ICB Board meeting and minutes

Question:

Q1

In considering the strength of the consultation exercise described in the report, as they are required to do before any service reconfiguration, will the ICB explore why the following points were not clarified in the report:

· Why only 5006 people were 'engaged with' out of 46,300+ people registered with the affected GP practices

· How care was taken not to double count people in reporting numerical involvement (e.g. same person responding to a survey and attending a public meeting)

· Whether all contacted in the consultation exercise had the same level of information and were asked the same questions?

(Gunning Principle 2 – Consultors must provide sufficient information to allow consultees ‘intelligent consideration’ of the proposals)

· the fact that the report states that on average 1 in 4 of those responding to the consultation across all of the GP practices concerned did NOT confirm they would continue to use them after the changes had been made but the report does not present this as significant :

- Foundry 1 – 1 in 5 did not confirm they would continue to use the service

- Foundry 2 – 1 in 5 did not confirm they would continue to use the service

- SAPA 1 – 1 in 3 did not confirm they would continue to use the service

- SAPA 2 – 1 in 4 did not confirm they would continue to use the service

A1

NHS South Yorkshire commissioned a social research agency to get the views of at least 1,000 people in each health centre area to ensure data was robust and reflective of the local population. In total more than 5,000 responses were received, which is considered a robust sample size. This means that the survey data is statistically reliable and has a very low margin of error. In addition, to ensure the voices of more people from marginalised communities were heard, we commissioned 17 voluntary and community sector organisations to raise awareness and seek views.

To ensure the consultation was widely known about the communication included media, social media and local practice, and via 17 the voluntary and community sector groups to marginalized communities. Materials were also in accessible formats, including common languages spoken in the four areas, easy read and BSL.

Respondents were able to feedback in more than one geographical area to avoid people from being prevented from giving their views, so there is an assumption for a small amount of double counting, E.g. someone who both attended a meeting and completed a survey. However, this does not affect the robustness of the sample.

Everyone taking part was asked the same questions. There was lots of information available, depending on how informed people wanted to be. This ranged from a few paragraphs, eight-page leaflet, 20 slide presentation, 28-page consultation document and an 84-page pre-consultation business case. We have considered the responses to from those who did not confirm they would continue to use the service and included in the recommendations we will help people to register at another practice if necessary.

The pre-consultation planning began prior to the launch of NHS South Yorkshire on 1 July 2022, and therefore Bassetlaw is referenced in the documentation.

Q2

A) How will the ICB monitor the delivery of the recommendations made in the report to address concerns raised by the public and patients and by the Sheffield Health Scrutiny Committee?

B) How will they ensure that these recommendations are delivered effectively and in a timely Manner?

A2

Building the new health centres in Sheffield is part of South Yorkshire and Bassetlaw Primary Care Capital Programme. There is a South Yorkshire and Bassetlaw Primary Care Capital Programme Board overseeing the implementation, including delivery of recommendations. Updates will be given to Quality, Performance, Patient Involvement and Experience Committee of the ICB, which oversees equality, and whose role will be delivery of recommendations to reduce any equality impacts. There are also requirements set out by NHS England and HM Treasury, who need specific detail and more plans, including outline business case (OBC) full business case (FBC). These much more detailed plans will ensure health centres are built in a timely and effective manner.

Q3

A) Why did those developing this reconfiguration of services not consider the very basic concerns about service change that were raised in the consultation process and predict the need for action specified in these recommendations?

B) Why did they not have dialogue with patients around any possible concerns earlier in the proposal development?

(Gunning Principle 1. [consultation] Proposals must be at a formative stage)

A3

The programme leads have considered all issues raised in the consultation and our response is set out in Section 7 of the decision-making business case. Within a few weeks of confirmation from NHS England that Sheffield had funding to build up to five health centres, we started engaging with patients and the public. This information shaped the options that the ICB consulted on, and determined which practices wished to proceed to formal consultation.

Do the ICB feel that their ‘Working with people and communities Strategy’ is still ‘fit for purpose’ given the points raised in the above questions, and WHEN will the co-production, with the South Yorkshire people and communities, of a revised strategy begin?

We will shortly be writing out to stakeholders and our citizen networks to invite views on the Strategy for the July 2023 refresh. We have already added to our website the details for people who would like to submit their comments on the document, which is via our email address helloworkingtogether@nhs.net 

Question:

Q1

SCHEDULE OF BOARD MEETINGS

I refer to Question 1 on 1 July 2022.

I welcome my first visit to Sheffield on Wednesday.

Will you please now ensure that the remaining two locations Barnsley and Doncaster will be available for the next two Integrated Care Board meetings?

A1

We’re committed to hosting our Board meetings and engagement meetings in areas across South Yorkshire to ensure that those members of our communities who wish to attend in person are able to do so. We are keen to continue to use our own premises to avoid incurring unnecessary cost. However, our facilities in Doncaster and Barnsley are not currently suitable to host Board meetings due to room size and technology. We’re continuing to liaise with partners on suitable locations that don’t increase the cost to the taxpayer.

Q2

I have difficulty as a member of the public of understanding the written 'general management speak' of the Integrated Care Board.

What is inexcusable is the continual use of ACRONYMS throughout the published documents. 

