The Big Health and Care Conversation: Brighton & Hove ‘Caring Together’ and the Sussex and East Surrey Sustainability and Transformation Partnership

The Department of Health (DoH), and Healthwatch England [HWE] have asked local Healthwatch to be involved in Sustainability and Transformation Partnerships (STPs)
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“Healthwatch Brighton and Hove welcomes the Big Health and Care Conversation and is keen to support open and frank discussion of the challenges that face health and care in the City.”
— Fran McCabe, Chair, Healthwatch Brighton and Hove, June 2017

1. Background

A number of documents have been produced which help to explain more about
(1) The Big Health and Care Conversation – Brighton and Hove Clinical Commissioning Group
(2) Brighton & Hove Caring Together – Brighton and Hove City Council, and
(3) The Sussex and East Surrey STP – Sustainability and Transformation Partnership

2. How is Healthwatch Brighton and Hove involved?

The Department of Health (DoH), and Healthwatch England [HWE] have asked local Healthwatch to be involved in Sustainability and Transformation Partnerships (STPs); and to assist in developing local health and care ‘place-based plans ’. Since Healthwatch Brighton and Hove (HWBH) was established in the City three years ago we have taken an active role in providing evidence and representation from the consumer’s view to health and care planners and decision makers.

HWBH is represented at the Brighton and Hove Caring Together Board, and the STP Board. We are also included in planning for engagement and consultation locally, and we work alongside colleagues in Community Works who represent the Community and Voluntary sector.

3. What does Healthwatch expect in the ‘Big Conversation’

– That proposals to change services are based on good evidence about better outcomes for users and patients
– That the conversation and any service change should address health inequalities and make them better, not worse
– The conversation should improve and streamline services for people, particularly those with long term needs
– The Big Conversation should involve the public and service users. It should adhere to the Gunning principles and ensure that less heard voices are included.

4. What can local people expect from Healthwatch?

– We want to ensure a transparent and robust process, and call the statutory agencies to account
– We will keep you informed about what is going on elsewhere through Healthwatch England and the local Healthwatch network, and provide independent information to the public
– We will translate difficult issues and concepts into user friendly information for the public
– We will provide independent ways in which people can express their views and ensure they reach decision makers.

For more detail see below:
• We provide direct evidence about how people experience health and care services. You can view Healthwatch reports by clicking here
• Healthwatch will help people share their views on issues of current and topical concern. Local people can tell us their experiences of GP and Primary Health Care services online. The survey can be accessed by clicking here. Individuals can also provide Healthwatch with comments about any health and care experience at Brighton Pulse
• We will share best practice, and provide independent assurance to engagement and consultation (see below). There is more information about involving people in planning and decision making from Healthwatch England and the Consultation Institute

5. What is Healthwatch not able to do?

Healthwatch are not party political, we do not support one political party or cause over another.
Healthwatch remain independent of party politics, the NHS and Brighton & Hove City Council.
We are independent but not neutral: Healthwatch will always be on the side of people receiving health and care services.

6. Healthwatch and the Capped Expenditure Process [CEP]

This is a topical issue which has been in the press recently. We understand that Sussex and East Surrey STP is one of a number of STP’s that have been asked to make a CEP submission to help close the gap between expected expenditure and achieving financial balance.

“It’s clear the health service faces deeply challenging times but the solutions don’t lie in closed rooms, rather in honest conversations with patients, carers and communities. The last thing we need is a chain of kneejerk reactions driving poor decisions that don’t make sense to people. “What the NHS needs is an open culture, where local people are given opportunities to contribute from the very beginning and throughout decision making. A good place to start would be by ensuring local Healthwatch are more consistently involved in these discussions. “Where difficult choices do have to be made, people need clear information explaining the rationale and outlining how the NHS will track the impact to ensure no one is left without the care they need. “Those at the top of the NHS have sent strong messages through the Five Year Forward View Next Steps about why and how communities should be involved, but this needs to run through the heart of everything the health service says and does.”
— Imelda Redmond, National Director of Healthwatch England:

7. Engagement and Consultation – best practice advice

7.1 The Gunning principles
The Gunning Principles
Before 1985 there was little consideration given to consultations until a landmark case in that year (R v London Borough of Brent ex parte Gunning). This case sparked the need for change in the process of consultations when Stephen Sedley QC proposed a set of principles that were then adopted by the presiding judge. These principles, known as Gunning or Sedley, were later confirmed by the Court of Appeal in 2001 (Coughlan case) and are now applicable to all public consultations that take place in the UK.

a. When proposals are still at a formative stage
Public bodies need to have an open mind during a consultation and not already have made the decision, but have some ideas about the proposals.

b. Sufficient reasons for proposals to permit ‘intelligent consideration’
People involved in the consultation need to have enough information to make an intelligent choice and input in the process. Equality Assessments should take place at the beginning of the consultation and published alongside the document.

c. Adequate time for consideration and response
Timing is crucial – is it an appropriate time and environment, was enough time given for people to make an informed decision and then provide that feedback, and is there enough time to analyse those results and make the final decision?

d. Must be conscientiously taken into account
Think about how to prove decision-makers have taken consultation responses into account.
The risk of not following these principles could result in a Judicial Review. A number of public bodies across the UK have been taken to Judicial Review and deemed to have acted unlawfully in their Public Sector Equality Duty – usually linked to the four Gunning Principles

7.2 Advice on engagement and consultation
Healthwatch Kent have produced advice on Public consultations: What you can expect
NHS advice on participation, involvement and engaging patients can be accessed here.

“Healthwatch expects the Big Conversation will bring more transparency and openness, more information about the substantive issues, so the public and patients can make an informed contribution to the debate.”
— David Liley, CEO, Healthwatch Brighton and Hove, June 2017

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