Questions and answers to the Joint Committee of Clinical Commissioning Groups (JCCCG)

Statement from Nora Everitt

The ICS has not been honest with people in asking them, on a website page, and social media I believe, to apply to be one of the 3000 people on the “brand new online health and care membership scheme”.

The ICS has not made it clear to them:

That by clicking the link to complete the survey people will be taken to the site of a Private Company (civica) that is outside the NHS
That the ICS has paid civica to act as Data Controller of the personal information the survey asks for and what this means
They have not specified whether civica will also manage the membership scheme for the ICS, meaning all patient and carer stories will be automatically shared with civica directly
That civica’s own Privacy Notice declares that they may:

- use some personal information gained in public participation projects to produce reports for promoting their business

- share such data with companies that they have a direct business arrangement with in order to jointly market civica related services

The ICS has not given people clear information explaining how the recruitment and membership scheme will work – such as:

That they will not automatically become a member of the new membership scheme
When the membership will be selected, by whom and how (e.g. is it first come first served)
When they will know if they have been selected as a member of the scheme
What happens to the personal information they disclosed on the survey if they are not selected as a member

This communication and invitation to complete the survey to join this “brand new online health and care membership scheme” does appear to breach both the ICS statement on their website ‘Privacy Notice’ page and the Sheffield CCG ‘Fair Processing Privacy Notice for Patients’:

The ICS has asked people to give a private contractor their personal information without making this clear to them that the survey is neither internal to the ICS nor the NHS
The ICS did not make it clear that by completing the survey people would be effectively consenting to sharing their personal information outside the NHS but doing so unknowingly
The Sheffield CCG Privacy Notice states that they will not share people’s personal information outside the CCG – but the ICS has effectively done so
Nowhere has it been made clear that people have the right to:
Opt out of sharing their personal information outside the NHS
See what personal information civica holds, including their NHS service experiences which are confidential and personal to them

Questions from South Yorkshire and Bassetlaw NHS Action Group (SYBAG)

1. The SYBNAG gmail account received notification from the Joint Health Scrutiny officers that they were about to meet in July, inviting us to send questions and to join the zoom meeting, so why do the JCCCG and the ICS not show us the same courtesy, when we regularly put time aside to read the papers, attend the meetings and ask public questions?

Response:

The JCCCG posts notice on the ICS website about meetings held in public, which are ordinarily every month. During Covid, the meetings were stood down while the CCGs responded to the incident. The meetings have now resumed.

2. Why does the JCCCG include a Public Question item on their agenda but not let the public know they are re-starting their monthly meetings, having not met since February, by publicising the fact on their Facebook and Twitter pages or their website’s ‘latest news’

Response

We are sorry this didn’t happen. The meeting will be streamed live and publicised on social media channels in advance of the session.

3. Does the JCCCG and the ICS intend to show such disregard and disrespect in communicating with the public, including ourselves, and could they take action to avoid this maybe?

Response:

On behalf of the JCCCG we can assure you no disregard or disrespect was intended and we will publicise all future meetings in public via social media channels.

4. The Nolan Principle on Accountability says this:

“Holders of public office are accountable to the public for their decisions and actions and must submit themselves to the scrutiny necessary to ensure this.”

The JCCCG and ICS could argue that anyone can attend JCCCG to hold Lay Members to account. In practice the role of Lay Members at JCCCG is a bit of a mirage, because their few contributions are barely recorded, and minutes are not comprehensive, and easily accessible.

Q. Is the process and criteria for selecting Lay Members and the Citizen Panel in the public domain, and if so where can they be found?

Response:

The recruitment for the Citizens’ Panel was publicised widely in 2017. The news story is still on the ICS website: https://syics.co.uk/news/news/could-you-be-part-our-citizens-panel

Questions from the public

Questions from SYBNAG members to the JCCCG February 2020 meeting:

Question 1 - Children’s Surgery and Anaesthesia

The report presented for discussion and support does not explain clearly what the changes will be to ‘unplanned’ services for poorly children from each of the five ‘places’ across the SYB ICS area. Can you please tell us:

1 a) What exactly are the changes proposed to be made to each of the services currently offered at each place for the ”four non-elective children’s surgical pathways for children”?

Response

The only change planned is to appendicectomies for children under 8 years or with significant complexities or comorbidities from district general hospitals to Sheffield Children’s.

1 b) How exactly do these changes differ from those proposed and consulted on in the winter of 2016/17 and those in the Decision Making Case approved by this Committee in June 2017?

Response

The differences are:

The Ear, Nose and Throat (ENT) non-elective service models that are in place should stay as they are
Torsion of the testis non-elective pathways should stay as they are
Abdominal surgery (for suspected appendicitis) is the most complex pathway and the recommendation is that a change should be made to the non-elective treatment of appendicitis in young children. They would be seen and treated at Sheffield Children’s.

