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;

(b)        Written Questions – to receive any questions submitted by the due date of 12 noon on the 29 January 2014;

(c)    Deputations – to receive any deputations submitted by the due date of 12 noon on the 29 January 2014.

 

(a) Petitions

 

40.1    The Chair noted that there were no petitions from members of the public.

 

(b) Written Questions

 

40.2         Mr Ken Kirk asked the following question:

 

“Should the Health and Wellbeing Board, in its function of identifying the health service needs of Brighton and Hove, scrutinise the proposed tendering of services by the CCG to –

a.                  minimise the fragmentation of the local NHS

b.                  ensure the financial security of local health services so that trusts are not denuded of profitable services

c.                  maintain the skill-base of local medical staff since the redundancy of well-trained medics is likely to follow outsourcing to a for-profit provider?

 

Does the H&WB in its role in overseeing the CCG actively challenge its decisions in the interests of the people of Brighton and Hove?”

 

 

40.3         The Chair gave the  following response:

 

“The HWB provides citywide strategic leadership to local health and social care commissioning with the ultimate aim of improving the health and wellbeing of local people.

 

As such the HWB has an interest in ensuring that CCG and city council commissioning policies do not result in negative impacts on local services.

 

However, NHS and local authority commissioners have limited freedoms with regard to commercial procurement, which is largely determined by national and European legislation. Although any procurement exercise inevitably involves some risks, such as those outlined in the question, it also presents a significant opportunity to improve the quality, social value and the value for money of services.

 

 For this reason it would not make sense to simply adopt a policy of opposing going out to tender where this might be legally possible.

 

Given this, it is unlikely that the HWB would seek to ‘scrutinise’ any particular CCG decision to go to tender. However, the HWB will seek to hold the CCG (and the city council) to account for the general impact of its commissioning decisions, particularly in terms of the Joint Health & Wellbeing Strategy commitments.”

 

40.4         Mr Kirk stated that the financial security of the NHS Trust would be placed in jeopardy if profitable services were contracted out.  He stressed that commercial companies would want to cherry pick profitable services.  He asked if the Health & Wellbeing Board saw its role as overseeing that process. 

 

40.5         The Chair replied that the Health & Wellbeing Board needed to work in the best interests of the City.  It would not be in the best interests of the City if the NHS became non-viable.  However, the Board needed to act within the law.  The Board would need to think about the financial implications of the decisions it took and it could be consulted on whether they wanted to agree a position on this matter. 

 

40.6    RESOLVED- That the written question be noted.

 

40.7    Ms Madeleine Dickins asked the following question on behalf of Ms Jozette Power:

“In view of the City Council’s referendum on a possible council tax rise, does the Health and Wellbeing Board share my concern that the people of Brighton and Hove are generally unaware of what is happening to their health services and that their views should be sought on the subject of are they  –

1.       concerned by the take over of their health services by alternative providers;

2.       supportive of the fragmentation of the unified NHS into pieces to offer to the private sector;

3.       aware that the publicly-run NHS will be left with the rump of unprofitable services that the private sector have decided it can’t make money from?”

 

40.8         The Chair gave the following response:

“Proposals to hold a referendum on Council Tax, if they go ahead, will present local people with a clear choice of accepting or rejecting a planned CT increase.

 It is hard to see, however, how local people could be presented with similar clear choices on the future of NHS services, since many of the key decisions here have been taken at a national level and local bodies are essentially implementing these nationally-determined policies.

To the degree that there is scope for local determination, commissioners are committed to maintaining a cohesive and effective healthcare system with delivers the best possible care for local people.

   NHS services are, and will continue to be, a key part of this offer; but it is the case now and will be the case going forward that NHS healthcare benefits from a plurality of providers. “

 

40.9    The Chair added that the CCG did have public meetings and that the public could make representations at those meetings.

 

40.10  Ms Dickins asked what mechanisms were in place in Brighton and Hove for meaningful public consultation on decisions being taken.

