Appendix 28 Miscellaneous Evidence
A
This email pertains to the much moved OSG meeting in South Molton on
15th July 2014, It was claimed in the press release given out before the meeting
that there would not be a vote on whether to close the hospital beds.(
Appendix 30 b) This press release states “At this meeting, no votes will be
taken on any decisions as this is not the role of the group” and yet the
statement below by Kerry Burton sent out to Oversight Group members
contradicts this.
From: Burton Kerry (NHS NORTHERN, EASTERN AND WESTERN DEVON CCG)
Date: 04/07/2014 13:23:41
To: Isaac Makylla (NHS NORTHERN, EASTERN AND WESTERN DEVON CCG); andy boyd;
anne ayre; carol mccormack hole; david humphries; di davey; dr david mclellan; Bagwell
Emma (NORTHERN DEVON HEALTHCARE NHS TRUST); gary beer; jane whittaker; julia lock;
Kennelly Nicola (NORTHERN DEVON HEALTHCARE NHS TRUST); richard rumbold; Doble
Stella (NORTHERN DEVON HEALTHCARE NHS TRUST); Miller Stephen (NHS NORTHERN,
EASTERN AND WESTERN DEVON CCG); Cheshire Nicola (NORTHERN DEVON HEALTHCARE
NHS TRUST)
Cc: Hudson Stephen (NORTHERN DEVON HEALTHCARE NHS TRUST); Walker Belinda
(NORTHERN DEVON HEALTHCARE NHS TRUST)
Subject: RE: RE: Next Oversight Group meeting
Dear All
First Makylla thanks for your help and I am sorry I was away this afternoon.
It was most helpfully brought to my attention later today that of course the second
group is not quorate in accordance with the TORs we agreed, and if therefore there
is no right to vote, should that be required, it rather invalidates any contribution that
membership would like to make or indeed the influence they could have.
Please do forgive my error. In discussion with Dr McLellan we would refer you to the
TORs again and ask Allin, Di, and Nicky to either offer contributions to be tabled at
the meeting on the 15th or nominate a deputy to attend the 15th instead.
I do apologise and for clarity this means there is just one Oversight meeting to
formulate recommendations for the NDHT and Northern Devon Boards and that will
be on the 15th July at 2pm, Torrington Hospital
Kind regards
Kerry Burton 01769 575129 or 07772 883 242
B
The delay in answering letters
A letter was sent from a constituent to MP Nick Harvey on 18th March
2014. This was then forwarded to the Trust. The Trust wrote a reply dated
14th May 2014 but this was not received by the MP until around 12th
June. The constituent received a reply on 18th June (a 3 month response
time)
C
Reasons for the long length of stay in Torrington Hospital –
mis-management?
Page 2 of a 3 page letter from Jac Kelly (Chief Executive Officer NDHT) to
Nick Harvey MP dated 16th January 2014 where she is admitting that
patients the length of stay in Torrington Hospital is increasing.... “if we
look at the reasons for the long lengths of stay for some patients it is not
because they have an ongoing medical need, but have a complex set of
needs including social care for which alternative support is required”
D
Concern for patients?
One of the reasons given for the switch in venue of the OSG from Torrington
Hospital to South Molton.
From: Dawe Caroline (NHS NORTHERN, EASTERN AND WESTERN DEVON CCG)
Date: 14/07/2014 11:23:55 Subject: Torrington oversight group
Dear oversight group member,After lengthy consideration, we have reluctantly
decided that we must change the venue for tomorrow’s oversight group meeting one
last time. We have not made this decision lightly and have taken account of your
emails today asking for clarification about the previous change.The meeting will now
be held at Crown Yealm House, South Molton, at 2 pm, Tuesday 15th July.
The reason the first decision was made to change the venue from Torrington
Community Hospital is because having a lobby group may compromise the safety
and confidentiality of the 50 patients expected there for clinic appointments
tomorrow.
Comment:- A gross exaggeration . A freedom of information request
FOI/14/075 (appendix 14) showed that there were only 7 patients seen on
Tuesday 15th July, not 50 as claimed by the CCG
E
“Freedom of information requests were responded to in a timely manner”
In the Trust/CCG Engagement Document it is claimed,
“Freedom of information requests were responded to in a timely manner”
The Oxford dictionary defines “timely” as “coming at the right time.”
A freedom of information request legally must be answered within twenty working days.
Here is an example of A freedom of Information Request reference FOI-13-185, which was later
renumbered FOI-13-263 and FOI-13-266, which provides a paper trail of correspondence stretching
from the original request for information on 24th November 2013 until 19th March 2014. This
request took almost four months to provide the information requested.
