Health & Social Care

This continues from my 2 previous posts, here and here. These posts dealt with the same subject but focussed on the antics of Cllr Walsh and his refusal to submit a motion to the next council meeting. He has been reading my blog and has taken offence at what I have said. He’s asked me to print an email from him which I’ll happily do this week some time.

For the moment, though, I want to concentrate on the correspondence with the chief executive of the Interated Joint Board for Health & Social Care (IJB). This is not all of the correspondence but it gives you a flavour of the efforts made to try and get the IJB to change its mind over the closure of Struan Lodge in Dunoon and the cessation of dementia services at Thomson Court in Rothesay.

From Michael Russell MSP to the IJB chief executive on 6 August:

Dear Christina

I write in connection with the decision to close the above facilities made by the IJB.

You will be aware that at the Argyll & Bute Area Committee held in Rothesay on Tuesday a member of your staff admitted that the “consultation” process announced regarding these closures was a sham and confirmed that the  decision to close had been made on 22nd June before the “consultation” was even announced. 

It is utterly unacceptable for an accountable public body to behave in this way.  “Consultation” means “Consultation”.  it does not mean attempting to perpetrate a confidence trick on the community by using warm words to cover up actions which are strongly opposed by those to whom the body is accountable.   

In addition it does not mean presenting figures and information which is not verified and robustly refuted as if it had  official imprimatur.

The IJB has got off to a very bad start.     There is no doubt that the public will refuse to place its confidence and trust in a body which operates in this way.  and that would bode very ill for the delivery of vital health and community care services in our area.

I therefore write to ask that you immediately revoke the closure decision (which I also understand will save virtually no money in this financial year) , apologise openly to the communities affected for operating in this way, undertake a review to ensure that your governance is radically improved and confirm that there will be no repetition of such actions.,

I am copying in your Convener and Vice Convener, the Bute and Cowal Councillors and the local media.

Yours sincerely

Michael W Russell 

Before Christina replied, I added the following on 12 August:

Since I was copied into this I think it’s reasonable that I make a point here Christina.

It was the total lack of consultation prior to the decision that is the issue, not how you intend to consult from now on having made the decision.

Not only was there a lack of consultation, the decisions on Thomson Court and Struan Lodge were based on absolutely no evidence of demand. Closure of Struan Lodge today would leave no spare bed capacity at all for Dunoon and Cowal. In 25 years the numbers over 75 will double across Argyll & Bute but I don’t know what the position will be in Cowal, do you Christina?

Pasted below is what I said on 28 July to the locality planning group when I was unable to attend the first group meeting.

Regards

I have not, as yet, seen any evidence that supports the proposal to close the care beds at Struan Lodge. Let me be clear about what I would need to see before I could support any such decision:

  • A long term, ie 25 year minimum, projection on the numbers of elderly people in Cowal.
  • Within this, I’d need to see a breakdown of the numbers in various elderly age groups based on best projections of increasing life expectancy.
  • The next key part of the information needed would be projections of the elderly who would need care of some type, split by care type. Having a larger percentage of the elderly cared for at home is accepted but with the growth in the numbers of elderly people, this could still mean an increase in the absolute number of care beds that are needed.
  • All of the above needs considered against current and projected future capacity.

As of today, there are 10 bed vacancies in Cowal. I got this from the papers for next week’s area committee. I am told that one of the care homes with 8 of these vacancies can’t actually fill them due to either finance or staffing issues. Even if that information is incorrect, closing Struan today would fill current spare capacity.

3 years ago, when the ill-conceived proposal to close Struan first surfaced, we were told there were 38 bed vacancies. We have a maximum of 10 today so demand has increased in 3 years; what will happen over the next 25+ years?

The empirical evidence to support the closure of care beds needs to be both long term and as sound as it can be before any decisions are taken. It’s far harder to create new capacity than it is to shrink it.

Michael Breslin

On 12 August, Christina West replied as follows:

Thank you for your email Mike,

the IJB have carefully considered the difficult decisions to progress the urgent transformation of health and social care. As part of proceeding with the redesign of these services, in line with national policy, the IJB have directed that there will be full public involvement and engagement with users, stakeholders and the public as we progress implementation of our new model over the next three years.

As stakeholders we will keep MSPs and elected members appraised of our process for involving and engaging with the users of services and the public. This will include meetings with those stakeholders and my office will be in touch in due course.