I would appreciate you letting me know what improvements you will make on both issues?

A2

We accept that some of our written papers are highly technical documents that are difficult to simplify. We will continue to try to ensure that our written communications support and uphold the principles and values set out in the NHS Constitution, including being clear, concise, straightforward and accessible, and avoiding jargon, acronyms and unnecessary technical language where possible. We will share these guidelines (https://www.england.nhs.uk/nhsidentity/identity-guidelines/tone-of-voice/) with future contributors in advance and create a standardised glossary of terms that can be included in our papers.

Q3

Given that a disproportionate number of vulnerable black / non white citizens were subjected to the most horrific abuse on an industrial scale at the specialist Doncaster children homes run by the Hesley Group and we once again learn that black parents / carers concerns were ignored within the shocking report -  Safeguarding children with disabilities in residential settings

- can the ICB Board offer an assurance that they are proactively committed to an ethos of anti-racism and the importance of ensuring that there is the necessary psychological safe space in Doncaster Place (9ii) to enable black citizens to have their say on the things that matters to them, including ensuring that our most vulnerable citizens are protected from harm in a culturally appropriate manner. 

A3

We’re grateful for this question being submitted. A formal response is being drafted by the integrated care partnership, where this question was also asked at the recent meeting in public on Friday 28 October 2022, and a commitment to provide a written response shortly was made. However, NHS South Yorkshire can give the assurance that one of its core purposes is to tackle inequalities in outcomes, experience and access, and within that we take a strong stance against any form of racism in health and care.

Question:

Q1

Question re item 16, The Health and Healthcare Impacts of Rising Costs of Living":

This paper largely ignores important factors behind the so-called "cost of living crisis", including the already existing gross inequality in the distribution of wealth in what is one of the richest countries on earth and the role that privatisation and profit-making have had in sucking resources out of public services/ stoking inflation. Private companies are now making record profits out of energy, water, rail, post and telecommunications, and probably also the NHS. The report also falsely suggests that rising pay is partly to blame, whereas the NHS and other public services have been subject to at least 12 years of pay restraint. The proposed response around "raising awareness" and "showing sympathy" is totally inadequate and will condemn the NHS in South Yorkshire to further decline, i.e. worse health, rising demand, exodus of staff, etc. Will the ICB raise its head above the parapet by calling on the government to:

• raise taxes on the richest in society;
• re-nationalise public services;
• return gas and electricity prices to previous levels;
• increase NHS pay at least in line with inflation?

A1

The paper outlines that rising cost of living the UK is currently seeing significant rises in the cost of living driven by rapidly rising energy costs coupled with supply chain issues and changes to the economy due to the impacts of the Covid pandemic, Brexit and war in Ukraine. At the time of writing the leadership contest for the next leader of the Conservative party was taking place and the Government plans had yet to be announced. Once further fiscal statements have been made NHS South Yorkshire will carefully consider what further action it can take in line with the resources made available and direction set by HM Government.

Q2

Ref : Agenda Item 11 : Corporate Assurance Report

Para 4.8 provides a table showing 8 categories of ‘Internal Incidents’ (staff) for each Place (Barnsley, Doncaster, Rotherham and Sheffield), during the period 1 July to 31 July 2022. Seven of the eight categories show no incidents at all. The only category showing any incidents is ‘Information Governance’.

What does ‘Information Governance’ include?

Is it normal for 7 of 8 categories to show no incidents?

Would it be more informative to also show the number and category of incidents for Financial Year to Date?

To mitigate the risk of under-reporting, what steps have been taken to ensure staff are aware of and understand these reporting categories?

Do ‘Serious Incidents’ include ‘Internal Incidents – Staff’? If not, what differentiates them?

A2

The information contained within this first iteration of an ICB Corporate Assurance Report relates to the month of July 2022 – this first month of ICB operation. The content and scope of the report will continue to be developed in the months ahead, and your thoughts and reflections are helpful.

Specifically:

• What does ‘Information Governance’ include? - IG incidents are usually data incidents, such as personal information being disclosed in error (sent to the wrong recipient), lost, disposed of or accessed inappropriately.
• Is it normal for 7 of 8 categories to show no incidents? – Yes, quite normal Would it be more informative to also show the number and category of incidents for Financial Year to Date? – This is showing the number of incidents for the financial year as the ICB was formally constituted from the 1 July.
• To mitigate the risk of under-reporting, what steps have been taken to ensure staff are aware of and understand these reporting categories? – There is no under reporting. This is the normal pattern of reporting that has been seen in the previous 4 organisations.
• Do ‘Serious Incidents’ include ‘Internal Incidents – Staff’? If not, what differentiates them? – No, serious incidents are what are usually reported by our provider organisations onto StEIS (The Strategic Executive Information System). The ICB is responsible for ensuring serious incidents arising from its commissioned services including primary care are properly investigated according to national frameworks with suitable actions taken to prevent recurrence. Information on the definition of a serious incident can be found here

Q3

Ref : Agenda Item 16 : South Yorkshire response to Cost of Living Crisis

This, the MOST CRITICALLY IMPORTANT agenda item is relegated to number 16 on the agenda, presumably because it has been categorized under ‘Strategy and Development’.

