The latest updates on the Derbyshire Clinical Commissioning Group’s Financial Recovery Plan.
Health Scrutiny Papers March 2019
Derbyshire County Council Health Scrutiny invited the Derbyshire CCGs to provide information about the financial plans for health services for 2019/20
This information, which sets out the current progress with their financial planning for 2019/20 and beyond, will be presented to the Health Scrutiny Committee on Monday the 11th of March 2019.
Proposed Cuts to Voluntary Sector Approved
The below table sets out proposed cuts to discretionary grants received by the voluntary sector in Derbyshire as recommended by the Derbyshire Clinical Commissioning Group Governing Bodies. These cuts were approved at the December Board Meeting of the four Derbyshire CCG’s on 13/12/2018.
For more information, including cuts to the voluntary sector infrastructure, please view the Governing body papers (p39-67).
Psychodynamic Therapy Consultation Paused
The Derbyshire CCG’s were proposing to decommission the Psychodynamic Psychotherapy element of the specialist psychological therapy provision. A consultation into the service, provided by Derbyshire Healthcare NHS Foundation Trust, was being held to gather people’s feedback about the potential impact of the proposed decommissioning.
Following an intervention from Healthwatch Derbyshire and other organisations, as Dynamic Psychotherapy had been singled out for decommissioning without a full review of psychological therapies taking place, the Derbyshire Clinical Commissioning Group decided to pause the consultation ahead of a wider review into the psychological therapy services available to the people of Derbyshire.
A third letter sent by DCC Health Scrutiny to Derbyshire CCG Chief Executive
A letter sent to Dr Chris Clayton Clayton, Derbyshire CCG Lead, by Cllr David Taylor following the meeting of the Health Scrutiny Committee on 1st October 2018.
Healthwatch Derbyshire calls for clarity on a further round of engagement regarding cuts to voluntary sector
Healthwatch Derbyshire welcomes the decision to defer cuts to discretionary grants for voluntary sector organisations until next year, following a Governing Body meeting that took place on 28th September 2018.
It was agreed that a further period of review would take place ahead of a final decision being made on proposed cuts to more than 20 groups or charities in the County.
This will include additional engagement to enable the Derbyshire Clinical Commissioning Group to reach a more informed decision which is set to be made at their Board Meeting in December.
Healthwatch Derbyshire chief executive Karen Ritchie said:
“All along I have been really concerned with the pace of implementation of the Financial Recovery Plan. Within such a short timeframe it was always going to be very difficult, if not impossible, for the public to be able to genuinely influence decisions being made on services that ultimately impact upon the care and treatment they receive.
“There is a legal duty on commissioners to inform, involve and consult patients and the public in the planning of commissioning arrangements, the development of proposals for change, and decisions about how services operate.
“I’m pleased that the Derbyshire Clinical Commissioning Group have been held to account and will now undertake a further round of engagement in order to meet their legal obligations.
“However, this does not excuse the fact that there should have been an appropriate period of review at the beginning of this process. Instead, they tried to rush through engagement over a 4-week period in order to be able to make a decision on the cuts at their Board meeting in August.
“The whole process has been ambiguous which has needlessly caused a lot of stress and anxiety.
“Communication with the voluntary sector during this period was poor, demonstrating a total lack of respect for their work and the years spent supporting Clinical Commissioning Groups to deliver health and social care services.
“The voluntary sector was undoubtedly owed the apology made by the Derbyshire Clinical Commissioning Group at the Governing Body meeting.
“Moving forward it is vital that voluntary sector services are informed immediately as to the format of the additional review period. The process needs to be transparent with clear lines of communication to avoid any further confusion or ambiguity.
“In August 2018 Healthwatch Derbyshire received a letter from the Derbyshire Clinical Commissioning Group expressing their desire to conduct future engagement at a much earlier stage and an invitation for Healthwatch to play a role in supporting this work.
