To give further consideration to proposed changes to the configuration of the local health service. 

The Committee gave further consideration to proposed changes to the configuration of the local Health Service.

 

In September 2005 the Committee had endorsed a joint response by the Leader of the Council and the Committee’s Chairman to an initial exercise conducted by the West Midlands (South) Strategic Health Authority on reconfiguration of services.  The SHA had been required to submit a proposal to the Department of Health in October 2005.  Following consideration by that Department consultation papers on proposals for the future organisation of the NHS in the West Midlands had been issued in December 2005.

 

As part of the consultation exercise representatives of the West Midlands (South) Strategic Health Authority (SHA) had asked to address the Committee.

 

The following representatives of the SHA attended the meeting: Mr Charles Goody, Chairman of the Authority, Bronwen Bishop Director of Primary Care Development and Corporate Services and Dr Mike Deakin Director of Public Health and Clinical Engagement

 

The following members of Cabinet attended this part of the meeting: Councillors P.J. Edwards (Cabinet Member - Environment), RJ Phillips (Leader of the Council), D.W. Rule M.B.E. and R.M. Wilson (Cabinet Member - Resources).

 

Councillors J.W. Hope M.B.E and W.J. Walling were also present

 

The following representatives of Health Bodies in the County were also present:

 

Hereford and Worcester NHS Ambulance Trust:  Mrs J Newton (Chairman), Mr R B Hamilton (Chief Executive).

 

Herefordshire Hospitals NHS Trust: Mr D Rose (Chief Executive)

 

Herefordshire Primary Care Trust: Dr P Ashurst, Non-Executive Director and Vice-Chairman of the PCT Board, Mr P Bates (Chief Executive), Mr S Hairsnape (Deputy Chief Executive).

 

Councillor W.J.S Thomas welcomed everyone to the meeting noting that representatives of Health bodies in the County were present and members of the Council’s Cabinet, including the Leader of the Council, reflecting the significance attached to the reconfiguration proposals and the united approach to health issues within the County.

 

Mr Goody explained that the focus of the consultation exercise, of which the presentation to the Committee formed part, was on health service structures not on services.

 

Bronwen Bishop then gave a presentation on the three consultations which were underway on the reconfiguration of Primary Care Trusts (PCTs), Strategic Health Authorities (SHAs) and Ambulance Trusts in the West Midlands.

 

She explained the background to the restructuring proposals, the detail of the proposals themselves and their expected benefits.

 

In terms of Primary Care Trusts and Strategic Health Authorities it was noted that the view was that to deliver a patient-led NHS required a strong commissioning function with strong PCTs, developing a wider range of services in response to the preferences, lifestyle and needs of local people.  The function and role of SHAs needed to be reviewed to support commissioners and contract management.

 

The benefits identified in terms of changes to PCTs were:

 

·          by reducing the number of NHS organisations money would be released for reinvestment in patient care.

 

·          sharing boundaries with social services providing local authorities would enable consistent joint working and the development of shared services.

 

·          larger PCTs would be better able to recruit the highest calibre staff.

 

·          by focusing on commissioning PCTs should be better able to strengthen choice locally by encouraging the development of innovative and alternative services.

 

In terms of Herefordshire it was noted that the SHA did not propose to recommend changes to the boundary of the PCT. 

 

In relation to SHAs the proposal was to create one new West Midlands SHA with the same boundaries as the Government Office for the West Midlands (GOWM).

 

The benefits of this were identified as the West Midlands being a recognised geographic area; the reduction in management and administrative cost; and that shared boundaries with GOWM and the Regional Development Agency and its Assembly would offer significant advantages in influencing and decision making to enhance health improvement and reduce inequalities.

 

The proposals for the Ambulance Service in England were to create 11 Ambulance Service Trusts.  This included a West Midlands-wide ambulance trust.  It was emphasised that there were no proposals to change the model of service provision locally or local control centres.  Local Delivery Units were to be created to ensure local focus was maintained.

 

The benefits identified were: capacity to drive up standards, current best practice would be shared, improved co-ordination on emergency planning, flexibility to invest time in improving training of staff, and savings to reinvest in front-line ambulance services.  It was stated that these benefits would, “only be fully realised if a large degree of the locally focused, drive, management and pride was maintained and locked into the new organisations via local delivery units.

 

It was noted that the SHA would make recommendations to the Department of Health on the basis of responses received during the consultation, with responses to the consultation on ambulance services being forwarded directly to the Department of Health. Final decisions would then be taken by the Secretary of State for Health.

 

Questions were then invited and the following principal points were made:

 

·          Clarification was sought on the commissioning role of PCTs under the proposals.   In reply it was stated that provision of services was to be a local decision.  However, where a PCT wished to act as provider itself it would have to ensure that the provider arm was separated from its commissioning arm.