Why isn’t the FAST EMERGING Cost of Living CRISIS, which will have a more long lasting impact on the public and the NHS than the Covid Pandemic, given the emphasis (i.e. top billing) it deserves by the Chair?

Why does the Chief Executives report at Agenda item 8 omit any mention of FAST EMERGING Cost of Living CRISIS?

Why do self-congratulatory (Story Telling) agenda items appear so high up in the agenda compared to a CRISIS that truly threatens the achievement of the core aims of the SYICS?  

Why does the report attached to this agenda item so meekly respond that many of the issues underlying the cost of living increases are “outside the NHS remit and sphere of influence”?

The Government habitually and criminally underfunds the NHS, but why, in an unprecedented Cost of Living Crisis, doesn’t the NHS, from Cabinet Health Secretary downwards (including the Chairs, CEX’s and management teams of ICB’s) elevate and sell the life saving advantages of ILL HEALTH PREVENTATIVE MEASURES?

Why doesn’t the NHS respond bravely, instead of meekly, by going to war against the Junk Food Industry?

A3

The Cost of Living is comprehensively covered in a detailed paper that outlines the likely causes and impacts. At the time of writing the leadership contest for the next leader of the Conservative party was taking place and the Government plans had yet to be announced. Once further fiscal statements have been made NHS South Yorkshire will carefully consider what further action it can take in line with the resources made available and direction set by HM Government. NHS South Yorkshire’s four priorities are all impacted by the cost of living and as such we place a huge emphasis on leading and supporting the response. Cost of living will affect outcomes in population health and healthcare, tackling inequalities, providing value for money and how we support broader social and economic development. NHS South Yorkshire is also committed to receiving patient and staff stories from those patients who use the service. These do and will focus on some of the challenges those patients and staff face, where services could be improved, especially through partnership working, and highlight the role of dedicated and professional NHS and care staff.

Q4

9i Barnsley Primary Care Network alongside Barnsley Healthcare Federation CONTINUES TO ENHANCE THE MODEL OF PRIMARY CARE  INTRODUCING OVER 120 new roles

Q. Are these new role with additional properly qualified staff members, or are these new roles with current staff with additional roles?

A4

These are all additional employees that have been employed specifically as part of the Primary Care Network across Barnsley in line with the role requirements. At the end of June 2022 there were over 120 posts equating to 113.1 WTEs.

Q5

Agenda Item 4 – minutes of the meeting 1st July 2022-09-05

The minutes give a passing reference to the actual number of questions received without recording how many there were, and only 5 of these 28 questions were reported and recorded, having been selected by the ICB, but does record that this agenda item is part of the ICB’s public a countability.

Why does the ICB limit how it records its accountability to the public it serves and aim to be more open and transparent and respectful to the public who submit their questions in future meeting minutes?

Why do the minutes not record the actual number and insert the link to the relevant page on the website where the questions and answers are recorded in full?

Also why did the individuals who submitted the questions not receive an answer directly as the minutes record would be the case?

A5

Questions from the public are welcomed by the Board; responses to the questions received before the 1 July 2022 Board meeting were published on the ICB website shortly after the meeting

Q6

Agenda Item 5 – Story telling

This item appears to be a celebration of the transformation work happening in patches across the ICS and a public information, effectively a public relations, opportunity which is selected and presented by the ICB.

Would it not be more powerful if delivered by patients or carers describing a bad experience where a service had let them down and how the ICB listened to their insights , how the service could have worked better for them, and acted to improve it.

Would this not demonstrate more effectively that the ICB does listen to patient experiences and their insights, and demonstrate that the ICB takes their responsibilities to the people they serve and their accountability to them seriously?

A6

Thank you for some really important points made in relation to storytelling, using real experiences good and bad to help shape how we develop services and pathways across the whole system. We are developing our approach through our comms and engagement function in relation to how we gather and utilise the experience of citizens from across the system and really bring that voice into “the room”, how these may be utilised through our System Quality Group, Maternity partnerships, Board Sub Committees and through to the Trust Board. These will evolve and will include a broad spectrum of experience.

Q7

Agenda Item 8 – Chief Executive Report

In this report the new Non- Executive Director is introduced, but there is no profile on the website and no clarity given about the NED responsible for working with people and communities, a statutory responsibility regarding commissioning plans and a mandated responsibility in the purpose of the ICB, as highlighted in all guidance documents.

Can the ICB tell the public which Board member takes responsibility for the involvement of the ‘people and communities’ they serve?

Can the ICB confirm that this person has the necessary experience, knowledge and skills in practice in enabling and overseeing the necessary mechanisms to ensure a meaningful patient, carer and public voice and influence in the ICB’s governance and decision-making?

Will the ICB allow sufficient resources to support the mechanisms to allow direct dialogue with people and communities in ‘real time’ and on their terms?

Will the ICB be sure to engage with the national leadership aiming move to improve how the patient voice is listened to and the acknowledgement that just repeating what the CCGs did is not acceptable?