“We hope that lessons have been learnt and that the Derbyshire Clinical Commissioning Group back up their words with actions which demonstrate a serious commitment towards public engagement and consultation.“This needs to happen at the earliest possible stage when people’s voice can truly influence the decision-making process.”
Healthwatch Derbyshire awaits the decision on cuts to the voluntary sector
Healthwatch Derbyshire awaits the final decision regarding cuts to the voluntary sector which is to be announced in public at the Derbyshire Clinical Commissioning Group (CCG) Governing Body meeting on Thursday 27th September 2018.
Following this meeting, Chris Clayton head of the Derbyshire CCGs is due to appear before the Derbyshire County Council Health Improvement and Scrutiny Committee for a third time on the 1st October 2018 where he will be asked to give a further update on the decisions that have been made with regards to the financial recovery plan.
The Health Improvement and Scrutiny Committee has the option of referring their concerns to the Secretary of State for Health for review, so we await their decision on the 1st October.
The Derbyshire CCGs have acknowledged they need to do more to involve patients and members of the public in their future plans and have invited Healthwatch Derbyshire to be part of this process, which we welcome. We have already started discussions with the CCG and will keep you all updated on the opportunities for involvement.
With a further deficit forecast for the next financial year, it is vital that there is a more open and transparent engagement plan, in which people are given a genuine opportunity to influence future commissioning decisions.
A second letter sent by DCC Health Scrutiny to Derbyshire CCG Chief Executive
A letter sent to Dr Chris Clayton Clayton, Derbyshire CCG Lead, by Cllr David Taylor following the meeting of the Health Scrutiny Committee on 10 September.
Council Leader Urges Health Chief to think again
Councillor Barry Lewis met with Derbyshire Clinical Commissioning Groups’ chief executive Dr Chris Clayton to question him about the “devastating” cuts the Derbyshire CCGs are proposing.
Councillor Lewis also expressed surprise at the way the county’s four CCGs had been wasting money over the years and said he was shocked they hadn’t addressed the overspending earlier.
“The CCGs say they can save £26million a year by stopping paying twice for some services and a further £16million on prescriptions,” said Councillor Lewis.
“If they’d looked at this sooner they wouldn’t be in the financial black hole they’re in now and wouldn’t have to look at the voluntary sector for savings.”
The £1.2million cuts to the voluntary sector proposed by the four Derbyshire CCGs aim to help address a funding shortfall of £95million. If they go ahead, they would affect 22 Derbyshire charities and community groups delivering many services for the county’s most vulnerable residents.
Councillor Lewis said:
“We had a constructive discussion and Dr Clayton assured me nothing had been decided yet on the proposals.
“I explained the cuts would have a devastating impact on the work of the community and voluntary sector and I have asked the CCGs to put them on hold and to look again at where savings can be made.
“I also raised my concerns about the woeful lack of consultation with the voluntary groups affected, partner organisations and the public.
“I urged Dr Clayton to consider deferring any decision to give more time for meaningful consultation to take place with the people who rely on these services, who would be badly affected if funding stopped.
“I am determined to ensure that the residents of Derbyshire continue to receive the care and support they need and deserve.”
Before his meeting with Councillor Lewis yesterday, Dr Clayton appeared before our Improvement and Scrutiny Committee – Health, which was considering referring the CCGs’ proposals to the Secretary of State.
The committee agreed to defer the decision as discussions were ongoing, but committee chair Councillor David Taylor said the committee reserved the right to refer the proposals to the Secretary of State for Health and called for a further meeting with Dr Clayton on Monday, 1 October.
Councillor Lewis added:
“During a parliamentary debate on this issue just last week, it was made clear by health minister Stephen Barclay, and there was cross-party consensus, that the voluntary sector should not be the first port of call when the CCGs are looking to make savings.
“They acknowledged the services run by the community and voluntary sector offer very good value for money.
“I understand that the Derbyshire CCGs face a huge financial challenge but, unlike the council, the NHS has received significant government funding for its services over recent years. These proposed cuts are very short-sighted as they could end up costing more in the long run.”
