The Monitoring Officer to report on the receipt of any questions, representations, or statements of case in accordance with the Council’s procedures.
From Indira Nath : Q1: “According to the Health Service Journal (29th July 2021) the New Hospital Programme Team requested the following documents of Trusts who are “pathfinder trusts” in the government’s hospital building programme.
· An option costing no more than £400 million;
· The Trust’s preferred option, at the cost they are currently expecting; and
· A phased approach to delivery of the preferred option.
So, in relation to the Building Better Hospitals for the Future scheme, when will the documents sent to the new hospital programme team on these options be made publicly available? Are they available now? If not available, why not?
Q2: “ICS Chair David Sissling stated at the Leicester City Health and Wellbeing Scrutiny Commission that the local NHS needs to become more adept at engaging the public. What do you think have been the weaknesses in NHS engagement with the public and what will becoming more adept at public engagement involve? Please can you also explain the relationship between the main ICS NHS Board and the ICS Health and Care Partnership Board, and tell me what each will focus on and the balance of power between them?
From Sally Ruane: Q1: “Following information requested by the New Hospital Programme Team, what changes were made to the Building Better Hospitals for the Future scheme in order to submit a version of the scheme which costs £400m or less? And what elements of the scheme were taken out to reach this lower maximum spend?
Q2: “My question to the Joint Health Scrutiny meeting in July asked about an ‘Impartiality Clause’ voluntary organisations were required to sign by CCGs if they wished to promote the Building Better Hospitals for the Future consultation in exchange for modest payment. Unfortunately, neither the oral nor the written responses fully addressed this question. Please can I ask again whether the Impartiality Agreement was legal, whether it is seen as good practice and what dangers were considered in deciding to proceed with these agreements; and what steps the CCGs took to ensure that organisations under contract informed their members/followers in any engagement they (the organisations) had with their members/followers that they were working under a service level agreement which contained an “impartiality clause”.
Q3: “There is little in the government’s legislation about the accountability of integrated care systems to the local public and local communities. How will the integrated care board be accountable to the public? Its precursor, the System Leadership Team, has not met in public or even, apart from the minutes, made its papers available to the public. The CCGs have moved from monthly to bi-monthly governing body meetings; UHL has moved from monthly to bi-monthly boards and does not permit members of the public to be present at the board to ask questions. How will the integrated care Board provide accountability to the public and how will it improve on the current reduced accountability and transparency?”
From Tom Barker:
Q1 “The government is indicating that they may now not fully fund trusts’ preferred new hospital schemes, despite previous assurances. Both a phased approach and a cheaper, £400m scheme will impact the delivery of care significantly as both will require changes to workflow. This would especially affect people in Leicester, Leicestershire and Rutland as the UHL reconfiguration plans have limited new build (the Glenfield Treatment Centre and the LRI Maternity Hospital) and involve a lot of emptying and reconfiguration of working buildings. Dropping a project or delaying it could very easily create a situation where necessary adjacencies are lost etc. What will be the impact on patient experience of both the £400m version of the project and the phased approach?
Q2 “With regard to Building Better Hospitals for the Future, what are the revised costings as of August 2021 for the full (and preferred) scheme including local scope/national policy changes as requested by the New Hospital Programme?”
Q3 “NHS representatives have stated that there will be no private companies on the Integrated Care Board. Can you assure me there will be no private companies on the Integrated Care Partnership, on ‘provider collaboratives’, or committees of providers, or any sub-committees of the Integrated Care Board or Integrated Care Partnership?”
Q4 “CCGs currently have a legal duty to arrange (i.e. commission or contract for) hospital services. This legal duty appears to have been removed for their successor, the Integrated Care Board. If this is indeed the case, the Integrated Care Board may have a legal power to commission hospital services but no legal duty to do so. What do you think are the implications of this for the way our local Integrated Care Board will run?
From Jennifer Foxon: “Re the hospital reconfiguration plans in LLR, how would a phased approach change the final organisation of hospital services when compared with current plans?”