A7

New Non-Executive Director profiles are added to the NHS South Yorkshire website as soon as they are available. A number of Executives have responsibility for involvement, including the Chief Nursing Officer and Executive Director of Strategy and Partnerships. In addition, Lesley Dabell, Independent Non-Executive Director, has a strong background in people and communities. They are supported by the wider engagement and involvement department, which is full resourced to engage and consult with our communities.

Q8

Agenda Item 9 – Place reports

How exactly do patients, carers and the public influence any decisions and discussions that the Place-Based Partnerships have?

Why are ‘people and communities’ not represented on the Place-based Partnership Boards as instructed by NHSE guidance?

A8

In line with ICB’s Start With People Public and Communities” strategy, public voice will be at the centre of our decision making for NHS South Yorkshire. Moreover, we want to build on the good work of our Place partners and continue close working relationships with dozens of voluntary and community sector organisations to bring in the needs and views to our committees

Please find the strategy here https://syics.co.uk/application/files/7716/5668/8265/Enc_9h_-_Start_With_People_South_Yorkshire_Strategy_Doc.V1.pdf

Our Place-based Partnerships Boards are currently being established, with current appointments representing Healthwatch, the Voluntary Community and Faith sector. These Boards will work alongside care and communities’ engagement and participations groups, exploring new ways of engaging with our communities to ensure their voice is at the heart of all we do.

Q9

Agenda Item 10 – Integrated Performance Report

Why do these reports always only show the success rates of meeting national targets, which suggests the ICB only measures and monitors what ‘must be done’?

Would it not be more effective to have a reporting mechanism that also captures the reality of service delivery, which does not always meet the need, and to monitor and reports on:

• Real time patient and carer experiences of service ‘system failures’, and how these were, or are intended to be, addressed to prevent repeat occurrences
• Actual reasons behind complaints rather than just counting how many there were
• Actual reasons for any negligence claims against a provider, not just the total amount paid

A9

The information contained within this first iteration of the ICB Integrated Performance report relate largely to the key measures by which the NHS is held to account by the public – through the NHS Constitution and HM Government. We will continue to develop our report over the coming months, and will bear your comments in mind.

Q10

Agenda Item 12 -  ICB Special Nominated Leads

Will the ICB introduce a mechanism for these officers to be in touch with the people and communities relevant to their new responsibilities so that real time intelligence is shared and acted upon?

A10

The ICB Special Nominated Leads will engage appropriately with partners, colleagues and the population were serve.

Q11

Agenda Item 13 – Commissioning Policies

Will the ICB adhere to their statutory duty to involve people in commissioning arrangements, plans and decisions which do not seem to be a priority in their commissioning strategy and lays them open to legal challenge?

A11

Yes – ICB will adhere to its Statutory Duty

Q12

Agenda Items 14, 16, & 19 – EPRR; Cost of Living Crisis; Population Health and Health Inequalities

The emergency preparedness, resilience and response document highlights the risk of business continuity, the Costs of Living Crisis highlights capacity and the population health and health inequalities document highlights existing poverty.

Will the ICB integrate its strategic response to the ‘tsunami’ of need for health and care that will emerge in the next few months?

Will the ICB recognise that non-statutory agencies will really struggle to meet the need for their support services as their energy, transport, premises and staffing costs become unaffordable, and reliance on volunteers may not be sustainable as people may not be able to afford to give as much of their time as this crisis unfolds?

Will the ICB recognise the serious risk of these providers having to close down which will make social prescribing and care in neighbourhoods unsustainable?

A12

Integrated Care Systems have four core purpose to:

• improve outcomes in population health and healthcare
• tackle inequalities in outcomes, experience and access enhance productivity and value for money
• help the NHS support broader social and economic development.

NHS South Yorkshire is committed to theses four key purposes and to working in partnership to deliver improvements. We recognise that the increased cost of living will have a significant impact and as such we place a huge emphasis on leading and supporting the response both locally in our communities and working with strategic partners across South Yorkshire so that we can combine our resources and expertise to best support all our local populations in Barnsley, Doncaster, Rotherham and Sheffield.  

Question:

Q1.                                                                                                                                                                                                                                                      

AGENDA ITEM 4 QUESTIONS FROM THE PUBLIC - ENCLOSURE 11 SCHEDULE OF BOARD MEETINGS

ICB meetings are scheduled every two months from 1 July 2022 to 1 March 2023 at Oak House, Rotherham. In order to attend meetings at Oak House without transport, I need to travel by bus, (commencing at 07.15) by train and taxi (and return) at a cost of £32.70. In the Constitution, Page 50, Section 9.1.3 states that the ICB has adopted the ten principles sent out by NHS England for working with people and communities. The first principle is putting the voices of people and communities at the centre of decision making and governance.

Why are you meeting in the same inaccessible place for at least the next five meetings? Will you today agree to host and rotate future ICB meetings at all four venues, Barnsley, Doncaster Rotherham and Sheffield?  

A1.

Oak House was chosen because it can accommodate a larger number of people in a socially distant way than our other locations. It also has the facility to hold meetings online to offer greater public access for some. We were keen to use our own premises to avoid incurring unnecessary cost. However, we will investigate the options for rotating the meeting to other locations.

Q2.

In relation to agenda item 4, Constitution and Standing Orders, the constitution contains no commitment to a comprehensive range of health services or public provision or provision free to anyone living in South Yorkshire. Why not?

