#64. Essential reading for ANYONE who thinks they know enough to express an opinion!

Will this be read in its entirety? Probably not because it challenges too many of the fondly clung-to misapprehensions that have bedevilled the “debate” (and there’s a laugh) over the future of Emergency Medicine in Shropshire.

The original pdf can be found if you google for… Emergency Medicine Taskforce Interim Report.

Because the report is a pdf document it was necessary to convert it to a Word document and re-format the text which results in the corruption of some formatting which it’s then necessary to put through a spell-check. I apologise for any typos, they’re mine not the original authors!

You will also note the absence of the graphs and figures referred to in the text, they were not translatable from pdf to document format.

Emergency Medicine Taskforce Interim Report.

Executive Summary

Background

In recent years, the poor recruitment at ST4 in Emergency Medicine (EM) has raised concerns within the specialty and the medical profession. The specialty in 2011 and 2012 has achieved a lower than 50% fill rate into higher training. Fewer trainees are opting to choose EM for higher specialty training due to concerns over the intensity and nature of the work, unsociable hours, working conditions and the sustainability of such a career to the age of 68.

The Emergency Medicine Taskforce was established by the Department of Health in September 2011. This is its interim report. The Taskforce in fulfilling its Terms of Reference has explored many aspects of medical education and training, which may be contributing to the problems that the specialty is currently facing.

Fill rates, trainee numbers and deanery data has been collected, expert evidence and opinion has been sought to establish the key factors effecting Emergency Medicine. Using this data and evidence the Taskforce has developed a number of recommendations focusing on medical education, training and service provision in order to improve the recruitment and retention in the specialty.

Commissioning

It is essential that commissioners seek advice from those who understand the urgent and emergency care landscape and the population served.

Workforce

Poor fill rates have lead to a decline in the number of higher trainees and thus the supply of future Consultants. The Taskforce group have looked at ways in which to increase fill rates for Emergency Medicine posts at ST4, whilst simultaneously identifying ways to enhance the desirability of the specialty.

The College of Emergency Medicine (CEM) has recommended a minimum of 10 whole time equivalent EM Consultants for each Emergency Department. This number is designed to provide up to 16 hours a day EM Consultant presence 7 days a week. Increased EM Consultant numbers will ensure improved work/life balance prospects for the trainees, enhanced protected training time and better supervision.

In recent years, there has been an increase of non-medical practitioners undertaking a role in the ED. These practitioners work with and compliment the senior medical workforce, interacting closely with Emergency Medicine Consultants. Many of these roles have been developed in UK hospitals.

Innovative developments in skill mix and roles will continue to play a major part in the delivery of urgent and emergency care. The Taskforce will look to highlight best practice and encourage dissemination to the wider health economy.

The Training Programme

To improve recruitment rates in Emergency Medicine more flexibility is needed in the way core training is configured and delivered. The specialty is currently considering the entry requirements for core training and recognising transferable competences of trainees currently in other specialties.

CEM also wishes to explore the parallel running of a run-through training programme.

Reconfiguration

Reconfiguration is a complex agenda and involves an understanding of professional views, patient safety, public access and the political dynamic. Given the pressures on primary care and EM services to meet unscheduled demand this may be a consideration for the future.

Market facing pay / terms and conditions

It is impracticable to pursue market facing pay and changes to terms and conditions at this current time as this would simply drive up current costs without fundamentally addressing the problem. In the longer term this area may well need to be reconsidered to make the specialty a more popular career choice.

Conclusion

The report should be used by Health Education England (HEE) as a basis for further discussions as to how best to address the workforce issues that the report highlights at a national and LETB level; recognising that each LETB area may need different aspects of the solutions that the Taskforce have identified.

However, there is an urgency to this and the Taskforce believes that measures will need implementing in the next months if we are to avoid increasing problems. The Taskforce would also wish to emphasise that urgent work is needed across the spectrum of emergency and acute care specialties (so not just EM) to address the service pressures. Developing an attractive and sustainable career in Emergency Medicine and those other specialties that have a large emergency component is the major and urgent challenge.

Department of Health (DH) officials and members of the College of Emergency Medicine (CEM) established the Emergency Medicine Taskforce in September 2011 to address workforce issues in Emergency Medicine. The group has considered

these issues and made recommendations on the future clinician staffing of Emergency Departments (ED) with the aim of ensuring patients within EDs receive high quality care that is consistent, responsive, safe and effective as well as being value for money. Regular updates of these recommendations were provided to the Medical Programme Board.

Introduction and principles

The specialty of Emergency Medicine is currently facing critical workforce shortages at ST4 and Consultant level in many areas in England. This problem is sufficient enough to potentially threaten the reliable delivery of urgent and emergency care services.

Waiting for a natural solution to the problem is no longer an option and EDs in partnership with the medical training and education system will have to actively seek alternative staffing and training solutions in order to meet service delivery and public expectation.

Fundamental changes in training support and supervision, working conditions and long-term career pathways are needed to ensure that Emergency Medicine is made attractive and sustainable to trainees in the future.

Additional pressures on acute medicine departments and General Practice could result in increasing pressures on the ED and the wider service in some trusts.

This is an interim report from the Emergency Medicine Taskforce Group.

The principle underpinning the work of the group is that patient safety is paramount and the current situation in which much of the care within the ED setting is invariably delivered by relatively junior doctors in training is no longer tenable or acceptable. All patients attending the Emergency Department should be reviewed by a suitably trained and experiencedclinician1.

The issues that prompted this initiative were:

    • Concerns over patient safety.

    • Desire to optimise quality and effectiveness of care in Emergency Departments (EDs).

    • Inadequate Emergency Medicine Consultant numbers.

    • Trainee recruitment difficulties and attrition.

    • Difficulty in staffing ED rotas at higher specialty trainee, SAS rota and senior level particularly overnight.

    • F2 and other junior doctors inadequately supervised in EDs.

    • Staff grade doctor recruitment difficulties and attrition.

    • Overnight closure of EDs.

    • Significant and increasing expenditure on locums and agency staff.

    • Emerging roles for non-medical staff that appear to lack national standardisation around preparation.

1CEM Operational Handbook, The Way Ahead, Version 2, Dec 2011

    • An opportunity to develop a collegiate response to meet the increasing demands placed on EDs.

Urgent and Emergency Care describes the provision of all unscheduled care, whether, in primary care or hospital based. The future model of care will determine the workforce needs. Workforce planning aims to create the capacity required for the known or predicted demand. This is the main aim of this document. It does however mention policy and service design issues, which may be able to influence demand, either by decreasing it or redirecting it. The present fragmented system across emergency and urgent care leads to duplication and poor use of its workforce. If every patient could see the appropriate clinician first; then the quality of care would be improved. An emergency and urgent care system that is truly designed around patients and the staff delivering the care, will address demand and capacity issues, variability and sustainability problems because it would become an attractive specialist area to in which to work. In addition, whilst it is undesirable for staff to be overstretched it is equally undesirable for staff to be underutilised and thus the model by which care is provided is highly relevant but is not addressed in this predominantly workforce-focused paper. The group recognises the era of tight financial constraints and thus the limitations for any additional investment in workforce. However, this must be balanced against the wider healthcare system’s commitment to patient safety, public expectation and the negative publicity surrounding the consequences of inadequate ED staffing. A permanent, fully trained and experienced senior ED clinical workforce will deliver the care that the public expect and deserve.

ED clinical staffing needs to reflect the high risk profile of many ED patients, of all age groups, presenting in large numbers with undifferentiated conditions with the consequent potential for significant mortality and morbidity. This care needs to be provided 24 hours/day, 7 days/week.

In England the year on year increase in ED attendances, both in terms of number and complexity, combined with the expanding role of EM in both diagnosis and treatment, has not been matched by increases in the ED workforce, particularly at a senior level. As a result, there is frequently a mismatch between demand and ED expertise, particularly overnight and at weekends.

Current ED senior staffing compares unfavourably with international models in North America and Australasia. The risks associated with inadequate senior EM staffing have been dramatically demonstrated in Mid-Staffordshire NHS Trust, and elsewhere.

A major contributory factor to the current workforce landscape has been the flawed assumption that emergency care demand can be managed downward. Although initiatives such as long-term condition surveillance, 111, NHS Pathways, Urgent Care centres and the Directory of Services are welcome and have been shown to have local impact on patient flows, this has not resulted in an overall reduction of unscheduled care ED attendance (for example, the Urgent Care Centres for Birmingham and Solihull area had 250,000 attendances per year, only 4% of which result in referral to secondary care, N Chauhan, personal communication). It should, therefore, be reasonable to anticipate a continuing rise in ED demand, as the population ages and public awareness of the importance of chest pain, stroke and infection initiatives, for example,increases.

The present urgent and emergency care system is inconsistent and is often commissioned and planned as individual components within the whole patient journey.

There is an enormous amount of variation in how this care is delivered, which often results in patients being confused with regard to which part of the system is most appropriate to meet their need. As a consequence, patient outcomes are not optimised, care is fragmented and staff are left feeling demoralised. More recently, ‘whole system’ and ‘team’ working are being encouraged which have benefits for workforce planning and for the quality of care being delivered, but the implementation of such arrangements is inconsistent, and is dependent upon individuals rather than systems.

Current financial challenges mandate an evidence based approach to the delivery of emergency care. The evidence suggests that care delivered by more experienced clinicians is safer, has better outcomes and is highly cost effective.

Landscape

  1. The model of care recommended by the College of Emergency Medicine (CEM) is for Consultant presence 16 hours per day, seven days per week. This requires 10 Whole Time Equivalent (WTE) Consultants per ED, compared to the current average of 4.5 WTEs.

  1. The Centre for Workforce Intelligence (CfWI) predicts it will take until 2020 to secure sufficient numbers of consultants. This is based on maintaining the number of training posts at current levels and ensuring 100% fill rates for such posts and programmes. However, this is unlikely to occur given current attrition rates which will inevitably lead to a significant revision towards2030.

  1. For core training, recruitment is to the Acute Care Common Stem (ACCS), of which EM is one constituent specialty. In 2011, 96% of the 192 posts were filled– but retention in ED training is poor. For example, many ACCS trainees migrate to another specialty rather than progressing to ST4 (EM). In 2012, 94% of posts we refilled.

  1. For ST4 (first year of higher training) in 2011 there were 135 posts vacant in England but only 45 (41%) were filled. In 2012, there were196posts vacant in England and 86 (44%) we refilled.

  1. Based on the GMC Trainee Survey there were 169 CT3 trainees in post on the 30 April 2012. Of these trainees, only 84 applied to the national EM recruitment ST4 recruitment round. 92% (77) were considered appointable and were offered a post, with 85% (71) accepting a post.

  1. Recruiting doctors from overseas represents a possible short-term solution but will not provide longer-term recruitment and retention solutions given there were significant immigration obstacles to this recruitment option during 2011-12. This route is now open and there is still significant scope for the UK to recruit non-UK/EEA doctors into EM posts in 2012. In practice, despite intensive recruitment efforts, this initiative has proved disappointing. It may be that the issues of quality of support and supervision of trainees are impacting on overseas recruitment.

Consensus views of the Taskforce group.

The benefits of an EM Consultant present service are well described.

Sub-optimal recruitment and retention and poor progression though training in EM may be related to:

  1. The difficult conditions under which Emergency Medicine is currently practised with its high decision density, relentless target pressures, overcrowding and with junior doctors competence stretched by the challenging caseload.

