This evening I attended a board meeting of Cambridgeshire NHS PCT followed by their AGM. The event was held at the South Fens Business Centre in Chatteris. I used the opportunity available for members of the public to speak to at the board meeting to make three points:
1. Openness and Transparency
I reminded the board that I had attended their previous meeting to comment on the specification for out of hours services in Cambridgeshire. As well as commenting on the document itsself I noted that the document had not been published online in advance of the meeting along with the other papers for the meeting. The board’s highly paid professional chair curtly responded that all board papers are published online. Immediately after the Cambridge board meeting I pulled up the trust’s webpage on my laptop and demonstrated to the board’s secretary that the specification was not present. She then, when confronted with the evidence, admitted she was aware of this as she had been contacted by others in the days running up to the meeting pointing out the omission. Having told the board this, I went on to point out that things had not improved, with none of the papers for the AGM (other than a “Programme”) having been published online in advance of that evening’s meeting. I said that said the PCT board wasn’t even getting the most basic elements of operating openly and transparently right. I suggested that the board had got their priorities wrong by producing a glossy booklet containing their annual report and accounts for distribution at the AGM, but not getting a PDF copy published on their website in advance of the meeting.
The board’s chair, Maureen Donnelly, replied briefly to say: “The board is committed to openness and transparency but no system is perfect.”
2. Consultation on Out of Hours Services
The PCT is about to undertake a mammoth and very expensive consultation exercise involving writing to every home in the county asking for their opinions on Out of Hours Service provision. Personally I think writing to everyone about this is overkill. The board meeting approved a draft of the consultation which had been put to them without amending it or commenting on it at all. I raised two points:
- The consultation approved by the board included the question asking which, if any, body the response was on behalf of in the confidential section which the PCT was promising not to disclose. I said I thought that was wrong, and it ought be possible to see which responses came from which organisations. (Not all organisations consulted are subject to the Freedom of Information Act, and in any case I think think the PCT ought to be able to identify publicly what MPs, Patients Groups, GPs and others have said).
- The consultation contains no clear question asking those responding if they think having local GPs being involved in providing the service is desirable or not. Given that was the key area of discussion at the previous board meeting which approved the specification I expressed my surprise at this.
The board’s chair Maureen Donnelly replied briefly to say that the PCT’s staff had heard my comments.
3. Ambulance Service in Cambridge
I asked about the relationship between Cambridgeshire NHS PCT and the East of England Ambulance Service NHS Trust. I told the board that I had found it difficult to determine from publicly available information which was the organisation to which concerns about the service should be addressed. I noted that it had been reported that in relation to the case in Cambridge where an ambulance took 20 minutes to reach a man who had died following serious head injuries he received while being assaulted near Hills Road in August; Cambridge’s MP was approaching the Ambulance trust and County Councillor Geoff Heathcock, Liberal Democrat spokesman for health was calling on the PCT to mount a review of Ambulance cover in Cambridge. (Neither the Board meeting or AGM considered any such review and Mr Heathcock was not present to call for it in person). The board’s chair told me that as the PCT commissioned the service it was they were the right body to approach with respect to concerns. Having had that confirmed I asked permission to briefly list three aspects of the Ambulance service in Cambridge which concern me:
- The level of resources providing a service to Cambridge, as shown to be lacking, for example, in the specific case mentioned.
- Using trainees to staff ambulances. In July an ambulance service manager speaking to the Cambridge-News said the practice was driven by a need to meet “ridiculous” Government-set targets on response times. He claimed the decision had been taken against “every single clinician’s advice and every level of management” saying : “The students are not suitable for road work. It puts the people working with them at risk.” In the resulting newspaper article the trust said it was the first time it had used student paramedics in such a way.
- I expressed a personal concern, not specific to Cambridge, that first responders are being used to meet government targets for 999 response times. (My view is that such volunteers ought be over and above, not in place of, the ambulance service).
A member of the public spoke to comment on what I had said. He introduced himself as a member of of “Cambridgeshire ACRE” which I have since learnt stands for Action with Communities in Rural England, and was appointed by Cambridgeshire County Council to deliver the “LINk Host role” for Cambridgeshire – they conduct lay inspections of Health and Social Care services in the area. He told he board that relative to the rest of the county response times were good in Cambridge, saying that if there was a problem even in Cambridge, the situation was much worse in the rural areas of the county.
The board’s chair responded to say that one of the priorities of the board is to “equalise the provision of services across the PCT area”. That could be taken to imply they are prepared to make the situation in Cambridge even worse to bring it more into line with the outlying areas.
During the presentation of the Chief Executive’s report to the AGM the first bullet point on a powerpoint slide entitled: “Priorities to improve” read: “Access to emergency care (ambulance response times)”. The Chief Executive also explained that the way the ambulance service is bought was complicated; Cambridgeshire NHS PCT doesn’t buy the service direct from the East of England Ambulance Service NHS Trust but via Bedfordshire NHS Trust. He said a year ago the service was poor, but it is now improving.
Other key points from the meetings
- The board had been meeting in secret for the whole day before the public sessions began at 17.00; This meant most board members had nothing to say in the public session.
- 15 “Members of the Public” were present at 17.00 rising to nearer 30 by 18.30; many were there in some sort of professional capacity or official role eg. there was a councillor, a GP, a County Council officer etc.; one member of the public said he was there to support his wife – a board member.
- The PCT take public questions after the “formal part” of the meeting is over. This means members of the public speak after decisions are taken; this leaves those who have attended to comment on an agenda item feeling frustrated that their contributions are futile. At this meeting one member of the public who wanted to speak prior to an item being considered, but who was not allowed to, decided not to speak at all.
