Agenda item - Formal Public Involvement

This is the part of the meeting when members of the public can formally ask questions of the Board or present a petition.  These need to be notified to the Board in advance of the meeting.  Ring the Secretary to the Board, Mark Wall on 01273 291006 or send an email to mark.wall@brighton-hove.gov.uk

54.1    Public questions A, B and C all concern plans for youth services, and were responded to jointly.

 

A       Public Question from Maddie Davidson:

 

54.2    “I have been to youth workers, CAMHS and RU OK. I prefer talking to youth workers because you can be yourself, they don’t judge you and they don’t make assumptions. I don’t like talking to strangers and I feel comfortable with youth workers. Why are the council cutting the services that young people want to go to?”

 

B       Public Question from Billie Deason:

 

54.3    “How do you think that mental health services like CAMHS are going to deal with all the extra referrals that they are going to have when youth services are cut?”

 

C       Public Question from Layla Garrard:

 

54.4    “If a young person is feeling suicidal or like self-harming, they still might have to wait weeks for a referral. Don’t you think it is important for young people to have someone that they can talk to straight away?”

 

54.5    The Chair thanked the three people for their questions; and stated that the services provided by the Youth Collective and by the more targeted in-house youth service have been much valued and it has been with a very heavy heart that we have proposed the funding reduction to these services. This is a consequence of large cuts to our central government grant. There are a large number of statutory functions that we have to do and also huge demands on our budget in, for example, children and adults social care and in temporary housing.

 

Although we are proposing a funding reduction here, there will continue to be preventative work done to support young people who are facing difficulties: by schools and colleges, the community and voluntary sector (many of whom do this without financial support by the council) and by council services such as the Youth Employability Service, RUOK our substance misuse service, our Adolescent Service and our Youth Offending Service.

 

We are in discussion with our partners about how we can redesign our services in the context of reduced funding in order to continue to provide support for our children and young people especially those who may face mental distress or have mental health needs. We have been working very closely with health commissioners to totally redesign the way we provide support for young people with emotional and mental health needs. We want to move away from a clinic based service which many young people decide to no longer access to earlier support in schools and in communities. To this end last year we started to work in 3 of our secondary schools with mental health workers being based in schools. This has been successful and has led to a reduction in CAMHS referrals so we are at the moment rolling this out across all of our secondary schools. This will not cost more money, but it will reach more young people.

 

The Board will remember that it has seen the children and young people mental health Transformation Plan and had presentations   about this. Please be assured that Local Authority, Public Health and CCG are working very closely to ensure that the impact is minimised and there is accessibility and connectivity across services.  Public Health is continuing its investment in specialist youth work for teenage pregnancy and substance misuse and this is still going to be accessible in schools.

 

            We have already mentioned above the primary mental health workers in schools and it also worth noting that from June 2017, the CCG is commissioning a new Community Wellbeing Service; we will keep you updated on this.

 

            In addition, ‘#IAMWHOLE’ is a new anti-stigma youth mental health campaign developed by NHS Brighton and Hove CCG in partnership with Brighton & Hove City Council and YMCA Right Here, a local mental health project.    For anyone worried about mental health, visit www.findgetgive.com - a new online mental health service directory website for 13-25 year olds designed by young people from YMCA’s Brighton & Hove Right Here project in partnership with other local partners for the #IAMWHOLE campaign.

 

Speaking to young people will also continue as a strong focus through the Youth Council, online surveys and focus groups.  Right Here will continue to be jointly commissioned with their important peer-led work.  Public Health have also just appointed a Young Apprentice.

 

54.6    Ms Davidson asked a supplementary question, querying why there had been no engagement with young people prior to the announcement of these changes?

 

54.7    Pinaki Ghoshal responded that unfortunately there had been no opportunity to engage before the plans were announced. However, he council is committed to engaging with young people and is now in dialogue about these plans. Children, Young People & Skills Committee will also be involved.

 

D       Public Question from Valerie Mainstone

 

54.8    "I was concerned at the HWB meeting on 22 November 2016 to hear the Chair describe the Children's Public Health Nursing 0-19 contract as a 'good news piece of work.'

"Please can the meeting outline what is good about:

1.    A £3m cut in the budget over 3 years

2.    More than 10% of the Health Visiting workforce being replaced by unregistered staff

3.    Sussex Community NHS Foundation now proposing to greatly reduce the number of clinical managers for this service - leading not only to downgrading, but also to safety concerns

4.    Decommissioning of the Family Nurse partnership, leading to the loss of jobs, and also to the loss of a highly valued service

5.    The huge waste in time and money that this tendering process took: money which could have been spent on client care or jobs."

54.9    The Chair thanked Ms. Mainstone for her question and stated that the large reduction in the ring-fenced public health budget and the overall council budget had meant that significant reductions in funding for public health programmes were inevitable.  The submission from Sussex Community NHS Foundation Trust was evaluated positively in its ability to deliver the described services within the financial envelope and SCFT and the Public Health  Commissioners were working together to minimise the impact of the budget reduction on the local service for children and families.

The Public Health Community Nursing workforce would be led by Health Visitors and School Nurses - some with specialist lead roles (for example for perinatal and infant mental health; and for teenage and vulnerable families), supported by skill-mix teams drawing on a range of skills and expertise to ensure that services are age and intervention appropriate and include staff nurses, assistant practitioners, youth workers and administrators. The focus would be on making the best use of the workforce by ensuring their skills are used appropriately at the right levels.

