Agenda item - Public Involvement

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

 

(a)          Petitions: to receive any petitions presented by members of the public 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 17^th January 2020

(c)          Deputations: to receive any deputations submitted by the due date of 12 noon on the 17^th January 2020.

 

25(A)  Janet Sang:

 

25.1    Ms Sang asked the following question:

 

“My understanding is that each Integrated Care Provider-Partnership central to the Long Term Plan will commission health and social care, and will have a contractually-capped budget based on per capita funding. If that is the case, two issues arise.

 

Firstly what concerns does HOSC have about the care of those not registered in participating GP practices?

 

Secondly, what will happen should the needs of the population exceed what can be provided within that budget?

 

If my understanding is not correct, please explain what is the funding and provision model enshrined in the Long Term Plan.”

 

25.2    The Chair responded:

 

“I’ve asked the CCG about this matter and they have informed me that the NHS LTP does not in fact prescribe that commissioning organisations will use a capitated payments model when contracting with an ICP. In fact, there is no prescribed form for the way that partnerships are developed locally outside of ensuring that whatever is delivered is fit for purpose in addressing health inequalities. The focus is on developing programmes for change against some of the identified priority areas and being effective in the way partners in the Brighton and Hove health and care system work together. Any decision made about how partnership working develops will be based upon how best to deliver these programmes; how outcomes can most effectively be improved for the population as a whole; and how this can be done within the funds made available across health and social care.

 

Your question raises important points about future contract models. I don’t believe that we can answer them now but they will become relevant as local thinking about the way organisations work formally as partners develops and we will certainly use them to inform our scrutiny.

 

We are clear, however, that any model which is developed in Brighton and Hove will need to be based upon providing health and care for the whole population and will include those who are “normally resident” as well as those who are registered with a GP.”

 

25.3    Ms Sang asked a supplementary question:

“Risk and reward sharing is a key feature of the policy agenda for Accountable Care Organisations in the US and Integrated Care Systems in England. The Integrated Care Systems/Partnerships already rolled out by NHS England appear to adopt mainly a model of risk/reward or “gain/loss sharing” which offers a financial reward to limit health care.

What are HOSC’s views on this culture of “managing” health-care demand for financial gain, and on its relation to the fundamental values of the NHS?”

25.4    The Chair thanked Ms Sang for her supplementary question. She agreed that any move to a model that rewarded health providers for under-treating patients would be troubling. Future scrutiny of the Long Term Plan will consider this issue.

25(B)  Judith Anston

 

25.5    Ms Anston asked the following question:

 

“In B&H we have 1 GP for every 2,526 residents. This is one of the worst ratios in the country, the national average being 1 GP to 1,780 patients. (March 2019 figures, from FOI provided by B&H CCG)

 

Does the Long Term Plan address the need for more GPs in the city? Fewer surgeries is making it harder for some communities to access appointments, and access to less qualified staff is propping up provision: is the Long Term Plan undermining primary care?”

 

25.6    The Chair responded:

 

“Thank you for your question.

 

We are not yet in a position to say precisely what the Sussex Health & Care Plan, the local response to the NHS Long Term Plan, contains. The Sussex Plan should be published soon and the HOSC will seek to scrutinise it in some detail, starting at our March meeting.

 

I do share your concerns about city GP services, as I’m sure do other committee members, and the HOSC will look closely at what the Sussex Health & Care Plan has to say about developing city provision.

 

I recognise that there are valid concerns about access. GP practices are not evenly spread across the city, with a particular scarcity of provision in East Brighton and in Hangleton. This is a long-term issue, but has been exacerbated by recent Practice closures and mergers. Whilst it is important to recognise that larger practices can offer real benefits to patients as well as offering a sustainable business model, the question of access is an important one and something that the HOSC will focus on when it scrutinises plans for primary care in the city.

 

The HOSC will also want to focus on the use of a wider range of clinical professionals by GP practices. This can have real advantages, perhaps particularly in terms of patients being able to access really expert pharmaceutical advice or physiotherapy services from their GP practices. It also needs to be recognised that there is a national shortage of GPs and that there is no easy fix. However, it is crucial that the quality of care provided by GP practices is maintained and improved going forward, and the HOSC will certainly want assurance that any plans to diversify practice staff-mix have a robust evidence-base and are closely monitored to ensure that quality does not fall.”

 

25.7    Ms Anston did not have a supplementary question, but did wish to note that most patients choose to register with their nearest GP as they value proximity of other issues. Any move to a model with fewer GP practices will therefore run counter to what patients want from GP services.

 

25(C)  Valerie Mainstone

 

25.8    Ms Mainstone asked the following question:

 

“It is recognised that there has been a dramatic increase in the number of people who are struggling with their mental health: an increase due, at least in part, to the politics of austerity. It is worth recalling Aneurin Bevan's question "Why is it that in times of economic crisis the working class is made to bow its knee to the needs of capital?"

 

The funding of our Child Mental Services is the lowest in Western Europe. Up to 70%of those sleeping in our streets suffered a traumatic childhood, necessitating their being received into the care of the Local Authority.

 

The British Medical Association states that mental health workers are overworked, demoralised, and forced to deliver a compromised service. How will the Long Term Plan improve mental health services in Brighton, Hove and Portslade?”

 

25.9    The Chair responded:

 

“I do agree that mental health services are very important, and that they have not historically received all the attention they should. This is a national problem, but a particular issue locally: Brighton & Hove has worryingly high levels of people with mental health conditions, including young people. This is reflected in local suicide and self-harm rates.

 

The HOSC will certainly be looking to see what the local response to the NHS LTP is proposing to do to improve mental health services for city residents and to improve preventative services so that fewer people develop problems in the first place. We will expect to see really ambitious planning backed with a level of funding that recognises that high needs in the city.

