Agenda item - Public Involvement

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Agenda item

Public Involvement

To consider the following matters raised by members of the public:


(a)         Petitions – to receive any petitions presented to the full council or at the meeting itself (copy attached).

(b)        Written Questions – to receive any questions submitted by the due date of 12 noon on the 4 September 2013.

(c)    Deputations – to receive any deputations submitted by the due date of 12 noon on the 4 September 2013 (copy attached).



(a) Petitions


            Improving Mental Health and Mindfulness


16.1    John Kapp presented the following e-Petition which was signed by 27 people.  


“We the undersigned call on the Health and Wellbeing Board to empower the Clinical Commissioning Group (CCG) to outsource provision of the Mindfulness Based Cognitive Therapy (MBCT) course to the third sector, so that GPs could prescribe it on a voucher scheme to reduce the waiting time from 20 years to a few weeks.”


16.2    The Chair responded as follows. 


           I recognise both that MCBT is a valuable treatment option and that 3rd sector providers have a role to play in providing this and other services. The CCG recently re-commissioned a range of services in this area, seeking to improve quality and reduce waiting times. This re-commissioning has been widely welcomed – specifically by HWOSC – and providers now include non-NHS not for profit providers of MCBT. Given these actions I am content that the CCG is acting properly in this regard and do not intend to ask them to make further changes.”


16.3    RESOLVED- That the petition be noted.


(b) Written Questions


16.4                  Mr Terence Rixon had asked the following questions:


    It has justbeen reportedby Hansardthat yesterday(11thJune)Jeremy Hunt,the Secretary of Statefor Health,when askedabout "Whatsteps heis takingto increaseaccountability inthe NHS"....

    That hereplied "Wehave transformedaccountability inthe healthsystem bysetting up Healthwatch andintroducing strongerlocal democraticaccountability throughHealth and Wellbeing boards".



    My questionis ...

               Can theHealth &Wellbeing Boardapply pressureto theCommunity VoluntarySector Forum (the CVSF)to acceptthe recommendations(and comments)of RobertFrancis QC in respectof howthey aredeveloping theBrighton &Hove Healthwatch?



    The FrancisReport identifiedmany seriousshortcomings ofthe StaffordshireLink, and made firmrecommendations tobe carriedforward intothe newHealth &Social Care Watchdog tobe knownas Healthwatch.



    These aredetailed ina separatepaper, whichis toolong toread outnow.



   My ownexperiences ofour localLINk and theCVSF showmany parallelswith Mr Francis'sfindings, andI amconcerned thatthe CVSFare nowdeveloping ourBrighton &Hove Healthwatchwithout anyregard tothe FrancisReport recommendations.



    We arenow overtwo monthsinto thecontract forthe newHealthWatch,and therehas been noPublic Engagementyet.  TheCVSF seemto begoing theirown "closedshop" way, and showingno "transparentprocess", despitequestions beingasked oftheir Chief Executive Officer.



    I shallconclude byquoting justtwo examples:

    Paragraph  i.174(of theFrancis Report)states thatthose witha responsibilityfor HealthWatchshould seekthe involvementof thepublic (asset outin thefull table of recommendations).

    Page 481of theFrancis Reportis flagrantlybeing disregardedin whichconcerns are expressed about"recruiting froma smallunrepresentative poolof theusual suspects".   TheCVSF arenot inviting"fresh blood"to jointhem inthe set-upof HealthWatch.



    Somy questionis:

Can theHealth & WellbeingBoard applypressure tothe CVSFto acceptthe recommendations(and comments)of RobertFrancis QCin respectof howthey are developing theBrighton &Hove Healthwatch?


16.5    Mr Rixon had been given the following response:


“The Health & Social Care Act (2012) required all upper-tier local authorities to establish a local Healthwatch organisation to replace Local Involvement Networks (LINks) in enabling public and patient involvement in the commissioning and provision of health and social care services.


