Tuesday, 25 October 2016

West Cheshire NHS Consultation - proposals to stop certain treatments

West Cheshire NHS Clinical Commissioning Group has just launched a consultation about which services, if any, it should cease to fund.
The consultation runs from today until Tuesday 17 January 2017.
West Cheshire CCG is consulting whether to cease funding or make available on a more restricted basis the following procedures:
  • Surgery for the correction of asymmetrical breasts
  • Surgery for breast reduction
  • Surgery for Gynaecomastia
  • Hair removal treatments
  • Surgery to remove benign skin lesions
  • Desensitising light therapy using UVB or PUVA for PMLE 
  • Ear wax removal including microsuction
  • In Vitro Fertilisation (IVF) with or without Intracytoplasmic Sperm Injection (ICSI) 
  • Surgical Sperm Recovery (Testicular Epididymal Sperm Aspiration (TESA)/Percutaneous  Sperm Aspiration (PESA) including storage where required
  • Donor Oocyte Cycle – depending on outcome of consultation relating to IVF
  • Donor Sperm Insemination
  • Intrauterine Insemination (IUI) unstimulated 
  • Sterilisation (male & female)
  • Arthroscopy – Shoulder (see document for more information) 
  • Dupuytren’s Contracture – surgical and nonsurgical interventions
  • Knee replacement 
  • Hip Injections (excluding bursitis)
  • Erectile Dysfunction 
  • Percutaneous posterior tibial nerve stimulation (PTNS) for urinary and faecal incontinence.

This is the text of the NHS press release:

In September we launched “Our Savings Plan” to start a frank conversation about the challenging financial position facing the local NHS and the savings we must make in 2016/17 to help ensure a sustainable, high-quality health and care system in West Cheshire – both now and in the future.

There are many reasons for the financial challenges we face, not least that we have a fast-growing, ageing population and more people than ever are being diagnosed with long-term conditions.

This means that demand for local health and care services is rising faster than our budget.We simply do not have enough money to continue to buy all the services we currently do in the same way as before. If we did, in 2016/17 alone we would spend £13m more than our budget.

As this challenge is similar in many areas, the Clinical Commissioning Groups (CCGs) for West Cheshire, Eastern Cheshire, South Cheshire, Vale Royal and Wirral, have come together in partnership to ask the public for their views on proposed changes to some services that we currently commission.

A consultation has been launched which is asking the public and other stakeholders for their views on the proposals, building on work already undertaken to engage with local people about the challenging financial position facing the local NHS and proposed changes to services.

Dr Andy McAlavey, Medical Director, NHS West Cheshire Clinical Commissioning Group comments: "This is the first time that CCGs in this area have come together to seek the views of the public and stakeholders as we continue with our programme of changes. Our aim is to ensure that the services we provide are effective and sustainable whilst we continue to encourage people to lead healthier lives. It is important for us to make the best use of our resources and we are encouraging people to have their say."

Cheshire and Wirral Clinical Commissioning Groups are undertaking a formal consultation on the proposals detailed in the consultation documents below to explore them in more detail and obtain feedback from patients and the public. The consultation will run from Tuesday, October 25, 2016 to midnight on Tuesday, January 17, 2017.

How to share your views
As part of the consultation we need your views on the proposals and to understand the impact they may have on you. To hear what you think about the proposals you have a variety of opportunities to give your feedback.You can fill in the questionnaire included in the consultation document below and submit by post to, SRP consultation, NHS West Cheshire Clinical Commissioning Group, 1829 Building, Countess of Chester Health Park, Liverpool Road, Chester CH2 1HJ

By email – send your completed surveys to: enquiries.wcheshireccg@nhs.netIf people are hard of hearing, have sight impairment, English is not their first language or they require the information in an alternative format, please contact 0800 132996 or email: enquiries.wcheshireccg@nhs.net'

Copies of the consultation documentation and surveys can be obtained from West Cheshire CCG.

Saturday, 22 October 2016

Congress of Local Authorities at the Council of Europe

I've been appointed as one of 18 UK local authority or regional assembly members to serve on the Congress of  Local Authorities at the Council of Europe for the next 4 years.

For those not in the know the Council of Europe was established by Winston Churchill after World War II to foster good relations between Europe's member states.  He first called for the creation of a body like the Council of Europe in 1943.   This led to the Council of Europe being established by the Treaty of London in 1949.  Initially there were 10 signatories to the treaty.  Now 47 countries are 'signed up to' the Council of Europe   The Council of Europe is both older and wider than the EU which only has 27 member states (if you don't count the UK).

