Thursday 17 July 2014

Brent NHS CCG takes its toys away

Guest blog by Nan Tewari

In the most extraordinary spectacle I have ever witnessed in over 40 years of attending public meetings and meetings of public bodies (two different things) on Wednesday evening, Brent NHS Clinical Commissioning Group (CCG) fell out spectacularly with its patient representatives. In short, the CCG refused a perfectly reasonable, unanimous patient request to change the order of the agenda items of the patient engagement meeting and in the face of patient disapproval, decided to close the meeting with no business having been transacted. The badly run meetings (by a CCG public appointee) had failed consistently to run on accepted lines, namely, apologies, approval of minutes. matters arising etc. and as a result, minutes of meetings held in November 2013, March 2014 and May 2014 have never been approved and therefore cannot be put onto the CCG website for the benefit of the public at large.

The law requires CCGs to consult with patients and the public on proposed changes to the delivery of health services.   Failure to comply with the requirement can be serious with the CCG being challenged by providers as well as by individual patients and groups of patients who perceive changes as being detrimental.  Even if the CCG is confident that it is making the best decision, it still needs to go through a proper and proportionate public engagement process.

In order to meets these legal obligations, the CCG set up a committee of its Governing Body called the Equality, Diversity and Engagement (EDEN) Committee to provide itself with assurance that its public involvement activity in the multiplicity of proposed service changes was as robust as it should be.

My fellow patient reps and I (some, appointed by the CCG and others, elected by fellow patients) worked really hard to help the CCG and pointed out where it could be open to challenge.  We take the view that we are neither a rubber stamp nor nodding donkeys, and it is our duty to withhold the desired assurances if patient involvement is unsatisfactory.  The CCG did not appreciate this one little bit and started a smear campaign against patient reps saying that we were failing in our duties.

The CCG is effectively rewriting the rules to tell patient reps how they must act. In the course of doing so, they are also breaching all of the accepted rules of public body committee procedure and have stated that their particular public body (the CCG) does not have to act in accordance with these norms.

I have taken up this guest blog spot, courtesy of Martin Francis, because there is nowhere officially in Brent CCG for patients to air their views on matters of public involvement in proposed changes to local health services as is required by s14Z2 of the NHS Act 2006 as amended by the Health and Social Care Act 2012. It would be interesting to hear what others patients and members of the public have to say.


Anonymous said...

Have complete faith in you from previous posts on this site. Have complete faith in your response to what's happened here. However, I think you're assuming a degree of knowledge and awareness we don't actually have. Could you clarify what the bodies you refer to are actually constituted to do?
Mike Hine

Anonymous said...

So doctors expect tokenism from patient representatives?
This is part of the reason GPs should never have been given the keys to the CCG.
I hope that Nan manages to get this out there to the wider media.

Nan. said...

Dear Mike,

It is always difficult to judge how much detail to put into something like this, so your question is really helpful. Do feel free to let me know if the information below does not address what yiou wanted to know.

Health services in Brent are purchased (commissioned) for us patients by a combination of NHS England, Brent CCG and Brent Council (public health).
The CCG is a membership body consisting of all the 67 GP practices in Brent. The practices are grouped into 5 localities: Harness, Kilburn. Kingsbury. Wembley and Willesden. Each locality elects a couple of GPs to represent it on the CCG Governing Body (GB). A number of committees report to the GB including the Equality, Diversity and Engagement (EDEN) Committee.

Brent CCG commissions generalist hospital, community health and mental health services.

NHSE commissions GP (primary care) services (on the principle that a group of GPs cannot buy services from itself!) and specialist medical services together with healthcare for the armed services and in prisons.

Brent Council public health is responsible for health promotion and health improvement services.

Brent CCG operates under a constitution that has been approved by NHS England. If the CCG wishes to vary the constitution, it has to apply to NHSE to do this.

The community representatives on the EDEN Committee consist of the chairs of the locality patient participation groups (PPGs) who have been elected by their fellow patients, and people in the community appointed by the CCG who represent people with learning and physical disabilities, people with mental health needs, children, carers, people with long term conditions, elderly people and ethnic minorities.

Since EDEN was established, the community representatives have spoken to the CCG with a united voice on all matters of substance in giving guidance to the CCG on how it can carry out its legal public involvement obligations meaningfully.

It is unfortunate that the CCG does not make best use of this excellent patient engagement framework and instead, tries to fob us off with half-baked involvement exercises that fail to meet NHSE standards as laid out in national guidance on how engagement, involvement and consultation should take place.

Anonymous said...

Thanks Nan,

Exemplary clarity. Got it now.
Isn't it endlessly depressing the way that the first instinct of those in control always seems to be to circle the wagons and try to head off democratic engagement and participation while simultaneously adopting the vocabulary of those values, (in fact making its inclusion practically mandatory in all communications)?
Good luck in your efforts to stop them.

Mike Hine