Public questions for West Yorks and Harrogate Integrated Care System Board 1st Dec 2020

Info here about the virtual/online Board meeting from 14:00 – 17:00. Tuesday 1st December. The Agenda and Papers are downloadable here. This seems to be the webcast page.

Update 1 Dec 2020 – CENSORED! Well well well, just watching the webcast and Stephen Gregg, the Governance Lead, announced only one person had asked questions and that was John Puntis. This is despite the fact that receipt of Jenny Shepherd’s questions (below) was acknowledged yesterday in an email by Karen Coleman, the Integrated Care System Engagement Officer. Here’s what happened next.

Questions from John Puntis/Leeds Keep our NHS Public

1. re Tackling health inequalities for Black, Asian and minority ethnic communities and colleagues Review.

The WY&H BAME independent review meeting on 2nd September 2020 agreed that overseas charging regulations as an element of the hostile environment “would be explored further as part of the review and that the findings would be included in the review”. While welcoming the breadth of the review as a whole and the many recommendations made, I can find only limited references to refugees and asylum seekers, with a single sentence referring to charging: “it is essential that we keep in view overseas visitor charging  . . . in terms of health inequalities”. Are there perhaps findings that I have missed or that have not been included in the review, or were there no findings to report? In any case, will the Partnership Board now commit to collect data on the scale of charging across its geographical footprint and any negative effects on both patient health (for example by surveying clinicians experience) as well as on applications for settled status? Will it also encourage NHS trusts to take steps to become more migrant friendly as set out by Medact? (section 6.2, https://www.medact.org/2019/resources/briefings/patients-not-passports/)

2. re: Update from the WY&H Partnership’s Chief Executive Lead.

Screening experts have raised many concerns about the mass testing for coronavirus in Liverpool, not least the overstated accuracy of the tests involved, the possibility of false negatives giving false reassurance, the possibility of false positives identifying people who are not actually an infective risk to others and don’t require isolation or contact tracing, and the recent scientific evidence that asymptomatic carriers may be at low risk of spreading infection. Will the WY&HPB encourage its members to insist on seeing a full scientific analysis of the results of the so called Liverpool ‘pilot study’ before making a decision to endorse roll out of mass testing in their own areas, bearing in mind a full cost benefit analysis may argue against such a programme?

3. re: Update from the WY&H Partnership’s Chief Executive Lead.

The privatised national test and trace service has fallen far short of the target for contact tracing set by the Scientific Advisory Group for Emergencies. This has had a devastating effect on spread of infection and ensured the UK’s place at the top of the European league table for deaths. Part of the problem has been to largely ignore local public health, hospital and primary care team expertise, and to fail to win public trust. We are now anticipating a mass roll out of vaccination when comprehensive coverage of the population will be necessary for maximum benefit. It is essential that the NHS, local government and public health teams have charge of the immunisation programme, with NHS England and Public Health England providing leadership to ensure local delivery. Appropriate funding must be made available for staff recruitment, training and messaging. To repeat the mistakes of national test and trace (and NHS 111 giving faulty covid advice) using low paid, poorly trained staff employed by private firms could only be another disaster. Will the WY&HPB insist that its plans for place level multi-agency teams to deliver immunization include that these are publicly provided in order to win the trust of the people and optimise the chance of success?

Questions from Jenny Shepherd, CK999

Re: Review of the Public Participation at the WY&H Partnership Board
1. In general, why are West Yorkshire and Harrogate Integrated Care System responses to public questions consistently so rubbish?

(I include Integrated Care System responses to questions at West Yorks and Harrogate Joint Health and Overview Scrutiny Committee meetings, as well as at Integrated Care System Board meetings).

The main ways in which Integrated Care System reponses are rubbish are:

  • not providing the requested information
  • using straw man arguments
  • questionable truthfulness
  • platitudes

There are examples of these types of responses at the bottom of these questions.

2) So, in particular:
  • Why do you not provide facts, when facts are requested?
  • Why do you not give evidence to show the validity of assumptions, when policy issues are being questioned?
  • Why do you make assertions that don’t stand up to fact-based scrutiny?
3) Will you attempt in future to show respect for the public by answering our questions with the facts and evidence requested, rather than treating public questions as a tick box exercise that allows you to claim you are engaging with the public – which is how regular questioners see your responses?
4) In future, please will you ask people with operational knowledge of the issues we are asking about to answer the questions? (I appreciate they are busy, but if the ICS doesn’t have time and resources to answer the public’s questions it would be better to say so, and not invite questions.)
Examples of Integrated Care System rubbish responses

As an example of the IIntegrated Care System failing to provide the requested information, at the 30th Sept West Yorks Joint Health and Overview Scrutiny Committee I requested information about the Integrated Care System’s work to build up the capacity of NHS labs to analyse Pillar 1 Covid19 tests. The Integrated Care System response was obfuscatory. It didn’t provide the requested information. I have since re-submitted the questions to Martin Barkley CEO for Mid-Yorkshire Hospitals NHS Trust, who has led the ICS and Local Resilience Forum programme to build up capacity for COVID testing in West Yorkshire. He should surely be in possession of the facts. Wakefield CCG emailed back that they are treating this as an FOI request. They have not yet sent a reply.

The Integrated Care System has also used straw man arguments to avoid answering a question, eg at the December 2019 ICS Board meeting, I asked for recognition that a salutogenic Local Industrial Strategy could not include the pursuit of economic growth, because economic growth is not a sustainable or salutogenic objective. So far no one has found a way to decarbonise economic activity, so “clean growth” – one of the government’s “challenges” that the Local Industrial Strategy commits to “making a contribution to meeting”- is a contradiction in terms. The ICS replied “The Leeds City Region Local Enterprise Partnership has made it clear throughout the development of the Local Industrial Strategy that it is not about growth ‘at any cost’ and the principles of inclusive growth and clean growth are embedded throughout the draft strategy.” (That’s the straw man argument – did we say the Local Industrial Strategy was about growth ‘at any cost’? No, we didn’t.)

There are also occasions when the truthfulness of the Integrated Care System’s replies seems questionable, eg At the 1st September Integrated Care System Board meeting, in response to a question about the West Yorkshire & Harrogate Clinical Forum’s Ethical Framework, the Integrated Care System replied “…our response to the pandemic in West Yorkshire and Harrogate has meant that we have been able to provide care to the standard expected.” To which we can only say, it cannot be truthfully said that the Integrated Care System has been able to provide care to the standard expected during the pandemic -unless the standard you expected was pretty dire. Because:

  • Almost all elective hospital care stalled for months during the initial months of the pandemic
  • Many people found themselves unable to ask GPs for advice and referrals.
  • Many hastily-discharged patients died in care homes.
  • There is a backlog of cancer patients who didn’t get seen.
  • The ‘excess death’ rate rocketed, beyond the numbers of people dying of Covid-19.
  • NHS England/Improvement sent out the directive on the Phase 3 Covid-19 response, instructing Sustainability and Transformation Partnerships and Integrated Care Systems to restore routine NHS services.
  • The Clinical Forum recognised the “inaccessibility of usual treatment pathways and consequent impact on wider population health due to the reconfiguration of hospital care to focus very heavily on providing capacity for treatment of COVID-19”
If you want more information about why ck999 considers your replies are generally rubbish, here are a few blogposts about them.

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