Bust of Winston Churchill at the Council of Europe
For those of us old enough to remember the Cold War and the battles that were had with the Eastern Bloc over Human Rights - they were largely 'fought' in the context of the Council of Europe and wider international diplomacy.

Over the years the member states of the Council of Europe have signed over 220 treaties between them covering all manner of things from terrorism, to animal welfare.  However most fundamentally they are about embedding democracy, the rule of law and human rights within the 47 member states.  The Council of Europe works largely by consensus, by persuasion, and by pointing out or establishing 'facts.'

Within the scope of the Council of Europe are a number of institutions such as the:
Council of Ministers
Parliamentary Assembly
Congress of Local and Regional Authorities
Court of Human Rights
I found attendance at the Congress of Local and Regional Authorities both very humbling and very interesting.

The Council of Europe is one of the few places outside the UN where delegates from all Europe's countries can meet each other.  As we all know there are too many places in Europe where there are tensions.
Map of the 47 countries - note Belarus is not a member.
I witnessed several 'encounters' between the Russian and Ukrainian delegates and there were several in depth discussions about the situation in Turkey.

For many of the new and emerging democracies of Europe the Council of Europe and its standards are seen as the benchmark against which they need to develop their democracies.  It was also very interesting both to see how other 'good Europeans' embraced everything and how far behind the UK some countries are - and that includes some of the founder members of the EU such as with regard to gender equality at a political representation level.

The representatives to the Congress of Local Authorities are meant to reflect each countries diversity - with particular focus on political representation and no worse than a 70:30 split between the genders.  However looking around the Chamber I was very conscious that it looked like the UK was leading the way in terms of minority diversity.

As a citizen of the United Kingdom though, and someone committed to greater partnership working across Europe it dawned on me increasingly whilst I was there that we don't see and understand 'Europe' in the same way as our continental friends.   We think differently to them.  Our constitutional background, our approach to fundamentals such as democracy and human rights is different.   Most crucially of all - we have no written constitution.

Also, with some exceptions such as the European Convention on Human Rights few of the Treaties signed over the years by the UK can be used as the basis for court challenges in the UK.   For us Parliament is Sovereign.  We all look to Parliament for our laws and ultimately to safeguard our democratic values.  Other European States look to their written constitutions and the various international treaties and conventions for their norms and values.

However whilst we differ in our approach we do appear to be marching along a similar path - looking to deepen and broaden democratic values and principles.

Does it matter if our approach is different if we reach the same goal?  As a pragmatic Brit I would say 'no' - however the Council of Europe experts don't like what they see as the UK's 'exceptionalism.'  They have assessed the UK's compliance with the European Social Charter unfavourably and on a par, in parts, with Turkey and Ukraine.  I had an 'exchange of views' with a Spanish Law Professor on this assessment and pointed out that 3.6 million EU citizens had come to the UK to live and work because of our liberal labour market and not because of our weather!

A number of delegates from other countries came up to me afterwards and indicated their agreement with my approach.

I spoke in 3 other debates.  Two related to gender – first with regard to gender equality at all levels of politics and another on ‘gender budgeting.’

The Council of Europe wants all European countries to have at least 40% female representation at all political levels.  Many European countries are no where near that level.  Having heard an inspirational speech from Mayor from an Austrian town of around 12,000 people  - who happened to be a young woman - I was able to interject that in the UK some 31% of councillors are female.  At CWaC 37% of councillors are female and both the leaders and deputy leaders of the ruling and opposition groups are female as is the leader of Cheshire East.  In 2011 when I became Mayor of Frodsham we had, and that council still has, a gender balanced council.  I am not personally in favour of quotas – but I did suggest that those institutions that haven't achieved reasonable representational levels should account to their communities as to why that hadn’t happened.

We also had a debate on ‘gender budgeting.’ My first reaction to the title of the debate was one of incredulity – and this was not helped when one delegate suggested that spending on motorways was  masculine and spending on pavements was feminine.  However on reading the papers it became clear that ‘Gender Budgeting’ was Euro-speak for making sure that public sector budgets reached and assisted everyone.   I was therefore able to support the principle – and pointed out that any public sector budget and spending that did not deliver for all its citizens was inherently defective.  I went further in my remarks and pointed out that public sector budgeting had to consider not only gender but also had to consider all the disadvantaged and minorities.  The rapporteur agreed with me.

