Agenda item

The Council welcomes contributions from members of the public.

 

Statements

If you would like to make a statement at this meeting on any item on this agenda, please register to do so at least 10 minutes prior to the meeting. Up to 3 speakers are permitted to speak for up to 3 minutes each on any agenda item. Please contact the officer named on the front of the agenda for any further clarification.

 

Questions

To receive any questions from members of the public or members of the Council received in accordance with the constitution.

 

Those wishing to ask questions are required to give notice of any such questions in writing to the officer named on the front of this agenda no later than 5pm on Wednesday 15 January 2025 in order to be guaranteed of a written response. In order to receive a verbal response questions must be submitted no later than 5pm on Friday 17 January 2025. Please contact the officer named on the front of this agenda for further advice. Questions may be asked without notice if the Chairman decides that the matter is urgent.

 

Details of any questions received will be circulated to Committee members prior to the meeting and made available at the meeting and on the Council’s website.

The Committee had received 26 questions from 8 individuals all relating to one subject, the new BaNES, Swindon and Wiltshire (BSW) Integrated Care Board (ICB) community health contract.   Those questions were published as agenda supplement 2 on 21 January 2025. 

 

The Chairman repeated the statement that he had provided in response to the questions:

 

‘It is in the remit of the Health Select Committee to scrutinise how local health services are meeting the needs of Wiltshire residents, and that they are effective and safe. 

 

The questions that have been submitted to the Committee require a level of knowledge about the commissioning process of the new contract and transition of services that the Committee does not have.  Many contain a request for the Committee to seek a pause in the transfer of services and this is not in our power.

 

The ICB as commissioners of the service have been asked to provide a response’

 

Caroline Holmes (Interim Executive Director of Place – Wiltshire BSW ICB) and Laura Ambler (Executive Place Director of Place – BaNES BSW ICB) and Allison Elliott (Director – Commissioning) were present at the meeting. 

 

Caroline Holmes gave the following statement:

 

‘Chair, thank you for confirming the role and remit of this committee and for sharing the questions that have been submitted about the award of the BSW community services contract.  

 

The contract has been commissioned by five organisations; BSW ICB, Somerset ICB, BaNES Council, Wiltshire Council and Swindon Council. 

We understand that people have further, detailed questions and queries about the process we undertook and how we are working together with our partners to mobilise for 1 April 2025. Mindful of the committee’s time today, we will supply full, comprehensive answers to the questions raised to this committee as soon as possible and will provide a dedicated briefing to the Select Committee as agreed.  These will also be published on our website alongside all the information that we have already shared about our work on integrated community-based care. 

 

We are confident that our innovative new community-based care partnership with HCRG Care Group, the NHS, local authorities and charities will transform the care and support that people get for their health and wellbeing at every stage of their lives.  

 

The decision to appoint HCRG Care Group as our lead partner followed a robust, detailed and legally mandated procurement process, to ensure fair competition and best value for money.  

The mobilisation process has been underway since October and follows a detailed mobilisation plan with full risk assessment.  The assurance of mobilisation is provided through the ICB. 

 

Our focus continues to be on working closely with colleagues across BSW and all organisations involved to ensure a safe transfer of services for patients. We know that it can be unsettling for some affected staff and are working hard to ensure they have all the right support in place to help them make the transition to the new arrangements. 

 

There will be opportunities to help shape the future of community-based care across Bath and North East Somerset, Swindon and Wiltshire over the coming months and years and we are looking forward to hearing from local people and communities about their ambitions for the care they receive outside of hospital and closer to home. 

 

Both the ICB and HCRG have information available on their respective websites and we will be happy to share these links as well when we reply to the detailed questions in writing’.

 

The following statement was submitted prior to the meeting from Helen Nash (Care Co-Ordinator) working for Wiltshire Health and Care and a Unison Steward and the statement was on behalf of Unison. 

