To receive a presentation on the work of the West Mercia PCT Cluster.

The Committee received a presentation from Mr Eamonn Kelly, Chief Executive of the NHS West Mercia PCT Cluster.  The presentation is attached as Appendix 2.  During the presentation, Mr Kelly highlighted the following areas:

·         The national quality priorities for 2012/13.  These included a general message concerning the needs to address the shortfalls in dealing with older people, and the pivotal role of carers.  There was also an emphasis on the military and veterans’ health.

·         There were a number of national clinical outcomes against which there were quality measures.  In the past there had been different standards for rural communities for measures such as ambulance response times, but these were now all of a single standard.  The area of quality of life for those with long term conditions would continue to grow and managing this area would be a huge challenge; there were presently 145 different significant illnesses in this category.

·         Key challenges for Herefordshire included meeting targets for C Difficile and A&E admissions.  Wye Valley Trust were confident that both of these could be met in the coming year.

·         That the reform of the commissioning system to complete the transition to the new architecture would be radical.  Across West Mercia there would be six Clinical Commissioning Groups under one Commissioning Support Organisation.  This was considered to be the most effective model.  The West Midlands would be one of the local parts of the single National Commissioning Board.  Principle responsibility for public health would fall to the Local Authority.

·         This would be a challenging time for staff, 45% of which would be employed by the Clinical Commissioning Group and the Clinical Support Organisation, 20% from the National Commissioning Board, 17% from the local authority, which left 18% to be determined.  There were a number of schemes running to offer support, such as regular briefings, surveys and Q&A sessions.

·         The QIPP (Quality, Innovation, Productivity and Prevention) plans would present a huge challenge for West Mercia, which would have to save £377m over 4 years.  The providers would have the greatest challenge, having to save £21m out of a total of £295m

In the ensuing discussion, the following points were raised:

• That the Wye Valley Trust would provide integrated provider services, and the organisational model was currently being reviewed.  The single management authority for the PCT would no longer exist after the abolition of the PCT.  The Clinical Commissioning Group (CCG) would take its place with the Local Authority and would commission services from Hoople Ltd and Herefordshire Public Services (HPS)

• That the CQC would be responsible for regulating all healthcare providers; they were currently responsible for all community health care providers.  The first responsibility for assessing providers would be to get the appropriate combination of PCT, CCG and Local Authority clinicians under the aegis of the Joint Commissioning, Public Health and the Health and Wellbeing Board.

In answer to a question, Mr Kelly said that whilst the changes were complex and appeared fragmented, there would be a net reduction of £1.7bn in national staffing costs.  The intention was that there should be greater clarity and accountability locally as providers and commissioners worked in an integrated fashion with the Health and Wellbeing Boards providing an overview of the system and acting as a lynch pin.  In answer to a further question, he went on to say that whilst alcohol consumption was not a national quality measure, it would be in Herefordshire.

The Deputy Chief Executive said that the work of the Health & Wellbeing Board was fundamental to the effective operation of local relationships within the County.  The Council was working with Mr Kelly and his team in order to minimise uncertainty during this transition period.

In reply to a further question, Mr Kelly agreed that the most formidable challenge would be to avoid staff losing heart during this process, not least as a result of the  necessary 4% year on year efficiency savings, especially in the Wye Valley Trust. Restructuring would reduce costs in the wider organisation.

In reply to a question concerning the ability to mitigate risk, Mr Kelly said that the PCT was no longer a robust organisation and that whilst the cluster was not an ideal replacement, it was the best option for West Mercia.  It would be run in a shadow form within the PCT umbrella, until the latter was abolished.  The biggest risk would be attempting to return to the original system, whilst bringing forward the implementation date would be the best option.

Whilst there was a certain amount of opposition within the NHS as a whole to the NHS reforms, there was an appetite amongst GPs in the County to embrace the CCG.  Real administrative improvements were being seen in the use of resources by GPs.  They were seeking to rebuild the relationships with colleagues in hospitals.  These relationships had broken down, but now there was a greater degree of communication.

RESOLVED:  That the Committee would regularly monitor the activities of the Health and Wellbeing Board.