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Waverley Borough Council Committee System - Committee Document

Meeting of the Executive held on 07/02/2006
ENSURING A PATIENT LED NHS



Summary & Purpose
This report advises members of two consultation exercises being undertaken by the Surrey and Sussex Strategic Health Authority in relation to modernising the NHS and the services it provides. It makes proposals about the future size and configuration of Strategic Health Authorities and of Primary Care Trusts.

As well as highlighting the main points of the consultation paper, this report also suggests a draft response from the Council that members may wish to develop further. The Community Overview and Scrutiny Committee considered this matter at its January meeting.

APPENDIX W
Waverley Borough Council

community overview and scrutiny committee - 16th jANUARY 2006

EXECUTIVE – 7th FEBRUARY 2006
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Title:
ENSURING A PATIENT LED NHS
[Wards Affected : All]
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Summary and purpose:

This report advises members of two consultation exercises being undertaken by the Surrey and Sussex Strategic Health Authority in relation to modernising the NHS and the services it provides. It makes proposals about the future size and configuration of Strategic Health Authorities and of Primary Care Trusts.

As well as highlighting the main points of the consultation paper, this report also suggests a draft response from the Council that members may wish to develop further. The Community Overview and Scrutiny Committee considered this matter at its January meeting.
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Environmental implications:

There are none arising from the recommendations in this report.

Social / community implications:

The changes being proposed in respect of the Strategic Health Authority and Primary Care Trusts are largely organisational/managerial and do not directly affect the provision of front-line services.

E-Government implications:

There are none arising from this report. A copy of the consultation paper is available on the
Strategic Health Authority’s website: www.surreysussexsha.nhs.uk/reconfiguration/index.asp

Resource and legal implications:

There are no resource and legal implications arising for Waverley directly from this report.
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Introduction

1. On 14th December 2005, the Surrey and Sussex Strategic Health Authority issued a consultation document entitled “Ensuring a Patient-Led NHS – Consultations on new NHS organisations in Surrey and Sussex: Strategic Health Authority and Primary Care Trusts.” This consultation document covers the future configuration of the Strategic Health Authority and PCTs.


2. This consultation builds on the Government’s ‘Modernising Agenda’ and its aim to gain greater efficiencies through creating organisations that have greater capacity, critical mass, ability to make cost savings through scale and have greater strategic relevance.

3. The consultation period is from 14th December 2005 – 22nd March 2006. It is proposed that following comments from this meeting, the revised draft response will be put before the Executive on 7th February 2006, and then go onto Council on 21st February 2006, with the formal response being sent to the Strategic Health Authority thereafter.

4. A copy of the consultation paper has been placed in the Members’ Room. It is also easily accessible on the Surrey and Sussex SHA’s website at www.surreysussexsha.nhs.uk/reconfiguration/index.asp

Reorganising the Strategic Health Authorities

5. In the south-east of England there are currently four Strategic Health Authorities covering the region. The Government Office for the South-east covers the same geographical area – as does SEEDA and SEERA. The four Strategic Health Authorities are:

Hampshire and Isle of Wight SHA
Kent and Medway SHA
Surrey and Sussex SHA
Thames Valley SHA

6. The consultation paper is proposing two options for strategic health authority configuration:

Option 1

7. One SHA for the South East Government Office, covering the areas currently served by the SHA’s listed above. It is believed that this option would achieve maximum savings from management and administrative costs provided that the size of the area did not lead to the necessity of geographically based management structures.

Option 2

8. One SHA to cover Kent and Medway and Surrey and Sussex; and one SHA to cover Thames Valley, Hampshire and the Isle of Wight.

9. This option is supported by the existing Strategic Health Authorities.

New Role and Function of SHAs

10. The consultation document outlines the new role and function of SHAs and in order to provide a response it is important to consider the two options against the role they will have to undertake:

Maintain a strategic overview of the NHS and its needs in the area;

Improve and protect the health of the population they serve by having a robust public health delivery system including emergency planning;

Provide leadership and performance management for the effective delivery of government policy for health and health protection through NHS commissioned services;

Provide leadership for engagement of health interests in the development of strategic partnerships across the public sector (working with Government Offices, Regional Assemblies, Skills Councils and the Regional Development Agencies) to secure the delivery of Government policy.

