Keep caring for Cambridgeshire and Peterborough

Residents across Cambridgeshire and Peterborough are being urged by civic and community leaders from across the county to “Keep caring” for one another, as coronavirus hasn’t gone away.

A campaign has launched to reinvigorate public health messages and remind people that while lockdown restrictions are gradually being lifted – everyone needs to take action to help us all return to a more normal life.

With certain government restrictions relaxed from 4 July, including being able to meet in groups of up to two households in any location – public or private, indoors or outdoors – it remains the case that even inside someone’s home you should continue to keep a safe distance from anyone not in your household or bubble.

The two metre rule being relaxed to a ‘1 metre plus’ approach depends on the setting, and means people are being trusted to continue acting responsibly by following this and the related guidance to care for themselves and each other.

The more people we interact with, the more chance the virus has to spread. Therefore, everyone should still try to limit the number of people they see and get close to. The risk of transmission is also higher indoors, so people should take extra care including wearing a face covering on public transport and in enclosed spaces where you can’t stay two metres apart.

The Keep Caring campaign led by Cambridgeshire County Council and Peterborough City Council, and supported by Cambridgeshire and Peterborough Combined Authority, Cambridgeshire Constabulary, the Office of the Police and Crime Commissioner, Cambridgeshire Fire and Rescue Service, East of England Ambulance Service, the local NHS, community organisations and local district councils, outlines ways that people can take care of themselves and each other – for instance highlighting that:

  • Caring is keeping your distance – inside or outside
  • Caring is being responsible – staying isolated if you think you’ve got symptoms, or been close to someone who has
  • Caring is covering your face – even with no symptoms you might still spread virus
  • Caring is washing your hands – regularly, when you enter or leave a new place

It also points out that:

  • Caring is staying and buying local – to support local businesses and jobs
  • Caring is being considerate – rubbish destroys our countryside, and puts those who clear it up at risk

Dr Liz Robin, Director of Public Health for Cambridgeshire and Peterborough said:

“It is the public who have reduced the transmission of coronavirus so far. By taking care of themselves and each other, fatalities and infection rates in Cambridgeshire and Peterborough have continued to fall.

But our message today is that this caring can’t stop now, as the most important thing we can continue to do is to stay alert, control the virus, and, in doing so, save more lives.

The government updated its plan for social distancing from 4 July, but the message remains strong that to continue to reduce the transmission of the virus, we should continue good hygiene rules, washing our hands and surfaces often, remain physically distant from people outside of our household, and keep your mouth and nose covered where you can’t be sure of staying apart.”

Comprehensive advice on current government rules is available on the gov.uk website.

Decision on which deckchairs to move delayed as healthcare in Cambridgeshire and Peterborough slowly sinks.

Earlier this week the Cambridge and Peterborough Clinical Commissioning Group (CCG) met to look at what funding it could cut to help it relieve its £192 Million deficit. This was of importance to local charities as they were looking at the funding for community services which includes a number of small grants that were to be ended or renegotiated. This blog concentrates charities but other community services that play a vital role are also under threat.

The first thing to say is that the groups affected have worked really hard with Support Cambridgeshire, and especially Julie Farrow from Hunts Forum to show the value of the work they do and to raise awareness of the impact of the cuts. This blog is simply CCVSs views which incorporate points raised by both Support Cambridgeshire and Healthwatch Cambridgeshire and Peterborough. You can read a statement from Healthwatch here.

The second thing to say is that the CCG are the second lowest funded per person in the country. This means that they get £350 per person less than West Norfolk CCG as an example. This is compounded by the speed at which the area’s population is growing. This is not new news, but it is relevant. What is also relevant is the fact that the CCG made a disastrous decision to contract out its older people’s healthcare and adult community services a number of years ago and lost a lot of money. It is probably also worth pointing out that this is not the first round of cuts for the sector from the CCG, I can still remember when many more projects were funded, including CCVS!

