To consider the future of healthcare in Herefordshire as part of a discussion with the Wye Valley NHS Trust, the Herefordshire Clinical Commissioning Group and the West Mercia PCT Cluster.

The Committee considered the future of healthcare in Herefordshire as part of a discussion with the Wye Valley NHS Trust, the Herefordshire Clinical Commissioning Group (HCCG) and the West Mercia PCT Cluster.  The Chairman welcomed Ms C Gritzner, Chief Operating Officer Designate and Interim Accountable Officer, HCCG, Mr P Maubach, Director of Commissioning Developments West Mercia PCT Cluster and Mr H Oddy, Acting Chief Executive, Wye Valley NHS Trust.

Ms Gritzner provided a presentation, and highlighted the following areas:

·         That the Governance structure for the HCCG as outlined for the Committee in the presentation had been agreed, and the organisational structure had been sent out for consultation with staff.  A report would be submitted to the Board in August. 

·         That the HCCG had slipped from Wave 2 into Wave 3 of the authorisation application process, the legal process through which CCGs were approved as the new local statutory NHS commissioning bodies.  The application would be submitted in September and assessed by an independent panel from outside the region.

·         That the objectives, vision and plan of HCCG had been endorsed by the Health and Wellbeing Board, and the Joint Strategic Needs Assessment had been embedded into the planning process.

Mr Maubach provided a presentation on the structure of the National Commissioning Board (NCB).  He said that there would be 8 local area teams within the Midlands and East Cluster, and they would have the same core functions around CCG development, emergency planning, quality and safety and system oversight.  All Teams would have responsibility for GP, dental, pharmacy and optical services. Local Authority Directors were currently being recruited.  There would be a West Midlands Cluster of 4 PCTs, and transitional risks as the present Cluster was split in two. 

·         In answer to a question, he said that the NCB would have responsibility for 20% of the commissioning spend, whilst the CCGs would be responsible for a total of 80% of spend.  The local Health and Wellbeing Boards and Councils would be expected to assume the bulk of local arrangements.

·         In reply to a question regarding the top down nature of the governance structure, he said that it would be necessary to secure resources in order to ensure service delivery, and that the sustainable nature of services would need to be addressed.  There would be a more top down approach should the local systems not prove to be sustainable, but the onus was on local determination.

·         In response to concerns that the organisational structure was too top heavy and therefore costly, Mr Maubach said that the logistical structure of the NHS Midlands and East Clinical Commissioning Board had been based on the number of CCGs and Health and Wellbeing Boards that would be under its control in order to provide each region with a consistent number of organisations to work with.  The structure had been designed to reduce bureaucracy, and was working with substantially reduced management overheads.  Ms Gritzner added that the Commissioning Support Organisation (CSO) that had been appointed by Herefordshire/Shropshire/Telford & Wrekin CCGs had identified Staffordshire as the preferred supplier, and they would work with Hoople and the Council.  The decision was not aligned to the Cluster structure, and was specific to those CCGs.

·         In reply to concerns over management costs, Mr Maubach said that these figures would be made available to Members.

·         In reply to a Member’s question regarding how savings would be made by Staffordshire and Hoople, Ms Gritzner said that Herefordshire was leading the country by asking its CSO to work with another organisation.  Further savings would be made around prescription service review, and the use of different mechanisms that were in place to achieve the necessary changes.

Mr Oddy provided a presentation on the Wye Valley NHS Trust.  He reported that Price Waterhouse Coopers had identified £5.5m of savings within the Trust, but considered it to be a lean organisation. During his presentation, Mr Oddy highlighted the following issues:

·         That there was a gap of £15m in the income and expenditure plans for 2012/13.

·         Discussions were in hand with the West Mercia PCT cluster and the Strategic Health Authority regarding non-recurrent funding of £9.5m in 2012/13.  Financial plans indicated a requirement for further non-recurrent support of £9.2m in 2013/14.  Future years planning assumptions required savings of 5% per annum which equated to £8m per annum for the Trust. 

·         That whilst the Trust could be financially viable by 2014/15, changes to its structure were inevitable.

·         In reply to a question from a Member regarding the impact the Trust’s financial situation would have on the health and social care transformation programme, Mr Oddy went on to say that the proposed changes would be undertaken more slowly.  It was in the interest of both the Trust and the Herefordshire Clinical Commissioning Group to reduce hospital admissions and to increase the role of the Neighbourhood Teams to provide care in the home rather than in high cost facilities.  The reduction of patient length of stay was also important in order to reduce the pressure on beds in the hospital.

·         In reply to a further question, Mr Oddy went on to say that the Trust was funded by an early example of a Private Finance Initiative, and was working to ensure that as much value as possible was extracted from the contract.  A review by KPMG had found that the PFI Contract was not a major factor in the current financial difficulties facing the Trust

RESOLVED:

That:

a)     the West Mercia PCT Cluster, the Wye Valley NHS Trust and the Herefordshire Clinical Commissioning Group should be invited to attend the Committee in order to ensure that common issues were debated at the same time and that each would have a chance to respond to matters of concern;

b)     an all Members Seminar be arranged to clarify the position in relation to Herefordshire’s Healthcare provision and specifically the progress of the Herefordshire Clinical Commissioning Board and the changes to the Midlands and East Strategic Health Authority; and;

c)     West Mercia PCT Cluster performance data should be monitored by the Committee on a quarterly basis and that the Committee should regularly assess the impact that changes would have on the population

The Committee adjourned for a 10 minute break at 12.36.