Agenda item - Public Involvement

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

(a)       Petitions: To receive any petitions presented by members of the public to the full Council or to the meeting itself;

(b)       Written Questions: To receive any questions submitted by the due date of 12noon on the 7 October 2021. One received at publication date (copy attached)

(c)        Deputations: To receive any deputations submitted by the due date of 12 noon on the 7 October 2021.

11.1    Mr Ken Kirk asked the following question:

“Worries about NHS under an ICS are ….

1. Rationing of care - owing to specified financial limit, care will be limited, possibly denied, quality downgraded;
2. More privatisation without transparency, see HSSF’s list of mainly private companies https://www.england.nhs.uk/hssf/supplier-lists/#shared-or-integrated-care-records
3. Private executives in decision-making positions, despite Bill amendments, can be on place-based committees, IC Partnerships;
4. Patients at risk – removes need for discharge assessment;
5. Deregulation of professions – down-skilling of medical care and ‘race to the bottom’ on pay/T&Cs.

Some councils have issued demands (a) – spending determined in partnership with LAs, guaranteed full access to services etc.

What action should you take to defend our health services?”

1. See Appendix of https://councillors.knowsley.gov.uk/documents/s71697/HWBB%20SP.pdf?StyleType=standard&StyleSize=none

11.2    The Chair responded:

There are several parts to this question, which raises a number of serious concerns about the current NHS reforms. I am not an expert on the Bill but I have spoken to many system leader locally and done a lot of reading and I can see both advantages and disadvantages in the government proposals.

Regarding financial limits, this has always been the case. CCGs have had spending caps from their inception and sadly rationing of NHS care, in different guises, has been here for many decades. We spend far less a proportion of GDP on health care than most advanced economies and get great value for money. But the real solution is to properly fund the NHS, and I might add social care.

The lack of transparency in procurement is defiantly of concern and I agree it could lead to more and more major contract going to private providers with little openness. It might also lead to more contracts going to NHS providers and the voluntary sector, but this remains to be seen and will require close scrutiny.

Private providers on NHS boards is, I agree, also a cause for concern. But I would say that this is not the only potential conflict of interest in the new Board structure as major NHS providers are also represented on Boards, as is primary care. The potential benefit here is the removal of the internal market which costs so much time and money, and in its place having greater partnership working and commissioning across the whole patient journey, which will lead to better patient outcomes and more cost effective services. The risk is that vested interests have influence on millions of pounds of public money with no improvement in care and privatisation by stealth.

On your concern around discharge assessment, I would say that this has been local practice for a while as you can provide a much better assessment of care needs when someone is back in their own home or care home, than in a hospital bed. Once someone is medically fit to leave hospital it is definitely the best thing to get them out as soon as possible. But discharge to assess only works if there are the right patient pathways in place, adequate step-down services, social workers to carry out the assessment, and providers to cover the new care packages. It is vital the whole system works together with the patient at the centre, which has not always been the case around hospital discharge. When someone vulnerable leaves hospital they need a soft landing as it is only the beginning of recovery.

Finally, you raise a concern about deskilling the workforce and this is another area of the Bill that has caused widespread concern. Closer partnership working with the VCS shouldn’t equate to the same service for less money!

You conclude Mr Kirk by asking what HOSC can do about this and the short answer is very little in terms of the primary legislation. There is only passing mention of HOSC in the guidance, but we will continue to work with organisations such as Heath Watch and scrutinise wherever we can.

11.3    Mr Kirk asked a supplementary question, requesting the Chair’s views on the establishment of a Sussex Integrated Care Board (ICB) which would potentially have private sector representatives, but only one local authority representative; on the risks of post-discharge assessment leaving vulnerable people without the care they needed; and on new NHS budgeting arrangements which would leave NHS provider Trusts rationing services because they would be unable to run deficits as they can currently.

11.4    The Chair asked NHS and social care colleagues if they wished to respond to these questions. Rob Persey, BHCC Executive Director, Health & Adult Social Care, noted that the Directors of Adult Social Care from all three Sussex upper-tier local authorities would in fact have seats on the ICB. In terms of discharge prior to social care assessment, Discharge to Assess schemes have been in place for several years now and offer better and more holistic assessment of people’s care needs than assessment in hospital. The Chair told Mr Kirk that she would be happy to meet him outside the meeting to discuss in more depth the points he raised and to explore ways in which the HOSC might scrutinise these issues.