The other debate I spoke in was about Turkey and in particular the removal of elected Mayors by the national government.  This process had started before the coup and has continued after it.

I spoke in support of the Turkish people and made the fundamental points about the need for the respect for the rule of law and human rights.  I went on to say that when democracy is under threat the answer to that threat is more democracy and not less democracy.

When the UK leaves the EU the Council of Europe will be one of our main points of contact with other European countries.

The frack-free 'Community Survey'

Lynn and I have been invited to attend the count of the Frack Free Frodsham and Helsby survey on Saturday 22 October.  It is our intention to attend.  The event is likely to prove interesting - although I do wonder just how informative and useful it will ultimately prove to be.

I have been told in writing that a 'simple questionnaire' has been hand delivered to 1,500 residents in Frodsham and 1,200 in Helsby.  Quite how or why these figures have been chosen or what they represent remains to be seen.

For example in Frodsham we have a population around 9,500.  Helsby's population is about half of Frodsham's.  If the survey is to be representative of all of Frodsham and Helsby a further 900 residents should have been surveyed in Frodsham so as to maintain the relative proportions between the communities.

My household received one of the survey forms - a week after an anti-fracking leaflet was distributed.
Regardless of what you think vis a vis fracking - the credibility of any survey and crucially if it is to carry any weight and reflect the views of local residents with developers, planners, councils and perhaps ultimately the planning inspectorate and Government Ministers - then bias is a dangerous thing.  I don't think it was a good idea to distribute an anti-fracking leaflet house to house the week before the survey is handed round.

Now I make these remarks as someone who wants to ensure that the public is given the decisive say in any controversial planning applications such as for fracking.  This has been my position for several years and it was on this basis that Lynn and I were re-elected in 2015.  It is also the policy of the opposition Conservative Group on the Borough Council.

I know that in the planning process poorly conducted surveys will either be ignored or exposed for being flawed.  That's why Lynn and I are committed to calling a formal parish poll if a planning application for fracking is received.  A parish poll is a rarely used form of local referendum conducted for a parish by the Borough Council.  Those wishing to take part in the parish poll will have to attend a polling station to register their views.

I've attached below a copy of the survey forms I received.  Incidentally the came through my letter box crumpled!

I have to say the question 'Do you think it would be a good thing or a bad thing is Shale Gas 'Fracking' takes place in Frodsham and Helsby' is too simplistic.

The issues about shale gas exploration and extraction can't really be summed up that way as anyone who attended the local debates organised by Frodsham Transition Initiative and our MP Graham Evans MP will no doubt agree.

I expect no one would support anything that would cause pollution - and everyone I envisage would support the UK having energy security and access to  essential chemical feedstocks.  However the issues are much more nuanced than just being a 'good idea' or a 'bad idea' in my view.

I'm also concerned that the survey only allows one family member to represent the views of other family members.  Every elector in a parish poll has to cast their vote themselves.

You may also notice that my survey form has the letters FH36 on the top right hand corner and that the postcode had to be added to the response form too.

This is clearly not an anonymous survey.  Someone will be able to trace FH36 and the answers that were provided - in this instance by my wife.  I wonder how she characterised my views and whether she wrote anything in for the views of our children all of whom are away at University?  She did tell me that two people called at the house on separate occasions and that they were most insistent that she provided answers.

Of course these issues necessarily raise questions of what the resultant information is going to be used for.  There are a whole host of Data Protection issues that necessarily arise too.  What is going to happen to survey form FH36 after this exercise?  How many were distributed to my postcode?

Now fracking policy is very much on the local political agenda at the moment.

Labour controlled CWaC, notwithstanding its unlawful election manifesto policy of banning fracking in the Borough (please see earlier blog posts explaining how the Borough Solicitor had to advise Labour about its unlawful policy) is now devising policy that will permit fracking to take place here.

I have table several amendments to their proposed policies - on each occasion seeking to tighten them and to provide greater protection for the environment and human health as well as by seeking to ensure a decisive say in such applications for the local community.  Whilst some of my amendments have been accepted not all of them have been.

Labour controlled CWaC consulted on these planning policies over the summer.  If you look at the council's local plan website today (18 October) you'll see that not one single Labour Councillor commented on any planning policy proposals.  I know that at least 18 Conservative councillors did so.

A Special Planning Document providing further planning guidance for those seeking planning permission for fracking has also just been published by Labour controlled CWaC.  In my view, again this does not go far enough in terms of providing protection for the environment and the local community etc.  I tabled amendments to this too - and again some were accepted - but not as many as should have been.

