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

 

5.1         The Chair noted that there were a number of public items on the agenda, which included a petition and public question on the same matter.  He was therefore inclined to take both items before responding to them.

 

5.2         He also stated that given the number of written questions and new members to the Board, he intended to respond to the initial question but would provide written responses to any supplementary questions.  The written responses would be sent to the individual questioners and reported to the next meeting of the Board for information.

 

5.3         The Chair then invited Ms. Walker to come forward to present her petition in relation to the service of a breastfeeding support worker.

 

5.4         Ms. Walker thanked the Chair and presented the petition which had been signed by over 500 people and called for the reinstatement of a breastfeeding support worker. 

 

“My breastfeeding support worker is having her role removed by the NHS. Without her so many mums in the area will not receive the support needed and may fail to breastfeed their babies. Please sign this petition in the hopes that we can save Donna's breastfeeding support role.”

 

5.5         Ms. Walker sated that the service provided was essential and meant that she and other new mothers had been able to cope and develop a bond with their babies and breast feed.  She was therefore seeking support for the reinstatement of their support worker whose role had been changed by the NHS.

 

5.6         The Board Members acknowledged that the petition raised an important question in relation to the importance of breastfeeding for children and the loss of dedicated support workers.  It was noted that the service provision was a matter for Sussex Community Foundation Trust and it was felt that a report on the change of provision to the Board would be helpful.

 

5.7         The Acting Director for Public Health noted that the SCFT service was performing well and wished to reassure the Board that the aim was to provide a broader service across the city.  The challenge was to duplicate the excellent service that had been provided at a local level.  He also noted that breastfeeding figures for 6-8 weeks for South Portslade were at 77% and North Portslade 73%.

 

5.8         The Chair thanked Ms. Walker for the petition and invited Valerie Mainstone to come forward and put her question on the subject to the Board.

 

5.9         Ms. Mainstone thanked the Chair and asked the following question, "Will the Board prevail upon Sussex Community Foundation NHS Trust to re-instate the post of Breastfeeding Support Worker for Hangleton and Portslade while a full impact and equality assessment is conducted, including a meaningful consultation with the service users, and then brought to the Board?"

 

5.10      The Chair replied to the petition and the question, “Thank you both for your petition and for your question about the breastfeeding support worker.

 

As the Board is aware in the past 15 months we have had several reports on the Public Health Community Nursing 0-19 service which includes the breastfeeding service. The current provider of these services is Sussex Community Foundation Trust.

 

Within the Healthy Child Programme the Department of Health has identified breastfeeding as one of the six high impact areas where the work of the 0-19 teams is expected to have a significant impact on health and wellbeing and improve outcomes for children, families and communities. The breastfeeding rate is one of the key performance indicators for the new public health community nursing service 0-19 years.

 

In Brighton & Hove the breastfeeding rates are amongst the highest in the country.  In 2016, the breastfeeding rate in Brighton & Hove at 6-8 weeks was 72% compared with the England rate of 43%. The local rates at ward level varied from 85% to 55% with Hangleton and Knoll at 67%.

 

The Health and Wellbeing Board does not have the authority to reinstate the breastfeeding support worker post.  This is a matter for the Trust. Having spoken with Sussex Community Foundation NHS Trust their strategy is to develop the public health nursing workforce to be able to provide the type of additional support being provided in Hangleton and Portslade for breastfeeding mothers living everywhere in the city.”

 

5.11      Ms. Mainstone asked the following supplementary question, “Could I have any information relating to the figures for Portslade and could the Chair explain how the revised service would support the most vulnerable people in regard to breast feeding.”

 

5.12      The Chair thanked Ms. Mainstone for her questions and invited Mr. Kapp to come forward to put his question to the Board.

 

5.13      Mr. Kapp thanked the Chair and asked the following question, “Will you please report on the number of vulnerable people who have been treated under the Better Care Fund (BCF) giving recovery rates and future plans to treat addicts and homeless people in the light of the Council’s policy of ending the need for rough sleeping by 2020?”

 

5.14      The Chair replied, “In 2014, the Homeless Integrated Health and Care Board was established under the Better Care Programme with the aim to: “Improve the health and wellbeing of homeless people by providing integrated and responsive services that place people at the centre of their own care, promote independence and support them to fulfil their potential.”

 

“As a result of the work of the Homeless Board during 2016 the CCG commissioned a new extended homeless GP practice to improve the health care offer to homeless people. The GP practice serves as a hub with an engagement outreach team working across the city. In addition the GP practice provides in reach support to homeless patients admitted to the Royal Sussex County Hospital and Millview Hospital. The service involved an additional investment in the service.

 

The contract for the new GP practice started in February 2017 and has been positively received.

 

The next phase of work is to ensure a broader range of health and care services are integrated to create a full Hub and spoke model. The aim is to change the way care is accessed, increasing utilisation of primary and community services and reducing reliance on unscheduled and emergency care.”

 

5.15      Mr. Kapp asked the following supplementary question, “What are you doing about dead doctors and nurses walking (not working) in the toxic NHS?”