In Brighton & Hove we opted to go out to tender for a Healthwatch provider. The ensuing procurement process was managed by the council’s Communities & Equalities team, which also performance manages the Healthwatch provider going forward.


A steering group was established to oversee the procurement process. This included representatives from the Council’s Policy, Scrutiny, Finance, HR, Legal and Procurement teams. It also included representation from the Clinical Commissioning Group and the LINk steering group volunteers. (The actual procurement was undertaken by a core group with no possible commercial interest in the awarding of the funding agreement.)


Subsequent to the Brighton & Hove Community & Voluntary Sector Forum (CVSF) being awarded the Healthwatch contract, the steering group was re-constituted as a virtual implementation group overseeing the implementation and performance management of the agreement.


One of the major issues in managing the transition from LINk to Healthwatch that was identified, was the loss of organisational memory and working capacity during the period of transition and the early months of Healthwatch operation. Local and national experience of managing the transition from Patient & Public Involvement Forums (PPIF) to LINks in 2008 underpinned these concerns. Many LINks took a year or more to actually begin investigative work following the transition from PPIFs, and few local areas had measures in place to ameliorate this problem. As the Francis report makes clear, this was the situation pertaining in Staffordshire at the time of the crisis in Mid Staffs hospital.


Having identified this major risk in terms of the LINk/Healthwatch transition, the approved provider - CVSF sought to mitigate the risk by appointing a group of former LINK members as a transitional group to continue investigative and representative work while Healthwatch was established. This action has the support of the implementation group as it offers continuity between LINK and Healthwatch, ensures that there is some retention of organisational memory, and avoids a situation where there is a ‘gap’ between one organisation and its successor (as was the case in Mid-Staffs).


An additional risk consists of the current limited public understanding of Healthwatch. It was felt that an exercise to recruit Healthwatch volunteers at an early stage would be unlikely to succeed in attracting the broad cross-section of the local public necessary to ensure that Healthwatch does not only appeal to the “usual suspects”. To reach a broad section of the local public, a process of public awareness of what Healthwatch is needs to be ongoing: hence there are significant advantages in having a considered approach to the involvement of the public.


There is absolutely no intention of limiting the recruitment of volunteers to Healthwatch to “a small representative pool of the usual suspects”. It is CVSF’s intention and that of the implementation group to encourage as wide a group as possible of local residents to become involved in Healthwatch. However, it has been agreed that the most sensible and least risky approach in the early months of Healthwatch is to retain a transition group of experienced LINK members whilst establishing Healthwatch organisational structures and planning how best to recruit and support volunteers to Healthwatch in the longer term. There is no intention to retain the transitional group for longer than is strictly necessary or to favour its members in terms of the development of volunteer roles within Healthwatch.


In terms of the question then, I’m sure it is the case that HWB and HWOSC members would agree that Healthwatch Brighton and Hove should “seek the involvement of the public” and should avoid “recruiting from a small unrepresentative pool of the usual suspects.”


However, at this time we are confident that the measures being taken by CVSF accord with both of these aims (and with the need to ensure there is continuing volunteer capacity to undertake investigative/representative work during the early days of Healthwatch), so we will not be seeking to apply additional ‘pressure’.


We are actively monitoring the establishment of Healthwatch and the HWB plans to have an item on Healthwatch development at its September committee meeting.”


16.6    Mr Rixon asked the following supplementary question in respect of contract compliance: 


‘Given the growing groundswell of public concern about the lack of broad democratic public involvement of our Local Healthwatch, as evident from the content of the paper to be discussed at Agenda Item 22, page 135, when can we expect a report to be brought to this committee which has been prepared by the council’s Contract Monitoring Section as to levels of performance and compliance concurrently being achieved under the contract?


Finally one of the ‘Tag Lines’ or ‘Mission Statements’ of Healthwatch is ‘For the People by the People’.’