  2. Perception of poor work/life balance in comparison with other specialisms and peers.

  3. Deficiencies in training and supervision, in part related to inadequate consultant and senior clinician numbers.

  4. The training assessment burden and sequencing of training.

  5. Uncertainty as to how a future career in EM will develop and be sustainable.

    1. Maximising the potential of the wider workforce is important

  1. General Practitioners have a crucial role in delivering urgent care, but the number of GPs who take on this role is less than was anticipated.

  2. Development of Advanced Clinical Practitioners (ACP) and Physician Assistants/Associates2as an increasingly important part of the future ED team would be valuable in providing a stable, consistent, ‘mid-level practitioner’ workforce.

  3. Roles and career development of SASG and specialty doctors working in Emergency Departments need addressing. This group need the opportunity to develop and maximise their potential.

    1. Commissioning needs to facilitate these changes and encourage whole system working

  1. In principle the reconfiguration agenda for EDs is supported. This will demand careful triangulation between the expectations of the public, the responsibility of the profession to ensure safe care and the political dimension.

  2. Reconfiguration of ED services overlaps considerably with other aspects of commissioning and wider configuration and provision of urgent/emergency care.

  1. Commissioning of services

Clinical commissioning groups (CCGs) will work under a statutory duty to seek advice in commissioning services from a broad range of professionals, including those who are well placed to understand the urgent and emergency care needs of local populations. They will also be able to access advice from clinical senates and networks.

The clinical senates will bring together doctors, nurses and other professionals to give expert advice, which we anticipate that clinical commissioning groups will follow, on how to make patient care fit together seamlessly in each area of the country. Clinical senates will provide advice and support on a range of issues, and from a variety of health care perspectives, including public health and adult and child social care experts, as well as allied health professionals. Health and wellbeing boards will provide an opportunity to ensure join up between health, social care and services that have an impact on health.

The framework in the Act for ensuring the competence of commissioners, in securing continuous improvement and ensuring the promotion of integration, apply particularly to emergency and urgent care services. Commissioners will need to use expert advice from senates and networks and from other sources to determine the best approach to commissioning.

CCGs must (under 14V of the NHS Act 2006, as inserted by Clause 25), obtain advice appropriate for enabling them effectively to discharge their functions from persons who (taken together) have a broad range of professional expertise in:

  1. the prevention, diagnosis or treatment of illness; and

  2. the protection or improvement of public health.

CCGs can include emergency care or unscheduled care specialists in their governing bodies or committees. The Department of Health does not want to require this specifically, but there is nothing to prevent it. CCGs should ensure EM Consultant input occurs to provide an informed contribution to this crucial area of commissioning.

For CCGs to make the best informed decisions the involvement of those central to the delivery of urgent and emergency care should be integral to commissioning. The local lead for Emergency care is such a person.

    1. Definitions of service

The delivery of a coherent 24/7 urgent and emergency care service aims to provide the highest quality of patient care. This will be facilitated by developing a system in which people can easily identify the right place for their care. The evidence indicates that many patients and healthcare professionals currently find the existing nomenclature and arrangements for urgent and emergency care services confusing. They struggle to understand which services are provided at which facilities at what time and where they should go to access the most appropriate service for them. Over the years, the picture has become more confused, and more layers of complexity have been added, and so work is under way to simplify this and make the system more consistent and more intuitive to navigate.

The new NHS 111 system should support the development of a simpler system and people will be encouraged to use this before attending a face-to-face facility, unless they have a life threatening condition in which case they will use 999. Following engagement with the public and the NHS, as well as various other stakeholders, the plan is for the NHS Commissioning Board to issue guidance on a simpler system. The ultimate aim is to produce an evidence-based categorisation of services that will improve patients’ ability to access the right service first time. To this end, discussions with external stakeholders and NHS colleagues continue and we expect further progress to be made in the second half of this year.

  1. Workforce

The future core ED workforce will, therefore, be a hybrid team of suitably trained and experienced decision-making clinicians including:

  • Em Consultants

  • EM Higher Specialty Trainees – ST4 and above

  • Consultants and higher trainees in acute medicine and other acute specialties including trauma and orthopaedics, paediatrics and psychiatry. This group can make an important contribution to patient care by their earlier involvement in the patient journey.

  • EM Specialty Doctors (SAS grade)

  • General Practitioners

  • Advanced Clinical Practitioners (from various nursing and AHP backgrounds)

  • Physicians Associates

  • Emergency Nurse Practitioners

  1. Em Consultants

The role of the EM Consultant is multi faceted and involves:

  • Direct patient care, particularly the most ill and complex cases

  • Supervision and teaching of other clinicians at all levels, and supervision of others in their supervision and teaching roles

  • Leadership including interacting with management, senior clinicians of other departments and the public

The demands on an EM Consultant are unrelenting, with a constant stream of decision making for high-risk patients presenting with critical illness, serious injury or with the potential for high morbidity and mortality, generally overlaid with additional Departmental management responsibilities.

In order to ensure patient safety, this decision dense activity is only safely sustainable for a limited number of hours. This is important when considering the total number of Emergency Medicine Consultants required in an ED, accepting that these Consultants will be working a shift pattern.

The College of Emergency Medicine has recommended a minimum of 10 whole time equivalent EM Consultants for each ED. This number is designed to provide up to 16 hours a day EM Consultant presence 7 days a week. Increased EM Consultant numbers will ensure improved work/life balance prospects for the trainees, enhanced protected training time and better supervision as well as an improvement in mortality and morbidity rates in and out of hours (OOHs).

Work is also being done to identify how ED Consultants may continue to work with a greater age given the likelihood that changes to NHS pensions. This may necessitate ED Consultants working in this high-pressured and relentless environment well beyondtheageof60.In the interest of patient safety,the intensity and unsocial

nature of EM mean that there should be the option to reduce the proportion of unsocial working as clinicians get older and this needs to be reflected in workforce planning.

  1. EM Trainees

Emergency Medicine is a highly attractive specialty for junior doctors throughout the world. Internationally, EM residencies rank amongst the top few specialties attracting junior doctors of the highest calibre in large numbers.

While EM is still viewed in the UK as an interesting specialty, trainees experiencing the current workload in ED, and witnessing the unsocial hours of their consultants, are leaving the specialty to pursue careers other specialties; usually anaesthetics or general practice. There are also significant problems with EM trainee recruitment at the more senior levels, and with progression from core to higher training.

The Emergency Medicine Trainees’ Association (EMTA) of the College of Emergency Medicine organised a survey of EM trainees in 2011 (reference).

The main points arising from this survey were:

  • A desire for greater Consultant supervision.

  • Greater emphasis on education and training compared to service provision.

  • Concerns over the current work/life balance in Emergency Medicine.

The trainees’ perception of their future in the specialty is judged problematic, as are the issues with the existing training programme.

Currently there are vacancies at ST4 in EM with fewer applicants applying than there are posts to fill. As well as the reasons described above, some of the difficulties in filling these posts have arisen from the current entry requirements being rigid. Currently applicants eligible for entry into ST4 need to have all the competences and experience that they would have acquired within an EM core training programme. They must also have passed the Membership examination of the CEM (MCEM). Doctors with some experience of the specialties comprising core training in EM often find it difficult to gain the additional experience needed for ST4 entry from outside a designated EM training programme. Doctors from other specialties are not encouraged to change specialty into EM since there is currently no agreement in place for transferable competences that might reduce the duration of the training programme to CCT. This means that all trainees applying for core EM training from another training programme must apply at CT1level.

The consequence of these factors is that approximately 30% of core trainees are opting to go into alternative specialties, such as Anaesthetics.

  1. The Training Programme

To improve recruitment in Emergency Medicine more flexibility is needed in the way core training in EM is configured and in the entry requirements for higher specialty training. This is most easily addressed by reverting to, or running a parallel, Run- through training programme (see Fig 1.)

CEM also wishes to explore ways of recognising transferable competences of trainees currently in other specialities in order to increase the pool of trainees eligible to apply for HST posts.

A trainee with some previous experience in the specialties comprising core EM training will be allowed to enter at a level higher than CT1 and, through targeted training, will gain missing competences later in the programme. Unlike the current core training programme, the actual length of time spent in each specialty area and the order in which the experience is gained, will be flexible, depending on the previous experience of the trainee. A review of the curriculum, person specifications, funding and assessment matrix will be required.

Progression through training needs to be improved: in particular, trainees in core training are failing to pass the MCEM within the three year ACCS programme. One of the reasons for this arises out of the current sequence in which experience is gained during the ACCS programme. Current trainees complete only 6 months of EM in the first two years of the programme. One part of the solution could be a reorganisation of the EM Core Training programme. A proposal to alter the current sequence of training has been considered in which the third year of EM training, (Paediatric EM and Musculo-skeletal competences) is moved to Year 1, with ACCS (EM, AM, Anaesthetics and ICM) being completed in years2-3.

Fig 1. Emergency Medicine Run through Programme

  1. SAS and Specialty Doctors

This group comprises doctors currently working under various titles including staff grade, Trust doctors, associate specialists and specialty doctors.

In the past, this group of doctors has been the backbone of many EDs providing high quality safe care throughout the 24-hour period 7 days a week.

Unfortunately, this contribution to emergency care has not always been valued or supported. Many of these doctors report working predominantly unsocial hours, have job plans with little or no provision for CPD and feel unsupported both within their department and in their organisation. As a result, there has been an increasing trend for these highly experienced doctors to leave EM, particularly into General Practice where there are opportunities for an increased salary and little unsocial hours working.

In turn, this has led to a great difficulty in populating SAS rotas, particularly overnight and at weekends. This has led to a vast expenditure on locum doctors of variable quality and/or very junior doctors being largely unsupervised in EDs, particularly overnight and for extended periods at weekends.

A recent survey of the College of Emergency Medicine FASSGEM group identified the following factors leading to attrition:

  • Non-sustainable rotas with high frequency of out of hours work

  • Poor morale within the department or perceived lack of respect

  • Poor working environment with high stress levels

  • Poor pay and conditions

  • A perceived inequality with higher specialty trainees

This group need the opportunity to maximise their potential. As well as CPD, the option for further training and development is important, so that these doctors have a sense of continued development and are able to make greater contributions to clinical care. A clear sense of career pathway and the opportunity to pursue the CESR route would enhance the working lives of this important group.

  1. General Practitioners

General Practitioners could have a crucial role in delivering urgent and emergency care. In principle, GPs could be invited to consider the following options:

  • Ensuring prompt access to community Urgent Care for as much of the seven- day period each week as possible, including some limited access available in the evenings and at weekends. There is evidence that improved access both in hours and out of hours is linked to decreased ED attendances.

  • High quality chronic disease management including individualised plans for acute episodes can prevent hospital attendance and admission.

  • GPs should provide Primary Care expertise in a facility co-located with the Emergency Department or fully integrated in to ED.

  • In the ED, facilitating discharge of patients back to community facilities.

  • Encourage those GPs who wish to develop Emergency Care skills as a special interest, with skills and competences as agreed by the RCGP and College of Emergency Medicine.

General Practitioner engagement is crucial. However, many locations are having difficulties in recruiting because of an increasing tendency for individuals to limit out of hours work and significant pressures on the GP workforce.

  1. Emergency Department Nursing

It was not considered to be within the remit of this group to consider emergency nursing, except where those with a nursing qualification take on an autonomous enhanced role as outlined below. However, the group did identify the relatively high turnover of staff in this general group and an increasing dependence on agency staff in many EDs.

