On 17th March 2021, members of Leeds Keep Our NHS Public and Calderdale and Kirklees 999 Call for the NHS met with West Yorkshire and Harrogate Integrated Care System officials and Healthwatch to discuss public participation in the Integrated Care System Board meetings in public.
Thank you to the ICS and Healthwatch for taking part in the meeting.
Here are our Notes on the West Yorkshire and Harrogate Integrated Care System Public Participation Meeting 17/3/21, held on Zoom.
Ian Holmes, WYH ICS Director
Karen Coleman, WYH ICS Engagement
Stephen Gregg, WYH ICS Governance
Helen Hunter, Calderdale and Kirklees Healthwatch
Hannah Davies, Chief Executive of Leeds Healthwatch
John Beale, Leeds Healthwatch
John Puntis, Leeds KONP (Chair)
Gilda Petersen, Leeds KONP
Christine Hyde, N Kirklees Support the NHS/CK999
Mike Galvin, Leeds KONP
Jenny Shepherd, CK999
A) Our takeaway action points from the meeting
- Ways in which the ICS can better respond to public questions in future: If Karen (or whoever has the task of responding to our questions) doesn’t know the answer to a question, please will they say so? And either tell us who they are asking to answer our question/s and when we can expect an answer, or direct us to ask these people ourselves? If they acknowledge the limitations of their knowledge, where this is a factor in their ability to answer questions straightforwardly and factually, this would be most useful and spare us the frustration of receiving an answer that evades or misses our point.
- We are still not clear about the answer to our question about Healthwatch being legally constrained in what they can question. Helen said one thing and John Beale another. Can this be definitively clarified?
- We would like to discuss with Healthwatch what the main changes have been to the NHS and social care services since the STP/ICS was set up in 2015 and show how they’ve affected people (Testimony 2 project https://bit.ly/Testimony_2).
- Re the 4 coopted members of the public on theIntegrated Care System Board, we need to know how to contact them. We also need to know what their remit, powers and duties are (if any).
- We were not convinced by Ian Holmes’ assertion that the Integrated Care System and the White Paper are not about privatisation. We are confused by how he can say this and at the same time refer to the need for a simplified procurement process for multiple Voluntary and Community Sector contracts. We have quite a few specific questions about various forms of privatisation being carried out by the Integrated Care System, that will be further enabled and encouraged by the White Paper, and wonder if another meeting would be the best way of asking these questions, rather than sending in written questions.
- We also have questions about the very narrow scope of targeted ‘engagement’ with specific groups of patients, that in our view serves to obscure the political constraints and direction that determine what’s on offer for patients and their families/friends, and makes it impossible for patients to challenge proposed changes to their services.
- We also have questions about the scope of effective challenge by Board members in meetings. The example given about Councils getting agreement to increase the budget for Voluntary and Community Sector contracts seemed to us to indicate that challenges are limited to how the pie gets cut, but not whether it is the right kind of pie.
- Also we wonder what was the mechanism for increasing and moving the money? Who had that money and where would it have gone, if not directed to Voluntary and Community Sector contracts? How Voluntary and Community Sector projects get evaluated and who by? Who monitors if the Integrated Care System has got value for money?
- Despite what Ian Holmes said at the end of the meeting, we do not agree that ‘we all have the same goals and concerns really.’ We do not agree with where the Integrated Care System are taking the NHS and social care. This disagreement is the basis of our participation in the Integrated Care System; we are continuing and developing our critique of what the Integrated Care System and the White Paper are up to. We do accept that Integrated Care System staff are concerned to do right by patients, but they work so much within a given envelope that it is hard for them to see the bigger picture beyond the confines of what they see is possible within their jobs. Together with Stephen Gregg’s aversion to adversarial dialogue, that he expressed early in the meeting, it struck us that the suggestion that ‘we all have the same goals and concerns really’ is about managing dissent by making out there are no fundamental differences of opinion.
