Future Fit: What a Shambles

Today, 13^th September, Shropshire CCG nodded through the next stage of the ‘Future Fit’ NHS cuts and closures plan. The ‘Pre-Consultation Business Case’ has been approved by the CCGs and will be submitted to NHS England for assurance on Friday. ‘Consultation’ – in a manner of speaking – will probably begin in mid-October and run for 14 weeks.

Last month, the two CCGs – Shropshire and Telford and Wrekin – published an independent review of Future Fit, carried out by KPMG[1]. The review identified ‘three overarching areas for attention’ and added ‘We recommend these are addressed by the programme before moving to public consultation’. Has that been done? No, very conspicuously not.

The first area was money. The independent review called for ‘Clarity around funding availability and affordability’. That certainly isn’t there! Today, one Board member, Dr Finola Lynch, gave her considered views on the financial case for Future Fit. She said ‘I don’t understand it’. CCG Chair, Dr Julian Povey, said ‘I understand the Business Case is affordable to the CCG’ and said that where the money came from would depend on SaTH, the hospital trust. His lack of clarity was echoed by Finance Director Claire Skidmore, who explained that SaTH wouldn’t get full capital funding from the Treasury, the CCG didn’t know how much, and added ‘I can’t comment on what that might be’.

Future Fit is the responsibility of the CCGs. It is a project commissioned by them. What we are now seeing is a shocking abdication of responsibility. On 15^th August, Shropshire CCG Accountable Officer Simon Freeman met with Shropshire Patient Group. The minutes are attached. Simon Freeman explained to the Patient Group that SaTH wanted £311 million for new hospital buildings, that there was a shortfall of £185 million (the gap between what they were set to get from the Treasury and the £311 million they plan to spend), and that SaTH would be looking at private solutions.

Today, member of the public Ron Berry asked the Board ‘Are you confident this kind of borrowing is affordable?’ – and didn’t get anything that resembled a clear answer. After the meeting, he commented ‘It’s extraordinary. Given the level of debt in the NHS at the moment, a lot of it caused by the last round of PFI deals, I can’t believe that health bosses might risk doing this all over again’. Any PFI deal would have first call on NHS finances for the 25 or 30 years of the contract and would drain resources away from frontline care.

The second area identified by the independent review was ‘Clarity around community models to address urgent and planned care needs’. The review stated ‘We recommend that proposals for reconfiguration of community care, and specifically those elements directly impacting on local acute care flows, be rapidly described and costed’. Unsurprisingly, this hasn’t happened either. The Future Fit Business Case claims there will be 8% fewer non-elective (emergency or urgent) admissions, 11% fewer in-patient bed days, and a 50% reduction in ‘Delayed Transfers of Care’ (where patients are stuck in hospital because the right community services aren’t available for them). How can this be achieved? No one knew today. If they can’t get the community services right, then the planned cuts in hospital care will be a disaster. But all we have in the Business Case are brave aspirations about ‘resilient communities’ and ‘developing social action’ – a kind of DIY approach to health and social care.

Jane Asterley-Berry, a member of the public attending the meeting, pointed out a further level of insult. The independent review said this had to be sorted out before public consultation. It’s plainly not sorted out. The answer? Do the consultation just on which A&E gets closed, and don’t ask people about community services at all! Jane told the Board they hadn’t made the progress demanded by the independent review, and added:

‘So how on earth can you justify dealing with that by dropping it from consultation altogether – by having consultation just on emergency care goes here and planned care goes there? You’re only consulting on half the picture. You shouldn’t be consulting on Future Fit until we KNOW what your plans are for community hospitals, and Minor Injuries Units and rural maternity, and where all these mythical improvements are going to come from. You’re preventing the public having a complete overview. That’s not meaningful consultation, is it?’

The third overarching area identified in the independent review was ‘Clarity around governance and conflict resolution’. KPMG meant the two CCGs disagreeing with one another, and they now seem to be united in driving forward Future Fit no matter how big the holes. What they have not sorted out is good governance, and they’ve developed an outstandingly clever approach to avoiding conflict with the public. The CCGs know that they have failed to convince the public that closing an A&E and running down hospital care is a good idea. The solution? They won’t ask us! They will offer the public two options only: Emergency Care at Shrewsbury and Planned Care at Telford, or Emergency Care at Telford and Planned Care at Shrewsbury – with no option to disagree, and tell them we need BOTH our A&Es and BOTH our hospitals.

Gill George, Chair of Shropshire Defend Our NHS, challenged the CCG on this at today’s meeting, and later explained why:

‘Right the way through, from 2013 onwards, they’ve promised one of the options in the consultation would be ‘Option A’, no change or minimal change. That would be about keeping both our A&Es, which is of course what we need to happen. They’ve always promised this would be consulted on. We have minutes of meetings in February this year, last November, last October, and there were repeated commitments before this. If they have confidence that the options they’re putting forward are better than no change, why are they suddenly making a massive U-turn and refusing to consult on no change? They’re too scared to ask the public what we think. There’s no other explanation’.

Gill added:

‘Future Fit is a cuts project. The Business Case spells out that this is about cutting £16.5 million a year from hospital care, and axing up to 371 jobs, but it’s much worse than that in reality. Future Fit is part of the ‘Sustainability and Transformation’ cuts plan, and that’s about slashing NHS spending in Shropshire and Telford and Wrekin by a shocking £135 million a year. I think there are two points here. We need our MPs to start fighting for proper NHS funding for this area. Their silence on this really isn’t good enough now. But a message to health bosses, too. They’re playing games with consultation in the hope that public anger will go away – well, it won’t. People care about our NHS, and the fight to defend it is only just beginning.’ 

[1] KPMG Independent Review of Future Fit. August 2017. Pages 7 and 10 are particularly relevant