He pointed out the cuts are contrary to the Derbyshire Joined Up Care proposals, an NHS-led plan for health and social care to work more closely together.
Our cabinet member for health and communities Councillor Carol Hart, who is responsible for public health, said:
“The impact of these proposed cuts is already being felt. Community Concern Erewash and Bright Street Laundry in Ilkeston have announced they’re to close in light of the threat of withdrawing NHS funding.
“Implementing these cuts would affect the very services the Derbyshire CCGs are relying on to help them deliver the NHS’s five-year forward plan for the integration of health and social care.”
Councillor Jean Wharmby, our cabinet member for adult care, added:
“It seems very short-sighted that at a time of growing demand and with more emphasis on prevention work, the Derbyshire CCGs are proposing to cut grants to the very groups that make such a big difference in local communities.
“Some of them are very low cost but bring a high level of benefit to the county’s most vulnerable people.”
Public Urged To Feed into Parliamentary Questions on Derbyshire Service Cuts
Healthwatch Derbyshire Chief Executive Karen Ritchie raised her concerns at a recent Derbyshire Clinical Commissioning Groups (CCG) meeting about the lack of public consultation on the health service cuts they are proposing.
The £95 million overspend means that cuts to services are required to save £51 million between now and April 2019.
At the public meeting, she argued that patients, carers and the public had so far not been given enough opportunity to have their say on the impact of the cuts which, she fears, will have a ‘catastrophic’ effect on local people’s lives.
The issue has now been picked up by Ruth George, Labour MP for High Peak who has secured parliamentary time on September 4 when MPs will have the opportunity to put forward questions to the Health Minister.
Ms Ritchie said today: “Having highlighted the issue of inadequate public and patient engagement, and raised concerns regarding the impact of the voluntary sector cuts on Derbyshire residents, Derbyshire CCG have stated that they will have further discussions with Derbyshire County Council and the voluntary sector to look at how the impact can be managed better.
“I am still concerned that the pace of implementation of the financial recovery plan will make it very difficult for the public to genuinely influence decisions being made that will ultimately impact their care and treatment.
“However, it is good news that questions will be raised at parliament about this. The cuts go against the long-term strategy of the CCG, particularly their intention to keep people independent and well in their own homes for longer, a key objective of the CCG.
“The demands of NHS England are focusing the CCG on short-term financial goals, rather than what’s best in the long term for patients and members of the public.
“I would therefore urge people to contact their local MP either directly or through Healthwatch Derbyshire to voice their concerns and specifically relay their personal experiences of services and the impact that these cuts will have on their own lives.”
“Hopefully NHS England, who are demanding large savings in a short period of time, will be made aware of these concerns and take into account the fact that proper consultation is a vital and necessary step in measuring the impact that cuts to services may have on the people of Derbyshire.
Health Scrutiny Concerns re: Financial Recovery Plan
Healthwatch Derbyshire recently contacted Derbyshire County Council’s Health Scrutiny Committee to highlight concerns regarding the Financial Recovery Plan put forward by the Derbyshire Clinical Commission Group.
Councillor David Taylor, Chairman for Improvement and Scrutiny for Health, responded to Healthwatch Derbyshire by sharing a letter sent to the Derbyshire Clinical Commissioning Group raising the Committee’s concerns about the potential impact of proposed cuts on local services and residents.
Healthwatch Derbyshire has been invited to attend the next meeting of the Health Scrutiny Committee where Dr Chris Clayton, as the representative for the Derbyshire Clinical Commissioning Group, has been asked to provide further information on the proposals put forward in the Financial Recovery Plan.
Pressure Continues For Public Views On Service Cuts
Healthwatch Derbyshire – the patient health and social care watchdog – has pledged to continue to fight for the public’s right to have their say on potentially drastic service cuts across the county.
Healthwatch Derbyshire Chief Executive Karen Ritchie is due to meet Dr Chris Clayton, the Chief Executive of Derbyshire Clinical Commissioning Groups (CCG) on September 11 following recent correspondence between the two organisations.