1 c) If the proposals will affect the “manner in which the services are delivered to the individuals or the range of health services available to them” such as “delivery at the point when they are received by users” then will the JCCCG insist on a public consultation?

Response

There has previously been public consultation, in line with statutory requirements, on a range of potential changes to Children’s Surgery and Anaesthesia. The Joint Health Overview and Scrutiny Committee will advise on whether given the proposed changes they would like us to re-consult with them formally, which will in turn influence our decision around further public consultation.

1 d) Who exactly will decide whether the proposed changes will take place?

Response

The Joint Committee of Clinical Commissioning Groups.

1 e) Will the services currently provided for elective surgery for each of these procedures be affected?

Response

No.

Question 2– Lay Member Representation

2 a) The report at agenda item six indicates that lay members are recruited to bring specific expertise and experience to the work of the JCCCG, to do with all aspects of governance. Could Priscilla and Philip each give us a two minute summary of how their experience in systems of internal control, internal audit, external audit, performance management, financial management, risk management or Annual Governance Statements informs their approach to lay member scrutiny and challenge in the JCCCG?

Response

Both JCCCG lay members were recruited through an open process and were appointed based on their extensive experience and expertise. Both have held lay member roles in CCGs.

2 b) In March 2019, Susanne Hasselman, then Chair of the NHS Clinical Commissioners Lay Member Network, produced a paper entitled “Lay Members & ICSs”. She lamented that “We continue to hear that there is variability in the engagement that ICSs are undertaking both with key partners across the system, and most importantly with patients and their local populations as they plan and implement integrated approaches to health and care delivery. This is where lay member scrutiny and challenge is critical in driving progress”. (Our underline).

This is exactly SYBNAG’s experience of SYBICS since it was formed – token public engagement and lack of lay member scrutiny and challenge. Do any JCCCG members (particularly lay members who we note have no voting powers) have any concerns that they want to share in this regard?

Response

This question is not relevant to the agenda.

The following question was received at the meeting from Peter Deakin, Barnsley Save Our NHS

The public have never been granted a vote and have had a very limited chance to voice our opinions in the JCCCG, ICS decision making process. A process set up without our consent in a way that hides almost every aspect of this process from our knowledge.

It is part of a larger legal and convenient method of transferring pubic money to the private purse.

Q. Aside from the recent survey when will the public be allowed to become involved in the decision making process and changes that are being made by the JCCCG, ICS. This could be an event which will inform the public and invite a response. Maybe the public will become informed about the ICS activities and who they are what they do, why they exist how they fit in to the future of the NHS. I am sure people will be interested to become enlightened regarding the decision makers.

Response

This question is not relevant to the agenda.

Public involvement in JCCCG work is ongoing and carried out by partners in line with their statutory duties. The public have also been involved in shaping the Five Year Plan for the region.

Going forward and as a result of the involvement work to inform the Five Year Plan, partners have committed to holding public events before each ICS Guiding Coalition to gather views to feed into the sessions and developing an online membership model to support involvement work on transformation.

The first of these events is scheduled for 25th March and this event will be widely publicised in the coming days, noting that the event could be postponed in the event of national guidance on public gatherings. The online membership recruitment is due to start in the spring.

Q. Does the citizen panel still exist?

Response

Yes.

Q. If so when will they meet again?

Response

The Panel meets bi-monthly and met most recently on 2nd March. The next meeting will be in May.

Q. When will the JCCCG lay members and Healtwatch representative begin to ask these questions, as they are at meetings to represent the public.

Response

This JCCCG lay members and Healthwatch representative are involved in ongoing discussions about public involvement. There are additional opportunities at the individual CCG Governing Bodies for lay members to challenge the work and decisions that are made at the JCCCG.

Questions for the Joint Committee of CCGs 29th January 2020 submitted by members of South Yorkshire & Bassetlaw NHS Action Group

Question on Enclosure A

In the Minute C156/19 d) the question asked for information in “in Plain English” for the public explaining the difference between transformation and reconfiguration, but the question specifically asks for this information to be “in addition to the usual Easy Read versions of information”.

So please can you explain why:

minute C156/19 e) and the Action Summary both report something completely different which the question did not ask for (namely a “simplified ‘easy read’ version of the Hospital Services Programme be produced for the public, explaining the difference between transformation and reconfiguration.”)
are you making work for yourselves, or a subcontractor, when the question only asked for a Plain English definition of the two terms ‘transformation’ and ‘reconfiguration’ (please note - a definition of the difference between Plain English and Easy Read can be provided)

Response

As with all the Hospital Services Review reports, we have produced an Easy Read version.

