Saturday, July 15, 2017

Health Scrutiny - looking back to 22nd March and forward to 24th July

I have today received the agenda papers for the forthcoming Cumbria Health Scrutiny meeting on 24th July which are available on the CCC website here.

This meeting will receive the draft minutes of the now notorious meetings on 22nd March for which the actual scrutiny meeting minutes are available here and the record of the "dispute resolution" meeting with the NHS "Success Regime" which took place during the recess is available here.

There is a protocol for attempting to resolve disagreements between the Health Scrutiny Committee and the NHS organisations which the committee is supposed to scrutinise before you get to the stage where the committee "calls in" decisions and refers them to the Secretary of State.

That in itself is a good thing but if the advice which was given to the 22nd March committee is correct, one aspect of that protocol was a disaster waiting to happen in terms of public confidence in the consultation and scrutiny process - and the disaster happened on 22nd March.

I can see the logic in encouraging the Scrutiny Committee and the NHS Trust to discuss the issues and concerns after a "call in" vote to allow for the possibility of some honourable compromise before the reference to the minister goes ahead.

Apparently the protocol provides the possibility of an immediate discussion with the Trust during a recess immediately after the vote, and for the committee to then reconvene and be asked to vote again the same day on whether to proceed with the previous decision.

Now even if you manage to avoid any confusion over whether the meeting is finished and don't end up with a decision reversed after some councillors have gone home - which was part of the problem on 22nd March - there is a serious problem with this process.

Whether you agree with the initial decision or not, the original vote to refer a decision to the Secretary of State would not be taken lightly, and would almost certainly involve a lengthy debate, as it did on 22nd March.

Is it really a good idea to try to resolve all the concerns that caused to a vote to refer a matter to the minister, and then reverse the decision that same evening?

If the times given in the draft minutes of the two meetings are correct - and I am asking for these times to be checked as I have difficulty believing them - then seven hours elapsed between the start of the Health Scrutiny meeting at 10.30am, and that of the "dispute resolution" meeting at 5.30pm.

That seven hour period included three ten minute adjournments after motions were proposed to refer items back and there was also a lunch break, but it is fair to argue that most of this period was . spent formally or informally discussing the Success Regime decisions. During this time there were votes in principle to refer three of the Success Regime proposals to Jeremy Hunt.

The draft minutes of the "dispute resolution" meeting between two members of the scrutiny committee and the success regime say that it started at 5.30pm and finished at 6.10pm.

The minutes of the final session of the reconvened Health Scrutiny meeting cover about two and a half pages of A4 typescript, which describe some additional assurances given by the Success Regime and the details of three votes, one each about whether to proceed with the previous decisions. Two of these votes reversed the previous decisions. The minutes state that this meeting finished at 6.20pm - ten minutes after the time given for the close of the "dispute resolution" meeting.  

So if these minutes are correct the maximum time available to present various assurances to those members of the committee who had not gone home, and hold three votes, reversing two major decisions, was ten minutes.

I do not accept that it is sound governance to have a protocol which allows a committee to spend seven hours debating the NHS Trust's proposals, immediately followed by a forty minute discussion with the Trust, after which there is a ten minute meeting of the committee which reverses two of the three proposals.

Even if it turns out that the minutes are wrong or that I have misunderstood them and that a bit longer was spent on the two later meetings, I would still argue that this protocol needs to be changed or clarified. It is not reasonable to spend an entire working day of detailed debate about the concerns raised by thousands of residents, patients and staff with the NHS Trust's proposals and then claim to be confident that due consideration has been given to the arguments presented when votes to challenge those proposals are reversed in two short meetings the same evening.

The change around of votes was

Maternity - initial decision ten votes to one to call in.
Subsequent vote - six to one to proceed with this decision, which was therefore upheld.

Children's services - initial decision eight votes to three to call in.
Subsequent vote - five to two against proceeding with this decision, which was therefore reversed.

Community hospitals - initial decision ten votes to nil to call in with one abstention.
Subsequent vote - four to three against proceeding with this decision which was therefore reversed by one vote.

We have to learn from this. The thousands of people who took part in the consultation need to know that their concerns have been properly considered - and this process could have been perfectly designed to destroy trust that this had taken place.


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