A2.

These are core pillars of the NHS Constitution. Our ICB Constitution does not replace the NHS Constitution, to which all NHS organisations are bound, therefore we did not find it necessary to repeat these in our ICB Constitution, which instead sets out how the ICB in South Yorkshire will operate.

The National NHS Constitution states that:

The NHS provides a comprehensive service, available to all - It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.

Access to NHS services is based on clinical need, not an individual’s ability to pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

Q3.

Can the Board explain for the benefit of members of the public what is meant by the term ‘at scale’, which appears frequently in all kinds of commissioning contexts, and here specifically in the ICB Constitution itself, paragraph 1.1.4?

Can the Board provide detail and context to help members of the public understand the values and objectives that underpin service delivery ‘at scale’?

It would be helpful if examples could be given of how areas of health provision have been transformed locally to align with ‘at scale’ principles.

A3.

The term ‘at scale’ is used to describe for example when a service may be planned or delivered by one or a number of care providers or across a larger geography to either have consistency of access, quality or outcome or where current or future staffing may cause patient safety or workforce resilience concerns, to ensure that there are sustainable services for all of the populations served.

Principles which underpin this would include improvements in quality, safety, and outcomes or sustainability.

In South Yorkshire we transformed our Hyper Acute Stroke Services to improve our patient pathway for stroke patients. This took place after significant work involving clinical input and public consultation.

A recent example of which is receiving specialist treatment in the first 72 hours after having a stroke is vital for patients to survive - and to survive well. Evidence shows that patients have a better chance of recovery, and are less likely to end up with long term health problems or disability, if they receive specialist stroke care as quickly as possible. In South Yorkshire and Bassetlaw these specialist facilities, known as hyper acute stroke unit's (HASU), are based at:

1. Doncaster Royal Infirmary, Doncaster
2. The Royal Hallamshire Hospital, Sheffield
3. Pinderfields Hospital, Wakefield

All of these hospitals provide clot-busting treatments 24 hours a day, 7 days a week. Patients with a suspected stroke or transient ischaemic attack (TIA or 'mini-stroke') will be taken to their closest hyper acute stroke unit in our region, including if they are out of area such as in Rotherham or Barnsley. After being looked after in a specialist unit, patients will either:

• Go straight home with a rehabilitation and support package (if needed)
• Be taken to their local hospital for further support and care until they are well enough to no longer need hospital care (eg. Barnsley patients will be taken to Barnsley Hospital and Rotherham patients will be taken to Rotherham Hospital)
• Be taken to a rehabilitation centre or unit at their local hospital or in their local area for further support until they are well enough to go home.

In 2021 a comprehensive HASU Evaluation involving multiple stakeholders, patients and their families was completed.

The evaluation concluded that the transformation of the HASU model in SYB has achieved many of the anticipated benefits:

• The HASU transformation has undoubtedly strengthened HASU provision with the adoption of a regional approach for the stroke pathway across SYB.
• Data demonstrates that there have been improvements in the speed of Stroke Consultant assessment provided within the region.

• Staffing levels and resilience are much improved with structures to support interconnectivity between teams across the network. A third of staff surveyed indicated that they had more job satisfaction since implementation of the HASU model.  88% of staff reported that the Integrated Stroke Delivery Network (ISDN) had enabled them to gain or share new knowledge.
• Strong improvements in clinical quality have been demonstrated across the regional footprint.
• One of the aims was to ensure all HASUs would have patient numbers of sufficient size to provide sufficient patient volumes to make a hyper acute stroke service clinically sustainable, to maintain expertise and to ensure good clinical outcomes and all are achieving this.
• Patients consistently rate HASU and ASU services highly and are likely to recommend the services Friends and Family Test (FFT). The HASU patient experience survey results show that a high proportion of patients and carers are extremely satisfied or satisfied with their care. Comments include: “I received excellent care and I thought I was in the best place”; “I felt reassured to be in the hands of specialists”
• HASU’s have sustainable seven day workforce models in place and there have been reductions in the average length of stay within SYB; data evidences that there are fewer SYB patients who have survived their acute episode are discharged to care homes, which suggests that more patients are returning home; data also shows there has been a reduction in patients being newly discharged to care homes across SYB as a whole.

Q4.

In the ICB Register of Interests the Chief Executive Gavin Boyle has declared a business interest in a company named simply as ‘GSI’. For full public transparency, will he provide the full registered company name, details of any parent or subsidiary companies, and details of what services are provided by said company/companies?

Will he also state whether he is, or ever has been, or is likely to become in any way a pecuniary beneficiary of his association with this company (e.g. as a receiver of dividends)?

A4.

Please find details for the company here: https://www.gs1uk.org/

GS1 is a not-for-profit organisation providing barcoding and digital standards services to private and public sector organisations. It is commissioned by the NHS to deliver the National ‘Scan for Safety’ programme using this technology to improve patient safety in hospitals. Gavin’s former organisation - the University Hospitals of Derby & Burton was the first NHS organisation to be accredited under this programme. He is an unpaid member of its supervisory Board.

