John Lister on a Cambridgeshire Health Service in Crisis

The CCG, Clinical Commissioning Group, is now facing a massive deficit, and still haven’t told us what they’re going to cut to try to put it right.

waiting_room07:07 Wednesday 24th February 2016
BBC Radio Cambridgeshire

DOTTY MCLEOD: Accident and Emergency departments across Cambridgeshire are under severe strain at the moment, according to the county’s Clinical Commissioning Group. They’ve contacted BBC Radio Cambridgeshire asking us to re-emphasise their message, only go to A&E if it really is an emergency. The news comes ahead of a meeting in Cambridge tonight about the problems faced by the NHS in Cambridgeshire and Peterborough. Before we find out more about that, here’s reporter Julia Greenaway with a reminder of just what’s been happening with our health service locally.
JULIA GREENAWAY: Thanks Dotty. Well it’s been a torrid few years for the NHS in Cambridgeshire. Things started well when Peterborough’s brand new City Hospital opened in 2010, but in the past five years it’s been dogged by the multi-million debt incurred by the financing package. Hinchingbrooke Hospital in Huntingdon then became the first NHS hospital ever to be run by a private company. Then Circle pulled out of the ten year deal last April. The Hospital was placed in special measures, and patients warned that departments could close. Cambridgeshire was again chosen to try something never before done in the NHS, when the £800 million Older People and Adult Social Care Services was outsourced. This was the biggest outsourcing contract in the history of the NHS, and it collapsed within months. And finally last year inspectors said that while Addenbrookes Gospital’s quality of care was outstanding, it had to go into special measures due to failures by senior managers. The Hospital is predicted a £60 million debt this year.
DOTTY MCLEOD: Well listening to that is Dr John Lister, who studies health policy. He’s also a campaigner against the privatisation of the NHS. He’s one of the speakers at this meeting tonight, and believes there are particular reasons to be concerned about the NHS in Cambridgeshire. So John good morning.
JOHN LISTER: Good morning.
DOTTY MCLEOD: These particular reasons, what are they?
JOHN LISTER: Well I think Cambridgeshire, as your summary has well pointed out, has been used as a kind of a testing bed for all kinds of experimental policies, which we have been warning as campaigners, we as researchers have been warning, would not work. And they haven’t worked. And of course it’s led to disastrous consequences.
DOTTY MCLEOD: But one man’s experimental might be another man’s innovative John.
JOHN LISTER: Well you can choose your word, but the reality is these have been untested, this is the first time. In Cambridgeshire this is the first time they’ve tried privatising the management of the hospital. Everybody knew it was ridiculous to hand it to Circle, which is a private medical company who’s hospitals are 27 and 30 beds, compared to the much larger and more complex running of Hinchingbrooke. It all hinged on implausibly huge savings they were supposed to make over ten years. We all pointed out, in fact everybody that looked at it other than the CCG pointed out, this was never going to work. They went ahead anyway, and of course it collapsed. And we’ve wound up now with Hinchinbrooke Hospital with the other two deep in deficit and facing serious problems.
DOTTY MCLEOD: So what? You want the NHS to just be preserved in aspic? No change ever.
JOHN LISTER: Not at all. But there are changes that make sense, and there are changes that don’t make sense. The Older People’s Services contract again which everybody warned was too complex and too expensive for the amount of money that was on the table. And we said it was not affordable. It was a good thing that they decided not to give it to the private sector as appeared to be the plan initially. It went to an NHS-led consortium. But the problem is they inherited this plan which in itself was not workable. So they wound up transferring thousands of staff from one Trust to another, completely reorganising services which actually were already excellent before they intervened, and in the process they had a contract which now is admitted they were trying to save more than 10% of the contract value over the five year period. And it clearly was never going to happen. There was never enough money for it to work, and now we’re picking up the pieces. The CCG, Clinical Commissioning Group, is now facing a massive deficit, and still haven’t told us what they’re going to cut to try to put it right.
DOTTY MCLEOD: So what do we do about it John? because I’m hearing a lot of criticism, but not much that’s constructive. There’s huge pressure on the NHS as a whole at the moment. How do you address that?
JOHN LISTER: Well for a start, when you’ve got an excellent service like they had with the community services don’t rearrange it. It’s just madness. We’re now in a situation that nobody wanted where all these services are in significant problems, all at once. And the CCG has major responsibility for that. And we always said, it was a huge gamble putting these completely untested teams in charge of clinical commissioning groups with massive budgets. And clearly this is a gamble that’s misfired, and left Cambridgeshire in a crisis. So if I was going to reorganise it, I would never have started from here in the first place, and it is a very very big job to piece it back together. And basically the reforms that set the CCGs up have got to be repealed, and we’ve got to get back to trying to organise the NHS as a centralised public service again.