Yours sincerely

Christina

Michael Russell then replied as follows on 16 August:

Dear Christina

Thanks for your reply to my email regarding the above. 

I have the greatest of admiration for your skills and this is a skilful reply not least because it answers questions I didn’t ask, but in so doing fails to answer the ones I did.

I am absolutely sure that the IJB will include relevant stakeholders going forward but that was not the point at issue.   The trouble is it didn’t include them when it made the decision on closing Struan Lodge and Thompson Court .   Moreover, to add insult to injury, it pretended that it was going to consult on the closures but instead only intended to consult on the consequences of closure and how those might be best managed.  In addition your answer seems to imply that consultation after decisions are made will be the norm going forward. 

That is – in terms of public accountability and public trust – very unfortunate.   You cannot be unaware of the huge public outcry in Cowal and Bute both about the substantive issue and this slight of hand and your answer has done nothing at all to help the situation.    

Accordingly let me be more explicit regarding the issues I would wish to see addressed by the IJB , and answered by yourself.    These were contained in the final paragraph of my email but I will separate them out to make clear the information, and changes, that I am seeking :

1) I am asking the IJB to immediately revoke the closure decision.   

2) I am asking the IJB to apologise for the way it has handled the closure decision.   The Provost told the Area Committee in Bute two weeks ago that you were “very sorry” for this and wanted to apologise.  If that is so, please do so.  If that is not so, perhaps you can explain why the Provost was so explicit about it and about his conversation with you regarding the matter.  Certainly your response to me contains not a hint at apology. 

3) I am asking the IJB to review the governance of the organisation to ensure that such a flawed process cannot be repeated – in other words when closures decisions are made they are announced as such and are pre-ceded by consultation, not followed by consultation.   The organisation also needs to be open about closures as I am told that press requests for the minutes of the meeting on 22nd June were evaded .  That is not the type of open, transparent decision making that is expected of public bodies in Scotland. 

4) I am asking you to confirm that there will be no repetition of these actions.  In other words I am asking that 3) above informs all future processes with regard to closures.

The points that Michael Breslin has made in response to you are also germane.  I would therefore add two further requests

5) I am asking for full information on the cost savings in this financial year, and in future financial years, from the closure of Struan Lodge and Thompson Court.

6) I am asking for all the information used to assess the consequences of closure and in particular the projections for care of the elderly and available high quality spaces in Cowal.

I look forward to hearing from you.   I have copied this to the original copy list and added in the new Chair of the IJB who , when he takes office, will have to address this major difficulty. 

Yours aye

Michael 

Christina’s reply was sent on 23 August, as follows:

Dear Mike,

I can confirm that the IJB reviewed the decisions made on 22nd June at their meeting on 4th August and concluded that they would not revoke their decision regarding Struan Lodge and Thomson Court as they are in accord with the 3 year Strategic Plan. The Board has acknowledged the timing of the announcement was poor and has apologised for this at its meeting on the 4th August, which will be captured in the publicly available minuted record. It has also directed its officers to reflect this in the planning and engagement events going forward.

The IJB is and will continue to review its processes and systems as it develops as a Board and tackles the urgent service delivery challenges it faces across Argyll and Bute. In line with the legislative framework of integration, the IJB expects the 8 Locality Planning Groups, as they develop in capacity and capability, to be at the forefront of the engagement and involvement processes with communities over the next 3 years, which should prevent a recurrence of this in the future.

The Head of Service is overseeing a period of engagement with the current residents and service users, their family and carers to ensure the plans that are developed are person centred and meet the needs of the individuals.

We are currently pulling together the detailed information detailed in points 5 and 6 of your email, as requested by the Locality Planning Group, as part of its information gathering and analysis. This will be brought to future meetings to inform the redesign of local services in line with the strategic plan. We will share this with you and other stakeholders either at a meeting or via a briefing note.

Yours sincerely

Christina.

On 9 September, I emailed Christina, cc all the people copied into all the above correspondence, with the following:

Good morning Christina. As you have not replied, and since I attended my first meeting of the locality planning group yesterday, I think you should know the following:

There is still precious little evidence of demand but some information has come to light which suggests a shortage of around 30 care home beds in Cowal at some point in the future. This came with a caveat to the effect that this what would happen if the way we do things doesn’t change. I am all for doing things differently and that is why I support the changes that have been ongoing here for around 3 years, where more home care is being provided rather than residential care. Despite that shift in the way we do things, the number of available care beds would be zero if we closed Struan today. See below to see what has happened in 3 years.

