Agenda item

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 the public.

 

Can the JHOSC as part of the past and ongoing ICS public engagement, ask the ICS for evidence of how they have involved the public in decisions around, clinical priorities - (agenda item b 9 to 20), cancer care, maternity and neonatal care, cardiovascular disease, respiratory disease, primary and community care, mental health services, learning disabilities and autism, workforce and Digital technology.       

 

NORA EVERITT

 

LTP Challenges – Money and Staffing:

 

The Long Term Plan deliberately skims over the two biggest SOLVABLE problems in the NHS.

 

The first is the money. 3.4% (it's actually 3.1% as many has commented)  is totally inadequate when, just to stand still, requires, according to the Audit Office, 4.3%. What we are seeing is a deliberate inbuilt continuous underfunding of the health service in the future which in turn impacts on the workforce. With 106,000 vacancies the minimum year on year increase needs to be at least over 5% and additional funding to restore nurses bursaries.

 

The health service, with this funding and no immediate plan to fill the 106,000 vacancies can only continue by cutting services, beds, and/or introducing top up payments either from personal income/savings or private health insurance.

 

Given the speed with which the ICS is being introduced will the JHOSC:

 

As Scrutiny Committees are non-partisan, questions of a political nature are deemed as not appropriate to be answered by the Committee.

 

a)      confirm that the funding is insufficient,

 

b)      seek assurances and details of how NHS England is going to fill the 106,000 vacancies and increase the funding to sustainable levels within the time allowed for the introduction of the ICS,

 

c)       establish that bed closures will cease and confirm that the fundamental rules of the NHS being free at the point of need will not be replaced by a fixed budget.

 

NHS money & budgets:

 

The money still flows with the patient - even though the budgets are allocated on whole populations.

 

As currently, funding follows the patient, how will patients be funded if:

 

a)      the funding is permanently inadequate?

b)      there are fixed budgets either on a personal basis ( as is being started with  maternity) or on an individual ICS basis?

 

Privately Provided Home Care:

 

We have seen how disastrous the privatisation of care has been. Where once we had an imperfect but affordable system we now have an even more imperfect system which has become ludicrously expensive, has workers on appallingly low wages, on zero hours contracts and no payment for " journey time " between " what is laughingly referred to as " clients ".

 

Many of these elderly people were promised a cradle to the grave health service built upon a basic tax of 33% and that was what they got.

 

Care for the elderly has become a system by which they lose their homes, their pensions, their dignity and their sense of place in a community and it is well past the time to take the whole care system out of the hands of the inefficient, criminally expensive, private sector and have it as part of the NHS as part of a genuinely integrated care system.    Why is that not being pursued? 

 

Agenda Items 6, 6a, 6b

 

All 3 reports contain a RISK AND ASSUMPTIONS section completed with the statement “"There are no specific risks associated with the recommendation in this report".

 

This is combined with a RECOMMENDATIONS section that is again bland and unfocussed “That the Committee considers and comments on the information presented”.

 

These two expressions negate what Scrutiny Committees should be about. The JHSOC agenda reports are designed to spoon-feed one option and avoid informed discussion, which is illegal under the Gunning Principles.

 

QUESTION Is Scrutiny content to continue supporting the illegal breach of the  Gunning Principles by the ICS and accept the legal, financial and reputational consequences?

 

Agenda Item 6a

 

Para. 15 of the report says that

 “changes set out in the Long Term Plan can be achieved within the current legislation”.

 

This directly contradicts the minutes of the Meeting of NHS England and NHS Improvement of 28/2/19 that proposed revoking present legislation to do with Mergers, Competition Requirements, Contested Licence Conditions and Contested National Tariff Conditions and the introduction of a new ‘best value test’.

 

QUESTION Are Scrutiny members aware of this contradiction, the FULL  implications of revoking present legislation, and the discredited record of the ‘best value test’ in PFI contracts that have imposed inestimable financial misery on the NHS?

 

Respect for statutory duty and responsibility:

 

On 25th June 2018 the judge found that this Joint Health Scrutiny Committee was wanting in carrying out their scrutiny responsibilities on a previous NHS service change by a lack of records. This related to a lack in their meeting records of:

 

•      any clarity that the NHS responses to the JHOSC questions around some concerns about the proposed NHS service change actually eliminated the JHOSC concerns

•      any record of a clear decision that there were no recommendations to be made to the NHS to alter their proposals

 

The rather repetitive documents presented contain contradicting, or inaccurate, information e.g.

 

Paper 6 states (P11):  “The purpose of this report is to provide Members with the opportunity to be consulted on the following areas:

 

A.      Integrated Care System Governance Arrangements;

 

B.      NHS Long Term Plan;

 

C.      Transformation Workstream Programmes within the South Yorkshire and

          Bassetlaw (SYB) Integrated Care system”

            And yet each Paper relating to A, B, and C states:                                                                

                         “There are no consultation implications within this report.”

 

2.         In paper 6a – relating to the ICS Governance arrangements specify in points 11-16 on P 14 that these involve action to “redesign services” and create “streamlined NHS commissioning arrangements to enable a single set of NHS commissioning decisions at a system level”

Both such actions require a statutory consultation of:

 

•      The JHOSCs, as they are very extensive and significant changes

•      The public as stated in Section 14Z2 (the statutory right to be consulted on changes in commissioning arrangements)

 

(14Z2 public involvement duty is for commissioners to ‘involve individuals to whom the services are being or may be provided’ in ‘proposals [and decisions] about changes to commissioning arrangements where the implementation of the proposals [and decisions] would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them”)

 

Is the JHOSC going to clarify if the ICS are formally consulting them on these three  very complex areas of change in NHS services that are intended to set the scene for the next five or ten years?

 

If it is not a formal consultation, then is the JHOSC going to ask when the ICS intend to formally consult them, when this will take place and will the changes have been implemented before the consultation takes place?

 

Closure of some Ophthalmic Emergency services (Agenda Item 6c Ps 37/8):

 

In Paper 6c – point 35 on Ps 37/8 refers to Communications and Engagement, and the last bullet point refers to the Ophthalmic out of hour’s emergency service.  The decision to close this service in two hospitals is reported as being in 2015, but the survey information given to patients in February 2019 implies it happened a few months ago. 

 

Local Senior Ophthalmic staff say it happened in November 2017 and Ophthalmic consultants across Yorkshire tell me that although it only affects few people, these patients still deserve safe, speedy accurate diagnosis and treatment, and explained that diagnosis cannot be accurately made virtually where the image of the eye cannot actually examined by the specialist.

 

Will the JHOSC question why there was a full statutory consultation of both the JHOSC and the public when similar closures were planned in Children’s Acute services in 2017 but were not carried out when this closure of out of hours emergency Ophthalmic services were planned, and implemented in the same year?

 

The Chair thanked those members of the public for their questions submitted prior to and raised at the meeting.  The Chair provided assurances that the questions and statements had been considered and would be incorporated into the Committees questions as well as being addressed through responses provided where applicable.  It was added that a full set of written responses would be provided to those questions that were within the remit of the Committee.

 

Please also see following link: - Responses to Public Questions