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NHS England Letter on Funding Crisis and My Reply

Below, finally, is a letter from NHS England on the Devon NHS funding crisis and my reply.


12 December 2014

Dear Ben,

Re: NEW Devon CCG plans

Thanks for your recent letters on this topic.

There is a real need to ensure that the NHS in Devon can live within its means. However I share some of your concerns about some of the short term measures under examination.

We were therefore pleased to see the CCG's decision announced yesterday to amend its initial proposals. Following significant feedback from a wide range of stakeholders, I am advised that the CCG has decided that the availability of smoking-cessation and weight-loss services for patients can be sufficient both to improve outcomes for patients and to avoid clinically-inappropriate healthcare expenditure. The CCG has publicly committed that patients will continue to receive the care and treatment to which they are entitled under the NHS Constitution. NHS England will continue to scrutinise the CCG's proposals, seeking assurance that the proposals are in the best interests of patients, are based on sound evidence and are subject to a well-planned process, including consultation if appropriate.

You also asked about the situation concerning the Exeter Walk-in Centre. I am told that the CCG's intention is to commission a doctor-led Urgent Care Centre (UGC) in Exeter, probably located on the Royal Devon and Exeter NHS Foundation Trust Hospital site, which would provide robust, consistent, high-quality medical care for urgent care problems. This service would be open from 8am to 10Dm seven days a week. Further planning and consultation will take place, and any changes would not take place until later in 2015.

As to the CCG's finances, the NEW Devon community was selected earlier this year as one of eleven 'financially-challenged health economies' in England, triggering extra support from NHS England, the Trust Development Authority and Monitor. This external support was designed to help the CCG and its partners (NHS providers and Devon County and Plymouth City Councils) establish plans for models of care and service delivery which would meet patients' needs and at the same time produce more efficient working.  I understand that this work is progressing, with the whole community of providers and commissioners now working together to set out a programme of joint action to improve services for patients through the development of new models of care, within the strategic framework set out in the NHS Five Year Forward View.

Yours sincerely,

Simon Stevens

CEO, NHS England




Dear Simon,
Thank you for your letter of today with an update of the situation affecting the NHS in Devon.
The Minister in her response to my debate yesterday said that a report based on the work done in Devon and the other financially challenged health economies would be published "soon". There is no mention of this in your letter. The results of this work are vital in terms of understanding the underlying reasons for the particular challenge facing the NHS in Devon and subsequent solutions. This work was commissioned in February - nearly a year ago. So I would be grateful if you could  
explain why it has taken so long, while the situation in Devon has been allowed to deteriorate, and when it will be published.
Mrs Ellison also said you would be having a meeting with New Devon CCG next week. I would be grateful if you could provide me with an update after this. While the dropping of some of the rationing proposals is welcome, many others remain in place - including very worrying ones affecting hearing and sight loss. The letter from the CCG of December 3rd (a copy of which you can find on my website) also indicates the rationing proposals are only a start and that more cuts and rationing will be identified in December and announced in January. This will only raise more concern in Devon that until the looming £430 million deficit is explained and addressed, we will simply be subjected to more unacceptable cuts to services in rationing in the weeks and months to come.
I also draw your attention to the letter I received yesterday (also on my website) from David Flory, head of the national Trust Development Authority, acknowledging serious concerns about how well North Devon NHS Trust interacts with the other NHS organisations in Devon. As NHS England is ultimately responsible for overseeing the work of local NHS organisations, I would be grateful if you could outline to me what steps you are taking to deal with this problem and ensure all of the NHS organisations in Devon focus on what is in the best interests of the public, rather than squabbling amongst themselves.  
The terrible case of the 16 year old girl with mental health problems kept in a police cell for two nights recently is an indication that things have not improved in young people's mental health services in Devon since I first began raising concerns about this with NHS England three years ago. As I indicated in my speech yesterday, the circumstances of this case were not unusual (there were 30 similar cases in Devon last year) and they were not as described by the Health Secretary to me in the House of Commons last week. They were as a result of the chaotic and fragmented commissioning and care pathway process put in place by the Government's Health and Social Care Act combined with the refusal of private sector providers to accommodate the girl. I would be grateful if you could arrange for the full details of what happened in this this case to be provided to me or made public, so that the right lessons can be learned. I would also be grateful if you could update me on what progress NHS England is making in addressing the problem of commissioning and the care pathway for children with mental health problems in Devon.
Finally, I am extremely concerned to learn that it appears to be the clear intention of New Devon CCG to close Exeter's NHS Walk In Centre. No data or evidence have been produced in support of such a decision. It would not be supported by any local GP I have spoken to, nor the thousands and growing number of patients who use it because they find it difficult or impossible to see a GP at all, or at a time when it's convenient for them.
I look forward to your reply.
With very best wishes,     


Ben Bradshaw MP

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