From Brenda Worrall: Q1: “Besides representation from the Integrated Care Board and three Local Authorities, which organisations will have a seat on the ‘Integrated Care Partnership’ and what will its functions be?”
Q2: “In moving towards integrated care systems, NHS England has significantly increased the role of private companies on the Health Systems Support Framework, including UK subsidiaries of McKinsey, Centene and United Health Group, major US based private health insurance organisations. Please could you tell me which private companies NHS organisations in Leicester, Leicestershire and Rutland have used or are using to help implement the local integrated care system.”
From Kathy Reynolds: “As we move towards Integrated Care Systems, I would like some clarity on Place Led Plans. About April 2021 at a Patient Participation Group meeting Sue Venables provided some information suggesting there would be 9 or 10 Places, 1 in Rutland, 3 in Leicester City and several in Leicestershire. I would like to know how many Place Led Plans are in or will be developed? What are the geographic areas covered by these Place Led Plans? Further what will be devolved to Places as the Place Led Plans become operational and how will this be funded including what will the Local Authorities responsibilities be for funding as a partner in the ICS? I’m not expecting detailed financial information at this time, but I would like to understand the general geographic areas, approximate funding requirements and where funding streams will come from.”
From Steve Score: “ The government intends to reduce the use of market competition in awarding contracts. While this is generally not problematic when contracts are awarded to NHS and other public sector organisations, it is likely to be controversial to extend a contract or give a contract to a private company without safeguards against cronyism provided by market competition. Given this reduction in safeguarding public standards and given the different motivation of private companies who prioritise shareholder interests over public good, can you confirm that neither the Integrated Care Board, nor its sub-committees, will be awarding any contract to private companies, much less without competition?”
From Jennifer Fenelon, Chair Rutland Health & Social Care Policy Consortium:
“At the last Joint HOSC, you kindly asked the CCGs to respond to the issues raised with them in December 2020. They came from a major conference of Rutland people which was called to consider the impact of UHL reconfiguration on Rutland. Andy Williams was present.
The resulting formal submission into the consultation process addressed how UHL reconfiguration plans to move acute services further away from Rutland could adversely affect this isolated rural community sitting as it does at the periphery of LLR.
It put forward 15 ways in which those effects could be mitigated including practical proposals from our Primary Care Network for bringing care closer to home. We have now had a reply from the CCGs dated 17th August, but it does not offer reassurance that action has or will be taken on these points.
Mr Williams has said frequently to us that compensating services will be provided “ closer to home” . Mr Sissling has added this week that the new ICS will be better than hitherto at engaging the public in planning modern integrated services. These words are very encouraging and reassuring.
We worry, however, that the NHS Plan to move non-urgent services closer to home has now been Government policy since 2019. Evidence shows that shifting work from acute hospitals to community services needs investment or it will fail yet planning is just starting on the Rutland Plan. That process will need to move at speed to ensure new services are in place before the UHL reconfiguration is completed. Above all it must be backed by capital and revenue.
Can we have assurance from the shadow ICS through the Joint HOSC that :-
· Where PLACE BASED PLANS contain proposals to provide alternatives closer to home, they are fast tracked to ensure they are in place before acute services are moved
· PLACE Based Plans will be supported by the necessary capital and revenue funding to support implementation of care closer to home especially where they will replace services that are no longer accessible.
· that these 15 issues (see list below) affecting this rural community will be resolved including the capital and revenue needed as above.
These questions will be considered in accordance with Rule 10 of the Scrutiny Procedure Rules of the Council’s Constitution.
The Monitoring Officer reported that several questions had been submitted by members of the public as set out on the agenda.
The Chair outlined the procedure for the meeting and advised that there was a wide amount of overlap in the questions which had therefore been put into three groups to be taken together with the opportunity for each questioner to ask a supplemental question.
· Health Service Journal report
From Indira Nath: Q1:“According to the Health Service Journal(29thJuly 2021) the New Hospital ProgrammeTeam requestedthe followingdocuments of Trusts who are “pathfinder trusts” in the government’s hospitalbuilding programme.
· An option costing nomore than £400million;
· The Trust’s preferredoption, atthe costthey are currentlyexpecting; and
· A phased approach to deliveryof the preferred option.
