Barnsley Save our NHS have protested to Helen Stevens (the Associate Director for Communications & Engagement at the South Yorkshire & Bassetlaw Sustainability and Transformation Plan Collaborative Partnership) about the Partnership Board’s plan for Healthwatch and voluntary organisations to lead on ‘conversations’ with the public about the South Yorkshire and Bassetlaw Sustainability and Transformation Plan, from 13th February 2017 until the end of March 2017.
This is because arrangements for such ‘conversations’ in Barnsley do not involve the general public.
South Yorkshire and Bassetlaw Sustainability and Transformation Plan is one of a handful of Sustainability and Transformation Plans that NHS England has identified as being on a fast track into new “accountable care” arrangements during 2017-18, ideally as quickly as within six-nine months.
Barnsley Save our NHS have pointed out to Ms Stevens that Barnsley Healthwatch’s ability to report the genuine concerns of the public about the STP and its significant NHS cuts and restructuring is limited by the fact that Healthwatch is legally unable to act in any way that can be interpreted as:
‘the promotion of, or opposition (including the promotion of changes) to, the policy which any governmental or public authority proposes to adopt in relation to any matter’
Barnsley Save Our NHS also explained to Ms Stevens that Barnsley Healthwatch is not accountable to the population it serves: it has repeatedly withheld any information about Healthwatch’s involvement in the South Yorkshire & Bassetlaw Sustainability and Transformation Plan development, and has told Barnsley Save Our NHS that what it says ‘on their behalf’ is confidential.
To begin to remedy this situation, Barnsley Save our NHS have invited Ms Stevens, and/or other representatives of the Collaborative Partnership Board, to the next Barnsley Save Our NHS open meeting in the week commencing 27th March 2017.
Here is the Barnsley Save Our NHS email to Ms Stevens
It is copied to Lesley Smith – Chief Officer Barnsley CCG; Chris Millington – Lay Member Barnsley CCG; Dan Jarvis MP; Michael Dugher MP; John Healey MP; Angela Smith MP and Cllr. Steve Houghton – Chair Barnsley Health & Wellbeing Board.
It will be interesting to hear their responses, as well as Ms Stevens’.
Subject : Conversation with Barnsley Save Our NHS
Thank you for responding to my query about public involvement in the SY&B STP development and for sharing the information about the plans the Collaborative Partnership Board have made with Healthwatch and voluntary organisations to lead on ‘conversations’ with the public, starting on 13th February 2017 until the end of March 2017, a seven week period.
BSONHS members discussed the offer of ‘conversations’ with the public at our meeting on Monday, 27th February, and have agreed the following response:
BSONHS members are not aware of any arrangements for such ‘conversations’ that have been made in Barnsley to involve the general public and are concerned that it is now two weeks into the seven week period.
We are aware that individual Voluntary and Community Sector organisations may have put arrangements in place for the people who use the services they provide – but not for the general public.
We are also aware that Healthwatch Barnsley, as a local healthwatch service, is required to act as a social enterprise, and therefore to abide by Regulation 36 (1) (b) (that is included in the Statutory Instrument 2012 No 3094) which states they are unable to act in any way that can be interpreted as
‘the promotion of, or opposition (including the promotion of changes) to, the policy which any governmental or public authority proposes to adopt in relation to any matter;’
We feel this requirement will limit their (HwBarnsley’s) ability to formally report the genuine concerns of the public about the STP and the significant restructure of services it proposes, or that our members may have about the decision by HM Treasury not to increase the funds to meet the growing need for both the NHS and Social Care services, in effect cutting the resources available.
We also have concerns that Healthwatch Barnsley is not accountable to the people of Barnsley, nor representing more than about 2% of them – (we expand on this below*)
We note that you offer to run numerous focus groups for the people in Barnsley we are in touch with, but we do not feel a focus group enables meaningful public involvement.
We feel that focus groups are recognised tools for market research, academic research and for pollsters, but not as a participation or involvement technique.
We are very aware of the general lack of understanding lately, within the NHS, of the recognised skills and techniques for enabling and faciltating meaningful and inclusive public involvement in decisions about services in the NHS.
We are also aware that all guidance documentation about New Models of Care and STPs from NHS England and NHS Improvement require meaningful involvement of the public, and that recent publications by the Kings Fund (Delivering STPs proposals to plans – Ps 31 & 32) and the House of Commons Public Accounts Committee ( Financial Sustainability of the NHS – Recommendation 4.) both say this is not happening.
We remember discussing with you, in September 2016, the newly published NHS England guidance about public involvement in the STPs called Engaging Local People, which clearly states on P8 that:
‘All footprints should be engaging with local people via Healthwatch and other patient and public groups, to discuss and shape their proposals’
– it doesn’t say to just work with Healthwatch who have been the only ones involved so far, by the SY&B STP Collaborative Partnership Board, to ‘represent’ the public – but without involving or informing the public.
BSONHS, is a ‘public group’, and is in touch with other public groups that exist across the STP area, and further afield; and we have also been represented at a number of national events about the STPs and the New Models of Care and we keep ourselves informed about the central NHS bodies’ current thinking.
We note that the Engaging Local People document repeatedly refers to terms such as ‘ongoing dialogue’ and ‘ongoing involvement’ saying that
‘ jargon free and accessible language that is appropriate to the audience will be essential to ensuring that people can participate meaningfully’ and that ‘ Effective communication and involvement throughout the process will help to build ownership and support for proposals to transform health and care and will also help identify potential areas of concern’
We are aware that the initial engagement (in February and June 2016) was NOT jargon free; that the general public have been excluded from the process since; that the people of Barnsley feel no ‘ownership’ in the SY&B STP and that they feel that these changes are being imposed on them, with none of their concerns and fears being heard or taken account of.
