Wellsbourne Healthcare: a local campaign triumph with wide repercussions

Something important has emerged from what might seem to be a small story down here in Brighton. It may have started quite small but it has then grown into a much bigger issue, with important implications, national-level coverage and a lot of interest from many different quarters. Following an energetic local community campaign, and in a very unusual development, a procurement decision of NHS Sussex has been overturned.

The short version is that the local GP surgery in the deprived area of East Brighton –  Wellsbourne Healthcare – established as a non-profit Community Interest Company (CIC) some seven years ago. It is, by all accounts, much-loved in the community and nationally-admired, with an ethos based on community engagement and wellbeing – but was to be replaced by a large, corporate, for-profit company, based in Leeds. This decision was made by NHS Sussex, through the local Integrated Care Board and announced to patients and staff in the Spring.

Almost immediately, several initiatives came together – some of them more organised than others, some seemingly spontaneous – in such a way as to build a head of steam big enough to force an independent review of the process which has led to NHS Sussex halting the process.  In many ways this has been an exemplary campaign and it’s interesting to examine how it came to fruition. 

East Brighton mobilises and builds irresistible cross-community momentum 

Soon after the decision went public one of the doctors at the practice wrote a piece in the local citizen’s journal, Sussex Bylines. This quickly got an unusual number of hits and seemed to resonate with patients and the community. This same doctor had previously made a presentation about the practice to a Brighton and Hove Compass meeting and had also spoken to Polly Toynbee at a different Compass event in Brighton. Polly picked up the story and ran a comment piece in the Guardian.

Meanwhile, many patients and people in the local community were starting to make a fuss. They contacted several local councillors, who offered early support, as well as the new MP for Brighton Kemptown and Peacehaven, Chris Ward. He organised a petition on his website and issued a strong statement supporting the existing practice: “I’m strongly opposed to a for-profit provider replacing a local community one, this is a matter of principle, it’s what the Labour party stands for” he said. The former MP for the area, Lloyd Russell Moyle, who had also spoken at a Brighton and Hove Compass event not so long ago, also posted a detailed account of events on his social media and lobbied NHS officials, the local council, and other members of the community. 

This was followed up by an unusual amount of press coverage: on the BBC, in the local Brighton Argus and in the medical press, all of this helping to push the numbers on the petition well above 3000.

A demonstration was held in the town centre: a tug-of-war, organised by Sussex Defend the NHS. It was the good guys at Wellsbourne CIC vs the profit-making baddies and was joined by staff, patients, and volunteers from Wellsbourne Healthcare. The whole issue had become a bit of a cause célèbre and for a while everyone in town was talking it up. 

By this time, NHS Sussex, had done three internal reviews of the decision-making process (i.e. marking its own homework) but, with the campaign momentum behind them, the team at Wellsbourne were able to go higher and appeal to the Independent Patient Choice and Procurement Panel, under NHS England. This paused the final decision for a few weeks. 

The decision overturned

The Panel’s report, when it came at the end of July, was something of a bombshell and it’s worth quoting the key findings at some length. In particular , “the Panel finds that Sussex ICB’s provider selection process …  breached the regulations in four respects.

• First, by conducting the evaluation and scoring process differently to the way in which it was described to Wellsbourne, …  and in particular its obligations… to act transparently and fairly.

• Second, by concluding that Wellsbourne did not address certain issues when this was not the case, and as a result (breaching regulations) which requires it to act transparently and fairly.

• Third, the Panel finds Sussex ICB:… evaluating proposals that contained a significant disconnect between the additional revenue estimates and the workforce and costs necessary to deliver this revenue, (so breaching) the regulations, and in particular its obligations to act transparently and fairly.

• Finally, breached regulations which requires the ICB to keep a record of the reasons for its decisions.”

Further into the evaluation report there is coverage of flawed financial modelling, especially related to staff matters and discussion as to the challenges in assessing Wellsbourne’s admired social model for community welfare. 

What can be going on in a public body which “fails to keep a record of the reasons for its decisions”? Interpreting the relevant section on this generously, you might want to say the ICB kept some records, but they weren’t adequate. Even stated like that, and perhaps I am being naïve, that does seem quite surprising.

Wider lessons for non-tribal politics

For our purposes though, it is worth summarising the key lessons from all this, lessons which can be useful to other campaigns and in Compass’ own work.

1. Advocacy has a real impact: grassroots campaigning (among patients and community), petitions, and people’s action were pivotal in influencing the decision;
   
2. Political leadership can amplify community voices: Active engagement from local and former MPs and councillors was critical in increasing pressure;

3. Media exposure was also helpful: extensive press coverage amplified the issue, helping to keep it in the public eye;

4. Specific issues resonated strongly with patients and the community and kept the wider story as a forefront issue in the local conversation for several weeks. These included:

• • • The whole notion of the profit motive in health provision in a deprived area, with the obvious ethical, political and operational concerns.  No one in the community would seem to be enthusiastic about supporting this.
    • Related to this is some confusion at the top as regards the favoured model for a GP practice in a place like East Brighton.  The recently announced plan for the NHS, emphasises prevention and community-based services, and the evidence suggests this is the effective way forward.  And while Wellsbourne has been in the vanguard of developing this model, yet the ICB’s contract tendering process seemed to more or less go against this, driven heavily by short-term financial considerations.
    • This is a clear consequence of the undervaluing of the social value that a surgery like Wellsbourne provides. The Panel’s report clearly accepts the importance of continuity in healthcare matters and here it’s talking about stability in staff, services, and relationships, especially important in socio-economically disadvantaged areas like East Brighton. It also suggests the procurement process was unable to incorporate this properly despite it being, a statutory consideration under NHS rules. There must be fears that such confusion (and undervaluing) is common in other areas within the NHS.
    • Then, of particular interest to Compass, comes the transparency and accountability angle. The independent review highlighted unfair treatment and non-transparent evaluation methods. This seems extraordinary. These days there should be no negotiation as to the necessity for clear decision-making and scoring.  The fact that this should be so casually swept aside should also give us pause for thought as to what goes on in every other inexplicable decision process we come across.

As we’ve learned in numerous other areas, a lack of transparency and accountability is a one-way street to a democratic/participative deficit, in this case in an area of policy and practice which directly touches on everyone’s life. This makes a substantial difference to outcomes at the individual level but, when aggregated up to national levels, is massive and corrosive.

So where we are at the moment?  Nobody seems quite sure. The MP issued a statement which said “crucially, this means there will be no change to existing services at Wellsbourne and that there will now not be a new private provider introduced to the area.”  This is not quite what it says in the report which calls for a return ‘to an earlier step in the provider selection process, namely the publication of a new contract notice… This will allow a new provider selection process to take place that addresses all of the issues identified by the Panel in this report”.

Probably the story is not over yet but, for the moment, the various parties are licking their wounds and considering their options. Clearly, it will hardly be a surprise if public confidence has been knocked by all this incompetence, prevarication, and wasted expenditure of resources and time. 

At the very least let us agree, before we go to the next phase of this painful rigmarole, to lift up the creaking, rotting roof beams and let the light in.