There is still an information deficit here Christina and until we have year by year projections as outlined below, I regret I have to retain my stance of opposition to the closure of Struan Lodge.

Regards

Michael Breslin

Lastly, Michael Russell wrote as follows on 11 September:

Dear Christina

I am afraid I am not prepared to accept that the issue is concluded.

There is a public meeting in Dunoon next week at which I will speak and I will indicate my continuing opposition to the closures and in particular to the way in which they were decided upon and implemented.  That, to me, is almost as big an issue as the decision itself.   No such decisions should be able to stand if they are so flawed in execution and if they are based on such flimsy financial and community evidence.   

Moreover this is an appalling way to start the business of the IJB.  The IJB will require all the public backing it can get to undertake the difficult task of adapting health and social care provisions to the increasing needs of our time and the particular difficulties of this place.   For its first significant impact to be one that speaks so strongly of  distant , unaccountable bureaucracy can do nothing but undermine its potential for success and erode public confidence in its actions and processes.   You cannot hope to tackle what you rightly categorise as “urgent service delivery challenges” without the strongest degree of public buy-in and that will be impossible to secure unless you are willing to re-consder these decisions and start afresh with genuine consultation. 

Accordingly I have written to the Cabinet Secretary for Health to make these points and to support the overwhelming opinion within Bute and Cowal which continues to oppose the closures.  In so doing I have also backed the approach to the Cabinet Secretary made by Cllrs Macintyre and Strong who I am certain reflect accurately the views of the Island of Bute. 

Yours sincerely

Michael Russell MSP
You will see that there appears to be an impasse here but the fact remains that, with no evidence base for closure nor any consultation, the IJB has not exactly got off to a good start. There’s another angle to this too which is that the IJB is not the employer of the council staff employed at Struan Lodge and Thomson Court. Can it be right that a body that isn’t the employer takes a decision that could make someone else’s staff redundant? Is this not a decision for one of the partners in the IJB, ie the council itself?

 

Cllr Walsh: playing both sides (2)

In yesterday’s blog (here) I wrote about the background to the privatisation of our care services and the pivotal role taken by Cllr Walsh as both a member of, and chair of, the committee that took the in principle decision to privatise.

The Integrated Joint Board took a decision in June this year to close the residential facility at Struan Lodge. They did this without any consultation and without any impact assessment. Critically, they took the decision without any evidence of the number of care beds that would be needed for Cowal both now and in the future. This decision effectively ended any public sector care for the elderly in Cowal, so the decision taken by Cllr Walsh’s committee in February 2011 was now being implemented in full.

There was a meeting that Cllr Walsh and I attended in Struan Lodge in July, details below, but at that stage we thought this was probably only a proposal rather than a decision.

We only knew that this decision was a final one at the August area committee meeting. A motion was agreed at that meeting which was a combined effort between myself and Cllr Walsh. The minute of that meeting, with the motion, can be found at:printed-minutes-tuesday-02-aug-2016-09-30-bute-and-cowal-area-committee

So far, so good but what was Cllr Walsh playing at? Why, on one hand, had he been behind the privatisation of care services and, on the other, portrayed himself as the saviour of Struan Lodge? You might be interested to know that the other side of our adult care services, care at home and privatised in 2012, has been a concern of mine for some time but Cllr Walsh has never shown any interest in the issue of the wages and conditions of the care workers.

If he was genuinely wanting to see the continuation of public sector care services, it seemed to be that he was in a prime position to make this clear by way of a motion at the next council meeting that, in effect, reversed the February 2011 decision. I said this at the meeting in Struan Lodge in July and I then followed it up with the following string of emails.

From: Breslin, Michael
Sent: 22 August 2016 12:52
To: Walsh, Dick
Cc: Max barr; Blair, Gordon; Strong, Isobel; Macintyre, Robert; Russell MW (Michael), MSP (Michael.Russell.msp@parliament.scot)
Subject: Public Sector Care Provision

Dick, you will recall me saying when we met with Max Barr at Struan Lodge on 7 July that we needed something formal to reverse what I believe to be the last stated council position on this from February 2011.

You spoke with conviction that evening about the need to ensure we retained public sector provision and you did so again at the last area committee.

The February 2011 meeting of the Special Committee for Adult Services is attached and you will see the decision made, presumably endorsed later by either the Executive Committee or the full council. That meeting was, in effect, the start of the privatisation of our care services and not only did you agree to this, you also chaired that committee at the time.

