The must-read stories and debate in health policy and leadership.

Bowing to pressure

Commissioners in Derbyshire have backtracked on their controversial proposals to decommission a service for people with severe mental health needs, following strong pushback from the public and local politicians. 

When HSJ first reported on the four Derbyshire clinical commissioning groups’ plans to decommission their psychodynamic therapy service as part of a wider cost savings plan, the local branch of Unite union warned the commissioners were “leaving patients with nowhere else to go”.

The typical patient who accesses psychodynamic therapy service needs support for severe mental health problems. Often they have suffered trauma or abuse as a child. Those against the closure of the service contested there was currently no alternative commissioned for this group, many of whom had already tried other therapies.

After months of public and political outcry, the CCGs - which have some serious financial problems on their plate - have decided to stop the consultation to decommission the service. Instead, they will be reviewing all psychological therapies offered across the region.

It seems very likely they will think twice before proposing the same cut again, at least not without proposing a convincing alternative.

Location, location, location

The Kent and Medway stroke reconfiguration has been a long time in gestation – it started in 2014 – but a decision on where to site three combined hyperacute and acute stroke units is expected early next year.

A decision by the joint committee of CCGs in late January is unlikely to be the end of the tale, however.

The immediate danger is opposition from within the joint health overview and scrutiny committee set up by Medway Council and Kent County Council, with representatives from Bexley Council and East Sussex County Council also taking part.

On Friday, a decision to proceed was only carried by the casting vote of the chair, and some members wanted to meet again this week to examine the plans further. The HOSC will get a chance to look again at a final version of the plans in January before they go to the joint CCGs committee for approval.  

Friday’s meeting heard concerns ranging from the practical (eg: are plans for rehabilitation likely to keep up with the acute services changes?) to more fundamental ones, such as the impact on deprived areas (neither Thanet nor Medway will have an HASU if proposals go ahead as they stand).

Another challenge might come from Medway Council, which this week may well push for judicial review of the way the sites were chosen. It says changes to the evaluation process, introduced at a late stage without time to assess them, ruled out options with Medway Hospital as a HASU. The NHS disputes some of this but councillors were obviously troubled.

Finally, implementation of whatever solution is adopted will have to happen in a rapidly-changing healthcare environment. In principle, the creation of HASUs in the north and west of the county could happen within 15 months. However, it may be a struggle to maintain services in Medway until then.