Agenda item

(A period not exceeding 15 minutes for questions from members of the public.)

Mr Tim Brown addressed the Board on his lived experiences of racism.  He expressed concern that it was now 20 years since the Council commissioned a report by Professor Gus John and no action had been taken on the recommendations.  More recently, an OFSTED report had highlighted that the ethnicity details of looked after children were not being recorded, which was an issue that had been articulated 20 years ago.  Mr Brown explained that despite the fact that he and his family worked in the NHS, they were excluded and could not have their say on things such as the OFSTED report or the newly formed Fairness and Wellbeing Commission.  Mr Brown continued by outlining the achievements of his children, despite the barriers they had faced through their lived experiences of racism.

In conclusion, Mr Brown asked how this Board was planning to commemorate the 75^th Anniversary of the Windrush Generation and recognise the contributions made by people who looked like him working in the NHS, and he stated that he would be happy to help with any arrangements.  Mr Brown also pointed out that at a meeting of the South Yorkshire Integrated Care Board (ICB) in October last year, Mr Gavin Boyle (CEO) and Mr Oliver Coppard (Mayor of South Yorkshire) had agreed to apply an anti-racist lense to tackling health inequalities and create a psychological safe space to enable people like himself to have their say.  Mr Brown hoped that this was being taken forward.  He also stated that he was privileged to be reverse mentoring a senior leader within the NHS and he encouraged others to get involved in similar initiatives if they were given the opportunity.

In response, the Chair thanked Mr Brown for his statement and gave an assurance as an NHS employee that there was a commitment within the ICB and wider NHS to continue to adopt an anti-racism stance and he was sure that this was the case in all the partner organisations represented on the Board. 

With regard to the Fairness and Wellbeing Commission, Dr Rupert Suckling explained that this was due to commence in January and membership nominations had been sought from the Minorities Partnership Board.  He added that there would also be opportunities for all people to have an input into the Commission’s work.

Richard Parker reported that the Doncaster and Bassetlaw Teaching Hospitals Trust had operated a reverse mentoring programme for a couple of years and that the vast majority of its Executive Directors had undertaken the programme.  He also advised that the Trust had become the first NHS organisation to qualify to use the RACE (Reporting Action Composition Education) Equality Code Quality Mark, following work undertaken with Dr Karl George.  This Code had been developed to help organisations take action to improve race equality within the workplace.  Furthermore, the Trust was supporting the national Breaking Through Programme, which was being used by the NHS and NHSI as a vehicle to fast track candidates from BAME backgrounds into senior management posts within the NHS.  Richard concluded by outlining the efforts being taken by the Trust and all NHS organisations to tackle health inequalities, and he cited as an example the work developed in Calderdale and Huddersfield to narrow inequalities in waiting lists, which was being built on and used in Doncaster.

The Chair confirmed that following the discussion on health inequalities at the Board’s last meeting and the Board’s commitment to extend training on health inequalities to non-Executive members across all of the partner organisations, Mandy Espey was putting the necessary arrangements in place for this to be delivered.

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Mrs Rhonda Job addressed the Board on the difficulties faced over the past 18 months by her elderly and severely disabled husband in obtaining face-to-face contact with a doctor and access, in general, to Primary Care services.  Having outlined her husband’s medical history and given details of the numerous health conditions he had been treated for, Mrs Job gave a number of examples where he had not been seen directly by a doctor.  She stated that since the pandemic, it had become very difficult for people to access a doctor and in her experience from talking to other people, direct contact with doctors often appeared to be the last option open to patients these days, after self-help and visiting their local pharmacy or even the Accident and Emergency department, which she did not feel was acceptable or appropriate.

Mrs Job referred to the Primary Care network and stated that she had read the contract that all individual practices had signed up, including the conditions that they were supposed to adhere to.  One such condition was the provision of out of hours appointments.  She explained that in her local practice, out of hours appointments were not being advertised or promoted and she knew from speaking to other people that this was the same in other practices.  In light of this, she asked who was monitoring and checking that practices across the primary care network were meeting the conditions in their contract, and whether any system was in place such as ‘mystery shoppers’ visiting these practices as patients.  Mrs Job added that it often seemed as though the service provided by general practices these days was geared more towards their own support staff than meeting the needs of patients.

During subsequent discussion, Dr Nabeel Alsindi thanked Mrs Job for presenting the Board with a very helpful set of observations.  He stated that no one was going to pretend from the General Practice and pharmacies side, nor colleagues from acute and community health trusts, that the level of service provided to patients during the pandemic had been adequate.  He also felt that those patients who had been most adversely affected during this time due to services being under strain were those who were most vulnerable, with a range of complex needs, as in the case of Mrs Job’s husband.  He commented that it appeared to be in the cases of low-level health complaints where the system was breaking down, with patients being referred to A&E when they should be directed to their local pharmacy instead, for example.