The explanation for the difference between transformation and reconfiguration has been drafted in Plain English and we note your helpful comment regarding the minute.

Question on Enclosure C – JCCCG Progress Report

(a) Paragraph 3.4 says “all JCCCG meetings now held in public” this implies complete openness and transparency, in line with the Nolan Principles of Public Life; does this openness and transparency also apply to the delivery plan, the performance report and the specific decisions referred to in points 3.5 and 3.6?

Response

The JCCCG Progress Report will be received quarterly at the JCCCG meetings held in public and also the CCG Governing Bodies held in public. Delegated decisions made by the JCCCG will continue to be made in meetings held in public.

Question: (b) Given we are still awaiting a response from the Joint Scrutiny Health Committee concerning lack of access to public transport for families and visitors, the increases in patient transfers between hospitals and health facilities, the severe bed shortages and specialist facilities and the continuing centralisation of services causing many severe hardship and stress, isn't it essential that the ICS Transport group be reinstated with a democratically representative group, a meaningful brief and the facilities to support and inform the public of changes, options and costs?

Response

A Transport Group was set up to support the potential for service change during the review of Hospital Services. Work also took place to look into transport issues during the Hyper Acute Stroke Services service change proposals.

With regards to the Hospital Services Review Transport Group, the Final Report did not recommend service changes and therefore the Group had no agenda and was stood down. With regards to the Hyper Acute Stroke Services as the pathway is now in place feedback is now routinely gathered as part of patient experience.

There are currently no JCCCG plans to change access to local services but if this changes the Transport Group will be reinstated.

Question on Enclosure D - HASU Update

(a) Post HASU transfers to Rotherham and Barnsley are working well in line with the agreed Regional Patient Flow Policy, with a very small number of delays reported.

Could you tell us:

Reasons for the above delay
How will future delays be avoided?

Response

Overall Rotherham and Barnsley residents have flowed well through the new regional pathway since the changes were enacted. There are a number of reasons why transfers may not go ahead as originally planned including a change in patient circumstances.

Monitoring is in place to ensure oversight of patient flows and to promote proactive conversations and continuous quality improvement to aid timely flow through the regional pathway.

Question: (b) Section Lessons learned,

Very surprised and dismayed that the new model was installed on the agreed dates, when clinical leads were not properly ready to start the new model. Staff with the appropriate qualifications, skills and experience need to be in Place to respond to the clinical needs of the patient in a timely and effective manner.

Could you please answer following:

Why did you decide to go ahead with the implementation of the new model on the agreed dates, when this very important element of the model was not quite in place?
Why is that it was decided that the risks involved in this, were not important enough to delay the starting date to ensure a safer implementation of the model?
Provide details of workforce structures and plans to address the above

Response

Strong clinical leadership was in place as a key component of the HASU work programme and this enabled us to implement the changes in line with the agreed implementation dates.

All HASU units successfully recruited additional staff, including nurses and allied health professionals with the skills and expertise ahead of the planned changes to ensure safe implementation of the model.

Each HASU unit has a workforce model that supports their service delivery and is linked into the delivery of the wider stroke pathway.

Workforce planning is an area that will be taken forward by the new Stroke Hosted Network.

Question: (c) Evaluation, assessment and monitoring of the new HASU service model

It is stated that the new HASU model was installed successfully, but we don’t know the extent to which the new model is successful in terms of patient care, its impact on patients and the expected outputs and outcomes from the patient/carer perspective. Not just in the sense of staff being kind, understanding and caring, but also and very importantly, in the sense of timely clinical interventions and outcomes.

Could you please answer/ provide the following information:

details of the evaluation system used to assess the above
details of what is being evaluated/ assessed
details of the monitoring system in place, including information of what is being monitored, who is involved in the monitoring, monitoring stages, data collation systems, products needed, reports systems etc.
details of whether patients/ public have been engaged or consulted on this.

Response

The specification for the new SYB HASU model included reporting and monitoring requirements. Most quality indicators included in the reporting were based on the evidence based nationally identified indicators set out as part of the SSNAP (Stroke Sentinel National Audit Programme) to enable us to measure improvements in stroke care.

A monitoring dashboard has been developed to enable us to monitor these and the plan is for this to be monitored as part of routine contract monitoring.

The Stroke Hosted Network will have a key role in embedding the new model and enabling us to realise the benefits. This will need to include understanding the experience for patients and their families and using this to drive continuous quality improvement.

Question: (d) If you did not have the above system in place, before the implementation of the new model (to start gathering systematic data from its incept)l, can you explain the reason for this.

Such an important service, which in many cases deals with life and death, and whose interventions can have long term quality of life consequences for patients, it needs a rigorous, effective, timely evaluation and monitoring system, to be able to avoid unintended mistakes in the future, as well as serving as a tool for service improvement.

