DRAFT Minutes of the WY&H Partnership Board Meeting Held On

Item 15/21

DRAFT Minutes of the WY&H Partnership Board Meeting held on Tuesday 2 March 2021

Members and Deputies Present (By place and then alphabetical by first name)

* = Organisation also part of the Kirklees Place ** = Organisation also part of both the Kirklees and Calderdale Places

Bradford, Airedale and Craven  Andrew Gold, Airedale NHS Foundation Trust  Cathy Elliott, Bradford District Care NHS Foundation Trust  Helen Hirst , NHS Bradford District and Craven CCG  James Drury, Bradford Metropolitan District Council (Deputy for Kersten England)  Dr James Thomas, NHS Bradford District and Craven CCG and Chair of the WY&H Clinical Forum  Dr Maxwell McLean, Bradford Teaching Hospitals NHS Foundation Trust  Mel Pickup, Bradford Teaching Hospitals NHS Foundation Trust  Patrick Scott, Bradford District Care NHS Foundation Trust (Deputy for Therese Patten)  Cllr Richard Foster, Craven District Council  Cllr Sarah Ferriby, Bradford Metropolitan District Council  Stuart Shaw, Airedale NHS Foundation Trust (Deputy for Brendan Brown)  Cllr Susan Hinchcliffe, Bradford Metropolitan District Council

Calderdale  Anna Basford, Calderdale and Huddersfield NHS Foundation Trust* (Deputy for Owen Williams)  Philip Lewer, Calderdale and Huddersfield NHS Foundation Trust*  Robin Tuddenham, Calderdale Council and NHS Calderdale CCG  Dr Steven Cleasby, NHS Calderdale CCG  Cllr Tim Swift ,Calderdale Council (Chair)

Harrogate  Angela Schofield, Harrogate and District NHS Foundation Trust (Vice Chair)

Kirklees  Carol McKenna , NHS North Kirklees CCG and NHS Greater Huddersfield CCG  Diane McKerracher, Locala Community Partnerships  Karen Jackson, Locala Community Partnerships  Dr Steve Ollerton, NHS Greater Huddersfield CCG  Cllr Viv Kendrick , Kirklees Council

Leeds  Brodie Clarke, Leeds Community Healthcare NHS Trust  Cllr Fiona Jenner, Leeds City Council  Dr Jason Broch, NHS Leeds CCG  Julian Hartley, The Leeds Teaching Hospitals NHS Trust  Linda Pollard CBE DL Hon.LLD, The Leeds Teaching Hospitals NHS Trust  Dr Sara Munro, Leeds and York Partnership NHS Foundation Trust

Item 04/21

 Professor Sue Proctor, Leeds and York Partnership NHS Foundation Trust  Thea Stein, Leeds Community Healthcare NHS Trust  Tim Ryley, NHS Leeds CCG  Tom Riordan, Leeds City Council

Wakefield  Dr Adam Sheppard, NHS Wakefield CCG  Chris Jones, South West Yorkshire Partnership NHS Foundation Trust** (Deputy for Angela Monaghan)  Keith Ramsey , The Mid Yorkshire Hospitals NHS Trust*  Rob Webster, South West Yorkshire Partnership NHS Foundation Trust**  Trudie Davies, The Mid Yorkshire Hospitals NHS Trust* (Deputy for Martin Barkley)

Other Partnership Board members (alphabetical by first name)

 Andy Clow, Co-opted Member  Anthony Kealy NHS England and NHS Improvement (North East and Yorkshire)  Emma Stafford, Co-opted Member  Helen Hunter, West Yorkshire & Harrogate Healthwatch organisations representative  Hilary Thompson, Voluntary, Community and Social Enterprise Sector representative  Jackie Dolman, Co-opted Member  Luen Thompson, Hospice Sector representative  Matt Sandford, Yorkshire Ambulance Service NHS Trust (Deputy for Rod Barnes)  Michael Crowther, Hospice Sector representative  Pip Goff, Voluntary, Community and Social Enterprise Sector representative  Sayma Mirza, Representative from the WY&H Race Equality Network  Stephen Featherstone, Co-opted Member  Tim Gilpin, Yorkshire Ambulance Service NHS Trust (Deputy for Kathryn Lavery)

Additional attendees (alphabetical by first name)

 Adrian North, WY&H Senior Finance Lead  Amrit Reyat, WY&H Health and Care Partnership (Item 07/21)  Esther Ashman, WY&H Health and Care Partnership  Fatima Khan-Shah, WY&H Health and Care Partnership (Item 07/21)  Hayden Ridsdale, NHS Graduate Management Trainee (Observer)  Ian Holmes, WY&H Health and Care Partnership  Karen Coleman, WY&H Health and Care Partnership  Karen Poole, WY&H Health and Care Partnership (Item 06/21)  Lauren Phillips, WY&H Health and Care Partnership (Secretariat)  Nadira Mirza, Airedale NHS Foundation Trust (Observer)  Pam Bhupal, WY&H Health and Care Partnership  Rachael Loftus, WY&H Health and Care Partnership  Sarah Smith, WY&H Health and Care Partnership (Item 07/21)  Stephen Gregg, WY&H Health and Care Partnership  Tony Cooke, Leeds City Council  Wendy Tangen, Leeds and York Partnership NHS Foundation Trust (Item 07/21)

Item 04/21

Apologies (alphabetical by first name)

 Amanda Bloor, NHS North Yorkshire CCG  Andrew Balchin, Wakefield Council  Angela Monaghan, South West Yorkshire Partnership NHS Foundation Trust **  Cllr Bob Metcalfe, Calderdale Council  Brendan Brown, Airedale NHS Foundation Trust  Brent Kilmurray, Tees, Esk and Wear Valleys Foundation NHS Trust  Charles Parker, NHS North Yorkshire CCG  Cllr Denise Jeffery, Wakefield Council  Cllr Faith Heptinstall, Wakefield Council  Jacqui Gedman, Kirklees Council  Jo Webster, NHS Wakefield CCG  Cllr James Lewis, Leeds City Council  Kersten England, Bradford Metropolitan District Council  Dr Khalid Naeem, NHS North Kirklees CCG  Martin Barkley, The Mid Yorkshire Hospitals NHS Trust*  Cllr Michael Harrison, North Yorkshire County Council  Cllr Mike Chambers MBE, Harrogate Borough Council  Mike Curtis, Health Education England (Yorkshire and the Humber)  Dr Mike Gent, Public Health England (Yorkshire and the Humber)  Mrs Miriam Harte, Tees, Esk and Wear Valleys Foundation NHS Trust  Owen Williams, Calderdale and Huddersfield NHS Foundation Trust*  Cllr Patrick Mulligan, North Yorkshire County Council  Paul Shevlin, Chief Executive, Craven District Council  Dr Peter Davies, Regional Ambassador for WY&H, Royal College of General Practitioners  Richard Flinton, North Yorkshire County Council  Richard Stubbs Yorkshire and Humber Academic Health Science Network  Rod Barnes, Yorkshire Ambulance Service NHS Trust  Cllr Shabir Pandor, Kirklees Council  Therese Patten, Bradford District Care NHS Foundation Trust  Wallace Sampson, Harrogate Borough Council

Item Agenda Item

01/21 Welcome

The Chair welcomed members, deputies and attendees to the eighth meeting of the West Yorkshire and Harrogate (WY&H) Health and Care Partnership Board. He reminded members of the Partnership’s shared mission to join up our services and investment to meet the current and future needs of the people of WY&H.

