We have some good news, thanks to the 118 members of the public who signed Plain Speaker’s petition to the Scrutiny Panel, to the Scrutiny Panel themselves, and to Calderdale 38 Degrees NHS Campaign Group, Calderdale Trades Council and other members of the public who lobbied the Scrutiny Panel meetings.

The Petition asked the Scrutiny Panel to:

• Hold a formal inquiry into Calderdale and Huddersfield NHS providers’ proposals to close/downgrade one or both A&E departments in Halifax and Huddersfield, and the associated NHS and social care reconfiguration proposals (“Right Care Right Time Right Place”)
• Call in all 5 local NHS organisations to explain their proposals, their evidence base and how public, community groups’ and staff views have been sought, documented and used
• Invite the public to take part and state their views

The Scrutiny Panel  agreed to:

• Acknowledge the petition, thank the petitioners, recognise the importance of what the petition asks for and use the petition as the basis for a work programme to bring in the NHS organisations to explain their Right Care/Strategic Outlline Case/NHS shake up proposals now and as they unfold.
• Make sure that members of the public are able to ask questions at Scrutiny Panel meetings, including questioning the NHS organisations when they are brought in to account for their activities/proposals.
• Ask Calderdale Clinical Commissioning Group (CCG) to the next meeting to explain their new proposals to scrap the scheduled public consultation on the “Right Care” NHS shake up plans, go ahead with setting up the “Right Care” community health and social care care system without public consultation, and only consult on the “Right Care” proposals for acute and emergency hospital service cuts after the “Right Care” community health and social care system is in place. By which time the outcome of the public consultation will be a foregone conclusion, since hospital services will have to be cut, because there isn’t enough money to pay for the existing hospital services to continue to run alongside the Right Care community health and social care system.
• Require the Scrutiny Panel Chair to write immediately to Calderdale CCG asking them not to make any decisions on Thursday that would pre-empt the possibility of proper public consultion on all aspects of the Right Care proposals, both care in the community service reconfiguration and the proposed A&E closure and cuts to acute hospital beds.
• Immediately ask the Council’s Chief Executive for funding to pay for external advisors to help the SP make their formal enquiries into the NHS organisations Right Care proposals.

Petitioners are now asking the Scrutiny Panel to appoint Professor Allyson Pollock as their external advisor.  She is Professor of Public Health Research and Policy at Queen Mary, University of London.

So: many thanks to the Scrutiny Panel for stepping up to its task, and to all the people who signed the petition and who have worked to encourage the Scrutiny Panel take it seriously and act on it.

For more info about the SP meeting discussion, please see section at the end of this article:  More detailed report on the Scrutiny Panel discussion of the petition and how the Scrutiny Panel will act on it

And then we have some bad news – GP commissioners ignore democratic decision

Calderdale Clinical Commissioning Group Governing Body didn’t take a blind bit of notice of the Scrutiny Panel Chair’s request not to make any decision that would pre-empt the outcome of a public consultation or lead to a significant variation in service before a public consultation had taken place.

Neither the CCG Chief Officer, nor Calderdale Council’s Director of Adults Health and Social Care, nor the Council’s Public Health Officer made any mention of the letter from the Scrutiny Panel Chair.

Information about the letter only came to light when a member of the public, Ken Cheslett, told the meeting that it needed to acknowledge and deal with the Scrutiny Panel’s letter, and went on to explain what it said.

Dr Walsh said he would talk about the letter later.

When he did get round to it, he brushed aside the Scrutiny Panel’s request to refrain from making a decision to carry out the community care service transformation without public consultation.

Dr Walsh said that the community care service transformation was about strengthening existing services and was based on findings from the engagement process.

He continued,

“I do not believe that if we accept the Report’s recommendations today, we act in any way in contravention of the letter from the Scrutiny Panel.”

He said the CCG would be happy to attend a Scrutiny Panel meeting.

None of the GPs on the Governing Body saw fit to comment on the fact that the elected representatives of their own patients had asked the Governing Body not to make a decision to commission and set up the community health and social care service changes before carrying out the public consultation that is required before making a major service change.

Plain Speaker finds this puzzling, since the whole rationale for Clinical Commissioning Groups of local GPs is that they are supposed to be about local commissioning for local people, but then the Clinical Commissioning Group GPs apparently have no respect for the democratic will of their own communities?

Stella Clarkson, a member of Band Together for Our NHS, said,

“The public can count it as a small victory that their opposition to the Right Care shake-up has made the NHS Commissioners move the goalposts. They have done this because they know the public consultation on Right Care, which should be taking place this summer, would say a big NO.
But it’s important to recognise the Commissioners’ proposal for what it is: an attempt to take away the public’s right to have a say in the proposed shake-up.
Calderdale Council’s Scrutiny Panel now has the task of making sure Calderdale CCG does not do this.

Locally our councillors have stated they are in full support of keeping Calderdale A&E open. In April, they voted unanimously to ask the hospitals trust to withdraw their Right Care Strategic Outline Case shake up plans.
The Council’s Adults health and social care Scrutiny Panel need to remember this, and stop the Commissioners from pushing through the Right Care community care service transformation without public consultation. The Commissioners have re-branded the Right Care community care proposals as Care Closer to Home, but they are still the same proposals.”

