6th Jan 2020
Is B&H council rubber stamping NHS England's Long Term Plan?
Will services be getting better or worse? Let us know what you think.
Issues arising from NHS items at Brighton and Hove Full Council Thursday 19th December 2019
Integrated Care Systems and Partnerships are the main bodies for implementing the NHS England Long Term Plan across England. Integrated Care Partnerships are consortia of health and social care organisations formed into a management company to implement the Sustainability and Transformation plan in a given area. Typically ICPs will operate on reduced budgets with a mix of private and public monies.
There were two items on the Full Council agenda relating to the NHS England Long Term Plan developments (including an Integrated Care Partnership) and democratic implications, as follows.
Item 59 SUSSEX HEALTH AND CARE PLAN -THE LOCAL RESPONSE TO THE NHS LONG TERM PLAN 141 - 478 Extract from the proceedings of the Special meeting of the Health & Wellbeing Board meeting held on the 5 November 2019.
Item 60/2 NHS Health and Social Care Decision Making: Democratic Deficit. Proposed by Councillor Shanks on behalf of the Green Group.
“Democratic deficit” The Green party notice of motion arose out of concerns about the last HWB meeting where 3 out of 5 Councillors present on the day were out-voted by 4 CCG members. The suggested response by the Chair of the HWB to deal with this major flaw in Council procedures was the establishment of a Councillor sub-committee to feed into a “restructured HWB”. We assume this new structure to be part of the CCG-led Integrated Care Partnership in the city, though it was not described as such.
If the Integrated Care Partnership is to be implemented what will be the Council's voice and power. The ICP will involve not only with the CCG but also representatives of the powerful NHS Trusts; the Primary Care network and GP Federation; third sector organisations running hived-off NHS services; the mainly private Social Care sector and whatever “other” organisations the CCG and others might see fit to include? How likely is a Council sub-committee to redress the fundamental imbalance of power? If Councillors are worried about the present HWB having only a rubber-stamping role, things under Integrated Care will only get much worse.
Successive Governments have been eroding the power, control and budgets of Councils. This latest development will ensure that in the spheres of social care and health Local Authorities sacrifice their residual powers. By participating in this development Councils are also letting themselves in for the inevitable adverse repercussions and voter blame for the implementation of the Govt's and NHS England's drastically eroded, largely privatised NHS.
Council Budgets
As was made clear at Full Council the local Long Term Plan is short on budgetary detail. The only things known for sure is that budgets will be capped and substantial deficits will have to be cleared (£27 million net for BSUHT alone). How are the overall levels of Integrated Care budgets to be determined? How will Council budgets for Public Health and social care be affected? How will respective allocations be decided? What will happen to the budget of the “on the verge of collapse” Social care system in the city when the Bettercare Fund is stopped? Under merged health budgets what Council budgetary control, right of scrutiny and oversight will there be? What “creative” accounting methods will be employed to meet NHS England and competing demands in the ICP? What new “partnerships” will be brought in to paper over the financial cracks?
Privatisation The word “privatisation” was barely mentioned in the Full Council meeting in relation to the two agenda items discussed. Disappointingly, given their crucial significance, the items gave rise to barely any discussion.
According to the HWB Chair, Brighton and Hove CCG has given assurances there will be no privatisation as part of Integrated Care plans. This is hard to believe when the CCG already presides over roughly £90 million (and rising) in services hived off to the private and third sector.
A moving statement of support for local education services was made in the Moulsecoomb Primary school debate - “we will fight privatisation classroom by classroom”. City health and social care services have been bombarded by cuts and fragmented by privatisation for years. Where are the rallying cries from Councillors for those services and the amazing workforce which is being placed under intolerable pressure, in many cases endangering health?
Substantial Variation in Service (SVS) – see the note below
At the meeting the Chair of the HOSC made a statement promising scrutiny of the local LTP proposals. It is very much to be hoped that the committee's powers will be fully utilised to ensure that proper scrutiny and oversight is enacted and appropriate action taken.
Conclusion
The Long Term Plan proposals and the intended new structures have no current basis in law and will have no public accountability nor right of redress. This is wholly unacceptable. Furthermore the Plan with its local variations and even more cuts and increasing privatisation is being foisted on to already severely weakened and increasingly unequally distribtuted health and social care services across the city. It will do nothing to address these fundamental issues.
Brighton and Hove Council is in an excellent position to adopt a progressive approach to saving our health and social care services from growing deterioration and dismantlement. With all the considerable expertise and good will in the City – the conduct of detailed consultation, possibly even the setting up of a People's Commission is an absolute priority. Any option has to be better than this headlong rush into this disaster for the NHS, social care and local democracy.
Note 1 Substantial variation in service Legislative & Constitutional Context Section 244 of the National Health Service Act 2006 authorises the Secretary of State to make regulations in relation to health scrutiny. Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 (The Regulations) place an obligation on NHS Organisations to consult with the Council where they are considering any proposal for substantial developments or substantial variations to health services other than where a decision must be made as a result of the risk to safety or welfare of patients or staff. The Council may issue a report to the Secretary of State where: a. the Council is not satisfied that consultation on any proposal has been adequate in relation to content or time allowed; b. the Council is not satisfied that the reasons given by the NHS Organisation not to consult are adequate; or c. the Council considers that the proposal would not be in the interests of the health service in its area.