The Chair welcomed Councillor Fiona Venner, Executive Member for Adult and Children's Social Care, Leeds City Council and Health Partnerships and Chair of the Leeds Health and Wellbeing Board as a new member of the WY&H Partnership Board.

The Chair noted his thanks on behalf of the WY&H Partnership Board to Cllr Rebecca Charlwood, previous Chair of the Leeds Health and Wellbeing Board and Executive Member for Health, Wellbeing and Adults for Leeds City Council.

Item 04/21

Item Agenda Item

The Chair noted the focus of the meeting today would be to consider the Partnership’s focus and priorities over the past three months, progress against the action plan in response to our review into inequalities for Black, Asian and minority ethnic communities and staff; the recently published government white paper and its implications for our partnership; the WY Devolution Deal and the Partnership’s planning priorities for 21/22.

The Chair explained that the meeting would be lived streamed on the Partnership website and recorded for future reference as part of the Partnerships’ commitment to transparency and accountability.

02/21 Questions and public deputations

The Chair advised that as part of the Partnership Board’s commitment to transparency and accountability, we want to give people an opportunity to ask questions and make deputations/statements at our meetings about items on that day’s agenda. Members noted that due to the COVID-19 restrictions, the approach to dealing with public questions would be slightly different for this meeting. Members of the public were invited to telephone with or email their questions to the Partnership Team by 5pm on 1 March 2021 so that a member of the Partnership Team could read them out on their behalf.   He advised that as always, wherever possible, the Partnership Board would aim to provide a concise verbal answer to questions during the meeting and that the Partnership Team would also provide further information verbally or in writing after the meeting and post all questions and answers on our website.  Stephen Gregg shared the full wording of each question received in advance of today’s meeting on the screen and read out a summary of each question that had been submitted (Annex A).

Stephen explained that a number of questions had been received on 30 November 2020 and subsequently responded to by the WY&H Partnership Team on 15 December 2020. Unfortunately, these questions and the WY&H Partnership responses to them had not been annexed to the minutes of the previous meeting and would be shared on the screen during today’s meeting. They had also been uploaded to the Partnership Website.

03/21 Declarations of Interest

The Chair explained that the Partnership Board takes conflicts of interest seriously and that declarations of interest would be a standing item on all agendas.

He highlighted that, as set out in the Partnership Board’s Terms of Reference, members and those in attendance must abide by all policies of the organisation that they represent in relation to interests. Members noted that the WY&H Partnership Team had prepared a composite register, bringing together, into one place, the declarations that members and attendees have submitted to their own organisation and that this had been published on the Partnership’s website.

The Chair invited members and those in attendance to declare any interests relevant to the agenda as required.

Item 04/21

Item Agenda Item

04/21 Minutes from the last meeting – 1 December 2020 and action log

The Chair asked members of the Partnership Board to consider and agree the draft minutes of the last meeting on 1 December 2020.

The draft minutes were agreed as an accurate record, subject to the addition of the questions received on 30 November 2020 and subsequently responded to by the WY&H Partnership Team on 15 December 2020, to the Annex.

Ian Holmes provided a verbal update on the action log.

 Members noted that an update on progress against the action plan following the Review into Tackling health inequalities for Black, Asian and minority ethnic communities and colleagues would be considered at today’s meeting and would be a standing item on all future agendas as agreed on 1 December 2020.

 In respect of the Partnership Memorandum of Understanding (MoU), Ian reminded members that at the WY&H Partnership Board meeting on 1 December 2020 members had agreed some minor amendments (for example, to reflect organisational changes including the merger of the three Bradford and Airedale CCGs to form NHS Bradford District and Craven CCG). Ian explained that as the changes agreed in December 2020 were minor, and the in light of the imminent legislation following publication of the White Paper, it was not proposed that the current version of the MoU be submitted for sign-off to each individual partner’s Board. Members agreed with the proposal, subject to the safeguard that partner organisations be given 2 weeks to raise any concerns / queries in relation to the MoU to the WY&H Core Team

ACTON Members to raise any concerns / queries in relation to the latest version of the WY&H 04/21-1 Partnership MoU by COP on 16 March 2021 to the WY&H Core Team.

05/21 Update from the WY&H Partnership CEO Lead

The Chair invited Rob Webster to introduce the item.

Rob explained that purpose of the paper was to update the WY&H Partnership Board on the priorities of the Partnership’s work over the past three months, as well as plans for the rest of this year in the context of Covid-19 and the WY&H Five Year Strategy.

Members noted that the paper was a very detailed paper in places, but essentially set out how the WY&H Partnership continues to:

a) tackle the wider determinants of health, including through the economic recovery plan and our response to the climate crisis; b) deliver services for people and support for staff against the WY&H Partnership priorities; c) collectively oversee the immediate operational activity in this third wave of Covid-19; d) progress essential elements of our Five Year Plan, particularly in relation to health inequalities and our Black, Asian and minority ethnic (BAME) populations; and e) work towards new NHS legislation for Integrated Care Systems (ICSs).