Now that both Huddersfield and Calderdale CCGs have published their RIght Care Commissioning Intentions, isn’t that the trigger for the Calderdale and Kirklees Joint Health Overview Scrutiny Panel to meet and review the commissioners’ plans, with the option of referring them to the Secretary of State if they find them wanting?

Plain Speaker will update with this information when it finds the answer.

More detailed report of the Scrutiny Panel discussion of the petition and how the Scrutiny Panel will act on it

This is more or less a verbatim transcript of what was said by Scrutiny Panel members, the public and Councillor Barry Collins, who sat in on the meeting. Although a few digressions and repetitions have been left out.

Appointing external advisors to help Scrutiny Panel investigate the “Right Care Right Time Right Place” proposals

Cllr Draycott asked if any progress had been made in appointing an external advisor or advisors, since the first Scrutiny Panel meeting agreed to do this.

The Chair Cllr James said,

“The general feeling at the first meeting was that there would be no difficulty finding money to pay for one or more advisors in particular areas. We are working on the basis that we will have money available.”

Cllr Draycott asked when, what is the timeline for setting that up?

The Chair said that it’s a question of availability of appropriate consultants, but the timeline for the CCGs seems to be moving out.

The Scrutiny Officer Mike Lodge said that the SP should take this decision after it has decided on its work programme. The SP should specify the pieces of work they want an advisor for and “then we’ll go out and find one.”

Much later in the meeting, prompted by discussion that CCG must not take any steps to implement community care service change without public consultation and SP inquiry (see that section below), Cllr Hall returned to the question of appointing external advisors.

He said,

“ On the issue of advisors, was that accepted by Cllr Tim Swift when he was  leader? It needs a decision from the SP to make a formal request that they approve funding for advisors for the SP.”

The Scrutiny Officer said that guidance asks Council to set aside a discrete budget for Scrunity Panels, so he advised the SP’s funding request should go to the Chief Executive, not to Cabinet.

The SP agreed to ask the Chief Executive for this funding. (As included in summary of action points agreed by SP, at the start of this article.)

Petition to call in NHS organisations and formally inquire about their Right Care proposals

The background to this discussion is that the Scrutiny Officer had presented a report to the SP recommending that they refuse to act on the petition and instead pass it to the People’s Commission.

Cllr Hall said that the SP should try and support the petitioners and get their questions answered and could do so without conflicting with the Joint Health and Overview Scrutiny Committee (JHOSC) that will review the Right Care commissioning intentions when the CCGs publish them. He said

“Anything we find can go to them.”

The Chair Cllr James reminded the meeting  of the legal requirement  to set up a JHOSC to consider any commissioners’ proposals for significant service change. He said,

“We have done this and have the JHOSC structure in place. When it will become active isn’t clear, because of what the Clinical Commissioning Groups need to do.”

He added that the People’s Commission is doing work at this time, and this is supposed to feed into Calderdale Clinical Commissioning Group’s Right Care Right Time Right Place commissioning plan.

He said the petitioners’ questions were valid and the SP “will be taking a view of this this evening.”

Concern about Commissioners’ proposals to push ahead without public consultation

Cllr Wilkinson said,

“I understand the JHOSC but I don’t think this should prevent us from scrutinising what’s been proposed so far and led to the Council’s unanimous proposal to withdraw the Strategic Outline Case, which the NHS providers have refused to do. And it’s the job of the Scrutiny Panel to hold them to account and find out why they refused.

The People’s Commission is about developing a vision for the future of health and social care, not about scrutinising existing proposals.

I’m also concerned about the new Clinical Commissioning Groups’ proposals to push ahead without consultation. We need to call them into Scrutiny. I think it’s really important to ask the CCGs and the Trust to come here regularly.”

The Chair said that the Clinical Commissioning Groups are developing their ideas for community care, not pushing the green button to enact proposals now.

Cllr Bob Metcalfe, introducing himself as also being a member of the People’s Commission, said,

“The detailed Right Care Report that the Clinical Commissioning Group will discuss this Thursday clearly says they want to start implementing the community care now.

This is a concern. This hasn’t been discussed at this Scrutiny Panel.

The detailed Report says the CCG wants to take on board the findings of the People’s Commission but it seems to have started before knowing what the People’s Commission can recommend.

The CCG needs to come the the Scrutiny Panel.”

Cllr Metcalfe added that CCGs were shifting the timetable to allow implementation of their Care Closer To Home community care system. He said this was significantly new proposal since the last Scrutiny Panel meeting.

The Chair Cllr James said,

“Probably the next thing is to ask the CCG to appear and clearly explain now where they are and what they’re doing next. At the last SP meeting, the CCG said they’re in the process of developing their specifications for community care. We need to see what that specification is.”

Need to investigate proposals now, not wait for Joint Health Overview Scrutiny Committee

Cllr Draycott agreed. He said,

“We need to be in a position to see what kind of services they’re talking about. There was no satisfactory answer at the last meeting.