So, in relation tothe BuildingBetter Hospitals for the Future scheme, when will thedocuments sent tothe newhospital programmeteam on these optionsbe made publicly available?Are theyavailable now? If not available, whynot?
FromSally Ruane: Q1:“Following informationrequested bythe New Hospital Programme Team,what changes were made tothe BuildingBetter Hospitals for theFuture scheme in order to submita version of the scheme which costs £400mor less? And whatelements of thescheme were taken out to reachthis lower maximum spend?
FromTom Barker: Q1“The government is indicatingthat theymay nownot fullyfund trusts’ preferrednew hospitalschemes, despite previous assurances. Botha phased approach anda cheaper, £400mscheme will impactthe delivery ofcare significantly as bothwill require changes to workflow. This would especially affect peoplein Leicester, Leicestershire andRutland as the UHL reconfigurationplans have limited newbuild (the Glenfield TreatmentCentre and theLRI Maternity Hospital)and involve a lot of emptyingand reconfiguration ofworking buildings. Droppinga project ordelaying it could veryeasily createa situation where necessaryadjacencies are lostetc. What willbe the impacton patientexperience of boththe £400mversion of the project andthe phasedapproach?
Q2“With regard toBuilding Better Hospitalsfor the Future, what are therevised costings as ofAugust 2021 for thefull (and preferred) scheme including local scope/national policychanges as requested bythe New Hospital Programme?”
FromJennifer Foxon: “Re thehospital reconfiguration plans inLLR, howwould a phased approach change thefinal organisation of hospital services when comparedwith current plans?”
Rebecca Brown, Acting Chief Executive UHL, responded that in terms of the reconfiguration, as one of the 8 national New Hospital Programme (NHP), Pathfinder schemes UHL had been asked to look at a range of approaches on how to go about building new hospitals in Leicester. Three scenarios were being considered:
– An option that fits the Trust’s initial capital allocation of £450m in 2019
– The Trust’s preferred option
– A phased approach to delivery of the preferred option
The Leicester scheme had remained almost exactly as described three years ago at the time of the initial capital allocation, however some of the parameters now expected to be met had changed significantly; for example the percentage of single rooms with the impact of Covid versus open wards, the amount of money expected to be set aside for contingency and the requirement to make the buildings “net zero carbon”. UHL had therefore submitted plans which illustrated what can be achieved within the original allocation, their preferred option and a phased approach which would deliver the preferred option albeit over a longer time scale.
It was recognised that it was a necessary part of the process for colleagues in the New Hospital Programme to challenge each of the Pathfinder schemes, this was a proper process on behalf of the treasury for delivery and value for money.
The content of the submitted template was commercially sensitive and not in the public domain however details of the way forward would be released once it had been agreed with the New Hospital programme.
The Chair invited supplemental questions:
Indira Nath asked why papers were being withheld, and for further explanation of why they are “commercially sensitive”.
Sally Ruane asked if there was any more information on what would be taken out of the scheme in the version expected to meet the changes requested nationally/locally.
Rebecca Brown Acting Chief Executive UHL replied that in respect of commercial sensitivity, whenever the government was given information that could impact on anyone wanting to bid or pursue a tender exercise then that information could not be shared. As this scheme involved 8 Pathfinders the information was all being held centrally. Once UHL was able to share details it would do so, but they had no timescale yet on that.
In relation to elements within the plan the UHL were committed to delivering all the proposals they went out to consultation for.
Tom Barker asked with regard to the £450m being cut to £400m and potential for a large overspend, if the impact was considerable would the public be consulted again?
Rebecca Brown Acting Chief Executive UHL, clarified that the Health Service Journal letter was talking about a different scheme and UHL were asked to put in a template against their £450m scheme and were committed to deliver the full programme on that.
The Chair referred to the Building Better Hospitals item later on the agenda where further discussion could be had and confirmed that £400m was another scheme.
The Chair indicated that the Joint LLR Health Scrutiny committee would recommend that the UHL reconfiguration scheme was funded in full and support that request.
