To receive a presentation on the work of the Midlands & East Specialised Commissioning Group together with an overview of the Groups current plans.

The Committee received a presentation from Stephen Washbourne, Director of Operations, Midlands & East Specialised Commissioning Group (MESCG). The presentation is appended to the Minutes at Appendix 2.

During his presentation, Mr Washbourne highlighted the following areas:

·         That specialised commissioning groups would be clustered along the same footprint as the Strategic Health Authorities (SHAs).  This was part of the transition into a single nationwide function following the publication of the Shared Operating Model for PCTs.

·         That specialised services, which were required for rare and complex cases that were high cost, needing specialist interventions with expensive equipment, would be provided in relatively few specialist centres to a population of more than one million people.

·         That services would be commissioned by the NHS Commissioning Board (NHSCB) rather than individual Clinical Commissioning Groups.  The budget and service portfolio for the Board would be determined nationally.  One of the challenges going forward would be to mitigate risk to patients during the transition period.

In the ensuing discussion, the following points were made:

·         In reply to a question, Mr Washbourne said that there was no question that Herefordshire would be marginalised within the new structure.  Across the West Midlands area there was a budget of £925m, of which Herefordshire had an allocation of £24m. This should be seen in the context of the allocation for Birmingham, which was £90m.  The Chair of NHS Herefordshire, the West Midlands NHS West Mercia PCT Cluster and the Midlands & East Specialised Commissioning Group (MESCG) was Joanna Newton.  She was always looked to rural issues, and ensured that the populations under the aegis of the Midlands & East Specialised Commissioning Group were treated equitably.

·         That one of the main challenges for the new structure was effective communications with elected Members.  This had been an issue in the past, and was one of the roles of that would be taken on by the Health & Wellbeing Board.

·         Mr Washbourne added that there was a need to ensure the correct access to cardiac, neurosurgery and dialysis, and how patients should be integrated back into the community from acute beds. There was often a focus by commissioners on commissioning numbers, rather than identifying outcomes.  NHS Herefordshire was the body accountable for ensuring the delivery of the portfolio of services from the MESCG.

·         The Vice Chairman pointed out that the Health and Social Care Bill was still under discussion in Parliament and that it would be appropriate to assume that the changes laid out would take place.  It was imperative that the local PCT should still have a voice in the decision making process.  It was important that at least 80% of available funds for commission should be provided to the Clinical Commissioning Group, whilst the rest could be handled by the MESCG.  There was a quarterly meeting of Overview and Scrutiny Committee Chairmen within the area covered by the Group, and it was important that this should continue to take place.  He added that it had been suggested to this committee that a review of Trauma Care should be undertaken in light of the introduction of the trauma care network in the West Midlands.

·         In reply to a question as to where power and accountability lay within the new structure, the Cabinet Member (Health & Wellbeing) agreed that there were enormous changes afoot and a lack of clarity as to how this was being managed.  It had been proposed that a seminar for Members should be organised to outline what the changes would entail and asked that Members provide her with specific areas of concern.

·         A Member expressed concern that appropriate service delivery models for localities were being developed within the area of adult social care.  It was not important to own the services, but it was important that users should not have to travel further in the future to access them.  The Cabinet Member concurred, and said that where possible specialist outreach services would be provided in the County.  It would be possible for people across Herefordshire to access services in a more coherent fashion with linked appointments to specialist clinics.

·         The Cabinet Member added that the role of the Health & Wellbeing Board was to hold the system that comprised the PCT Cluster, Wye Valley NHS Trust and the GP Parliament to account.  As with all other Health & Wellbeing Boards, the Board was still in the process of working out how this could be effectively done.  She suggested that the work of the Board might be an area that Overview & Scrutiny could consider in 18 months’ time.

RESOLVED:

That

a)    the Committee expressed concern that there was a lack of clarity as to how specialised services would be delivered under the new centralised commissioning model.

b)    It be recommended that centralised specialised services should be organised within the Midlands & East Specialised Commissioning Group in a manner that did not disadvantage the residents of Herefordshire.