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, Giles Rossington on 01273 295514 or send an email to giles.rossington@brighton-hove.gov.uk

39     Formal Public Involvement

 

39A   Deputation:

 

39A.1The following Deputation Was received from Dr Carl Walker. It has been signed by the requisite 5 people. Dr Walker presented his deputation to the Board.

 

 

Deputation- Findings from the 2^nd Brighton Citizens Health Services Research

 

·         I would like to thank the board for the opportunity to feedback the findings of this project.

·         The second Brighton Citizen's Health Services Survey (BCHSS) has been developed using a distinctive approach to survey design that is aligned to public consultation, participation and critique rather than toward the more typical production of a validated instrument and knowledge form.

·         Almost 700 residents of Brighton and Hove responded to a survey based on key current and upcoming commissioning issues.

·         This survey was split into three broads areas

o   topical commissioning concerns like the Sustainability and Transformation Plan and the Patient Transport Service

o   whether people feel they have a say in their health services

o   future commissioning

 

The key findings were as follows-

 

1.    96% of residents think that local councillors and the CCG should put together an immediate strategy to guarantee no more GP surgery closures across the city.

 

2.    In terms of whether the difficulty of getting a GP appointment has changed in the last year, 50% of residents say it is more difficult or much more difficult, 45% say no change and 3% believe it has become easier.

 

3.    90% of residents report that they have never been consulted by the local CCG  on any of the local NHS changes they have carried out in the last 3 years. 7% of residents could not remember, 3% said that they had.

 

4.    83.1% of people believe they have no say at all in the way their local NHS services are run and commissioned. 15.2% have a little say and 0% believe that they are fully informed and consulted.

 

5.    96.6% of residents preferred the NHS public health nursing services to stay in the NHS.

 

6.    97% of residents believe that Brighton and Hove CCG should not spend money moving NHS contracts into the private sector.

 

The upcoming sustainability and transformation plan will become a significant local issue, in particular with respect to public accountability. Kieran Walshe, Professor of health policy and management at Manchester Business School, in an article in the HSJ, noted that we have entered “a shadowy era of extra-legislative reform where it is getting difficult to work out where accountability lies, who’s in charge, and whether organisations are doing their job properly….For NHS boards, there is a potential conflict between their statutory duties as a board and an organisation, and some of these changes which require them to cede autonomy and authority to new organisational forms (like STPs) which have no formal existence.” 

 

Regarding public accountability, the secrecy surrounding the drawing up of STPs has been a major national concern. Despite requests from various organisations, the STPs have largely remained secret. Recently, both Birmingham & Solihull and Camden released their plans against the instructions of NHS England. Explaining the decision to publish, Islington Council leader Richard Watts said:  “These are not transformation plans – they are not going to put prevention at the heart of health service. They feel much more like a way of making short term budgetary savings rather than any meaningful way of transforming services." Little or no public consultation has taken place on the plans and even GP leaders, who will be directly affected by the plans, have reported that they are being excluded from discussions.

 

7.    In relation to the local Sustainability and Transformation Plan, 90% of people believe that large scale cuts to the NHS should be subject to wide public consultation before they are made.

 

8.    97% of residents disagree with STP cuts in principle.

 

9.    93.5% of residents support their local councillors actively campaigning against impending STP cuts. 

 

10. 95% of residents believe that the privatisation of patient transport services  should not have been allowed to happen 

 

11. 74% of residents believe that the commissioners who agreed the contract should also have been part of the investigation as to what went wrong

 

12. In terms of health service contracts that are planned between now and 1st June 2017-

 

·         93% of residents did not know about the wellbeing service and 93% would prefer the contract go to the NHS

·         96.4% of residents did not know about the anti-coagulation service and 93% would prefer the contract to go to the NHS

·         91% of residents did not know about the integrated urgent care and GP out of hours and 96% would prefer the contract to go to the NHS

·         97% of residents did not know about the commissioning support unit services and 93% would prefer the contract to go to the NHS

 

We also have a wealth of qualitative data and in the form of comments from local people should anyone on the HWB want the further data.

 

There were four key conclusions-

 

1.    As with the results of the first survey, this deputation shows that the public in Brighton and Hove hold clear and compelling values on the way that they want their health services to be commissioned.

2.    In the city of Brighton & Hove, a vast majority of the public are against the use of private companies in the local health economy and very concerned about some recent decisions that have been made to commission private companies to undertake certain services.

3.    Despite the extremely tight timetable for STP implementation, the results suggest a need to publish the detailed plan for full public consultation as soon as possible.

4.    The survey team welcome the awarding of the contract for children’s community services to the NHS, in line with the wishes of a very significant majority of the public.

