What are we talking about?
- England has been split into 44 areas each had to write an STP, Sustainability & Transformation Plan, to reorganise local NHS & care services
- The STP has to deliver NHS & care services more cheaply (to save money) and also to make them more effective and safer and they have to do all this very quickly
- (The STPs have to SAVE money as the Treasury refuses to give the NHS more money to meet the growing need for its services – so we are to have CHEAPER NHS services)
- The local organisations responsible for planning local services are Clinical Commissioning Groups (CCGs) there are 209 of these in England
- BUT CCGs have had to come together, in the 44 new areas, to plan these changes
Please be patient – it is very complicated
- Each CCG has a LEGAL DUTY to involve the public in their area in any plans to change how services are made available to them
- The Act (Health & Social Care Act 2012) says they ‘must make arrangements to secure that individuals to whom the services are being or may be provided are involved (a) in the planning of the commissioning arrangements by the group (b) in the development and consideration of proposals by the group for change 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,
- By ‘commissioning arrangements’ the Act means that ‘CCGs must arrange for the provision of the services and facilities …. as they consider necessary to meet the reasonable requirements of the persons for whom they have responsibility‘ (Explanatory Notes of the Act)
So when we say it is THE LAW – we mean that the law requires that:
- All CCGs MUST involve the public in their decisions about OUR local NHS services
- That means each CCG – working in each STP – MUST involve the public in their decisions about the ‘development and consideration‘ of the STP ‘proposals‘
- And that they MUST be involving ‘individuals to whom the services are being or may be provided’
- That does NOT mean a chosen few who are not accountable to the rest of us
The Patient Activists in Barnsley Save Our NHS (BSONHS) have shared with us how involved the Barnsley public have been, so far, in the South Yorkshire & Bassetlaw (SY&B) STP:
BSONHS asked Barnsley CCG, last summer, how the South Yorkshire & Bassetlaw (SY&B) STP was going to involve the public – according to the CCG’s legal duty to involve the public in decisions about changing services.
We were told that the local Healthwatch would represent the public in developing the plans.
In November 2016 we were told there would be a big conversation with staff and the public – to be done by partners, by voluntary organisations and by Healthwatch. And that it would include a number of face to face discussions with people.
In February 2017 BSONHS were contacted by the SY&BSTP to say that ‘conversations’ with the public, run by the local Healthwatch, would start on 13th February and end at the end of March. We were told any feedback, from the public, would go to the Collaborative Partnership Board (STP) to be discussed before taking the (STP) plans any further.
They also sent us a link to a simple online survey that had an introduction giving some basic STP information.
A visit to a BSONHS meeting was offered, to discuss the STP and ‘capture’ our views. We asked if they could visit an open meeting, with our wider membership, but were told no, it would be a focus group, that would be repeated if many members wished to attend.
So BSONHS decided to send an email to the STP officer saying we would not want a focus group but would welcome a visit to our meeting, for a discussion.
In the email we reminded them of national guidance and the legal duty to involve the public in plans to make service changes.
The email is lengthy – but includes links to, and quotes from, the LAW and the many NHS documents that state clearly that the public MUST be involved in STPs ‘at the early stages’
- CCGs and Trusts, and NHS England are ignoring their duty to involve us
- Challenging bad practice needs to give reasons why it is bad practice (evidence)
We share two extracts from this email.
Both extracts include information about public involvement rights that may be useful to others:
“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 VCS (Voulntary 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.”
“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 – http://www.healthwatch.co.uk/reports/5-things-communities-should-expect-getting-involved. 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 refered 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 has now received a reply – which we share below.
From the SY&B STP Associate Director of Engagement and Communication to BSONHS:
“Many thanks for your email and your comments on the current public and staff engagement exercise underway to gather views on the ambition and ideas in the South Yorkshire and Bassetlaw’s Sustainability and Transformation Plan.
We are in the very early stages of looking at how we can achieve our ambitions of improving our health and care services and are beginning to explore what is possible. At this stage, we are taking account of public and staff views on the STP’s direction of travel and see this very much as the start of ongoing involvement in discussions to shape the future of services. There are currently no plans to change any services, other than those that existed pre-STP – which are hyper acute stroke services and children’s surgery and anaesthesia services and on which we recently consulted the public.
