Agenda item - Formal Public Involvement

This is the part of the meeting when members of the public can formally ask questions of the Board or present a petition.  These need to be notified to the Board by 12 noon, Wednesday 6 September 2017.  Ring the Secretary to the Board, Mark Wall on 01273 291006 or send an email to mark.wall@brighton-hove.gov.uk

25.1    The Chair noted that three public questions had been received and that there were no petitions or deputations.

25.2    The Chair invited Valerie Mainstone to come forward and put her questions to the board on the subject of targeted breastfeeding services.

25.3    The Chair read Ms Mainstone’s question on her behalf; “The Joint Health and Wellbeing Strategy expressly supports targeted breastfeeding services, such as those provided by this worker, in order to reduce health inequalities by increasing breastfeeding rates. In view of this policy, can HWB now explain the decision made by Sussex Community Foundation NHS Trust, to cut this role and the dedicated support it provided; and will the Health and Wellbeing board now publish the Equality Impact Assessment and the results of the public consultation, which we assume was carried out prior to these changes in service?”

25.4    The Chair thanked Ms Mainstone for her question and responded “There is a report on breastfeeding coming to the Board today. I hope you can stay for this item as it will provide more detail.

25.5    “The Public Health Community Nursing Contract was awarded to Sussex Community NHS Foundation Trust in November 2016. An Equality Impact Assessment was undertaken as part of the re-procurement process. Available online from: https://present.brighton-hove.gov.uk/Published/C00000826/M00008005/$$Supp27824dDocPackPublic.pdf

25.6    “The Public Health commissioners set out the outcomes and key performance indicators the contract must achieve. It is for the provider to determine how it will achieve these outcomes within the financial envelope. We do not set a description of what will be delivered but we set an expected result”. The Chair than asked if Ms Mainstone had a supplementary question.

25.7    Janet Sang asked a supplementary question on behalf of Ms Mainstone “The original question of why a health inequalities impact assessment wasn’t done when this specific cut was made still stands. The data presented in the report shows that the lowest breastfeeding results in the city are in East Brighton which is likely to be the result of the cut support worker. The report also states that further questions should be taken to the Health Overview and Scrutiny Committee (HOSC), we have made two previous attempts to ask questions at HOSC both of which have been refused.”

25.8    The Chair responded that “HOSC is entirely independent of the Health & Wellbeing Board. The Board has no influence over HOSC’s agenda and there is no cross over in membership. The figures you quote from the report are the most up to date figures by ward but they are from the first quarter of 2016 and so the support worker would have been in place.”

25.9    The Chair invited The Acting Director of Public Health to respond to the supplementary question. The Acting Director stated that the structure of the community nursing programme is down to the provider and not dictated by the council and if an impact equality assessment had been carried out it would have been service wide ahead of the restructure. He also stated that the points raised could be put to Sussex Community NHS Foundation Trust who are the provider and will be present later in the meeting.

25.10  The Chair then read Mr Kapp’s question to the board on his behalf as he was not present: “Can I ask if the Board thinks that the City should become a Vanguard pilot project, trialling the Multi-speciality Community Provider (MCP) model of mental health care, by inviting third sector organisations to apply for a licence agreement contract to provide Community Care Centres to treat vulnerable citizens with evidence-based interventions, including the NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 8 week course and supporting meditations, on GP prescription, funded by the Better Care Fund.” 

25.11  The Chair responded “As you may be aware the NHS invited areas to become Vanguard sites several years ago. While there are some areas still with pilot status that is coming to an end are no new opportunities available as this programme has ended. With regard to the mindfulness programme I can confirm that this is available through the Improving Access to Psychological Therapy service which has an option for GP and self-referral. The service has additional capacity from 2017/18 to meet more of our mental health need.”

25.12  The Chair then invited Ms Madders to ask her question to the board: “Why and how has there not been a public consultation on the proposed definitive form of service specification for the re-commission of the mental health provision services?”

25.13  The Chair thanked Ms Madders for her question and responded: “The CCG always undertakes consultation about services it is reviewing or commissioning. The Big Conversation update, which will be part of a report item later, is a demonstration of the range of engagement and communication that is undertaken and detailed consultation is undertaken if services are going through the commissioning process. I can confirm there are no new mental health services currently being procured at this time.”

25.14  The Chair asked Ms Madders if she had a supplementary question. Ms Madders asked “Where and with who does the accountability lie and what does the five year forward plan say?” Ms Madders also raised concerns around unqualified mental health workers practicing in the city who were not adhering to doctor patient confidentiality.

25.15  The Chair responded that from memory the forward plan made no mention of the recommissioning of mental health services. The Chair stated that being registered did not guarantee quality but it did guarantee oversite and that the Council, CCG, Healthwatch and CQC all provided oversite to unqualified practitioners.

25.16  Dr Supple also responded to the concerns raised by Ms Madders. He stated that the CCG acknowledged that there were issues around the provision of mental health care and that it was one of the areas identified as being a priority for Brighton & Hove. Dr Supple also stated that he would be greatly concerned if there were practitioners in the city who were not aware of confidentiality. He asked Ms Madders to submit any specific complaints she had to the CCG and would be happy to revisit the complaint Ms Madders’ had previously made.

25.17  Councillor Penn asked Ms Madders to copy her in to any correspondence with the CCG regarding this complaint. Mr Lilley also asked Ms Madders to copy Healthwatch in to any complaints to the CCG as they would also like to follow up on the concerns she had raised.