DOTTY MCLEOD: A lot of people said though, when the CCGs were founded, and indeed before that Older People’s Care contract came in in Cambridgeshire, that something did have to change, that services couldn’t be provided in the same way for the same amount of money.
JOHN LISTER: Well they can’t be provided in the same way for the same amount of money, because we’ve got a growing population and growing needs for that population.
DOTTY MCLEOD: So where does that extra money come from John?
JOHN LISTER: Well there are all kinds of very large companies that are paying virtually no tax. There are all kinds of projects the Government can find money for. Or it’s possible to find all kinds of other ways to actually raise money which the Government, as I say, can run if they want to run a war. If they want to build a new railway up north, which obviously doesn’t benefit anybody in Cambridgeshire, they can do that. But it doesn’t seem that they can fund the NHS in one of the most needy counties actually in the country. So it does seem that the priorities are all wrong here. We need to start from how much money .. we are spending less on the NHS proportionally per head and as a share of national wealth than most other health systems in Europe. And we need to address that and put the resources in to make the system work.
DOTTY MCLEOD: Well we should maybe say that the Government has promised an extra £3.8 billion above inflation cash injection this year. That’s for NHS services in England. Also joining me in the studio this morning is Val Moore, who is the Chair of Healthwatch Cambridgeshire, who will be at tonight’s meeting. Morning Val.
VAL MOORE: Good morning.
DOTTY MCLEOD: John there saying that Cambridgeshire faces particular challenges in the healthcare system. Of course whatever the challenges, patients everywhere presumably just want the same thing. They just want to be looked after when they’re not well. Are patients getting that in Cambridgeshire?
VAL MOORE: Well let’s be clear at the outset, Healthwatch Cambridgeshire is a non-political organisation. We’re practical not ideological. We’ve got a remit locally to support people’s views to be taken into account in the process of change in the local health and social care services, whether they be the big system changes, or more smaller improvements in care …
DOTTY MCLEOD: So you represent patients. And what are patients experiencing?
VAL MOORE: Well the system has to change from our point of view, from the patients’ experience point of view, rather than the financial picture that’s just been painted, because poor care is more likely to happen as people pass from one service area to another. There are many different providers of care in the different areas of Cambridgeshire, many points of access to the system can be confusing, and information given can be confusing. So there that’s the kind of feedback that we get, and we promote those points of view, and accumulated evidence that people tell us about their stories of care into the various meetings and opportunities that are around. And last week we visited Papworth, we visited the Pinpoint Group which is parents and carers support. Tonight I’m going to a business meeting. I’m also meeting the chaplains at Hinchingbrooke to talk about how they communicate with the local communities. So we’re there to talk to everyone, to gather local experiences of care, and to find ways of making them count for improvement in the local system.
DOTTY MCLEOD: And what are people telling you about the care they’re receiving in Cambridgeshire? Are there problems there?
VAL MOORE: I’ll give you some recent examples if you like around waiting times and confusing letters to come to Out Patients appointments at our hospitals. We noticed this was an issue and we talked to Addenbrookes about it. We’ve entered into a partnership with them to do some more detailed work in Out Patients clinics, to check on people’s journey of care up to that point and their experiences. So we see ourselves as trying to be constructive. Yes we’ll speak out, but to be part of the solution as well as raising people’s concerns about long waiting times or confusing communications about care.
DOTTY MCLEOD: And just on the strain that A&E departments in Cambridgeshire say they’re experiencing at the moment, do patients need to take some responsibility for this? Are there people still going to A&E when they’d be better off going to the local pharmacy?
VAL MOORE: Well I would encourage, and I know this does happen, for us to ask people why they’ve attended. Were they aware of other options? What led them to come to these particular doors at this particular time? And to understand that and work with that. We can’t look at the theory and the books that say oh this is the best way for that kind of care to be provided, and this is the best way for another type. But actually you’ve got to match this with the habits, the needs, the desires, the information or misinformation that local people have got, and work from there.
DOTTY MCLEOD: Val, thank you very much for your time this morning. That’s Val Moore who is Chair of Healthwatch Cambridgeshire, representing patients across the county. You also heard from John Lister who is a campaigner against the privatisation of the NHS.