Ms Ritchie has highlighted her grave concerns that patients, carers and the public are not being given the opportunity to have their say on the impact of actions required to address the £95m budget deficit in health budgets.
She fears that services will be cut on a piecemeal basis but that, collectively, these will have a ‘catastrophic’ effect on local people’s lives.
Ms Ritchie said: “Healthwatch Derbyshire received a response to the letter issued highlighting our concerns on Friday 10th August 2018, this was within the required timeframe of 20 working days.
“We would like to thank Dr Chris Clayton, responding on behalf of Derbyshire Clinical Commisioning Group, for replying in a timely manner.
“We welcome the commitment to conducting future engagement at a much earlier stage and the invitation for Healthwatch to play a role in supporting this vital work.
“Unfortunately, having taken the time to carefully analyse the full response, it does nothing to allay the grave concerns Healthwatch Derbyshire felt it necessary to raise.
“In some instances, Dr Chris Clayton fails to directly answer specific questions and in others, responses are so vague that it offers little assurance that the Clinical Commissioning Group intends to meet requirements as stated in the *Health and Social Care Act 2012 Section 14Z2, or the *Equalities Public Sector Duty S149.
“Expert advice has been sought on this matter and, over coming months, Healthwatch Derbyshire will continue to challenge the Derbyshire Clinical Commissioning Group with regards to the implementation of the Financial Recovery Plan.
“A meeting has been scheduled with Dr Chris Clayton to take place on Tuesday 11th September 2018 to follow up on the response and take forward our concerns.
“We will also take the opportunity to discuss his plans for a more open and transparent engagement plan, in which people are given a genuine opportunity to influence future commissioning decisions.”
Ms Ritchie continued: “Legally, public and stakeholder consultation must be at a time when proposals are still at a formative stage and I see no evidence that this is the case.
“Furthermore, with the pace of implementation of the plan, it is going to be very difficult for the public to genuinely influence decisions being made that will ultimately impact their care and treatment.
“As discussions progress, I would urge local people to share with us their views and experiences of service cuts to help us build a picture of the impact that these actions are having.”
Derbyshire Clinical Commissioning Group letter of response to Healthwatch concerns re: Financial Recovery Plan
Healthwatch Derbyshire wrote a letter to Derbyshire Clinical Commissioning Group expressing grave concerns in regard to the Financial Recovery Plan that has been put forward. It was requested that questions raised in the letter be addressed and a formal response provided within 20 working days as per legislation.
The below letter of response from the Derbyshire Clinical Commissioning Group was received on Friday 10th August 2018:
(15/08/2018) Statement from Karen Ritchie, Healthwatch Derbyshire Chief Executive:
“Healthwatch Derbyshire received a response to the letter issued highlighting our concerns on Friday 10th August 2018, this was within the required timeframe of 20 working days. We would like to thank Dr Chris Clayton, responding on behalf of Derbyshire Clinical Commisioning Group, for replying in a timely manner. We welcome the commitment to conducting future engagement at a much earlier stage and the invitation for Healthwatch to play a role in supporting this vital work.
“Unfortunately, having taken the time to carefully analyse the full response, it does nothing to allay the grave concerns Healthwatch Derbyshire felt it necessary to raise. In some instances, Dr Chris Clayton fails to directly answer specific questions and in others, responses are so vague that it offers little assurance that the Clinical Commissioning Group intends to meet requirements as stated in the *Health and Social Care Act 2012 Section 14Z2, or the *Equalities Public Sector Duty S149.
“Expert advice has been sought on this matter and, over coming months, Healthwatch Derbyshire will continue to challenge the Derbyshire Clinical Commissioning Group with regards to the implementation of the Financial Recovery Plan.
“A meeting has been scheduled with Dr Chris Clayton to take place on Tuesday 11th September 2018 to follow up on the response and take forward our concerns. We will also take the opportunity to discuss his plans for a more open and transparent engagement plan, in which people are given a genuine opportunity to influence future commissioning decisions.”
