The Board of  Monitor (the Ofgem of the NHS, ie the quango that promotes “competition” in the NHS “market”) met on 29th October to deliberate in secret about re-commissioning NHS community services like Locala’s in Kirklees.

Agenda item 7 asked the Monitor Board to note, in secret, “significant developments with regard to the work of the Co-operation and Competition directorate.”

They say if the public knew what the directorate had found, this would “inhibit the free frank disclosure of information.”

Secret examination of how privatised community services like Locala’s are being recommissioned

The Cooperation and Competition Directorate’s secret report on “significant developments” included a review of how Clinical Commissioning Groups are re-commissioning privatised NHS community services like the ones contracted out to Locala, now that their  initial three year contracts are up.

Locala was set up under the Transforming Community Services scheme that transferred NHS community services from what were then Primary Care Trusts, to private/corporate providers under block contracts.

Kirklees Clinical Commissioning Groups put £284m NHS community services contract out to tender

Now that the Locala contract is coming to the end of its one-year extension to its original 3 year contract, Greater Huddersfield and North Kirklees have just published a competitive tender document inviting bids to deliver an estimated £284 000 000 worth of community services, over a 7 year period.

It would be good for the public to know more about this re-commissioning process, but Monitor doesn’t want us to.

Monitor says that this – and several other “significant developments” in the work of the Co-operation and Competition Directorate – are exempt from FOI under section 36, because:

“The information is exempt because disclosure of that information would, or would be likely to, inhibit the free
and frank provision of advice, or exchange of views for the
purposes of deliberation…. disclosure of this information will not enhance the accountability or transparency of Monitor as its disclosure would inhibit the free frank disclosure of information.”

So what are Monitor saying behind closed doors that they know the public would not tolerate if they knew about it?

Locala’s “commercial confidentiality” issues behind hospital Trust’s refusal to  publish Outline Business Case for Right Care Right Time Right Place

Monitor’s secret deliberations come at the same time that Calderdale and Huddersfield Hospital Trust’s Freedom of Information Office has gone back on its promise to release a redacted version of the Outline Business Plan for the Transformation of Calderdale and Huddersfield Health and Social Care, after it had twice failed to meet its own deadlines for sending me the redacted document.

The Trust’s FOI Office justified its backtracking on the grounds that once tenders for Kirklees Clinical Commissioning Groups’ Care in the Community contracts have been submitted on 24th November, the Outline Business Case will no longer include commercially sensitive information.

So the CHFT’s partner organisations (Locala and the mental health Trust) have agreed to publish the full, unredacted OBC after 24th November.

Before CHFT FOI Office went back on its word, I had just complained to the Information Commissioners Office about the two-times failure of Calderdale and Huddersfield NHS Foundation Trust to provide me with a redacted version of the Outline Business Case for the transformation of Calderdale and Huddersfield NHS and social care, by the deadlines they had promised to meet.

Scrutiny Committee ignores Calderdale 38 Degrees NHS Campaign’s call for public consultation

And what are our Councillors on the Calderdale and Kirklees Joint Health Scrutiny Committee (JHSC) doing to make sure the local NHS commissioners and providers are acting in the best interests of the public, and to stop them if they’re not?

Not a lot.

The Chair and Secretary of Calderdale 38 Degrees NHS Campaign group wrote to the JHSC Chair, Councillor Elizabeth Smaje, after the first meeting of the JHSC on September 22nd when it started its scrutiny of local NHS commissioners’ commissioning intentions for the new system of NHS community care that they are calling Care Closer to Home.

The Calderdale 38 Degrees Secretary pointed out that the commissioning intentions for Care Closer to Home amount to a significant variation in the NHS and so require a formal public consultation before the Clinical Commissioning Groups can set them up – but the CCGs have decided to go ahead without any public consultation.

Replying on behalf of Cllr Smaje, Kirklees Council’s Principal Governance & Democratic Engagement Officer wrote:

“The re-commissioning of community services and the proposed changes will be closely scrutinised and appropriate challenge will be made if deemed necessary. The Kirklees Scrutiny Panel is currently seeking more detailed information on the services that will be included in the procurement process that will be followed to secure the future community healthcare services.

Once this information is available the Panel will consider the implications of the proposed changes which will include consideration on whether they constitute a substantial development of variation in health service.”

But there is no date for the JHSC to meet again. Despite the fact that the Kirklees Clinical Commissioning Groups have now published detailed information in the £284m community health care services tender document.

The Calderdale 38 Degrees Chair, Ken Cheslett, suggested to the JHSC that it would benefit from the appointment of an advisor to help them scrutinise the proposed changes to hospital services in Calderdale and Greater Huddersfield.

The Principal Governance & Democratic Engagement Officer replied:

“The Committee has been established to scrutinise any proposed service configuration with a specific focus on proposals to hospital services and it is at this point that the Committee may have to give consideration to obtaining independent expert advice and support. In advance of this phase of work we will be investigating a number of options on how we can obtain this support.”

The Save Calderdale Royal Hospital campaign had previously contacted two expert advisers who agreed they would be willing and able to advise Councillors.

The Calderdale 38 Degrees Chair Ken Cheslett has replied to Cllr Smaje and Richard Dunne as follows:

“Dear Councillor Smaje and Mr Dunne.
Your response is very disappointing.
The fact that the CCG. Plan to set up ‘Care Closer to Home’ without any public consultation has to be legally questionable, therefore the need for an expert advisor to unravel the legality, or otherwise, is even more imperative.
How strange therefore, that you do not consider it appropriate to appoint an expert advisor asap.”

As one member of the public said after attending a “public engagement” event about the proposals to cut acute and A&E hospital services and replace them with the new, cheaper care in the community system, trying to find out what’s going on is “like wrestling with fog”.

Despite this ongoing secrecy and obscurity, we know what’s happening. It’s NHS cuts and privatisation.

Back in 2010, in the dying days of the New Labour government, the House of Commons Health Committee said that after 20 years of costly failure, NHS marketisation and privatisation may need to be abolished.

What a pity MPs refused to take any notice of their own Health Committee.  And then went ahead and passed the ConDem’s Health and Social Care Act 2012.

This has increased the “costly failure” of NHS marketisation and privatisation and made decision making about the future of our NHS more and more secretive.