  1. Mid-level non-doctor clinicians

It is increasingly clear that there are many practitioners undertaking a role in the ED but who are not themselves doctors. Such roles have been developed in many UK hospitals and of course also world-wide. They have the potential to provide a hugely important ‘ballast’ of professional continuity within the ED, reducing the turmoil resulting from the rapid turnover of junior doctors in training. If substantial numbers are employed, the continuity and quality of care would be improved. In addition, the quality of education for juniors could enhance, allowing them to focus on their learning needs (‘deliberate learning by doing’) rather than only the needs of the service (‘serendipitous learning while doing’). Such clinicians also bring a great deal of experience to their role since they tend to stay in place for some years (e.g. UK Advanced Clinical Practitioners (ACPs) and US Physician Associates typically stay in a single specialty for over 8 years3). Such mid-level clinicians may be drawn from nurses (e.g. ENPs), other practitioners (e.g. ACPs) or could be new to the clinical world (e.g.PAs).

Fig 2. shows the ‘flow’ of junior doctors at various stages of training as they ‘pass through’ the core ‘medical’ workforce: most direct care is delivered by junior doctors, SASG and Specialty doctors and, increasingly, non-medical clinicians and the diagram demonstrates the delivery of care as well as the role of the junior doctors, and the supervision delivered for those in training by the permanent members of the workforce, including senior specialty trainees, SAS doctors and consultants.

3American Academy of Physician Assistants. National physician assistant census report: results from AAPA’s 2009 census. Alexandria:AAP,2010.www.aapa.org/uploadedFiles/content/Common/Files/National_Final_with_Graphics.pdf[Accessed 5 January 2012]. 

  1. Emergency Nurse Practitioners

During the past 10-15 years, the role of Emergency Nurse Practitioners in emergency

/urgent care has developed and matured. Most EDs now have an ENP service and ENPs tend to be the mainstay work force in Minor Injury Units, Urgent Care Centres and Walk in Centres. In many EDs this contribution has been predominantly in providing high quality safe care for patients presenting with less serious injury or illness. There is a good evidence base that those with appropriate training do provide a very safe and effective minor injuries service. Unfortunately, training and degree of autonomy have been variable. However, the move to an all graduate nursing profession in 2013 has been an impetus for nurses particularly ENPs to achieve graduate status particularly in the sphere of emergency nurse practitioning.

The Taskforce feels there needs to be a consistent definition of what an ENP is as well as their scope of practice and training requirements. There need to be mechanisms developed so skills are transferable between NHS organisations.

    1. Consultant Nurses

The role and numbers of Consultant Nurses in EDs has increased, there are now in excess of 50 nurses employed in this role throughout the UK. While the role has 4 specific core functions including clinical practice, there are variations in role and scope of these posts in terms of advanced clinical practice. Future Consultant Nurses are likely to be drawn from current ACPs who possess an advanced clinical focus that will enable them to work at an intermediate tier and beyond. This group of staff are well placed to manage the increasing body of ACPs and ENPs within many EDs. They will obviously work closely with Emergency Medical Consultants who will have overall responsibility for the service and will contribute to greater consistency in terms of clinician workforce planning.

    1. Advanced Clinical Practitioners

In recent years, Advanced Clinical Practitioners (ACPs) have developed skills and competencies in providing care for more seriously ill and injured ED patients. They come from a variety of backgrounds. The most effective schemes train them to see the whole range of patients presenting to the ED. There has been a proliferation of this type of role in an unknown number of EDs across England. The high volume high- risk nature of undifferentiated patients presenting to the ED mandates absolute certainty with regard to the skills and competences of any clinicians working in all areas of the ED as it does for doctors.

It is crucial that development of the ACP model is underpinned by the following:

      • An emergency care workforce profile

      • A national curriculum

      • Nationally agreed standardised assessments

      • Standardised assessments and competence across disciplines working at this level of practice

      • Defined role and scope of role and lines of accountability

      • Nationally agreed indemnity for the role

      • Nationally agreed remuneration for the role

Representatives of RCN, FEN, Emergency Consultant Nurse Association (ENCA), College of Emergency Medicine and Department of Health are currently exploring these issues. The curriculum and assessments developed by the College of Emergency Medicine provide a proven template with some transferable commonality to the ACP agenda.

It is crucial, however, the group developing the ACP model explore the role and scope of such practitioners, which will be applicable to the generality of EDs.

The general principle should be that ACPs work with and complement the senior medical workforce, interacting closely with the Emergency Medicine Consultant.

Where individuals have greater experience or wish to enhance their core ACP skills, then specific additional training maybe arranged. This would ensure that those ACPs who so wish are allowed to fulfil their potential, whilst ensuring that the greater body of ACPs provide high quality safe care within their scope of practice.

ACPs should therefore be regarded as a crucial part of the ED clinical team of the future.

Further work should be undertaken to develop the ACP role, this includes:

  • Develop a nationally applicable curriculum, competences and assessment framework.

  • Achieve consistency with regard to the clinical role.

  • Describe the boundaries of such practice in the generality of Emergency Departments.

  • Define the likely timescale for a widespread implementation.

  • Undertake piloting to define the evidence base for this initiative.

  • Develop an evidence base for the role.

To develop an effective ECP will take three years of training and then a period of two years of mentorship, building on a previous background of specialist skills in nursing or an AHP.

  1. Physician Associates(PAs)

The situation regarding Physician Associates (PAs) is analogous to that of ACPs described above.

The role of PAs in the ED has been impressively developed in North America, for example a typical ED staffing, such as at Johns Hopkins, involves approximately 12 PAs, 3 FY1/2s equivalents, 5 specialty trainees and 8-9 consultants. (Personal communication, T Ritsema, PA-C, Assistant Professor, George Washington University.)

The optimal contribution of PAs to the ED is by working under the supervision of a senior EM doctor undertaking a range of activities contributing directly to patient care. This model provides a defined scope of practice with an invaluable contribution to the overall provision of patient care. The senior EM doctor benefits from being able to allow the PA to practice within their skills and competences, thus freeing up the EM doctor to care for other patients.

PAs are currently working in a number of UK EDs (City Hospital, Birmingham; Dudley Group of hospitals; Northwick Park; Leicester Royal Infirmary; Kingston Hospital; Mid Staffordshire; Hairmyres Hospital (Lanarkshire); Derby Royal Infirmary will advertise posts shortly.

PA training programmes last 2 years and the Taskforce identified that University- based programmes can be established and a new cohort of students recruited within a very tight time frame of less than a year. Programmes follow a national curriculum and graduates have to pass a national assessment. PAs are expected to join a managed voluntary register, and to undertake re-accreditation every 6 years (as per the US model for PAs and indeed doctors). Thus, PAs development is one of the workforce measures that could be introduced most quickly.

The Taskforce identified that there is no current defined responsibility within DH, or elsewhere, to support the further development of PA training programmes within England despite increasing evidence that PAs can provide a high quality contribution to patient care, and mounting support from doctors working in a number of specialties including EM, physician specialties, mental health, family medicine and surgery. The Taskforce recommends that Health Education England looks actively at promoting this new pluri-potential health professional discipline.

EM Professional

Implementation Time

GP

Immediate if they can be

recruited.

ENPs

Approx. 3 years

PAs

Approx. 3 years

ACPs

3-5 years, dependent on level

of experience

Consultants

5-12 years

  1. Reconfiguration

It is recognised that having an increased number of specialists in one location allows more patients to be seen by senior clinicians earlier in their care. It also gives those clinicians more exposure to serious illness and hence improves their competences and abilities; this underlies the rationale for hospital reconfiguration.

Given the ED workforce shortages and the current era of tight financial constraints, the potential opportunities provided by reconfiguration demand consideration.

There is a view, given the pressures on both primary care and EM services to meet unscheduled demand, that the system should consider reconfiguration in the form of integrated emergency or unscheduled care services working across primary and secondary care, for which doctors (from EM and GP backgrounds) and other clinicians would be trained to the same standard and accredited. The key to this model would not just be the accredited clinicians, but even more crucially the development of community and social resources, which would provide alternative options for care other than acute hospital admission, access to rapid specialist assessment when necessary.

Decisions regarding the reconfiguration agenda are complex and involve triangulation of the views of the profession regarding safety, of the public regarding access and the political dynamic but there is a clear urgency if services for patients are to be maintained.

  1. Market-Facing-Pay/Terms-and-Condition

Market facing pay and adjustments to terms and conditions can, in certain circumstances, improve recruitment and retention in unpopular working environments (specialty and/or geography). However, market facing pay in the current circumstances, of significant and sustained workforce undersupply, will simply drive up costs without fundamentally addressing the problem of maintaining comprehensive service provision.

In the longer term, this area may well need to re-considered as it could be part of a package that would make EM a more popular career choice for a number of professional groups, and in particular doctors. There is some experience of the positive impact this can have from Australia.

  1. Summary of Recommendations of group

  1. An increase in Emergency Medicine Consultant numbers to ensure a consultant presence for 16 hours a day, 7 days/week in all Emergency Departments and 24 hours a day, 7 days/week in larger departments or Major Trauma Centres.

  1. Work with the CfWI to explore workforce modelling in EM.

  1. EM trainee numbers should be carefully calibrated to support continued Consultant expansion.

  1. Early exposure to the EM component within ACCS core training to improve early experience and improve MCEM pass rates.

  1. Develop alternative routes into EM training for trainees currently in other specialty programmes.

  1. Explore the recognition of transferable competences of trainees currently in other specialities to increase the pool of trainees eligible to apply for EM training at a level higher thanCT1.

  1. Support Associate Specialist and Staff Grade Doctors (Specialty Doctors) in their roles to ensure retention and increase work satisfaction. Measures to achieve this should include:

    • Job planning to avoid unsocial hours’ predominance and enhance support for CPD.

    • The College of Emergency Medicine will look to ways of supporting the development of this group using the College curriculum and assessment systems.

  1. GPs could be invited to consider the following options:

    • Ensuring prompt access to community Urgent Care for as much of the 24 hour period each day as possible, improving access available in the evenings and at weekends.

    • GPs could provide Primary Care expertise in a facility co-located with the ED.

    • GPs could work with the ED team to facilitate discharge of patients back to community facilities.

    • Those GPs who wish to develop Emergency Care skills as a special interest should be encouraged to acquire skills and competences as agreed by the RCGP and CEM.

  1. Expand training of clinical nurse specialists and PAs, and define their roles. It is clear that the day-to-day delivery of ED care will require significant expansion of the non-medical clinical workforce. No formal estimates have been performed but given current issues re: delivering care, the Taskforce recommends that there is a need for at least 10 such higher specialty trainee and SAS rota clinicians per ED. To ensure consistency, development of the roles of each of these groups should be underpinned by:

    • A national curriculum for ED-specific competencies

    • National Standards for skills and competencies

    • National Assessment framework

And the working group also recommends that the College supports such developments.

  1. There is a real urgency about the ED workforce crisis, and these recommendations need to be enacted urgently. For PAs, core generalist training takes two years, and universities need up to a year to initiate programmes. Thus, a recommendation to use PAs within ED needs to be made quickly so that new graduates will be available from summer 2014, and can then undertake post-graduate training and provide a significant impact on the ED workforce by say mid-2015. In addition, many PAs taking a generalist PA course will not enter ED, thus significant numbers of PA courses need to be instituted as soon as possible. Lastly, PAs are not statutorily registered and thus cannot prescribe not order x-rays, both of which are clearly significant barriers to their effective implementation. Registration with HPC would solve this problem quickly.

18. Actions underway:

  1. CEM and GMC are working together to develop a Run-through training programme and facilitated entry into EM training.

  1. Work with ACCS colleagues in anaesthesia and acute medicine to consider-ordering the training programme to provide earlier experience in the main specialty.

  1. Training and assessment review and development of alternative training and assessment system that is now ready for consideration by the GMC.

  1. CEM and DH colleagues working with colleagues in advanced nursing and PAs to support development of curricula and assessment systems.

  1. Research and piloting to demonstrate effectiveness and provide the evidence base for clinical and cost considerations of recommendations.