Response

The monitoring dashboard was developed ahead of implementing the new model.

Data has been systematically gathered by providers in relation to key quality indicators set out in SSNAP. The dashboard aims to bring together data from a number of different data sources, including SSNAP, patient flows and activity data and there is a commitment to continuous quality and service improvement.

Question: (e) In relation to risk management

Risk management is a very important supporting element in delivering a new service model, and more so when people’s lives depend on such a service. Awareness of risks, sharing and reporting on them are of paramount importance. Risk systems are key to ensure the service is as safe as possible. It is important that a risk system is in place in order to raise the “alarm” when needed, to avoid fatal consequences.

Could you tell us why you think the decision to go ahead and implement the new model was a responsible one when a rigorous, well thought risk management system was not embedded in its structures, especially in its initial stages when anything could have gone wrong?

Response

The decision to change the way Hyper Acute Services is provided across South Yorkshire and Bassetlaw was made following a rigorous business case which addressed risks. Risk management was undertaken at both programme and organisation/service level throughout the programme.

Questions for the Joint Committee of CCGs 29th January 2020 submitted by members of South Yorkshire & Bassetlaw NHS Action Group

Question on Enclosure A

In the Minute C156/19 d) the question asked for information in “in Plain English” for the public explaining the difference between transformation and reconfiguration, but the question specifically asks for this information to be “in addition to the usual Easy Read versions of information”.

So please can you explain why:

minute C156/19 e) and the Action Summary both report something completely different which the question did not ask for (namely a “simplified ‘easy read’ version of the Hospital Services Programme be produced for the public, explaining the difference between transformation and reconfiguration.”)
are you making work for yourselves, or a subcontractor, when the question only asked for a Plain English definition of the two terms ‘transformation’ and ‘reconfiguration’ (please note - a definition of the difference between Plain English and Easy Read can be provided)

Response

As with all the Hospital Services Review reports, we have produced an Easy Read version.

The explanation for the difference between transformation and reconfiguration has been drafted in Plain English and we note your helpful comment regarding the minute.

Question on Enclosure C – JCCCG Progress Report

(a) Paragraph 3.4 says “all JCCCG meetings now held in public” this implies complete openness and transparency, in line with the Nolan Principles of Public Life; does this openness and transparency also apply to the delivery plan, the performance report and the specific decisions referred to in points 3.5 and 3.6?

Response

The JCCCG Progress Report will be received quarterly at the JCCCG meetings held in public and also the CCG Governing Bodies held in public. Delegated decisions made by the JCCCG will continue to be made in meetings held in public.

Question: (b) Given we are still awaiting a response from the Joint Scrutiny Health Committee concerning lack of access to public transport for families and visitors, the increases in patient transfers between hospitals and health facilities, the severe bed shortages and specialist facilities and the continuing centralisation of services causing many severe hardship and stress, isn't it essential that the ICS Transport group be reinstated with a democratically representative group, a meaningful brief and the facilities to support and inform the public of changes, options and costs?

Response

A Transport Group was set up to support the potential for service change during the review of Hospital Services. Work also took place to look into transport issues during the Hyper Acute Stroke Services service change proposals.

With regards to the Hospital Services Review Transport Group, the Final Report did not recommend service changes and therefore the Group had no agenda and was stood down. With regards to the Hyper Acute Stroke Services as the pathway is now in place feedback is now routinely gathered as part of patient experience.

There are currently no JCCCG plans to change access to local services but if this changes the Transport Group will be reinstated.

Question on Enclosure D - HASU Update

(a) Post HASU transfers to Rotherham and Barnsley are working well in line with the agreed Regional Patient Flow Policy, with a very small number of delays reported.

Could you tell us:

Reasons for the above delay
How will future delays be avoided?

Response

Overall Rotherham and Barnsley residents have flowed well through the new regional pathway since the changes were enacted. There are a number of reasons why transfers may not go ahead as originally planned including a change in patient circumstances.

Monitoring is in place to ensure oversight of patient flows and to promote proactive conversations and continuous quality improvement to aid timely flow through the regional pathway.

Question: (b) Section Lessons learned,

Very surprised and dismayed that the new model was installed on the agreed dates, when clinical leads were not properly ready to start the new model. Staff with the appropriate qualifications, skills and experience need to be in Place to respond to the clinical needs of the patient in a timely and effective manner.

Could you please answer following:

Why did you decide to go ahead with the implementation of the new model on the agreed dates, when this very important element of the model was not quite in place?
Why is that it was decided that the risks involved in this, were not important enough to delay the starting date to ensure a safer implementation of the model?
Provide details of workforce structures and plans to address the above

Response

Strong clinical leadership was in place as a key component of the HASU work programme and this enabled us to implement the changes in line with the agreed implementation dates.