Sussex Defend the NHS 6th January 2019
Is B&H council rubber stamping NHS England's Long Term Plan?
Will services be getting better or worse? Let us know what you think.
Issues arising from NHS items at Brighton and Hove Full Council Thursday 19th December 2019
Integrated Care Systems and Partnerships are the main bodies for implementing the NHS England Long Term Plan across England. Integrated Care Partnerships are consortia of health and social care organisations formed into a management company to implement the Sustainability and Transformation plan in a given area. Typically ICPs will operate on reduced budgets with a mix of private and public monies.
There were two items on the Full Council agenda relating to the NHS England Long Term Plan developments (including an Integrated Care Partnership) and democratic implications, as follows.
Item 59 SUSSEX HEALTH AND CARE PLAN -THE LOCAL RESPONSE TO THE NHS LONG TERM PLAN 141 - 478 Extract from the proceedings of the Special meeting of the Health & Wellbeing Board meeting held on the 5 November 2019.
Item 60/2 NHS Health and Social Care Decision Making: Democratic Deficit. Proposed by Councillor Shanks on behalf of the Green Group.
“Democratic deficit” The Green party notice of motion arose out of concerns about the last HWB meeting where 3 out of 5 Councillors present on the day were out-voted by 4 CCG members. The suggested response by the Chair of the HWB to deal with this major flaw in Council procedures was the establishment of a Councillor sub-committee to feed into a “restructured HWB”. We assume this new structure to be part of the CCG-led Integrated Care Partnership in the city, though it was not described as such.
If the Integrated Care Partnership is to be implemented what will be the Council's voice and power. The ICP will involve not only with the CCG but also representatives of the powerful NHS Trusts; the Primary Care network and GP Federation; third sector organisations running hived-off NHS services; the mainly private Social Care sector and whatever “other” organisations the CCG and others might see fit to include? How likely is a Council sub-committee to redress the fundamental imbalance of power? If Councillors are worried about the present HWB having only a rubber-stamping role, things under Integrated Care will only get much worse.
Successive Governments have been eroding the power, control and budgets of Councils. This latest development will ensure that in the spheres of social care and health Local Authorities sacrifice their residual powers. By participating in this development Councils are also letting themselves in for the inevitable adverse repercussions and voter blame for the implementation of the Govt's and NHS England's drastically eroded, largely privatised NHS.
Council Budgets
As was made clear at Full Council the local Long Term Plan is short on budgetary detail. The only things known for sure is that budgets will be capped and substantial deficits will have to be cleared (£27 million net for BSUHT alone). How are the overall levels of Integrated Care budgets to be determined? How will Council budgets for Public Health and social care be affected? How will respective allocations be decided? What will happen to the budget of the “on the verge of collapse” Social care system in the city when the Bettercare Fund is stopped? Under merged health budgets what Council budgetary control, right of scrutiny and oversight will there be? What “creative” accounting methods will be employed to meet NHS England and competing demands in the ICP? What new “partnerships” will be brought in to paper over the financial cracks?
Privatisation The word “privatisation” was barely mentioned in the Full Council meeting in relation to the two agenda items discussed. Disappointingly, given their crucial significance, the items gave rise to barely any discussion.
According to the HWB Chair, Brighton and Hove CCG has given assurances there will be no privatisation as part of Integrated Care plans. This is hard to believe when the CCG already presides over roughly £90 million (and rising) in services hived off to the private and third sector.
A moving statement of support for local education services was made in the Moulsecoomb Primary school debate - “we will fight privatisation classroom by classroom”. City health and social care services have been bombarded by cuts and fragmented by privatisation for years. Where are the rallying cries from Councillors for those services and the amazing workforce which is being placed under intolerable pressure, in many cases endangering health?
Substantial Variation in Service (SVS) – see the note below
At the meeting the Chair of the HOSC made a statement promising scrutiny of the local LTP proposals. It is very much to be hoped that the committee's powers will be fully utilised to ensure that proper scrutiny and oversight is enacted and appropriate action taken.
Conclusion
The Long Term Plan proposals and the intended new structures have no current basis in law and will have no public accountability nor right of redress. This is wholly unacceptable. Furthermore the Plan with its local variations and even more cuts and increasing privatisation is being foisted on to already severely weakened and increasingly unequally distribtuted health and social care services across the city. It will do nothing to address these fundamental issues.
Brighton and Hove Council is in an excellent position to adopt a progressive approach to saving our health and social care services from growing deterioration and dismantlement. With all the considerable expertise and good will in the City – the conduct of detailed consultation, possibly even the setting up of a People's Commission is an absolute priority. Any option has to be better than this headlong rush into this disaster for the NHS, social care and local democracy.
Note 1 Substantial variation in service Legislative & Constitutional Context Section 244 of the National Health Service Act 2006 authorises the Secretary of State to make regulations in relation to health scrutiny. Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 (The Regulations) place an obligation on NHS Organisations to consult with the Council where they are considering any proposal for substantial developments or substantial variations to health services other than where a decision must be made as a result of the risk to safety or welfare of patients or staff. The Council may issue a report to the Secretary of State where: a. the Council is not satisfied that consultation on any proposal has been adequate in relation to content or time allowed; b. the Council is not satisfied that the reasons given by the NHS Organisation not to consult are adequate; or c. the Council considers that the proposal would not be in the interests of the health service in its area.
Sussex Defend the NHS 6th January 2019