This is listed on the Register of Interests as a ‘Non-Financial, Professional Interest’ that has been declared and as such Gavin Boyle would be excluded from any decision making related to this company.

Q5.

The Deputy Chief Executive Chris Edwards’ entry in the ICB Register of Interests lists a familial interest in a company named as ‘Attain’. For full public transparency, will he provide the full registered company name, details of any parent or subsidiary companies, and details of what services are provided by said company/companies?

A5.

Attain are an Independent Healthcare Delivery Organisation, 2-4 Packhorse Road Gerrards Cross Buckinghamshire SL9 7QE. Please find further details for the company here: https://attain.co.uk/

A familial interest is where an individual has a close association with an individual who has either a financial interest, a non-financial professional interest or a non-financial personal interest (as those categories are described above). For example, this should include:

• Spouse / partner;
• Close relative e.g., parent, grandparent, child, grandchild or sibling
• Close friend;
• Business partner.

The member of the board themselves does not have a financial interest, a non-financial professional interest or a non-financial personal interest, they are just related to someone who does.

Q6.

Given that the Medical Director (or ‘Chief Medical Officer’, as listed in the Register of Interests) is required to be a registered Medical Practitioner, and that the present incumbent has private business interests in the Primary Care sector, how will the Board ensure that their role is appropriately represented if that they have to be excluded from an item of business?

A6.

The Medical Director role will not be a General Practitioner in all Integrated Care Boards across the country and is not expected to represent Primary Medical Services. Any conflict would be managed in line with the NHS and ICB Conflict of Interest policies.

Q7.

Given that the Partner Member – Primary Medical Services (not listed in the Register of Interests as at 1st July 2022) is required to be a registered General Practitioner, and therefore highly likely to have private business interests in the Primary Care sector, and a particular personal experience of conducting their profession, how will the Board ensure that:

a) their role is appropriately represented if that they have to be excluded from an item of business?

b) views and interests of Primary Care providers and their patients in different circumstances across South Yorkshire are consistently canvassed and fairly represented?

A7.

a) The partner member appointment process is yet to be completed. This role is to bring wider experience and knowledge of Primary Medical Care services to discussions at the board. The ICB chair at the meeting acknowledged that some conflicts of interest will exist in the new ways of working. Any conflict would be managed in line with the NHS and ICB Conflict of Interest policies.

b) The Integrated Care System is supporting a Primary Care Alliance to ensure that voices from across all of the Primary Care providers are heard. Engagement and consultation with patients will be an important function of the Integrated Care System.

Q8.

How soon will the Register of Interests be updated to include declarations from the following Board members, currently not listed (at 1st July 2022)?

a) Partner member – Primary medical services
b) Place Director – Rotherham
c) One of the four Non-executive members (only three are listed on the Register of Interests)

A8.

a) as soon as the appointment is made

b) already listed – the Place Director for Rotherham is also the Dept CEO of the ICB Christopher Edwards

c) as soon as the person is appointed

Q9.

Under Section 9 of the ICB Constitution, item 9.1.5(e) states that a ‘Non-Executive Member with a specific role to seek assurance on the ICB's arrangements for discharging its duties in relation to patient and public involvement’ will be appointed. Has this appointment been made?

A9.

The Non-Executive Members and their roles are as follows: Remuneration Committee (Moira Wilson), the Audit and Risk Committee (Kevin Turner), the Finance and Investment Committee (Moira Wilson) and Quality, Performance Engagement & Experience Committee (Lesley Dabell).  The 4^th Non-Executive member when recruited will chair the People, Workforce and Culture Committee. The Non-Executive who Chairs the Quality, Performance Engagement & Experience Committee will be the lead for patient and public involvement.

Q10.

Regarding ‘Urgent Decisions’ (section 4.9 of the ICB Constitution):

a) (re. 4.9.4) who is responsible for determining whether something requires an ‘urgent decision’, or constitutes ‘exceptional circumstances’, and by what criteria?

b) (re. 4.9.5) for clarification, may consultation and discussion of matters deemed urgent be conducted in private? If so, will a record of such discussions be kept in written form and made publicly available without recourse to Freedom of Information requests?

A10.

Powers may be exercised by the Chair and Chief executive or relevant lead director (in the case of committees) subject to every effort being made to consult with as many members as possible in the given circumstances.

The exercising of such powers shall be reported to the next formal meeting of the board for formal ratification and the audit committee oversight.

An example of an extraordinary situation might include disaster management

Records of any urgent decisions will be kept and made publicly available and will not necessarily be made in private unless circumstances expressed above make it not possible for them to be carried out in a meeting in public.

Q11.

Could the Register of Interests be re-ordered so that members are listed alphabetically by surname, not first name?

A11.

Yes we will do this.

Q12.

Will the Board undertake to write to all elected members across South Yorkshire, inviting them to subscribe to updates from NHS South Yorkshire (including the ICB and ICP)?

A12.

Yes, we will undertake to do this.

Q13.

Agenda Item 9 - ICB Governance Documents, Policies and Procedures - Para 8 (page47) is about the duties of the Remuneration Committee “to determine salary (including any performance-related elements), bonuses, pensions and cars, for the Chief Executive, Directors and other Very Senior Managers”.

