Proposal to Establish a Primary Care Trust in Waverley Response to the Consultation Paper : Executive on 28/08/2001

Waverley Borough Council Committee System - Committee Document

Meeting of the Executive held on 28/08/2001
Proposal to Establish a Primary Care Trust in Waverley Response to the Consultation Paper

This report briefly outlines the content of a consultation paper that the Council received from the West Surrey Health Authority/Waverley Primary Care Group concerning the proposal to establish a Primary Care Trust for the Waverley area. A copy of the Consultation Paper can be found in the Members Room.

The report proposes a response to the Consultation Paper. The response takes account of comments and observations that Members made at a presentation by the Chief Executive of the Waverley Primary Care Group on this subject on 24th July 2001, to which all Members were invited. The closing date for response is 31st August 2001.

There are no resource, environmental, or Crime and Disorder, issues arising from this report that relate to the Council. Clearly the new arrangements for providing and commissioning health services across the Waverley area have important ‘Opportunity for All’ implications as the access to health services is often an issue for people who are disadvantaged.

APPENDIX O

WAVERLEY BOROUGH COUNCIL

EXECUTIVE COMMITTEE - 28TH AUGUST 2001

Title:

PROPOSAL TO ESTABLISH A PRIMARY CARE TRUST IN WAVERLEY
RESPONSE TO THE CONSULTATION PAPER

[Wards affected: ALL]

Summary and Purpose

This report briefly outlines the content of a consultation paper that the Council received from the West Surrey Health Authority/Waverley Primary Care Group concerning the proposal to establish a Primary Care Trust for the Waverley area. A copy of the Consultation Paper can be found in the Members Room.

The report proposes a response to the Consultation Paper. The response takes account of comments and observations that Members made at a presentation by the Chief Executive of the Waverley Primary Care Group on this subject on 24th July 2001, to which all Members were invited. The closing date for response is 31st August 2001.

There are no resource, environmental, or Crime and Disorder, issues arising from this report that relate to the Council. Clearly the new arrangements for providing and commissioning health services across the Waverley area have important ‘Opportunity for All’ implications as the access to health services is often an issue for people who are disadvantaged.

Introduction and Background

1. In recent years, the Government has been making significant changes to the way in which health services are delivered and managed across the country. The Government’s change agenda is about making ‘step changes’ in order to modernise public services generally and to improve customer satisfaction. There is also an intention on the part of the Government to devolve ‘power’ away from the centre to a more local level, with the expectation that local decision-making will be more flexible and responsive to local needs and circumstances. In the health sector, the stated aim is, inter alia, to give clinicians greater decision-making powers and opportunities.

2. More recently, in April, the Secretary of State for Health announced his intention to undertake a major structural change in the way the health service is administered and organised and to further build on the policy direction described above. In late July 2001, the Government confirmed the pace of change by issuing a consultation paper entitled ‘Shifting the Balance of Power’ which makes a range of proposals about reducing the number of Health Authorities, working differently, empowering staff and involving customers.

3. The ‘Shifting the Balance of Power’ paper envisages the abolition of all regional health authorities and their replacement with four regional directors of health and social care, along with the creation of 30 strategic health authorities to replace the existing health authorities. It is recognised that the main point of contact with local people will be Primary Care Trusts (PCTs) and some 75% of the NHS revenue budgets will be passed directly to the PCTs.

4. Given the content of the ‘Shifting the Balance of Power’ paper and its very short timescale for response, it is not considered necessary for the Council to make a formal response. In any event, commentators on health issues suggest that the Government is intent on implementing their proposals as they stand.

Primary Care Groups

5. In 1999, the Government required Health Authorities to establish Primary Care Groups (PCGs) as a first step in devolving power. Following a period of consultation, two PCGs were established to cover the Waverley area. In April 2001, these two PCGs merged to form one Waverley Primary Care Group.

6. PCGs deal largely with local family doctor services. They are managed by a local Board – which is a sub-Committee of the Health Authority. The Board consists of a number of GPs, a Lay Person, a Nurse, a Health Authority representative and a local authority representative – by which is meant an officer of the local Social Services authority. Representatives of the Community Health Council are also in attendance at PCG meetings. [As an aside, it would be fair to say that most of the papers emanating from the Department of Health seem to be based on the premise that all ‘local authorities’ are unitary authorities and have Social Services responsibilities.]

7. PCGs are responsible for:

· Improving the health and well-being of the people of the area they serve;
· Commissioning health services; and
· Developing primary care and community care services.

