Health chief named as permanent boss of Shropshire CCG

Shropshire’s troubled health organisation has named its new chief officer.

Dr Simon Freeman has been appointed as the new accountable officer for Shropshire Clinical Commissioning Group – subject to ratification by NHS England.

Dr Simon Freeman
Dr Simon Freeman

Dr Freeman has been leading the group as acting accountable officer since October last year.

Shropshire CCG, the organisation that commissions health services in the region, was put under formal “directions” last year by NHS England to address its financial problems.

NHS England has been working with Shropshire CCG to strengthen its governance and leadership, and to address its financial deficit.

In 2015/16 the trust ended the year with an in-year deficit of £14.75 million and carried forward a recurrent deficit of £20.2 million.

It is currently heading for a £26 million deficit in the current financial year.

Dr Freeman previously worked as accountable officer and managing director of NHS Leicester City CCG.

Prior to this he was the director of commissioning for both Leicester City PCT and Leicestershire County and Rutland PCT.

He has also undertaken a number of IT director roles in the NHS in both commissioners and hospital trusts.

Dr Freeman tweeted “delighted and proud to have been offered the role. The future looks bright”.

He has worked with the NHS for the last 11 years joining from Ernst & Young’s strategy & transformation practice where he focused on financial services, bringing 10 years’ experience of working for NatWest Group.

David Evans, who is accountable officer at Telford CCG and is also heading up the Future Fit review of the county’s hospitals, had been brought in as interim accountable officer at Shropshire CCG in April last year following serious concerns from NHS England over the organisation’s finances.

However, due to what Shropshire CCG said were “considerable financial challenges”, Mr Evans left the post in October last year and was replaced by Dr Freeman.

He has been leading the group as acting accountable officer since then.

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Comments for: "Health chief named as permanent boss of Shropshire CCG"

Roger

The circle is complete. CCGs were all about moving the decisions making process from administrators to clinicians because the perception was that decisions taken were not in the best clinical interests but rather administrative.

The GP's had the last word on money. Because Shropshire CCG is under funded and we have the adult social care crisis happening at the same time the Shropshire CCG or rather individual GPs addressed the clinical needs of patients and over spent. It is completely beyond the NHS to accept that they made a mistake in allocations of budgets so they require Shropshire CCG to cut it's spend to suit their political objects and NHS mistakes by depriving Shropshire patients of treatment. The GPs have great deal of difficulty accepting that option so they have been deprived of control of the budget. Initially that was by putting Telford’s accountable GP to oversee the process but that did not work. Now they are putting in an accountant to over see the process.

So now we are back to where we started, the GP's will not have clinical control of the budget it will be accountant controlled. Clinical need is out of the window, everything is about balancing the books. We know what the problems are and three are two of them;

1. NHS funding of Shropshire is under funded for the specified performance requirement, so can not be met within the budget.

2. Local government support grants have been decimated on consecutive years since 2010. The local Authority no longer has a budget from which it can meet the social needs of it's elderly so there is a degree of neglect which increases the load on the NHS both in A&E admissions and demands on GPs.

3. There are not enough doctors due to cuts in university places to keep replenishing the NHS. Recruitment, retention and early retirement problems result.

You cant pour a quart of water from a pint pot The CCG has a choice of cutting services or over spending. It has an account in charge now so the budget will be balanced and patients will suffer the withdrawal of services.

It is now the question is how do we balance the books by not withdrawing services completely and that is Dr Simon Freeman's job. Now I think we need to address the "Dr" part of his title;

University of Leeds

BSc (Hons), Pharmacology, First Class Honours 1981 – 1984

University of Leeds PhD, Biochemistry 1984 – 1988

Chartered Institute of Bankers Associateship, Banking, Corporate, Finance, and Securities Law, Top 20 worldwide placing 1991 – 1995

The University of Manchester, Manchester Business School MBA, Business Administration, Distinction 1997 – 1999

The Open University BA (Hons) Lit (Open), Literature, First Class Honours 2007 – 2013

So he is not a GP and never has been. His first degree was pharmacology and his PHD biochemestry so he is a "Doctor" by reference to qualifications in same way that a Businessman or Engineer might be addressed as Doctor. I don't mean that in a disparaging way because he bring the business management perspective to the party which the essential element that GPs lack and was the NHS's mistaken view that GP can run mega businesses, it not what they do, it's not what they are trained to do.