Item 04/21

Item Agenda Item

Rob highlighted:

 since our last meeting, Covid-19 rates in the community have fallen, but they are falling at a lower rate in our area than elsewhere in the country;  we are emerging from a third wave on the pandemic and for some place in WY&H;  the variant of coronavirus first detected in Kent is now the dominant circulating strain in WY&H, as well as the rest of the UK;  from the 8 March 2021, people in England will see restrictions start to lift with the government’s roadmap outlining four steps for cautiously easing restrictions – however, before proceeding to the next step, the government will examine the data to assess the impact of previous easements, based on four tests which are that: o the vaccine deployment programme continues successfully; o evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in people vaccinated; o infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS; and o the assessment of the risks is not fundamentally changed by new Variants of Concern.  as at 14 February 2021, over half a million people had received their first dose of the Covid-19 vaccine in West Yorkshire (WY) - this is approximately a quarter of the adult population living across the area;  uptake of the vaccine has generally been very good – for example over 94% of over 70s in WY accepting offers of a first vaccination;  vaccines are now being offered to those in the Joint Committee on Vaccination and Immunisation’s (JCVI’s) cohorts five and six;  vaccine uptake has been lower in some communities / population groups and this is an area of work we continue to focus on as part of our vaccine hesitancy work;  recently published research indicates that for older people (aged over 80) who develop Covid-19 infection, those who are vaccinated have a much lower chance of death (about 56% lower) than someone with an infection who hasn’t been vaccinated and are around 40% less likely to be hospitalised than someone who has not been vaccinated;  our hospitals continue to work together, supported by other partners to ensure surge capacity is available;  enhanced testing is being made available in areas of where there are outbreaks of new / more contagious variants;  in mid-Feb 2021 an expansion to the Clinically Extremely Vulnerable cohort was announced, which for WY we believe translates to approx. 65,000 people additional people being classed as CEV;  work is underway by the University of Huddersfield into people’s experiences of shielding;  Healthwatch Leeds have been able to track the voices and views of clinically extremely vulnerable people throughout the last year – which has helped to shaped the support offered in Leeds;  we must not lose sight of the fact that behind every death reported is a person and we must not forget the impact that the last 11 months has had on those families who have lost a loved one;  we must maintain a focus on health inequalities – for example through the WY&H Health Inequalities Academy, the work on inclusive growth, the work with the WY Violence

Item 04/21

Item Agenda Item Reduction Unit;  the recent Public Health England (PHE) report into learning disability deaths during the COVID-19 pandemic laid bare the inequality in mortality rates at a national level – work is underway to look at this with a WY&H lens and a proposal will be considered by the WY&H System Leadership Executive Group at their meeting on 6 April 2021;  all people on the learning disability register will now be prioritised for a Covid-19 vaccination along with carers, following advice from the JCVI in mid-February 2021;  waiting times for elective operations have increased for some people and there are now over 7,000 people waiting over one year - this is less than we had forecast, thanks to collective action and activity, but the pressure will remain whilst we work to develop capacity;  urgent two week wait cancer referrals now at 96.8% of pre Covid-19 numbers so far this calendar year (accurate at 14 February 2021) and in December 2020, cancer treatment volumes were higher compared to December 2019;  NHS England and NHS Improvement (NHSE / NHSI) have released a General Practice COVID-19 Capacity Expansion Fund to support GP services through the pandemic until March 2021 - we have received £6.41m as our share of the fund and this will be distributed to places on a fair shares basis;  £1.3m of the national General Practice Forward View Transformation Funds has also been distributed to clinical commissioning groups with a focus on supporting GP retention and resilience;  since November 2020, we have had local and national business case approvals for over £24m funding to support improvements to our digital infrastructure.  the Partnership has secured funding from NHS England/NHS Improvement to the end of March 2022 of more than £1million to develop and maintain a mental health and wellbeing hub for all staff working in health and care services in WY&H  work is progressing with Universities in our region to develop a Health and Care Workforce Observatory; and  the economic impact of COVID-19 across WY&H has led to significant job losses and a recession which brings additional risks to the health of people.

Rob noted his thanks on behalf of the WY&H Partnership Board to Dr Phil Wood and all those involved in leading, planning and delivering the WY Covid-19 vaccination programme team.

The WY&H Partnership Board was asked to note the substantial impact that the Partnership has in supporting our communities at this time; and to consider the context of this report.

The following comments were raised during the discussion:

 to date the national Covid-19 vaccination has been a “push model” from the centre - distributed around the country based on numbers of people within specific cohorts – however we must continue to lobby nationally for a “pull model” where, as a Partnership, we can ensure we are reducing health inequalities, whilst following the JCVI prioritisation;  the recent an expansion of the CEV cohort through the use of a predictive risk model, based on a person’s cumulative risk which considers their age, gender, ethnicity, body mass index, smoking status etc. in addition to their clinical condition/s or the treatments they have had or are having – means that more, younger people in WY&H facing health

Item 04/21

Item Agenda Item inequalities will be receiving their vaccination sooner; and  we must not forget the mental health and wellbeing of our care home staff (who are often not employed by the NHS or Local Authorities) and ensure they are equally supported – through offers such as the WY&H Mental Health and Wellbeing Hub.

06/21 Accessing health and cares services during COVID-19

The Chair welcomed Karen Poole, a nurse and the Programme Director of the WY&H Local Maternity System, to the meeting.

Karen shared her experiences of receiving a cancer diagnosis in May 2020 and accessing cancer services, including specialist cancer surgery, during the Covid-19 pandemic.

The Chair thanked Karen on behalf of the WY&H Partnership Board for sharing journey, experiences and reflections.

Tackling health inequalities for Black, Asian and minority ethnic communities and 07/21 colleagues

The Chair explained that this item was in two parts:

 Firstly, Paper A which provides an update on progress against the Action Plan we agreed at our meeting in December 2020 in response to the Review re: Tackling Health Inequalities for Black, Asian and Minority Ethnic Communities and Colleagues, published in October 2020.

 Secondly, Paper B which provides am update to the WY&H Partnership Board on the development of a WY&H wide, anti-racism movement aimed to support colleagues and communities

Progress against our Action Plan

The Chair invited Fatima Khan-Shah, Sarah Smith and Amrit Reyat to introduce the paper.

Sarah reminded members that the independent review was commissioned in July 2020, by the WY&H Partnership Board to build on the report findings published by Public Health England on 2 June 2020, Disparities in the risk and outcomes of COVID-19 as well as learning from the experience of its own partners across the WY&H Health and Care Partnership. The independently chaired review panel published its report on 22 October 2020 with 16 high-level recommendations.

Members noted that the action plan (enclosed at Annex A) was considered by the WY&H Partnership Board at its meeting on 1 December 2020 where it was agreed that an update on progress against the Action Plan developed in response to the recommendations should be a standing item on future WY&H Partnership Board Meetings.

Our Partnership recognises that the actions in response to the recommendations cannot be delivered in isolation by any one programme or place and that this requires the energy and drive of collaboration - many of the actions, whilst facilitated at a WY&H level, are taking place and being delivered within our places and neighbourhoods

In respect of progress since the last meeting, Sarah highlighted the following examples from

Item 04/21

Item Agenda Item the paper:

Review Theme 1 - Improving access to safe work for BAME colleagues in WY&H:

 development of culturally competent information for managers and leaders to support culturally sensitive conversations as part of the risk assessment process; and  development of a robust anti-racism movement for the WY&H Partnership (further details about the campaign are at Item 07-21b)

Review Theme 2 - Ensuring the Partnership’s leadership is reflective of communities:

 implementation of the WY&H BAME Fellowship, launch of WY&H Shadow System Leadership Executive Group, leadership training and alignment to partnership programmes.

