Agenda item - Formal Public Involvement

This is the part of the meeting when members of the public can formally ask questions of the Board or present a petition.  These need to be notified to the Board in advance of the meeting.  Ring the Secretary to the Board, Mark Wall on 01273 291006 or send an email to mark.wall@brighton-hove.gov.uk

 

4.1         The Chair began by explaining that the Board would no longer be receiving informal public questions, as they had become repetitious and the time allotted was not regularly being used. An improved engagement strategy is being developed.

 

4.2       The Chair noted that a total of four public questions had been submitted. The Chair then invited Madeline Dickens to come forward and to put her question to the Board.

 

4.3(a)  Ms Dickens thanked the Chair and asked the following: “Does the HWB share the serious concerns the LGA has presented to NHS England and Jeremy Hunt about the impact on local governance, accountability and democracy the Sustainability and Transformation Plan presents? How does the Brighton and Hove HWB propose to deal with these concerns?”

 

Relevant link - http://www.local.gov.uk/documents/10180/5572443/STP+process+and+LG+involvement+-+Slides+April+2016.pdf/f39cd0a7-286c-4fa0-b9c8-83680fef576d 

“The pace of implementation of STP undermines local ownership and squeezes local government or community engagement

STP shows a lack of democratic accountability

STP erodes the role of HWBs

Chosen footprints override devolution or LG transformation boundaries.”

 

The Chair replied: “Thank you for the question. The Council and CCG are very engaged in the STP process and there will be a presentation and update to the Board today.

 

There are a number of outstanding areas including how Health and Wellbeing Boards will engage with the STP and its delivery once agreed. The LGA has been encouraging STP/NHS leads to be talking to councils now for both substantive conversations about the changes required, and to talk about governance processes so key milestones are timetabled. Today we are able to welcome Michael here to the Board as part of our ongoing conversations.

 

In addition we are aware of a number of events that are in the process of being set up to provide other stakeholders with information.

 

The STP will remain a standing item on the Board agenda until the Plan is agreed and the Board will be updated accordingly.”

 

Ms Dickens asked the following supplementary question: ‘Are you taking on board the level of public anger about the lack of public engagement in decision making? The public want to engage about the level of cuts being proposed. People have been excluded from the process.”

 

The Chair replied that “No decisions have yet been taken, but I take your point about the discussions.”

           

4.3(b)  The Chair thanked Ms Dickens for attending the meeting and invited Mr Michael Foulkes to come forward and put his question to the Board. Mr Foulkes was not able to attend, but sent a representative who thanked the Chair and asked the following:

 “I am sure you agree that good early years’ provision is crucial in providing children the best start in life.  In the light of this I am concerned to see the budget reduction (£1m over 3 years, £200,000 this year) you have agreed for Public Health Nursing.  I am also concerned that the service is undergoing a costly tendering process.  There has already been a procurement event (24th May).  With that in mind what providers attended and what is the timescale for deciding who the contract is awarded to?”

 

The Chair replied: “Thank you for your question. As in the case in across the country, the commissioning of the Healthy Child Programme Services for children aged 0-19 is taking place in the face of severe financial challenges, resulting from reductions in the ring-fenced Public Health grant.  In Brighton and Hove there is also the requirement to meet the Council’s savings targets over the next four years. The savings for the re-commissioning of these services are £1,000,000 over the next three years from a total annual budget of £5,569,583.

 

As explained in the Health and Wellbeing Board report of 15th March, the possibility of a collaborative re-design process with the current provider (SCT) was considered as it would have presented a number of benefits.  However legal requirements which came into force in 2015 require that such contracts are advertised by way of a Prior Information Notice (PIN) or Contract Notice in the Official Journal of the European Union (OJEU).  Not to place a PIN or Contract Notice would be in breach of the legal requirements and open to challenge. The Council’s Members Procurement Advisory Board recommended that a PIN should be issued.

 

The Board agreed that the Director of Public Health could place a Prior Information Notice pursuant to the requirements of the Public Contracts Regulations 2015 and to carry out a competitive procurement process if alternative providers come forward.

 

That if no alternative providers come forward, the Health & Wellbeing Board delegates authority to the Director of Public Health to lead a collaborative re-design process and contract negotiation with the current provider, Sussex Community NHS Trust (SCT).

 

That the Health and Wellbeing Board receives a further report on the outcome of this process before a new contract is awarded.

 

The procurement process is now underway and a potential providers' workshop took place on 24th May, which was attended by 3 potential providers.  This was not a public meeting.  Under procurement rules the names of the potential bidders cannot be shared.  It is anticipated that the contract will be awarded around December time. A further report will come to the Health and Wellbeing Board in due course.”