  1. East Midlands Deanery/LETB held a half-day symposium in July 2012 to look into the issues faced by the specialty in the area. The symposium brought together stakeholders to share information and solutions that were being implemented to address recruitment, retention and progression of a multi- professional workforce in speciality.

  1. The issue of provision of a workforce to deliver Urgent and Emergency Care is the focus of the Academy (7/7 working group) and the RCP (Future Hospital Commission).

  1. DH survey of the Emergency Department workforce.

  1. CEM Dashboard exercise which includes staffing, training and commissioning.

References

  1. Guidance for commissioning integrated Urgent and Emergency Care: Royal College of General Practitioners August2011.

  1. Guidance and competencies for the provision of services using practitioners with special interests – Urgent and Emergency Care RCGP2008.

  1. The Benefits of Consultant Delivered Care: Academy of Medical Royal Colleges January2012.

  1. Developing and Emergency Care Workforce for the Future: The Nursing Contribution – discussion paper Royal College of Nursing January2012.

  1. Reorganisation of ACCS Emergency Medicine Elements – EMTFG Subgroup.

  1. Emergency Medicine Operational Handbook – The Way Ahead. College of Emergency Medicine December2011.

  1. College of Emergency Medicine and Department of Health Taskforce Group National Survey of Emergency Medicine Trainees 2011 – Trivedy and Jenkinson January2012.

  1. Emergency Medicine Competencies Subgroup Report – EMTFG January2012.

  1. Reconfiguration of Emergency Care System Services – College of Emergency Medicine Position Statement January2012.

  1. The development and potential of mid-grade non-doctor clinicians to deliver safe ED care in the context of a Consultant Led Service – Peter Chessum and Gary Swann, Jim Parle February 2011, modified July2012.

Appendix 1

Emergency Medicine Taskforce Membership:

Prof. David Sowden – (Chair) Director of Medical Education (England), METP, DH John Heyworth – Immediate Past President, CEM

Patrick Mitchell – Director of National Programmes, METP, DH Joanne Marvell – Specialty Recruitment Manager, METP, DH Alison Carr – Senior Clinical Advisor, METP, DH

Mike Clancy – President, CEM

Helen Cugnoni – ACCS lead for Emergency Medicine

Andrew Fraser – Policy Support Officer, Urgent and Emergency Care, DH

Prof. Matthew Cooke – National Clinical Director, Urgent and Emergency Care, DH Colin Holburn – Consultant in Emergency Medicine, fellow of CEM

Prof. Robert Crouch, Consultant Nurse, University Hospital Southampton NHS Foundation Trust Jim Parle – Professor of Primary Care, Physician Assistant Course Director, University of Birmingham

Gary Swann – Consultant Nurse, Emergency Care Directorate (HEFT) Tim Yates – JDC Representative, BMA Junior Doctors Committee

Peter Chessum – Advanced Clinical Practitioner, Heart of England NHS Foundation Trust Agnelo Fernandes- Representative, RCGP

Alison Graham – Chair, Scottish Association of Medical Directors Mike Jones – Vice President, RCP, Edinburgh

Prof. Moira Livingston – Commissioning Director, CfWI Barry Lewis – Chair, COGPED

Don MacKechnie – Representative, CEM

Bill McMillan – Head of Medical Pay and Workforce, NHS Employers Prof. Gillian Needham – Postgraduate Dean, NES

Trish O’Conner – Emergency Medicine Consultant, Hairmyres Hospital Emma O’Donnell – Senior Policy Manager, DH

Sarah Parsons – Medical Workforce Manager, NHS Employers Chris Roseveare – President, Society for Acute Medicine Caroline Shaw – Chair, FASSGEM (EM)

Garry Swann – Consultant Nurse, RCN Stephen Timmons – Lay Representative, CEM Chet Trivedy – Representative, CEM

India Peach – Project Support Officer, METP, DH

Previous chair

Patricia Hamilton – Former Director of Medical Education England, Department of Health

#63. Snowflakes, please read the writing on the wall…

…the writing that’s been there, in plain sight, for YEARS!

So many people with so much to say and all saying it through their backsides, especially the intensely irritating ‘Save Our NHS’ who have so much to say, all of it selectively picked from articles that support the arguments of its “spokeperson” and which she uses to reinforce the prejudices of her unquestioning supporters.

Well, to balance the argument – insofar as there is any room for argument in the face of the facts – I present two articles taken from the Shropshire Star of three years ago.

 

PUBLISHED: May 14, 2016 07:59

Future Fit: Doctors defend plans for having one A&E in Shropshire

Having one A&E department in Shropshire will mean patients are cared for in the “right place at the right time”, according to senior county doctors.

Consultants from the Shrewsbury and Telford Hospital NHS Trust have said plans for how hospital services will work in the county in future will provide the best care for patients.

It comes after the county’s two clinical commissioning groups threw plans for the future for the region’s two main hospitals into chaos when they failed to agree on whether to back the strategic outline case for Future Fit – the programme in charge of the review into hospitals in Shropshire.

The outline plans suggest one single A&E unit supported by a network of urgent care centres, one diagnostic and treatment centre and local planned care on both the Royal Shrewsbury Hospital and Princess Royal Hospital sites.

No decisions have been made and several options are suggested in the strategic outline case, which is effectively the first stage of the project.

Mark Cheetham, consultant general and colorectal surgeon and scheduled care group medical director, said: “One emergency department doesn’t mean worse access to healthcare. In fact, it would mean greater access to the right people in the right place at the right time. This is better for our patients.

We need to be brave and we need to look at ways of providing the best care for our patients in a sustainable way in the long-term. This isn’t about what is right or easy for us. And it’s not only about what is good for our communities today.

This is a long-term plan which is about providing the best care for our children and our children’s children.

The SOC is a further step forwards towards the development of better health services for Shropshire, Telford & Wrekin and mid Wales.

I have seen at first-hand the benefits that consolidating services can bring. In emergency surgery – which was consolidated on the Royal Shrewsbury Hospital site in 2012 – for instance we now have a team of 11 surgeons who specialise in abdominal surgery.

There is always one consultant free from all other activities to provide emergency care for our patients. The result has been a thriving large department of surgery with improved outcomes.

“I believe that by co-locating key services in an emergency centre, we will be able to provide safer, better care for patients who are seriously ill or injured. “Developing a separate diagnostic and treatment centre will allow us to provide better care for patients having planned surgery with an improved patient experience and a reduced chance of cancellations.

There is much more work to do as we refine our thinking and further develop these plans; I feel it is a positive start that will help to provide the best care possible for our patients whilst resolving some of the issues we face.

The easiest thing in the world would be to do nothing. That would be dangerous.”

“These plans are about ensuring patients now and in the future have the best access to the best medical staff in the best place when they need it, and I fully support that move.”

Dr Kevin Eardley, consultant renal physician and unscheduled care group medical director, added: “The strategic outline case describes options that will improve current hospital services ensuring that the sickest of our patients have access to better emergency, urgent and critical care services.

The reconfiguration of health services between hospitals has been observed locally already for the benefit of patients.

Patients from our region who have sustained major traumatic injuries currently travel to major trauma centres in Stoke or Birmingham. Patients who have serious or life-threatening heart attacks already go directly to Stoke or Wolverhampton.

In recent years at SaTH we have already made successful changes – children with severe illnesses are cared for at the Princess Royal Hospital and patients with major surgical illnesses are cared for at the Royal Shrewsbury.

The driver for these changes has been to improve access to the very best possible care and therefore improve the chances of a full and quick recovery.

Improving access to specialist services requires clinical pathways that direct patients to the most appropriate service where they will be cared for by specialist teams made up of a workforce who have come together, grown their expertise, and are therefore better able to deliver the very best possible care for generations to come.

 

Friday 20 May 2016

We, the undersigned Emergency Medicine Consultants, would like to take this opportunity to clarify our views on NHS Future Fit, The Shrewsbury and Telford Hospital NHS Trust’s (SaTH) Strategic Outline Case (SOC) for its Sustainable Services Programme, and the portrayal of “Accident and Emergency” in the media. NHS Future Fit and the SOC are an attempt to redefine high level medical care to the population that we serve.

We know that having all the services a patient requires on the same site improves the care delivered to that patient and the clinical outcome. We already send patients with major injuries or who have had heart attacks to Royal Stoke University Hospital. These patients have a lower risk of dying and an increased quality of life after being discharged. Within SaTH we have already concentrated emergency surgery onto one site in Shrewsbury and this has led to better outcomes. We now have a death rate below the national average. Acute stroke services are on one site in Telford and again this has improved the care and quality of life for patients who have suffered a stroke. Concentrating the paediatric inpatients at one site in Telford has increased our ability to recruit and retain high quality medical staff, which is better for our patients.

We acknowledge concerns about the increased transport time for patients. However, whilst getting a patient to hospital quickly is important, it’s more important that patients are seen in the right place, by the right person as soon as possible. A bigger more specialist site will mean more high quality staff, meaning patients can be seen by the right person much more quickly.

It’s all very well saying that we should employ more people at our sites, but the fact is our Emergency Departments are not attractive because they are small, with staff preferring to work in bigger state-of-the-art units. A single but larger Emergency Centre will help us to recruit.

At present the majority of patients who present to our A&E do not actually need to be seen there and would be equally well treated in an Urgent Care Centre/Minor injury Centre (e.g. cuts, fractures, stitches etc), which would remain at both sites if the SOC moves forward to Outline and then Full Business Case, as we hope. People would be seen, diagnosed and treated with local follow-up arranged, if required. The proposals would ensure that a high quality service is provided on both sites for the majority of patients who don’t need treatment in an A&E and the remaining patients would be cared for in an Emergency Centre. The Emergency Centre would be able to deliver high quality, life-saving care through a dedicated Emergency Team well supported by other relevant specialities.

Having one Emergency Centre would allow the Trust to ensure there is always one of our own senior doctors present 24-hours-a-day, seven-days-a-week to deliver care compared to the current situation of locum doctors more frequently delivering the care.

This model would also help to keep services in the area rather than moved to the bigger centres in Stoke or Wolverhampton. In addition, it would allow the Trust to be at the forefront of medical research, which it cannot currently do with the present configuration.

Following consultation with colleges from across the region, the ability to recruit and retain experienced, highly skilled staff would be increased – ensuring our patients receive the safest and kindest care possible in the county, rather than having to travel outside of Shropshire and Telford & Wrekin.

Doing nothing is not an option. The current model is not sustainable and change is needed. We must ensure patients now and in generations to come have the best services possible.

Yours

Mr Subramanian Kumaran FRCS, FRCEM, Consultant and Clinical Director for Emergency Medicine

Dr Adrian Marsh FRCEM

Consultant and Clinical Lead for Emergency Medicine, The Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, SY3 8XQ

[and]

Princess Royal Hospital, Apley Castle, Telford, TF1 6TF

 

 

#62. Jennifer Arcuri ‘virtually’ exonerates Boris Johnson.

photo-15410

When I started to watch the following interview on the Victoria Derbyshire show this morning I thought: “You’re screwed, Boris!”

But then as the interview progressed (and all credit to Derbyshire for one of the most balanced interview techniques I’ve seen in a long time, especially when compared with Andrew Marr) the situation subtly changed to one nuanced towards actuality (‘the state of existing in reality’) rather than as it’s appeared in the media – as a scrabble to mine the situation for the tiniest crumb of dirt.

Notwithstanding her hurt personal feelings, Arcuri is scrupulously fair to Johnson in dismissing what Andrew Marr was desperately trying to get Johnson to admit, that Johnson’s dealing with Arcuri as a businesswoman during his time as London mayor were somehow, let’s say, “questionable” if not downright illegal. They were anything but.