Review Theme 3 - Population planning - using information to make sure that services meet different groups’ needs:

 launch of the WY&H Health Inequalities Academy in February 2021, including specific session on reducing inequalities related to ethnicity, for Migrant Health and Gypsy Traveller populations;  establishment of the WY&H Health Inequalities COVID-19 Vaccination Group; and  £1.15 million NHS Charities Trust Granting Funding is now open for applications across WY&H. Priority population groups for this funding include refugees and asylum seekers and Gypsy and Traveller communities.

Review Theme 4 - Reducing Inequalities in mental health outcomes by ethnicity:

 the WY&H Mental Health and Learning Disabilities and Autism Programme Board have considered the recommendations and identified the actions they will lead on behalf of the partnership; and  the launch of a £60,000 WY&H Green Social Prescribing Grant Fund with those groups identified as part of the review, included as priority populations for the funding.

Amrit reminded members that the WY&H Partnership has an established principle of utilising existing mechanisms and the governance and accountability of the action plan has been underpinned in the same way. She explained that the core team had been proactively engaging with programmes and utilising existing governance in the WY&H Partnership to ensure that tackling health inequalities is seen as everyone’s business and embedded into the day to day business of the Partnership. Many programmes have been proactively supporting the agenda which is reflected within the attached report.

Fatima explained that the WY&H VCSE voices panel are now meeting on a quarterly basis providing insight, expertise as well as constructive challenge to the work and representatives from the group would be in attendance at the next WY&H Partnership Board meeting.

The WY&H Partnership Board was asked to:

• formally note the progress made on the review Action plan since the last meeting of the WY&H Partnership Board on 1 December 2020; and • approve the approach taken and support the ongoing work at both programme and place level.

Item 04/21

Item Agenda Item

In response to a question as to whether the accountability and responsibility for delivery of this work is extending / shifting beyond the senior leaders from across the partnership - Sarah and Fatima gave some examples of how they are engaging with colleagues across WY&H, including the WY&H Joint Committee of CCGs, Health and Wellbeing Boards; and the West Yorkshire Combined Authority.

The following comments were made during the discussion:

 in the document Implementing phase 3 of the NHS response to the COVID-19 pandemic (August 2020) one of the eight urgent actions to address inequalities in NHS provision and outcomes was to “strengthen leadership and accountability, with a named executive board member responsible for tackling inequalities in place in September in every NHS organisation” – this creates an opportunity to connect with those NHS executive leads to this work through mechanisms such as the Healthy Hospitals Programme, WY&H Health Inequalities network and the WY&H Health Inequalities Academy;  this should be should be mainstreamed in the way that we do business in the Partnership;  later on the agenda we will be considering the implications for our partnership in response to the White Paper – we should have that discussion in the context of reinforcing the recommendations from this review;  data inequalities in life expectancy by ethnicity is not currently held at a WY&H level – however work is underway to understand the gaps and ensure that datasets are complete and timely, to underpin an understanding of and response to inequalities;  once available, we should consider the data on inequalities at a WY&H (described above) at a future meeting of the WY&H Partnership Board; and  the WY&H Partnership recently completed a round of quarterly review meetings to discuss the progress that partners in each place are making with shared priorities; to consider the risks and issues associated with them; and to agree any action or support that might be required from the Partnership – a letter was shared with the WY&H System Leadership Executive Group highlighting some of the areas of good practice we heard from each place – and it was noted that in Bradford District and Craven there was a clear, coherent plan for implementing the recommendations from the review – set in a framework that mirrors the report and that others may benefit from using.

WY&H Anti-racism Movement

The Chair invited Karen Coleman and Wendy Tangen to introduce the item.

Karen explained that the purpose of the paper was to:

• provide an update to the WY&H Partnership Board on the development of a WY&H wide, anti-racism movement aimed to support colleagues and communities; and • seek support from members before, during and after the launch date.

Karen reminded members that one of the review’s recommendations was the co- production of an anti-racism movement, which recognises and appreciates that BAME people are not one homogenous population. Karen explained that the movement would aim to amplify communications messages at a local level whilst not making assumptions about

Item 04/21

Item Agenda Item language or method.

Karen explained that by working across our large Partnership, the hope is to embed the movement within organisation structures to ensure it is much more than a one off campaign and that it becomes something which is sustainable well into the future.

Karen explained that the a project group including, WY&H BAME Network colleagues, VCSE colleagues, councils, Healthwatch, GPs and other front line workers had been set up and includes people with lived experience of racism.

Karen highlighted some of the aims and objectives set out by the Project Group:

 Visible commitment by all partners, staff, senior leaders, organisations and institutions to have a united anti-racism approach across all areas of business, with a strong message that the public will gather behind.  Collate examples and realities of racism in the workplace, including lived experience of staff to help facilitate a broader understanding of the issues and the impact on colleagues, which can be promoted through the movement.  Raise awareness of racial disproportionality in the workplace.  Inspire individual action; encouraging staff, senior leaders, communities, organisations and institutions to call out racism (linking to existing organisation policies, where they exist).  Reduce racism in the identified target audience.  Collate and share good practice and co-create a multi-sector campaign, with lived experience at the heart.  Celebrate the advantages of cultural differences and diversity, with spotlight campaigns to raise awareness of the richness that all cultures bring to society.

Members noted the suggested target audience, budget and indicative timescales for the development of the movement.

Wendy Tangen, a member of the WY&H BAME Network and Chair of her employing organisation’s Race Equality Network, endorsed the concept of the movement. Wendy explained that she believed that the movement would allow the Partnership to examine the structures and processes in place that contribute to discrimination amongst our culturally diverse community and the way in which we work with those communities. She explained that the “movement” would allow flexibility and be adaptable to place-based systems as well as work at a system level – enabling the sharing of good practice to create a stronger, healthier community.

The WY&H Partnership Board was asked to:

• note that this is a system wide, co-produced movement that must be embedded in system change; and • support the work via members’ own organisations, whilst sharing the experiences of colleagues and communities to ensure it is the best it can be.