So what were the plans? I have highlighted the charity aspects from the papers which recommend

The Governing Body is asked to approve:

The outcome of the MDT process, Steering Group, COT and IPAC discussions is that we would cease funding or decommission the following:

  • Dial-a-Ride
  • The Stroke Association
  • The Alzheimer’s Society
  • The Carer’s Trust Cambridgeshire & Peterborough, Norfolk
  • The Health and Wellbeing Network
  • ECHIS (The Evelyn Community Head Injury Service)

The CCG would seek to renegotiate service provision and/or payment for the following:

  • The Care Network
  • Cambridge Hearing Help

The CCG would continue to fund:

  • The East Anglian Children’s Hospital

Just some initial thoughts.

The grant to Dial-a-ride is £6,516 a year or 0.003% of the deficit. The fact that this service is for Cambridge only and is not seen as clinical does not mean it is not saving the health service money. People can get ambulances, and in fact the CCG have a contract with the ambulance service. But dial-a-ride is so much more than just getting people to hospital, and is also I assume way cheaper per trip.

Cambridgeshire Hearing Help (CHH) work with 6500 users at 43 clinics across Cambridgeshire plus house bound provision to help them with hearing aids, they receive £34,682 or £5.34 per user. Specsavers receive £1,682,653 a year for their audiology service and charge £17 a session and people have to get to the shop. So, if these are to be renegotiated as per the papers lets hope loads more money goes to CHH. These figures do not even start to think about the value added of the CHH delivery model and the benefits of working with volunteers.

Why is the first main finding on the East Anglia Children’s Hospice (EACH) entry in the papers is “This service has great reputational impact on CCG if funding was ceased.” I think that the work EACH does is fantastic and needs to continue, and I hope that the proposal to continue to fund it was not because of the possible reputational impact and simply because EACH is fantastic!

So what’s the problem and what’s the solution?

There is undoubtedly a lack of money in the system and things need to be fairer. The local MPs are on the case

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We should be putting pressure on whoever we can to get a fairer funding settlement, just as we are for education (what has Cambridgeshire done to upset the Whitehall mandarins to get such lousy settlements in education and health?)

Along with this we need to help the CCG understand the true value of funding the voluntary sector and the added value we bring. The savings that family carers make to the health system is massive, and so funding them to be better able to continue seems like a no brainer, but the CCG feel that the service supplied by Carers Trust is not cost effective as

“ this service provides services for carers rather than patients themselves and is more of prevention and crisis management rather than clinical provision.”

So if it prevents people accessing expensive services and helps the management of crises outside the system it should be welcomed. At an event I attended recently a Carers Trust volunteer and ex carer stated (and I paraphrase this)

“Carers Trust didn’t save my life, but they definitely saved my sanity and allowed me to continue to provide care for my partner”.

I know all the charities facing possible grant cuts would have similar stories, and I know that much work has gone on to ensure that these are shared with the CCG decision makers. At the end of the day they have to decide if it is making decisions based on just the basic figures, or if it recognises that prevention is always better than a cure.

Three things that small charities want to say about commissioning

Lots has been written about commissioning, much of it focused on big national projects, much of it focused on failure. This article is focused on the local and the small. The first thing to say is that this is not a criticism, we understand the funding constraints that local government are under, we understand that at the heart of it local government workers and local councillors are as passionate about people and communities as we in the community and charity sector are. But before you write that paper or take that vote please give these three points some thought.

1 Commissioning is ultimately about people and communities.

The paper you are writing or voting on about the latest commissioning proposal might be motivated by finding savings or rationalising delivery. But ultimately it is about people and their wellbeing. What you decide will make an impact (positively or negatively) on people and communities. Small charities and community groups are integral to the health of communities and the people who live in them. Local services add value whoever they are delivered by. When thinking about commissioning you need to think how your decisions will impact on the wider community and not just about how a service in isolation will look.