Now, if you have had a change of view on this (and that certainly appears to be the case) then we need a motion at the September council meeting that makes this clear and which reverses the decision taken in 2011, at least in principle. That motion, as I suggested in July, is best coming from you as council leader perhaps seconded by one of the other members of the committee in 2011.

Are you willing to do this please? I am sure you will get widespread support for this if you do.

Thanks

Michael Breslin

He wrote back, taking most of the people copied into the above out of his reply:

From: Walsh, Dick
Sent: 31 August 2016 16:13
To: Breslin, Michael
Cc: ‘Max barr’
Subject: Public Sector Care Provision [OFFICIAL]

Classification: OFFICIAL

Michael

I note with interest the detail in your communication, your references to me, and your belief that the position set out in the minute that you supply going way back to February 2011 ( over  5 years ago) to be the last stated position of the Council. Whilst noting your personal interest in my activities and your personalisation of council decisions to me, it is important to note, having regard to the chronology of actions/decisions, that you are clearly wrong in your belief.

To further assist with your understanding I would advise as follows :-

  • The business cases for Adult Care Services, including Home Care and Care at Home Services were a number of years in development and included consultation with service users and potential providers. I understand this included at least one market test prior to the decision to  move to tender. From memory I further understand that no service provider was willing to take over the Council’s Care Homes when this issue was being considered.
  • Whilst there was an agreed process to be pursued at that time ( February 2011 ) a long journey followed prior to finalising policy and the direction. Much of this journey you will well know as you were involved as a senior member on the then Council SNP led Administration from May 2012 until I think around May 2013.
  • To assist with clarity on that journey and the formalised policy positions of the Council then the following applies :-
  1. Council elections and new SNP led administration – May 2012
  2. Formal acceptance by the  new SNP led Administration and Council to externalise the Home Care Services to certain parts of Argyll and Bute including Cowal and Bute – June 2012
  3. The budget promoted and agreed by the new SNP led Administration to close Struan Lodge and subsequent decisions around this – February 2013. As you will know ( I will not remind you on the detail here ) the successful opposition and public campaign reversed this move   and Struan Lodge remains open. It is important to advise you here that you supported my successful amendment on 25th April 2013 to retain this facility.
  4. A new collective Administration is formed in September 2013 ( which you were part of for a short time ) with budgets being agreed for 2014,2015,2016 on the basis of the continuation of  the services in question.
  5. The implementation of the Scottish Government’s Public Bodies Joint Working legislation and the creation of the Health and Social Care Partnership ( HSCP ) responsible for all health and social care policy direction and service implementation – April 2016.
  6. The position adopted by the Integrated Joint Board agreeing their Financial and Quality Plan 2016 onwards – August 2016
  7. Position adopted unanimously by the Bute and Cowal Area Committee in August and by the Council at its special meeting held in August 2016. The latter related to the proposals within the HSCP Financial and Quality Plan.
  • Having regard to all of the above and the recorded detail as well as the most recent direction of travel then my position has been clear and consistent from February 2013 ( my budget amendment, the agreed amendment on 25th April 2013, my actions since then and more recently) the decisions at the Bute and Cowal Area Committee and the decision taken at the Special Council meeting in August 2016 ( formal position ).
  • That position recognises the issues and changes proposed by the HSCP around reducing hospital beds , reducing Home Care, removing public care home beds, changes to day care, reduction in sleepover services and many more identifying workable solutions – notwithstanding my personal displeasure with all of this I believe what is needed is for all ( identified ) to sit around the table to rectify. Both the council and the H&SCP are facing unprecedented financial reductions and increasing demands however the decisions need to be sustainable and ensure the continuity of care for our older persons.

With the best of intention it is my hope that all of the above assists you with your understanding and the formal decision making process. It also demonstrates I have been consistent in my position from 2013 onwards and the evidence of that is a matter of public record.

Regards

Councillor Dick Walsh

I replied as follows, copying back in the people he had taken out:

From: Breslin, Michael
Sent: 07 September 2016 13:51
To: Walsh, Dick
Cc: ‘Max barr’; Blair, Gordon; Strong, Isobel; Macintyre, Robert; Russell MW (Michael), MSP (Michael.Russell.msp@parliament.scot)
Subject: RE: Public Sector Care Provision [OFFICIAL]

Thanks Dick.

I note you haven’t replied to my question but that you have taken much time and effort in giving me information I already knew.