Given that this request took almost four months to provide the information requested, this could
not be considered a “timely response”. Some people might therefore say that to claim,
“Freedom of information requests were responded to in a timely manner”
Would not be an honest statement.
..................................................................................................................................................
F
This submission is included as evidence as it gives an insight of the thoughts of a Torrington GP
compared with the Vice-Chair of the Clinical Commissioning Group (now Director for Community –
NDHT) leading the changes to close the overnight beds in Torrington Hospital.
THERE FOLLOWS A SERIES OF E-MAILS BETWEEN DR ALISTAIR BREMNER OF CASTLE
GARDENS SURGERY TORRINGTON, AND DR CHRIS BOWMAN VICE-CHAIR NORTHERN
LOCALITY, NEW DEVON CCG. ( Dr Bowman is now Director of Commuity sernices and an
employee of the Trust)
Oldest e mail is printed first so that they can be read in sequence.
19 SEPT 2103 FROM ALISTAIR BREMNER TO CLLR MARGARET BROWN and others
On Behalf Of Alastair Bremner
[Alastair@bremnerhome.com<mailto:Alastair@bremnerhome.com><mailto:Alastair@bremnerhome.c
om<mailto:Alastair@bremnerhome.com>>]
> Sent: 19 September 2013 14:06
> To:
Margaret.Brown@torridge.gov.uk<mailto:Margaret.Brown@torridge.gov.uk><mailto:Margaret.Brown
@torridge.gov.uk<mailto:Margaret.Brown@torridge.gov.uk>>
> Cc: Bowman Christopher (WALLINGBROOK HEALTH CENTRE); Womersley John (WARWICK
PRACTICE); Reed Chris (TORRINGTON HEALTH CENTRE); Kaliciak Alisha (CASTLE GARDENS
SURGERY); Davey Stuart (CASTLE GARDENS SURGERY)
> Subject: Torrington Hospital beds
>
> Dear Margaret,
>
> I would be very happy for you to show my letter ( and this
> email )to Nick Harvey MPand also To Geoffrey Cox QC MP. In fact I
> have already posted a copy to Geoffrey Cox at his Bideford office so
> he should already be aware of its contents .
>
> With regard to paragraph 3 of your letter and the use of the
> hospital as an overflow ward - Of course it may be correct to say
> " No not happening " now , but my impression and that of my
> colleagues is that it did happen on a fairly regular basis . I am
> afraid I just do not agree with the Trust .( I regret now that I
> did not spend my time marking down the numbers in a little notebook
> to present as evidence at a later date !...)
>
> "Saying that Home Care Teams will be there for the patient" is
> full of good intent , but the proof of this pudding will be in the
> eating .. I have been told that the Trust has appointed a Community
> Care of the Elderly Consultant - but have learned later that this
> will be for one session ( ie one morning or one afternoon) per
> week .. This seems to me to be something of a sticking plaster in
> terms of medical manpower.
> The key to making something like this work is in building a
> mutually supportive and stable community nursing team . I think that
> a full time consultant care of the elderly physician could act as
> a leader of the community nursing team and a direct link with GPs
> in sorting out organisational problems in the care of patients . To
> make a generalisation , but one which I think many doctors and
> nurses would agree - nurses tend to work in a rule bound
> hierarchical structure. This has benefits in terms of standardising
> care - but it sometimes leads to a "work to the rulebook " (> sometimes for fear of repercussions from higher up the management
> tree-) and when this happens there are times when the needs of the
> patient are not met . As the management at NDHT knows this can
> lead to situations which are frankly unacceptable for ongoing
> patient care. To have a doctor with overall responsibility for the
> community nursing team (rather than a nurse manager )might help
> to resolve these problems as they arise in future, without the
> need for all the GPs in Torrington to arrange meetings with
> nursing management as has happened in the past .
>
> As regards GPs having to cover large geographical areas- that
> is a problem already and with a the significant increases in
> population which I have already mentioned I do not see it getting
> any better . Frankly the Tust is just wrong to brush these
> concerns aside .
>
> Dr Chris Bowman ( of the Locality Commissioning Group as
> opposed to NDHT ) has sought to reassure me that the reason for
> these changes is not fundamentally driven by a need to save money
> , and in fact it may work out as more expensive in the long
> run than keeping Torrington Hospital Beds open . I would not
> question his sincerity but I just wonder if the commissioners have
> had full access to the accounts for Torrington Hospital to see
> exactly what is spent on what . When I was attending the
> "shadow" commissioning board ( before GPs assumed overall
> commissioning responsibilty ) the response of the Trust to
> enquiries regarding the costs of Torrington Hospital might best be
> described as oblique .... Sometimes I have wondered whether a Freedom
> of Information Act enquiry might force the Trust to release the
> figures regarding what is after all taxpayers money .