 

5.16      The Chair thanked Mr. Kapp for his questions and invited Ms. Gee to come forward to put her question to the Board.

 

5.17      Ms. Gee asked the following question, “What is the HWB doing to support the self-management of the large number of primary care patients with medically unexplained symptoms yet who tend to reject psychological therapy (CBT) due to their explanatory model being physical and the stigma of mental health services?

 

There is a research-informed approach based on substantial evidence which has been designed with service users and piloted at the University of Hertfordshire. This service promotes self-care for this patient population with strikingly positive outcomes for patients, substantial increased GP capacity as well as huge savings in the NHS.

 

5.18      The Chair replied, The CCG has commissioned the GP Persistent Symptoms service to provide a multidisciplinary care pathway for people with medically unexplained symptoms. The service started in April 2017 at the following surgeries:

 

·                Matlock Road Surgery

·                Hove Park Villas Surgery

·                Trinity Medical Centre

·                Charter Medical Centre

·                Brighton Health & Wellbeing

·                Benfield Valley Healthcare Hub

 

This is a 12 month pilot which will be fully evaluated using a range of evidence based clinical outcome measures. The GP, Psychiatrist and Psychologist providing this service have all received specialist training the treatment of medically unexplained symptoms, and have provided training to Primary Care Clinicians within the cluster.

 

We will be reviewing every 3 months and depending on demand / capacity will roll out to other Clusters over the course of the pilot.”

 

5.19      Ms. Gee asked the following supplementary question, “Will the pilot be focusing on self-management of symptoms?”

 

5.20      The Chair thanked Ms. Gee for her questions and invited Mr. Kirk to come forward and put his question to the Board.

 

5.21      Mr. Kirk asked the following question, “I can see the approach you collectively take to the STP is to make the best of it. To try and minimise the effect of the reduced budget and redefine services to fit the diminished funding and at the same time account for the deficit; yes and integration health and social care. The approach I think that would best serve the interests of B&H patients, and surely the message the general election result conveys, is for you to say ‘No, enough of this pretence. We had at one time a comprehensive health service and now you expect us to destroy it, we will not be part of the Conservative party’s pursuit of small government. What the government expects us to do is just plain immoral. Can you not see this?”

 

5.22      The Chair replied, “Thank you for your opinions around the STP. We understand the concerns you have raised about the national context of the STP.  One of the priorities of all STP is, of course, to ensure that we are getting the most out tax payer’s money for the residents we cover and maximise the resources available, including the workforce. However, it is not right to say that the STP is just a cost cutting exercise.

 

The Sussex and East Surrey Sustainability and Transformation Partnership (STP) outlines how the NHS and social care will work together to improve and join-up services to meet the changing needs of all of the people who live in our area. There are 23 organisations in our partnership – local authorities, providers and clinical commissioning groups. It is the first time that we have all worked together in this way and it gives us an opportunity to bring about significant improvements in health and social care over the next five years. The STP aims to ensure that no part of the health and care system operates in isolation. For example, we know that what happens in GP surgeries, impacts on social care, which also impacts on hospital wards, and so on. The STP aims to make practical improvements – like making it easier to see a GP, speeding up the diagnosis of cancer, and offering help faster to people with a mental illness. It also aims to support people to take more responsibility for their own health and wellbeing.

 

The STP is not one single separate plan. It is a way of making sure that all the plans being developed by the partners across the area are joined up and working together. The STP’s overarching approach is to ensure that there are local ‘place-based plans’ so that people can get the care they need as close to home as possible. The place-based plans are being developed locally, led by the CCGs and local authorities, and are being incorporated into the STP, rather than the other way around. Much of the work that underpins the place-based plans would be going on already even if it were not for the STP; the STP ensures that it is joined-up.

 

Caring Together is Brighton and Hove’s response to the STP and is part of the local place-based plans to improve health and social care across the city. The programme builds on work that has already been underway in Brighton and Hove and sets out how the city can improve and transform adult and children’s services, physical and mental health, social care, public health, GPs, pharmacies, community, voluntary sector and hospital services. It is a joint programme led by Brighton and Hove CCG and Brighton & Hove City Council. The two organisations have already engaged with the public about the aims and objectives and a programme description was approved by the CCG’s governing body in March. More detailed plans will now be developed alongside significant engagement with the public, patients, the community sector, Healthwatch and GPs in the coming months. A comprehensive engagement plan is being developed and the next public engagement event is planned for 4 July.”

 

5.23      Mr. Kirk asked the following supplementary question, “Do you agree that the best approach for residents would be for the Health & Wellbeing Board to say no and not be part of the Government’s proposals?”

 

5.24      The Chair thanked Mr. Kirk for his questions and invited Ms. Kehoe to come forward and put her question to the Board.

 

5.25      Ms. Kehoe asked the following question, “What impact assessments (ia) have been undertaken by Mr Persey, his department, council employees, Councillors or sub-contractors, of our STP/place-based plan relating to Brighton and Hove (B&H). A written report on its implications for health and care service changes/provision for B&H, including a financial breakdown of implementing these changes is essential.  Consultation on same, with awareness of the impact of these changes to our health and social care provision, can then take place. Therefore, if not already available, when will a full ia report on these changes be available?  A time-table of public consultations would also be appreciated.”