· Integrated Care System
From Indira Nath Q2: “ICSChair David Sisslingstated at theLeicester City Healthand Wellbeing ScrutinyCommission that the local NHS needs tobecome moreadept at engagingthe public. Whatdo you think have been the weaknesses in NHS engagement with the public and what will becomingmore adeptat public engagement involve?
Q3 Please can youalso explain the relationshipbetween the main ICS NHS Boardand theICS Health and Care Partnership Board,and tell me what eachwill focus on andthe balance ofpower between them?
From Sally Ruane Q3: “Thereis littlein the government’s legislation aboutthe accountability of integrated care systems to the local public and local communities. Howwill the integrated care board be accountable to thepublic? Itsprecursor, the System Leadership Team, hasnot metin public or even,apart fromthe minutes,made its papers available to the public.The CCGs have moved frommonthly to bi- monthlygoverning bodymeetings; UHL has movedfrom monthlyto bi-monthly boardsand does notpermit members ofthe public to bepresent atthe boardto ask questions. How will the integratedcare Board provideaccountability to the public andhow willit improve on the current reduced accountabilityand transparency?”
From Tom Barker: Q3 “NHSrepresentatives have stated that there willbe no privatecompanies on the Integrated Care Board. Can you assure me there will be noprivate companies onthe Integrated Care Partnership, on ‘provider collaboratives’, or committees of providers, or anysub-committees of the Integrated Care Board or Integrated CarePartnership?”
Q4“CCGs currentlyhave a legalduty to arrange (i.e. commission orcontract for) hospital services. This legalduty appears to havebeen removed for their successor, theIntegrated Care Board. If this is indeed the case,the Integrated Care Board mayhave a legal power tocommission hospital services but no legal duty to do so.What do you think are theimplications of this for the way our local Integrated Care Boardwill run?
FromBrenda Worrall:Q1: “Besides representationfrom the Integrated Care Boardand three LocalAuthorities, which organisations will have a seat on the ‘IntegratedCare Partnership’ and what willits functionsbe?”
Q2: “Inmoving towards integratedcare systems, NHS Englandhas significantly increasedthe role of privatecompanies onthe Health Systems Support Framework, includingUK subsidiaries of McKinsey, Centene and United Health Group,major US basedprivate health insurance organisations. Please couldyou tell me whichprivate companies NHSorganisations in Leicester, Leicestershire andRutland have used orare using to help implement the localintegrated care system.”
From KathyReynolds: “As we move towards IntegratedCare Systems, I wouldlike some clarity on PlaceLed Plans. About April 2021at a Patient Participation Groupmeeting Sue Venablesprovided some information suggestingthere would be 9 or 10 Places, 1 in Rutland,3 in Leicester City and several in Leicestershire. I wouldlike to know howmany PlaceLed Plansare in or will be developed?What are the geographicareas covered bythese PlaceLed Plans? Further what will be devolved to Places asthe Place Led Plans become operationaland howwill this befunded includingwhat will the LocalAuthorities responsibilities befor fundingas a partner in the ICS? I’mnot expecting detailedfinancial information at this time, butI would like to understandthe general geographic areas, approximatefunding requirementsand where funding streamswill comefrom.”
FromSteve Score: “ The government intendsto reduce theuse of market
competition inawarding contracts.While thisis generally not problematic when contractsare awardedto NHS andother public sector organisations, it is likely to be controversial toextend a contractor give a contract toa private company without safeguards against cronyismprovided by market competition. Given this reduction in safeguardingpublic standards and given the different motivationof private companieswho prioritise shareholder interests over public good, can you confirm thatneither the Integrated Care Board,nor its sub- committees, will be awardingany contractto privatecompanies, much less without competition?”
The Chair invited David Sissling to respond
David Sissling, Independent Chair, LLR Integrated Care System responded regarding engagement that the NHS in Leicester, Leicestershire, and Rutland would continually reflect on its engagement practices and strengthen these wherever possible. During the Covid-19 pandemic in particular the NHS had worked hard to re-establish links with many communities through genuine outreach and have worked to understand relevant issues and co-create solutions. Work with the voluntary and community sector, including faith and community leaders, has been central to this, as has been our partnership with Healthwatch.
