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Why plans to 'ration' surgery in Devon were too politically unpalatable

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Although Northern, Eastern and Western Devon Clinical Commissioning Group has made a U-turn on rationing, it may be a sign of things to come across the country

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Pensioner friends who have just left Devon to live in London again are fearful that the NHS they find in the capital will prove inferior to the one they left behind in the West Country. But did they head up the A303 just in time?

The long running saga of Northern, Eastern and Western Devon Clinical Commissioning Group’s financial woes has reached Parliament and raises wider questions about the future.

In the past week Ben Bradshaw, Labour ex-health minister and culture secretary in Gordon Brown’s cabinet, has staged a Commons adjournment debate in his capacity as MP for Exeter. It seems to have helped prod the CCG into a headline grabbing retreat on its plans to restrict operations on smokers and the obese who have not shown sufficient commitment to addressing their problems by quitting or losing weight.

‘Even St Simon of Stevens had expressed “reservations” about the Devon plan’

Money, not clinical need was the driver, the MP said - surely a breach of the NHS constitution? Public health minister Jane Ellison seemed to agree. NEW Devon backed down.

Despite being a BBC journalist by trade (pause for tabloid hisses), Bradshaw has proved a durable MP who survived controversies as health minister - hospital parking charges, the use of the private sector, to name but two - and still takes a constructive interest in his old portfolios.

“Wholesale rationing” and “a return to the worst kind of postcode lottery”, he warned MPs - and in England’s largest CCG area, which takes in most of Devon, excluding all but the Torbay and Plymouth areas.

The deaf, partially sighted, frail elderly and mentally ill - remember that teenager held in a police cell? - were all up in arms, and Mr B had sad, angry letters to prove it, along with the CCG’s own justification. Even “St Simon of Stevens” (“he’s not the Messiah”, even if he does top the HSJ100 power list) had expressed “reservations” about the Devon plan.

Nothing new

As HSJ readers know, this finance driven crisis has been going on a long time. The CCG is £14.5m in the red this year and it was one of 11 local health economies in England judged earlier this year to be facing severe problems of financial stability and sustainability.

‘The CCG was one of 11 local health economies in England judged to be facing severe problems of financial stability’

The Barnstaple based Northern Devon Healthcare Trust - with its 19 scattered community hospitals, some of which are threatened - is in the firing line, too. Not all has been going well locally. “Relationships must change as a matter of urgency,” trust development overseer David Flory tactfully explained in a letter that arrived too late for the MP’s debate.

“Strained” is the word Mr Bradshaw uses. The Flory team and Monitor have been on Devon’s case since the spring, but the CCG’s long term viability proposals have not yet been signed off by Whitehall.

Down in Devon

What’s the problem? asks Bradshaw. Too many retirees in Devon - at least my two pals have left - too much inefficiency, squabbling, “spending money unwisely” as health minister Norman Lamb apparently told BBC Radio Devon?

‘Times are going to stay tough’

Every region has distinctive care needs and problems, which is why David Cameron has been struggling this week to put some belated coherence into long stalled English regional devolution. Large, rural and elderly Devon’s health headaches will not disappear simply if its greater autonomy can be made to work better, and public confidence is restored through improved consultation and communications.

Times are going to stay tough.

In HSJ last month the King’s Fund’s Chris Ham optimistically extolled the merits of the new “bilingualism” that unites clinical and management skills, budgets and services, Kaiser Permanente style. Pessimists look at the Devon crisis as the “canary in the coal mine” paving the way for a shrinking NHS service menu and, one day, even top-up insurance for the rest.

Michael White writes about politics for The Guardian

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