Build strong commissioning processes, organisations and systems;

Ensure NHS Trusts are in a position to apply for Foundation Trust status by 2008/09;

Work with regulators and external inspectorates to develop the local health community, including ensuring choice and plurality of provision and managing the consequences of clinical performance failure and patient safety breaches;

Promote better health and ensure that the NHS contribution to the wider economy is recognised and utilised at regional level;

Lead the NHS on Emergency and Resilience Planning and Management;

Work closely with DoH to inform and support policy development and implementation and handle routine Parliamentary, Ministerial and Department of Health business;

Improvement of Research and Development

Provide effective communications with the DoH

Draft Response to the Consultation Paper in respect of Strategic Health Authorities

11. The Council welcomes the opportunity to be consulted on the proposals for the reconfiguration of the Strategic Health Authorities.

12. Given the high level strategic role envisaged for the new SHAs it is considered that Option 1 should be the preferred option for SHA configuration into the future.

13. Option 1 aligns with the boundaries for the Government Office, SEEDA and SEERA and so, given the links with these bodies, it seems sensible for them to be co-terminus.

14. Option 1 also provides the greatest managerial and operational cost savings and, given the financial difficulties facing the health economy in the south-east, it is important that resources are effectively focussed at front-line health services, rather than at organisational structures.

15. Mindful of the important role the SHA will play in relation to planning for civil emergencies and developing resilience, consideration should also be given to proposals for the realignment of Police Authority boundaries when coming to conclusions about SHA boundaries.



Reconfiguration of Primary Care Trust Boundaries

16. As well as proposals for realigning the SHAs, there are also proposals to reconfigure Primary Care Trusts across the country. Again, the motivating force is a belief that this will provide greater organisational capacity, critical mass and generate cost savings that can be redirected into patient care.

17. At present there are fifteen PCTs operating across the Surrey and Sussex SHA area. The Surrey based PCTs are:
18. The consultation paper makes two proposals for PCT reconfiguration across the SHA area. Both proposals are that all the Surrey-based PCTs should be merged to create one commissioning PCT for the whole of Surrey and would align with the County Council’s boundary.

Option 1

19. There should be four PCTs viz:

Brighton and Hove City PCT made up of Brighton and Hove City PCT

Option 2

20. Option 2 proposes five PCTs – two PCTs for East Sussex split east and west, West Sussex PCT, Surrey PCT and Brighton and Hove City PCT viz:

Brighton and Hove City PCT made up of Brighton and Hove City PCT

New role and function of PCTs

21. The consultation paper recognises that the new role and function of PCTs will become clearer as health policy and reform moves forward. The following list of roles and functions is therefore not necessarily conclusive as others may be added later. It is envisaged that the new PCTs will:-

Improve and protect the health of the population they serve by assessing need and having a robust public health delivery system including emergency planning;

Secure, through effective commissioning, a range of safe and effective primary, community and secondary and specialised services, which offer high quality, choice and value for money;

Reduce health inequalities and ensure that the role of individuals is recognised and utilised at a local level;

Develop and sustain strong relationships with GPs and their practices and implement a system of Practice Based Commissioning;

Work closely with local authority partners and other commissioners to ensure integrated commissioning of health and social care, including emergency planning;

Ensure that nurses, midwives and allied health professionals play a key role in improving the health of the local population;

Stimulate the development of a range of nursing, midwifery and allied health professionals;

Provide appropriate levels of clinical leadership in a system of diverse providers;

Develop robust communication and involvement systems to manage relationships and engage with their local residents and communities;

Ensure that a range of services are provided for their communities in ways that most appropriately meet their local needs.

22. The consultation paper states that the Department of Health has a significant programme of policy development work on the future regulation and management of the health system overall and will be providing further guidance in 2006 about the implications of this work on PCTs and SHAs and other NHS bodies.