These improvements will be continued and feedback from as many people as possible will be sought. The NHS would look to engage with all individuals and communities on their own terms, in places and at times that suit them, using materials in appropriate languages and formats. It was recognised too that there were often communities within communities and that these may be hidden and not typically have a voice and steps would be taken to provide the opportunities for these people and groups to be heard.
Engagement activity across NHS partners was increasingly being joined up, using common approaches, pooling resources and sharing intelligence. Work had also begun to work more closely with local authority partners on engagement where practicable.
Across the NHS partnership focus has increasingly been on actively listening to communities to understand their experiences and aspirations. This insight allows us to make enhanced decisions about the way in which services will be delivered and to flag potential issues that may require closer examination by partners. We recognise the need to do more to close the feedback loop, explaining to the public how what we have heard through our engagement has influenced our thinking and the decisions that are made.
The next step of the improvement process will be to embed genuine co-production techniques throughout the system to redesign services and tackle health inequalities in partnership with people and communities. We will also learn from recognised good practice and build on the expertise of all ICS partners.
It was planned to develop a system-wide strategy for engaging with people and communities that sets out an approach to achieving this by April 2022, using the 10 principles for good engagement set out by NHS England as a starting point.
In terms of the relationship between the main ICS NHS Board and the ICS Health and Care Partnership Board, the will operate as a forum to bring partners: local government; NHS and others, together across the ICS area to align purpose and ambitions with plans to integrate care and improve health and wellbeing outcomes for their population.
The ICS Partnership will have a specific responsibility to develop an ‘integrated care strategy’ for its whole population. The expectation is that this should be built bottom-up from local assessments of needs and assets identified at place level, based on Joint Strategic Needs Assessments. These plans will be focused on improving health and care outcomes, reducing inequalities and addressing the consequences of the pandemic for communities.
The NHS Integrated Care Board will be established as a new organisation (replacing CCGs) that bind partner organisations together in a new way with common purpose. The NHS Integrated Care Board will lead integration within the NHS, bringing together all those involved in planning and providing NHS services to take a collaborative approach to agreeing and delivering ambitions for the health of their population.
The relationship between the ICS Partnership and the NHS Integrated care Board is non-hierarchical and based on existing and enhanced relationships with the three Health and Wellbeing Boards.
In relation to accountability once established meetings of both the ICS Partnership and the NHS Integrated Care Board will be held in public, with papers published.
Whilst final membership of both the ICS Partnership and the NHS Integrated Care Board is to be finalised, local Healthwatch organisations, are expected to continue to fulfil a key role in both of these groups. The NHS Integrated Care Board will have a minimum of two independent members, in addition to the independent chair.
Local authority health scrutiny will retain an important role in ensuring accountability. The primary aim of health scrutiny is to strengthen the voice of local people, ensuring that their needs and experiences are considered as an integral part of the development and delivery of health services and that those services are effective and safe.
Regarding private companies the Membership and terms of reference for the ICS Partnership and the NHS Integrated Care Board were still under development, although any private companies were not expected to be members of these groups.
However, Non-NHS providers (for example, community interest companies) may be part of provider collaboratives where this would benefit patients.Collaborative work was still at a very early stage of design and NHS organisations in Leicester, Leicestershire and Rutland are not using any private companies to help develop or implement the local integrated care system.
With regard to legal duty under the proposed legislation the NHS Integrated Care Board would assume all statutory duties of the CCGs, including the responsibility to secure provision of NHS services for its area.
Andy Williams, Chief Executive Leicester CCG, responded to the question on Place Led Plans that the CCG’s had worked with local government to determine place and so that was constituted differently as a local place for Place Led Planning. It was not a hierarchy or about delegating certain things to a place. Three place based plans were currently being developed, one for each of the three upper tier unitary authorities (Leicester, Leicestershire, Rutland). These plans were being developed in partnership between the local NHS and the local authorities, taking account of evidence and insights of what is important to the public and other stakeholders in those areas, and would be supported by additional local public engagement where appropriate.
