JOINT HEALTH SCRUTINY COMMITTEE

NHS BOURNEMOUTH AND POOLE – PROVIDER SERVICES REVIEW

13 NOVEMBER 2008

The Meeting commenced at 7.08pm and concluded at 8.30pm.

Present:

Borough of Poole

Councillors Bulteel, Meachin and Mrs Rampton

Bournemouth Borough Council

Councillors Mrs Bailey and Griffiths

Dorset County Council

Councillor Mrs Elliott

In attendance

Debbie Fleming:Chief Executive, NHS Bournemouth and Poole

Mark Callingham:Review Manager, NHS Bournemouth and Poole

Dr Adrian Dawson:Director of Public Health, NHS Bournemouth and Poole

Sarah Elliott:Director of Service Provision, NHS Bournemouth and Poole

Nicola Plumb:Head of Communications, NHS Bournemouth and Poole

Cllr Elaine Atkinson:Portfolio Holder, for Social Care and Equalities, Borough of Poole

Eileen Dunnachie:Service Director - Adult & Community Support, Bournemouth Borough Council

Lucy Johns:Health Partnerships Officer (Health Scrutiny), Dorset County Council

Liz Baron:Principal Overview and Scrutiny Support Officer, Legal & Democratic Services (Borough of Poole)

Members of the public present:0

JHSC01.08ELECTION OF CHAIRMAN

RESOLVED that Councillor Karen Rampton be elected Chairman of the Joint Health Scrutiny Committee for the NHS Bournemouth and Poole Provider Services Review.

JHSC02.08ELECTION OF VICE-CHAIRMAN

RESOLVED that Councillor Sally Elliott be elected Vice-Chairman of the Joint Health Scrutiny Committee for the NHS Bournemouth and Poole Provider Services Review.

JHSC03.08APOLOGIES FOR ABSENCE

Apologies for absence were received from Cllr Allister Russell (Bournemouth Borough Council), Cllr Bill Batty-Smith (Dorset County Council) and Cllr Philip Gaussen (Dorset County Council).

JHSC04.08DECLARATIONS OF INTEREST

Cllr Bulteel declared a personal interest in Agenda Item 6 ‘Options for the Future Organisation of NHS Bournemouth and Poole Provider Services’ as he was an employee of Leonard Cheshire Disability.

Cllr Mrs Rampton declared a personal interest in Agenda Item 6 ‘Options for the Future Organisation of NHS Bournemouth and Poole Provider Services’ as she was an employee of Poole Forum.

JHSC05.08TERMS OF REFERENCE

RESOLVED that the Terms of Reference for the Joint Health Scrutiny Committee - NHS Bournemouth and Poole’s Provider Services Review, having been previously circulated, be formally approved and adopted by the Joint Committee.

JHSC06.08OPTIONS FOR THE FUTURE ORGANISATION OF NHS BOURNEMOUTH AND POOLE (FORMERLY BOURNEMOUTH AND POOLE TEACHING PRIMARY CARE TRUST) PROVIDER SERVICES

Members received a report from the Chief Executive of NHS Bournemouth and Poole on proposals by the Primary Care Trust to cease to provide its own health services directly to the public and to instead commission these services from other organisations.

The presentation covered various aspects of the Provider Services review including the services which would be affected, the reasons for the proposed change, the consultation process (including feedback already received) and future plans including individual service reviews, options for potential providers of Community Health Services and the timetable for change. The presentation is appended at Appendix A for information.

The following key points were drawn from the presentation:

  • Under the PCT’s current operating framework, an internal separation of provider and commissioner services had already been created as the two functions were now anomalous under new NHS Operating Framework arrangements;
  • Only 5% of the combined Commissioning and Provider Services Budgets (2008/09) was currently spent on Provider Services – a sum of £24M in comparison to the £471M total spend on Commissioning services;
  • Emerging priorities from the Joint Strategic Needs Assessment suggested that the PCT would in future need to commit greater resources to services for older people / people with long term conditions; mental health services (for adults and older People); and services to reduce health inequalities;
  • The PCT was developing a strategy for a new model of service, encompassing different ways of working including:

-commissioning from a wider range of providers (including the third sector)

-more integrated working with local authorities

-working with patients and carers to promote self care

-promoting healthy lifestyles

-developing a workforce with appropriate skills.