 

‘The Health Select Committee has rightly recognised its role in scrutinising decisions that impact the health and well-being of residents. However, the recent decision to award the contract for community care services to HCRG raises significant concerns about transparency, accountability, and the committee’s ability to fulfil its responsibilities effectively. 

 

This decision was made by the Integrated Care Board (ICB). Why, then, does the committee consider it appropriate for the ICB to scrutinise its own decision and compliance issues? This is clearly the responsibility of the Health Select Committee. 

 

This raises fundamental questions: How is this committee fulfilling its role and responsibilities regarding this contractual award? How does it plan to ensure it has the capacity and authority to scrutinise decisions that have such far-reaching implications for residents’ health? 

 

UNISON is particularly concerned about the potential for disruptions to patient care arising from this decision. As healthcare workers, we submitted key questions to the committee to gain a clear understanding of the risks and implications of transferring services to HCRG. Disappointingly, we were informed that many of these questions could not be answered due to insufficient information, which only deepens our concerns. 

 

This lack of transparency is deeply troubling, especially given the committee’s duty to safeguard healthcare services from disruption. For the committee to effectively protect patient care and ensure accountability, it must have access to all relevant information about this transition. Utilising its representative on the ICB board. 

 

To address these concerns, I urge the committee to exercise its authority and refer this matter to the Full Council, requesting a temporary pause in the transfer process. This pause would allow for the following: 

 

1.          Adequate Information Sharing and Investigation: 
HCRG and the ICB must provide the committee with the necessary information to address our questions and offer a comprehensive understanding of the proposed changes and their potential impact on patient care. Furthermore, the Council should appoint a lead investigator to address these concerns, including the statutory obligation to produce a full business case and conduct meaningful consultation with the workforce via recognised unions. 

 

2.          A Thorough Impact Assessment: 
The committee must assess the potential risks and disruptions to patient care and put in place strategies to mitigate them during the transition. 

 

3.          Evidence-Based Decision-Making: 
The ICB should produce a transparent and detailed business case, ensuring compliance with its roles and responsibilities while enabling the committee to make informed and accountable decisions.  

 

This is a complex and significant matter that requires thorough, independent scrutiny to protect the health and well-being of residents. I strongly encourage the Health Select Committee to act decisively in the interests of transparency, accountability, and patient care’.

 

Caroline Holmes confirmed that they would provide a response to the above statement as part of the response to the questions.

 

The Chairman then invited any questions/comments from the Committee and these included but were not limited to:

 

·            Feel that Unison have brought this to the Committee very late as they knew about it in October 2024 and their concerns could have been highlighted then and that it is too late to do what they ask as this time which is to demand a pause in the changes.  Don’t feel it is relevant to answer questions about contract costs now in this format and do not recall the contract coming before the committee as a dedicated item for such a large contract and should it have done so?   Very disappointed that this huge contract award was not brought to the Committee which should provide the democratic scrutiny of health services provided to Wiltshire residents. Because of the closeness of time to the start of contract suggest that the Committee receives a proper briefing to be able to hear from both parties and for the Committee to discuss.  Why was this not brought to this Committee with a briefing item regarding the award of the contract;

The Chairman confirmed that they would be requesting a full briefing on the issues raised (following receipt of a written response to the questions and statement) and then following that they could look at how as a Committee they could undertake scrutiny of the redesign and transformation of services to ensure that the intentions of the ICB meet the needs of Wiltshire’s residents.   This briefing should be held in February 2025 and if following that there are concerns in relation to the impact on services for residents the Committee would look to undertake either a rapid scrutiny exercise or bring it back as a full agenda item to the next meeting on 12 March 2025.

