THIS is how you hold a CCG to account!

“The NHS will face calls from leading county councillors to publish a comprehensive plan for public consultation on its controversial proposals for a major shakeup of health services in Lincolnshire.

Concerns have been raised by the county council over the lack of progress on the Lincolnshire Sustainability and Transformation Plan since an initial draft was first published in December 2016.

At the time, the plans outlined a required £205 million investment to improve the facilities at Lincoln County Hospital, Boston Pilgrim Hospital and Grantham Hospital.

The proposals revealed that Grantham A&E could be downgraded to an urgent care centre and maternity services centralised to Lincoln.

Over 500 jobs are also set to be lost by 2021 under the plans.

Lincolnshire County Council unanimously voted against the STP at a Full Council meeting in December 2016, just over one week after the report was first leaked to the press.

County council leader Martin Hill wrote to NHS chiefs in March 2017 adding his criticisms, claiming that “making things better for most people, at the detriment of others, is not good enough”.

Since then, the county council said that there have been delays in publication of the STP plan, with further concerns raised about the lack of answers to the financial struggles of the NHS in Lincolnshire as well as fears about the changes themselves.

United Lincolnshire Hospitals NHS Trust, which covers the three main hospitals in the county, was put in special measures by the Care Quality Commission for performance failures and in financial special measures by NHS Improvement in 2017.

Even this month, ULHT has forecast an end of year deficit of £82.4 million, £5 million more than its deficit control target agreed with NHS Improvement.

In addition to asking the NHS to publish a plan for public consultation “without delay”, Lincolnshire County Council will also call for a review of governance arrangements for the STP to provide clarity over decision-making, accountability, democratic engagement and oversight of the process.

Glen Garrod, Executive Director of Adult Care and Community Wellbeing at Lincolnshire County Council, said in a report to councillors: “The county council has a long and successful track record of working with NHS partners in Lincolnshire. More recently and with the development of the STP programme the nature of the relationship has changed and, given the quality, performance and financial imperatives facing NHS services in Lincolnshire, more profiled.

“Disappointingly little progress has been made to address underlying budget deficits, performance continues to be poor at ULHT and successive inspections by the Care Quality Commission have reported on serious quality issues.

“This has been the picture for a number of years with little sign that ‘the tide has turned’ and these critical issues are getting better.

“Change is likely, indeed necessary and improvements critical if Lincolnshire residents are to receive NHS services that they deserve.”

In response, John Turner, Senior Responsible Officer for the Lincolnshire STP said that Lincolnshire County Council is a key partner for the NHS in the county but refused to be drawn on when it would publish its plans for public consultation.

He said: “We are fully committed to working together with Lincolnshire County Council in the best interests of patients and the people of Lincolnshire. The level of our integrated services between the NHS and Lincolnshire County Council already compares well nationally.

“There is much to be proud of in our local NHS, with our dedicated staff and partners working to provide the best care for our patients. At the same time, it is widely recognised that health and care services in Lincolnshire are very challenged – we struggle to provide consistent care and meet all quality standards, to recruit clinical staff in key areas, and we are currently overspending by £100 million a year.

“In recent months the STP has reported progress in areas such as mental health, GP services, integrated community services and operational efficiencies and improvements have been delivered for patients.

“In addition, the STP is also undertaking an acute services review which is examining what would be the future configuration of acute hospital services for the population of Lincolnshire.

“We look forward to discussing this openly across the county in due course.”

Councillors on the council’s Executive will consider the next steps to take at a meeting in Lincoln on Tuesday, May 1.”

Claire Wright fights for proper scrutiny and transparency at DCC

Owl says: it beggars belief that (a) councillors are banned from asking public experts any questions and (b) minutes do not reflect PUBLIC anxieties!

And what would we do without INDEPENDENT councillors like Claire Wright!

“A recommendation will be put before Devon County Council Chairs of Scrutiny Committees on relaxing the rules around asking questions of members of the public, following today’s Procedures Committee meeting.

I proposed that there should be flexibility in the rules relating to public speaking in allowing questions from councillors on the committee. This was after I was prevented from asking a local GP a question following his submission relating to concerns on care at home, at January’s Health and Adult Care Scrutiny Committee meeting.

There was some discussion at today’s meeting and it emerged that other scrutiny chairs (Cllr Rob Hannaford in this instance) exercise discretion for points of clarification. I asked that this be made into a formal policy and it was agreed that the issue would be put before the next Chairs of Scrutiny meeting, which I will attend and make my case.

It is difficult to see a reason to argue against this modest change! My proposal to reduce the length of time that members of the public must register, from four days to two days, was not supported, unfortunately.


However, my request for more detailed recording in the minutes of members of the public submissions was backed by the committee this morning – after a bit of persuasion! This is important for the sake of balance. I argued that the committee exists to investigate matters of public concern. And it’s also important for the audit trail if the local health service did (heaven forbid) catastrophically fail and the health scrutiny committee was held to account.

Currently, the NHS presentations are recorded in detail, but members of the public representations are so glossed over in the minutes that no one would have a clue what their position was on the subject or what they said. With a simple tweak this will hopefully now be altered, which I believe more fully reflects what we are are here to do as councillors … which is represent members of the public.”