 

We have also got a report on the recent Sussex-wide review of young people mental health services coming to this committee in March. Again, I would expect to see robust planning to improve services for children and young people, including better and timelier access into services.”

 

25(D)  Pat Kehoe

 

25.10  Ms Kehoe asked the following question:

 

“Is HOSC concerned that the recent raising of treatment thresholds and rationing of services is preparing the way to provide restricted budgets for Integrated Care Partnerships, irrespective of the care that is actually needed?”  

 

25.11  The Chair responded:

 

“It is clear that there is considerable local concern about NHS plans to limit           access to particular medical procedures, whether this is about ceasing to use particular treatments, limiting or delaying access to treatments, or raising the threshold for referral.

 

It does need to be recognized that there may be good reasons for these actions: as our understanding of medicine increases, we may find that some treatments are ineffective or even damaging or that they benefit only a proportion of patients. The NHS does need to regularly review the clinical basis for what it does and to act on the latest evidence.

 

The NHS Clinically Effective Commissioning programme, which is what I think the question is referring to, has been presented by NHS commissioners as just this type of review of the evidence base to ensure that all procedures are based on the best possible clinical evidence and not as an attempt to save money or to restrict spending in preparation for ICPs or any other change.

 

I do recognize that there are valid concerns about whether this type of initiative is clinically rather than financially led. I am confident that the evidence base for many of the Clinically Effective Commissioning changes was compelling, but I will ask CCG colleagues to provide the HOSC with some more information, set out in terms that are accessible for lay people, about some of the tranche 2 decisions that have caused local concern, specifically changes to the thresholds or treatment pathways for some orthopaedic surgery. This will be reported at a HOSC meeting later this year.”

 

25.13  Ms Kehoe asked a supplementary question, enquiring when tranche 3 of the Clinically Effective Commissioning Programme would be published. The Chair responded that no date has as yet been communicated to the HOSC. Tranche 3 is on the work programme and will be scrutinised as soon as possible.

 

25(E)  Liz Williamson

 

25.12  Ms Williamson asked the following question:

 

“In a recent meeting of the full council, concern was expressed about the democratic deficit which was illustrated by the CCG outvoting the elected members on the HWB on the fundamental issue of the Long Term Plan and Integrated Care. One Member went as far as to say it was simply a rubber stamping exercise.

 

This meeting followed a recent report on the Population Health Check in Brighton and Hove which revealed a lamentable 1.8% of the population were consulted. This statistic is even more concerning since the population is expected to increase by a further 6%  by 2026.

 

This democratic deficit experienced by both Council members and the local citizens of Brighton and Hove could be addressed in the form of a people’s or citizen’s commission on health and social care which would be under-pinned by the political will and support of the Council and which would provide Council Members with detailed information that would inform the decision making processes. Will the HOSC propose this more progressive and meaningful consultation drawing on the expertise of a wider group of people in Brighton and Hove with the knowledge and experience of health and social care?” 

 

*Office of National Statistics estimate for population was 287,200 in 2016 with an estimated rise of 6% until 2026 reaching 304,300.

 

25.13  The Chair responded:

 

“I would be happy to discuss ways for the HOSC to engage with a people’s commission on health and social care. For clarity though, I think it’s important to note that the council has a very limited budget for engagement across many areas. I’m therefore not in a position to promise any kind of financial or administrative support.

 

I would be happy to arrange a meeting with you to further discuss your plans.”

 

25.14  Ms Williamson asked that, if the HOSC is unable to establish a health commission, it should refer the matter to Full Council.

 

25(F)   Linda Miller

 

25.15  Ms Miller asked the following question:

 

“Our local hospital is very short of staff. From the figures supplied by BSUH it appears we currently need 512 more nurses and 43 more consultants.

 

How does the CCG's Sussex Health and Care Plan address the shortfall of staff at our local hospital? Will the CCG's long term planning result in a sufficient number of nurses and doctors to serve our population? How can our local healthcare service improve if there isn't the staff to provide it?”

 

25.16  The Chair responded:

 

“Thank you for your question.

 

I share your concern at the very high number of medical and nursing vacancies at BSUH and would further note that vacancy levels at the Trust and at other local NHS trusts have been worryingly high for a long time. The local health and care system has long-standing issues with the recruitment and retention of staff, something that has been acknowledged by system leaders.

 

We will wait and see what impact Brexit has on the local NHS workforce situation, but nationally there has been a very significant fall in nursing applications from Europe following the Brexit decision.

 

I would also like to note the negative impact that the decision to end nursing bursaries has had. Political groups on the Council unanimously supported the partial reintroduction of bursaries last year.

 

We don’t yet know the content of the Sussex Health & Care Plan, but I think you are quite right to identify workforce as a key element in any improvement planning. The HOSC will certainly seek assurances that the Plan addresses these longstanding issues of recruitment and retention as well as the allied performance issues that mean local people often have to wait much longer than they should for both emergency and planned healthcare, with Brighton & Hove residents currently having to wait longer than anyone else in England for planned operations. We know that the 3Ts development at the Royal Sussex Hospital will help with some of these performance issues, but the system clearly needs to find some effective workforce solutions also.

 

This is something that I hope NHS colleagues can begin addressing at today’s meeting when we have a presentation on the NHS Long Term Plan – I have forwarded your question to them. It is also definitely an area we will address at the March HOSC meeting when we will begin scrutinising the definitive Sussex Health & Care Plan”

 

25.17  As a supplementary question Ms Miller asked what the HOSC would do if members were not satisfied with the workforce measures set out in the Sussex Health & Care Plan. The Chair assured her that this issue would be robustly pursued by the HOSC.