According to Arcuri’s own testimony, Johnson did not patronise Arcuri he supported her as a business PERSON who was of use to London, a point she makes throughout the Derbyshire interview.

If Johnson were a French politican he would rejoice in whatever notoriety a “scurrilous media” (with one or two singular exceptions) could have thrown at him.

But he’s not French and so he suffers the slings and arrows thrown at him by Opposition politicians and others whose moral compasses perhaps could do with a bit of oil to free them up because they appear to be stuck permanently pointing north.

https://www.bbc.co.uk/iplayer/episode/m000bhpw/victoria-derbyshire-18112019

 

 

#61: THE BLIGHTING OF VIABLE ALTERNATIVES AKA LOCAL PLAN REVIEW.

See also #53; #54; #56

The direct impact of the promotion of the ‘preferred sites’ on Highley.

The realisation of the potential impact of the ‘review’ of Shropshire’s Local Plans (supposedly reflecting the aspirations of local communities within parameters established by national and county policy) started with this email, received Friday, June 15, 2018.

The consultation exercise was part of the Local Plan Review and was promoted by planners as an information gathering exercise, at no time during the meeting that followed was preference for any site considered because, we were told, that would form part of the later “consultation” process.

What we didn’t fully appreciate at that time was that to planners “consultation” means something entirely different to what most people understand to be consultation. [See: #53: How Do Planners Get Away With It?]

The letter Highley parish council received said:

Meeting to discuss Shropshire Local Plan Review – Preferred Options for Site Allocations in Highley

As you are aware, Shropshire Council recently consulted on the Preferred Scale and Distribution of Development as part of its review of the Local Plan. The next stage of work involves the identification of preferred site allocations for Shrewsbury, the market towns and the key centres, [Highley is classified as a Key Centre in planning terms] together with the preferred scale of growth, development boundaries and potential allocations for Community Hubs. We hope to publish these preferred options for consultation in October 2018.

To inform this stage of work, we are assembling relevant information for all settlements which we are proposing will be identified as locations for development in the new Plan (this includes Shrewsbury & the market towns) so that we can arrange a focussed discussion on the key issues. The growth guidelines which we have identified for housing and employment land for Highley within the Preferred Scale and Distribution of Development consultation, will require approximately 4 hectares of additional housing land and 1 hectare of additional employment land to be allocated.

Shropshire Council has undertaken an initial strategic screening of development sites around Highley in order to discount those sites which are unavailable and/or wholly unsuitable. I have attached a map and accompanying table showing the remaining sites which have been promoted to us by landowners (only a small proportion of which will actually be required). This information is currently confidential and should not be shared more widely at this stage. More detailed assessments, including analysis of landscape and visual impacts, are currently being undertaken and these will help to identify constraints and opportunities associated with the remaining sites, which, alongside views from the local community as expressed through the Town Council will inform the site allocation process.

The irony of the planner’s use of the term “preferred site” seemed to have passed them by, because that last sentence clearly implies that whilst the identified “preferred” site is identified as the preferred option, the planners go on to say that the word “preferred” should not be taken to mean what everyone else thinks it means – that using the word does not indicate a preference.

Question a planner on this and you’ll get a blank look because they simply will not see what they’re doing here, and they certainly won’t get your confusion at being told that the word “preferred” doesn’t actually mean exactly what you’ve always taken it to mean – that something is favoured over any alternatives on offer.

It’s necessary to explain all that because the planning department’s take on the English language is unique and, together with “preferred”, their understanding of what constitutes “consultation” will also require a fair bit of effort to get your head around. It’s as well to be prepared and that earlier reference to an earlier blog article will help. [See: #53: How Do Planners Get Away With It?]

In the following article, the question I’m posing is: how does the way Shropshire Council planning department’s approach to “local engagement” relate to principles laid down as far back as 1969.

The Skeffington Report, ‘People and Planning. Report of the Committee on Public Participation in Planning’, prepared by Arthur Skeffington MP was published in 1969 so planners have had plenty of time to get their heads around it.

Until the Skeffington Report, planning had been a largely ‘top down’ system, consultation had been a gesture only, involving those already familiar with the planning process and how to participate, resulting in poor community involvement.

The Skeffington Report proposed that local development plans should be subject to full public scrutiny and debate. Planners were supposed to become more pro-active and ‘hard to reach’ parts of communities become better engaged as part of a “genuinely democratic process”, working towards consensus between a wide range of competing interests.

Those lessons appear to have been forgotten, at least by that part of Shropshire Council’s planning department responsible for the current Local Plan Review.

Shropshire Council’s approach to consultation gives rise to concerns about effective community engagement with the planning system, which can be complex, remote, and generally difficult to engage with, negative factors planners often do nothing to mitigate because the status quo works to their advantage!

As the Rt Hon Nick Raynsford MP said following the recent review of the planning system he undertook in 2018:

“We ignore at our peril the anger and disaffection felt by so many communities at the failure of current planning policies and procedures to listen to their concerns and respond to their needs”.

Well, someone doesn’t mind a bit of peril because very little has changed in the interim and it’s arguable that things have actually got worse!

How much worse for Highley?

The map accompanying the letter we got from Shropshire Council setting out Shropshire Council planning department’s intentions identified seven sites, two of which had been the subject of earlier applications for Outline Planning Permission, one had been withdrawn for unspecified reasons – the agent acting for the landowner in that case had been Helen Howie (see blog #56: Planning: The Failed Process or The Curse of the NPPF, a community nightmare) – the other (HNN014, see map below) had been refused, the details of which I set out later in this text.

[Taking advantage of the newly-acquired ‘preferred site’ status, HNN014 subsequently reappeared as an application for 20 ‘affordable’ houses, a development that was refused as ‘over-development’ See Appendix.]

The earlier history of the preferred site.

YEW TREE SITE

 

Look closely at that location map above, in the centre at the top you’ll see “Hazelwells”, a Grade 2 Listed building, the preferred site falls within the curtilage of that historic local asset Hazelwells Hall!

You will also notice that the left hand (western) boundary of the preferred site is indented because 20 years ago, householders on Yew Tree Grove, whose properties overlook the field, bought a 25 yard strip to extend their gardens.

YEW TREE SITE BUFFER STRIP

 

The householders on Yew Tree Grove applied to get the strip of land changed from Grade 3 Agricultural land to Residential but Bridgnorth District Council (BDC) placed an order called an Article 4 Direction on the whole of this site…

An article 4 direction is made by the local planning authority. It restricts the scope of permitted development rights either in relation to a particular area or site, or a particular type of development anywhere in the authority’s area. Where an article 4 direction is in effect, a planning application may be required for development that would otherwise have been permitted development. Article 4 directions are used to control works that could threaten the character of an area of acknowledged importance, such as a conservation area.

Article 4 directions can increase the public protection of designated and non-designated heritage assets and their settings. They are not necessary for works to listed buildings and scheduled monuments as listed building consent and scheduled monument consent would cover all potentially harmful works that would otherwise be permitted development under the planning regime. However, article 4 directions might assist in the protection of all other heritage assets (particularly conservation areas) and help the protection of the setting of all heritage assets, including listed buildings.

[Historic England: Restricting Permitted Development: Article 4 Directions and Heritage]

ANY development by those householders, regardless whether that “development” took the form of a greenhouse or raised vegetable beds, was forestalled by Bridgnorth District Council planning department’s Article 4 Direction placed on the WHOLE FIELD.

Not to be outdone, the house owners on Yew Tree Grove did eventually go to the expense of getting the Article 4 Direction overturned on the strip they’d purchased, had they not then every household would have had to apply for separate planning permissions to erect any “structure” (however loosely defined) on their individual plot.

Crucially, that Article 4 Direction remains in force on the rest of the field to this day.

The senior planning officer for Bridgnorth District Council at the time issued additional guidelines that precluded any further development on the WHOLE of the eastern ridge of the ‘plateau’ that Highley sits on, to preserve the skyline as viewed across the Severn Valley. That senior planning officer was Ian Kilby, current head of planning at Shropshire Council who said…

The view of the Bridgnorth Office is that we would prefer not to see more development on the eastern side of the village – i.e to not add to existing development on the western ridge of the Severn Valley or the upper slopes to the western side of the village. We consider therefore that any allocations should be on land to the south/southwest on the basis of landscape impact.”

The blighted alternatives.

There are a number of realistic alternatives to Shropshire Council planning department’s preferred site, but one in particular offers a solution to a long-standing problem on the main road through the village – the rat run down the Hazelwells estate road to avoid being stuck behind the 125 bus in either direction as it travels along Clee View Terrace, the terrace of houses shown in the centre of the Google Earth image below.

There is a bus stop opposite the middle house in the row (under the large tree in the image). With cars parked on the road immediately outside the houses the road becomes a single carriageway, so if there is a bus there you have to wait until it clears Clee View.

Clee View bus stop and rat run via Hazelwells Road…

CLEE VIEW AERIAL

Coming from the northern Bridgnorth direction, in anticipation of that hold up vehicles choose to turn left off the B4555 and travel down Hazelwells Road to its southern junction with the B4555, the route shown shaded running vertically down the middle of the image below.

RAT RUN AERIAL

This site offers the solution…

TAYLOR SITE
… Woodhill, obscured by the ‘HNNO19’ label, to the left of Clee View terrace.

The schematic drawing below shows one design for the site. The block shown away from the separate dwellings (bungalows) is a residential block for nursing the elderly and infirm.

TAYLOR SITE PLAN WITH CLEE VIEW

The design is an indicative illustrations only and subject to change following detailed discussions with the landowners, their architect, and the planners, but it’s an idea of what COULD be done.

The bus stop is to the right of the word “Shelter” and the area roughly drawn in outline is the area where off-road parking for Clee View residents could be sited, together with an off road pull in for the 125 bus.

The bonus offered by this alternative site is the employment opportunity offered by the sheltered retirement housing, a significant economic benefit to Highley.

APPENDIX

The following Appendix is particularly useful in demonstrating how advisory comments can be ignored by both developers and by the planning officers that make them.

A planning application for the smallest of the preferred sites (HNN014) for TWENTY two-storey ‘affordable houses’ has recently been submitted. An earlier application had sought to build NINE bungalows.

The earlier application for bungalows was refused planning permission in 2016 and was taken to appeal on the grounds of non-determination because of delays by Shropshire Council in processing the application. The application was then refused for the following reasons:

1. Insufficient information has been provided to enable the Local Planning Authority able to conclude that the proposal will not cause an offence under the Conservation of Habitats and Species Regulations (2010), the scheme as such is contrary to National Planning Policy Framework and Shropshire Council Local Development Framework Core Strategy CS17.

2. In the absence of the agreement to make a contribution towards affordable housing provision, the proposed dwellings would be contrary to Policy CS11 of the Shropshire Council Local Development Framework Core Strategy and to the Council’s Supplementary Planning Document on the Type and Affordability of Housing.

(Officer’s report to the South Planning Committee.)

My own view as the Local Member was that whilst the application for nine bungalows was a reasonable use of the plot (because relatively low profile in terms of its visual impact), I shared both the parish council’s concerns about the site falling outside the established development boundary and the serious concerns about access to the site off the busy B4555, otherwise it would have met a local need for such housing.

On notice of the appeal, Shropshire Council’s report (subsequent to the earlier officer’s report to the South Planning Committee) was submitted because…

2.1 An appeal has been lodged against non-determination of this application and the decision now rests with the Planning Inspectorate. However the Council is required in the appeal process to indicate what its decision would have been if it still had authority to determine the application.

