Agenda and draft minutes

Apologies for absence were made by Cllr Elizabeth Rhodes of Wakefield MDC and

Cllr Simon Evans of Rotherham MBC.

Apologies were also received from Sir Andrew Cash, Chief Executive Officer, South Yorkshire and Bassetlaw Integrated Care System (SYBICS).

None

There were no declarations of interest made.

RESOLVED that the minutes of the meeting held at Barnsley MBC on the 22nd October 2018 was agreed as a true record.

It was noted that all information cited in the minutes had since been circulated to all Members of the Committee.

The Chair informed members of the public, that a meeting would be arranged in early summer for Committee Members to meet with them to help better understand their concerns.  It was clarified that no more than 3 representatives from each of the Save Our NHS Areas, a representative from each Healthwatch area and finally a representative from the South Yorkshire and Bassetlaw group would be invited to the meeting.

Questions were raised from three individual Members of the Public.

The Chair referred to the full set of questions received which were as follows: -

DOUG WRIGHT QUESTIONS

NHS ENGAGEMENT WITH THE PUBLIC

A theme running through the above agenda is 'an essential part of the long term plan is undertaking wide engagement with Health and Care staff, parents, the public' .....

Yet both SYB Oversight and Assurance and Executive Steering Group meetings have always been held in secret.

The SYB Collaborative Partnership Board still refuses to allow the public to attend their meetings.

Both Barnsley and Doncaster Joint Commissioning Management Groups currently also exclude members of the public.

Will this Overview and Scrutiny Committee now belatedly consider recommending to these bodies, that members of the public can attend the above regional meetings and also ask them to have a standard early agenda item, 'questions to the public?'

JHOSC ANSWERS TO PUBLIC QUESTIONS

In future, can the rotating Chairs of this Committee ensure that answers to questions from the public are published in the minutes of JHOSC minutes?

PETER DEAKIN QUESTIONS

With regard to the

The South Yorkshire, Derbyshire, Nottinghamshire and Wakefield Joint Health Overview and Scrutiny Committee agenda

Agenda item 6b item 31 to 43 - Involving people and communities in taking forward the NHS Long Term Plan

Appendix 1 - Our approach to meeting the principles of the NHS England Patient and Public Involvement Framework

I am concerned that these actions/exercises do not and will not involve the public. In past few years the ICS and previous incarnations the actual events and surveys said to involve the public were and are stage managed to give the impression of public engagement.  Many who take part are NHS staff, managers and supervisors and patient groups in order to produce the right input and right responses. This consists of limiting discussion, dismissing and not recording critical voices, whilst giving the pretence of full public engagement

Scrutiny Committees can undertake investigations into a specific topic. The Committee can then collect evidence from relevant people and organisations ('interested parties') so that the members of the Committee can produce a public report that covers their findings, conclusions and recommendations.

Can the JHOSC be sure that the construction of the long term plan, communication and engagement report (agenda item 6b), will involve the public and not be stage managed.

Can the JHOSC be sure that all of the suggested actions in (agenda item 6 and appendix 1) will happen and that this is not just a list of suggestions of what could be done to involve  ...  view the full minutes text for item 14.

Members were presented with the covering report that presented the following areas for discussion.

A report was provided that outlined the next phase of governance arrangements for South Yorkshire and Bassetlaw (SY&B) Integrated Care System (ICS) for 2019/20.  It was explained that work would continue on the full governance arrangements, which recognised both the national developments on NHS system architecture and the work with system partners in order to develop an overall system governance framework for the ICS.

It was noted that shared governance working arrangements had been in place since the South Yorkshire and Bassetlaw (SY&B) Sustainability Transformation Plan (STP) had begun before becoming the Integrated Care System (ICS).  Members were informed how a number of changes would be undertaken this year, which would help strengthen the collaboration.

It was stated that given the work being undertaken amongst partners (and which included the public), there was a need to share information effectively within South Yorkshire so commissioners were able to make shared decisions with providers.  Members were reminded that to date the Joint Committee of CCGs had considered service changes specifically around Hyper Acute Stroke Services as well as Children’s Non-Specialist Surgery and Anaesthesia but that this might not be the case for other areas in the Long-Term Plan.

Members were informed how the SYB ICS leadership had engaged directly with local authority partners to shape proposals for partnership working and identify priorities, which would benefit from system collaboration and where greater value could be added.  The Committee was informed that this was seen as a required step for health partners to do so before undertaking wider discussions with system partners. It was reported that the Collaborative Partnership Board would continue to meet on a bi-monthly basis (to be reviewed) in due course further to work undertaken with local authority partners and system partners.

It was emphasised that the ICS was not an organisation but a partnership and therefore not a decision making body. 

It was explained that further work would be undertaken to consider what the actual governance arrangements would look like.  It was commented that within the majority of local authorities, there were Health and Wellbeing Boards to support this process.

It was outlined that from the outset it had made sense to join up and take decisions collectively in relation to what was taking place around health within each of 5 places that made up the SYB ICS.  It was continued that Health and Wellbeing Boards, local Overview and Scrutiny and local providers had a great deal of work to undertake and that all elements of the architecture were considered as important.