16.7    The Chair informed Mr Rixon that he would receive a written response to his supplementary question.  He gave a commitment that he would get in touch with Healthwatch to find out when they would be fully operational.  He was concerned as Mr Rixon that Healthwatch should be the face of the public. 


16.8         RESOLVED- That the written questions be noted and a written response be prepared for Mr Rixon’ supplementary question.


(c) Deputations


16.9    The Chair noted that the following deputation had been referred from full Council held on 18 July 2013.


16.10  Mr Kapp presented the following deputation:


“I am a complementary therapist, and a facilitator of the Mindfulness Based Cognitive Therapy (MBCT) 8 week course (1) which is NICE-recommended (2) to improve mental health by teaching people self-help tools by which to better manage their emotions, so they don’t need to go to A&E. There are more than 20 facilitators in the third sector of the city (3) providing this course for clients who pay the going rate (£150-370). This course is provided free on the NHS, but the waiting time is 20 years unless you are suicidal. (4) causing health inequalities as the poor can’t afford it.


3 years ago, to reduce the waiting time, I created the Social Enterprise Complementary Therapy Company (SECTCo) (5) whose slogan is: ‘medication to meditation’, and whose mission statement is: ‘Give a man a pill, and you mask his symptoms for a day. Teach him mindfulness, and he can heal his life’. To get public sector contracts I sent hundreds of e mails, documents, phone calls, to commissioners. These were not answered, because there was no-one at home who could make a decision, even to say: ‘no’. The NHS did turn 65 last week, and decision paralysis is a symptom of dementia. Even Jeremy Hunt says it is sick. My experience proves thatit has dementia. For the sake of both doctors and patients, we need to cure it.I am the Julia Bailey of Brighton, and pleading for your help now,


The government has done its part by filling the democratic deficit in health. You are now responsible for public health, and for directing the strategy of the new Clinical Commissioning Group, (CCG). I am therefore calling on you councillors to play doctor to the CCG and cure its demented paralysis by banging headstogether. Please set up a ‘chemist shop’ voucher system by which GPs can prescribe the MBCT course as easily as Prozac. This would boost their morale by restoring their original function as teachers, (6) Then patients could access the course free within a few weeks from the third sector, so wouldn’t need to go to A&E.  This will fill the disconnect (7) between drugs and talking therapies, and restore patients’ trust.


Please do not dismiss this proposal automatically as ‘privatisation by the back door’. It is just a way of reducing waiting times for effective treatment, which has had all-party support nationally for more than 7 years. (8). Opening up the market to local complementary therapists would create local jobs and keep the money in the local economy, benefitting our citizens, rather than swelling the profits of drug companies. It will also improve health, reduce inequalities (9) and save taxpayers’ money.


First recommendation. The Council authorises the CCG to engage with SECTCo to do 2 pilot trials of the MBCT course for £5,000 (10) and to engage a researcher to evaluate them, and report back to Council in November.

Trial 1. Up to 12 patients referred from a GP surgery in Hove.

Trial 2.  Up to 12 sick council staff.


Second recommendation. The Council instructs the CCG to consider this proposal to set up a voucher system for the MBCT course in the city, and report back to the Health and Wellbeing Board (HWB) at its next meeting on 11.9.13.”


16.11  The Chair had given the following response at full Council:


“Thank you for your enquiry.


Improving mental health and wellbeing has been a priority for the city council andClinical Commissioning Group andthere is considerable jointwork in pursuing this aim. The 2012 Mental HealthCommissioning Prospectus wasas you know a joint initiative between the CCG and the city council the commissioningand the management of mental health budgets are undertaken jointly.


You will also know that there is now a Brighton and Hove Wellbeing Servicewhich aims to improve access to psychological and support services for people with common mental health conditions such as anxiety and depression. This contractwas awarded following a competitive tendering process and includes as part of the specification a range ofevidence-based treatments including MindfulnessCBT. General practitioners across the city arereferring patients to this new service.