So what should we expect from Dr Simon Freeman. Well first of all he complies with the ambitious shaker and mover principles. Get a job and introduce change with short term gains but make sure you move on to the next job before the consequences land. Dr Freeman complies with that;

Post Doctoral Research Associate Cancer Control Agency of British Columbia March 1988 – July 1989 (1 year 5 months)

Post Doctoral Research Associate University of Leicester July 1989 – February 1991 (1 year 8 months)

Head of Change Management NatWest Mortgage Services February 1991 – March 2000 (9 years 2 months)

Principal Consultant ASE Consulting April 2000 – January 2001 (10 months)

Managing Consultant Cap Gemini Ernst & Young January 2001 – October 2003 (2 years 10 months)

Director of IT George Eliot Hospital NHS Trust October 2003 – September 2004 (1 year)

Director of IT

South Warwickshire General Hospitals NHS Trust September 2004 – October 2006 (2 years 2 months) Joint Director of IT with South Warwickshire PCT

Joint Director of Contracting, Performance & Informatics NHS Leicestershire County & Rutland and NHS Leicester City November 2006 – February 2011 (4 years 4 months)

Director of Commissioning Services & QIPP Leicester, Leicestershire & Rutland Commissioning Cluster March 2011 – August 2011 (6 months)

Managing Director & Accountable Officer

NHS Leicester City Clinical Commissioning Group August 2011 – October 2014 (3 years 3 months)

Large urban CCG, 370,000 population, 64 practices, 225 GPs - successfully applied for Wave 1 of authorisation.

Chief Operating Officer Arden & GEM CSU October 2014 – October 2016 (2 years 1 month)

Interim Accountable Officer NHS Shropshire CCG October 2016 – Present (5 months).

That is an impressive CV that ticks all the right boxes. If Shropshire CCG is financial viable with the underfunding he will know how to make it work on paper.

By repute he very concerned with Patient pathways. I.E. getting patients into the system in the right place and progressing their solutions along the right pathways. Without any doubt what so ever this is something that needs to be addressed in Shropshire. That is the best use of resources by dealing with tasks at the lowest possible grade but can result in grade slip which using somebody who is not fully qualified to do jobs under supervision, where that supervision is the variable. Cutting cost means less supervision. It means initially the correct pathway has to be set at the reception point of GP surgeries or 111. It can be corrected if wrong by the attending professional.

Cash flow management. Putting off paying for things by managing the expenditure commitments and payments. Managing payments is illegal and the best example was the Sandwich fiasco. Will the contractor wait two months for payment or simply not pay them for two months. Tends not to work very well in the long term. So manage the ordering. The classic being hips and Knees which can wait a while so don't commission the work, make the patient wait for their operation. That has the effect of balancing the books by moving operation from one financial year to next but leaves the NHS pushing a bow wave of outstanding work as measured by waiting lists. It also passes the parcel of cuts from the CCG to the hospital trust as the trust loses the cash flow it expected.

Passing the parcel. The STP defines where work should be carried out. That is a shift from hospitals to GPs As the GPs are underfunded this a problem. It means as the parcel is passed the budget and staff involved must move with it. Everybody resists this. They want to pass the parcel but not lose the resources currently employed. That is all internal politics of the NHS The patient is not involved other than not getting the treatment when desired.

Dr Freeman is obviously a player in the NHS game and has been recognised as an achiever in Leicester. So he can thump the table with a bigger fist and win arguments at the margins. He should be good for the CCG. But if the problem is fundamental such as underfunding, to get it work is like walking on water. Not possible. The art of the game then is to please the right people and in our case that is reducing or deferring services to balance the books. If he can succeed in doing that he will get the plaudits and promptly move on to another job before the consequences land. Our only hope is the Shropshire syndrome. Drawing in executives to do a job and they fall in love with the pace of life and life style not wanting to move on. This jobs becomes the retirement job and they stay until they retire.