What criteria will be used to determine performance related pay and bonuses?

A13.

The current national pay framework for ICB Executives makes no provision for performance related pay or bonuses.

Q14.

Agenda Item 9 (a) Standing Financial Instructions and Financial Limits - Ref: SYICB SFI 10.2 - Annual Reporting and Accounts

This says that “an annual report must, in particular, explain how the ICB has discharged its duties in relation to improving ………public involvement.”

What processes and procedures will be undertaken to evidence this?

A14.

Annual reports for the ICB will include a section detailing how it has discharged its public involvement duties, this is in line with the approach taken by predecessor CCG organisations.

Q15.

Agenda Item 9 (e) Adoption of Standards of Business Conduct - This is about ICB members committing to good governance as exemplified by the Nolan Principles of public life. It is aimed at achieving the NHS fundamental purpose “to improve the health and well-being of patients and service users, supporting them to keep mentally and physically well’.

How do board members reconcile this objective with the actual experiences of the public that clearly show that demand for NHS services is being actively managed downwards?

(e.g. scores of treatments withdrawn; difficulties in getting doctors appointments; Over 6 million waiting to start treatment; the story of those waiting to get on a waiting list!; A&E waiting times, etc etc)

A15.

Our staff and our Board are fully committed to the values and principles that underpin the NHS, including the fundamental purpose ‘to improve the health and wellbeing of patients and service users, supporting them to keep mentally and physically well’. We have just undergone a process to build a vision and purpose for NHS South Yorkshire, we did this in collaboration with all our colleagues and have developed the following:

Our purpose
To improve health and wellbeing, the quality and experience of care, eliminate health inequalities, and ensure South Yorkshire’s people have access to the services they need to live well throughout their lifetime.

Our vision
We are a system leader and a trusted partner who has South Yorkshire’s people at the heart of what we do. We think differently and work creatively to transform the health and wellbeing of our communities.

Our goals

Inspired colleagues: To make our organisation a great place to work where everyone belongs and makes a difference

Involved communities: To work with our communities so their strengths, experiences and needs are at the heart of all decision-making.

Integrated care: To relentlessly tackle health inequalities and to support people to take charge of their own health and wellbeing.

It has been an unprecedented few years for the NHS as a result of the pandemic, not only did it make it very difficult to deliver ‘normal’ services, the inordinate amount of pressure it put on our colleagues also meant more people than could have been predicted decided to leave their professions. The NHS is still very much in recovery and it is doing so with the full commitment of staff and with the aim of delivering high quality, sustainable health and care services for our population at its heart.

Q16.

Agenda Item 9(f) - Employment Policies and Procedures

Current CCG employment policies are being adopted for ‘Day One’, subject to a “subsequent process for the harmonization of the policies”.

Is ‘Fire and Re-hire’ explicitly excluded as a means of harmonization?

A16.

Fire and Re-hire is not a feature of the harmonisation approach. 

Q17.

Agenda Item 9(i) - Integrated Care Board Special nominated lead roles - With regard to the Special Role of – Conflict of Interest Guardian.

The person nominated for this role is the Audit and Risk Chair (i.e. an Independent Non-Executive Member). The role is about acting “as a conduit for anyone with concerns relating to conflicts of interest”. However only “employees or workers of the ICB” are mentioned as potentially having concerns.

What about patients and service users that may have concerns about conflicts of interest. Why are the ICB’s key stakeholders omitted? 

A17.

A register of Interests is published on our website. Members of the public, services users and patients are encouraged to raise any concerns they have.  This can be done through a number of routes including through raising questions in advance of Board meetings, through speaking to a member of ICB staff or through writing to the ICB.

Q18.

I have tried so many times to get in touch with CCG Doncaster and I have been to the CCG headquarters personally to find out how I can introduce myself as a domiciliary care provider. When I got there I was told at the reception they are working remotely, email them or call and leave your details and they will come back to you. No response from both ends after doing exactly what I was told not once not twice

• Why is it so hard to get to you for information?
• Is it because you don't need care providers and you have enough?
• If that is the case why do you not respond and let me know?
• Is this equal opportunities?

If you cannot give advice when you are on the commissioning team where else would I go?

How come Leeds, Surrey, West Sussex, Cheshire and Durham are happy to talk to providers and give them the information they need

I just want to know/?  if I have to go through tenders where do you post your tenders.

A18.

Your question in unrelated to the Agenda for our meeting, however, we would like to suggest that you submit an FOI to the following email address: sheffieldccg.freedomofinformation@nhs.net asking for the details of the person you need to contact with regards putting forward your services.

Q19.

Agenda Item 4. Constitution - Background/Forward 1.1 (Ps 5- 7) In the list of Partners in the ICS (1.1.4 - 1.1.6) there is only mention of NHS Providers, local authorities, the VCSE and Healthwatch as Partners in the ICS.

Please can you tell me if patients, carers and the public you service are also partners in health and care and therefore with the ICS?

A19.

Patients, carers and the public we serve are also partners in their health and care and the partners listed are also mechanisms for working in partnership with patients, carers and the public.

Q20.