The following comments were made during the discussion:

 there was support for the movement from the WY&H BAME Network – and the group stressed the importance of support for those experiencing racism;  there is opportunities through this work to use lived experiences to create inclusive cultures

Item 04/21

Item Agenda Item  the visual model Becoming Anti-Racist (Andrew M. Ibrahim MD, MSc) is useful resource movement;  working with children and young people would be incredibly impactful and the Project Group will look to work with the WY&H Children, Young People and Families Programme and the WY&H Young People’s Voices Group;  should the first phase of the movement be successful – there will be an opportunity to expand to a wider audience in Phase 2 – including schools potentially;  this work should link into existing training available within the Partnership and elsewhere;  it will be important for the movement to be able to signpost to good resources and support within local places;  the approach to this, as a social movement that will flex as needed and learning from the work the Partnership has done previously on campaign approaches is welcomed;  this is long term work that we need to maintain – seeking to reduce tolerance as well as educate and support change – however we must be aware of the impact of racism and the harm it causes and so ensuring the right support for people is in place is vital;  the WY&H Partnership can, and should be, anti-racist - and this will have a wider impact - we can't force others, and we should be focused on what we can do, but we can refuse to tolerate racism in the WY&H Partnership;  a recent study by King’s College London, in collaboration with the UK in a Changing Europe: Unequal Britain - Attitudes to inequalities after Covid-19 – demonstrated how endemic racism is within our society;  we need to view this work over the longer term and look for marginal gains which won’t always be visible over a short time – but the test is whether the sum total comes together over a period of time;  our NHS partners need to look at this in the context of their own organisation’s NHS Workforce Race Equality Standards (WRES) Reports; and  we should look at training and support for staff / line managers about having uncomfortable conversations.

Government White Paper: “Integration and Innovation: Working together to improve 08/21 integration and innovation for all” - Implications for our partnership

The Chair invited Ian Holmes to introduce the item.

Ian explained that the purpose of the paper is to provide a summary of the key proposals for Integrated Care Systems set out in the White Paper (published on 11 February 2021) and the implications for our partnership. Members noted that the paper also sets out the work that we are undertaking in response to the White Paper to ensure that out working arrangements remain as effective as possible beyond April 2022.

Ian reminded members that in November 2020, NHSE/I published ‘Integrating Care: next steps to building strong and effective Integrated Care” which set the future direction of travel for ICSs and options for legislative changes to put ICSs on a statutory footing. The direction of travel described was one that is familiar to our ways of working and included a greater emphasis on collaboration at neighbourhood, place and system; a clearer role for provider collaboration in place and across systems; and a strong emphasis on closer partnership working between the NHS, local government and the voluntary and community sector.

Item 04/21

Item Agenda Item

Ian explained that the recently published White Paper confirmed this direction of travel and set out the intention to legislate to create statutory arrangements for ICS. He highlighted some of the important aspects of this as follows:

 A statutory ICS will be formed, made up of a statutory ICS NHS body and a separate statutory ICS Health and Care Partnership, bringing together the NHS, Local Government and partners.  Place-based arrangements between local authorities, the NHS and providers of health and care will be left to local organisations to arrange.  A new duty will be introduced to promote collaboration across the healthcare, public health and social care system. This proposal will place a reciprocal duty to collaborate on NHS organisations and local authorities.  It will be made easier for organisations to work closely together through joint committees. Provisions will set out the governance of these joint committees and the decisions that could be delegated to them; and separately, allowing NHS providers to form their own joint committees.  There is an intention to repeal Section 75 of the 2021 Health and Social Care Act, which is a positive move – if replaced by procurement arrangements that are transparent and ensure best value for money  The White Paper creates uncertainly for staff – including those employed by CCGs and some staff in NHS E /NHS I and the partnership is really keen to provide certainty to those staff as soon as possible and a shared HR Framework is under development.

Ian explained that six workstreams were being established to address some of the key issues as follows:

1) reviewing the ICS operating model – how the ICS is structured, how it functions and the relationship between WY&H and place; 2) producing an ICP (Place) development framework, which will describe the components of an effective place arrangement, and the delegation and accountability arrangement with the ICS; 3) developing new financial arrangements, including how money flows through the system, and contracting and planning approaches; 4) developing an approach for system clinical leadership at WY&H and place level – building on the arrangements we have got; 5) designing future workforce strategy and leadership arrangements, in partnership with Health Education England and NHSE/I ; and 6) progressing our strategic commissioning work which will define how population health planning is carried out in line with our subsidiarity principle.

Ian explained that a WY&H Future Design and Transition Group, chaired by Rob Webster would be established to provide oversight of the work that the ICS is undertaking in preparation for the move to statutory arrangements from April 2022.

The WY&H Partnership Board was asked to:

• note the changes to ICSs set out in the government White Paper; and • consider the next steps set out and confirm support for this approach.

Item 04/21

Item Agenda Item

The following comments were made during the discussion:

 this is not legislation yet and we therefore we must continue to lobby nationally to maintain the permissive nature and flexibility described in the white paper;  the WY&H BAME Network had reflected that it will be important to maintain focus on our Partnership 10 Big Ambitions, including the ambition around diversity in our leadership throughout the changes – and use this as a further opportunity to deliver on this;  we want to retain a place focus on commissioning to enable both a joined up vison for each place and for funding to flow to those grass-root organisations who deliver to some of the most disadvantaged of those in our population;  one of our Partnership’s principles is that of subsidiarity – and this should continue to be central to our design work;  we need to ensure there are regular loops back into the Health and Wellbeing Boards as this work develops;  we need to be mindful that this affects some members of staff more than others;  as a Partnership, we should not “slow down” as a result of the white paper / potential legislation;  alongside clinical leadership and a focus on outcomes – we should also aspire to be citizen / people led;  we should be accountable to local people and engage them in their care;  the WY&H Future Design and Transition Group should include representatives from all five places and sectors (NHS, Local Authorities, Public Health, Social Care etc);  it would be helpful to establish a Reference Group of NHS Chairs and Council Leaders to support the work of the WY&H Future Design and Transition Group;  our understanding is that the Chair of the NHS ICS Statutory Body can be different person to the Chair of the ICS Partnership;  the WY&H Clinical Forum has started work to develop a set of principles for Clinical Leadership for our Partnership which will be presented at the WY&H System Leadership Executive Group meeting on 6 April 2021;  we want to have a distributed and diverse leadership, with depth and breadth - and this should be reflected in our clinical leadership too;  clinical leadership must also be inclusive of social care;  in respect of the “joint committees” (described in paragraph 15) – this is about replacing and streamlining, rather than overlaying current arrangements;  we need to be mindful of navigating the system so that organisations that add value but are not necessarily at the core or have the loudest voice can be part of decision making are visible and have a voice with the right representation at the right level;  we learn most from addressing challenges and gaps and we should us this as an opportunity to focus on some of the problems our local areas face whilst we are feeling grateful for what we already have in place – we are ahead of the game, so we need to make sure we utilise that lead.

The WY&H Future Design and Transition Group should have representatives from all five ACTION places and sectors (NHS, Local Authorities, Public Health, Social Care etc) and be 08/21-1 supported by a Reference Group of NHS Chairs and Council Leaders.

