APPENDIX 1

Oxfordshire Joint Health Overview19th January 2006

& Scrutiny Sub Committee

Scrutiny Briefing note:Consultation on the reconfiguration of Oxfordshire PCT’s

Report author & contact :Julia Woodman

Scrutiny Officer

Oxford City Council

01865 252318

Introduction

The catalyst for the reform of the roles and functions of Primary Care Trusts (PCT’s) and Strategic Health Authorities (SHA’s) was the Dept. of Health (DoH) Paper ‘Commissioning a Patient led NHS’ in July 2005. The proposals had three main aims:

  • A reduction in the number of PCT’s to enable them to become more effective
  • An emphasis on providing local services through commissioning rather than staff employed by PCT (recent DoH guidance suggests that there is no compulsion for PCT’s to do this)
  • Achieving administrative savings (estimated at £250 million) from streamlining management structures.

Thames Valley Strategic Health Authority (TVSHA) papers on the proposed changes to structure emphasise the need to make financial savings and the achievement of coterminosity with local authorities (at a County-wide level)

In October 05 TVSHA submitted its proposals to the DoH, which outlined 3 options, 2 of which involved a county –wide structure for Oxfordshire, the 3rd option being the creation of 3 large PCT’s within the Thames Valley region.

The Consultation process

After Thames Valley Strategic Health Authority (TVSHA) received a formal response to their proposals from the DoH, they launched the public consultation on 14th Dec. The consultation process will run until 22nd March 2006.

The two options put forward by TVSHA for consultation, involve a County-wide PCT structure for Oxfordshire.

The document indicates that there has been ‘broad agreement’ for a single PCT in Oxfordshire, with significant advantages for being coterminous with Social Services and establishing effective financial management. It also details the need to establish locality structure, which will ‘ensure the specific needs of defined areas’ and maintain the strong links that the PCT has with district councils.

In essence the City is faced within an inevitability of a County-wide PCT. Although it is interesting to note that DoH guidance recognised that SHA’s may want to recognise urban / rural differences by creating:

  • County –based PCT’s with separate PCT’s for urban areas
  • Divide counties with urban and rural areas into joint territorial units

The TVSHA makes no reference to the distinct health needs of urban and rural environments. I would therefore advise the Committee to seek further clarification from the TVSHA on how it plans to secure one of the DoH criteria for re-organisation that is to improve health and health inequalities. In particular how present PCT services targeted to the urban health needs of the City will be improved within a county-wide structure.

Responding to the Consultation

The Joint Committee will respond to the consultation at their meeting on 26th January and will co-ordinate responses from the three Sub – Committees.

In terms of a City Committee response, I would advise the Committee to look at the consultation in its broadest sense.

At the Committee’s meeting in September, Nigel Webb (Chief Executive – North Oxfordshire PCT Partnership) suggested that putting forward proposals for a locality model within a County-wide PCT would be the most effective method for ensuring the recognition of area differences.

The DoH has stated that reconfiguration proposals are ‘unique to each area’ and therefore the Sub- Committee could encompass in its response expectations regarding area – based health planning and the boundaries for a City locality.

As an overall response, I would advise the Committee to consider fundamental expectations of a locality model e.g.

  • Health need assessment data available at a locality level
  • Service design reflects the locality population
  • Services have the flexibility to respond to and prioritise health need at a local level
  • Service development which is influenced by stakeholders at a locality level
  • The need for local delivery plans
  • Locality budgets and funding formulas that are health need driven.

The Committee should consider which health services would benefit from locality working, particularly where that are strong partnerships already between the City Council and Oxford City PCT. Public Health is an obvious example. Furthermore the Committee should consider the decision-making powers it would like to see given to these services at a locality level.

The DoH have made it clear that commissioning arrangements are not a matter for the reconfiguration consultation and yet the greatest lever for shaping City health services will probably be the flexibility of commissioning arrangements, outlined in the original DoH paper. I would advise the committee to keep a watching brief on developments in this area.

When are the changes likely to happen?

The new PCT chair designate appointments will be made from May 2006. From June 2006 candidates for Chief Executive positions will be appointed. The new PCT’s will be established between July 06 – March 07.

JHO_JAN2606R21.doc