Can I take it that you won’t propose a motion to the next council meeting supporting the continuation of public sector care provision?

Regards

Michael Breslin

He replied again, and again taking people out of his reply:

From: Walsh, Dick
Sent: 08 September 2016 09:09
To: Breslin, Michael
Subject: RE: Public Sector Care Provision [OFFICIAL]

Classification: OFFICIAL

Michael,

I refer to your further communication.

Having regard to the detail in your earlier communication and what I took as your understanding of the position of the Council and on the basis of your question to me and to be helpful to you I responded as I did. The formal position of the Council should be clear.

Given your continued interest in my position on this matter, let me be clear once again. I am supportive of the retention of Public Sector Care Home provision in the three areas of Argyll and Bute where this already exists.

Regards

Dick Walsh

I replied to this, again putting back in all the people he had copied out:

From: Breslin, Michael
Sent: 08 September 2016 13:25
To: Walsh, Dick
Cc: ‘Max barr’; Blair, Gordon; Strong, Isobel; Macintyre, Robert; Russell MW (Michael), MSP (Michael.Russell.msp@parliament.scot)
Subject: RE: Public Sector Care Provision [OFFICIAL]

I am pleased to hear you support the continuation of public sector provision Dick. The point, though, is that the last stated position of the council was otherwise, ie from the committee you chaired in 2011.

Seems to me you’re not willing to put up a motion in September to get the last stated position of the council altered.

Regards

Michael Breslin

It will be interesting to see if he replies but the position seems clear. He will not try to reverse the in principle decision he took with his committee in February 2011. I am at a loss as to why he behaves in this way but he seems to me to be dodging and diving. Straight questions deserve straight answers and of these there has been none.

This is far from the first time I have witnessed this kind of behaviour from him but, I regret to say, there are plenty others in the council who have learned from him because evasive replies are now firmly part of the culture.

There will be more to follow on this because the Integrated Joint Board (IJB) is digging in and refusing to alter their flawed decision of June this year. I will be publishing some correspondence between various people and the IJB on this issue.

 

Cllr Walsh: playing both sides

I thought long and hard about writing on this issue but with the recent decision of the new Integrated Joint Board for Health & Social Care to close Struan Lodge, the time is right.

People in Dunoon will recall Dick Walsh making himself the saviour of Struan Lodge back in 2013. It was the proposal to close the home, based on misleading financial information, that made me resign from the then administration of the council in order to join forces with Dick in trying to reverse the closure decision, which we eventually did.

Readers of this blog will also know that I have written on a number of occasions about the dire pay and conditions of many of the care at home workers, an issue that has still not been resolved.

At the heart of both these issues was a decision made in February 2011 before I was elected. Some time before this the council had set up a special committee for older people’s services. Dick Walsh was on this committee and for a good period of time he chaired it. He was the chair at the meeting in February 2011 when the following was agreed:

Decision

1. Agreed that homecare and day care services, within the Older Peoples’ part of
Adult Services be put to a tender process to externalise to multiple providers;
2. Agreed that care home services within the Older Peoples’ part of Adult Services
be put to a tender process to externalise to multiple providers and that Adult
Services give further consideration to withdrawing from direct provision of the
service and produce a detailed implementation plan to the Project Board in that
regard; and

3. Noted that timescales have been altered to pick up the direction of travel.

The above decisions meant the privatisation, in principle, of all older people’s care provision in Argyll & Bute. That was what Cllr Walsh wanted and, as chair of the committee, he would have been influential in ensuring this happened.

The full minute can be found here: printed-minutes-thursday-03-feb-2011-12-15-special-committee-for-adult-services

The consequences of this decision were and remain far reaching. The decision to privatise the care at home service was taken in June 2012, my first council meeting. I recall clearly being told by the then council leader, Roddy McCuish, that the paper to privatise (deliberately left by the outgoing leader Cllr Walsh) had to be approved due to the costs involved in re-running the tender if we delayed. I bitterly regret that, as a new councillor, I voted for this. I regret even more that the claimed savings were to come straight from the pockets of the care workers.

There was no mention of this in the paper, of course, because had there been, a number of us would have binned it. Officers later told me that they knew then of the employment practices of the care companies. I think we were misled by omission; do you?

For the man who chaired the committee that made this woeful decision in 2011 to then become the saviour of Struan Lodge in 2013 shows just how Cllr Walsh plays both sides, and so far has got away with it. My next post will take this issue further.