At the end of January, in a venue seemingly selected to be as remote and inaccessible as possible from the community in Telford and Wrekin, whose hospital services were to be downgraded and cut back, a joint meeting of Shropshire and Telford and Wrekin CCGs took just one hour, with no significant debate, before rubber stamping their controversial ‘Future Fit’ plan.
The decision, which had been expected, was immediately challenged by Telford & Wrekin council, invoking its scrutiny powers to refer the plan to the Secretary of State. Many of the county’s Tory MPs and councillors fearful for the consequences will be covertly hoping Matt Hancock either rejects the plan or drags out the process of agreeing it, so that the axe does not start to fall on local services at least until after the local elections in May, or even after a general election. A 136-page “Decision Making Business Case” was passed: the Future Fit website promises that this and the 21 Appendices can be downloaded by anyone with the energy to plough through them.
Strangely however the Appendices have not been published by the CCGs, despite the numerous references to them in the Business Case.
It has been left to campaigners challenging the plans, who have wisely archived their collection of the documents, to make them available on a Google Drive.
Optimityism
Another document which the CCGs have wisely chosen not to publish as part of the discussion, confining themselves to a few confusing extracts in the Business Case, is the report expensively compiled by US and multinational consultancy Optimity Advisors.
The first Optimity document, published in March 2017 but based on ancient 2013/14 figures, makes the unsurprising point that patients over 60 accounted for 41% of emergency caseload and 45% of elective admissions, and that “Health care costs increase with patients’ age […] the average cost per head significantly rises over the age of 60”.
Optimity went on to discuss the hypothetical advantages and cash savings that might result from improving out of hospital services: “The Optimity review identified there would be £11m savings in admissions if the right services were in place in the community.” This statement from the February 2018 Shropshire CCG governing body meeting went on to concede the community services had been reducing rather than improving and that neither the necessary staff nor the funding was actually available to expand them. In fact the July 2017 Optimity report was never published, but quoted by campaigner Gill George’s powerful Alternative to Future Fit. It drew on what it argued were useful comparisons from a number of other countries as well as an abstract model developed by the NHS:
* Buurtzorg, the Netherlands;
* Network Mobile Unit, West Skaraborg, Sweden;
* Coordinated Community Care, Oregon, US;
* Geriant Model, the Netherlands;
* Primary Care Home Model, UK; and
* Project Hälsostaden, Ängelholm, Sweden.
It’s not clear whether the Future Fit leaders made any effort to check any of the claims made for these very different systems.
However the Business case rests upon this second even more optimistic Optimity report, which assumes it is possible to give older patients an extra 5 years of healthier life, effectively making them younger:
“If we assume that a new model of out of hospital care can deliver a shift in population health (an increase in healthier lives lived for the population of Shropshire) of five years, a saving of £19m -£21.9m could be made in acute care from reductions in emergency, elective and day case admissions; outpatient appointments; and A&E attendances.” (page 31).
This assumption was at best aspirational (the next sentence pointed out “These are gross figures only and do not include the investment that will be needed to deliver a new model of out of hospital care.”)
Few people other than ‘Future Fit’ leaders would regard such tenuous assumptions as a basis to plan for a reduction in bed numbers and emergency services.
Now the plan has been referred to the Health Secretary, it will be interesting to see whether they stand up to any external scrutiny.
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