2 Is commissioning really the best way to deliver?

Can better results be achieved through grants or controversially by delivering services in house. There is a growing recognition that contracts are not always the best way forward. Whether this is down to the collapse of Carillion nationally, the failure of some large charities like 4Children or Lifeline who aggressively pursued contracts or more locally with the demise of Uniting Care Partnership, there is a move to look at alternatives. Much has been written about the benefits of grants, not least in the fact that it shares some of the risk between the charitable sector and the statutory sector. Grants can increase innovation, as you are not as likely to stipulate a model of working and it leaves small groups to adapt to local circumstances. Grants to small groups will bring value added as often they utilise volunteers to enable better value, or they are able to help with associated issues rather than just tick the contractual box.

3 If you are commissioning be inclusive.

Sometimes commissioning will be the best or only way to proceed, and if this is the case then everything needs to be done to be inclusive to smaller local participants. The move to bigger contracts may seem to offer better value but often this is a false economy, and at the same time bundling contracts into a bigger package means smaller more specialist local providers may be unable to bid as they can not take on the whole contract. Social value should be given its rightful place in deciding on the contract, this is a legal requirement and helps non-profit providers demonstrate the added value they are often able to bring to delivering a service. Finally, if you are commissioning please do not ask providers to jump through excessive hoops, this will disadvantage smaller organisations without the experienced commissioning teams and means many great providers fall at the first hurdle. The law has to be adhered to, but sometimes legal teams are so risk adverse that their interpretation can exclude the best providers.

There are good examples of commissioning and good examples of where commissioning has been avoided in favour of different funding models. We believe that local delivery by not for profit organisations has many advantages; it keeps the money spent in the local economy; it adds social value through the use of volunteers and fundraising; it invests all the money into delivering the service and not delivering a return to shareholders; it contributes to healthy and resilient communities. In short we want all those who decide on how to deliver services to remember these three things

  • If you have to commission do it in a way that enables smaller local providers.
  • Think carefully if there is a better alternative to commissioning
  • In all your deliberations remember the impact will affect the lives of real people and the communities they, and you, live and work in.

Please contact mark@cambridgecvs.org.uk if you would like to discuss this further.

What the Health is going on?

Hands up – it has been a while since any reports on attendance at health meetings, so this blog is designed to rectify that and to draw together some general thoughts on health related issues and the voluntary sector.

So what is going on – the big news is that the new provider for adult services has been announced. UnitingCare Partnership, which is a consortium of Cambridgeshire and Peterborough NHS Foundation Trust with Cambridge University Hospitals NHS Foundation Trust, are the lucky winners. They will have a duty to work with voluntary sector providers and we will need to keep a close eye on how the sector can get involved and especially how smaller local providers can be supported.

Another big announcement saw the publication of the Public Health Annual Report This can be viewed here. This report sets out the different health issues facing the county broken down by district. The report will inform much of the future work across the council and CCG and should be regarded as a source of information for VCS organisations.

Other big health news includes

  • The Better Care Fund which is a government plan for allowing local areas to reform health care. It looks to move funding from acute to community health provision. The County Council are responsible for this and have put in their initial plans to government. This has been a long and difficult process and the sector have been involved to some part, but expressions of interest for projects have not been taken forward despite the time and effort put into preparing them. More information can be found in the papers from the latest Health and Wellbeing Board here.
  • The Cambridgeshire and Peterborough Clinical Commissioning Group CCG have been developing a Five Year Plan. More information can be found on the CCG website. There is ongoing discussion as to the role of the VCS in this and it is important that we keep an eye on how providers can get involved. The fact that this area is one of the countries ‘financially challenged health authorities’ probably precludes lots of money for grants to support projects, this does not mean that some funding should not flow into the sector.

These notes follow attendance at the following meetings (if papers are available follow the links)

So what does all this tell us about health and what the voluntary sector can do?

