AGENDA ITEM 3

BOROUGH OF POOLE

HEALTH SCRUTINY COMMITTEE

MINUTES OF MEETING HELD ON TUESDAY 14th FEBRUARY 2006

The meeting commenced at 7.00 p.m. and concluded at 9.47 p.m.

Members of the Committee present:

CouncillorMrs Hillman (Chairman)

CouncillorsBrooke, Bulteel, Adams (substituting for Mrs Deas), Mrs Hives, Mrs Lavender, Mason (substituting for Meachin), Montrose, Mrs Moore and Wilson

Members of the public present: 2

1.APOLOGIES FOR ABSENCE

Apologies for absence were received from Cllr Mrs Deas (who was substituted by Cllr Adams) and Cllr Meachin (who was substituted by Cllr Mason).

2 DECLARATIONS OF INTEREST

Councillor Adams declared a personal interest in item 4 on the Agenda, as his daughter worked for the NHS and he was a carer for his elder daughter.

Councillor Bulteel declared a personal interest in item 4 on the Agenda, as he is an employee of the NHS.

Councillor Hives declared a personal interest in item 4 on the Agenda, as she was a carer.

3.MINUTES

RESOLVED that the Minutes of the Meeting held on the 6th December 2005 be approved as a correct record, confirmed and signed by the Chairman.

4.COMMISSIONING A PATIENT-LED NHS

The Chairman requested those present to introduce themselves to the Committee, explaining their roles.

The Chairman welcomed the five panel members: Edward Colgan (Dorset and Somerset Strategic Health Authority Lead for “Commissioning of Patient-lead NHS”), Jane Barrie (Chair of DSHA), Adrian Dawson (Acting Chief Executive of Poole Primary Care Trust), Jim Wilson (Chairman of Poole PCT), Martin Carter (Director of Communications (DSHA) and Ken Wenman (Chief Executive of Dorset Ambulance Trust).

The Chair of DSHA began the presentation by outlining that they would be discussing the structure of the Service and not the Frontline Services. The Dorset and Somerset Strategic Health Authority Lead for “Commissioning of Patient-lead NHS added that it was important to look at the future structure of Primary Care Trusts (PCTs) to make them more strategic and added that the role of the Strategic Health Authority (SHA) would change. The commissioning of a Patient-Led NHS would become more strategic and work on a regional basis. The SHA would become an intermediate between the Department of Health (DOH) and the PCT. There would not be a change to service delivery as the reorganisation process was about the Management of the Organisation.

The Director of Communications (DSHA) then gave a presentation to the Members of the Committee of which the key points were as follows:

•The document ‘Commissioning of Patient-Led NHS’ was published in July 2005 and it set out to focus on a step change in commissioning by Frontline Staff to reflect patient choice. These changes were subject to local consultation. Once the consultation had been completed this would lead to a rapid implementation of proposals.

•The main point of the consultation was to look at the reconfiguration of Primary Care Trusts, Ambulance Trusts, Strategic Health Authorities and further development of Practice Based Commissioning. There would be a move by NHS Trusts to become NHS Foundation Trusts.

•The future role of PCTs would be to improve and protect the health of the population, effective commissioning, reduce health inequalities and to develop and sustain strong relationships with GPs and their Practices. This would include an implementation system of practiced based commissioning. PCTs would work closely with Local Authority Partners and they would ensure that a range of services are provided for their Communities.

•The possible future configuration in the South West would be for Dorset and Somerset to have three or four Primary Care Trusts with Avon, Gloucestershire and Wiltshire having three or seven Primary Care Trusts. The South West Peninsular would look to have four, five or six Primary Care Trusts.

•The future role of the Strategic Health Authorities (SHA) would be to maintain a strategic overview of the local NHS Leadership and Performance Management. It would be to ensure proper engagement of health interest in the development of strategic partnerships. The SHA would ensure that the NHS contribution to the wider economy was recognised and used at a regional level. There would be emergency and resilience planning management.

•There would be a move to practice based commissioning which was a process whereby GPs and their teams take on responsibility from PCTs for commissioning services best suited to the health needs of their local population. They would have a national budget with the money held on their behalf by their local PCT. At present very few practices were large enough to undertake this solely, so it would normally require groups of practices to work together. The main function of the practice based commissioning would be to design better patient pathways, which would improve the Patient’s journey through the various parts of the NHS. Working in partnership with PCTs, it would create community based services which were more convenient for patients. Responsibility for budgets would be delegated from PCTs to buy acute (hospital) community and emergency care.

•The timetable for this process had begun on 30th November 2005 when the Secretary of State approved options for consultation in Dorset and Somerset following the informal consultation process. Local consultation on proposed changes to Primary Care Trusts, Strategic Health Authorities and Ambulance Service NHS Trusts were being held between 14th December 2005 and 22nd March 2006. The implementation of the first wave of practice based commissioning was to begin 31st March 2006. Implementing a new configuration for PCTs was to commence on 31st October 2006. The implementation of further development of practice based commissioning would begin on 31st December 2006. Complete reconfiguration of the Strategic Health Authority was set for 1st April 2007.