I think there are elements of NHS disaster and Shropshire syndrome at play here. He might like the life style but the job is impossible which means failure. Failure is not a part of Dr Freeman's CV. That means a different approach to the problem that starts with recognition of the under funding and redirecting failure to the under funding which is well above his pay grade to change. That then is a case of being seen to be doing the bast possible in the circumstances. I suspect that that is what is actually happening with the STP at the moment. They are telling us the parameters within which they must work and then trickling out the consequences. One major injuries unit, Birthing centres to replace mid wife led maternity units. Shifting the blame for the A&E crisis to patients turning up too much. It is a very dangerous methodology because it defies common sense most of the time/

1. We have had two major injuries units for decades it has not failed.

2. The maternity units work well but not a 9 to 5 basis because babies are not 9 to 5.

3. Patients can’t get appointments for their urgent needs so they go to A&E..

4. Knees and Hips can wait for the optimal time for replacement which is a balance of pain to inconvenience of recovery times. The recovery times are unavoidable so the issue is pain. If operations are delayed beyond the optimal time the patient pays for that in actual pain beyond pain control regimes and immobility.

In this mode of short-termism the crisis grows but slowly but the books balance. The manager running the short termism needs to get recognition and promotion to move on before the consequences hit. Politicians do with cabinet reshuffles, so Hunt was not moved and is destined to fall as the consequences hit. The various heads of NHS departments are destined to fall as government scapegoats because it was their plan not the government’s. The question is how far down the NHS the night of long knives will go. The government will say the NHS got it wrong we need another parliament to put it right vote for us. That might not work either.

The truth is the NHS is a complete disaster area and will be ten years before we can put enough people through University into useful work. In the mean time the NHS is going to be sub optimal. Making it work in the mean time probably needs people like Dr Freeman to continuously shuffle the pack so no one department completely fails and the pain is spread. In the mean time we need to lift expenditure to 10% of GDP to deal with the nonsense cuts. That is no more than France or Germany and only half of what the US spends. The big issues care Recruitment and retention which will take time.

johnfrederick

Roger Dr Freeman is a hatchet man put in by NHS England you can not expect them to put in a pussy cat ? It is NHS ENGLAND that are calling all the shots in Shropshire now not the Councillors or the Public ? Roger Please read all your papers and reports ?

Roger

I hope I have opened the possibility of that to the readers. So yes i agree he could be a hatchet man here to do a short term fix it job with long term consequences for when he is long gone to his next step up the ladder,

I am trying to be open minded because he could help us if he has a mind to. I particular think of the siyuation where Telford CCG are interfering and the Hospital Trust seem to have taken over the STP. I think he could provide a stronger voice for Shropshire in the final carve up.

Personally I see the NHS as on the brink of national explosion where the public are going to tell the government sort or resign. It is that bad. If that happens we will need stronger leadership in the post crisis recovery. Shropshire has an unfortunate habit of coming second far to often in far too many things. So I am keeping an open mind but I have no delusions about management conduct or the sacrifices they force on others to grease their own progress.

We need to give the guy a chance but at the same time keep a very close eye on what he is doing. Ifr our CCG had been well led we would not be where we are. Personally I do not believe that GPs are the right people to lead the NHS. By and large they can't even manage their own surgeries to thge point of being able to get an appointment. I do see some good things in what's happening to improve the NHS but at the end of the day without the budget required nothing will work properly. The good is overwhelmed by the negative. This not Shropshire being over ruled by Telford and that is an improvement. Shropshire CCG is probably the biggest organisation in the STP and should have the biggest say in what's going on but they have been marginalised. That is the first thing he needs to do, reverse it.

johnfrederick

When you get county councillors not wanting the public to know what is going on in Shropshire we will all ways have a second rate health service in Shropshire ?