2.2 The application is presented to committee as the Parish Council has submitted a view contrary to officers and the application has been requested to be referred by the Local Member.

That report went into considerable detail to explain how the development of nine bungalows would have a moderate-to-low impact, both aesthetically and in terms of its impact on the local infrastructure, Shropshire Council’s own planners were of the opinion that whilst…

Highley is identified as one of the key centres in Policy CS3 of the Core Strategy. This establishes the principle of Highley as a sustainable location for new development. The application site in particular is located within walking distance of town centre services and facilities (the town centre around 500m from the site boundary) and is within close proximity to the Severn Centre. It is considered that in these respects there are clear sustainability credentials to the site which must be weighed up when determining the application.

…it should be noted that…

Sustainable development’ isn’t solely about accessibility and proximity to essential services. The NPPF states that it is ‘about positive growth – making economic, environmental and social progress for this and future generations’. In paragraph 7 of the NPPF it states that these three dimensions give rise to the need for the planning system to perform a number of roles:

an economic role – contributing to building a strong, responsive and competitive economy, by ensuring that sufficient land of the right type is available in the right places and at the right time to support growth and innovation; and by identifying and coordinating development requirements, including the provision of infrastructure;

a social role – supporting strong, vibrant and healthy communities, by providing the supply of housing required to meet the needs of present and future generations; and by creating a high quality built environment, with accessible local services that reflect the community’s needs and support its health, social and cultural well-being; and

an environmental role – contributing to protecting and enhancing our natural, built and historic environment; and, as part of this, helping to improve biodiversity, use natural resources prudently, minimise waste and pollution, and mitigate and adapt to climate change including moving to a low carbon economy.[6.1.15]

Significantly, the original committee officer report referenced the contextual factors that are supposed to be at the heart of a “plan-led planning system”.

It is not considered necessary or appropriate to [seek] additional sites outside of the Highley development boundary in an area of open countryside, and this would be contrary to the development strategy for the area. A core planning principle in the NPPF is that development should be genuinely plan-led, empowering local people to shape their surroundings, and this is what the recently adopted SAMDev Plan [Shropshire Council’s long term development plan] has achieved, providing a practical framework within which decisions on planning applications can be made. The use of this land for residential development would undermine the NPPF’s objective of a Plan-led approach to development.

The presumption in favour of sustainable development that runs through the NPPF is a relevant material consideration, but it is not considered that this ‘presumption in favour’ should outweigh the significance and primacy of the up-to-date development plan policies in making decisions. On balance, it is considered that the proposal would not be acceptable, being contrary to Policies CS3, CS4 and CS5 of the Core Strategy, and SAMDev Policies MD1, MD3, MD7a and S9.

The promotion of Shropshire Council planning department’s preferred sites blows a hole through all those clearly expressed reservations about the earlier application for the development of the site HHN014, the smaller of the two sites comprising the preferred development area identified by Shropshire Council.

According to Shropshire Council’s figures, the two sites HHN016 and HHN014, are scheduled to take a development of 122 dwellings, despite the reservations expressed over the earlier 2016 application for “just” nine bungalows.

The more cynical among us saw the recent application for 20 affordable two-storey houses as an ill-disguised attempt to sneak in a larger development on the back of the clearly expressed Shropshire Council preference for this, a suspicion that was confirmed in the albeit brief conversation I had with the developers of those 20 two-storey houses at their ‘public exhibition’, the preferred status actually being cited to confirm the “local need” for “such a development”.

It was also clearly inferred that their decision to apply for planning permission was AFTER discussion with Shropshire Council and so I was doubly gobsmacked that, given the history of the site, they still went ahead with an application that was subsequently refused as “over development”!

And Shropshire Council are giving the go-ahead for 122 dwellings regardless of the consequences. Why? Because they can point with one finger to a site that meets in one go what Shropshire Council planning department has determined to be Highley’s contribution to meeting the county’s housing quota until 2036.

That’s why.

 

#60. County Councillor’s Report, November edition of the (Highley) ‘Forum’.

County Councillor’s Report

Excepting my RAF years from 1959 to 1965, I’ve been known to have a bit of an anti-Establishment “attitude”, doubtless because of a dry/wry sense of humour that has meant I’ve always had a bit of a job taking seriously people who take themselves too seriously, but I’ve nevertheless always respected the views of others as long as they haven’t tried to thrust their views down either my throat or the throats of others.

Sincerely held beliefs are deserving of respect unless they are extreme and impact adversely on the lives of others. I’m an atheist and have been for as long as I can remember, but I believe that religious principles are the basis of any civilised, caring society and as such are central to the principles of democracy because they are the basis of the civic principles upon which an orderly society are based.

Just as religious symbolism is important to the communicating of religious principles, so civic symbolism is important to the communicating of civic principles, “the panoply of State”, whether the Monarch’s ‘opening of parliament’ or the small ceremony that marks the opening of full council at Shirehall, when a bell is rung and everyone stands for the prayer that precedes official business. You don’t need it explaining, you just know that something “important” is going on, and even if the significance isn’t obvious to you, you appreciate its importance to someone.

Out of respect for the beliefs of others and to show deference to those principles of democracy, I stand throughout that little opening ceremony because it costs me nothing and reminds me that others hold to different beliefs.

I always remember what we “sprogs” (new recruits) were told when we were first on parade in our blue serge uniforms and had the technique of saluting drilled into us along with the explanation of the significance of the cap badge.

Each of the armed services has a different way of saluting. In the RAF, palm facing forward, finger tips one inch behind the right eye; in the army, palm facing forward, edge of index finger above the right eye; the navy, palm down, index finger above the right eye)

The crown on the cap badge was what mattered because it was symbolic of what we had joined up to defend. As explained by the sergeant instructing us on why we were expected to salute officers:

“Even though you scrawny lot are not old enough to be trusted with a vote in this democratic country of ours” – most of us were 151/2 or 16 at a time when you had to be 21 to vote – “the head of the British state is the Queen, and what does the Queen wear on her head? A crown. THAT’S what you’re saluting. Even if the person wearing that badge is a complete idiot, it’s the QUEEN as represented by that crown that you’re saluting, not the person who holds a commission from her!”

That was our baptism into the significance of symbols, of symbolic ceremony.

Whether it’s saluting that cap badge, standing for the prayers of others, singing the National Anthem, or respecting the procedures of council that engender civilised debate over matters of differences of political opinion. Which is why I was so angry about the disruption of council business by members of Extinction Rebellion at the last Shropshire Council meeting and the unforgivable applauding of that disruption by members of the Labour, LibDem and Green parties.

Such behaviour is bad enough in Parliament, but in what I’ve always vainly believed should be a non-political arena primarily concerned with local issues, it was incredibly disheartening.

But also revealing.

Dave Tremellen

Independent Councillor for Highley Ward of Shropshire Council.

#59. Thinly veiled contempt of the liberal elite, updated…

A motion tabled by Green Party Councillor Julian Dean at full council on Thursday 19th September made the headlines of the Shropshire Star. For some reason the motion and the subsequent debate (which consisted largely of defensive statements by Julian Dean and his LibDem allies in response to my speech) was reported in the North Shropshire edition of the Shropshire Star but in neither of their two other editions.

This is the article followed by the full text of my speech…

This is the full text of my speech…

This move by openly anti-Brexit Members to continue to damage this nation with their delaying tactics is to be regretted.

In the Shropshire Star of September 12th it was reported that Shropshire farmers, like the rest of the nation, just want to “get on with Brexit” and end the uncertainty introduced into the whole process by the people who propose motions like this, motions that prove that ANY arguments supporting the result of the 2016 referendum won’t have the slightest impact on the pro-EU camp.

They display a breathtaking arrogance, dictating policy by arguments based on denigration and verbal intimidation, using emotive terms like “disaster”, “cliff edge”, and “crashing out”.

I didn’t gloat over the outcome of the 2016 referendum, I just drove home and got on with looking forward to seeing the government carry forward the clearly expressed will of the British people to leave the EU, with or without “a deal”, because I had researched the potential options BEFORE choosing which side I would campaign for. The deciding issue for me was that we leave the EU – not the Europe with whom we’d had a succession of successful free trade arrangements within a common market, but the explicitly political EU and its plans for a federalist state.

The thinly-veiled contempt in this motion for anyone who voted for Brexit displays the liberal elite’s denial of the right of anyone else to hold any view that runs counter to its own.

Anyone tempted to read too much into the “narrow” margin by which they failed to get their way, should take note that the total number of Shropshire votes cast for Remain was 78,987, the total number of Shropshire votes cast for Leave was 104,166, which is a wide enough margin to convince anyone that Shropshire’s vote to LEAVE THE EU was both conclusive and informed.

To fully understand my anger at Julian Dean’s action you need to read my earlier blog post from three years ago, July 11 2016…

#25. On the Liberal elite’s thinly-veiled contempt for anyone who voted for Brexit.

From which you will see why Julian Dean’s motion stoked an old fire that had smouldered for over three years, with Andrew Bannerman continuing to stoke the embers…

https://www.shropshirestar.com/news/local-hubs/shrewsbury/2019/03/04/open-britain-shrewsbury-to-join-brexit-march-in-london/

This (further) response of mine was meant to appear a few days after my speech in response to Julian Dean’s motion but, after the contentious judgement that came out of the Supreme Court ruling on the legality of Boris Johnson’s proroguing of parliament, it’s taken me a while to calm down and take on board the many observations on that ruling that subsequently appeared, not least that of an ex-SUPREME COURT JUDGE

https://www.express.co.uk/news/uk/1177020/brexit-news-gina-Miller-supreme-court-lord-sumption-sky-channel-4-prorogation-parliament

Although I’d written my response to the motion early on the morning of Full Council (19th September), I still wasn’t sure whether to speak because I know that nothing anyone says in support of Brexit has ANY effect on the pro-EU Remain lobby, but once Julian Dean stood up and voiced his “concern” for the livelihoods of livestock farmers and the agricultural industry generally in the event of a ‘no deal Brexit’, well the hypocrisy was just too much.

One thing I do regret is that after the debate I never thought to ask how many of those supporting the motion were vegetarian or vegan, or how they squared the Green Party’s advocacy of plant-based diets to reduce dependency on the greenhouse-gas producing livestock industry with the motion’s claimed concern for the livelihoods of those same greenhouse-gas producing livestock farmers rearing all that offending livestock.

The LibDems, of course, are determinedly anti-Brexit, period, so Heather Kidd’s insistence that their ONLY worry was the impact of a no deal Brexit was at best disingenuous.

That the Labour group supported the motion, despite the Leader of the Labour group attacking the LibDem’s for hypocrisy, was to be expected, although what wasn’t expected was my not being singled-out and reference made to my past membership of UKIP!

NOTE: I actively campaigned with UKIP during the lead up to the referendum and left the party three days after the result, job done as far as I was concerned. I was actually dismissed from the Independent Group at Shirehall because, I was told: “UKIP is racist and we don’t want a member of a racist organisation in the Group”. This despite the Local Government Association (LGA), of which the Independent Group at Shirehall is a member, includes UKIP as a member of the LGA Independent Group along with the Green Party. A few months after I’d left UKIP I was allowed back into the Independent Group.

The Leader of the Independent Group who helped sponsor the motion has relatives who live and work in Europe and so her support for such a motion was a given.

But the background…

Most of the people campaigning so loudly against Brexit have no idea of where most of us who want to leave the EU are coming from because most of the pro-EU grouping have no idea of a UK outside the EU; most of them either weren’t even born when the EU’s roots were first put down or were too young to know what was happening.