Our methodology to take account of views looks at gathering feedback from both quantitative and qualitative approaches. This includes:
- Commissioning Healthwatch and the voluntary sector across SYB to engage with groups and communities, with a particular emphasis on the seldom heard to capture and report their feedback on the plans. They are doing this through a variety of methods, of which focus groups are one. Their role is to put the plans forward as they stand and gather feedback, it is not to promote the plan. Their strong links into communities and with patient groups will help to ensure we reach audiences with an interest in the Plan and also those who are less likely to be heard
- Media release distributed at the launch – we will also send a ‘two weeks to go’ media release – signposting people to how they can get involved
- Social media activity via CWT account, amounting to more than 1,700 reached via Twitter and almost 600 people have so far clicked onto the survey via social media. STP partners are also carrying out social media activity which we will include in the final report on the exercise
- E-bulletin to all those who signed up to the Commissioners Working Together distribution list
- Between 13-20 March, all bus tickets across all journeys in South Yorkshire and Bassetlaw will alert people to the opportunity to have their say
- STP partners are also raising awareness of the survey and holding discussions in their organisations to gather qualitative feedback
At the end of the exercise, we will analyse the survey responses, along with themes that develop from conversations, and report these back to the Collaborative Partnership Board. The Board is very keen to hear the findings and will discuss them before any next steps are agreed.
I note your comments about Healthwatch. The team at Healthwatch Barnsley is aware that the conversations need to encompass as many view points as is possible and are visiting groups individually to gather feedback, as well as holding two focus groups on March 21 in partnership with Voluntary Action Barnsley. To ensure accessibility, one is being held in the morning and in the evening and the team is also providing access support such as care cover where it is requested. In addition to the two focus groups arranged, they are also facilitating discussion sessions for the following groups:
- Carers workshop
- Buckingham House care home, Penistone
- Springvale Community Gardens, Penistone
- Barnsley Independent Alzheimer’s and Dementia Support
- Supporting safe and independent living in Barnsley
- Barnsley MIND – LBGT group
- Wednesday Voice – learning disabilities group
- Parkinson’s District Branch Meeting
- Goldthorpe Development Group
- Wombwell cricket club
- ROMERO coffee morning – the group provides many forms of support for local people marginalized by social inequality
- Salvation Army, Goldthorpe
- Conversation Club
They are also attending a Core tenant’s breakfast meeting where the following organisations are represented:
- Plus Me
- Creative Recovery
- Barnsley Sexual Abuse & Rape Crisis Services
- 360 Engagement
- The Well
I understand Healthwatch has had some technical issues with their website, which have now been resolved and the information is available. See http://healthwatchbarnsley.co.uk/get-involved/south-yorkshire-and-bassettlaw-stp/ The team has also been using social media to raise awareness of the opportunities for Barnsley people to have their say, as well as adverts in the Barnsley Chronicle.
Thank you too for your offer to attend the next Barnsley Save Our NHS meeting, which will be held in the week of 27 March. Unfortunately, I am on leave for much of this week and have commitments on the evening I am not. Can I therefore suggest that myself and the STP Programme Director arrange to meet a delegation of Barnsley Save Our NHS the week after. This would allow us to hear the group’s concerns and address questions. I would also encourage your members to complete the online survey (hard copies and alternative formats of the survey are also available) so that we can ensure their views are captured. Dates and times we could make are:” – (possible dates were given)
BSONHS are arranging to meet with them in April –
(if it is confirmed that issues we raise in the ‘conversation’ issues will be included in the feedback to the Board.)
We have two main concerns about how this ‘involvement’ is happening:
Firstly that having a few targeted ‘conversations’ excludes ‘individuals’ within the wider general public, and prevents a collective, and informed, public voice.
Secondly that the ‘conversations’, and the survey, ONLY focus on the information provided, which is ONLY telling people that the STP aims to improve services.
- There is NO public information about changes to where, when or how services will be available to patients and the public in the future.
- There is NOTHING explaining to the public about how the ‘commissioning arrangements’ are changing, including the governance and accountability of local commissioning and how the decisions about services will NOW be made.
By not telling the public ALL the information means that any public involvement is not fully informed nor is it about ‘commissioning arrangements’ – as the LAW requires.
National NHS Public Voice (N-NHS-PV) is keen to hear how other areas are experiencing ‘public involvement’ in their local STP – general comments welcome too.
Please share with us either:
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