Brighton Citizens' Health Services Survey 2016

Researchers undertook a project that sought to bring the voices of the people of Brighton and Hove to important topical health issues like funding cuts, NHS privatisation and the broader link between local health commissioners and national funding policy directives.

Researchers from the universities of Brighton, Essex and Surrey collaborated on the project which addressed the disparity that had arisen between some current commissioning practices and public values.

Research on the functioning of local healthcare commissioning since the passing of the Health and Social Care Act (2012) (HASC) had revealed a number of problematic issues. Many of these concerned the constitution and activities of the Clinical Commissioning Groups (CCGs). In key guidance documents issued to CCGs on governance, it was recommended that Clinical Commissioning Groups had a responsibility to ensure that patients and the public were actively involved in commissioning arrangements. However the groups are also accountable to multiple other agencies.

Recent reports from clinicians across England, documented in the British Medical Journal, describe dysfunctional commissioning processes in areas undergoing competitive tendering, with compromised patient pathways and where cost-efficiency seems to be the overriding concern.

Patient participation groups, the current prominent feedback mechanism, are considered fragile and variable, poorly defined and with no evidence to suggest they have been effective in securing engagement at practice level. As such there is a need to look for additional ways through which to engage with the public, beyond the traditional set-piece consultations.

Recent research suggests that health care professionals, including commissioners, do not feel Clinical Commissioning Groups policies reflect their own views and that they have very little chance to impact the groups' policy decisions. There is strong evidence that patient participation is linked to better treatment results, higher patient satisfaction and more responsive services.

This, the first Brighton Citizens' Health Services Survey (BCHSS) was conceived by academics at the University of Brighton to hold regular six monthly independent public consultations with thousands of people of Brighton and Hove to explore some of the broader questions about healthcare commissioning that often get missed during traditional consultation.

These consultations are not about patients’ experience of their local services directly but rather seek to capture rich data representing the voices of the people of Brighton and Hove on important topical health issues like funding cuts, privatisation and the broader link between local commissioning and national funding policy directives.

A survey of eight questions, relating to key current and upcoming commissioning issues, was completed by 1,300 residents of Brighton and Hove. Questions focused on core values on health commissioning, current commissioning issues and future commissioning plans.

The key findings were published in the Brighton Citizens’ Health Services Survey team, 'Brighton Citizens' Health Services Survey' (March 2016) findings report and included the following:


When asked who they would prefer to be treated by, almost 88 per cent of the respondents said the NHS. This compared with 9.1 per cent who had a preference for a private healthcare company.
When asked whether people believed that “health companies should not make financial profit from people’s health problems”, 92 per cent strongly agreed or agreed with this statement.
Participants were asked whether, in light of Optum’s international legal difficulties, there should have been a full public consultation on Optum. 93 per cent said that there should have been.
Over 93 per cent of people said that they were concerned or very concerned about the award of the Optum contract locally.
The council recently revealed an intention to cut £21.9 million over the next four years from the Adult Social Care budget. Over 97 per cent of people were either very concerned or concerned about these cuts.
97 per cent of people either strongly agreed or agreed with the following statement, ‘The council should be actively resisting these latest cuts by evidencing their impact and sending the messages back to central government’.
In 2016 and 2017, the Brighton and Hove Clinical Commissioning Group (who buy in local health services) are considering inviting health providers to bid to run a primary care mental health service. 93 per cent of people would be very concerned or concerned if this contract was given to a private provider.
Similarly, regarding the potential contract for NHS 111 service for non-emergencies, 85 per cent of people would be very concerned or concerned if this contract was given to a private provider.
The Public Health contract for Health Visiting, School Nursing and other children's community health services is due for renewal by the end of March 2017. 90 per cent of people said that they would prefer that this stayed with the NHS.
There were four key conclusions:

This report showed that the public in Brighton and Hove held clear and compelling values on the way that they want their health services to be commissioned.
It restates that CCGs have a very clear constitutional remit to ensure that these views are appropriately reflected in their decision-making.
In the city of Brighton & Hove, the vast majority of the public is against the use of private companies in the local health economy and very concerned about some recent decisions that have been made to commission private companies to undertake certain services.
Thus further work is needed on the part of the CCG to reflect the public needs and values in their commissioning decisions.
New guidelines developed and published by NICE on community engagement suggest the development of collaborations and partnership approaches to encourage and support alliances between community members and statutory, community and voluntary organisations, particularly involving people in peer and lay roles and making it as easy as possible for people to get involved.

As a result of the findings above and recommendations from NICE, it is intended that the Brighton Citizens’ Health Services Survey will continue. It will also act as the beginning of a broader project seeking to recruit various local stakeholders and members of the public to use the University of Brighton as a platform through which to host innovative ways to address the disparity that has arisen between some current CCG commissioning decisions and public values.