 

·          It was confirmed that every PCT whether changing boundaries or not would have to make savings on management costs.  The indicative requirement was for savings of 15% although negotiations were continuing.

 

·          It was confirmed that any debts held by PCTs would not be written off upon reconfiguration.  PCTs had a statutory duty to break even and any overspends would have to be resolved at a local level.

 

·          The Leader of the Council expressed the hope that the establishment of a Single Strategic Health Authority coterminous with the boundary of the Government Office for the West Midlands would bring benefits to rural areas facilitating rural regeneration work.

 

·          The changing role of the ambulance service was discussed.

 

·          The scope for the reconfiguration to improve managerial capacity to deliver improvement was explained.

 

·          A question was asked about the freedoms and flexibilities which might be made available to Local Authorities under the Local Area Agreements.  In reply it was stated that the Agreements would not come into effect until 2007 and each locality would be different.

 

·          It was acknowledged that different approaches in England and Wales meant that there were cross-border issues which needed to be managed.

 

·          In relation to the provision of Mental Health Services the Chief Executive of the PCT explained that discussions had initially been based on the assumption that the PCT would not be able to continue as a provider of services.  Consideration had therefore been given to the establishment of a Foundation Trust with Worcestershire and/or Gloucestershire, Shropshire having agreed to work with South Staffordshire.  An assessment would now be undertaken by the Strategic Health Authority and key partners.

 

·          There were a number of joint commissioning issues which the PCT needed to discuss in more depth with the Council.

 

·          It was reaffirmed that, in relation to the PCT, responses to the consultation exercise would be considered by the Strategic Health Authority and would inform its recommendation to the Secretary of State who would take the final decision on reconfiguration.  It was expected that unless some overriding issue came to light it would be expected that the Secretary of State would endorse the SHA’s recommendation.  In the case of the Herefordshire PCT one consideration to be addressed was the size of the PCT and its capacity to make savings and still fulfil its role, particularly if it no longer provided mental health services.

 

·          In relation to the forthcoming White Paper and the impact on overstretched surgeries of additional responsibilities it was stated that money would follow the patient.

 

The Chairman then invited the representatives of health bodies present to comment.

 

Mr Bates noted that the PCT was consultee and the PCT Board would be submitting a formal response.

 

His view upon publication of “Commissioning a Patient Led NHS” had been that Herefordshire would want to retain its own PCT and that co-terminosity with the local authority provided a strong case for doing so.  It was recognised, however, that whether the PCT could continue to act as a provider of services and achieve the required reduction in management costs were matters which needed consideration. 

 

The Non-Executive Directors on the PCT Board had challenged officers to demonstrate that if the PCT were retained it would be able to deliver a good service.  Having considered the officer response the PCT’s view was that a Herefordshire PCT should be retained.  However, its future role would see it operating as a partner in a Public Service Trust which would combine the commissioning powers of the Council and the PCT and other partners.  The aims of the Local Area Agreement and the Local Strategic Partnership could be delivered at a local level by a Herefordshire PCT working with its local partners.

 

The aims of the forthcoming White Paper were pertinent to Herefordshire and the PCT wanted to be able to take those proposals forward.

 

Mr Rose said that the Hospital Trust’s aim was to achieve Foundation Trust status by April 2007.  If that were achieved, who was commissioning services was less important.  A Herefordshire PCT which, as one of the smaller PCTs, was fit for purpose would suit the Trust.  He supported the change to the boundary of Strategic Health Authority and the change to the Ambulance Trust on the basis that local delivery units were put in place.

 

Mr Hamilton reported that the Ambulance Trust Board was due to meet the next day.  He expected the Board to support the proposed change to the Strategic Health Authority Boundary and the creation of one PCT for Herefordshire and one PCT for Worcestershire.

 

In relation to the ambulance service the Ambulance Trust acknowledged that as a smaller organisation there were issues of capacity and resilience.  However, it was important that there was a local footprint and discussions needed to take place with partners over what structure would be appropriate for Herefordshire and Worcestershire.

 

Dr Ashurst supported the comments made by Mr Bates, advising that the non-executive directors had closely questioned the position.  Financial management, clinical management and Governance requirements had all been carried out outstandingly well by Herefordshire PCT.  The PCT had also led the way in much of the joint working with the Council.  It would be disappointing if all these achievements were lost.  The PCT Board therefore strongly supported the retention of the PCT.

 

Mrs Newton commented that it was important that safeguards were in place to ensure the level of service to the community was protected.  Discussions on the local footprint and the preservation of the rural voice were therefore very important.

 

Councillor Thomas thanked everyone for their contribution and summed up by saying that there was a keen awareness of the challenges to be faced and a willingness to work together to meet them.  The co-terminosity with the PCT helped greatly in seeking to develop and improve services for Herefordshire.

 

It was noted that an additional meeting would be arranged in consultation with Cabinet to determine a response to the consultation exercise.