 

40.11The Chair explained that a number of council decisions were made after a public consultation process.  Geraldine Hoban explained that the CCG had a range of public consultation in relation to its service plans.  With regard to procurement, the CCG was legally obliged to follow legislation. Legal advice would have to be sought as to whether it would be possible to have a consultation process.     

 

40.12  Ms Dickins stated that many residents were concerned about the tendering process already taking place.  She accepted the point about the legal implications but stressed that there was often room for manoeuvre.

 

40.13  The Chair replied that he would investigate if there was a way members of the public could have an input in how services are delivered.  Geraldine Hoban stated that the CCG did have public questions at its public bodies.  The CCG were keen to hear what people had to say. 

 

40.14  The Chair mentioned that the Health & Wellbeing Overview & Scrutiny Committee might be an appropriate place to raise this issue. 

 

40.15  RESOLVED- That the written question be noted.

 

40.16  Ms Katrina Miller asked the following question on behalf of Mr Dave Baker:

“The presidents of British Association for Sexual Health and HIV and the Royal College of Physicians have written to all local councils:

“Tendering has negatively impacted on the provision of sexual health services, destabilising, disintegrating and fragmenting services, causing significant uncertainty amongst patients and staff, and reducing overall levels of patient care."

They are warning against tendering, saying it’s not in the interests of patient care. Monitor’s guidance for commissioning say the interests of patients determine whether tendering should occur.   

 Therefore, on the basis of what evidence would this Board offer B&H’s sexual health services to tender outside the NHS?”

40.17  The Chair gave the following response:

 

“Brighton & Hove City Council is currently considering all the options available, which may not necessarily require procurement by competitive tender, to achieve the most clinically and cost effective service.

 

This issue will be considered at the March 2014 Policy & Resources (P&R) Committee. As this is a decision for P&R rather than the HWB, and because the report for P&R is still at a draft stage, we are not in a position to provide any more details at this point.”

 

40.18  The Chair explained that when public health became a council responsibility, the council were under the impression that it would be necessary to tender the service.  Over the Christmas period new guidance emerged that suggested this might not be the case.  Legal advice was being sought on this issue. 

 

40.19 Ms Miller asked about the role of the Health and Wellbeing Board in relation to tendering.  She asked when the original decision to tender was taken.  She asked what the resolution stated and whether it was minuted. 

 

40.20  The Chair explained that not all the work of the Public Health directorate was taken to the Board.  Decisions could be taken under delegated powers and some decisions were taken to the Policy & Resources Committee.   

 

40.21  Councillor Shanks explained that she was a member of Policy and Resources Committee.  She confirmed that the Policy and Resources Committee had considered this matter due to the financial implications involved.  The Committee had decided that this service should be tendered.    

 

40.22  Ms Miller questioned how the public could be informed about these matters.

 

40.23 The Deputy Head of Law explained that all public committee papers were published on the Council’s website a week before the meeting.  The Council had to abide by the Access to Information Act with regard to making information public.  The minutes of meetings were also published on the website.  There were a number of reasons why reports were referred to the Policy & Resources Committee. It might be due to the budgetary implications or it might be because the issues affected several areas of work such as children & adults etc.            

 

40.24  Councillor Meadows asked why the Children & Young People Committee and the Adult Care & Health Committee had not been informed about this issue.

 

40.25  The Deputy Director of Public Health informed members that the report was a general paper submitted to the Policy & Resources Committee and included other business such as substance misuse.  

 

40.26  Councillor Pissaridou suggested that there should be a report back to the Board on what had happened with regard to the report.  The Chair agreed that a brief report on this matter be circulated to Health & Wellbeing Board members and potentially included as an item on the next committee meeting agenda. 

 

40.27 RESOLVED- (1) That the written question be noted.

 

(2)       That a report be circulated to members explaining which meeting had considered the original decision to tender and the date of that meeting.  The report should explain why the matter was considered by that Committee and provide details of the resolution. 

 

(c) Deputations

 

40.28  The Chair noted that there were no deputations from members of the public.