The city council andClinical Commissioning Group will be retendering mental health promotion contracts next summer (2014) followingapproval of the Public Health Commissioning paper at P&R committee on 11thJuly 2013. The defined outcomeswill reflect the mental wellbeing strategy that is being developed through the Health and WellbeingBoard and is likely to ‘Five Ways’ (Connect, Be Active, TakeNotice, Keep Learning, Give) and the Public Health /NHS/ Adult Social Care outcomes frameworks.


Many other locally commissioned programmes acrossthe city council andCCG deliver on ‘Five Ways’. These include joint work ofPublic Health with the Sports Development Team (Be Active), considerable city council and CCG community development and equalities work (Connect),Adult Learning Schools (Keep Learning), Volunteer training andcoordination (Give) and a large arts andculture programme (Take Notice) including a proposal for specific arts and culture work for World Mental Health day this year.


Mindfulness courses are also delivered independently by several local voluntary organisations such as Mind and MindOut, and you will be aware that there are several local independent practitioners of mindfulness.


The city council andCCG will continue to work together on the mental health and wellbeing agenda, and promotemindfulness where there is evidence for its effectiveness.Mental wellbeing willremain a priority on the current Health and Wellbeing Strategy.”


16.12  RESOLVED - That the deputation be noted.


Deputation on Sexual Health Services to Brighton and Hove Health and Wellbeing Board meeting on 11 September 2013


16.13  Mr D A Baker and Mr Ken Kirk presented the following deputation:


‘We apologise for the short notice of this deputation.  We have only recently been alerted to the issue and have therefore submitted this deputation for your consideration at short notice.  We thank the board and the Chair of the board for their indulgence in receiving this deputation.  Because of the short notice we have only been able to put two names and addresses to this deputation.  However many people were involved in discussions about this issue and we could send a full list to the chair after the meeting if he requests it. 


We the undersigned (and others) are concerned about the possible competitive tendering and hence privatisation of Brighton and Hove sexual health services.  As lay people we may not fully understand the current position.  We will layout our understanding of the position in point 2 below. 


1  We seek the following from the board:


1.1  a clarification of the current position (see our understand in point 2 below)


1.2  an undertaking that putting sexual health services out to competitive tender will only be undertaken if there is clear evidence that such a process will lead to an improvement in sexual health services for the people of Brighton and Hove and that this evidence will be made available publically. 


1.3  a reassurance that if there is evidence that sexual health services will be improved by putting them out to competitive tender then to ensure the best possible service the CCG or other commission body will insist that the current NHS providers in the field of sexual health will be expected to submit a tender. 


1.4  an explicit reassurance that any potential restructuring of sexual health services resulting from competitive tendering will not result in any adverse sexual health services for the people of Brighton and Hove.


1.5  an undertaking that any potential restructuring of the sexual health services due to competitive tendering will not result in adverse employment conditions for current staff in the area of sexual health in Brighton and Hove. 

2  Our understanding of the current position. 

Since April 2013 the NHS Commissioning Board is responsible for commissioning HIV treatment, while local authorities remain responsible for the commission of sexual health and genito-urinary medicine (GUM) services, and HIV prevention and testing.   At the moment many of the facilities in sexual health are shared.   Plans to put sexual health services out to competitive tender could result in a clear cut separation of such services.  This separation may mean that if a part of the sexual health service goes to an outside provider then the BSUH trust may find that continued independent HIV treatment and care is unviable.  This may have huge implications for HIV patients.  They might either lose a vital service or have these services transferred to a different or new provider.’


16.14  The Chair responded as follows. 


            “I recognise concerns about the future of sexual health services and would not want to see any reduction in quality of these services.  However, it is important that services for local people are as good as they can be and offer the best possible value for money. This does mean that the council will put services out to tender when there is a compelling case to do so.  A written response will be provided on what the current obligations are and what commissioning will take place.


16.15  RESOLVED- That the deputation be noted.


Supporting documents:


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