides very practical help and personal care for patients following hospital discharge or requiring support to avoid hospital admission; ending a Moving and Handling service that provides support to the carers of older people with dementia or mobility problems; probably ending most pain management services in Shropshire and hoping that GPs will absorb the work; and ending a specialist service at Oak House that provides health assessment and intervention for adults who have profound intellectual and physical disabilities and sensory impairments.
There are also plans to privatise START, a service that provides a short term period of intensive assessment and support to people in their own home thus avoiding residential care. Several other services associated with the flagship Integrated Community Services (ICS) will end. GP-based counselling services will probably end, although the decision on this has been passed to another committee.
All of these services will now be hastily considered by ‘Task and Finish Groups’, and the CCG wants to bring proposals back for ratification in September if it can. The policy approved by the CCG on Wednesday – a policy being implemented before it was agreed – states that decisions on whether or not there is a need for formal consultation can be made through an informal discussion with the Chair of the Council’s Health Overview and Scrutiny Committee (Councillor Gerald Dakin). Any other ‘engagement’ is deemed non-statutory and a matter for the CCG to determine. They could of course find themselves subject to legal challenge on a failure to consult.
Likely targets for cuts or privatisation next year include community rehabilitation for people who have had a stroke or who have other neurological conditions; the RAID mental health crisis service; and the Bridgnorth and Oswestry provision of DAART, offering multidisciplinary assessment, diagnostic tests and clinical treatments to keep patients out of hospital where possible, with care provided in the community.
The cuts proposed by the CCG are completely at odds with their stated priorities of shifting care out of hospital and providing ‘care closer to home’ instead. This is crude firefighting, in response to a financial crisis caused by underfunding of our local NHS. Another national priority for the NHS is meant to be that mental health has parity of esteem with physical health – and that’s certainly not happening in Shropshire, given the level of cuts here to mental health provision.
There was almost no discussion in the Board meeting. There was no discussion of the individual services set to be axed, no discussion of the clinical consequences, and no discussion of the impact on the vulnerable people who rely on those services. The GP members on the Board mostly sat in depressed silence, while senior bureaucrats, few of them with a clinical background, drove forward the cuts agenda. They talked about their deficit – and they forgot about the human beings who will be harmed by their cuts. A representative of NHS England now attends meetings, because the CCG is one of two in the country under ‘intensive intervention’ because of the scale of its financial deficit. The intensive intervention on Wednesday consisted of telling the Board ‘You have difficult decisions to make over the next few weeks’, and ‘You have got to increase the pace at which you stop spending money’.
The Board members muttered and mumbled their way through the meeting, inaudible much of the time for a meeting that they are required to hold in public. You would think that with 25 or 30 members of the public there, Board members might have had the courtesy to speak up. Sadly not. Repeated reminders from members of the public that we couldn’t hear were simply ignored. Several members of the public walked out in disgust, seeing little point in remaining. The only possible conclusion is that most Board members didn’t want to be heard.
It’s not possible to know the names of many of those who voted for the cuts, or what their job roles are meant to be. The Shropshire CCG website is hopelessly out of date on Board membership, the Chair is inaudible when he calls people to speak, and Board members don’t bother to introduce themselves (and wouldn’t be audible even if they did). One member of the public had hoped to at least ask for the website to be updated – but questions from the public were arbitrarily disallowed at the end of the meeting to anyone who had raised earlier concerns on cuts. The grotesque lack of transparency will presumably continue.
The contempt for members of the public was matched only by the contempt for organisations providing the services that will be cut. Astonishingly, there was no advance discussion of cuts with most of these organisations – including Shropshire Community Trust, Shropshire Council, Age UK, and the Movement Centre based at Robert Jones and Agnes Hunt Hospital. A few had phone calls the day before the meeting. Others found out from Shropshire Defend Our NHS. We’re glad we were able to let them know – but why on earth was the CCG incapable of showing this basic level of decency? The manager of a threatened GP counselling service attended the meeting. When she spoke as an advocate for her service, her views were dismissed – and she was accused of using ‘emotive language’.
Several organisations, tipped off by us that cuts were on the way, had written to the CCG explaining the impact of proposed cuts on the patients they serve. They asked for the letters to be circulated to Board members, giving them at least some way of being heard. The decision from the Chair? The letters were withheld from the meeting, and will be circulated only with the minutes.
The CCG was already trying to cut services by £12.6m this year. They now want to add an extra £3.6m cuts, and Wednesday’s slash-and-burn exercise amounts to only a small part of this. No NHS service in Shropshire is safe. The problem is one of funding. The NHS is half way through a decade of the most severe austerity in its existence, receiving far, far less in core funding than it needs. Shropshire faces a triple whammy: our share of national cuts, the discrimination against rural areas that’s built into national funding policy, and the underfunding of areas with an older population. There isn’t enough money coming into Shropshire’s NHS – and that’s why we are now facing devastating cuts.
Whatever the reasons, we can’t allow the most vulnerable members of our community to lose essential services.
Here are three things to do, if you live in Shropshire:
- Email Councillor Gerald Dakin, Chair of the Health and Adult Social Care Committee of Shropshire Council. Ask him to insist on full public consultation on these cuts, rather than letting them go forward unchallenged. His email is: firstname.lastname@example.org
- Email your MP. Point out the impact that these cuts will have on service users. Ask him to insist on proper public consultation – and to take up the catastrophic underfunding of Shropshire’s NHS. You might want to contact your councillor as well. You can find and contact MPs and councillors through the WriteToThem website: writetothem.com
- Think about coming along to the next meeting of Shropshire CCG so that these people know that their actions are under scrutiny. We’ll publicise what’s happening in advance. We’re expecting the next meeting to be on the 14th September at the Royal Shrewsbury Hospital; we don’t have a time yet.