We are also conscious that the Engaging Local People guidance warns that
‘Service change must be evidence-based, and this evidence should be publicly available during the …… decision-making stages’; that ‘public bodies with responsibility for STPs have a variety of legal duties including to involve the public in the exercise of their statutory functions’ and not ‘doing so effectively is likely to cause legal challenge and lengthy delay’; and also that ‘failure to appropriately involve patients and the public in plans may lead to judicial review and criticism’ , and ‘could lead to proposals that do not adequately meet the needs of the local community’
We are very aware that the Collaborative Partnership Board is not a legally constituted organisation with powers to make decisions about service change, but that each constituent CCG carries the legal duty for public involvement, under the Health & Social Care Act 2012 Section 26 14Z2 Public involvement and consultation by clinical commissioning groups, which states:
(2) The clinical commissioning group must make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information or in other ways)—
(a) in the planning of the commissioning arrangements by the group,
(b) in the development and consideration of proposals by the group for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them,
(c) in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.
(6) The reference in subsection (2)(b) to the delivery of services is a reference to their delivery at the point when they are received by users.
Regarding our concerns about Healthwatch Barnsley acting as THE public representative for Barnsley people:
Members of BSONHS have looked regularly on the Healthwatch Barnsley website and there is no clear information about the proposed ‘conversation’, with no events planned according to the events page – there is nothing mentioned on the main website in either news or events
After searching for some time on the Healthwatch Barnsley website I eventually found that the last link on a general tweet takes you to a poster asking you to book on a Healthwatch Barnsley event about ‘changes to services’ that is happening on March 21st. However the image doesn’t mention the SY&B STP and gives no phone number to use to make a booking.
When I copied the poster onto a word document the contact details then became visible
This gives BSONHS very little confidence that the general public will be able to find out that they are being invited to two events on one day within the seven week period of the ‘conversation’, that are set for two specific times of two hours each, 11am – 1pm and then 5 – 7pm.
There seems little awareness that around 20% the population in Barnsley has never used the internet so will not know about this event, many of the others will not find the information, which is not clearly visible and gives no mention of the STP to explain that the event is about this plan.
In a seven week period there is only 4 hours of public information/conversation offered by Healthwatch Barnsley, which is the statutory service with the sole purpose to gather the views of patients and the public around the health and social care services available to them, but in Barnsley they reach less than 2% of the local population.
A local healthwatch service is also required to be accountable to the population it serves – this is not the case in Barnsley as they have repeatedly withheld any information about their involvement in the SY&B STP development, and have told us that what they say ‘on our behalf’ is confidential.
We note that:
Healthwatch England produced a summary of the five key things that communities should expect in getting involved in decisions that affect them, particularly about service changes – These are not happening in Barnsley.
The Local Government Association describes the purpose of healthwatch as:
‘ The aim of local Healthwatch is to give citizens and communities a stronger voice to influence and challenge how health and social care services are provided within their locality.’ ( Delivering Effective local Healthwatch – Key Success Factors 2013 P8 – Local Healthwatch purpose – engagement and relationships)
This is not happening in Barnsley.
NHS England says that
‘It is important that there is an ‘intelligent customer’ in the STP communications and engagement team who has skills and experience in public involvement and the associated legal duties’
on P 13 in their Engaging Local People document referred to above.
We do not feel that the apparent delegation of the required public involvement function to Healthwatch Barnsley, and other local healthwatches, ensures that the STP Collaborative Partnership Board is giving due regard to the guidance provided, or the expectations of them and of their constituent statutory bodies, regarding patient and public involvement.
We are aware that this email is lengthy and contains a substantial amount of material but this signifies the seriousness of our concerns about the level of public involvement that has been offered so far in the development of the SY&B STP, and that is proposed to be offered in its future development, its governance, any commissioning arrangements and, in particular, the accountability to the public it is intended to serve.
We would therefore like to invite you, and/or other representatives of the Collaborative Partnership Board, to come to our next BSONHS open meeting, that will be open to our wider membership, in the week commencing 27th March 2017. We usually meet on a Monday in the evening but will confirm the time and venue to allow some flexibility, as we really do hope it is possible for yourself, or team members to join us.
We will be chairing the meeting, but you are welcome to give a brief, Plain English explanation of the STP’s purpose, content and decision making structures
We will then invite you to hear the concerns of our membership and to answer their questions.
We will ensure that the dialogue is respectful and around the issues, and not the people or personalities involved in the Collaborative Partnership.
BSONHS are looking forward to a constructive and honest ‘conversation’ which will allow our members to be directly involved in sharing their views and fears with you. Please let us know which time and day is convenient during the week starting March 27th.
on behalf of Barnsley Save Our NHS
Lesley Smith – Chief Officer Barnsley CCG
Chris Millington – Lay Member Barnsley CCG
Dan Jarvis MP
Michael Dugher MP
John Healey MP
Angela Smith MP
Cllr. Steve Houghton – Chair Barnsley Health & Wellbeing Board
There is some info about the proposed Barnsley Accountable Care Organisation here.
It has been set up by the commercial team of a private sector consultancy company called Attain. Attain’s commercial team sets up new models of care and the Accountable Care Organisations that run them. They have set up a Barnsley Accountable Care partnership board that will become an accountable care organisation in 2017-18,
“underpinned by a multispeciality community provider contract. ”
A multispeciality community provider is a large scale primary and community care provider that blurs the boundaries between hospital and GP/community care: as hospital services are transferred into the “community”, very large scale GP/community services operate across a big population. This can mean that – far from Care Closer to Home, primary and community care could be anywhere in rather a large area. And hospital care could be anywhere in an even larger area, as more and more hospital departments are closed and District general hospitals become husks of their former selves, as is happening rapidly with Dewsbury District Hospital.