  • The PCT intended to commit additional resources to providing care services outside of a hospital setting and make a greater investment in public health and preventative services; a significant growth in community and intermediate care services was also anticipated;
  • Services to help people stay healthy, services to help people maintain and regain their independence , services to people at high risk of being admitted to hospital, end of life care services, therapy services and community based outpatient services would all be affected by the PCT’s proposals to cease to provide services directly to the public. It was acknowledged that these were all vital services which were fundamental to the delivery of the PCT’s strategic plan;
  • Drivers for change included the introduction of new national guidance for PCTs, new rigorous standards for commissioners and the opportunity to drive up service quality, clinical effectiveness and responsiveness to patients and carers. By concentrating resources on a commissioning function, greater value for money could also be achieved.
  • Considerable challenges were involved in retaining a provider arm, with costs, skill sets and focus and contestability rules all likely to prove particularly problematic.
  • Provider services staff were likely to be better served by an organisation whose principal role was the provision of health services.
  • The consultation process to date had encompassed staff meetings, focus groups with patients, meetings with local Health Overview and Scrutiny Committees and the publication of a report outlining the PCT’s intentions, which had been widely distributed;
  • Five-year commissioning plans would be produced at the conclusion of each individual service review and these would be open to consultation before final proposals were agreed.
  • potential future providers of local community Health Services could include:

-other NHS organisations

-local authority / care trust(s)

-primary care organisations eg. GP practices or consortia of GP practices;

-Social Enterprise organisations, voluntary or third sector organisations

-Commercial / private sector providers of health services.

  • Service reviews would be completed by March 2009; future potential service models would be considered from April 2009 onwards;
  • The PCT remained fully committed to commissioning high quality services for local people.

On behalf of the Committee, the Chairman thanked the Chief Executive of NHS Bournemouth and Poole for her interesting and informative presentation.

Questions:

In response to questions from Members, the following issues were clarified:

  • Neither local Diabetes Services nor sexual health services were directly provided by the PCT and would not be affected by proposals to cease to provide services directly to the local population;
  • Any potential provider of community health services would be required to be registered with the Care Quality Commission; standards of service would also be governed through contractual arrangements with the PCT as commissioner;
  • The Chief Executive undertook to share more information with its staff on the social enterprise model of care;
  • Noting that these were ‘major proposals’ under consideration, Cllr Griffiths sought specific assurances that community services currently delivered by the PCT Provider arm would continue to be delivered. In response, the Chief Executive gave an assurance that the PCT remained committed to ensuring that the Trust commissioned high quality services for the local population;
  • It was explained that the Trust would be required to invest a significantamount of money should it decide to retain its provider services. As the Trust provided only a small number of directly managed services with a combined budget of £24M, the amount of investment required to maintain provider services would be disproportionate;
  • The Trust had thus far been unable to consult with the Local Involvement Network (LINk) on its proposals as the local LINk was as yet insufficiently established as an entity;
  • Whilst it was anticipated that Service Reviews would be completed by the end of March 2009, a formal timetable to consider future potential service models with partners and key stakeholders had not yet been agreed;
  • In response to a question from the Chairman on the potential for some services to be ‘lost’, the Chief Executive explained that all the services which featured in the Trust’s commissioning plans were considered ‘essential’ and would not be diminished; instead new providers would be commissioned to deliver the right services to suit the local population’s need;
  • It was the Committee’s expectation that, following completion of the individual service reviews, the Joint Committee would be reconvened in order to consider NHS Bournemouth and Poole’s specific proposals for individual services. It was expected that each service review would be considered by the Joint Health Scrutiny Committee in turn;
  • It was expected that the PCT would consult with neighbouring Primary Care Trusts over proposals which may affect services accessed by neighbouring populations;

No further comments were received on policy issues as outlined in the Trust consultation document and no further options were recommended by the Committee;

In summary Members AGREED that:

(i)NHS Bournemouth and Poole be requested to give a formal assurance that it would continue to commission high quality services which were appropriate to the local community;

(ii)community services currently provided by the PCT and which were considered to be essential should not be diminished;

(iii)PCT staff be given every opportunity to contribute to discussions relating to new models of care delivery;

(iv)the ‘direction of travel’ of NHS Bournemouth and Poole to cease to

provide services directly to the public be noted;

(v)That the results of each service review should be shared with this Joint Health Scrutiny Committee and reported, in turn, to each Local Authority Health Overview and Scrutiny Committee for information. The Joint Committee to be reconvened on an ad hoc basis in order to respond to each individual service review; and

(vi)That a formal response from the Joint Committee be compiled by the Principal Overview and Scrutiny Support Officer and forwarded to NHS Bournemouth and Poole as soon as possible. (Response appended at Appendix B for information).

CHAIRMAN

- 1 -