•The benefits of this process would be recurring savings of at least £6 million in Dorset and Somerset which would be invested principally in cervical, breast and bowel cancer and Palliative Care Services. There would be more effective commission leverage from larger PCTs who would be able to exercise this over Secondary Care Providers to improve the quality and standard of services. Larger PCTs would be able to deliver commissioning coherence in terms of priorities and investment and services available to patients ending differential access to services, drugs and treatments. This currently characterised the workings of some smaller PCTs. There would be a more consistent strategic and focused approach to planning and commissioning specialist and tertiary services avoiding duplication of planning. There would be increased involvement in the influence of the public in co-creating and redesigning services as equal partners with clinicians. “Practice Based Commissioning” would enable GPs in discussion with patients to access and develop services most appropriate to their patient’s needs. Congruence with Social Care and Local Authority boundaries would facilitate improved partnership working and delivery of integrated services across the health/social care interface. There would be a realigning of capacity in capability so that the right people would be in the right place to manage the NHS more effectively in organisations which would ensure that the NHS would be “fit for purpose” and able to deliver improved quality of care and value for money.

•The possible future service changes were about the number and configuration of NHS Organisations, not changes in service provision at the present time. Any possible changes to service provision in the future would either directly or indirectly relating to the commissioning of a Patient-Led NHS but would be subject to full consultation, including all Overview and Scrutiny Committees involved in the areas concerned.

•The criteria for the new PCTs would be that they were safe, secure and that they delivered high quality services. They would improve the health of local people and reduce health inequality. They would need to secure the support and involvement of GPs and rollout Practice Based Commissioning with clear support from GP Practices. Better ways to involve patients and the public in the work of the local NHS were needed. They would need to improve the way local services were planned, delivered and made best use of resources available. They would need to achieve and maintain financial balance and manage risk. Co-ordination would need to be improved with Social Services through having common boundaries with relevant Local Authorities. It was not permissible for PCTs to have two or more Social Service’s Local Authorities within its geographical boundaries, as long as the Local Authority was contained wholly within the Primary Care Trust boundaries. It esd not permissible for PCT boundaries to straddle different Social Service’s Local Authority areas. The PCTs must deliver at least a 15% reduction in its manager and administration costs.

•The advantages for separate Primary Care Trusts in Bournemouth and Poole were that there would be no disruption to local NHS Organisations. The relationship would be maintained at local level which had been developed over several years. They were of a suitable size to be sensitive to very localised issues. At present they were a good platform for improved public and patient involvement. The disadvantages of separate Primary Care Trusts for /Bournemouth and Poole were that their influence as a single PCT would be diminished compared to that of a large organisation. They would not be able to achieve the 15% reduction in management and administration costs which would mean that they would have to be achieved in other ways which could possibly lead to a cut in frontline services. There would also be complicated planning arrangements for people living on the boundaries of Poole and Bournemouth in areas such as Westbourne.

•The advantage of a single Primary Care Trust for Bournemouth and Poole would have the advantage of creating greater influence over local hospitals and other health care providers. There would be simple arrangements for people who lived on the boundaries of Poole and Bournemouth. There would be significantly more savings as a result of any merger. The disadvantages of a single Primary Care Trust for Bournemouth and Poole would be more work would be needed to maintain existing strong local partnerships and develop new ones. There could be a perception that they were remote from local populations. Some new relationships would need to be formed with local authorities who were currently used to working with separate PCTs which had the same geographical boundaries as them.

The Chairman thanked the Director of Communications (DSHA) for the informative Presentation.

After this presentation the Chairman of Poole PCT acknowledged that a merger would create a strong commissioning platform which he believed many people wanted. The Acting Chief Executive of Poole PCT, added that smaller PCTs would have more difficulties in implementing the Agenda for Change. The Chief Executive of Dorset Ambulance Trust, acknowledged that he would support a merger of the two PCTs.

Question and Answer Session

A Member raised the question of whether a GP Practice would increase in size or whether a number of practices would join together? The Acting Chief Executive of Poole PCT outlined that Practices would need to work together as this would have the benefit of creating more influence against some of the smaller Practices.

A Member raised the question of whether larger organisations were better? A number of people on the panel outlined that savings from restructuring PCTs would mean that more money could be deployed in frontline service care.

A Member asked the question of whether the new practice structure would change to one of a Patient-Led structure? The Acting Chief Executive of Poole PCT acknowledged that in the longer term it could be possible to register with more than one GP for different services.

