Despite doubts over their Committee’s capacity and governance, at their meeting on 28.11.2017 West Yorkshire and Harrogate Councillors decided to scrutinise the West Yorkshire and Harrogate Sustainability and Transformation Plan (STP) as a whole, and produced a workplan for this.
A report on their discussion of the Accountable Care System proposal is here.
Meeting as a result of public pressure after a gap of 8 months – although only 5 Councillors (including the Chair) turned up – the West Yorkshire and Harrogate Joint Health Scrutiny Committee (JHSC) listened to our request to scrutinise the West Yorkshire and Harrogate STP as a whole – not just in bits and bobs, as they had been doing.
Uncertainty about capacity and mechanism to scrutinise the whole STP
The Chair, Cllr Helen Hayden, replied they don’t know whether they have the capacity, nor the mechanism – since individual councils’ scrutiny committees are accountable to the constituents of each council -but who are this scrutiny committee accountable to?
She added that they are not a campaigning body, and
“We don’t scrutinise government policy but its delivery and significant service changes for our people and if they need consultation.”
The ck999 Chair clarified that ck999 are not asking them to scrutinise government policy – but to scrutinise the effects it is having on the significant NHS and social care service changes that the STP is causing.
She added that the fact that Cllr Hayden said there are governance issues about the ability of this Joint Health Scrutiny Committee to scrutinise the whole West Yorkshire and Harrogate STP (in terms of who the Committee is accountable to), means that the STP is a clearly significant service change and needs public consultation.
“If the JHSC lacks capacity, scrutiny committees are allowed to employ experts with the required skills and knowledge and we are happy to recommend some to the JSHC and hope that you will take them on board.”
Cllr Smaje (Kirklees) said in this Committee they would look at items of the STP that would affect whole of West Yorkshire (West Yorkshire-wide themes), and at the committee’s own governance.
The Chair said that the local individual scrutiny committees are scrutinising the STP’s effects on people.She said if there was an issue that covers the whole of West Yorkshire, the Joint Health Scrutiny Committee would set up a work programme to scrutinise anything that affects West Yorkshire.
“We don’t know enough about it to scrutinise it”
Cllr Greenwood (Calderdale) said each local STP authority is looking at their own priorities individually. It would be impossible to look at the whole of the STP. Later she added,
“I found out about the STP by being called into the Council Leader’s office, who said ‘This is the STP but I can’t let you see it because it’s confidential and I don’t understand it either.’
“We don’t know enough about it to scrutinise it.
“I find it a bit patronising when we’re dumped this and told to scrutinise it. The Health and Wellbeing Board Chair doesn’t understand it. It’s really annoying we didn’t know about it when it was introduced. That’s why it’s easier to scrutinise it on a locality basis. I don’t know if we can scrutinise it.”
Rob Webster, the West Yorkshire and Harrogate STP Chief exec, replied,
“The initial submission we had to make to national bodies was a draft. The local bits had been through councils and had met with Health and Wellbeing Board Chairs to talk about it. I’m very sensitive to the fact that it was a draft and hadn’t engaged people as it might have.
When Councils made the joint statement that they didn’t support it as it hadn’t been consulted on, we understood and appended lists of previous engagements.”
But that was not what Councils had asked for – they wanted
“a commitment from NHS England to publish promptly the full STP” so that “all parties – particularly our communities and all local politicians – have full disclosure of the challenges and options.”
This has still not happened and Rob Webster refused our Freedom of Information request for the full STP information.
Scrutiny Committee needs to be involved in West Yorkshire and Harrogate STP changes from now on
The Chair, Cllr Hayden, told Rob Webster,
“The Scrutiny Committee need to be involved in changes from now on.”
At the end of the meeting – after two councillors had left early, leaving the meeting inquorate – the Committee agreed this Joint Health Scrutiny Committee Work programme:
- JHSC terms of reference need revising
- Need to set clear meeting dates
- Look at timelines for 9 priority STP areas (which seem to be: Cancer services, Urgent and Emergency Care, Mental Health, Maternity, Primary and Community Care, Stroke, Prevention at Scale, Standardisation of Commissioning Policies, Acute Care Collaboration)
- Read across between that and locality STPs/Health Scrutiny Committees
- Business case Stroke
- Urgent and Emergency Care delivery plan
- West Yorkshire Association of Acute Trusts
- Accountable Care System, governance issues, contract.
What they seem to have forgotten
They seem to have forgotten about the need to scrutinise:
- STP estates, finance and workforce plans,
- the plan for economies of scale in back office and support functions as a means of cutting costs,
- shared digital data plans
- the principle of localising the NHS which is one of the core principles of the STP – taking the “N” out of the NHS.
Evidence from the decentralisation of the Italian Health Service is that it increased geographical inequalities. Research showed that without a strong central government to support and control local authorities, health service
“decentralization may cause a zero-sum game where the gains for the better-off regions counterbalance the losses in performance of the weaker ones; a situation which could lead to the growth of social inequalities, including gender inequalities.”
The Scrutiny Committee’s discussion of the STP’s proposal to become an Accountable Care System is here.