 

5.26      The Chair replied, “Impact assessments are done at service level as changes are made. People who come to the Board regularly will know that as service are retendered or services reviewed a full  impact assessment has to be undertaken as part of the process and this will continue.

 

With regard to public consultation and engagement. The council and CCG have had a series of events last year, which many of the people here attended. Now more information is becoming clear we are starting a programme of conversations about out health and care across the city, the first will be on 4^th July. We are currently planning out the heath and care conversations and a communications strategy should be coming to the Board on 11 July.

 

5.27      Ms. Kehoe asked the following supplementary question, “Who will provide replacement financial implications of the changes being proposed and can you provide details of that information?”

 

5.28      The Chair thanked Ms. Kehoe for her questions and invited Ms. Dickens to come forward and put her question to the Board.

 

5.29      Ms. Dickens asked the following question, “Given Councillor Yates February statement refusing to cooperate with the STP Board how have the STP proposals relating to Primary and Social Care been passed into CCG operational plans for 2017-2019 with no public consultation no impact assessments? Given the council’s crucial role in the provision of social care did the HWB or another council committee sign off on this?

 

Will the HWB agree to demand urgent answers from the CCG on these matters of crucial public interest citywide; and in particular ask for urgent clarification of the true level of cuts entailed in the main STP and the Place-based plan and their consequences?”

 

5.30      The Chair replied, “Caring Together is the strategy for the future of health and care in the City. It is jointly owned by the CCG and Local Authority and approved by the Health & Wellbeing Board.  The Operating Plan describes the actions required to deliver Caring Together. The Operating Plan indicates where our local plans align to the STP but does not commit us to any proposals for primary care which are over and above those set out in Caring Together.

 

The HWB has this item as a standard item.  We are continuing to work with our partners on this and will provide further updates at each meeting. “

 

5.31      Ms. Dickens asked the following supplementary question, “There still appears to be a miss-match of the figures relating to the cuts, could a true figure be provided on the level of cuts that are anticipated?”

 

5.32      The Chair thanked Ms. Dickens for her questions and noted that brought the public questions item to an end.  He confirmed that the written responses to the supplementary questions would be included in the minutes and sent to the questioners.  He then invited Ms. Aston to come forward to present her deputation to the Board.

 

5.33      Ms. Aston thanked the Chair and outlined the deputation that had been submitted in relation to the findings of a survey of GPs and their views on the proposals relating to the STP.

 

5.34      The Chair thanked Ms. Aston and responded by stating that the Board was aware of the challenges currently being faced in General Practice. One of the key areas of Caring Together is to find ways to address these to help ensure we have general practice across the city that is sustainable, more resilient and works efficiently and effectively for the years ahead. This will include integrating services, with other clinical specialists like pharmacists better supporting GPs, and to have a model of care that sees GPs working more collaboratively and at a larger scale.

 

Our GPs recognise the need for change and they can identify the benefits of working in this way. We have been engaging with them to help us shape a new model of care that works best for them and local people and work is currently being done to develop how this will look like. Our GPs are already working within groups, or ‘clusters’, caring for between 30,000-50,000 people and we already have some services that work across these clusters, such as pharmacists.

 

He also noted that a full response to the questions had been prepared and would be issued with the written response to the deputation and appended to the minutes for information.

 

5.35      Councillor Page stated that he had found the information given in the deputation to be very informative and that it gave a clear message that GPs were concerned about the implications of the STP.  He was also aware that the HOSC had a Working Group looking at the STP process and hoped their findings could be considered in the future.

 

5.36      Dr. Supple stated that to date the engagement process with GPs in regard to the STP had been minimal and noted that things had been changing rapidly over the last few months, which may well have prevented any meaningful engagement until now.  However, now that it was becoming clearer he was hopeful that an engagement process would be taking place across the city.

 

5.37      Councillor Barford stated that there had been a lack of information around the STP, but she had been reassured with the intention to take the Caring Together consultation process forward.  She also welcomed the opportunity for a bottom-up approach to developing the provision of services across the city and feeding into the STP on a regional level.

 

5.38      David Liley stated from Healthwatch’s perspective it was important to have a meaningful engagement process and he was encouraged by the intention to have a ‘Caring Conversation.’  He noted that a recent survey that Healthwatch had put online had gained 90 responses within the first 48 hours, which showed the level of interest across the city and stated that he would share the results with the Board in due course.

 

5.39      The Chair noted the comments and proposed that the Board should note the petition and note the deputation and that the information provided by the deputation be shared with the HOSC Working Group.

 

5.40      RESOLVED:

 

(1)    That the petition be noted and a report detailing the changes to the service provided by SCFT in relation to breastfeeding and support to mothers be requested for the Board in the autumn;

 

(2)    That the deputation be noted and referred to the HOSC Working Group for information.