Agenda item - Public Involvement

(a)          A written question has been received from Ms Janet Sang (copy attached)

37.1    There was a public question from Ms Janet Sang. Ms Sang asked:

"The CCG’s Clinically Effective Commissioning Policies are prefaced with a statement about the responsibilities of the CCG in relation to Equality. What analysis has HOSC seen which considers the likely equality impact of the reduction of clinical procedures listed in the Policies, and what plans are there  to monitor their impact?”

37.2    The Chair responded:

“NHS bodies are required to consult formally with local HOSCs when planning to make service changes that may constitute a Substantial Variation in Service (SViS). As part of this process, HOSCs would typically expect to consider relevant Equality Impact Analyses (EIAs) alongside other evidence.

In the opinion of the CCGs, none of the service changes that form tranches 0-2 of the Clinically Effective Commissioning (CEC) programme constitute a SViS, and CCGs have therefore not sought to consult formally with local HOSCs on these changes. CCGs have engaged informally around CEC, including providing briefings on the programme to individual HOSCs and holding regular discussions of CEC with Sussex HOSC Chairs.

This informal engagement has not included the formal sharing or discussion of EIAs. Commissioners have consistently told HOSC representatives that there are anticipated to be few if any negative impacts of CEC tranches 0-1 as the changes are designed to improve the clinical effectiveness of procedures, leading to better outcomes for service users with no significant detriment to any group.

The HOSC has requested more information on tranches 0-2 of CEC and is currently in dialogue with BHCCG about what information is required.

It is anticipated that tranche 3 of CEC may include changes which will constitute a Substantial Variation in Service ,and, if this is the case and the changes are to be implemented across Sussex, then these will be subject to formal consultation with Sussex HOSCs (via a Joint HOSC as required by law).”

37.3    Ms Stang then asked a supplementary question:

"The Royal College of Surgeons has said that 'It is wrong for commissioning groups to label operations for hip and knee replacements, and hernia surgery, as of limited value – thereby delaying or denying surgery to patients in pain.’ Yet hip and knee replacement surgery are included in Tranche 2, and these are procedures which affect in particular older people, who often have multiple health conditions. Shockingly, the qualifying threshold locally for a referral for a replacement joint has been set at having been in severe pain (i.e. the highest category of pain) for at least six months.

Isn’t further scrutiny of the impact on particular groups a more urgent matter than your reply suggests?”

37.4    The Chair told Ms Stang that he was unable to answer this question at the meeting, but would provide her with a written response to be included in the minute of the meeting.

37.5    The following written response was subsequently sent to Ms Stang:

“Thank you for your supplementary question. I believe that you raise valid issues about some of the tranche 2 Clinically Effective Commissioning procedures; indeed some HOSC members have voiced similar concerns. We have local elections this May, and a new HOSC and HOSC Chair will be appointed following these elections. I cannot commit the future HOSC to follow any particular course of action, but I will write to the new Chair drawing their attention to these outstanding concerns relating to tranche 2 of CEC.”