- We are worried that the main NHS workforce (apart from small pockets like the young medical students and young doctors in Sheffield MEDACT) has been demoralised and lost the founding ethos. We think this may take a generation or more to reverse and would require quite radical revision to the curriculum through greater emphasis on Public Health and Social Sciences as well as Medicine.
B) Record of the 17.3.21 zoom meeting, based on notes.
1. Healthwatch report on the outcomes of their Review of the Public Participation at the WY&H Partnership Board, covering its findings and any follow up actions.
- Helen Hunter said that responses indicated a level of dissatisfaction with the Integrated Care System’s response to questions.
- Public questions are a limited but valid way of involving the public.
- Need to involve a wider range of people in asking questions.
- Healthwatch made a list of recommendations in December. https://www.wyhpartnership.co.uk/application/files/2816/0623/4770/37-20_Review_of_the_Public_Participation_at_the_WYH_Partnership_Board.pdf
- Ian Holmes said the ICS have now responded to the recommendations. They now have a webpage for public questions.
- Karen Coleman: Public questions are a small part of the ICS’s public engagement. And the public can ask questions in between Board meetings as well as at Board meetings. The ICS also carries out targeted engagement with specific groups of patients.
- Member of the public (can’t remember who): Public questions may be small to the ICS but they’re important to us.
- Ian Holmes: there are 4 coopted members of the public on the ICS Board and there’s a need to explore further how they can work.
- Jenny Shepherd: When face to face Board meetings were happening, we were able to talk to them before the meeting, but since meetings have been virtual we have no way of talking to them.
2a. Healthwatch explanation of the limits of their role in enabling public participation, since they are constitutionally prevented from disagreeing with government policy
- John Beale basically said he didn’t know the actual constitutional position but switched the conversation to the Church of England Synod and its exemplary model of democracy. He made the point about about an agenda being a ‘draft’ and open to modification and thought that with careful questioning Healthwatch could challenge government policy even if they couldn’t outright say they disagreed with it.
- Helen Hunter: There is no constitutional impediment to criticising government policy. She wants to make sure that the public voice is heard.
2b) Healthwatch explanation of their response to the White Paper on NHS and social care integration and innovation and whether/how they’re going to engage the public with it
- Helen Hunter: All healthwatch groups will engage on the White Paper. They will capture public voices on how the local system will work rather than looking at the White Paper itself.
- Hannah Davies: White Paper – structures, specifics – doing lots of work at local level about what the structures look like. Concerned about hidden things in the White Paper eg Secretary of State powers. Have asked Healthwatch England to do some analysis of hidden things in the White Paper. What conversations does Healthwatch have to have with the public about how the White Paper is going to affect them? They can’t explain this to them because they don’t know.
- Jenny Shepherd: We do know because the White Paper basically just tidies up workarounds put in place since the Sustainability and Transformation Plans/Partnerships were set up in 2015, by replacing them with legally binding arrangements. We know how services have changed with the cuts/privatisation agenda over the past 6 years, and how this has affected patients and there will just be more of the same.
- John Beale: Healthwatch can’t actually say we oppose moves to more central control, but we can word it as a question about why more central control is needed.
- Ian Holmes: The s75 requirements in the 2012 HSCA were a huge waste of time and resources.They created ridiculous transaction costs for multiple contracts particularly with Voluntary and Community Sector organisations. s75 needed to be replaced by something fair, transparent and accountable. And he had words to the effect that it was odd that as big critics of the 2012 HSCA, the members of the public were now criticising the s75 repeal proposal in the White Paper.
- Jenny Shepherd: We’re not defending s75 or any form of marketisation or privatisation of the NHS. We want to end and reverse NHS privatisation and marketisation. Repealing s75 ofthe 2012 HSCA isn’t going to do this. The new care models are all about partnerships with private and voluntary sector organisations. And this has led to problems with fragmentation of commissioning for Kirklees Care Closer to Home.
- Ian Holmes: The white paper isn’t about privatisation and NHS privatisation has been happening for decades anyway. Most social care is privatised.