All HASU units successfully recruited additional staff, including nurses and allied health professionals with the skills and expertise ahead of the planned changes to ensure safe implementation of the model.

Each HASU unit has a workforce model that supports their service delivery and is linked into the delivery of the wider stroke pathway.

Workforce planning is an area that will be taken forward by the new Stroke Hosted Network.

Question: (c) Evaluation, assessment and monitoring of the new HASU service model

It is stated that the new HASU model was installed successfully, but we don’t know the extent to which the new model is successful in terms of patient care, its impact on patients and the expected outputs and outcomes from the patient/carer perspective. Not just in the sense of staff being kind, understanding and caring, but also and very importantly, in the sense of timely clinical interventions and outcomes.

Could you please answer/ provide the following information:

details of the evaluation system used to assess the above
details of what is being evaluated/ assessed
details of the monitoring system in place, including information of what is being monitored, who is involved in the monitoring, monitoring stages, data collation systems, products needed, reports systems etc.
details of whether patients/ public have been engaged or consulted on this.

Response

The specification for the new SYB HASU model included reporting and monitoring requirements. Most quality indicators included in the reporting were based on the evidence based nationally identified indicators set out as part of the SSNAP (Stroke Sentinel National Audit Programme) to enable us to measure improvements in stroke care.

A monitoring dashboard has been developed to enable us to monitor these and the plan is for this to be monitored as part of routine contract monitoring.

The Stroke Hosted Network will have a key role in embedding the new model and enabling us to realise the benefits. This will need to include understanding the experience for patients and their families and using this to drive continuous quality improvement.

Question: (d) If you did not have the above system in place, before the implementation of the new model (to start gathering systematic data from its incept)l, can you explain the reason for this.

Such an important service, which in many cases deals with life and death, and whose interventions can have long term quality of life consequences for patients, it needs a rigorous, effective, timely evaluation and monitoring system, to be able to avoid unintended mistakes in the future, as well as serving as a tool for service improvement.

Response

The monitoring dashboard was developed ahead of implementing the new model.

Data has been systematically gathered by providers in relation to key quality indicators set out in SSNAP. The dashboard aims to bring together data from a number of different data sources, including SSNAP, patient flows and activity data and there is a commitment to continuous quality and service improvement.

Question: (e) In relation to risk management

Risk management is a very important supporting element in delivering a new service model, and more so when people’s lives depend on such a service. Awareness of risks, sharing and reporting on them are of paramount importance. Risk systems are key to ensure the service is as safe as possible. It is important that a risk system is in place in order to raise the “alarm” when needed, to avoid fatal consequences.

Could you tell us why you think the decision to go ahead and implement the new model was a responsible one when a rigorous, well thought risk management system was not embedded in its structures, especially in its initial stages when anything could have gone wrong?

Response

The decision to change the way Hyper Acute Services is provided across South Yorkshire and Bassetlaw was made following a rigorous business case which addressed risks. Risk management was undertaken at both programme and organisation/service level throughout the programme.

South Yorkshire and Bassetlaw NHS Action Group Questions for the JC CCG Meeting on 23rd October 2019

1. Commissioning for Outcomes Policy:

a) How will people be involved in proposals and decisions about the clinical procedures that will be added to the list of those already on the existing SYB Commissioning for Outcomes Policy, given that this will reduce the range of services available to people in SYB?

Response:

The JCCCG invites written questions on the items on our agenda. Unfortunately, this item is not on the agenda. However, we will give some consideration to this when developing this work.

b) What are the arrangements for monitoring how the Commissioning for Outcomes Policy has affected people in SYB and will these arrangements involve patients, carers and the public across SYB?

Response:

The JCCCG invites written questions on the items on our agenda. Unfortunately, this item is not on the agenda. However, we will give some consideration to this when developing this work.

2. Hospital Services Review

a) What do you see as being the main drivers of the transformation strategy and what are the main outcomes that you are looking to achieve before you would reconsider reconfiguration?

Response:

The main drivers of the transformation strategy are concerns around the sustainability of acute hospital services: in particular, workforce shortages and the implications for quality and equality of services that result from these.

The main outcome that we would be aiming to achieve is a more stable and sustainable approach to workforce. In particular, this includes improved recruitment and retention, and better use of new workforce roles, enabling us to achieve sustainable levels of staffing without relying on locum and agency staff.

b) What metrics will be used to measure the success of transformation and will these include a patient focus?

Response:

The NHS already has a large number of performance metrics which are measured and tracked at a national level. Part of the success of transformation would be whether we become more able to achieve these metrics: for example, does transformation of Urgent and Emergency Care make us more able to meet the national target for 4 hour waiting times in A&E; or has transformation improved scores against the Friends and Family Test which is one of the main measures of patient satisfaction.