We live in interesting times - at the moment.  Not everything is what it seems to be.

You may wonder why I've raised party politics about this survey?  Well it is a known Labour activist that is one of the key promoters of the survey - seemingly at odds with what his party is doing on the Borough Council.

Sunday, 16 October 2016

The Police and Crime Commissioner's poor performance - and on so many levels

Every quarter the Police and Crime Commissioner is expected to appear before the Cheshire Police and Crime Panel for a scrutiny session in public.  

Our last meeting was on 23 September.  As the meetings are webcast you can view the meeting by following this link http://cheshirewestandchester.public-i.tv/core/portal/webcast_interactive/218012

The panel meetings start at 10am and the Police and Crime Commissioner's scrutiny session typically lasts an hour and is expected to start at 11am.  However on 23 September the Police and Crime Commissioner was late.  In fact he was so late that, as a panel, we began discussing postponing the meeting.  

When he and his entourage finally arrived he complained that he had had problems parking and getting into the building.  Given that there is a public car park at Wyvern House, a long drive where he could have got out of his car and, of course the building is a public building where both CWaC and Winsford Town Council provide services to the public I struggle to understand how he was nearly 15 minutes late - and especially as he and his entourage only had to make the short journey from Police HQ in Winsford to Wyvern House which is also in Winsford.

I was brought up that if you arrive 'on-time' you are late... specifically so you can deal with the minor delays that happen to all of us.

Now our scrutiny sessions are an opportunity to ask questions and on occasion challenge the police and crime commissioner about how he is performing his duties.  They are a blend of questions that are asked on notice, and those that arise on the day.  Personally I'm not a great fan of questions on notice as you tend to get officer drafted responses - however I accept that if you don't give notice it can be perfectly reasonable, depending on the topic, for the commissioner to respond that he needs to undertake further research.

On Monday 19 September I tabled 6 questions for the Commissioner.  They were all focused on Police and Crime Support Officers.  There are over 200 PCSOs in the Cheshire Police area.  Many of these PCSOs are solely funded by the Police and Crime Commissioner out of the police precept  - however others are part-funded by the Borough Councils, Town and Parish Councils and other organisations such as Housing Partners such as Social Landlords.

Most, if not all of these part-funding organisations have a Service Level Agreement that sets out what the Partner organisations can expect if they pay - what is generally reckoned to be - about a third of the costs of the PCSO.  The annual contribution is around £12,800 per co-funded PCSO.  Those SLA agreements deal with 'tasking' of the partner funded PCSO amongst other things.  Interestingly the agreements also seek to pass any potential employment related costs - such as TUPE redundancy cost onto the partner organisations and not the police!  The offer to the partner organisations is that they can influence how 'their' PCSO is tasked locally - why otherwise part fund a PCSO?

So my questions were:
  1. whether the commissioner is to continue his predecessor's policy of one PCSO per ward; 
  2. whether he welcomes funding from partners - such as from the unitary authorities, Town and Parish Councils, social landlords and the like; 
  3. what steps he is taking to secure funding from partners if any; 
  4. what steps he is taking to ensure fair funding of PCSOs - and in particular the potential triple if not quadruple taxation of a social housing tenant in a parished area who is paying for a PCSO via the Police and Crime Commissioners precept, the Borough Council's precept, the Town/Parish Council's precept, and via the rent paid to the social landlord;
  5. what incentive do Town and Parish Councils have to continue funding PCSOs if one is to be provided by the Chief Constable; is he ready for an increase in Town and Parish Council's ceasing to fund 'their' PCSO in this budget round; and finally 
  6. How many PCSOs are habitually available in Frodsham.
Now I expected that with the Commissioner having been given a week's notice he would have provided me with word-perfect, pre-prepared answers.

He didn't.

As you can see from the webcast he waffled, dodged, evaded - and gave me the very clear impression that he simply did not understand the issues.  And it wasn't just me, one of my colleagues on the panel, and not a member of the Conservative party said to me afterwards: 'Can he ever answer a question?  He just waffled.'

His first answer that surprised me by how poorly informed he was came when he indicated that his predecessor did not have a policy of one PCSO (and indeed one Special Constable) per ward.  This was the policy of his predecessor and was regularly discussed at the Police and Crime Panel.  I even have correspondence from the former commissioner confirming this policy and if he challenges me over it - I will publish it - as well as referring him to earlier webcast meetings of the Police and Crime Panel where this policy was clearly set out.