 

We hope that commissioners and councillors find these conclusions of use. Our team at the University remain willing to support commissioners and councillors during what may prove to be a very challenging commissioning context.

 

39A.1Cllr Page noted that the survey showed that local residents felt strongly about health and care issues, perhaps particularly regarding the Sustainability & Transformation Plan (STP) and about outsourcing of NHS services.

 

39A.2In response to a query from Cllr Penn on survey methodology, Dr Walker told members that his team sought to sample as wide a range of respondents as possible, by using on-street survey techniques and by sending the survey out to a range of local community and faith groups, rather than relying solely on the on-line survey. The team would welcome suggestions of additional community groups to send future surveys to.

 

39A.3The Chair thanked Dr Walker for his deputation. The Chair also queried whether, when Dr Walker offered to help support the Board in its engagement activities, this offer came from him personally or from Brighton University. Dr Walker clarified that the offer was from his research team, not formally from the University.

 

Public Questions

 

39B Public Question: Madeleine Dickens

 

39B.1Ms Dickens asked the following question:

“What is the HWB view of the fact that NHS Improvement is now working with two of the city’s NHS Trusts in special measures? How do these processes relate to the content of the STP which the regional Board is required to submit to NHS England? What information does the HWB have about the time-table for submission of the STP?” 

39B.2             The Chair responded to Ms Dickens’ question:

“Thank you for your question. There will be verbal update on the STP. There will be a brief presentation on our part of the plan, Brighton & Hove Caring Together, as part of this agenda.

It is a matter of concern that we have underperforming organisations working in the city. The Board welcome the involvement of NHS Improvement and the support they will bring.

These processes do not relate to the STP as they are part of the regulatory framework following the recent CQC inspections.

However the STP is clearly focused on quality and financial sustainability which both these inspections highlighted as needing improvement.

The STP was submitted on 21^st October. We are waiting for feedback and will update the Board accordingly.”

39B.3 Ms Dickens asked a supplementary question: “The involvement of NHSi in local trusts diminishes the decision-making role of the HWB and of trust boards. How do you feel about this?

39B.4             The Chair responded by saying that NHSi does not take over trusts; it supports them, but trust boards remain in charge. Adam Doyle added that the CCG plays a very active role in the quality improvement planning at both Brighton & Sussex University Hospitals Trust (BSUH) and South East Coast Ambulance NHS Foundation Trust (SECAmb). David Liley noted that Healthwatch was also involved in BSUH quality improvement work, sitting on the trust’s Quality Outcomes Group.

39C   Public Question:  Athene Crouch

39C.1Ms Crouch asked the following question: "Why, when there are two high-ranking local authority members on the STP board, has no information about the plan been made available to the council?"

 

39C.2             The Chair responded that: “There are not two high-ranking council officers on the STP Board. The Council have not seen a final version of the STP and is disappointed by this. This is a source of frustration for many people including the Board.”

 

39C.3Ms Crouch asked a supplementary question: “At the recent Brighton & Hove Caring Together engagement event, one of the officers present claimed to have seen the STP submission.” Is this the case?”

 

39C.4The Chair responded that this would not have been a council officer; council officers have had sight of the Central Sussex & East Surrey Alliance Place-Based Plan, but not the STP submission. John Child added that CCG representatives may have talked in very general terms about the STP submission at engagement events (e.g. that the STP includes no plans to close local hospitals), but there had not been detailed discussion of the STP as opposed to local planning initiatives.

 

39D   Public Question: Neil Younger

39D.1             Mr Younger asked the following question: “Given its commitment to addressing health inequality in the city, how does the HWB explain the £1million cut in the budget of CYPS which has resulted in the closure of the Family Nurse Partnership and a reduction in the numbers of health visitors by 10%? These are key services mainly targeted at the most deprived and vulnerable in our city and should be seen as the cornerstone of any healthcare provision.”

39D.2             The Chair responded that: “The Board have received a number of papers since the announcement last year of the reduction of the national ring fenced grant to public health. These reports covered the financial implications as well as the detail of the impact on services. 

We have had several papers at the Board outlining the proposal for recommissioning the public health nursing services, including a report in March 2016. Today we will be receiving the outcome of the commissioning process.

The value of the contract has been reduced – but the service will continue to be a universal service. It is a reality that as funding reduces there is an impact on service but there has been a comprehensive Equality Impact Assessment as part of the recommissioning process. The focus on the EIA was to ensure that the new service will continue to provide additional support to the most vulnerable and disadvantaged.”

39D.3 Mr Younger asked a supplementary question about why the new contract only extended to age 19 when the council had responsibilities for some young people up to the age of 25.