A Member asked whether the link would be lost between Local Authorities and PCTs? The Panel highlighted that locality working would still be needed under the new strategic framework. The Member asked a supplementary question regarding how the local authority could influence the changes in the new structure? The Dorset and Somerset Strategic Health Authority Lead for “Commissioning of Patient-lead NHS” reassured those present that there would still be a need to maintain the link with local authorities and also to continue improving the relationship.

The Policy Director (Social Services) highlighted to the Panel that at present there were a number of appointments between the Local Authority and the PCT which were costing an estimated £100,000 from the Local Authority budget and that it was supposed that Bournemouth had similar arrangements. The Policy Director (Social Services) added that with the changes within the PCT that they would be looking for new agreements in this new structure. The Dorset and Somerset Strategic Health Authority Lead for “Commissioning of Patient-lead NHS” replied that the SHA transition team would be asked to consult with the Local Authorities regarding this issue.

A Member asked who would benefit from the proposed restructuring? The Member added that he believed that the process at present, looking at the structure first and needs of patients last was the wrong way round and that it would be more beneficial to find out local needs before looking to change the structure.

The Dorset and Somerset Strategic Health Authority Lead for “Commissioning of Patient-lead NHS” replied that the Secretary of State had asked for this consultation. He added that the PCT was a funding organisation and looked at a strategic level for services that were needed in a local area. The evaluation of PCTs showed that there were a need for larger organisations as pointed out in the presentation. He believed that the NHS had become top heavy so this consultation process was about releasing money that could be put into patient care services. The Acting Chief Executive of Poole PCT pointed out that if the PCT created new ways of working then many units that work across the county could be brought under one simplified structure as opposed to being funded from three or four different funding streams.

A Member queried if the structure was presently working, why was it being changed? He added that if the current system did not necessarily require PCTs then why was the option not to scrap PCTs in total and save a greater proportion of money?

The Dorset and Somerset Strategic Health Authority Lead for “Commissioning of Patient-lead NHS” replied that PCTs had improved services and waiting times. The consultation showed exactly what savings could be achieved and where they would be achieved. He believed that this was the most open consultation that had occurred within the NHS for many years.

A member asked how the savings would be monitored?

It was explained that savings would be moved into providing patient services. With an increase in patient services this would indicate that savings had been made.

A Member raised the issue of how older people would be consulted, because they may have concerns about the changes that were being proposed?

The Acting Chief Executive of Poole PCT emphasised that this consultation was about the administrative structure of the organisation and not about any service delivery. If service delivery was to change then a separate consultation process would be undertaken.

A PPI Forum Member, sitting as a Non-Voting Member of the Committee, pointed out that she believed that a merger would benefit the Forum as they could learn methods of best practice from the other PPI forums that with whom they were merging.

A supplementary questions was asked as to whether both PCTs were in balance? The Panel believed that both PCTs where in balance and that the financial affairs of each PCT were published in April every year for public scrutiny.

A Member raised the question of whether the proposed merger of the SHAs in the South West would lead to one of the largest areas in distance in the whole country and questioned whether this would not be too large?

It was explained that in terms of distance there were many others which covered a significant area.

RECOMMENDED that

i)The presentation by the Strategic Health Authority be noted;

ii)The Health Scrutiny Committee note the formal consultation from the Ambulance Service and the SHA; and

iii)The Health Scrutiny Committee endorse the merger of Poole and Bournemouth PCTs.

5.DEVELOPMENT OF LOCAL GP SERVICES – IN THE CONTEXT OF ALL COMMUNITY HEALTH SERVICES

The Head of Primary Care at Poole PCT gave a presentation regarding this subject the main points of which were as follows:

•There would be a development of local GP Services Practice Based Commissioning. This would be designed to ease pressures on hospital care by moving services into the community whenever this was safe, appropriate and effective. Practices working co-operatively to redesign services would help increase capacity of Primary Care to provide some traditional hospital services. The PCT would control funding which would follow the patient through the system.

•The development of local GP services would include a link of all services into a strategic clinical service framework. This would follow the structure of the documents, ‘A Patient-Led NHS’; ‘Practice Based Commissioning: Our Health, Our Care, Our Say and ‘Care Outside Hospital’. This would be enabled by new Primary Care contracts, Standards for Better Health, Foundation Trusts and Payment by Results. GP services are provided by independent contractors who would deliver the service. Basic Services include consultation, diagnosis, treatment or appropriate referral. This service would be underpinned by a variety of employed staff funded through contracts with the PCT.

•The development of other community health services within the local GP services would include Community Nursing, Intermediate Care Services, Dietetics, School Nursing, Occupation Therapy, Palliative Care and Oncology and Medicine Management. There would also be enhanced Primary Care Services such as Physiotherapy, Counselling, Audiology, Dermatology, Ophthalmology, Psychology, Ultrasound, ECGs, Echocardiography, Surgery and Outpatient Services.