Item 04/21

Item Agenda Item

09/21 West Yorkshire Devolution

The Chair invited Councillor Susan Hinchcliffe and Tom Riordan to introduce the item.

Cllr Hinchcliffe explained that the West Yorkshire devolution deal is the biggest deal of its kind, bringing more than £1.8 billion of investment for the region into local control. It will also see the creation of the first ever directly elected Mayor of West Yorkshire with elections taking place in May 2021. Members noted that the deal will give the Combined Authority and Mayor new powers and funding including control of £38 million per year allocation of gainshare investment funding over 30 years, to drive growth and take forward our priorities.

Members noted that the devolution deal will help the region invest in economic recovery by supporting transport improvements, adult education, skills and jobs, infrastructure, housing and regeneration.

Cllr Hinchcliffe explained that, unlike devolution in Greater Manchester, the West Yorkshire deal does not include any nationally held public expenditure for health or care services or devolution of any nationally held powers in relation to health and care.

Tom explained that the devolution deal provides significant opportunities for the WY&H Partnership to work collaboratively within the new powers, devolved funding and mayoral authority to progress better health and care outcomes, in line with its priorities. The scope of the deal in skills, economic growth and transport is firmly part of the wider determinants of health within which proposed legislation states Integrated Care Systems will have a strong partnership role. More concretely, the deal has significant potential to both directly

and indirectly support the Partnership’s ’10 Big Ambitions’. Tom highlighted some of the key areas of opportunity, including addressing skills gaps, digital and technology.

Members noted that North Yorkshire and York are also in discussions about a potential devolution deal and in February 2021, the Government launched a consultation on two alternative plans for new unitary authorities in North Yorkshire. The two options are being consulted on are: unitary authorities following the current North Yorkshire County Council and City of York Council areas and an east/west model.

The WY&H Partnership Board was asked to note:

 the significant progress to date of the deal and the areas of financial and powers devolution encompassed in the West Yorkshire agreement;  the scope of opportunities the deal offers in relation to health and care outcomes and wider determinants of health; and  the requirement to engage with the devolution structures and consider how they may best be linked across the ICS and associated partnership forums.

The following comments were made during the discussion:

 the devolution deal for WY will be beneficial to us all and we should continue to identify and clarify the priorities for us  the way in which we rebalance our nation (particularly in respect of the North / WY&H) will be very important - further devolution of central government departments to the region continues to be encouraged by the West Yorkshire Combined Authority;

Item 04/21

Item Agenda Item  we are seeing the consolidation of the national / arms-length bodies in the health service (many of which are based in our region) and we should continue to make the case for them retaining / expanding their footprint in WY&H;  the devolution agreement includes housing supply (though the planning powers will remain at the local place level) - hopefully this will help us enhance other important housing issues, e.g. quality of neighbourhoods, housing decency and density, etc.

10/21 Planning priorities for 2021/22

The Chair invited Anthony Kealy and Tony Cooke to introduce the item.

Anthony explained that the purpose of the paper was to provide an update on the approach that we are taking across the WY&H Partnership to agree planning priorities which will ensure that we achieve our shared priorities for 2021/22, including stabilising and resetting health and care services and making progress on our 10 Big Ambitions. The paper sets out how NHS, local government and other partners will work together in each place to develop shared, integrated plans.

Anthony explained that the Partnership’s priorities for 2021/22 would be influenced by a number of factors, including the need to:

 address widening health inequalities;  lock in the benefits of innovation and changes brought about through the pandemic;  prepare for the introduction of proposed legislative changes in 2022/23;  take account of NHS national planning guidance and priorities - which we are expecting will be issued in April 2021 (possibly earlier for mental health priorities).  respond to the financial and sustainability challenges in the social care sector; and  take account of the Government’s devolution deal for West Yorkshire.

Anthony explained that we will expect to see a number of common priorities reflected in our place and system plans:

 Staff recovery – the need to allow staff, who have coped with the relentless pressure of the pandemic for a year, to have some opportunity for rest and recuperation, and to factor this into the phasing of recovery plans;

 Elective care recovery – the West Yorkshire Association of Acute Trusts is working to agree a common WY&H system-wide elective recovery and reset plan which recognises the primacy of place-based and acute trust care, but allows the development of innovative, resilient, cross-system working to significantly reduce the number of patients waiting over 52 weeks and prevent patients waiting more than 104 weeks for their treatment.

 Health Inequalities – we will continue to focus on delivery of the eight urgent actions on health inequalities that we agreed as part of our stabilisation and reset plans in the autumn

 Living with COVID-19 – we will need clear plans to move the programme for vaccine delivery from a ‘campaign’ to a business-as-usual footing, with a sustainable workforce and delivery infrastructure. Similarly, local arrangements for test-and-trace will need to develop a sustainable delivery model for the foreseeable future.

Item 04/21

Item Agenda Item

In respect of social care – Tony Cooke added that whilst there have been significant challenges in social care (particularly in the care home sector) over the last 12 months – but also great innovation, use of technology and a greater understanding of the needs of people who use services.

The WY&H Partnership Board was asked to:

 discuss the approach to whole-place integrated operational planning; and  be assured that it will support the development of more integrated, place-based plans to achieve our shared priorities for 2021/22.

The following comments were made during the discussion:

 as a Partnership we have previously agreed to establish a WY&H programme focussing on children, young people and families – the majority of the work will continue to be delivered at place and supported by WY&H;  we must ensure that we don’t lose sight of all aspects of care;  we must acknowledge the importance of rest and recuperation for our staff and utilise the Voluntary, Community and Social Enterprise Sector along with innovations / technologies in our reset plans;  our Acute Trusts continue to ensure that prioritisation is clinically-led; and  the approach we take to operational planning 2021/22 will further reinforce the progress that we have made as a partnership in moving towards more integrated working, both within each place and across WY&H as a whole – as such we would want to see disproportionate investment in prevention, mental health and wellbeing and in areas of inequality in our plans.

11/21 AOB and Close

There was no further business.

The Chair thanked all members and attendees for their participation.