 

Mr Foulkes’ representative asked the following supplementary question: “Can the contract be published?”

 

The Chair replied that: “the Prior Information Notice (PIN) is published and a link can be sent to this. Public engagement was not normally carried out as part of the procurement process.” The Statutory Director for Adult Social Care added that they would be consultation around the re-design of services, but not as a formal part of the procurement process. The Acting Director of Public Health advised that a consultation is planned with young parents and young people aged 16-19.

 

4.3(c)  The Chair thanked Mr Foulkes’ representative for attending the meeting and invited Mr Ken Kirk to come forward and put his question to the Board.

 

As Mr Kirk was unable to attend or to send a representative, the Chair read out his question:

 “In having regard to the report of the Kings Fund, ‘Is the NHS heading for financial crisis?’ and NHS England’s demand for ‘aggregate financial balance’ in its Sustainability and Transformation Planning guidance, can the Board confirm whether it is correct to make the assumption that the inevitable result will be (a) an inferior NHS services, like those provided locally by Coperforma, or nationally by names now synonymous with NHS failure: Harmoni, Serco, Circle, Virgin Healthcare; and (b) that you as commissioners are being set up to reduce the NHS from a once world-class service to that similar to the USA's Medicare system?”

 

1. http://www.kingsfund.org.uk/projects/verdict/nhs-heading-financial-crisis

2. https://www.england.nhs.uk/wp-content/uploads/2015/12/planning-guid-16-17-20-21.pdf 

 

The Chair replied, “we are faced with a number of issues:

 

·         People living longer and needing long term support

·         People with increasingly complex health and care needs

·         Reduced funding for social care and public health, and health care funding that is not keeping pace with the growth in demand for services.

 

Clearly we need to ensure we are getting best value for money so people can receive the vital services that they need. Later in the Board the presentation about the STP will describe how some of this challenge is being tackled. We know we have a large financial deficit in the provision of healthcare across Sussex and East Surrey. We want to act collectively and in the best interests of our citizens, before it is as you describe it a ‘crisis’.

 

In my Chair’s communications I earlier informed the Board about the supporting structure that has been put around the Patient Transport Services as well as looking at lessons learnt and how this service can be improved. The Health Overview and Scrutiny Committee will be keeping up to speed with this and will examine how future procurement can be improved.

 

This Board remains committed to trying to ensure good quality services are available for people but these also have to be provided within a restricted financial envelope.

 

The Board will have the STP as a standing item and we will update the Board with progress.”

 

4.3(d)  The Chair thanked Mr Kirk for his question and invited Mr Kapp to come forward and put his question to the Board. The Chair first asked Mr Kapp if he wanted to declare an interest as a service provider and Mr Kapp agreed that he did wish to declare such an interest. Mr Kapp then asked:

“In regard to the Sustainability Transformation Plan item on the Board’s agenda can the Chair confirm: (a)  whether the new contracts for mental health interventions take into account the issues raised in papers on www.sectco.org.uk, and section 9 of www.reginaldkaopp.org; (b) how many NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week courses will be included in the STP; and (c) will the new contracts for provision of interventions for mental sickness be outcome based (rather than performance based)?”

 

Notes to this question:

 

1 The MBCT course has been shown to be 100 times more cost effective than one to one CBT, so are the most cost effective way of teaching depressed patients how to better look after themselves so that they do not need so much public services.

 

2 Outcome based contracts have been shown to be more effective in healing and curing patients because they incentivise the provider, whereas performance based contracts dis-incentivise them.

 

3 Further information and details are shown in papers on www.sectco.org.uk, and section 9 of www.reginaldkapp.org.

 

The Chair replied: “The STP development is still in early stages. It is far too early to be respond in any detail to the question you have raised. However, one of the national key must do's is focused on mental health. However the Plan has not been agreed and there is no detail yet around what, if any, contracting will come out of this Plan in the short term.

 

The STP will remain an item for the Board and we will update the Board as the Plan is developed.”

 

 

Mr Kapp then asked the following supplementary question:

“Given that the wellbeing contract will shortly be put out to tender, I seek assurance that it will give additional capacity for mindfulness and cognitive behavioural therapy (CBT).”

 

The Chair agreed to provide a written response to be attached to the minutes of the meeting. Cllr Penn explained that she had met with the Clinical Commissioning Group (CCG) about wellbeing and lots of good work is taking place and with a much broader focus than CBT.