The Chair asked for further details of those Place led Plans to be shared at respective scrutiny committees across Leicester, Leicestershire ad Rutland.
David Sissling, Independent Chair, LLR Integrated Care System responded to the question around market competition in awarded contracts, that whilst they were pleased by what was offered in terms of continuity and being able to form longer contracts the priority was that NHS and other public sector organisations will provide the overwhelming majority of services as they do now.
It was noted that proposals contained in the draft legislation would remove the current procurement rules which apply to NHS and public health commissioners when arranging healthcare services. The ambition was to provide more discretion over when to use procurement processes to arrange services than at present, but that where competitive processes can add value they should continue. As a result, the local NHS would have greater flexibility over when they choose to run a competitive tender.
The Chair invited supplementary questions:
Indira Nath asked whether the public would be allowed to ask questions once public meetings were held?
Steve Score sought a response to the commercial conflict example mentioned earlier.
Sally Ruane in relation to accountability asked for confirmation that meetings would be held publicly monthly and in relation to ICS Board meetings, what the timescale for opening these up was?
Tom Barker raised concern that assurances given at other meetings were not the same as those now being given and was concerned that the discussion was of the role of private companies during the pandemic rather than referring to the funding position of NHS.
Brenda Worrall asked for more detail of funding and how the funding stream would flow?
David Sissling, Independent Chair, LLR Integrated Care System replied that the frequency of meetings for the body which prefaced the ICS Board was monthly and would continue to be monthly, however the ICS board would make its own decision about frequency and papers would be made available to the public. At this point it was still open to consideration how best to involve the public in meetings. The broader Integrated Care Partnership was currently meeting three times a year and would be subject to review.
Regarding procurement it was clarified that any decision in a possible scenario with a private company would be done entirely in an open and transparent tender process.
In relation to capacity, the priority was to grow the service to meet needs of people who have had to use private sector as an alternative.
In terms of the role of private companies it was not possible to be more definitive on private companies involvement on the Leicester Care Partnership as that doesn’t exist yet, however as it became clear David Sissling would be happy to return and discuss any decision or basis for its membership.
Andy Williams Chief Executive Leicester CCG responded to the supplementary point about Place stating that initially there was a plan with budgets set for a range of services. No final decisions had been made but thought was being given to continue to plan and programme services in the same way and include those by place e.g. a City Plan, a County Plan and a Rutland Plan. The aim was to try and avoid a limited range of services and to be inclusive, it was still to be decided how to make allocations of resource.
In the absence of Jennifer Fenelon, Chair of Rutland Health & Social Care Policy Consortium, the Chair agreed to take her questions as read on the agenda and invited officers to respond.
Rebecca Brown Acting Chief Executive UHL advised this had been partially answered in the earlier responses and confirmed that the preferred option was not to have a phased approach. It was not possible to discuss that further as more information would be needed than was currently available and it would be a political decision as to when the programme would be started.
· UHL Reconfiguration
From Sally Ruane: Q2:“My question tothe Joint HealthScrutiny meetingin July askedabout an ‘Impartiality Clause’voluntary organisationswere required to sign by CCGsif theywished to promote the Building Better Hospitalsfor the Future consultation in exchangefor modest payment. Unfortunately, neither the oralnor the written responses fullyaddressed this question. Please can I ask again whether the ImpartialityAgreement was legal,whether it is seen as good practice and what dangers were consideredin decidingto proceed with these agreements; and what steps the CCGs took to ensure thatorganisations under contract informed theirmembers/followers in any engagement they(the organisations) hadwith their members/followers thatthey wereworking under aservice level agreement which containedan “impartiality clause”.
Andy Williams responded that the CCGs were confident that the agreements reached with the voluntary and community sector to support participation in the recent Better Hospitals Leicester consultation was both lawful and based on examples of best practice and that remains their view and overall the CCG’s believe the activity achieved this very successfully.
The Chair thanked all for their questions and responses.
That full written responses would be appended to the final minutes.