In addition we will be asking each of the Hosted Networks to develop a small number of specific metrics to track the impact of transformation and to act as early warning signals if transformation is not having the necessary impact. These will be developed once the Networks are set up, but they might for example include measures of patient feedback, or measures around workforce.

c) Will the six monthly review process considering the successful progress of transformation directly involve patients and will the findings be shared with patients and the public?

Response:

The review process to track the impact of transformation will be designed once the Networks are set up.

d) Can you provide some information for the public explaining, in Plain English, the difference between transformation and reconfiguration, but in addition to the usual Easy Read versions of information?

Response:

Transformation is described in the reports of the Hospital Services Review as being about improving services in the settings where patients currently receive care, or about enabling acute care to be provided closer to home.

It is often about using the workforce in a different way, for example bringing in Advanced Medical Practitioners to support the traditional roles of consultants and nurses. It is also about making sure that all hospitals in the area provide the same care in a given situation, so that all patients are getting good quality care.

Reconfiguration is defined by the House of Commons Research Briefing as “changes in location or the type of treatment provided, usually as part of a reorganisation of services across a larger health geography.”

There can be some overlap between these two terms, and reconfiguration would usually be accompanied by transformation.

e) What implications are there for patients in a hospital unit where experienced staff are moved to support another hospital’s unit that is struggling, as part of the hosted network approach?

Response:

None of the Hosted Networks are currently proposing to move staff from one hospital to another.

As the Networks are set up, there are many different ways that hospitals could support each other. At the moment, some of the hospitals regularly send consultants to other sites, for example where Sheffield Teaching Hospital consultants run regular outreach clinics in the other hospitals. Some hospitals have appointed staff who work half their time in one hospital and half in another, for example some gastroenterologists who work across Barnsley and Rotherham. This is designed as a standard part of job planning for the two sites.

1. Hospital Services Programme Enclosure D Page 2 Third bullet point - Reconfiguration

There is a pattern with some hospitals nationally of reducing and/or withdrawing paediatrics services, then maternity services followed by closing Accident and Emergency Services because of hospital service changes and subsequent staff shortages.

Do you forsee either maternity services and/or the Accident and Emergency Services at Bassetlaw following this pattern and being closed in the next ten years?

In the early stages, the hospital services work looked at Accident and Emergency and determined that at this current time no change is necessary, other than the Hosted Network arrangements which are being put in place. (More information on the Hosted Networks can be found on the SYB ICS website, and in previous question and answers to the JCCCG).

The review also looked at maternity and paediatrics in Bassetlaw and identified that there are ongoing issues, particularly around staffing, however the review has found that there is no system-wide reconfiguration solution to this and has invited Bassetlaw commissioners and providers to work together to develop plans to address these current and forecast challenges.

Ten years is too far in the future to be able to say whether we can forsee any changes that would close these services at Bassetlaw

2. Enclosure D Page 2 Fourth bullet point - Public engagement

This states 'the CCG MAY consider formal consultation with patients and the public' on any proposed permanent changes to services. Why can't the CCG AUTOMATICALLY have formal consultation with patients and the public on any permanent changes to services?

Bassetlaw CCG would engage with patients and the public on any proposed permanent changes to services. The level of the proposed change would determine whether the engagement would require formal public consultation.

Guidance on when formal public consultation is required can be found in the NHS England Planning, Assuring, Delivery Service Change for Patients document https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering-service-change-v6-1.pdf

The section on P10 describes ‘What is service change and when is consultation with the local authority and public consultation required?’ (detailed below)

The National Health Service Act 2006 sets out the legislative framework for public involvement (Sections 13Q (NHS England), 14Z2 (CCGs) and 242 (NHS Trusts and FTs)). Consultation with local authorities is provided for in the Local Authority (Public Health, Health & Wellbeing Boards and Health Scrutiny) Regulations 2013 (“the s.244 Regulations”) made under section 244 (2)(c) of the NHS Act 2006.

Broadly speaking, service change is any change to the provision of NHS services which involves a shift in the way front line health services are delivered, usually involving a change to the range of services available and/or the geographical location from which services are delivered.

There is no legal definition of ‘substantial development or variation’ and for any particular proposed service change, commissioners and providers should work with the local authority or local authorities Overview and Scrutiny Committee (OSC) to determine whether the change proposed is substantial. If the change is substantial it will trigger the duty to consult with the local authority under the s.244 Regulations. It is this that can trigger a referral to the Secretary of State and the Independent Reconfiguration Panel.

Public consultation, by commissioners and providers, is usually required when the requirement to consult a local authority is triggered under the s.244 Regulations because the proposal under consideration would involve a substantial change to NHS services.