>
> I hope this is helpful .
>
>
Yours sincerely ,
>
>
Alastair
>
>
*******************************************************************************************************************
*
>
23RD SEPT FROM DR CHRIS BOWMAN TO ALISTAIR BREMNER
> On 23 September 2013 00:15, Bowman Christopher (WALLINGBROOK HEALTH CENTRE) <
christopher.bowman@nhs.net<mailto:christopher.bowman@nhs.net><mailto:christopher.bowman@n
hs.net<mailto:christopher.bowman@nhs.net>>> wrote:
> Dear Alastair
>
> Thank you for copying me in to your email. With regard to the Community Physician provision it
would appear two separate issues have become mixed into one.
>
> The situation is that the Trust has been trying to appoint a full-time community based physician for
the last 3 years without success. They continue to try and appoint to this full-time post. This is an
ongoing issue and not related to Torrington.
>
> In recognition of the concerns raised by yourselves and the request for support, the Trust is able to
support an extra session of time for an existing physician to provide support in the community. When
we originally spoke regarding this support you did indicate that telephone contact would be adequate.
This I understand you will have as well as a physical presence once every 2 weeks and possibly
weekly. The logistics to make this happen have not yet been finalised. It has been suggested that the
session coincides with your CCT weekly meeting so the physician can both meet with yourselves but
also the community team and provide that clinical leadership you requested.
>
> I assume this addresses your concern and I apologise for not being clear in differentiating between
the two issues. I am more than happy to be contacted to answer any queries regarding this or any
other issue as it is important that judgements are based on timely and accurate information.
>
> With kind regards
>
> Chris
>
> Dr Chris Bowman
>
> Vice-Chair Northern Locality, NEW Devon CCG
23RD SEPTEMBER FROM ALISTAIR BREMNER TO DR CHRIS BOWMAN- MARGARET BROWN
and others
> Sent: 23 September 2013 11:24 From Alistair Bremner
> To: Bowman Christopher (WALLINGBROOK HEALTH CENTRE)
> Cc: Margaret.Brown@torridge.gov.uk<mailto:Margaret.Brown@torridge.gov.uk>; Womersley John
(WARWICK PRACTICE); Reed Chris (TORRINGTON HEALTH CENTRE); Kaliciak Alisha (CASTLE
GARDENS SURGERY); Davey Stuart (CASTLE GARDENS SURGERY); Smith Tim (CASTLE
GARDENS SURGERY)
> Subject: Re: Torrington Hospital beds
>
> Dear Chris ,
>
>
The Trust may have tried unsuccessfully to appoint a community based physician prior to
the Torrington Hospital beds issue, but I believe these issues are clearly linked in that they both
affect nursing and medical care in the community .
>
> Regarding physicians and telephone calls - there seems to have been a misunderstanding .
Ultimately a community physician has to be available to make an assessment of a patient in person
( ie in the community ). There is a limit as to what can be achieved by telephone contact, and I
certainly would not have wanted to give any other impression of my opinion .
> I know that a community physician will cover a larger area than the 100 + square miles of
Torrington +parishes but they need to be available to see patients at home ( in some cases
within 24 hours ) to be effective . I am afraid I was rather disappointed when I learned that the
community physician would be available to Torrington for one session ( ie half a day ) per week . I
think that any community physician needs to be free to plan their own timetable to be flexible to
the needs of patients in different areas . It probably won't work if he or she is bound by a contract
which says for example that they will be available to Torrington for tuesday afternoons only , and
whether a total time allocation of one session a week will be adequate remains to be seen.
>
> With Kind regards,
>
>
Alastair.
25TH SEPT. FROM DR CHRIS BOWMAN TO ALISTAIR BREMNER
> On 25 September 2013 12:24, Bowman Christopher (WALLINGBROOK HEALTH CENTRE) <
christopher.bowman@nhs.net<mailto:christopher.bowman@nhs.net>> wrote:
> Dear Alastair
> We are in agreement that they are clearly linked with regard to both nursing and medical care in the
community. The point I was responding to in your email was, "I have been told that the Trust has
appointed a Community Care of the Elderly Consultant - but have learned later that this will be
for one session ( ie one morning or one afternoon) per week." The clarification was that this is not a
new appointment but a redefining of the workload of an existing physician. Naturally this will not have
the flexibility to provide the maximum benefit as it will have to be worked into an existing schedule of
outpatient clinics, ward rounds etc. I have copied Kate Lyons into this email as I am sure the
opportunity exists for both the local GPs and the District Nursing Team to agree with the physician
how best that time can be used.
