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Home , Blaenau Gwent, Jon Owen Jones, Win Griffiths

STRUCTURAL REVIEW IN THE NHS - SUMMARY OF DECISIONS

The following is a summary of the Minister for Health and Social Services decisions in relation to the structural proposals for NHS . The Minister communicated her decisions in a statement to an Assembly Plenary session on 15th November. These were debated at a further Plenary session on 27th November.

1. Local Health Groups will be strengthened to become Local Health Boards (LHBs), in each local authority area. These will be the building blocks of the new NHS in Wales. The principle of co-terminosity with local authorities is widely regarded as providing very important advantages. 22 Local Health Boards will be established which will be statutory bodies. This will give them the power and status essential for them to discharge their responsibilities.

2. The partnership between LHBs and local authorities is critical. The Welsh Assembly Government is seeking specific Welsh clauses in the NHS Reform Bill that was introduced to Parliament on 8th November 2001. These will make provision to place a duty on each local council and each LHB jointly to formulate and implement a strategy for the health and well- being of members of the public in the local authority’s area. This will include agreeing joint investment priorities and the joint planning of interface services, based on a joint assessment of need.

3. Over the next 18 months, from December 2001 onwards, a full implementation programme will be undertaken to prepare LHBs for their new roles and functions in order to be confident that they will be fit for purpose.

4. The membership of LHBs will need to be widened, to include local authority representation and to strengthen the place of voluntary and lay representation. The membership will also include an executive team including public health and other professional staff. This will result in a Board that will have a wider and more inclusive membership than at present. An amendment to the Plenary motion for the debate held on 27th November was passed, which will allow that of the two lay members to be on each board, one will represent the carer .

5. Individual members of the LHBs will need to be selected in a way that secures the legitimacy of representation. It is clear that Boards must be required to conduct business in public and to strengthen ways in which engagement with the public can be ensured.

6. The concept of LHB consortia, as outlined in the original document will not be pursued.

7. The model to be adopted in the new arrangements will be one in which LHBs, local authorities, Trusts and the voluntary sector work together, to ensure joined up and, where appropriate, integrated commissioning arrangements for the hospital and community services within local areas. We will seek to ensure that local organisations will set up processes to work together in this way so that the best possible range and quality of services are secured for their local populations through effective and value for money commissioning. In the first stages, this process will be overseen by three regional Assembly offices. This will ensure a consistent and paced development of such joint working.

8. On this basis, there will be some 10 -12 local partnerships throughout Wales, most often made up of two LHBs, two local authorities and one NHS Trust.

9. The project to bring the NHS Trust and the LHB together, to form a single Powys Health Board, as outlined in the Structures Report will now proceed.

10. A small number of pathfinder projects will be considered, as a result of proposals from the NHS, in which LHBs will assume responsibility for community services that are currently provided by Trusts. Only areas that have volunteered for these projects will be considered for inclusion as pathfinders.

11. To enable LHBs and Partnerships to be capable of taking on their new duties an All-Wales LHB and Partnership Development Team will be set up, to sit alongside and complement the Implementation Team which is already operational. Both Teams will operate under the direction of the Director of the NHS in Wales. The Development Team will include some of the most senior figures in the services in Wales, including those with direct experience of the commissioning process.

A Framework Development Plan, including specific milestones to be achieved between now and 1 April 2003 will be published in the near future. This document will provide a clear blueprint for those in the field, and will form the essential work programme for the Development Team to build the capacity of LHBs and the Partnerships.

12. We must ensure that the skills and experience available within Wales are retained and that those skills can be utilized well. At the Assembly level, the NHS Directorate will be strengthened both in the way it is organised and also in the range of skills directly available to it.

In order to enhance strategic planning, performance management and other operational functions, Assembly offices will be located in North, Mid/West and South Wales. These regional bases will enable the Directorate to maintain a visible local presence and an accessible source of information and advice to the local NHS organisations. They will hold lead organisations to account on a day to day basis on behalf of the Director.