SCFT has informed Brighton & Hove City Council that a staff consultation was in place and we would be informed of the outcome in a timely manner. We do not know the content of this yet. The re-commissioned service would include a new enhanced service for vulnerable families including teenage parents. Young parents were consulted and their feedback was included in the design of the new offer.

The procurement exercise had to be undertaken. As the Board knows they were bound by legal constraints. The procurement exercise was undertaken in accordance with all relevant European and UK public procurement legislation and the Council’s contract standing orders. This led to the redesign of the service with a mobilisation start date of 1st April 2017.”

E       Public Question from Mr Ken Kirk

54.10  The whole issue of STP begs so many unanswered questions. I don’t expect you to know the answers, but I would like to know if these same questions had crossed your minds.

 

1.    We know that owing to the funding not keeping pace with increasing demand the NHS is in crisis. Under STPs the NHS budget will be cut by a further £20 billion; how can we provide a comprehensive health service for B&H when our share of the NHS budget is reduced?

2.    Under STPs US-style MCP and ACO are used. Why copy the organisations of the worst health service in the world, where the poorest third can’t afford healthcare?

3.    Why doesn’t NHS England run a pilot of STPs to see if STP works?

4.    Why can’t we see the full details of the changes proposed for our healthcare?

54.11  The Chair thanked Mr. Kirk for his question and noted that the Board had a verbal update on Brighton Caring Together, the city’s response to the STP as part of the agenda.  In response to the questions today, she stated that our previous answers and presentations have demonstrated the ‘do nothing’ approach will not resolve the issues we face which include: demand, quality, finance.

The STP was first and foremost about improving health and care for patients, by ensuing health and care services work together better, It provides the opportunity to use economies of scale, plan more regionally and rationalise the limited resources that we have.

 

The Board, like you, were waiting to see the full detail of the changes proposed before we debate them.  However there will be no changes to services people currently receive without local engagement and where required consultation.

 

54.12  Mr Kirk further commented that NHS services have traditionally been responsive to demand, but the STP is not, and this will lead to rationing. In addition, growing problems such as obesity require a strong public health response, but funding is not available to run preventative services effectively.

 

54.13  Councillor Page agreed with Mr Kirk that NHS services should be based on clinical need, rather than the available budget.

 

F         Public Question from Mr John Kapp

 

54.14  MR. Kapp asked the following question and requested a written response rather than a verbal one at the meeting; “Will you support my proposal dated 17.1.17 to double the number of treatments for depressed patients by 2020 by opening up the market to Any Willing Licenced Provider starting in June 2017?”

 

Notes (Numbers refer to my published papers on www.reginaldkapp.org)

This is the same question that I tabled at the CCG board yesterday (24.1.17).  No answer is better than the wrong answer, so I give both your organisations 20 working days to agree on the same affirmative answer, which would make GPs wannabees instead of drug dealers, and save £20 m poaching 500 GPs from Europe to fill the vacuum causing the crisis of toxicity (news 24.1.17) . If you give the wrong answer, I will do a Gina Miller and call on the Justice Secretary for a judicial review on your failure to obey the law (HSCA) for reasons given below.

 

1 On 9.1.17, the prime minister called for 1 million more depressed patients to be treated by 2020, which is approximately double the number presently effectively treated. (In 2015/16 226,850 patients recovered thanks to an IAPT treatment) On 17.1.17 I proposed how this could be done to councillors and Owen Floodgate (latest article on www.sectco.org.uk)

 

2 The Health and Social Care Act 2012 called for the market to be opened up to Any Willing Qualified Provider under simplified procurement rules, and NHS England have since directed that contracts should be outcome based (not performance based) to incentivise providers to heal and cure their patients.

 

3 I proposed a licencing scheme (9.81 on 11.4.14) by which you could meet the prime minister’s target quickly by inviting  Any Willing Providers to apply for a licence to provide effective, evidence based interventions.

 

4 SECTCo has run 40 NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 10 week courses with supporting meditations (9.91 on 4.15) for 220 vulnerable people (including homeless drug addicts) who completed the course since 2010, with average 80% recovery rate. We offer this course for a tariff price of £1,000 per satisfied patient who completes it. We estimate that it is 100 times more cost-effective than 1 to 1 CBT, and can save £7 for every £1 invested (9.76, 23.6.14).

 

5 To relieve pressure on GP surgeries and A&E, I proposed (9.103 on 20.1.16) that the Locally Commissioned Services (LCS) budget of £2.3 mpa be spent to provide each cluster with a Community Care Centre open 24/7 as a mental health A&E, to provide the above intervention every day of the week.

 

6 I proposed (on 12.10.16 and 13.12.16)  to practice manager, Greg Barnes at Wish Park surgery that cluster 4 rent 187b Portland Rd Hove (which is in the surgery building) for use as a Community Care Centre. I have also proposed to Jane Lodge and Michelle Elston (12.16) that cluster 6 rents a room at Revitalise, 86 Church Rd Hove, and am awaiting a response.

 

54.15  The Chair thanked Mr. Kapp for his question and assured him that he would receive a written answer as requested.