Jim Parker: Chilly wind blowing through Torbay's pioneering health care partnership - now heat is on to close £35million gap

It was freezing outside and there wasn’t exactly a warm feeling inside.
The Torbay Heart campaigners, under the auspices of Torquay Chamber of Trade and led by chair Susie Colley, had been called to another public meeting in their battle to make sure life-saving cardiac treatment services don’t end up being transferred from Torbay Hospital to the Royal Devon and Exeter more than 20 crucial miles away.
But this meeting at Torquay’s Imperial Hotel and chilly Torbay Suite wasn’t just about heart treatment services. This was about another issue just as big and which could have a major bearing on services across the board and not just cardiac care.
‘Ice Queen’ Mrs Colley — and I use that description because of her ice-hard, dogged determination to succeed in this campaign and not in any derogatory manner — fired the first frosty blast over the absence of invited officials from the NHS in Devon as she threatened: “We will have to take them to the high court if they keep messing our hospital around.”
In attendance, however, was Joe Teape, chief executive of the Torbay and South Devon NHS Foundation Trust, Chris Balch, chairman of the Torbay and South Devon NHS Foundation Trust Board, Torbay Council leader Dave Thomas, Anna Coles, director of adult and community services for the local authority, and our two local MPs, Steve Darling and Caroline Voaden.
The main topic of conversation was the partnership between the council and health trust when looking after some of our most vulnerable residents in adult social care.
The ‘integrated care’ model is seen as pioneering and something the government would like to see rolled out across the country.
The trouble is the partnership is facing a hefty financial challenge this year, with the Trust facing a black hole of between £30million and £35million and looking to possibly pull the plug on the entire arrangement by ending a so-called Section 75 agreement.
The council has been paying around £60million a year for the past two decades as its contribution to the care partnership.
When the partnership was first launched there was a financial risk shared between the council, NHS trust and what was then the body looking after GPs.
The contract is negotiated every two to three years. The last agreement was in 2024 and the integrated partnership agreed for five years - but there was no financial risk sharing this time.
Now the NHS Trust is faced with the huge overspend and, unlike in previous years, the government has told them they must balance the books. There is no bailing out.
And that could have a chilling consequence for all concerned.
Council leader Thomas started the ball rolling when he outlined the 20-year partnership.
“It is unique. It’s what the government wants and we are ahead of the curve,” he told the meeting.
He added: “This would bring significant change to the residents of Torbay. Consultation is needed about substantial changes.”
He said he hoped this latest issue would not lead to the end of the contract with the Trust. “This isn’t the end of the partnership. It is a hiatus,” he hoped.
Head of adult social care Anna Coles reiterated the desire to continue with partnership but recognised there are financial challenges.
It is understood the Local Government Association will be advising on and reviewing the financial partnership.
“We absolutely want to continue with the partnership,” said Cllr Thomas, who revealed the government had looked at the partnership and were impressed.
Baroness Louise Casey is a crossbench peer in the House of Lords, known for conducting a number of other high-profile government reviews into social welfare.
She and her team have visited Torbay as part of her review into adult social care to study its nationally recognised “joined-up care model”.
The model, which helps people stay in their homes and frees up hospital beds, is now being considered by her commission as an example of good practice for potential national implementation.
Torbay councillors and local MPs have engaged with and referenced Baroness Casey’s work in local discussions and in Parliament.
Torbay MP Steve Darling said people are better cared for in their own homes.
He said: “This is a special system in Torbay. We have been under a bushel in how good this partnership has been.”
He claimed the partnership had been a winner financially, with £147million saved in the past 20 years with the closure of 67 beds and changes in care.
He told the meeting: “I have no issue with management. They have inherited the challenge. The government has kicked social care into the long grass.”
He said he and Lib Dem colleague Caroline Voaden had written to ministers and invited them to the Bay.
“We will keep pushing. There is cross-party support on this.”
Trust CEO Joe Teape has only been in post for 10 months. Welcome to Torbay, Mr Teape!
He said they are for a health and social care integration.
“It has stood the test of time,” he said.
But the biggest stumbling block was the ‘financial risk sharing’.
“The sharing has disappeared. Those costs are a burden on NHS budgets,” said Mr Teape.
He said the current overspend was £35million, which later in the evening became £30million.
“We have to break even on adult social care,” he said. “Every penny we spend we can’t spend on services. This is a financial issue. We are under pressure to balance the books. The current model cannot be sustained. The council has come up with financial savings.”
He emphasised that no decisions had been made and there would be no staff changes if the partnership was changed.
He said there was a different model for the rest of South Devon.
He emphasised: “We are very committed to transparency. We will work fully with the local authority.”
It is, however, not clear what consultation will take place as there are no changes to actual services, but Mr Teape said: “This is not stepping away from integration. The central issue is funding. Our commitment to integrated working will continue.We are trying to find a solution.”
It was revealed the South Devon Trust is facing an overall deficit of £50million.
Trust board chairman Chris Balch said: “We have to address our deficit.”
Mr Darling said pressures have been on Devon NHS for years and Ms Voaden added there had been massive underfunding for years.
“Health and social care should be integrated. Why has the funding partnership gone by the wayside?” she asked.
Cllr Thomas said there was a possible ‘transformation programme’ in place which could achieve £14million in savings which the Trust Board had seen and could see them breaking even in three years’ time.
But Cllr Thomas said: “The council has no financial levers and we have no money.”
Board chairman Mr Balch hit the nail on the head: “The deficit puts us under pressure to deliver other services. It is about choice. We have to find a solution to deliver services at an acute hospital. Those choices have to be made.”
And that really brings you back to square one. With such a big deficit how can any organisation deliver the services it wants to deliver and should be delivering, including cardiac care?
Torbay Council can’t suddenly find millions without going bankrupt, which won’t exactly help their bid to stay as a sole unitary authority in the local government reorganisation process.
Cllr Thomas is still hopeful and says: “Health care has always been overspent. The government has covered it in the past but not this year. They have said the health trust must be a zero balance position within three years. We either go out and say we are in trouble or we continue to talk. We have to keep talking. I believe there is a way out of this.”
Ice Queen Susie was somewhat cold in her summing up.
“How did we ever get here in the first place?” was her question.
Perhaps we need to turn the heat on Baroness Casey and Westminster. If they like this way of partnership working so much can they please come on down and save it.
The clock is ticking. The Trust has until the end of March to make a decision either way. The pioneering deal could disappear altogether 12 months after that...