Healthwatch Derbyshire’s concerns around the Financial Recovery Plan – A letter to the Derbyshire Clinical Commissioning Group
Healthwatch Derbyshire has written a letter expressing grave concerns with regards to the Derbyshire Clinical Commissioning Group’s Financial Recovery Plan. We have requested the questions raised in this letter be addressed and a formal response provided within 20 working days of receipt of this letter as outlined in legilslation.
Healthwatch Derbyshire Calls for Meaningful Public Engagement in Local £80m Health Financial Recovery Plans
The head of Derbyshire’s independent health and social care watchdog has warned that meaningful public and patient input into the future of local health services is in danger of being side-lined following recent developments in the county.
Derbyshire’s Clinical Commissioning Groups (the NHS bodies responsible for the planning and commissioning of health care services in the county) have announced that action will need to be taken to address an £80m financial gap in the services they fund against the budget they receive.
This financial challenge has led to the development of a financial recovery plan that will see extensive cuts to services over the coming year and one of the first casualties has been the announcement that an engagement group focusing on mental health will soon be disbanded.
Karen Ritchie is Chief Executive of Healthwatch Derbyshire – the organisation which ensures that patients, service users and members of the public have a say in the design and delivery of services.
She explained that listening to patients, carers and the wider public’s own experiences of and views on services was a vital part in planning and shaping future health provision in the County. However, during times of financial hardship, she is concerned that it becomes much more difficult for patients and members of the public to influence decisions that are being made about the services they rely on.
Furthermore, as part of the £80 million financial recovery plan, Derbyshire’s Clinical Commissioning Groups have announced the decommissioning of Mental Health Together, a new service focused on giving people with first-hand experience of mental health conditions a greater say in how services are delivered. The service will end in the autumn of 2018.
Mental Health Together was launched in July 2017, and is already engaging extensively with Mental Health Service Receivers and carers to hear their views on access to services, care and treatment whilst receiving services, and support they received to maintain their recovery.
Ms Ritchie said that the service was extremely important given that the recent Care Quality Commission Inpatient report showed that patients with a pre-existing mental health condition persistently reported a poorer experience of care across most areas of the NHS.
This was in terms of patient experience, i.e. information sharing, respect and dignity, coordination of care, confidence and trust, respect for patient centred needs and values, and perceptions of overall experience of care.
Ms Ritchie said:
This is highlighted time and time again in their survey and would indicate that priority should be given to this issue if it is to be resolved. However, the CCG is decommissioning the very service put in place to help improve outcomes for Mental Health Service Receivers by putting them at the centre of decisions made about them.
With this news Healthwatch Derbyshire have very real fears that the wider views and experiences of patients and members of the public will not be taken into account during the implementation of the financial recovery plan, over the course of this year.
Ms Ritchie continued that the recent Gosport Hospital Inquiry highlighted the importance of listening to patients, service users and the wider public and warned that public engagement and consultation should not be side-lined simply because of financial constraints.
Gosport was an extreme case of authorities not listening to concerns and experiences but it brings into sharp focus the importance of the patient and public voice.
There is no question that health and social care services are facing big challenges and that changes need to happen. However, the whole point of engagement and consultation is to create a safe space for legitimate debate over difficult issues, which is even more important when decisions are being made with financial restraint in mind.
Important decisions which are driven by financial pressures need to take into account the views of patients and members of the public and fully explore the impact that changes might have on patient experience. This is precisely the role of Healthwatch Derbyshire, and in turn that of Mental Health Together.
We ensure that patients and members of the public have the opportunity to input their own experiences and views of service provision into the process by advocating for honest and genuine engagement.
I therefore appeal to the commissioners and providers of health and social care services in Derbyshire to reconsider how they implement their financial recovery plan over the coming months to ensure that it gives patients and members of the public the genuine opportunity to influence decisions that will impact on them.