It was noted that Project Management Teams working on behalf of partners, were in place to move the agenda items forward.

It was noted that in comparison to the previous model, the new model was clearer and more focused with decisions being tracked back to state organisation discussions that had taken place in front of the public, therefore providing assurances with the new set of arrangements.

Accountability – The Committee was informed how the ICS partnership  ...  view the full minutes text for item 16.

A report was provided to the Committee that set out the background and context to the NHS Long Term Plan.  It highlighted areas of focus within the Plan that included clinical priorities, key service area commitments and enablers to delivery.

It was explained how the plan was intended to provide a framework for local planning over the next five years.  The report outlined how SYB ICS would engage with its many audiences to determine what the NHS Long Term Plan meant for them and to co-design the most effective ways to put the commitments into practice locally.  It was recognised that healthcare was constantly evolving and this resulted in changing expectations and its own challenges.

It was expected that the changes set out in the Plan could be achieved within the current legal framework, although it was stated that proposals were being made to change legislation that related to the NHS.  Members were informed that national consultation had been launched on potential proposals for changing current primary legislation relating to the NHS and this would close on the 25th April 2019.

It was stated that in respect of procurement, a “best value test” could be applied and where best value could be offered by a NHS provider, then the service would not necessarily need to go through the procurement process.

It was noted that the Plan, alongside primary care networks, was committed to developing ‘fully integrated community-based health care’. It was reported that this involved developing multi-disciplinary teams, including GPs, pharmacists, district nurses, and allied health professionals working across primary care and hospital sites.  It was recognised that it was about how everything worked together as a system and what it would take to achieve that ambition.

It was noted that the SYB ICS response to the NHS Long Term Plan will be published in the autumn. The areas of focus will form the basis of the ICS work plan for the next five years and therefore the current workstreams will be reviewed and aligned.   Priorities included smoking, obesity, air pollution, resistance to antibiotics, maternity, Children and Young People mental health, learning disabilities and autism, children and young people with cancer. 

It was reported that some of the key messages developed since the publication of the plan included;

·         Boosting out of hospital care;

·         Publication of new GP contract;

·         Encouraging to work in networks going forward;

·         Backed up by new staff in out of hospital care.

Reference was made to the next steps for public engagement as outlined in the report.  It was reported that the above reports and updates would be shared with Members of the Committee.  The steps included that;

·         the communications and engagement plan would be shared with the Collaborative Partnership Board and Executive Steering Group and once finalised, shared with Boards and Governing Bodies for their meetings in public. 

·         updates on the engagement and themes emerging from the feedback would be brought to the Collaborative Partnership Board and Executive Steering Group.

·         a report on the engagement would  ...  view the full minutes text for item 17.

A report provided an update to the Committee on the transformation workstream programmes within the South Yorkshire Bassetlaw (SYB) Integrated Care System (ICS).  It was outlined that the corporate services workstream priorities were to 1. Agree the procurement work plan for 2019/20 and 2. Support the development of ‘hosted networks’ that will support shared working between the acute Trusts =.

A presentation was provided on progress made with Hosted Networks.  The following areas were included:-

·         The proposal for Hosted Networks

·         Hosts of Hosted Networks

·         Role of the Hosted Networks

·         Developing Priorities and Resources for each Network

·         Generic Structure

It was explained that there were a number of existing structures to take forward shared working between acute providers, but that some existing structures had failed to gain traction. The the hosted networks therefore represented a formal collaboration between acute providers which were intended to have more levers to support shared working, and a higher degree of transparency, in order to give them the best chance of success.   It was explained that there would be three levels of hosted networks, beginning from collaboration on workforce and clinical standardisation, and gradually moving up the levels with increasing levels of collaboration around resources and capacity. .  The intention of this shared approach was that patients would be receiving services to the same standards across South Yorkshire and Bassetlaw. 

It was added that work was now being undertaken to work with Trusts and commissioners to agree the structure, membership and work programme of the individual networks. It was commented that the work programme for each of the networks would focus on different areas in line with the requirements for that specialty.

It was explained that the role of the Host for each network would be to facilitate this shared working. Trusts had put themselves forward to each host one of the Networks.

It was outlined that each Network would include a Network Steering Group which would provide direct oversight  and ensure that the Hosted Network was linked to the leadership of the Host and the ICS governance structure.  It was noted each network would also have a Clinical Group formed part of the generic structure, which was likely to include representatives from primary care and other services.

It was reported that the networks were provider led but that commissioners would have an important role in ensuring that proposals in line with strategic priorities for the system were deliverable.  It was explained that any areas requiring decisions would be linked into the Joint Committee of NHS CCGs and issues may be escalated into the governance of the Integrated Care System.

Further to concern raised by a Member of the Committee, it was commented that there was no intention to create disengagement amongst those Trusts that were not hosting a particular network.  The Networks would include a variety of roles, such as clinical leadership, which might well be drawn from organisations other than the Host.  

Members were informed that there had been a dialogue  ...  view the full minutes text for item 18.

It was noted that a date had not yet been identified for the next meeting of the Committee.  It was proposed that this could be further considered following the proposed meeting in early summer with representatives of Save Our NHS and HealthWatch.