Sunday, February 24, 2013

Like Oliver Twist Redbridge should ask for more

Neil Zammett writes 
Just recently the Public Health budgets for the next two years have been published by the DOH in a complicated format which shows the enormous differences in spend across London.  Apart from Bexley Redbridge has the lowest current and planned spend per head, now and in two years time.
                                                      Baseline 2013-14         Grant 2014-15  
                                                              £Per head                      £ per head
Tower Hamlets                                          113                                         116
Hackney                                                        112                                         117
Newham                                                       68                                           81
Barking and Dagenham                            60                                           71
Waltham Forest                                         38                                           45
Havering                                                       33                                           39
Redbridge                                                    32                                           38

Even though we have shared public health challenges with Inner London around Diabetes and Tuberculosis there is an enormous disparity in investment in these vital preventive services.   The supposed “equalisation” exercise has in fact seen the gap between Redbridge and most other boroughs actually increase.

It is not just Public Health where Redbridge is the poor relation; investment in family doctor service has been cut as well.  As part of the closure of A&E, Redbridge was supposed to be getting four more polyclinics now that is down to one in vacant accommodation at King George.  The bulk of new investment in primary care will be going into other boroughs.

There are also warnings that the overall allocation for next year, used to buy all of our hospital and other health services is short by well over £10 and possibly up to £20 million.  I have also heard that there are plans to reduce community beds at places such as Wanstead hospital.

Looking around; Havering has Queen’s, Whipps has a new A&E, Barking and Dagenham a new birthing unit, Newham a new A&E and maternity extension, the Homerton a maternity extension  and Tower Hamlets a billion pound new PFI hospital. 

Redbridge has nothing.

In all of this Tower Hamlets and Inner London more generally are the big winners but Redbridge stands alone as the Borough which loses most and on all fronts. Isn’t it time for us to start asking for a bit more and not to be bashful about it?  If Oliver had the courage do it so can we and it’s time for our CCG and other representatives to start making some noise.

Public representation and CCGs

How the public are going to be represented in the new style NHS is like so much else these days-a complicated arrangement.  The former LINKs (local involvement networks) are being transformed into Healthwatch with a brief to represent the public as an independent body.  For those who remember the CHCs (community health councils) they are going to be much the same although in Redbridge complaints will be dealt with by a body covering several boroughs. They become operational on 1st April this year at the same time as our CCG (clinical commissioning group) goes live.

The CCG itself will have two lay members one for governance, mainly financial issues, and the other to represent the views of the public.  How they are going to do this is not entirely clear given the size and complexity of the population here in Redbridge.
To add to the mix there is a CCG Engagement Forum made up of representatives of the PPGs (patients’ participation group) at individual GPs practices across the Borough.  They also have a role in informing GPs about public opinion.

It also now looks as if the local authority Health Scrutiny Committee will continue and we can add to this the Joint Health Overview and Scrutiny Committee and I personally welcome this. Confused? Well who wouldn’t be.  Here in Redbridge we have additional problems because of the history of public opinion being so strongly opposed to the closure of A&E and Maternity at King George, baggage which the CCG has inherited.

To build confidence they need to ensure that they have representation which is truly independent and have a demonstrable commitment to linking with existing community networks and organisations.

The DOH are worried about this as well and have commissioned an external report on embedding patient and public engagement in CCGs.  To quote from a statement in the Health Service Journal taken from the study
”Some are concerned that CCGs may pick lay members who act as champions for them rather than challenging decisions.”
The test we should be applying is one of credibility looking at the track record of representatives in terms of their connections with local networks and speaking out on issues such as closures and also their association with the NHS. 
We need to recognise that any representative will have to deal with the baggage the CCG has inherited particularly as the most senior staff are so closely associated with the previous PCT’s history of poor quality consultation.
They deserve our support.

Let’s have clear financial accounting
If all of this wasn’t enough we also have a simmering problem with the way in which the finances of trusts and PCTs/CCGs are reported.  Regular readers of this Blog will know that I have been pointing up the amount of non-recurrent reserves and other special funds which have been propping up the spending position in NE London for a while now.
This means that a quick look at financial reports and year end accounts does not show the underlying position, although I have calculated that there is some £120 million of non-recurrent funding of various types supporting Barts Health and BHRUT alone.  How much of this is going to be “bridged” for future years is not clear to me. NHS London due to close this March is forecasting a surplus overall  for 2012-13 of £150 million including the use of reserves but understandably they have not produced draft balance sheets and I &E (income and expenditure) statements for 2013-14.

My concerns are that we are being lulled into a false sense of security which could affect key decisions. Barts Health is slipping badly on its savings target which is ironic because the savings were one of the main reasons for creating the giant trust in the first place.  Similarly with BHRUT I am not clear how their savings plan reports compare with the baseline they set at the start of the year or whether the additional money they have received for over performance (treating more patients than planned) is artificially generous.

I would like to see a separate section of financial reports and accounts introduced as an accounting standard which required trusts and PCT/CCGs to show the true underlying financial position more clearly.

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