We don’t want a gap  now before the JHOSC. We should be scrutinising developments now.”

The Chair said,

“ I agree it’s not a question of sitting on the side till the JHOSC. We need to ask the CCG what they’re doing. It isn’t clear though.”

Cllr Blamborough said there was a lack of communication and  he agreed with Cllr Metcalfe that it would make sense to have a set of stepping stones to gather information that could go to the JHOSC, and could also help to manage people’s expectations about what’s happening when. He said,

“Presumably the SP can call anyone to account that we want to. Including the CCG.”

Cllr James, the Chair, said,

“We need to get the CCG to a SP meeting. The last meeting was woolly about where they were going.”

Cllr Metcalfe returned to the Right Care Delivery Report that the CCG was to discuss on Thursday. He said,

“We need to know exactly what they’re talking about implementing. We need to know if it amounts to a reconfiguration of services. The Report talks about themes but doesn’t spell out exactly what they’re starting to implement. Is it a reconfiguration, and if so should go to JHOSC?”

The Chair said that the CCG say they’ve had an engagement process but not a consultation. He went on,

“Engagement is a phase. The Report is their view but consultation has yet to happen. The Scrutiny Panel need to see what is the structure in depth about what they will put to the public for consultation.

The People’s Commission is doing a different role. It is looking at what people in Calderdale want from NHS service provision.

The Council turfed out the providers’ proposal and said that’s not acceptable for our population.”

Cllr Hall said they need to understand the drivers – what’s caused the need for change. He said no-one’s got the full picture.

Cllr Metcalfe said that the CCG Report on delivering Care Closer To Home was also about how care in the community integrates with adult social care as well as wider NHS services, so he was hoping the SP would  get a meeting with the CCG asap.

He said,

“Having a standing item on any health and social care changes is a wise move to make, to keep up to date and identify who the SP needs to talk to next.”

The Chair agreed that the story is unfolding over time. He said,

“We have these elements coming to the surface. We need to focus on this at every meeting and invite the NHS organisations to the SP to make it clear what they’re doing.”

He asked whether the SP should retain the petition or pass it to the People’s Commission.

Cllr Hall said,

“It should be retained here. If we’re able to do that, this was the intention of the people who signed it.”

Cllr Wilkinson agreed.

“The People’s Commission doesn’t have any of the powers that the SP does. And given that the SP has those powers we have a duty to hold the CCGs and NHS providers to account.”

Cllr Blamborough agreed that there was absolutely no harm in keeping the petition in the SP.

There was then a bit of a discussion about the wording of the petition and how to translate that into SP action.

The Chair summarised that the Petition aims to get to the bottom of what the NHS organisations are proposing to do, and this is what the petitioners want the SP to do, plus the opportunity to express their opinions.

The Scrutiny Officer suggested that the SP invite the CCG formally to the next meeting to explain their decisions and that could determine the nature of the formal inquiry requested by the petitioners. The next stage is to talk in depth with the CCG.

Cllr Hall returned to the point that,

“It would be helpful if we could discuss draft ideas and proposals, rather than waiting until decisions have been made. We need to be more in the curve to be able to put ideas in before decisions are made. Not just to be presented with the final decision.”

CCG must not take any steps to implement community care service change without public consultation and SP inquiry

From the public section of the meeting, Cllr Barry Collins, who is not a SP member, said,

“There are only two days before the CCG meeting. Can we ask the CCG to undertake that they will not take decisions on the community care specifications without first discussing it with the SP and not to take any steps to implement the community care service change until the People’s Commission has presented its findings?”

The Chair agreed.

Cllr Metcalfe said,

“There are a few different strands in the big picture. This can get confusing.

We need an urgent meeting with the CCG so they don’t start making any meaningful implementation before hearing from the SP and People’s Commission.”

Cllr Hall said,

“When we call in the NHS organisations it would be helpful to have public questions in writing in advance, and have the opportunity to take questions from the floor.”

A member of the public asked when public consultation begins and what triggers it.

The Scrutiny Officer Mike Lodge replied,

“When the CCG makes a proposal for a substantial variation of services, they have to have a public consultation and contact the Councils involved about the dates they’re minded to make a decision. That would trigger the formal consultation. And the Joint Health Overview Scrutiny Committee if it affects more than one local authority area.”

Cllr Barry Collins said,

“The engagement process is absolutely not a public consultation. I’m delighted that the CCGs are proposing to delay the public consultation, but the suspicion is that if public consultation is delayed, significant decisions may be made. We have to make sure that this doesn’t happen. Nothing final must happen before the consultation and this mustn’t lead to privatisation. All the public’s aspirations and worries need to be fed into the CCGs’ plans.”

The Chair agreed that the CCG mustn’t go ahead with any contracts etc before the public consultation.

The points of action agreed the SP then agreed are listed at the head of this report.

Updated 19th August with addition of section: More detailed report of the Scrutiny Panel discussion of the petition and how the Scrutiny Panel will act on it