 

Laura Ambler highlighted that as lead commissioners, on behalf of the ICB, she and Caroline had given an informal briefing about the procurement process through the Chair and lead members able to attend in September 2024.  At that point they were in a confidential mandated procurement process with three Local Authorities and two ICB’s.  The appropriate governance route was through the ICB Board (which includes the Council Leader and Chief Executive) with scrutiny through the ICB’s Finance and Investment Committee and oversight of the process by the ICBC Programme Board which also included Council representatives.  It would not have been appropriate at that time to bring it to the Health Select Committee as the decision to award the contract was not for any one Council or Scrutiny Committee to decide. 

 

Laura advised that she thought the request was about having an information briefing to understand if there were going to be any impacts moving forward and to confirm the role for the Committee moving forward in relation to transformation or service change and being able to inform what potential engagement or consultation might involve.  The ICB would be happy to accept the request to provide an information briefing and they had provided that in BaNES Council recently following a request from them. 

 

A Committee member suggested that the Committee receive a detailed paper outlining the changes and differences services that the people of Wiltshire might expect from 1 April 2025 and wished to thank Unison to bringing this to the Committee.

 

The Chairman confirmed that he would look to request a high level overview from the ICB, whilst acknowledging that they had had informal briefings on the transformation process and strands within it, but he felt that for the benefit of the committee, an explanation of where the contract sits within the overall transformation process would be required.

 

·            A committee member who had worked for the NHS for many years commented that she had been through a lot of changes and reorganisations and had experience of heath scrutiny committees looking at service provision and quality standards but did not have any experience of health select committees getting involved in the commissioning process and that may enlighten others as to how things had got to where they are currently.   A concern was that has the NHS increasingly commission work from the independent sector there had been some examples of when pay and terms and conditions of employment had moved away from those set in the Agenda for Change and that is an area where they would want some assurance that that is respected. 

 

Caroline Holmes (ICB) responded that in terms of pay parity HCRG had advised that staff moving into HCRC would move across on their existing terms and conditions and pension and the vast majority of those that join HCRG as new employees will be offered parity with NHS Agenda for Change pay scales and terms and conditions.  They could answer that question more fully in the response that was to be prepared. 

 

·            A committee member suggested that the committee return to his issue in a year’s time as it was felt that they were seeing her privatisations of a number of health services roles and that they could receive an update on the privatisation of the community services one year on – that was the right role of the committee to see what have been the benefits of the change to its residents.

 

The Chairman agreed that the committee needed to be careful that they were not drawn into the ideological matters of private versus public as that was not their remit.  The crux was that the committee should be satisfied that the needs of the residents are being met and that it was crucial that the next Health Select Committee does revisit this to ensure that those services are better that what they currently are and to be involved in the redesign of services as they are rolled out from April.  He felt that there does need to be scrutiny oversight in the redesign of services and then the committee should hear back in around six months to find out how it is going.

 

Caroline Homes (ICB) wished to explain that the contract that had been awarded was for HCRG to lead a partnership of organisations across BSW which included third sector organisations and existing NHS organisations.  For some services staff would TUPE into HCRG and for others HCRG would enter into subcontracts with other NHS organisations and partners.  Caroline explained that HCRF had been commissioned to develop collaborative approach with partners and won’t be directly providing all services. 

 

Caroline Holmes highlighted that they had already had some questions and answers raised at the November ICB Board which were published on the ICB website.  The responses address a number of the issues raised and the ICB would provide a link to that in advance of the briefing so that could be passed on for members to access as soon as possible. 

 

The Chairman thanked the ICB and Unison representatives for their attendance at the meeting.

 

Resolved:

 

That the Health Select Committee:

 

1.          Encourage the Integrated Care Board (ICB) to provide a timely written response to the questions submitted by Unison to the Committee.

 

2.          Receive a briefing on the community health contract in February 2025 following receipt of the responses to the questions in order for the Committee to have a clear overview of what this contract means in terms of transformation of services for Wiltshire residents.

 

3.          Following that briefing the Committee will consider commencement of a rapid scrutiny exercise if this felt is required by the Chair and Vice Chair.

 

4.          That further updates be provided to the Committee as relevant.