There seem to a whole raft of positives for the sector in all these new initiatives. Firstly everyone is expressing their love for the work that we do to ensure healthier communities; secondly there is a real narrative that services have to move to a more preventative nature, this is great for the sector because as a rule it is where the bulk of our work is situated. Thirdly there is a move to a more person centred, local style of service, again right up the sectors street. There are undoubtedly going to be opportunities for sector providers to play a role in the new ways of working but things are not all rosy – given that there are severe financial constraints, given that commissioning does not generally favour the small, localised and specialist services that a lot of CCVS members provide, and given that acute services can not be stopped and will continue to demand greater funding despite the desire to work more preventively.

Finally we must recognise that change brings about a certain amount of introspection and this has been evident in those organisations responsible for funding health and wellbeing; hopefully, although there are still changes happening, both the CCG and the County Council are looking out more and more. I believe that it is important that as they start looking out they see a confident and professional VCS waiting to take up the opportunities that arise. There needs to be more joined up thinking about how the sector delivers and this is starting to happen, and there needs to be projects that clearly align with the priorities that have been articulated.

The search for someone to provide Older Peoples services continues

The consultation on the Older People’s Programme dominated the latest meeting of the Fenland Health and Wellbeing Partnership. And so it should it my opinion.

This is the biggest change in the way that health services are delivered in the county for a long time, and Cambridgeshire and Peterborough CCG are leading the way nationally in commissioning such a big piece of work. So the first thing to say is – have your say – check out the consultation website and encourage all those you work with to do the same. Spoiler alert – this page is quite long as is the consultation so it is not particularly user-friendly.

I guess for me there are three questions about this.

The first is what will the impact of the consultation be, especially the first question that asks

“On page 11 of the consultation document, Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) explains the reasons behind these changes. Please can you rate on the scale below how supportive you are of these reasons for changes?”

If everyone strongly disagrees will they not go ahead with the process? There was a hint at the meeting that this project could still be stopped if the prospective suppliers did not meet standards etc. So could people power really make a difference?

The second question I have is how this all adds up for services, for those using them and for those proving them. In effect the contractors are being asked to provide comparable services for less money. I am sure that there are efficiencies to be made in the current system that contractors could exploit to drive costs down, but introducing an extra layer of monitoring and a whole new infrastructure will surely cost so will services remain the same, will standards really improve and can we be assured that those delivering services on the ground continue to have the same salaries and benefits as they currently have. As those that know me will attest I am not a financial genius but I cannot see how these companies can deliver the same services for less money, and that overall that this way of working will save the NHS and us significant amounts of money.

My third question is where do the Voluntary and Community sector sit in this process? The consultation document talks a lot about community services and even has a section on the voluntary sector that states

“We believe that the use of the voluntary sector is very important in supporting independence and healthy living. One of the questions the CCG is asking bidders is how they will work with the voluntary sector. For bidders to answer this, we would expect them to make contact with voluntary organisations and to develop an understanding of what benefits the voluntary organisations can deliver to our patients.

As part of the procurement process a number of events have been held to provide an opportunity for voluntary sector organisations to meet with bidders to showcase the services they provide.

Bidders will be asked to explain how they will work with and fund services offered by the voluntary sector.”

So there you have it we should be expecting to receive funding – grants as well as commissions I hope. That said I don’t think that any of the shortlisted providers have been knocking on the door of CCVS to find out what the sector is doing and what they might like to do. If you have met with the shortlisted providers do let me know I would be interested to hear your experiences. CCVS will continue to push for a greater dialogue with all parties on the sectors role. We feel that it is essential that some guarantees are built into the contracts.

Getting back to the wider Fenland Health and Wellbeing Partnership I am pleased to say that future minutes and agendas will be published on the FDC website. I will post a link once they become available.

There continues to be a real feel of joined up working across some of the key priorities that the partnership have identified. Despite not getting funding to become a Local Alcohol Action Area the council are looking at how to reduce issues caused by alcohol both around health and crime and will be looking at the impact of a super strength campaign similar to the one underway in Ipswich. Similarly there is some great work underway about reducing Coronary Heart Disease and encouraging people to get a health test. More info on the FDC website.

Update the latest newsletter about the Older People’s Service is available here