Date of next Tuesday 1 June 2021 meeting:

Item 15/21

WY&H Health and Care Partnership Board – Action Log

Action Log No Agenda Item Action By Who Deadline Status OPEN ACTIONS

Tackling health inequalities for IN PROGRESS / Progress against the action plan should be a WY&H 40/20-1 Black, Asian and minority ethnic ONGOING standing item on the WY&H Partnership Board Partnership Ongoing (Due for consideration (1 Dec 2020) communities and colleagues meeting agendas for future meetings. Team at Item 17-21 on 1 Review June 2021) Actions closed at or since the last meeting

Members to raise any concerns / queries in CLOSED 04/21-1 Minutes from the last meeting – 16 March relation to the WY&H Partnership MoU by COP All (No concerns / queries (2 March 2021) 1 December 2020 and action log 2021 on 16 March 2021 to the WY&H Core Team. raised) Government White Paper: The WY&H Future Design and Transition Group “Integration and Innovation: should have representatives from all five places CLOSED WY&H 08/21-1 Working together to improve and sectors (NHS, Local Authorities, Public Partnership ASAP (Both Groups integration and innovation for Health, Social Care etc) and be supported by a (2 March 2021) Team established and all” - Implications for our Reference Group of NHS Chairs and Council meeting regularly) partnership Leaders. CLOSED Review of the WY&H (Agreed to close this WY&H 42/20-1 Partnership’s Memorandum of A revised MoU to be circulated to partners for 31 March action at 1 March Understanding and Integrated agreement by 15 December 2020, for sign off by Partnership 2021 meeting and (1 Dec 2020) 2021 Care System working partner organisations by 31 March 2021 Team instead complete arrangements Action 04/21 as described above)

Item 15/21 Annex A

WY&H Health and Care Partnership Board Meeting – 2 March 2021

Response to questions from members of the public

In respect of Item 08/21: Government White Paper: “Integration and Innovation: Working together to improve integration and innovation for all” - Implications for our partnership

Question 1

We appreciate that The West Yorkshire Partnership has raised a flag for accountability and striven to retain CCGs but would like to know how the Board thinks it can avoid being steamrollered by the legislation, stem the loss of accountability and uphold the primacy of place based planning in reality, not just in rhetoric? Only at place is there some accountability to the electorate and the intimate, local knowledge and networks needed to make a decent fist of tackling health inequalities.

Question 1: Response

Place will continue to be the primary unit of planning and collaboration across our system, with the statutory ICS working to support our places to integrate services, reduce health inequalities and improve outcomes.

Under the White Paper, place-based arrangements between local authorities, the NHS and providers of health and care will be left to local organisations to decide and we will build arrangements that maintain clear leadership and accountability at place level. This will continue to include the central involvement of Health and Well Being Boards. In addition, we expect significant devolution of functions and resources to place-based committees to enable joint decision-making with local government. This is anticipated in the legislation and is expected to be available to us.

We are absolutely committed to this model of working, and do not believe that the legislation proposed in the White Paper will preclude us from working in this way.

Question 2

We would also like to know how the Board thinks the planned legislation will give Adult Social Care a greater voice in NHS planning and allocation? Although another tier of organisation has been added to the proposed structure, it seems to have been relegated seats in the upper balcony while health and a few representatives from Local Government get seats in the front stalls.

Question 2: Response

The White Paper sets out a number or measures for strengthening the role of social care, including representation in ICS governance structures and a new duty to collaborate. For example the statutory ICS Board includes proposed requirements to have local authority representation, unlike the current CCG governing bodies.

In West Yorkshire and Harrogate, social care already has a strong role in all of our partnership arrangements and is seen as an equal partner in delivering health and care improvement. This will continue under the new arrangements.

We recognise that the arrangements at place level are key to this, and will ensure that this is built in to our thinking. 19

Item 15/21 Annex A Question 3:

Given the White paper is suggesting that ICS will have more control over procurement, we would like to know:

i. What is the Board going to do to avoid the loss of oversight, transparency and accountability which has characterised recent Government contracting and resulted in a poorly performing test and trace system and significant waste on PPE provision by firms whose main qualification seems to have been having friends or cronies in Government? ii. What efforts are going to be made to use public providers and avoid private firms taking money out of the public purse to pass on to their shareholders? iii. How can the Board avoid strategic planning being skewed by private companies whose primary responsibility is to their owners and shareholders if, as suggested, they are given seats and thereby power and influence on the proposed Health and Care Partnership Boards?

Question 3: Response

NHS England has issued a consultation document on the proposed new provider selection regime. This covers the checks and balances that will apply and arrangements for ensuring transparency and accountability. We support the need for such measures. The Partnership will be responding to that consultation paper and will publish its response. (enclosed at Appendix 1)

The current requirement to go out to competitive tender has been widely criticised as creating unnecessary complexity and costs for commissioners and providers and acting as a barrier to health and care integration. It has also been criticised by many for enabling and accelerating the “privatisation” of NHS services.

The WY&H Partnership broadly welcomes the proposals to give commissioners more flexibility and only go out to tender when there are demonstrable benefits. It is of course vital that in making decisions, commissioners act in the best interests of patients, taxpayers and the local population.

Question 4:

Given the White paper also seems to be taking initial, small steps towards making Social Care a handmaiden to Health in one integrated system, with the focus on facilitating hospital discharges and reducing the use of expensive secondary care, we would like to know if the Board will resist this direction of travel? We fear that such a move will reverse the decades’ long struggle of the disabled people’s movement to stop Social Care being seen through a medical lens rather than situating it firmly in the development of inclusive societies and independent living.

Question 4: Response

Social care is focused on supporting people. In doing so, the best care works with people and other partners. This is reflected in the White Paper, which recognises the need for inclusive partnerships that reach beyond health and social care and focus on population health and reducing health inequalities. It also emphasises the importance of close partnership working between the NHS and local authorities at neighbourhood, place and system level.

Item 15/21 Annex A These partnerships are at the centre of how we work in West Yorkshire and Harrogate across health and social care and we see them as key to our success so far. We will carry on with our approach of local authorities (including public health, housing and other key services, as well as social care) being equal partners with the NHS in delivering health and wellbeing improvements.

Item 15/21 Annex A - Appendix 1

Policy Development and Implementation Team 5E42 Quarry House Leeds LS1 7UE

7th April 2021 Dear Colleague

Response to consultation on NHS Provider Selection Regime

The West Yorkshire and Harrogate Health and Care Partnership welcomes the proposals set out in the consultation paper on the NHS Provider Selection regime. Our response to the consultation questions is attached. On behalf of the leadership of the Partnership, I also wanted to make some general comments.

We believe strongly that local decision-makers are best placed to identify and understand the needs of their communities, engage with them and arrange services that meet their needs. We have previously supported proposals to give decision-makers more flexibility in arranging healthcare services and to choose to go out to competitive tender only when there are demonstrable benefits in so doing. This flexibility will mean a much greater emphasis on the merits of provider selection and the preferred outcomes, rather than the current legislation-driven approach. This will, in turn, support both collaboration and the integration of services, which are critical if we are to improve the health and wellbeing of our communities and reduce health inequalities.

It is of course vital that in making decisions, commissioners act in the best interests of patients, taxpayers and the local population. We therefore also support the proposed checks and balances set out in the consultation document, together with the arrangements for ensuring transparency and accountability. The latter are strongly supported.