On the question of monitoring, Anthony Fitzgerald explained that a range of qualitative and quantitative indicators were looked at in relation to primary care, including utilisation of the additional capacity provided by weekend and evening appointments.  Alongside this, patient feedback was also collected and studied, both from primary care surveys and from the patient participation groups.  Anthony stated that he wished to give an assurance that the messages coming from the patient feedback with regard to the present difficulties being experienced by people were being taken on board and closely monitored.  He confirmed that access to primary care services was a key priority for Doncaster Place and stated that he would be happy to have further dialogue with Mrs Job outside of the meeting, to provide her with further details of the actions being taken to improve the situation.  He added that the Board would also be happy to have further reports and discussion on the subject of primary care at future meetings, given that this was such a high priority issue at the current time.

Steve Shore then gave further details of the Patient Participation Group (PPG) Network that was administered by Healthwatch Doncaster, which brought together all of the Doncaster PPGs, and encouraged Mrs Job to join her local group.  He also drew attention to the Care Opinion website, which was a platform enabling members of the public to make positive or negative comments on health and care services they had received, and which was a primary source of information used by Healthwatch Doncaster.

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The Chair informed the Board that the following question had been submitted by Mr Wayne Goddard on behalf of the Doncaster Dementia Collaborative who was unable to attend today’s meeting in person:-

"Based on current data and captured lived experience of people effected by dementia living in Doncaster, it is clear the position has in fact deteriorated not improved since our question was discussed at the HWB in June 2021.  Can the HWB explain what is being done to address this declining position?"

The Chair then read out the following joint response from the ICB/LA in relation to Mr Goddard’s question:-

“The Strategy which is currently in development is much broader than the current procurement process which includes the pre/post diagnostic service, and the Community therapy services.  The Strategy will be developed jointly with partners and is not just about commissioned services but how dementia impacts Doncaster across several pathways and how we can set actions to improve this.

The decision to undertake a full procurement exercise for these services was made in 2020 to ensure procurement law was adhered to and all providers were made aware of this decision.  The development of a Strategy was agreed by partners and encompassed into the Ageing Well Delivery Plan in 2021 and a Strategy development group established thereafter.

With regards to the engagement work, this was a commissioned piece of work and Healthwatch undertook the engagement across Doncaster.  The Dementia Deep Dive which was undertaken in late November 2019 was also a significant piece of engagement work.  In addition to ongoing feedback from people with dementia and their carers and other stakeholders, engagement with the Dementia Collaborative and these two significant pieces of work demonstrates intense engagement throughout which has informed and shaped the specifications.

People with lived experience have evaluated both elements of the service and the specifications allowed for the development of co-producing the offer.  I can confirm that now the procurement has closed, no award has been made for either element of the services.  It is the intention that a further procurement will be undertaken early 2023.

In relation to the data, the dashboard has only recently been updated.  The reduction in rates in several areas has been significantly impacted by the pandemic.  Every effort has been made with providers during the Accountable Care Partnership meetings to engage them with wider work that is happening across Doncaster, some are now engaging with the localities work and a lot of effort has gone into co-producing Dementia Pages on Your Life Doncaster with them and people with lived experience.

We are also working with providers to implement actions linked to winter/cost of living crisis alongside immediate actions to improve services based on the findings from the insight report.”

The Chair confirmed that a copy of this response would be sent to Mr Goddard after today’s meeting.

Lucy Robertshaw stated that she was slightly concerned from a community and voluntary service perspective that the procurement exercise for the community therapies tender and one other service had closed with no award being made.  There was little information as to future plans regarding the delivery of these services, other than some market place events taking place in February, but there had clearly been some delays and problems in the procurement process.

Arising from discussion on the three public questions received at today’s meeting, Dr Rupert Suckling undertook to liaise with the Chair of the Board to identify ways of scheduling the above 3 topics into future HWB meetings as main agenda items for discussion, to be led by people with lived experience.  Lucy Robertshaw also highlighted the importance of not losing sight of the difficulties faced by people with learning disabilities in terms of health inequalities.

Richard Parker felt that more work was needed to communicate and explain to people how health care services had changed as a result of the COVID-19 pandemic and that they were unlikely to ever return to the pre-pandemic model.  He stated that there was a need to match expectations with the reality of delivery, in the light of increased demand for services and competing pressures.  This being the case, he stressed that going forward, there would need to be a focus on working with communities to ensure that people accessed the right service at the right time to get the right result.

Councillor Nigel Ball added that there appeared to be a certain level of confusion felt by the public in terms of how to access health services and what was available these days, and he felt that this could be helped by having effective information, advice and guidance provided to people at their first point of contact.  To this end, it was important that the person taking the call or enquiry was suitably qualified and knowledgeable in order to be able to signpost people to the correct service.  This change was needed alongside a culture shift so that people began to ask themselves the question “Do I need to see a doctor about this?”