On Monday 28th April, Calderdale Council Cabinet authorised the Chief Executive, in consultation with Party Leaders, to finalise the terms of reference for a People’s Commission on Health and Social Care, arrange for the Commission Panel to be established and arrange for the initial call for evidence.

The only thing is, what the Cabinet has set in motion doesn’t seem much like a People’s Commission.

A People’s Commission is a way for civil society to highlight unresolved violations of law, in a public hearing of evidence and testimony from anyone who’s affected.

At the 16th April meeting the Council decided unanimously to set up a People’s Commission about the Hospitals Trust’s Strategic Outline Case (SOC) and called on the Trust and its partners to withdraw the SOC.

The Strategic Outline Case is the document that outlines how and why Calderdale and Huddersfield hospitals would have their beds and acute and emergency departments reduced, and replaced by cheaper NHS and social care in the community.

At the 16th April meeting, it seemed clear that the People’s Commission would go beyond identifying any violations of the law about NHS reconfigurations – vital though that is. It would also map out what future NHS and social care services in Calderdale and Greater Huddersfield should consist of.

Councillors also spoke of the need for the Commission to review NHS governance, in order to avoid repetition of the current problems of lack of democratic accountability and snarled up communications.

But the Chief Officer’s terms of reference for the Commission seem unlikely to deliver anything as meaningful or clear cut as this.

Control freakery and infantilisation of the public

Rather than a membership made up of a small panel of independent lawyers, doctors and health policy analysts (3 people), Calderdale’s so-called People’s Commission will have a large membership of 6 Council politicians (2 from each of the 3 parties) and NHS bureaucrats from Calderdale Clinical Commissioning Group and NHS England West Yorkshire, plus Calderdale Healthwatch.

This membership doesn’t seem likely to shine a fresh light on the Strategic Outline Case, or on the problematic NHS governance structures that have removed the NHS from democratic accountability and produced the SOC.

Imo, the Commission panel should be made up of a small number of independent people, who are far enough away the problem that they can see the big picture; with a strong background of appropriate knowledge and experience; and the fearlessness and willingness to support the public, patients, and NHS and social care staff in speaking their minds and giving their evidence in a single, big public hearing.

I can’t see that the Commission Panel members as designated in the Chief Officer’s Report have it in them to do this job.

And the job the Report hands to the so-called People’s Commission is not the job of organising an effective, big public hearing of people’s evidence.

The Chief Executive’s Report says that the Calderdale so-called People’s Commission will carry out a detailed review of evidence and information that any group or individual can submit; hold a public debate; and make recommendations for the future of integrated health and social care.

Fine, but the proposed process doesn’t inspire confidence that it will allow people to speak strongly and clearly to each other, and to the powers that be.

The Report proposes that the People’s Commission will take place in a 5-stage process, although this may be subject to change:

• Call for evidence and establishment of Commission Panel.
• First Panel meeting to consider submissions of evidence and identify other information the Panel wants to look at.
• Round table or World Cafe Method public events in each of the Council’s main towns, or in its four localities (whatever a locality is), to discuss  issues specific to the particular locality, local views that may not have emerged in the call for evidence, and topics that the Panel would like to see debated in public. At the same time, the Panel would have its second meeting to explore in depth evidence it had asked for following the first panel meeting.
• A third Panel meeting would explore the outcomes of the public, round table, local discussions
• The Panel would produce a draft report and recommendations for public comment before finalisation.

What’s wrong with a proper public hearing for the whole of Calderdale, where people give evidence in response to a barrister’s questions, so that all points are clearly and thoroughly covered? And where everyone hears everything – all the issues are discussed in one place and one time.

Why is the public only going to be invited to speak about issues for their neighbourhood or area, and about topics defined by the Panel? And in round table discussions that make it impossible for everyone to hear what everyone else is saying?

Are Councillors afraid that the public might say things they don’t want to hear? And why do Councillors want to consider evidence amongst themselves in the Panel, rather than hearing it in public at a proper hearing for the whole of Calderdale?

Imo, these terms of reference are as much about fragmentation, disempowerment and lack of openness to public scrutiny as the Strategic Outline Case that they purport to hold up to public scrutiny.

As well as outlining the terms of reference for the so-called People’s Commission, the Chief Executive’s Report states that the NHS providers – Calderdale and Huddersfield NHS Foundation trust, Locala and South West Yorkshire Foundation Partnership Trust – have not yet responded to the Council’s call to withdraw the SOC.

It doesn’t say what powers the Council might have to require them to withdraw the SOC, although – in a possibly separate move – Kirklees Council’s Scrutiny Panel for Health and Wellbeing is to work jointly with Calderdale Council’s Adult Health and Social Care Scrutiny Panel to investigate the SOC proposals. Together they will, if necessary, refer the reconfiguration proposals to the Secretary of State for Health via the Independent Reconfiguration Panel.

Do the Strategic Outline Case and Calderdale Clinical Commissioning Group’s Strategic Review Engagement Plan violate the law on NHS reconfigurations?

Since the Strategic Outline Case (SOC) was published, Plain Speaker has been calling for a review of evidence to identify whether the Clinical Commissioning Groups are in breach of their legal duty to allow the public to be involved in making the decision about whether or not the proposed NHS and social care reconfiguration should go ahead; and also whether they are in breach of the wider Four Tests that have to be met before an NHS reconfiguration can go ahead. These are:

• Support from GP Commissioners (Clinical Commissioning Groups)
• Clarity on the clinical evidence base for improvement
• Strengthened public and patient engagement in the consultation process
• Consistency with current and prospective patient choice, ie justification for any restriction of choice

Plain Speaker and members of the public are gathering information and evidence about the 4 tests.

This information and evidence needs to be expertly reviewed, in order to find out whether there are grounds for a legal challenge to the Right Care Right Time Right Place reconfiguration proposals.

But Calderdale Council’s People’s Commission is not going to be the place where this happens.

You can read the Chief Executive’s report on the People’s Commission on Health and Social Care here

What a People’s Commission is and does

Historically, People’s Commissions have highlighted violations of international law. Bertrand Russell convened a tribunal of international civic conscience on the American-Vietnam war in 1966, and the tribunal reconvened on Palestine 2010-12. Both highlighted unredressed violations of international law. Another similar tribunal took place in the Hague to focus on human rights abuse in Iran. Civil society has been the sole motivating and organising force behind these tribunals.

More recently, the Save Lewisham Hospital campaign group set up the Lewisham People’s Commission of Inquiry on behalf of the people of Lewisham, to highlight legal violations by the Secretary of State, Jeremy Hunt.

The Secretary of State had tried to use the Trust Special Administrator process to close or seriously curtail several of Lewisham Hospital’s departments, including A&E, acute, maternity, emergency and complex surgery units, and to sell off 60% of its estate and turn the hospital into a centre for elective surgery. The reason for this was to save money to pay off the PFI debt of an insolvent nearby Trust.

After the Secretary of State announced his intentions, the Save Lewisham Hospital campaigners identified that he had ignored the “Four Tests” that have to be met for a major NHS reconfiguration to go ahead, as well as ignoring a mass of evidence and opinion. They also raised questions about the validity of evidence that the Secretary of State had presented to justify his decision to close and downgrade many of Lewisham Hospital’s departments.

This gave rise to the idea of the Lewisham People’s Commission (LPC)

You can watch some of the LPC here.