39D.4 Peter Wilkinson responded by saying that the age range for the service is 0-19. Under the previous contract this was 0-16. Pinaki Ghoshal added that, whilst the council does responsibilities for some young people up to the age of 25 (e.g. for people with Special Educational Needs or Disabilities), this group is supported via a range of services rather than by this contract specifically.

39E   Public Question: Valerie Mainstone

39E.1Ms Mainstone asked the following question:

 “I am pleased to see that the Sussex Community NHS Foundation Trust are the preferred bidder for the Children's Public Health Nursing (0 - 19)
contract. I am also aware that the Public Health Team's recommendations about the contract are coming to the Health and Wellbeing Board on 22 November (today.)

However, I am concerned that there has been no response to the second aspect of the petition concerning Children's Services that was presented to the last meeting of the Health and Wellbeing Board - the fact that more than two thousand Brighton and Hove residents wanted the decision to cut the budget for this contract by £1million (19%)to be overturned.

My question is, given the Health and Wellbeing Board's and Council's stated commitment to reducing health inequalities and giving every child the best start in life, what will the Health and Wellbeing Board do to rescind this budget cut?”

39E.2 The Chair responded: “Thank you for your question. The Board papers show that the petition was accepted and the Chairs comments can be found in 29B.2 and the Acting Director of Public Health also responded, again the comments are in 29B.3.

Like many councils we have also lobbied national government for the Public Health ring fenced grant not to be reduced especially in year.  We continue to work through the Local Government Association on these issues.” 

39E.3 Ms Mainstone asked a supplementary question, requesting clarification of the actual per annum budget saving; and how this saving tallied with the Acting Director of Public Health’s comments (at the September HWB meeting) that the contract prioritised quality over price.

39E.4 Peter Wilkinson responded that the saving was approximately £1 million for each year of the contract. Dr Wilkinson’s comment at the previous meeting was that the tender criteria scored quality over price in terms of scoring bids.

39F   Public Question: Mr John Kapp

39F.1  Mr Kapp asked the following question:

 

“When are you going to do your duty under your terms of reference and call the CCG to account to improve the procurement system following the Coperforma debacle?”

 

Notes to this question

1 The HWB terms of reference were adopted by the Council in May 2014 (reproduced in appendix 1 of paper 9.97 of www.reginaldkapp.org) and say 3 times that the HWB’s duty is ‘to call the CCG to account.’

2 The written answer to my public question at the last HWB meeting on 20.9.16 was in denial of your above mentioned duty, as it said; ’The HWB is in no way responsible for the CCG.’

3 I have written many papers (reproduced on the above website) pointing out that Parliament intended that the HWB and CCG should work together as a hierarchical team, with the CCG being the executive arm of the HWB.

39F.2  The Chair responded:

“There are a number of bodies in the city that have responsibility for ensuring the smooth running of the health and care system. In this instance, the issue of Patient Transport Services (PTS) is being dealt with by the Health Overview & Scrutiny Committee (HOSC), since the HOSC is the body principally responsible for overseeing the quality of NHS provision and commissioning.

 

The HOSC has been tracking PTS problems for a number of months, meeting regularly with commissioners and with the Sussex PTS provider, Coperforma. The HOSC will continue to monitor the process of temporarily passing the contract over to the South Central Ambulance service and of procuring a new permanent provider. Working in conjunction with other Sussex HOSCs and with local Healthwatch, the HOSC will seek to ensure that the appropriate lessons are learnt from the failures in PTS.

 

Should the HOSC identify systemic issues with commissioning as part of this work, it may wish to make recommendations to the HWB, as the HWB is the local system leader for health and care commissioning. However, the HOSC will take up specific issues relating to the letting of the PTS contract directly with the CCGs involved rather than with the HWB. The HWB is not responsible for overseeing CCG commissioning, other than for jointly commissioned services, which does not include PTS.”

 

39F.3  The Chair added that he had written to the Chair of the HOSC and to the relevant CCGs raising a number of learning points that we wanted to see addressed. The HOSC will consider these and other points at its 01 February 2017 meeting.

 

39F.4  Mr Kapp asked a supplementary question, asking whether it was acceptable for public service funding decisions to be taken by unelected CCG officials rather than elected Councillors.

39F.5  Natasha Watson (BHCC legal representative) responded by saying that Mr Kapp had previously raised a very similar question at the Board (in September 2015), and had received a written response from the council’s Executive Lead for Strategy, Governance & Law. In brief, the strict hierarchical relationship assumed in Mr Kapp’s question does not accurately reflect either the terms of the Health & Social Care Act (2012) or the Terms of Reference of the HWB. These Terms of Reference require the HWB to hold the CCG to account in terms of its strategic commissioning plans, not for specific commissioning decisions or outcomes. The Terms of Reference commit the HWB to the oversight of joint funds, but not to CCG funding for non-joint work.