Change of site from which services are delivered, with its consequent impact on patient, relative and visitor travel times, even with no changes to the services provided, would normally be a substantial change and would therefore trigger the duty to consult the local authority and would be likely to require public consultation. Decommissioning a service could also be a substantial change. Tendering a service by itself is unlikely to be a significant change unless the new service specification will provide a substantial change in service.

When proposals are first considered, discussion with the local authority will help assess whether the change is considered substantial. Public consultation may not be required in every case, sometimes public engagement and involvement will be sufficient. The decision around this should be made alongside the local authority.

SYBNAG Questions to the JC CCG September 2019 meeting

1. (a) Can the members of the CCG tell us which section of which act describes the legal duty The HSP Final Report (to CCGs) on P82 where it states that, and repeats in item 9 Enc. D on this meeting’s agenda : “‘Individual Health Overview and Scrutiny Committees (HOSCs) are legally responsible for identifying whether a CCG needs to go to public consultation on a reconfiguration change” ?

Item 9 Enc D of this meeting’s agenda states:

Public engagement: Any proposed permanent change to services will need to go through public engagement, and (following discussion with the relevant Overview and Scrutiny Committee) the CCG may consider formal consultation with patients and the public. The timing of such a consultation and other issues that may also be included in a consultation process are matters for the CCG to consider.

This statement is correct and in line with the NHS England process.

The wording in the full report is a typo and should read: Discussions with Individual Health Overview and Scrutiny Committees (HOSCs) take place for identifying whether a CCG needs to formally consult the local authority on a change. If any CCGs wish to proceed with reconfiguration, or (in the case of Bassetlaw, consultation to confirm a temporary change), the process would be discussed with its own HOSC.

Thank you for drawing this typo to our attention, we will ensure the document is updated on our website.

(b) Do the SYBICS officers and the CCG members of the JCCCG know that the legal duty is actually the CCG’s – to directly consult with the HOSC itself on the significant change to services they propose – as clearly set out in Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013?

As has been illustrated with previous answers, SYBICS officers and CCG members of the JCCCG are aware of their legal duties to consult with individual HOSCs or the JHOSC.

SYBNAG yet again have a need to remind the CCG members of the JC CCG of their legal duties for public involvement, which is as the H&SC Act 2012 still says: “26,14Z2 Public involvement and consultation by clinical commissioning groups

(1) This section applies in relation to any health services which are, or are to be, provided pursuant to arrangements made by a clinical commissioning group in the exercise of its functions (“commissioning arrangements”).

(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, and

(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.

3. As you have not addressed the duty (S.26 14Z2 (2)(a) or (b) for the SYB people about your proposed changes to the commissioning arrangements for your delegated authority priorities (such as the collaborative commissioning for 999 & 111 contracts) – do the members of the JC CCG recognise that you are proving our point for us – which is that you are not doing what you should?

From a patient perspective there is no patient impact of the joint approach for commissioning YAS ambulance services, it is a model of NHS lead contracting well established nationally in CCGs and in SYB.

It is for each CCG to fulfil their obligations to involve the public in accordance with s.14Z2 of the NHS Act with regard to determining commissioning intentions this question is not relevant to the JCCCG and should be asked of each individual CCG at their Governing Body meetings.

ADDITIONAL QUESTIONS FROM PETER DEAKIN SUBMITTED AT THE MEETING TO BE ANSWERED OUTSIDE THE MEETING

1. Previously the HSR review proposed that up to one, two or three consultants led maternity units and paediatric units should be considered for closure and then that the closure of one or two should be modelled.

My interpretation of the HSR programme report is apart from Bassetlaw overnight paediatrics with possible implications for maternity services, no other closures are being proposed in the short term – is this your understanding of this report as well?

Response:
The Report recommends transformation as the approach for all services considered as part of the Review and for the Hosted Networks to take this forward. With Bassetlaw, the Report recommends a more advanced (Level 3) Hosted Network approach in the first instance for paediatric and maternity services and for Bassetlaw CCG to consider the best way forward as the commissioner of all local hospital services. This might lead to consultation on options for the provision of paediatric and maternity services.

2. The report says that Transformation may not resolve all challenges and “if transformation fails to address the workforce issues in the medium to long term, reconfiguration may have to be reconsidered” – What is your understanding of “medium to long term” as measured in years?

Response:
We consider medium to long term to be two to five years.

3. In the earlier HSR review, reference was made to the introduction of personal budgets for maternity services which I interpreted as a proposal for privatisation of some maternity services. I found no reference to this proposal in the HSR Programme. Does this mean that this proposal is no longer being made, or that it is part of the changes that will be introduced under the heading of “Transformation”?
If the latter is the case, do you not think that this report is being dishonest in not spelling this out knowing that it will be a controversial issue?

