Social Affairs, Health and Housing Scrutiny Committee

AGENDA ITEM NO

SOCIAL AFFAIRS, HEALTH AND HOUSING SCRUTINY COMMITTEE

11 FEBRUARY 2009

REPORT FROM STRATEGIC DIRECTOR, PHILIP WALTON

CONTACT OFFICER – GILLIAN COWAN (01978 297032)

CONSULTATION PAPER II: PROPOSALS TO CHANGE THE STRUCTURE OF THE NHS IN WALES

1.  PURPOSE OF THE REPORT

1.  To advise the Members of the proposals and inform them of the areas

for consultation.

2.  To provide Members with an opportunity to debate the proposed changes, thereby contributing to Wrexham County Borough Council’s Response to the Welsh Assembly Government.

2. INFORMATION

2.1 Background

This consultation paper builds on the feedback received on the first consultation Paper: Proposals to Change the Structure of the NHS in Wales, published in Spring 2008. Consultation Paper II: Delivering the New NHS for Wales, proposes a simplified structure for the NHS in Wales by the dissolution of 21 Local Health Boards (all LHBs in Wales except for Powys LHB), and the current 7 NHS Trusts in Wales.

In November, the Health Minister confirmed that the new NHS local bodies in Wales would be established as Local Health Boards (LHBs). This consultation document provides details of the proposed model, membership and functions of the 7 LHBs, which will be operational by Autumn 2009.

The 7 LHBs will be responsible for planning, designing, developing and securing the delivery of primary, community, in- hospital care services, and where appropriate, specialised services for citizens within their area.

The North Wales LHB will be known as the:

Betsi Cadwaladr University Local Health Board.

Four supporting technical papers have been produced that do not form part of the Consultation Paper.

·  Paper 1: Vision, Values & Standards of Governance & Accountability

·  Paper 2: Working at a National level

·  Paper 3: Localism and Partnership Working

·  Paper 4: A new Planning System

2.2 Local Health Board Membership – it is proposed that the LHB Boards will combine the best of both the current LHB and NHS Trust arrangements. This model will have a corporate board, which will represent key interests and will be capable of making decisions.

It is proposed that the membership of the Board will be:

·  Chair – to be appointed by the Minister through the public appointments process;

·  Vice-Chair – to be appointed by the Minister through the public appointments process, and to have responsibility for Primary and Community Care and Mental Health Services;

·  Chief Executive, LHB;

Officers:

·  Medical Director

·  Director of Nursing

·  Director of Primary and Community Care and Mental Health Services

·  Director of Public Health

·  Director of Finance

·  Director of Human Resources

·  Director of Planning

With the following non-officers appointed through the public appointments process:

·  Local Government- to be a current member of a Local Authority within the area of the LHB

·  Third Sector- to be a current member or employee of a Third Sector organisation within the area of the LHB

·  University Representative- to be appointed through the University

·  Trade Unions/Representative Bodies

Five other Independent Members, who would together have expertise in the following areas:

·  Legal

·  Finance/Estates

·  IT

·  Community knowledge and understanding (2 members)

The proposals include the following Associate Members who would also attend the meetings on an ex officio basis, but will not have any voting rights.

·  Director of Social Services (nominated by local authorities in the LHB area);

·  Chair of the Stakeholder Reference Group

·  Chair of the Professional Forum

Under the proposals public appointments to the Board together with the appointment of associate Members will be up to 4 years and not more than a term of 8 years.

Sitting alongside the Local Board will be two non –statutory groups:

·  Stakeholder Reference Group (SRG) – the document states that this group will have wide representation and be rooted within the community. The group will provide advice to the LHB Board on any issues it considers important to citizens.

·  The Professional Forum (PF) – the forum will provide advice to the LHB Board on all professional and clinical issues it considers appropriate. It is proposed that it will include representation from professional groups working within the NHS.

2.3 Local Health Board Functions – in order for the new LHBs to take on the functions of Trusts and LHBs, the existing Trusts and LHBs will need to be abolished and staff and property of those Trusts and LHBs to be transferred across to the new LHBs.

2.4 Localism and Partnership Working –effective local partnership working is essential to provide the building blocks of effective planning and delivery of services to meet people’s needs. The aim is to achieve this through empowering and strengthening existing formal networks and partnerships at Local Authority level, including Health, Social Care and Well-being strategies, Children and Young People’s Plans, Community Plans, and in partnership with Local Service Boards.

Paper 3 Localism and Partnership Working sets out how partnership working must continue to be developed within the NHS and Paper 4 A New Planning System should be considered together.

2.5 Planning, Funding & Performance Management – the new structures will require a new system of working, particularly for planning, funding and performance management

2.6 The Next Steps

There are a number of issues that will be addressed at a later stage. These include:

Community Health Councils

A further consultation paper was issued on the 30th January which focuses specifically on the role and functions of Community Health Councils within the new NHS in Wales.

Health Commission Wales (HCW)

A review into the functions of HCW is currently being undertaken.

Unified Public Health Organisation (UPHO)

The Minister confirmed the formation of a Unified Public Health Organisation in September 2008. The future structure and functions of the UPHO will form part of a separate consultation paper which was issued on the 30th January 2009.

A Primary and Community Care Strategic Delivery Programme

As this work develops, it will support and strengthen out-of-hospital services, ensuring cohesive services to support people in the community.

Proposed Timetable

In her statement to the National Assembly for Wales on the 11th November 2008, the Minister for Health and Social Services confirmed the following provisional timetable:

·  1st December 2008 – Consultation Paper II to be issued for a 12-week consultation period up to the 23rd February 2009;

·  December 2008 – commence public appointments for the members of the National Advisory Board and National Delivery Group;

·  December 2008/January 2009 – commence public appointments process for LHB Chairs and Vice Chairs;

·  1st April 2009 – National Advisory Board and National Delivery Group established;

·  Between March – May 2009 – all orders/regulations required to establish new LHBs made and/or laid before the National Assembly for Wales;

·  1st June 2009 – seven new LHBs operate in shadow form;

·  1st October 2009 – seven new LHBs become fully operational.

