The Health & Social Care Act, effective April 2013 and CMBC

Effective from 1st April 2013, this major change to the provision of Health services will pass responsibility for some previous local NHS services to CMBC. I feel it will be reasonably well known the previous local NHS Primary Care Trust (PCT) is to be replaced by a new local GP Commissioning Group; however I guess it will be less well known how this Health & Social Care Act will affect CMBC?

In July 2012 having read the local new NHS Commissioning Group’s 2013/14 final version 4 Plan I submitted a FOI request to CMBC asking if they had an equivalent plan. The response, I quote There is no one Council Plan dealing with the implementation / integration of Public Health Reforms

CMBC speak for there is no plan

The response continued, I quote the two primary areas affecting the Council are the transfer of Public Health functions and the requirement for the Council to establish a Health and Wellbeing Board

Note the integration element previously mentioned has now disappeared.  Is this a serious worry, yes it is! Please see the Problem!

The FOI response then stated, I quote A Shadow Health and Wellbeing Board was established in 2011. Details of progress (minutes not progress) and reports can be found on Calderdale Forward’s website. Meetings, especially “collective board meetings” (members having a shared responsibility but not a shared personal professional interest) can be meaningless, a waste of time. Please see the Problem!

I discovered Calderdale Forward (CF) has now been discontinued, as it is to be replaced by the new Health and Wellbeing Board (H&W board) effective from April 2013. However the old CF website continues in use, with a small title change, moving Calderdale forward now used by the H&W board. Clever this, a good idea, there being no need to invent a new wheel

So there we have it CMBC will have a new Statutory Committee, the Health and Wellbeing Board to oversee CMBC’s increased public health services, April 2013.

Who are the members of the interim board, and therefore the prospective members of the new board “effective” from April 2013?

Politicians (6)

The Political Party Leaders (3)

Councillor responsible for Adult Health & Social Care

Councillor responsible for Children’s Social Care

Councillor responsible for Education & Life Long Learning

CMBC officers (4) (**)

Chief Executive

Director responsible for Public Health

Director responsible for Adult Health & Social Care

Director responsible for Children’s & Young People’s Services

Calderdale Head Teachers Representative (1)

NHS (4)

Chair NHS Calderdale, Kirklees, Wakefield District Cluster

Chair Calderdale Commissioning Group

Accountable Officer Clinical Commissioning Executive

(Aka CEO Calderdale Commissioning Group?)

Director of Quality & Engagement, NHS Calderdale

Currently a committee of 15, plus others who are invited to attend from time to time. This is 9 above the Health & Social Care Act’s minimum statutory number, which is

At least one Elected Representative

The Directors of Children’s Services, Adult Services, and Public Health (**)

A representative of the Local Health Watch Organisation

A representative of the Clinical commissioning Group

(**) However existing Government Legislation states with very good reason, Council Officers cannot be members of a Council Committee. This rule must not be overturned or even watered down!  The government’s ineptitude here presents a superb aptitude test or buggers muddle even, for Council Leaders to resolve!

You may feel the H&W board will at least make quite a good talking shop, as its predecessor Calderdale Forward did. This may get better, I mean worse! The draft minute re agenda item 11 meeting 17 July 2012, I quote As the board moves towards a statutory committee of Council (April 2013) consideration (should be given) to expanding the board’s membership. Blimey, isn’t 16 enough, being 9 above the statutory minimum already?  

The next meeting’s agenda, 9 October and the previous meetings draft minutes, 68 A4 pages, posted by the shadow Health & Wellbeing Board on the renamed Moving Calderdale Forward website illustrates my talking shop point, some examples being

  • There are quite a number of reports concerning, social engineering, such as Calderdale is a place where everyone has a sense of pride and belonging based upon mutual respect, sky blue thinking. These reports contain standard sub headings such as Why is this a priority for Calderdale, What will success look like, How will we measure success, Approach to tackling (should this be achieving?) this outcome, Commitments to action, Calls (partners that is) to action This may be brilliant bureaucracy but unfortunately there is absolutely no mention of any target dates or any specific individual responsibilities, therefore in reality, not value adding bureaucracy, just talk!
  • The terms of reference for the Health and Wellbeing Board are still being discussed despite the shadow board having been established fifteen months ago. CMBC may say this is because the mandatory requirements for this board have not yet been determined by government, but this is no reason for still discussing what CMBC would like these terms to be
  • There was no opposition representative present at the last meeting 17July, Councillor Stephen Baines our opposition leader presented his apologies but unlike others he did not arrange a substitute. Perhaps our “constructive opposition” feel as I do, that in the main, talking shops like these are rather a waste of time
  • 9 October meeting agenda item 10 a note to provide CMBC Health and Wellbeing Board with feedback from the joint Health and Wellbeing event, yet more talking  organised by the Calderdale, Kirklees and Wakefield NHS Cluster Board meeting on 12 September 

Unfortunately meetings and talking are not an alternative to good management.

Should you have read this far well done! You may be wondering what the main point I wish to make is or put another way, what is the problem with all this, as I see it?

The Problem!

There is an urgent need to develop an improved, more cost effective CMBC social care organisation and management structure integrated with the new additional requirements of the 2013 Health and Social Care Act.

This work should now be taking place but this does not appear to be the case  

The Solution to the problem

One CMBC Public Health Care Directorate (not three) to provide public health services in Calderdale; Children, Adults, Alcohol and Drugs dependency etc, with one management team, just one set of plans and one set of common processes.

Let us have no worst case, that is, an additional Directorate to cover the 2013 Health Act and not even just a new Service Department either!

The Current Position, reality

The 2013 Social Care Act talks about the need for integrated local authority service delivery, but unfortunately this is not a mandatory requirement, another major government mistake. Integrated service delivery along with integrated social care commissioning in these economic times would be a superb step forward for CMBC, Calderdale Social Care Users and the CMBC Budget requirement that is Calderdale Rate Payers.

 According to the Courier, 31 August, I quote with the impending abolition of the primary care trust (PCT) the future for its staff is uncertain some will remain to support the Calderdale Commissioning Group and some will move to CMBC which takes over responsibility for public health in Calderdale but exact numbers of staff moving or being made redundant, are not yet known. How many, along with their Senior Managers will be allowed to scrabble aboard the good ship CMBC, far too many I guess!

Will the Council Cabinet leave the development of our CMBC Health Care management structure and organisation with their Senior Officers, to get on with as they best think fit or does the cabinet have the experience and also the will power required to lead from the front and set out the one directorate structure required?

Will CMBC continue with a top heavy little value adding management structure employing multitudinous duplicated complex procedures, consuming scarce  financial resources better spent on the front line (each existing senior officer involved protecting their own situation, that is, their empire) or will we see a new 2010 decade management and organisation structure, fit for purpose today?

We will see.

It is so easy and even enjoyable to spend time sky blue thinking and to justify this as essential meaningful work. Unfortunately it is far less easy and certainly not enjoyable to implement change e.g. a flat management structure, even when you see this is required

After the elections in May a councillor told me CMBC is like the NHS as both are battleships difficult to turn round and impossible to stop. In fact a battleship could do both these things given time, space and an experienced Captain and crew. CMBC has an experienced crew but does CMBC have an experienced Captain?

Watch this space

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