Having been around at the time, I remember few people signing up to the political aspects of what is now the EU when the UK joined its predecessor the European Economic Community (EEC) on 1 January 1973 because, at the time, the “political aspects” weren’t in the forefront of everybody’s mind because, during the subsequent campaign leading up to the 1975 referendum on whether the UK should stay in the EU, both Conservative and Labour supporters of EU membership ignored the political and constitutional issues and emphasised the economic aspects of membership.

That said, the political and constitutional issues were a factor in uniting some individuals who on most other issues would have been violently opposed to each other, people like ultra-right-wing Enoch Powell and the ultra-left-wing Tony Benn, both of whom strongly opposed membership because they could see that talk of “ever closer union” foreshadowed federalism: the creation of a European State to which all its constituent member states would be subservient, subsequent moves by the EU proving Powell and Benn right to voice concerns.

Tony Benn said: ‘Britain’s continuing membership of the Community would mean the end of Britain as a completely self-governing nation and the end of our democratically elected parliament as the supreme law making body in the United Kingdom.’

[It’s worth reading the Spectator article that came from to see how it would, today, be a commentary on the shambles that dedicated anti-Brexit parliamentarians (especially the Conservative ones) have created in their determination to frustrate the result of the 2016 referendum… https://blogs.spectator.co.uk/2016/05/a-lesson-from-the-1975-referendum/ ]

[It’s also pertinent to consider Benn’s words in the light of the recent ruling by the UK’s Supreme Court that they have the right to consider themselves “the supreme law making body in the United Kingdom”, rather than merely empowered to enforce laws passed by parliament, parliament being the government of the day by virtue of their majority within the House.]

My principle objection to the EU is about what the UK signed up to back in the day, as former Master of The Rolls Lord Denning put it in 1974: ‘The Treaty of Rome is like an incoming tide. It flows into the estuaries and up the rivers. It cannot be held back.’ He was referring to the further integration of “European” states into a single political entity, the federation of states known as the European Union.

A fear too far.

It is 74 years since the end of the Second World War and yet the rhetoric from the pro-EU side is still about Europe trying to escape from its shadow, despite all the institutional changes that have happened since to make a repeat of that dreadful time difficult to comprehend. Despite the emergence of far-right groups within some members of the EU, to envisage the kind of ‘triumph of evil’ that led to the Third Reich is to assume that the world has not moved on.

It is worth reminding those who promote the EU as an engine of peace of the signal failure (in which the UK played a significant role) of the EU not only to prevent but to implicitly encourage the massacre of more than seven thousand Bosnian muslim men by Serbian forces – an act of genocide that could have been prevented had “Europe” not sat on its hands – by insisting that the break up of the former Yugoslav Republic was a ‘civil war’ in which the competing factions should be allowed to sort out their ‘differences’ without outside interference.

It was the US-led air attacks against the Belgrade-backed Serbian military that led to the ‘Dayton agreement’ and the backing down by Slobodan Milošević.

After the Second World War Germany was a divided country with scant hope for reunification. The Cold War raged and people lived with the ever-present fear of nuclear annihilation, a reality I was actually a part of as a 19 year-old airman nurse-maiding the nuclear bomb in the bomb bay of one of the Victor v-bombers at RAF Honington, with the aircrew on 4-minute standby for what would have been a suicide mission because there would have been nothing to return to. That was the ‘Cuban missile crisis’ of October 1962. The Second World War was just 17 years past and yet here we were literally four minutes away from WW3.

In 1962, it was a totally different world. Whilst travel by aircraft was common, it was still rare for the majority of people. Compared to today, there were still few telephones (I never had one in any of the houses I lived in until 1973) and even fewer televisions – most of those that were around were rented – and certainly no computers or at least none available to ordinary people, so no internet and no email.

But as the shadow of the Second World War receded the European economic community, the precursor to the EU, was changing, its membership greatly increased once the Berlin Wall came down and fear of the old Soviet Union and the prospect of WW3 receded.

The advantages of membership of a Common Market between the continental European nations made sense as the old fears receded and the post-war effects of the war were gradually overcome.

The UK had not been as badly damaged in the war as mainland Europe, its small and efficient agriculture sector surviving intact, but that wasn’t enough to stop the UK’s economic post-war decline (relative to the continental European countries who anyway started from a lower base line), a decline that – despite the obvious comparisons with its Continental neighbours – had nothing to do with Britain being outside the European Community.

As unpalatable as the fact is to some sectors of the UK political establishment, the reason the UK’s relative economic performance improved was down to Margaret Thatcher (Prime Minister from 1979 to 1990) getting to grips with the real factors that had held the country back: excessive trade union power (I witnessed that first-hand at British Leyland), weak management (the self-destruction of the British car industry being a case in point), and under-investment resulting in a poor economic structure.

But still the Establishment insisted that wholehearted membership of the European Community (with an aspiration to monetary union) was the only answer to Britain’s ‘problems’. It was only later that the fallacy of such thinking was exposed when, in 1992, with the UK inside the Exchange Rate Mechanism (ERM, introduced by the European Economic Community), unemployment was soaring, businesses were going bust and the economy was in recession. Nevertheless, the Treasury and most of the ‘usual pundits’ (coincidentally the same ones who rail against Brexit) insisted that if the UK came out of the ERM, the results would be disastrous.

When the UK was eventually forced out of the ERM on 16 September 1992 interest rates fell and economic recovery was soon underway. There was a lesson there, one that those of us who voted Leave in the 2016 referendum had not forgotten!

https://en.wikipedia.org/wiki/European_Exchange_Rate_Mechanism

Sovereignty, what’s that all about?

The EU’s shoehorning of states with different histories and characteristics into an artificial common identity – “Cross-nation integration” – may be a noble objective, but it is one doomed to failure because it is an abstract intellectual construct predicated on wishful thinking.

Which is what drives UK euroscepticism. Too many vested interests, prime amongst them being the Common Agricultural Policy (CAP), the reason most British farmers supported leaving the EU at the 2016 referendum. And of equal significance for communities directly impacted by it is the Common Fisheries Policy that devastated communities around the coast of the UK from Scotland to Cornwall.

I mentioned earlier:

That the UK had not been as badly damaged in the war, its small and efficient agriculture sector surviving intact”.

What angers British farmers is seeing the bulk of the vastly expensive CAP being channeled to the inefficient agricultural sectors of France and what are referred to as “the emerging economies” of the ex-Eastern bloc countries. For years the heavily-subsidised French farmers have effectively (as one farmer expressed it to me when I was campaigning in the lead up to the referendum) “taken the piss”. That farmer was scathing in his opposition to the CAP, others who campaigned to Leave reported similar unsolicited reactions from farmers, who approached us to voice their support. That was an eye-opener for me.

The Cameron years.

And not the recent BBC programme of that title, but the few years leading up to the 2016 referendum when David Cameron tried to negotiate reforms within the EU to bring it more in line with the expectations of not just the UK but many other European countries, most of whom were quietly complaining but doing nothing about it.

Cameron did try, although seeking for the UK to be excused from the EU’s ultimate aim of “ever-closer union” was an unrealistic step too far because the EU’s founding fathers had made it clear from the outset that they were about establishing “ever closer union”, an aim that remains at the root of UK unease with the European project.

Martin Schulz, at the time the president of the European Parliament, said it all:

“What makes me sad and angry is the undertone of national resentment. Hatred is spread. People are used as scapegoats.” It was “not possible” to change the UK’s relationship with the EU, said Schulz, adding that Britain “belongs” to the EU.

Cameron, in a January 2013 speech, laid out general principles for reform that included a transfer of powers back to member states and their national parliaments so that European leaders should remain accountable, although the “remain” bit was always a case of hope over expectation because one thing the EU has never been is accountable and they’ve never given any indication that that’s ever likely to change.

The coup de grace to these aspirations was Cameron wanting to enshrine these changes in a new treaty for the EU. Not a chance.

Despite his efforts to get reform (meeting resistance at every turn), Cameron was never a fan of the UK’s coming out of the EU and his hopes of keeping the UK in the EU lay in winning the general election in 2015 and then winning the in/out referendum he had promised in January 2013 in an ill-concealed attempt to neutralise the growing support for UKIP.

Note: Cameron first raised the prospect of a referendum in 2010, when he said that voters had been “cheated” out of a vote on the Lisbon Treaty

Cameron did not expect to lose in the referendum and so he simply didn’t prepare for something he considered an impossibility.

As we all know, the referendum happened in June 2016 with the majority voting to leave the EU.

One of the things that convinced me that I was right to campaign to leave the EU was WHY Cameron failed to obtain those reforms – EU intransigence. The EU had been, without putting too fine a point on it, contemptuously dismissive of Cameron and, as Cameron was Prime Minister of the UK, contemptuously dismissive of the people of the UK.

In his thoroughly-researched book ‘Brexit & Ireland’ (pub. Penguin Books, 2018), Tony Connelly says:

[within the EU single market] There are still many obstacles that, according to critics, are simply forms of protectionism under the guise of health or cultural sensitivities.

Ireland is not alone in wanting those impediments removed. Denmark, Finland, the Netherlands, Poland and the Baltic states all pursue a more liberal, free-market course. Germany and France tend to be protectionist.”

He goes on to say:

There was one member state Ireland could always rely upon to champion greater access for companies to sell their goods and services across the EU. That member state? The United Kingdom of Great Britain and Northern Ireland.”

Cameron didn’t have a hope in hell of getting change, let alone compromise, out of a EU dominated by France and Germany.

Is there life after the EU?

No one doubts that the UK’s trade with the rest of the EU is significant, but it is wrong to presume that all British exports to the EU would cease as soon as the UK leaves the Union. A good proportion would continue, pretty much come what may. Exactly what would happen depends on what sort of trade relations were agreed.

The thing is that whilst we cannot be sure of the answer, we can get quite some way by focusing on considerations of self-interest and the structure of existing international arrangements. One thing is clear, though: there would be enormous advantages for both sides in continuing a very close commercial relationship. Those supporting Brexit believed that would have been the most likely outcome but for the tactics of the Remain lobby sabotaging any attempt to get ANY deal from negotiations with the EU.

The UK is in a strong position to negotiate. The UK is the EU’s largest single export market. The EU exports more to the UK than the UK exports to the EU. The UK has a strong hand in negotiations over future access to UK fisheries.

European car manufacturers would want to maintain free and open trading links with the UK. With the UK’s existing trade relations favouring EU imports into the UK, it’s likely that Britain could negotiate a trading relationship that would work to everybody’s benefit, except that with ‘no deal’ effectively off the table (thanks to the mischievous Benn Act – I wonder what his father would make of that!) the UK has literally to hand even more negotiating leverage (and the mere act of triggering Article 50 also meant the EU called the shots on the nature and timing of any negotiations) to a EU that just wants to keep us in the EU.

What about foreign direct investment (FDI)?

It’s not an easy one to call.

The answer is that the UK is successful at attracting FDI for reasons other than its membership of the EU:

  • the English language;
  • a legal system that can be trusted;
  • a skilled and flexible workforce;
  • a familiar social and political culture and global links

– although all of the above can be said of Ireland who, moreover, introduced a notoriously corporation-friendly tax regime, lowering capital gains tax (in Apple’s case to 0.005% in 2014) in order to attract high-tech companies to the Republic at the UK’s expense.

https://www.investopedia.com/ask/answers/060316/why-ireland-sometimes-referred-tax-haven.asp

By doing so, Ireland raised the ire of the European Commission (EC) who ruled the move illegal. Ireland appealed the European court’s judgement on the grounds that, as a sovereign nation, it had the right to determine what was best for Ireland and to do whatever was necessary in order to achieve that end.

There is, of course, nothing to stop the UK from doing the same!