Primary Care Trusts

8. At the time that PCGs were being established, it was also announced that there was an expectation that PCGs would develop into organisations that would have more power and autonomy, and this would be achieved by becoming a ‘Primary Care Trust’ (PCT). The Secretary of State for Health now expects the country to covered by PCTs by 2004. However, where PCGs are confident that they have and/or can develop appropriate expertise and capacity, they can apply to become a PCT earlier. In all cases the Secretary of State for Health will need to be convinced that proposed PCTs are fit for purpose.

9. The six local PCGs covering the West Surrey Health Authority are all making applications to become Primary Care Trusts as from April 2002.

10. There are two levels of PCTs – level 3 and level 4. All but one of the West Surrey PCGs are proposing to achieve Level 4 PCT status including the one serving the Waverley Borough which means that they will be autonomous legal entities, can both commission and provide services, employ staff, own property (e.g. hospitals and health centres).

Suggested Council Response to the Waverley PCT Consultation Paper

11. The following paragraphs form a suggested draft response from the Council. Members are invited to make comment and to suggest amendments.

12. Waverley Borough Council welcomes the proposal of the West Surrey Health Authority and the Waverley Primary Care Group for the establishment of a Waverley Primary Care Trust.

13. The Council considers that the PCT will bring a range of benefits to the local community including:

· better co-ordination of the delivery of services because there is clear terminosity of boundaries shared by the PCT and other related service providers;

· the opportunity to build on existing strong partnerships and enable greater ability to give more meaning to the idea of a Local Strategic Partnership and Community Strategy;

· focusing on local health care priorities and issues and the opportunity to work with partners to assess and understand local health/deprivation determinants and how to tackle health and social inequalities better;

· responsibility and accountability will be at a more local level and so decision-making should be more transparent to local people.

14. The Council is of the view that, although there are potential benefits to this new way of working, these changes are Government-led and relate more to how organisations operate and conduct themselves. It is considered that the real health issues for the people of Waverley are the content of the health services they receive, and whether they are adequately financed in a high-cost area with a larger than average number of older people. It is probably true to say that the people of Waverley are less interested in the organisation of a service, and far more interested in whether the health services are available in a timely, efficient and effective fashion when they are required. Organisational effectiveness is clearly important, but it is earnestly hoped that this proposed change will result in discernable benefits in the health system – however, in the West-Surrey context - re-organisation alone will not achieve this.

15. The consultation document does not contain very much information regarding financial arrangements or details of the budget that the Trust will command. It would be useful to be aware of this and to know how the funds will be allocated between services covered and whether these will be ring-fenced within the new arrangements. There is no real financial sensitivity analysis contained within the document.

16. Whilst the Council is in support of the creation of a Waverley Primary Care Trust, it is considered that:

· the local health system currently appears to receive less than adequate resources to meet health-care demands and that the PCT will simply inherit a legacy of relatively low level of funding;

· the philosophy and rhetoric of devolving decision-making to local areas – which is welcomed – may well be undermined by too many central Department of Health directives and hypothecated funding streams requiring local PCTs to adhere to national health priorities, which may be very important nationally, but not necessarily an issue/priority locally;

· the PCTs for the West Surrey Health Authority are at the lower end of the anticipated population numbers and so there may be issues about economies of scale, critical mass etc.;

· the proposals for hosting services between PCTs need careful monitoring and review;

· there is an apparent lack of clarity (on the Department of Health) in relation to the role of Borough/District Councils in respect of the Scrutiny role of PCTs;

· the pace of change within the NHS – whilst intended to bring “step-change” improvements to service delivery – is so unrelentless and at such a pace there is a risk that these changes will simply demoralise staff further. It would be hoped that PCTs would enjoy a period of managerial stability once established so that they can indeed bring about the improvements to health services for which they are being created.

17. The Council considers that there are very real potential benefits from the creation of a Waverley PCT and supports the proposal in broad terms.

Resource Implications

18. There are no resource implications relating to the Council.

Other Implications

19. There are no environmental, Crime and Disorder or Human Rights issues, arising from this report that relate to the Council. Clearly, the new arrangements for providing and commissioning health services across the Waverley area have important ‘Opportunity for All’ implications as the access to health services is often an issue for people who are disadvantaged.

Recommendation

It is recommended that:-

1. the Executive Committee supports the creation of the Waverley Primary Care Trust, as proposed by the West Surrey Health Authority and Waverley Primary Care Group; and

2. a response to the consultation paper be sent to the West Surrey Health Authority which is based on paragraphs 12 – 17 in the body of this report.

Background Papers (DoH)

Consultation Paper entitled ‘A proposal to establish a Primary Care Trust in Waverley’ issued jointly by the West Surrey Health Authority and Waverley Primary Care Group June 2001

CONTACT OFFICER:
Name: Mr J Swanton Telephone: 01483 869375
E-mail jswanton@wav.gov.uk