In 1.1.6 the ICB constitution says that "Effective public involvement, particularly with those with lived experience and who are seldom heard, ensures that we make the right decisions" implying that the Board has mechanisms to hear any insights, not just questions, directly from the public, including patients and carers; but in 1.1.6 it also says that "Healthwatch ensure that citizen voice is at the centre of the Partnership",

Can you tell me why this is and how they are going to do that?

A20.

The involvement approach will involve both working with Healthwatch to ensure that citizen voice features prominently in our work, but also working with other partners to involve, and in some cases directly with patients, carers and the public.

Q21.

Agenda Item 4. Constitution - Composition of the Board 2.1 (Ps 13 - 16)

Please can you clarify how many Non-Executive Directors you have, what sub-committees they chair and which one takes responsibility for public involvement?

A21.

There are 4 Independent Non-Executive Members on the Board.  The committees they chair are as follows: the Remuneration Committee (Moira Wilson), the Audit and Risk Committee (Kevin Turner), the Finance and Investment Committee (Moira Wilson) and Quality, Performance Engagement & Experience Committee (Lesley Dabell).  The 4^th Non-Executive member when recruited will chair the People, Workforce and Culture Committee.

Q22.

Agenda Item 4. Constitution - Arrangements for determining the Terms and Conditions of Employees 8. (Ps 47-48)

Why, in 8.1.6 do you task the ICB Remuneration committee to determine the performance-related elements of the pay of "the Chief Executive, Directors and other Very Senior Managers" out of the public purse namely "bonuses" and "cars" when the NHS staff who actually deliver services, and are saving and extending people's lives and relieving the  pain and distress of the people you all serve are so overstretched and demoralised?

A22.

The current national pay framework for ICB Executives makes no provision for performance related pay or bonuses.  Lease cars are available to all staff through a salary sacrifice lease scheme and so in practice will not be a matter for the Remuneration Committee.

Q23.

Agenda Item 9. - Governance, Policies and Procedures - Functions and Decisions Map 9b  

Why is there no mention of patients, carers or the public contributing to the ICB decision making if, as you say, repeatedly, that listening to the public and "public involvement, particularly with those with lived experience and who are seldom heard, ensures that we make the right decisions", or is that not what you really meant?

A23.

The Summary Functions and Decision Map shows how the Quality, Performance, Patient Involvement and Experience Committee, which will have oversight of our involvement processes, fits into the governance. Our Start with People Strategy demonstrates our ambition to increasing and improving our involvement processes to ensure that public involvement does ensure that we make the right decisions for our populations.

Q24.

Agenda Item 9 - Governance, Policies and Procedures - Adoption of Terms of Reference for ICB Board Committees 9d (Ps 21- 26)

Why do you not follow, in full, the model Quality Committee Terms of Reference produced by the, NHS, National Quality Board which suggests the ICB Medical Director and the ICB Director of Nursing should be full members and not just observers, and the committee should also have two lay members with lived experience, one being from Healthwatch, and one representative from each of Primary Care, Acute Trusts and Local Authorities and maybe ambulance and mental health services too? 

A24.

The South Yorkshire Quality, Performance, Patient Involvement and Experience Committee, terms of references will be reviewed by the committee at the first meeting. We will consider your comments at that time.

Q25.

Agenda Item 9 - Governance, Policies and Procedures - Adoption of Terms of Reference for ICB Board Committees 9d (Ps 21- 26)

Can you explain to me, and to the general public, why you diluted the wording in the 'purpose' section of the model Quality Committee ToR by changing the words "scrutinise the robustness of ...quality governance..." to read "oversight.....on the adequacy of quality structures...." and how this fits with the public accountability and honesty required in the Nolan Principles?

A25.

The South Yorkshire Quality, Performance, Patient Involvement and Experience Committee, terms of references will be reviewed by the committee at the first meeting. We will consider your comments at that time.

Q26.

Agenda Item 9 - Governance, Policies and Procedures - Communities and People Involvement and Engagement Strategy 9h

How can you approve an incomplete strategy which gives no information about how people can be involved in the ICB to influence decisions - which guidance requires should be clearly stated in all your governance documentation?

A26.

The Strategy fully complies with NHSE guidance. It is a high level strategy with further detail to be determined, however from day one of the ICB involvement will continue to take place in the forms already undertaken by the four CCGs that precede the board and the ICS PMO, and the approaches previously used will continue.

Q27.

What is the total allocated budget for the ICS 2022/23 and 2023/24?  How is this budget broken down?  

A27.

The 22/23 budget for the ICB is £2,861m (£2.9bn).  We do not yet know what the budget will be for 23/24. We require further clarification with regards what is meant by how is the budget broken down however questions from the public on matters that are not part of the governing body meeting agendas can be submitted by Freedom of Information request, details about which can be found here: https://southyorkshire.icb.nhs.uk/contact-us

Q28.

Can the Board ensure that representatives from the private sector cannot be permitted to attend meetings of the Board, or its committees or subcommittees? Will the Board ensure that this requirement is written into the ICB Constitution?

A28.

The Board intends to hold its meeting in public and therefore anyone can attend these meetings.  They are meetings in public and not public meetings.

The board is required to ensure that the underpinning principle of the NHS is not undermined and that the independence of the NHS is maintained. Any interests are published on the website.