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“NHS England will keep you informed” Thats not dialogue!

November 11, 2015

dwb nhse blog

NHS England has invested millions of pounds in its NHS Citizen programme to strengthen its dialogue with the public. Unfortunately, where it really matters – when its decisions affects whole communities – there is no dialogue.

Here’s the story

Darnall Wellbeing is a small community organisation in Sheffield working alongside citizens in this poor, multi-racial, vibrant part of our city to help them improve their wellbeing. Darnall has a community that includes white British, South Asian, Somali, Roma, Eastern European and more.

Darnall Wellbeing works hard to integrate its services with other voluntary organisations and also the local General Practice – who are all salaried employees of Sheffield Health and Social Care Trust – they are called the Clover Group and provide a General Practice service in 3 other parts of the city as well.

Approximately 3 years ago Darnall Wellbeing made a decision to move into the same premises as the GPs in order to provide a more integrated service. This move is in line with the ambition set out in the NHSE 5 Year Forward View for ‘Multi-Speciality Community Providers’.

This is about providing a better service with citizens from the local community bringing their skills and creativity to create solutions to Health and Wellbeing on their terms.

Darnall Wellbeing has

  • 4 Health Trainers (including one recently recruited from the Roma Community)
  • Over 40 Volunteer Practice Champions – who work with the General Practice
  • Over 40  Community Health Champions

People in Darnall have created:

  • Allotments
  • Cycle Training
  • Dance groups
  • Conversation Groups……and more

In addition Darnall Wellbeing is part of the Enhanced Primary and Community Care Project with the General Practice. This identifies those who are most likely to to be at risk of premature hospitalisation and then tailors targeted health and community support to them. The Practice Champions and Heath Trainers are the bridge; building relationships and community support for these priority people.

You can read more about Darnall Wellbeing’s work here.

Then along comes NHS England

NHSE are tendering for the Clover Group service – the outcome will directly affect Darnall Wellbeing and the citizens of Darnall have helped to create this integrated service.

So the chair Dr Jack Czauderna wrote to NHSE on the 9th of October. his letter is available here, one of his key concerns was:

“we are minded about the degree of consultation which NHS England are required to carry out when making commissioning decisions in Primary Care. This particularly applies to the involvement of patients in these decisions. The community organisations, particularly related to Darnall include many Clover patients among their staff and users. DWB has at least 40 Practice Champions who volunteer around health issues but remain patients of the Clover Practice.

We are formally asking you:

  • What consultation have you undertaken so far with the communities who rely on these services?
  • If asked would you be prepared to come to a public meeting to explain your tender specification and how this will improve the services, assets and health needs of these communities?”

On the 6th of November Darnall Wellbeing received a reply from NHS England NHS England reply (I have taken out names) which can be read here, there is an excerpt below:

“In terms of the consultation process, advice received is that as the services to be recommissioned by NHS England (core, additional and essential GMS services) remain the same. Therefore there is no service change for the element NHS England is responsible for and patients should experience no adverse change to the services they currently receive.

NHS England will be employing a communications strategy to keep patients and the current provider informed of any developments.”

Not good enough

  • The ambitions set out in the NHS England five year forward view don’t seem to be understood by staff who are managing procurement. The letter says that services “are the same” as they were before the Five Year View was written. I cannot see how the contract for these services “stays the same” when NHS England has in the interim produced a report that explicitly calls for different service models!
  • As I explain above the Darnall service has  not “stayed the same’ there are now rich co-produced relationships involving almost 100 local citizen volunteers who are directly involved in delivering a sophisticated holistic service in partnership with the practice.

It feels as though there is a no interest in engaging and talking directly to the communities and organisations who are actively involved in seeking to improve their own wellbeing and are at the front line of creating a the new health service that the five year forward view calls for.

As I said in an earlier blog – I support the 5 year view – its analysis is good and its call for greater integration and strengthening the role of the voluntary sector is spot on its just that NHS England don’t appear to be working to it!

I don’t see how NHS England can run a procurement process without bothering to understand what the Darnall model might be and the implications of this for any tendering process.

What do you think?

Declarations of Interest
I am a trustee of Darnall Wellbeing and a Lay Member on Sheffield Clinical Commissioning Group – the views above do not represent those of either organisation.

6 Comments leave one →
  1. November 11, 2015 12:19

    I think this is spot on. You can see what the trustees of a local charity, Darnall Forum, think about this issue at

  2. Ruth Rigby permalink
    November 11, 2015 15:11

    Oh dear, this is very disappointing isn’t it and, on the face of it, smacks of something between unimaginative and poor quality commissioning/procurement. I’d be interested to understand what level of NHSE co-commissioning the CCG has as, although it creates a real confusion of interests in some situations, this is exactly the kind of scenario where you would anticipate the CCG’s more locally focussed, strategic approach to commissioning would see the benefits and may be look more carefully at commissioning options. Also, it highlights what for me is a major concern about the ability of the VCS to deliver on the challenge that I think the 5YFV sets for it and for health commissioners working with it. It is a sector not easily understood by Health commissioners, understood best – within the NHS – by frontline practitioners, and it’s the sector most damaged/easily destroyed by poor commissioning and procurement. So we risk setting up innovative and successful vanguard MCPs and PACS with voluntary sector input that risk being pulled down as soon as someone looks at longer term procurement. Mark, this is an area I’m really interested in and really concerned about. We’re LinkedIn if you want to compare notes!

    • November 11, 2015 15:59

      Hi Ruth Thank you for your thoughtful response to the blog – I agree completely – Sheffield CCG moves to level 3 – (the one with the greatest autonomy as I am sure you are aware) in March 2016. This does of course make this process all the more frustrating because if NHSE had their thinking cap on they would have found a way of delaying this exercise until then – which would as you say have allowed the re-procurement to be much more sensitised to local circumstances…..and I will check you out on linkedin!

      All the best – Mark

  3. Gaynor Lloyd permalink
    November 12, 2015 00:05

    Our 5 APMS practices in Brent are being tendered by NHSE with no engagement – unless you call letters advising patients and summoning them to meetings on no notice to tell them their “GP’s knew their contracts were coming to an end” and that “some staff may stay” “engagement”. Patients who got the advice letter in time we re told that the point is that, if you have a complaint against your GP, NHSE can more easily get rid f them. (I am told). The fact that the practice’s patients had battled for 9 years to get the practice transferred to their (Previously PCT employed) GP’s till they could take it under a Right to Request as a social enterprise in 2013 – and deeply value their GPs QUITE irrelevant. This is all about NHSE wanting to impose new model contracts and moving to 30000 list sizes. Here in Brent we are fighting with everything we can think of. There is a duty on NHSE to consult under section 13Q of the 2006 Act (as amended by the 2012 Act). And what does the local LMC think?


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