2.7 Supporting Technical Papers

The consultation document contains four supporting technical papers as appendices. The papers set out the proposals in more detail than the deliberately short consultation paper.

Paper 1: Vision, Values and Standards of Governance and Accountability

The Welsh Assembly Government’s vision for the new NHS in Wales remains “to create world-class health and social care services in a healthy, dynamic country by 2015”. The existing NHS structures in Wales are not the best way to take forward this vision, as this will only be achieved by working in full partnership with local people, local partnership organisations and central government.

There are a number of values that must underpin the new structures:

·  Putting patients and patient safety above all other things;

·  Maintaining consistently high standards of care;

·  All services being given equal prominence;

·  Open and transparent governance;

·  Compliance with the highest standards of probity;

·  Strong commitment to partnership working; and

·  Valuing staff.

New standards of governance will ensure clarity for everyone working within the NHS system, including those organisations working in partnership with the NHS, those receiving care or caring for someone receiving care. Responsibility will be placed with those best equipped to take that responsibility, there will be recognition for those achieving their objectives and actions to ensure that activities remain on track and achieve value for money.

The new NHS will have a culture that fosters co-operation and partnership working, learning, innovation, responsiveness, accountability and leadership. The citizen will be at the centre of the NHS with the introduction of strengthened citizen involvement in all aspects of NHS provision. NHS bodies operating at community level will have to work collaboratively with citizens, local government, independent and third sector partners, and will be required to demonstrate how this is done. Relationships between contractors in both primary care and third sector will be developed into stronger partnerships.

The Minister for Health and Social Services will retain responsibility and accountability to the National Assembly, and will set the policy and strategic framework, determine the strategic distribution of NHS resources and set the performance and standards framework. The Chief Executive of NHS Wales will have a range of responsibilities and will chair a National Delivery Group. Local Health Boards will be responsible to the Minister through the Chief Executive and will be responsible for planning and developing primary, community, secondary care services and where appropriate specialist services.

Paper 2: Working at a National Level

The National Advisory Board will be chaired by the Minister and include the Deputy Minister, Chief Executive NHS Wales, Welsh Assembly Government Chief Medical Officer and the Welsh Assembly Government Director of Social Services, there will also be five individuals to be appointed through the public appointments process. Three of these with an understanding of Local Government, Third Sector and Trade Union bodies and two will be independent members. In addition there will be two groups to have the right to attend annually –from the medical profession and community and public (via new structures to emerge from the review of Community Health Councils). The National Delivery Group will be chaired by the Chief Executive NHS Wales and will include the Director of Social Services Senior Team and WAG Medical Director, WAG Nurse Director and WAG Director of Public Health. Up to three independent members will be appointed through the public appointments process.

It is anticipated that both bodies will be operational from the 1st April 2009.

Paper 3: Localism and Partnership Working

The paper is clear about the need to build on the positive partnership working that exists and sets out a number of principles to underpin local accountability:

·  A drive for local needs, planning and delivery, but also a recognition that health organisations will need consistency of services;

·  Maintenance of a focus on unitary authority level;

·  A local ability to account for resource decisions within a clear framework;

·  A fresh approach to delivering strengthened local community and primary care services, more closely aligned to social care;

·  Building on and enhancing existing local partnerships;

·  An understanding of the relationships with Local Service Boards;

·  A clear framework for accountability, engagement and assurance;

·  A focus on public health and health improvement;

·  Recognising cross-boundary flows of population;

·  Relationships and behaviour that will deliver lasting and long-term change.

There is recognition for the range of partnership initiatives already in place in many local authority areas, including statutory partnerships, the initiatives in place for citizen, service user, carer and public involvement, the development of plans including the Health, Social Care and Well-being Strategy and Children and Young People’s Plan, relationships with the third sector and the fact that they are valued by all stakeholders.

The paper suggests building partnerships at local level through the development of Locality Networks – including primary and community NHS care, social care and voluntary sector centred on natural communities. Whilst the paper is clear that the changes to structures must not present barriers to areas, which have the leadership, and maturity to align local health and social care services in the interest of citizens improved experiences, it offers no concrete proposals for the development of the Locality Networks.

Paper 4: A New Planning System

The primary purpose of the planning arrangements within the new system is to improve outcomes and patient experience and shift the balance of care toward prevention, early intervention and local solutions to keep people well and independent. It will be a continuous process and will provide evidence that national standards are being met through the provision of consistent services based on global best practise tailored to local circumstance.

The Assembly Government will set a Strategic Framework for the NHS with clear targets. The National Delivery Group will ensure that an overall national plan for the NHS is produced, that is influenced by advice from clinicians and other stakeholders. There will be an Annual Operating Framework based on the NHS National Plan based on intelligent targets reflecting clinical priorities, to which the LHB’s must prepare a Local Delivery Plan in response.

LHB’s must develop integrated services to ensure that NHS services work smoothly with social, housing and other local government services. They need to ensure that they build on existing partnerships and deliver on the statutorily required plans (including HSCWBS), they must continue to support partnerships and will dedicate senior staff who are empowered to take forward work on producing and implementing local strategic plans.

Local planning will be based on a programme of public engagement to ensure that citizens and patients have a greater impact on how services are designed and run.

Funding for the LHB’s will be via a capitation-based approach based on resident population, with an adjustment for cross boundary flows thus supporting continued progress implementing the Townsend Formula. Health Commission Wales will be replaced, with most of its function being transferred to LHBs.