At the time of Ireland’s scrap with the EU, Nigel Farage said:

I think Ireland, in the next few years, [.…] is going to have to have the same debate about its future relationship with the European Union, about its right to its own government.” (ibid)

If the economic case for coming out can be made to appear “not particularly overwhelming”, the economic case for staying in is equally challenging because they are both based on uncertainty about how the world will be in the foreseeable future, an uncertainty made worse in terms of its impact on UK businesses by the delaying sabotaging tactics of the Remain lobby.

But the Bexit side didn’t exactly help its case. Had we done what the Irish government did, anticipating an ‘either way’ outcome to the 2016 referendum (explained in forensic detail in Tony Connelly’s book), then the UK would indeed have left the EU, fully prepared, by the end of the transition period triggered by Article 50.

The ‘personal’ bit.

About 14 years ago I had been contracted to convert a regular customer’s cellar into a study/playroom for their children. My business was called ‘Conservation Joinery Services’ which involved joinery work almost exclusively on older properties, the bulk of my work coming either through word of mouth between customers or via the Conservation Department of Bridgnorth District Council (prior to unitary). I worked alongside fellow tradesmen who I either sub-contracted directly or recommended separately to the customer to contract in.

I was working with a plasterer friend, Nigel, who had recommended to the customer a local company to do the electrics. When the electrician turned up it happened to be the owner of the electrical contracting company. Now he was known to turn up to quote for work but then usually sent one of his two employees to actually do the work. We took the mick, pulling his leg about things having got so bad that he was forced to get his hands dirty for once. We had no idea how close to the truth we were.

Faced with competition from Polish tradesmen, (at that time Poland had recently joined the EU and so its people could move freely across other EU member states) he found his work – including long term regular contracts established over many years – simply going to Polish workmen who were charging prices so low that he couldn’t compete. The Poles were able to do that because they were coming over from Poland and staying with relatives among the long-established Polish community in Telford, often two or three to a room, staying only long enough to earn however much and then returning home to Poland, coming back to the UK when they needed to earn more money.

The Polish guys the electrician found himself competing against were getting around the need for work to be certified [ Approved Document P: electrical safety, dwellings ] by doing what quite a few uncertified UK electricians were doing, paying a Part P qualified sparks to inspect the completed work and signing it off for Building Regs. All perfectly legal and an experienced electrician in one European country doesn’t have to do much to adapt to working with the electrics of another European country. The Poles are bloody good tradesmen, the trouble was they were over here and seriously undercutting British tradesmen who had mortgages and families with a reasonable expectation of a decent standard of living – but at UK prices.

That Part P-qualified electrician working on that cellar job was no longer the owner of a three-man company with regular contracts, he was now a sole trader having had to lay off his two guys who he then found himself competing against for work as well as the Poles.

And what went for electricians also applied to all other construction trades. Many Eastern European construction gangs were multi-skilled, able to offer a full service to customers, from digging the first hole in the ground to topping off. You can’t blame the British customers for wanting to save a few thousand pounds on their job, nor could you blame them for not appreciating the severe impact it was to have on the availability of home-grown tradesmen, an impact that wouldn’t be felt until – as is now becoming evident – Poland’s economy picked up and Poland started enticing those Polish tradesmen back home.

The EU policy of open borders and free movement of people had a direct impact on the British tradesmen that I knew back then and, arguably, on the skills shortages that are now beginning to be felt in the construction industry.

On a personal level I wasn’t directly affected because I operated in a specialist niche market that had as much to do with a knowledge of English architecture combined with a professional relationship with Local Authority officers and specialists from English Heritage (now ‘Historic England’). At the time in question there was also an unofficial ‘approved tradesman’ scheme operating in Bridgnorth District Council, entry to which was dependent on your “coming to the attention” of the local Conservation Department, if you weren’t “approved” you didn’t get the Listed Building Consent to work on buildings of “historical architectural interest”. A bit of a specialist closed shop, in other words, which officially didn’t exist – or at least wasn’t admitted to!

That personal experience of the impact of at least one of the EU’s “four freedoms” isn’t the only one, the second case surprised me even more.

In the course of my work as a joiner working on older (usually Listed) properties it sometimes happened that I needed to form a complex profile that my existing machinery couldn’t produce in a single pass, one such being the corners of a shop-front I’d been asked to repair. I could have done it using multiple passes and some delicate positioning of expensive oak, but that was risky and expensive in time. I needed a bigger machine and so I went on ebay to see what was out there. I found just the thing, a spindle moulder with the capacity to take the size of piece I needed to shape those shop-front profiles.

The machine was in Ipswich, I was in Shropshire, but the ‘Buy It Now’ price was good enough to make the trip worthwhile.

I arrived at a sizable building on the River Orwell just outside Ipswich, a boat builder. When I got inside the building I was amazed at the two boats inside, one of which reminded me of the yacht in the film ‘High Society’, True Love, on which Bing Crosby serenaded Grace Kelly, it was all mahogany and brass – beautiful.

Having phoned ahead to give an approximate time of my arrival the owner was waiting for me with the machine blocked up ready to load onto my van. His son came out of the office to help us load, during the course of which I asked him why he was selling such a good machine for what was a ‘give-away’ price (in fact I had been sceptical about the claimed quality of the machine on the basis that if it seems too good to be true it usually is) and he told me that he’d tried to sell it locally but had no interest at all, and that the ebay entry I’d responded to was the second one he’d submitted. He then went on to tell me that ALL the machines I could see around me were available if I cared to make him a reasonable offer, either for the lot or for individual machines. Because my own workshop was already well equipped I passed on the offer but asked him why he could afford to be so generous. And that’s when it all came out.

He was closing the business down because he couldn’t compete with boatyards in the Baltic states who had recently joined the EU. He had been in the business all his life, the third generation of boat builders in the same shed, his son would have taken over the business had he been able to keep it open, as it was the shed was so quiet because the other two craftsmen he’d employed (both of whom had done their apprenticeships with his company), both highly experienced men, were now working at a local composite-board factory doing unskilled jobs, and his son was starting at a local replacement window factory as works manager. Himself? He intended to retire.

He explained that it wasn’t the Eastern European tradesmen coming to the UK that was the problem, it was those Baltic states boatyards taking business off UK yards by undercutting them; it was cheaper for the owner of a yacht, like the ones he still had in his shed (although they were both owned by him – “Part of my pension”), to pay for the boat to be taken by road to, in this instance, a Polish yard on a low-loader, have the work done by highly skilled Polish tradesmen – as he put it: “Boat building is boatbuilding” – and then sailed back to a UK port by a Polish crew. To add insult to injury, a Polish yard could buy Volvo marine engines from Sweden and then SELL them on cheaper than a UK boatyard could BUY them for. Why? Because the EU allowed Volvo to subsidise the sale because Poland, having just joined the EU, was classed as an “emerging economy” and state aid rules (designed to cut out unfair competition) didn’t apply.

And I am NOT singling out Poland for criticism here but the EU’s insistence on no opt-out from its four freedoms – for goods, services, people and capital to move freely within Europe – regardless of any individual country’s circumstances, it is just that my personal experiences have their basis in events that involve that country, in fact Poland has been a friend to the UK throughout the Brexit process, as witness this Daily Express report…

‘It is NOT ACCEPTABLE’ Poland hits out to demand EU stops punishing Britain over Brexit… POLAND’s foreign minister has accused Brussels of punishing the British people over Brexit as he argued the EU must accept some of the blame for the UK’s vote to leave and MUST undergo ‘deep reform’ if it hopes to keep the bloc together. (Daily Express Tue, Oct 23, 2018)

Now contrast that with an earlier article back in 2016 that reflects an attitude maintained throughout the negotiations between the EU and both Cameron and May (and latterly Johnson)…

https://www.theguardian.com/politics/2016/oct/07/uk-must-pay-price-for-brexit-says-francois-hollande

So no, I’m not a fan of the EU and I don’t agree that the UK will not do well outside of the EU… had it been allowed to complete the process that should have started in earnest over three years ago.

And for the record, the Farmers Weekly poll in 2016 prior to the referendum…

https://www.fwi.co.uk/news/eu-referendum/survey-reveals-58-farmers-back-eu-exit

And after the referendum…

https://www.fwi.co.uk/news/farmer-support-brexit-strong-ever-fw-poll-reveals

At the time the National Farmers Union, much quoted by LibDem Heather Kidd, disagreed with its own readership and lobbied to Remain. Hmmm. Sounds a bit like some of our parliamentarian’s attitude towards the people who voted them into power and trusted them to honour the result of the referendum and get us out of the EU.

But what do I know?

#58: County Councillor’s Report, first published in the (Highley) ‘Forum’ September 2019.

County Councillor’s Report

Not a lot to report or comment on this month because for some obscure reason everything “political” still closes down over August. A fellow councillor said that he’d been in Shirehall earlier in the week (I’m writing this in mid-August because of the Forum’s deadline) and reported that the place was “like the wreck of the Hesperus”. The ‘Marie Celeste’ might have been a more accurate comparison.

I suppose I can understand Parliament at Westminster shutting down to allow MPs to spend time in their constituencies, but at a local level it always seems a bit of a faff because it’s not as if local councillors spend days stuck in committees or attending rounds of meetings, as I explained in last month’s report all that is a thing of the past since the Cabinet system was introduced in 2009.

The concerns of our town or parish constituents don’t go away for a month so council officers are still in post to keep the wheels turning, although with the increasing tendency to promote “flexible” working trying to find an officer at their desk when you phone can be challenging, if often happens that your first point of contact is a request to leave a voicemail, ending with the dreaded words: “… and we’ll get back to you.”

There is some advantage to email because at least you have a paper trail, but there are often instances when you’re having to chase someone up just to check they’ve had it, the old fashioned way of confirming receipt as a simple common courtesy is sadly a thing of the past, which can be embarrassing if you’ve told a constituent that you’ll get onto their case without delay but then find yourself having to hang fire getting back to them because you’ve been assured you’ll get a response “ASAP” and then hear nothing.

Which is why I’ve given up making promises or indeed raising expectations, because a central plank of Tremellen’s First Law of Fundamental Errors acknowledges that disappointment is directly proportional to expectation – the greater the expectation the greater the disappointment. Conditional assurances like: “I’ll get back to you as soon as I hear something”, are meaningless because making an outcome ‘conditional’ on something else happening is to introduce doubt; the hedging of a bet where the chances are odds-on.

I’ve always tried desperately hard to avoid doing that conditional thing, but over the last few years it has got increasingly harder because “non executive councillors” (by definition those councillors who are not one of the ten members of Shropshire Council Cabinet) have very little power, they are essentially conduits of information.

Add to that the obvious North Shropshire bias evident in both Cabinet and the Authority as a whole and you have a recipe for the factional make-up of Shirehall, where even some Members of the majority Conservative group can find themselves representing areas that are overlooked for funding. It’s a bit of a postcode lottery, but one weighted in favour of the north.

Pretty much every area to the south, east and west of the Wenlock Edge consistently loses out in favour of the north and north-west, which is why I have – for a VERY long time – insisted that the Wenlock Edge isn’t just a geological barrier for the powers-that-be at Shirehall, it’s a psychological barrier.

Shrewsbury is an anomaly because a massive amount of funding goes into the town despite it being the power base of the Labour group at Shirehall (virtually all Labour seats are in Shrewsbury electoral wards). So how come? Simples. Shrewsbury Town Council sees power shared between Labour and Conservative, two recent (successive) mayors of Shrewsbury have been Labour and Conservative, their electoral self-interests are mutual. So yet another factor that sees the self-interest of “the north” work against the desperate need of “the south” for a fairer share of funding.

But at least we have each other.

Dave Tremellen

Independent Councillor for Highley Ward of Shropshire Council.