Agenda and draft minutes

To receive any apologies for absence.

No apologies for absence were received.

To invite Members of the Committee to make any declarations of pecuniary and non-pecuniary interest in connection with items on this agenda.

Councillor Ennis declared a pecuniary interest in relation to his position on Barnsley Health Care Federation Community Interest Company, and made members aware that if discussion in any way related to this he would leave the chair and take no part in the discussion.

To receive questions from Members of the Public, which will be managed at the discretion of the Chair.

The following questions were received

From Doug Wright:-

1.    The Joint Overview and Scrutiny Committee have previously stated that 80% of all NHS business (presumably from STP to ICS) should be scrutinised at a local level. In Doncaster there has been no NHS business scrutinised by the Doncaster Overview and Scrutiny Committee since at least 2015. I believe that some of the other four ICS local authorities may be in a similar position.  Can you inform me and the 1.5 million people in South Yorkshire and Bassettlaw how democratically this will be done in the future?

2.    Is it the responsibility of the above committee to scrutinise Doncaster Joint Commission Management Board? (DJCMB) I ask this question because both Doncaster CCG and Doncaster Council have held many DJCMB meetings without giving formal notice of meetings, consulting or allowing members of the public to participate in any form. For procedural reasons this is unlikely to change for another ten months. If this committee is not responsible for DJCMB then who is?

From Leonora Everitt:-

1.    Are the JHOSC members aware that the ICS public involvement does not meet the CCGs’ statutory involvement duty and that:-

·         The public should be involved in commissioning proposals, plans and decisions, as the law states in Section 14z2 of the H&SC Act 2006 – as amended in 2012?

·         The Citizen’s Panel only has two thirds of its membership selected as citizen representatives, the remaining third being from ICS partners and ICS staff?

·         The ‘citizen’ members of the Citizen’s Panel do not represent the  geographical demographics across the five places in SY&B proportionately?

From Deborah Cobbett on behalf of South Yorkshire NHS Action Group (SYBNAG):-

1.    Are the JHOSC members aware that many paediatric staff are not supportive of the proposals for paediatric services, including those involved neonatal and maternity services and that they dispute the data used in making the HSR recommendations?

2.    a) What reports have the JOHSC received on the red and amber risks relating to the Integrated Care System (ICS) and the Hospital Services Programme (HSP) in the last two months; and when did the JHOSC last consider the risk register for both the ICS and HSP?

b) Do the risk registers include risks relating to:

            - Lack of public information and involvement

            - Diversion of funds from patient care to, for example

                        *Outsourcing of engagement tasks

                        *Commissioning and managing contracts

            - Transport for patients and families

            - The level of staff ‘buy in’

            - the speed and secrecy of decision-making outside a legal framework    for the ICS

c) What items on the risk register are of most concern to the JHOSC members?

From Deborah Cobbett:-

1.    Future challenges include: "Governance that supports change and doesn't delay it."  (page 21, para 4.3) 

Are Scrutiny members satisfied with this, given public concerns about the speed and secrecy of decision-making outside a legal framework for the ICS?

2.     In section 6, on the Hospital Services Review,  it is stated, on page 7,  ...  view the full minutes text for item 3.

To approve the minutes of the previous meeting of the Committee held on 12^th June 2018 (Item 4 attached).

The minutes of the previous meeting held on 12^th June, 2018 were received.

In relation to Hyper Acute Stroke Services Members noted that the work is progressing, and it was suggested that a full report be brought to a future meeting of the committee.

Given that Doncaster Royal Infirmary was unable to be designated in relation to Children’s Non-Specialist Surgery and Anaesthesia, an update was requested.  Members noted that each hospital was reviewed under the designation process, which would finish at the end of the year.  Not all hospitals were expected to reach the required standard, with some working towards these.

RESOLVED:-

(i)            that the minutes be approved as a true and correct record.

(ii)          That an update report on Hyper Acute Stroke Services be sent to Members of the committee in 4 weeks.

To consider a Cover Report of the Executive Director Core Services at Barnsley Council (Item 5a attached) in respect of a report on the South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS) (Item 5b attached).

The following witnesses were welcomed to the meeting:-

Lesley Smith, South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS) Deputy System Lead and Lead for Strategy, Planning and Transformation Delivery as well as Chief Officer at Barnsley Clinical Commissioning Group (CCG);

Will Cleary-Gray, Chief Operating Officer SYB ICS;

Helen Stevens, Associate Director of Communications and Engagement, SYB ICS;

Alexandra Norrish, Programme Director, SYB Hospital Services Programme.

By way of introduction a brief overview of the report previously circulated was provided. The report provided a comprehensive update of the work of partners across SYB.