3. Why does Healthwatch, as a replacement of previous organisations representing the public and patient interests in the NHS, lack the independence and powers of the former Community Health Councils in protecting the public? In their roles as supporters and promoters of public participation in the ICS, what can the ICS and Healthwatch do to reinstate the CHC’s independence and powers in relation to the ICS?
- Neither Helen nor Hannah seemed to know about Community Health Councils.
- In the zoom Chat, Christine Hyde referenced the 2 Healthwatch reports into Dewsbury’s availability of NHS dentistry, which has been nil for some considerable time. That is still being addressed. Her fear is that when other services are nil locally, there will be no remedy. eg Covid-19 testing prior to a hospital procedure has to be done at Pontefract hospital for the Mid Yorks Hospital Trust hinterland. For some people that’s 2 or 3 bus rides, one of them taking one and a quarter hours one way. To have to take even one 2 and a half hour bus ride for a 15 minute appointment is awful.
4. ICS clarification of their process for: a) deciding which public questions to read out at the ICS Board meetings (or allow to be read out when real life meetings resume) and which to suppress; b) getting them answered; c) recording Qa and As in ICS Board meeting minutes
- Ian Holmes: all public questions are read out at Integrated Care System Board virtual meetings. It was an accident that Jenny’s questions about public participation were not read out, or included in the Minutes of the next meeting.
- Jenny Shepherd gave an example of problems with Integrated Care System answers to questions, in relation to a recent question about subcontracting to insourcing companies for effective use of residual elective capacity. She said the answer had been evasive. Karen explained that often questions had to be answered by organisations that were part of the Integrated Care System. In relation to the insourcing question, WYAAT was the organisation that would know about this.
- Ian Holmes said that all Q&As are recorded in Integrated Care System Board meeting minutes and it was an oversight that Jenny’s questions weren’t.
5. Request for the public to be included in the Integrated Care System Board Board virtual meetings and read their own questions to the meeting, as the West Yorkshire and Harrogate Integrated Care System Joint Health & Ooverview Scrutiny Committee already does.
Ian Holmes agreed this was possible and should be done
6. What is the Integrated Care System Board idea of public participation? To us, this appears to be limited to input from ‘community assets’ in furtherance of Integrated Care System Board aims and objectives. Our experience over the past years is that it’s proved pointless to try and ask the Integrated Care System Board about the medico-political and wider implications of what they’re doing, eg the Integrated Care System Board support for the West Yorkshire Combined Authority economic growth agenda.
- Stephen Gregg bemoaned the adversarial nature of questions to the Integrated Care System.
- Jenny Shepherd said she thought adversarial dialogue is a useful way for different views to be identified and discussed. It has a long history as a means of trying to determine the truth of a matter (or agreeing that no such conclusion was possible), based on laying out and respecting the differences between people’s views. It is the basis of Socratic dialogue.
- Helen Hunter said this was a useful clarification and tied in with stuff she had been thinking about.
7. Information from the ICS about the ballpark cost in staff hours/wages of attendance at each Board meeting and preparing papers for each Board meeting
- Ian Holmes: the costs were part of people’s normal work and papers presented to Board meetings were not written for the Board, but as part of people’s normal work. They were just presented to the Board for info/discussion.
- Gilda Petersen: do Board meetings serve any function beyond rubber stamping and is there was any possibility of effective challenge by Board members, let alone the public?
- Someone from the ICS or Healthwatch (sorry can’t remember who): at the start of the ICS Board meetings, Councils had made an effective challenge that led to an increased budget for VCS contracts.
- Jenny Shepherd: Re the White Paper, Cllr Susan Hinchcliffe had made a challenge to clinicians on the ICS Board about who will have power in the ICS, clinicians or councillors as elected representatives of the public – given that the new statutory ICS body will be NHS only and then there’s an ICS partnership Board alongside.
- Ian Holmes: The statutory IC body Board will have Local Authority membership as well as NHS membership.
8. What next.
It was agreed we should all consider if a future meeting would be useful. Ian Holmes proposed that we all had the same goals and concerns really.