The Partnership particularly welcomes:

 the provision that existing arrangements may be continued when current providers are performing well and delivering agreed outcomes.  the use of key criteria to guide decision-making when changes need to be made, and the flexibility for decision makers to determine locally a hierarchy of importance for these criteria.  that the proposed key criteria cover population health outcomes, reducing health inequalities, patient choice and access to services for minority and vulnerable groups.  that the key criteria include innovation, integration and collaboration and social value considerations including environmental impact, economic growth and community cohesion. These social value considerations will be an essential part of future benefits from investment in health and care services and deserve higher profile.  the recognition of the important role of the Voluntary, Community and Social Enterprise sector in providing health services and that this will continue under the new provider selection regime. Item 15/21 Annex A - Appendix 1

We welcome the application of the new provider regime to all bodies responsible for arranging healthcare services, including local authorities and NHS Trusts when making arrangements with other providers. However, the new regime is likely to create a bigger gap than currently exists between NHS and local government procurement practice and requirements. In order to support integrated commissioning of integrated services, it would be helpful to extend the application of the regime to social care commissioning by local authorities. This will support and simplify joint working between all ICS partners, promote collaboration and the integration of services and help tackle some pressing social care issues.

To ensure that the provider regime operates effectively, it will be important that decision making is transparent and that decision-makers are publically accountable. The Partnership therefore welcomes the measures set out in the consultation paper, including the continued role of local authority health oversight and scrutiny committees. We also welcome the recognition that decision makers must act in the context of existing wider duties, including ensuring public and patient involvement and managing conflicts of interest.

The proposals focus on not using competitive procurement for existing providers, or when where there is a single most suitable provider. Under the existing NHS 2013 regulations on patient choice, which will remain, providers of consultant-led outpatient care should be awarded a contract if they can demonstrate that they meet the criteria. Guidance would therefore be helpful on the circumstances under which an ICS could decide to not award a contract to a new entrant if they met the set commissioning criteria.

We welcome the provision for providers to challenge decisions with the decision making body and, in line with greater autonomy for local systems, the proposal that NHS England will not be routinely involved in complaints and challenges against decision making bodies. We note that NHS England will retain its powers of intervention in serious cases where commissioners are in breach of statutory duties and that judicial review would be available for providers that want to challenge the lawfulness of a decision. To avoid any unnecessary legal challenge, it will be helpful if guidance is clear on how the challenge process will operate in practice, and how an ICS will be expected to manage provider challenges.

We look forward to working with you further in the development of these important proposals.

Yours sincerely

Rob Wester CBE, Chief Executive Lead, West Yorkshire and Harrogate Health and Care Partnership

Item 15/21 Annex A - Appendix 1

Detailed questions

Application

1. Should it be possible for decision-making bodies (e.g. the clinical commissioning group (CCG), or, subject to legislation, statutory ICS) to decide to continue with an existing provider (e.g. an NHS community trust) without having to go through a competitive procurement process?

Comments:

This choice should be publicly reported with clear demonstration of benefit.

2. Should it be possible for the decision-making bodies (e.g. the CCG or, subject to legislation, the statutory ICS) to be able to make arrangements where there is a single most suitable provider (e.g. an NHS trust) without having to go through a competitive procurement process?

Comments:

This choice should be publicly reported with clear demonstration of benefit.

3. Do you think there are situations where the regime should not apply/should apply differently, and for which we may need to create specific exemptions?

Yes. As outlined in the consultation document, there may be situations where the regime should not need to apply, for example where urgent needs arise unexpectedly or patient safety is at risk. In such circumstances it will be important that decision-makers are able to act swiftly in the best interest of patients, taxpayers and the local population.

It will be helpful if guidance sets out the type of circumstances in which the regime should be applied differently. It will be important that decision makers are required to demonstrate exceptionality and to provide a public account of the decision making process.

4. Do you agree with our proposals for a notice period?

A notice period will be important to ensure transparency and scrutiny. The proposed notice period of 4–6 weeks would appear to strike the right balance between the need for transparency and accountability and the need to progress decisions in a timely way. This time period would need to be subject to any exceptions such as those outlined in question 3 above.

The 4-6 weeks’ notice is measured from the date of intended award. If a decision to not procure is made 4- 6 weeks before the end of contract, and is then successfully challenged, there would be insufficient time at that point to procure. At least in the short term, an extension beyond contract would be forced by the timescales. The date of notice, or planned award, should take into account the necessary time to procure, so due process can be followed if a different decision is made, or a successful challenge made.

3 Item 15/21 Annex A - Appendix 1

5. It will be important that trade deals made in future by the UK with other countries support and reinforce this regime, so we propose to work with government to ensure that the arranging of healthcare services by public bodies in England is not in scope of any future trade agreements. Do you agree?

The framework within which decision-making bodies operate must be both consistent and transparent. It is important that it is not subject to change as a result of future trade agreements.

Key criteria

6. Should the criteria for selecting providers cover: quality (safety effectiveness and experience of care) and innovation; integration and collaboration; value; inequalities, access and choice; service sustainability and social value?

Do you have any additional suggestions on what the criteria should cover/how they could be improved?

We support the broad scope of the key criteria, and the proposal there will be no centrally imposed hierarchy of importance. As set out in our covering letter, the social value elements are an important addition.

It is important that local systems have the flexibility to determine their own hierarchy of criteria in the light of local population health needs. It will of course be important that decision-makers are transparent about how they have prioritised and applied the criteria.

In relation to criterion 5, Service sustainability, there will be a need to recognise connected services that are co-dependent, in some circumstances. Good practice on this and further guidance may be helpful. This could cover how decision-makers should consider the impact of their decisions on the stability and sustainability of the NHS and integrated system locally and the circumstances under which they could use this to justify either continuation of the status quo ante or the acceptance of one set of provider proposals over another.

Transparency and scrutiny

7. Should all arrangements under this regime be made transparent on the basis that we propose?

Strongly disagree | Disagree | Neutral | Agree | Strongly agree

In order for the provider section regime to be credible and have the confidence of taxpayers, patients and the population it is essential that decision making processes are made public and that there is sufficient scrutiny of the arrangements.

4 Item 15/21 Annex A - Appendix 1

General questions

8. Beyond what you have outlined above, are there any aspects of this engagement document that might:

 have an adverse impact on groups with protected characteristics as defined by the Equality Act 2010?  widen health inequalities?

No. We welcome that the key criteria for decision-making specifically include impacts on health inequalities and ensuring access to services for minority, excluded and vulnerable groups.

9. Do you have any other comments or feedback on the regime?

Our general comments are covered in our covering letter.