> I do fully accept that this is not the same as a full time Community Physician but the learning gained
will help inform now best a full time post holder can be employed once that appointment is made.
> To better understand all of these issues is one of the reasons we are undertaking a test of change
and until this has been undertaken and evaluated no long term decisions can be made.
> I will be in Torrington next Monday so would welcome the opportunity to discuss this further if you or
your partners are available.
> With kind regards
> Chris
>
> Dr Chris Bowman
>
> Vice-Chair Northern Locality, NEW Devon CCG
26TH SEPT. FROM ALISTAIR BREMNER TO DR CHRIS BOWMAN
From: waggadon@googlemail.com [waggadon@googlemail.com] On Behalf Of Alastair Bremner
[Alastair@bremnerhome.com]
> Sent: 26 September 2013 11:24
> To: Bowman Christopher (WALLINGBROOK HEALTH CENTRE)
> Cc: Margaret.Brown@torridge.gov.uk; Womersley John (WARWICK PRACTICE); Reed Chris
(TORRINGTON HEALTH CENTRE); Kaliciak Alisha (CASTLE GARDENS SURGERY); Davey Stuart
(CASTLE GARDENS SURGERY); Smith Tim (CASTLE GARDENS SURGERY); Lyons Kate
(NORTHERN DEVON HEALTHCARE NHS TRUST)
> Subject: Re: Torrington Hospital beds
>
> Dear Chris,
>
>
So there we have it . This is not a new appointment but merely a redeployment of an
existing post involving one tenth of a working week .
>
> What can I say ? Who is NDHT trying to kid ? I think it is very unwise of NDHT to give misleading
information and this simply further undermines its credibility .
>
> Has NDHT been trying for three years to appoint a Community Physician ? Has it really ?
What is the job description and salary ? I think we need to have sight of this information to appraise
it for ourselves .
>
> The term " test of change " is management terminology which is indefinite and could mean
many different things . If you could explain exactly what you mean by this I would be grateful .
>
> I am sorry if this email seems rather blunt - my beef is with NDHT and not yourself . The
problem is that NDHT do not seem to grasp how important it is to be totally transparent with all the
facts and figures in order to be credible . This is after all public money . It seems in retrospect
that they put a sort "spin" on their "community physician " information and I find this really
distasteful.
>
> You would be very welcome for a cup of coffee at Castle Gardens on monday if you have
time at about 11.20- 11.40 ish am - although the whereabouts of GPs on mondays in particular
has more in common with Heisenberg's Uncertainty Principle than anything else ... ( you know predicting the position of an electron at any one time)
>
> With kind regards,
>
>
Alastair
26TH SEPT FROM DR CHRIS BOWMAN TO ALISTAIR BREMNER
> On 26 Sep 2013, at 20:19, "Bowman Christopher (WALLINGBROOK HEALTH CENTRE)" <
christopher.bowman@nhs.net> wrote:
>
> Dear Alistair
> I would be grateful if you would let me know who said this was a new appointment as I am not
aware that anyone has.
> Look forward to seeing you on Monday, maybe you can apply the rules of entanglement to ensure
you are in 2 places at once!
> Kind regards
> Chris
>
> Dr Chris Bowman
>
> Vice-Chair Northern Locality, NEW Devon CCG
...............................................................................................................................................................
G
A decision to close the hospital had been taken 2 years prior to its closure
Source pages 9&10 of the Trust/CCG appendix 4
“In terms of the Torrington project we could have aided greater public understanding
had the initial section 256 investment been more widely communicated since 2011.
Instead we waited for the evolving model to become established and perfect before
engaging people”
Comment:So called engagement was started when the hospital beds were closed July 2013.
The evolving model was established and “perfect” before the engagement took place
July 2013.
Conclusion –the model was probably started in 2011 when the 256 investment
money was granted
H
Trust Patient stories
Has the Trust made use of patient stories beyond the terms the consent form that
those patients signed?
Some patients have signed a consent form* which states “I agree for my name to be
used when sharing my experience for the reasons given below
The Trust would like to increase understanding of the type of care that can be
delivered in people’s homes. We will also use patient stories to inform future service
developments.”
Patient stories have been used in Trust propaganda videos and on the world wide
web, which promote the ‘Care closer to home’ model of care. Did they give their
consent to appear in a Trust advertising campaign?

Source:-TCC involvement and engagement report 2014 Appendix 5 Patient Stories Report Page 10 of 12