Members were reminded of the long history of partnership working across SYB, which helped to support integration.  Over the past 2 years many lessons had been learned, and a number of priority programmes had been established to take work forward.   All partners had committed to the vision of giving everyone in South Yorkshire and Bassetlaw the best start in life with support to stay healthy and live longer. 

Members were reminded that the majority of the work was still undertaken in each of the five areas, with the role of the ICS to support the needs locally by working together.

The paper circulated provided an update on the progress made in each of the priority areas, including value added, and gave details of how staff, patients and the public had been engaged.

Questions were then invited from the committee, and the following areas were discussed and challenged:-

When asked of the biggest challenge facing the ICS that would have the greatest impact if resolved, it was suggested that demand for services continued to grow and meeting the expectations of the public was challenging. However, it was thought that the workforce presented the greatest challenge as it was not growing in line with demand.

The importance of public engagement was stressed, and the possibility of ICS colleagues attending community events was discussed. It was agreed that engagement was a priority and contact would be made in each of the places to engage in events at a community level.

Communications remained an issue and was acknowledged that this needs to be improved, with the system dependent on high quality communications.  The need to differentiate between ICS work and that of each place was noted, and it was suggested that ICS and place based teams could work better together.

The Hospital Services Review was given as an example where consultation had been extensive including in libraries, GP surgeries, and pharmacies.  Detailed conversations had also taken place with underrepresented groups such as the Chinese community and those in prisons. It was noted that feedback from consultation would inform the next stage.

Members also noted that many residents were also engaged through attendance at summer events. It was stressed that more could and would be done, but the key was ensuring that conversations were meaningful and tangible.

With regards to social prescribing and the public’s understanding, it was noted social prescribing locally had been recognised as an exemplar, but there  ...  view the full minutes text for item 5.

To consider a Cover Report of the Executive Director Core Services at Barnsley Council (Item 6a attached) in respect of a report on the Hospital Services Programme (Item 6b attached).

The following witnesses were welcomed to the meeting:-

Lesley Smith, South Yorkshire and Bassetlaw (SYB) Integrated Care System (ICS) Deputy System Lead and Lead for Strategy, Planning and Transformation Delivery as well as Chief Officer at Barnsley Clinical Commissioning Group (CCG);

Will Cleary-Gray, Chief Operating Officer SYB ICS;

Helen Stevens, Associate Director of Communications and Engagement, SYB ICS;

Alexandra Norrish, Programme Director, SYB Hospital Services Programme.

In introducing the item, Members were made aware that the Strategic Outline Case (SOC) had been to the CCG Governing Bodies in the area and had received their approval and it had therefore been formally published.  Members noted that an easy to read version had been developed and published alongside the SOC in response to feedback from the Committee.  Also published was a report detailing the engagement which had been undertaken over the summer.

Members were reminded of the two main themes to build on the potential for shared working facilitated by the ICS, and to develop sustainable care across the acute sector.

The SOC contained a number of proposals which included establishing Hosted Networks, to further enable shared working, standardise care, share best practice and maximise the impact of the workforce.  The proposals also included plans to build on innovation, ensuring this was adopted across organisations and across geographical boundaries.  Proposals for transformation, ensuring patients are dealt with in the most appropriate setting by a flexible workforce were also included.

In addition further development of models for reconfiguration was proposed, to ensure future sustainability, and clinical working groups had been established to drive this agenda. Public consultation would be ongoing throughout and appropriate consultation would take place once options had been more fully developed.

Members noted that work to develop Hosted Networks was ongoing with the aim to appoint hosts around Christmas, 2018 and have these operational by April 2019. 

The Committee noted the need for local consideration of place based plans through Health and Wellbeing Board and Overview and Scrutiny Committees once proposals were more developed.

Questions were welcomed from the Committee and the following concerns were pursued:-

In considering reconfiguration, Members were concerned that there may be unforeseen impacts which could potentially lead to further health inequalities.

Assurances were given that the ICS approach was one where any intervention should not make inequalities worse, with the principal for this included in the Memorandum of Understanding.  In addition the terms of reference for the Hospital Services Review had ncluded the consideration of health inequalities. 

The proposals contained within the SOC were intended to standardise care across the area in order that everyone receives the best possible care.  Members also noted that in taking forward any reconfiguration, any evaluation criteria would consider health inequalities.

It was acknowledged that when considering travel and transport, modelling would be undertaken at Lower Super Output Area (LSOA) level, and that the patient and public forum would include a wide range of representatives.  It was noted that it was proposed that these would be recruited through  ...  view the full minutes text for item 6.