The Heads of Health Care in Walsall faced a grilling off members of the the Council’s Social Care and Health Overview and Scrutiny Committee (the council’s equivalent of Select Committees at Westminster) following a damning report from the CQC health watchdog .

The Scrutiny Committee met last night and spent over three hours trying to get to the bottom of what led Walsall Healthcare Trusts services to be judged as “inadequate” following a Care Quality Commission (CQC) inspection report. The Trust was placed in special measures as a direct result of the report (www.cqc.org.uk/provider/RBK).

The Committee was also tasked with scrutinising the recovery plans to ensure that they are robust enough to ensure that the Trust recovers to provide services which are safe and sustainable together with evidence of culture change within the Trust, the commissioners and the regulators.

To ensure that the Committee could get at all the facts the following organisations faced intensive questioning: Walsall Healthcare Trust, Clinical Commissioning Group Walsall (CCG) and something called the Trust Development Agency (TDA).

Have to admit until we received the papers for the meeting we hadn’t heard of the TDA. Did wonder why the Walsall Healthcare Trust Board had left it to the Trust’s Chief Executive and the Chief Clinician to answer a barrage of questions from the Committee and others. It would also have been good to have had Walsall Healthwatch, the public voice of health and social care, at last night’s meeting.

The Trust’s centre piece is Walsall’s Manor Hospital which has been rebuilt over recent years and as a result has a “mortgage” as part of a Public/Private Finance Initiative (PFI) which costs the Trust £14 million a year. This millstone has to be taken into account as does the continuing austerity measures from Central Government.

When pressed on the question put by Cllr Ian Shires (Willenhall North) on how much is the money, or lack of it, actually driving what is done within the Trust the Chief Executive said that health must be the top priority and always has been.

One aspect of this whole sorry affair baffled the Committee. How come nobody saw this coming? To some extent the Trust found itself in the centre of a “perfect storm”, their words not ours, issues outside of their control at Stafford Hospital were exacerbated by decisions to change maternity arrangements at Sandwell Hospital. Alongside this there was an obvious shortage of qualified staff available which put the Trust in short term fire fighting mode. However the CCG which places Walsall’s healthcare contracts and monitors their delivery seem to have missed the obvious. It also came to light that the regulator, the TDA, had also been working with the Trust to try to turn it round.

Other areas of concern centred about the TDA’s actions since putting the Trust into measures. Without reference to other health and social care partners, namely Walsall Council, the TDA has identified an “Improvement Director” whose job it will be to support and challenge the Trust in the delivery of its improvement plans. The Improvement Director reports directly to the TDA, a body which many were not aware existed until recently.

Walsall Healthcare Trust is a key partner along with Walsall Council with its Social Care and Public Health responsibilities. It is of paramount importance that whatever is planned to recover the Trust it must be transparent and it needs to be public and include Partners. Why? Because any action taken by the Trust has an effect on others as has been the case with Stafford and Sandwell. Closer to home as Walsall Council delivers Public Health and Social Care any action by the Trust will affect what the Council does and vis versa.

One action already taken by the Trust has been to reduce the number of births at The Manor. This action was taken to ensure that the Midwife to birth ratio was in line with the national target of 1:28. The Trusts currently is 1:33.

Under questioning this equated to some 500 fewer births at the hospital. So where have those 500 hundred gone to? How many have gone to other hospitals like New Cross or Good Hope? How many chose instead to have home births and what impact does this have on Community Nursing and the already hard pressed GP.

It is issues like this that most concerned the Committee but it does not stop there. All through the CQC report their are references to a lack of qualified staff. Now that hasn’t come about because the Trust has been penny pinching. Far from it. To try and keep the numbers up the Trust has had to hire expensive agency staff and more recently has had to go outside the UK to find suitably qualified midwives and nurses. This is because the demand for medical staff outstrips the supply. There are just not enough students going through college or university to satisfy the demand. This is where greater use of Partners such as the Council working through local schools should be encouraging through our schools to get the qualifications needed to satisfy local needs and this should include the medical profession.

The Scrutiny Committee having made its concerns know has asked for further reports on progress and feedback as to how each of the three organisations, The Healthcare Trust, the CCG and the TDA were addressing the concerns around openness and Partnership working.