A present from Santa George?

Readers who were awake may have noticed a fleeting appearance by the Chancellor of the Exchequer on BBC London TV just before Christmas. He was announcing the London Health Devolution Agreement, supposedly signed by George Osborne himself along with all London CCGs and all London Borough Councils.

Ever vigilant on behalf of Brent patients, BPV asked Brent CCG and Brent Council about the process by which they had considered the case for signing up and to see any papers they had considered. We also wanted to know what the benefits might be and what exactly was being devolved.

Carolyn Downs, Chief Executive of Brent Council, was quick to reply. She told us that Brent had not signed anything, but the agreement had been negotiated on behalf of all boroughs by an organisation called London Councils, see http://www.londoncouncils.gov.uk/our-key-themes/health-and-adult-services/health/health-and-care-devolution-lond

She added: “There is no extra money and there are no implications at all for Brent Council. We have not delegated to London Councils, any decision as to taking part in a devolution deal would be a matter for our council.  And they cannot bind us through this agreement.” She agreed that there was a lot of spin involved.

Rob Larkman, CEO of Brent CCG, came back to us after Christmas, with a longer reply but not much more of substance. He said that on 21 October the CCG Executive had delegated power to sign the Agreement to Dr Marc Rowland, Chair of the London Clinical Commissioning Council, and that the CCG Governing Body would ratify it at their 13 January 2016 meeting – which they did. In a question session for the public before the Governing Body meeting when BPV pressed for clarification he volunteered that “devolution” was maybe a misnomer for the Agreement and that the CCG had signed up on a precautionary basis only. Brent is not so far affected.

The intention of the Agreement appears to be to encourage London NHS and local authorities jointly to devise improved health and social care arrangements tailored to London’s needs but strictly within the budget funds approved by the Government. What’s new pussycat?

The Treasury Press Notice of 15 December 2015 is a masterpiece of deliberate obscurity designed to re-assure all concerned without committing anyone to anything other than that NHS care is to still to be provided by the NHS, and a requirement to keep within the Government budgeted funds. It goes so far as to suggest that the changes are to be as significant as the discovery of penicillin!!

BPV is of the view that any alleged present from HM Treasury needs very careful scrutiny indeed.

Robin Sharp, BPV Interim Chair


  1. Wouldn’t it be nice to see a statement that contained enough substance which you could really test against current facts and future plans ?

    Carolyn Downs refers us to the “health-and-care-devolution-lond” site. I quote from that document “At its heart is the reform and updating of the way public services are provided, that recognises: the need to shift from reactive care to prevention, early intervention, self-care and care closer to home that maximises people’s independence and wellbeing”. This at least is the first aspect of the plan and it’s one which various meetings in Brent have kicked around over the last few years. It’s also one which I believe is necessary, but to achieve it raises some difficult problems. For a start it needs to be tested properly to discover if it is likely to be effective and affordable.

    Even a quick reading of Chapter 5 of the Mansfield Report will leave the impression that we simply dont have any idea what it will cost, either on its own, or when balanced by savings elsewhere, in “A&E” admissions or GP attendance for a start. My own experience of working with the CCG in Brent has left me with precisely the same impression on other issues.

    The budget for the NHS is not so large that we can spend it without serious thought as to what we achieve. As a yard-stick (or metre-rule ?) let me provide an example of what I mean.

    Recently we were informed that £3.5B would be allocated to local councils in England to help with their new commitment for social care in the face of a reduction in their overall grant from Whitehall. I hope someone in Brent’s Civic Centre is already handling the impact. But let’s ask what the £3.5B could buy in terms of social care in England.

    My yard-stick is the cost of 24h care at home. It’s about £100K/year. Does it sound a lot ? Then do the sums. There are 8760 hours in a year; with minimal on-costs and a pay rate of say £10/hour that amounts to about £100K. So what do we get for our £3.5B ? It’s 35000 (thirty-five thousand) 24h care workers, or their equivalent, and at £10/h they are not highly skilled.

    It is certainly a lot, but how would it measure against the increasing needs of the elderly. There are about 4.4 million people aged over 75 in England at the moment, and this seems likey to increase to about 5 M in 2020. That increase alone is getting on for 20 times the number of 24h care equivalents, and that just the elderly population. Is it enough for them ? And what then would be left to cover the increasing needs for care throughout all the other age ranges in the community ?

    Is this £3.5B really going to work ? Are there sufficient savings elsewhere ? Or is this pie in the sky to disguise the slow unravelling of the NHS.

  2. In a recent Select Committee it was stated that 4% of patients used 50% of a Cornwall General Hospital’s budget. If this is indicative of a statistic that is true across the whole of England there is the potential for massive savings to be achieved by keeping ‘frequent flyers’ out of hospital with effective integrated care strategies.

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