- NHS PCT Chief Executive Mr Banks is paid over £150K annually and has had a pay rise this year. His pension pot is worth around £400K.
- On the out of hours care consultation PCT officers have offered to come out to speak to organisations – basically any meetings of interested people eg. Parish Councils, etc. Stephen Heard, Director of Contracts & Performance at NHS Cambridgeshire said that legal advice had been sought on the legality of running the consultation after the specification had been published and tenders sought. He said he was confident that running the consultation in parallel with the contracting process is legal. (It might be legal but it doesn’t really give those responding much chance of significantly influencing anything. I wonder why so many public bodies consult the public after the fact. )
- A report on Pandemic Flu preparedness by the PCT’s “Flu Director” Frank Hume was presented. He said that following a Health Protection Agency resilience exercise called “Peak Practice”, on 15 September 2009, problems meeting the regional requirement to triple Intensive Care Unit capacity had been identified and Addenbrookes had since purchased “technical equipment” to enable them to provide more ICU beds. Mr Hume also reported processes for joint working between Papworth and Addenbrookes had been put into place.
- Ex Police Chief and Non-Executive Board member Robert Kynnersley asked made one of the very few comments by the non-exec board members of the evening. He asked if staff who had been drawn into the H1N1 flu response had yet got back to their day jobs. The answer was that the director of public health was now able to focus on some other work, but that the Flu Director was still “100% flu”
- It was reported that procedures for separately distributing antivirals to the student population were being drawn up.
- Peter Southwick asked if it was now clear who would be offered any flu vaccine first. Mr Hume said the Department of Health had been very clear on that point and had clearly defined NHS frontline staff.
- The Chief Executive said that what the PCT did was not introduce a market, or commercialisation into healthcare but ran on an “Any willing provider” basis.
- Chlamydia screening was mentioned as an area where the PCT was not meeting targets. It was reported that they are getting into Barracks, Universities and Pubs board members joked that even a Chief Executive of a Trust had been collared for screening.
- MMR update was 81.8% compared to an 87% target, and it was reported the target is rising to 97% next year.
- The PCT’s spending amounts to £1,229 per person per year.
- A public questioner asked about the future outlook given a potential change of government. The officers responded by saying: “They country has never borrowed so much”, and went on to say that the NHS had received massive increases in funding in recent years. They gave their opinion that: “as the comprehensive spending review has one more year to go, there will be one more year of growth in 2010-11″. After that they said three possible options had been forcast by the think tank “The Kings Fund” – Tepid, Cool and Arctic – he didn’t explain these though a googling translates them into tepid = low growth, cold = no growth and arctic = real reductions.
- The Chief Executive spoke of opportunities arising from funding cuts. He pointed out that if you get the treatment right the first time its often a lot cheaper than making mistakes; so good quality service can cost less than poor quality. He reported that clinicians are quite bullish about the opportunities they’ve got to save money if they’re given a free hand.
- A member of the public asked if the PCT was going to pool mental health provision with neighbouring trusts – and was given a clear answer of “No” by the chair.
- A further member of the public drew a comparison between the NHS and the private sector. He said a company in Huntington had given all its staff a 6% pay cut to enable the company to keep running. He pointed out that the NHS spends most of its money on staff, and can’t take that kind of action; based on that he questioned where savings were going to come from. He said that suggestions for savings he’d heard about so far – such as clubbing together with other trusts to buy toilet rolls in bulk – weren’t going to amount to much. The Chief Executive responded saying that NHS staff were on “unusual” national pay agreements, and at the moment the PCT has no control over the wage bill. The questioner asked if job cuts would be needed, the Chief Executive responded to say the PCT “might deploy staff differently”.
- Victor Lucas , an ex-navy officer who is Chair of Cambridgeshire Community Services Board pointed out that the PCT worked in lots of collaborative partnerships and that it was the array of partners which would be likely to suffer in terms of funding. He said the PCT’s challenge would be to make the best use of others’ limited resources. There appeared to be agreement on this point; later a county council officer said he expected the county council to have 1/3 less spending power in five years compared with what it now has. The general view of the board appeared to be was that the actual cash amount spent on the NHS itself was likely, due to political pressure, to remain at worst the same.
- The meeting concluded with an amazing presentation by a nurse who works in a GP surgery in the village of Manea. She reported on a “Healthy Village Project” she had run. The local GP had accumulated a surplus of more than £30K, of which £8K was returned to the practice which used it to try and improve the public health of the village by doing lots of social activities. One of the most successful was a “walk and talk” where elderly people were collected by car and taken to a hall where they had tea and cake, then walked around the hall for exercise, before sitting down and doing exercise in chairs. This was an idea imported from Gretna where the pavements are hilly and icy so this scheme was created to allow the elderly to exercise and socialise indoors. Other schemes involved all age groups, including pole dancing in the fire station, dog grooming, allotments, aerobics etc. The nurse running the project said she had had no help evaluating the projects success from the public health practitioners. The PCT’s director of public health said she wasn’t aware help had been requested. The county council officer said that projects like these were a possible way of getting a huge amount of value for money, and perhaps the council ought stop doing high cost projects and fund more things like this. One worrying and unpleasant statement the project’s organiser, Belinda Carson, made was that as she was organising all these events whenever anyone new arrived in the village the first question they were getting asked was “Have you got your CRB check and insurance”; making sure they were OK before they were invited to get involved in village life. This is crazy, requiring a government check before being allowed to participate in village life shows how silly this country’s attitude to risk has become.
- The process is underway to make Cambridgeshire Community Services into an NHS Trust in its own right, it is currently part of NHS Cambridgeshire.