“The Case for Public Consultation Hearings”

In its latest Briefing Paper, the Institute argues the case for Public Consultation Hearings. In the recommended format, organisations undertaking a consultation will provide the opportunity for selected consultees to appear before decision-makers and give their evidence and their viewpoint – a little like Parliamentary Select Committees.

It is not a new idea, but there are important reasons why the time is right to consider these forms of dialogue:

People are heartily fed up with perfunctory, tick-in-the box forms of dialogue, especially simplistic online surveys with questions like ‘Do you agree with us that we should revise the regulations …. Blah blah.? ‘ Serious stakeholders want a better level of debate that considers issues properly. Public hearings can help.

We have to tackle what can be described on the week of Stephen Hawkins’ death) as the consultation ‘black hole’ It is where respondents make a submission or reply to a consultation but have no idea what happens to their views. Does anyone read them? Are they considered? If so, by whom. It is as if responses disappear down a black home never to reappear. Public hearings are one way to demonstrate that consultors listen!

All the emphasis is now on digital dialogues, and they have many fine features that encourage participation by large numbers who might not have responded using traditional methods. Public hearings can be a welcome antidote to the de-personalisation of electronic media – where real people can be seen to sit down and discuss evidence. Video-streaming can make this visible and transparent to far wider audiences, and be living proof that consultation is really taking place.

The Briefing Paper looks at the role of evidence in public debate, and the need for participants in consultations to evidence their claims and assertions. It then presents the arguments in favour of public hearings, and explores whether they might work in the context of public consultations. For existing public engagement practitioners, the most valuable section may well be on the practicalities of organising a programme of hearings and the challenges that might need to be overcome.

Our conclusion is that where there is a considerable amount of public interest, or where the subject-matter is deeply controversial, they will help convince sceptical communities that decision-makers care enough to explore the issues openly and in public. There is even a case for holding events like this well before a consultation is launched. A pre-consultation exploration of key issues and an opportunity for stakeholder to spell out what they would like to see considered might be a first-rate way of involving the public. Used in this way, hearings can even form part of a co-production approach.

Make your own mind up by reading the latest ‘Briefing Paper 35’ which you can view here if you are member. Alternatively contact Rebecca Wright to request a copy if you are not a member, or would like Institute Associates to help prepare a programme of Public Consultation Hearings for your own organisation.”

DCC Councillor Martin Shaw (East Devon Alliance) updates on NHS changes

This is a long article but if you want to know where we are with NHS changes in Devon this gives you all the information.

Our pressure has led to Devon NHS joining a national retreat from privatising Accountable Care Organisations. However the Devon Integrated Care System will still cap care, with weak democratic control – we need time to rethink

We must thank ALL our Independent Councillors – particularly DCC Independent Councillor Claire Wright, DCC Councillor Martin Shaw (East Devon Alliance) and EDDC Councillor Cathy Gardner (East Devon Alliance) for the tremendous work they have done (and continue to do) in the face of the intransigence (and frankly, unintelligence) of sheep-like Tory councillors.

At EDDC Tory Councillors told their Leader to back retaining community hospitals, so he went to DCC and voted to close them (receiving no censure for this when Independents called for a vote of no confidence).

At the DCC, Health and Social Care Scrutiny Committee Tory members were 10-line whipped by its Chair Sarah Randall-Johnson to refuse a debate on important changes and to vote for accelerated privatisation with no checks or balances.

At DCC full council – well Tory back-benchers might just as well send in one councillor to vote since they all seem to be programmed by the same robotics company!

Consultation by Parliament should be more than asking people for their views then ignoring them

Concluding paragraph of article

“The analysis of the UK Parliament’s attempt to integrate the public’s voice into the legislative process shows, therefore, that while the public’s view may enhance the understanding of the consequences of a bill and therefore enhance its scrutiny, this in itself does not constitute effectiveness. In order to have a greater impact on legislation, its integration needs to be thought through as something more integral to the legislative process rather than simply sitting in parallel with it. Integrating the public’s view directly into representative institutions requires a very careful consideration of their role and of the processes in place to facilitate it and to maximise its effect on scrutiny.”

“Fix the NHS: Protesters rally in London [and Exeter] to call for government action

“Health workers, activists and unions are marching in central London on Saturday to protest against government inaction over the NHS winter crisis.

Hospitals have been overwhelmed in recent weeks by a surge in admissions that has led to delays of up to 12 hours on emergency wards, patients left on trollies for hours and thousands of patients forced to wait in ambulances before receiving urgent care.

Two pressure groups, the People’s Assembly and Health Campaigns Together, have organised the rally to call on the government to plug funding and resource gaps in the health service. …”

Mid-Devon Scrutiny Committee consults residents on problems

People are happier in Crediton than their neighbouring district towns of Tiverton and Cullompton a survey has found.

Members of Mid Devon District Council’s scrutiny committee went to the three towns between May and August to gather opinion after it was agreed a lack of consultation was a key issue for the public. …”