This is a significant point - as, why should partner organisations part-fund PCSOs if they are going to be provided for them anyway?  Parish Councils in both CWaC and Cheshire East have already ceased their funding on this basis.  

Also this raises questions of double, triple or even quadruple taxation.  Just how many times and in how many ways should you pay towards a single PCSOs?

We all pay council tax.  The council tax in Frodsham is made up of contributions to:
  1. CWaC
  2. Police and Crime Commissioner
  3. Fire and Rescue Service
  4. Frodsham Town Council
In local government speak these are 'precepting organisations.'

Elsewhere in the Borough there can be a fifth element to the council tax.  It is called 'special expenses.'  Special expenses is CWaC's way of charging a defined community for the costs of services CWaC provides to that defined community which elsewhere in Borough are provided by Town or Parish councils.  In Frodsham the special expenses figure is zero simply because it is the town council that provides these very local services such as 'our' PCSO.

Three of the four precepting organisations either provide or part-fund PCSOs - the only one that doesn't is the Fire and Rescue Service.  However even though Frodsham Council Tax payers pay three organisations that fund or part fund PCSOs we only have one PCSO and that's the one part paid for by the Town Council.

The situation is even worse if you are a social housing tenant and your landlord part funds PCSOs.  You'll be paying a contribution through your rent for those PCSOs too.

Now within CWaC we used to have at least 12 parish or town councils that funded PCSOs.  Great Boughton Parish Council has already ceased funding a PCSO,  Tarporley Parish Council looks set to cease funding a PCSO.  This takes us down to 10.  This is in addition to Weaver Vale Housing Trust that ceasing funding 'their' PCSOs last year.   You'd have thought the Police and Crime Commissioner would have been across this issue as it threatens not only the funding of PCSOs but also the partnership working which part funded PCSOs embody.  He wasn't.  

The withdrawal of partnership funding in my view should be a matter of significant concern for him.

Parish and Town Councils typically work out their budgets in November - as they formally set them in January.  So Town and Parish councils will be deciding now whether to continue co-funding their PCSOs.  I pointed this out to the Commissioner and sought to encourage him to work with Town and Parish Councils now.  He declined to do so saying he would have a review - but that it wouldn't be completed in the timeframe that would assist town and parish councils setting their budgets now.

You'd have thought the Commissioner was interested in preserving the maximum number of PCSOs in Cheshire - seemingly not though given his answers.

Now, so far as I am concerned it is too early to determine whether this Commissioner is simply badly briefed, badly informed, or whether he is simply not up to the job.  I suspect it is the latter - especially as he was on notice of the questions I was going to ask and the preparation required to answer my questions shouldn't have taken anyone that long.  Also we have to remember that our current Commissioner remains a Warrington Borough Councillor and a Parish Councillor so you'd have expected him to be familiar with Cheshire Police's partnership working with councils.

However, I'll give him the benefit of the doubt for now.  But lets see if he is actually able to answer questions next time.

If I was to mark him on his present performance though he is firmly in the 'must do better' category.  He has to grasp that he is there to be accountable and part of his duties includes answering questions.  And if he is to do that effectively he has to do his homework first.

Thursday, 6 October 2016

How many PCSOs do we have in Frodsham?

So how many PCSOs do we have in Frodsham?  A simple question you may think.

I believe the answer is 1.

Now I've understood that we have had 1 PCSO in Frodsham for as long as there have been PCSOs. So given this I was somewhat shocked to discover that CWaC had data suggesting that Frodsham shared another PCSO with other rural communities - and, worse they wanted to charge Frodsham council tax payers extra council tax to pay for this seemingly additional resource.

I was not happy.

I started to ask questions.  I spoke with our local police and our PCSO.   They confirmed that whilst, understandably, there was some mutual support with colleagues looking after other communities there is one PCSO for Frodsham.

I asked CWaC to show me why they thought we had an additional share of a PCSO.  I went so far as to ask our Police and Crime Commissioner.  Now I'm going to blog separately about my interchanges with the Police and Crime Commissioner as they are a whole new story in themselves.  Interestingly he was unable to tell me how many PCSOs we have in Frodsham.

Any way the good news is - at  a meeting with CWaC yesterday I was pleased to see that CWaC now accept that Frodsham has one PCSO only - and he is part funded by the Town Council and as such they will not be seeking to levy an additional charge on Frodsham council tax payers.