Draft Response to the Consultation Paper in respect of Primary Care Trusts

23. There have been many changes to the structure of the NHS and service delivery over the past decade. The South West Surrey Health Authority was replaced by the West Surrey Health Authority. This in turn was superseded – in Waverley’s case – by the East Waverley Primary Care Group and the West Waverley Primary Care Group. These subsequently merged to form one PCT, which was then followed by mergers to create the Guildford and Waverley Primary Care Trust.

24. Many of these changes were inspired at national level with a view to creating more locally responsive NHS services that included GPs and patients in greater involvement in decision making and, indeed, to provide efficient and effective management structures.

25. Evermore management/organisational restructuring within the NHS is not at all appealing. Whether constant structural reorganisation will lead the local health economy meeting the Government’s objectives is questionable – previous re-organisations/restructuring has not given rise to the cost savings and efficiencies that were hoped for. Indeed, given the levels of indebtedness of organisations such as the PCTs in Surrey and the demands being made on health services locally, it is difficult to see how the current proposals can lead to financial stability.

26. Of all the forms of health re-organisation we have seen over the last decade, perhaps the most successful in terms of inter-organisational relationships has been the creation of the Guildford and Waverley Primary Care Trust. The Council therefore regrets that the consultation paper does not provide a ‘status quo’ option. However, it also recognises the need for PCTs to be larger to create a critical mass, capacity and efficiencies of operation.

27. However, an advantage of a larger PCT will be that some of the communication problems between the PCTs across Surrey may be overcome if there is one body.

28. As a local authority, Waverley has particularly valued the PCT’s ability to work as part of the Local Strategic Partnership (LSP), to be partners in joint initiatives, and to be able to share issues that are a common challenge to us in the public realm. Were PCTs to become very much larger, what the Council actually value as partners might be lost.

29. The proposals for moving to larger commissioning PCTs are based on a return to Practice-based commissioning at a more local level. At one level the Council welcomes this initiative because it believes in public services being locally responsive. However, there is concern that GP Practices do not necessarily have the same cultural outlook when it comes to resource management and rationing of services. It will be interesting to see how the SHA and PCTs will help train those who are responsible for Practice-based commissioning to ensure that Practices live within the resources allocated to them.

30. The consultation paper cites one of the advantages of the current proposals is that the Surrey PCT will be co-terminus with Surrey County Council. However, given recent Ministerial correspondence reported in the local government press, it is entirely possible that there will be another round of local government review and the current structure of local government may well not exist into the future.

31. The Council welcomes the proposals for more local arrangements to interface with the new PCTs. This is important to Borough/District Councils and the Local Strategic Partnerships.

Conclusion

32. The consultation paper issued by the Surrey and Sussex Strategic Health Authority (endorsed by the Department of Health) outlines important ways in which the management and oversight of health services will be potentially reconfigured into the future. This consultation exercise provides members with the opportunity to influence the outcome of these proposals.

Consideration by the Community Overview and Scrutiny Committee

33. The Community Overview and Scrutiny Committee considered the draft response and this report at its meeting on 16th January 2006. Members did not agree with paragraph 27 which read; 'the smaller PCTs in Surrey have had the advantages of enjoying largely co-terminous boundaries with other public sector partners. They are small enough to understand local needs and issues, and be able to make real contact with its service users and yet of a scale to be able to manage a range of services'. [Officers have deleted this paragraph from the proposed response].

Recommendation

It is recommended that:

1. the report be noted; and

2. the draft responses to the consultation paper be considered.
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Background Papers (DoH)

“Ensuring a Patient-Led NHS – Consultations on new NHS organisations in Surrey and Sussex: Strategic Health Authority and Primary Care Trusts.” Surrey and Sussex Strategic Health Authority 14th December 2005

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CONTACT OFFICER:

Name: John Swanton Telephone: 01483 - 523375

E-mail: jswanton@waverley.gov.uk


Comms/executive/2005-06/255