Response:
Earlier Hospital Services Review Reports mention personalised care, not personal budgets. Personalised care for maternity services is outlined in the NHS Long Term Plan and refers to the commitments to delivering choice and personalisation in maternity services, complementing the recommendations in the national maternity review, Better Births. You can read more about it here: https://www.england.nhs.uk/mat-transformation/mat-pioneers/

4. Has the planning process for the Integrated Urgency and Emergency Care changes in the Yorkshire and Humber considered, or asked for, evidence of outcomes for patients after using the 111 services or from relevant coroner’s reports as there are growing concerns nationally about the safety of their processes?

Response below at item 6:

5. Why is there such inadequate information for people to say how they can be involved in the system commissioning planning meetings, or work-streams, and no information at all about what issues are considered in these meetings, given people should be involved in commissioning arrangements and plans?

Response below at item 6:

6. I received the Y&H MOU for Collaborative Commissioning of the Integrated Urgent and Emergency Care Services – can we see a copy of the Public Involvement Report for this commission.

Response :
The Y&H MOU is not a commission, it is simply a set of expectations and responsibilities that supports collaborative working for how the 21 CCG commissioners across the Y&H region will work together on the commissioning of UEC services and support the lead contractors on the management of the YAS contract. MOUs for lead commissioning and lead contracting in the NHS are well established and this is the second updated version of the MOU, the first version was agreed a number of years ago by Governing Bodies and covers the services YAS provides to all 21 CCGs. It has been updated to reflect the emerging ICS / STP footprints

a. Is there a survey of the service so for that has led to this conclusion, for public view?

Response:
N/A see above

b. How will public and patients be involved in the revision of commissioning?

Response:
See above. There are no changes to commissioning the YAS UEC MOU is an already established way of working for a complex contract across 21 commissioners

c. Is the revision of commissioning about saving money?

Response:
N/A see above

Questions from SYBNAG members to the JC CCG meeting on 24^th July 2019:

1. What exactly is the JC CCG responsible for?

Paper C from the June JCCCG meeting includes the JCCCG Terms of Reference, Manual Agreement and Workplan, setting out the role and responsibilities of the JCCCG. The papers can be found here: https://healthandcaretogethersyb.frank-digital.co.uk/application/files/5915/6096/1736/JCCCG_-_26_June_2019_Agenda_and_Papers.pdf

2. What powers have members of the JC CCG applied for to NHSE/I to enable the Long Term Plan approach for system wide commissioning?

The JCCCG is established as a decision making committee of the CCGs. The JCCCG does not have its own list of duties set out in statute like a CCG or NHS England does, it only exercises those functions a CCG member specifically delegates to it. The legal duties are for CCGs, they do not apply to the role of the JCCCG. Therefore, system wide commissioning takes place within existing legal frameworks with CCGs working together and using the JC CCG to enable any joint decision making where this has been delegated by CCGs (ref MA /TOR).

3. What we see from the JC CCG Sub Group minutes are reports being discussed that are concealed from public and we want to know why are you deliberately keeping information from the public?

JCCG sub group meetings are business meetings, they are not public meetings or meetings in public. Papers upon which decisions need to be made are heard in public meetings either by the JCCCG if it is a matter for which they have delegated authority, or at partner CCG Governing Body meetings in public.

4. How much will it cost to rebrand this statutory body (the JC CCG)?

The JCCCG is not a statutory body. The JCCCG is established as a decision making committee of the CCGs. The JCCCG does not have its own list of duties set out in statute like a CCG or NHS England does, it only exercises those functions a CCG member specifically delegates to it. There will be no cost to rebrand the JCCCG.

5. What mechanism is there to report back to the people of the Footprint by those self-selected to sit on the ICS transport group?

The Transport and Travel Panel was set up by agreement of the Working Together on Hospital Services Steering Board to provide an independent view on issues which relate to travel and access in relation to the five services provided in our trusts, identified in the Hospital Services Review. The group has been set up to ensure that the voice of the local population is heard and influences any developments. The purpose of the group is to advocate for the general public in informing travel times modelling specifications and in raising any other transport issues that should be taken into consideration as options are developed. The Terms of Reference for the group does not include the requirement for members to report back.

6. What is the cost so far of the required restructuring of SY&B health and care service commissioning and delivery since January 2016?

There has not been any restructuring of health and care commissioning, the focus has been on joint working across CCGs in SYB. There has been no cost as a result of restructuring.

Questions from SYBNAG members to the JC CCG meeting on 24^th July 2019:

1. What exactly is the JC CCG responsible for?

Paper C from the June JCCCG meeting includes the JCCCG Terms of Reference, Manual Agreement and Workplan, setting out the role and responsibilities of the JCCCG. The papers can be found here.