It will also be particularly important for the Directorate to involve a full range of professional advice in order to create and deliver sound policies and strategies. These professionals will require effective support and will draw upon strengthened professional advisory structures within the NHS. The Director and the Chief Medical Officer and the Chief Nursing Officer will be working closely together to secure this.

13. It is vital that the National Assembly has the capacity to provide the leadership in primary care, an important area of service development and delivery. There will be a Primary Care Directorate at the Assembly, supported by a reference group, representing professional interests.

14. Hospital and community based health care services will be recognised in the new arrangements. A lead director at Assembly level will be nominated to represent these interests, supported by a reference group.

15. Lead Directors will also be nominated for mental health and children’s health services at Assembly level to strengthen policy and strategy and ensure their effective implementation.

16. The professional advisory machinery as a whole will be re-established and be well positioned in the new structural arrangements.

17. The public health capacity will be strengthened in Wales. At Assembly level this will be achieved under the leadership of the Chief Medical Officer (CMO). NHS Public Health services will be organised on an all Wales basis located within an NHS Trust but with accountability to the CMO. Responsibility for the health of the population and meeting statutory and operational requirements will be located at Local Health Board level. The Wales Centre for Health will provide an independent focus for the development and support of public health practice in all sectors and partner organisations.

18. The role currently played by the Specialist Health Service Commission for Wales (SHSCW) will be strengthened. In the reformed health service in Wales, the Commission will continue to provide an All-Wales, arms-length, commissioning body, dealing with tertiary and other highly specialised acute services. Post reorganisation, a Board will be constituted which is made up of regional representatives of LHBs, Trusts and the National Assembly.

In addition to securing tertiary services, the Commission will be available to provide advice to the NHS in Wales in relation to more specialised secondary and regional services commissioning.

The Commission will be strengthened to provide dedicated guidance, support and facilitation more generally in relation to acute services commissioning. Where, for example, difficult issues need determination, the Commission will be able to provide a first source of arms-length, independent advice and guidance. The Commission will be strengthened, to provide a direct input to the phased organisational development plan referred to above. List of Organisations who responded to the Consultation:

Local Health Group Association Trust Chief Executives Group All Wales Health Care Professions Committee Ynys Mon Local Health Group Information Quality Review Group Blaenau Local Health Group Iechyd Morgannwg Health Promotion Committee Clinical Psychology Advisory Sub-Committee Wales Industry Group of the Association of the British Pharmaceutical Industry Welsh Advisory Sub-Committee in Anaesthesia North Wales Local Pharmaceutical Committee Gwent Community Health Council Senior Nurses, Bro Taf Health Authority Human Resource Directors Unllais – One Voice Welsh National Board for Nursing, Midwifery & Health Visiting Children’s Hospice in Wales Gwent Local Medical Committee Morgannwg Local Medical Committee Old School Surgery – District Nurses Cyngor Cymru Bridgend Community Health Council University of Bangor School of Nursing & Midwifery All Wales Specialist Registrars in Public Health Medicine Neath Council Royal College of Midwives UK Board for Wales NHS Trust Board General Practitioners Committee (Wales) Therapeutic Professions Forum, Swansea NHS Trust Clinical Governance sub group of Health Challenges Task & Finish Group Powys Mental Health Alliance Welsh Committee of Radiologists Morlais Medical Practice Legal Services Commission in Wales Community Health Council Conwy Federation of Community Health Councils Gwynedd Local Health Group Conwy Local Planning Group Welsh Nursing and Midwifery Committee Dental Service Group, University Dental Hospital Local Health Group Swansea Community Health Council Neath and Port Talbot Community Health Council Conwy and NHS Trust Gwent Local Medical Committee North Wales Youth Justice Forum Society of Directors of Public Protection Wales Gwent Nursing & Midwifery Advisory Committee Cynghrair Iechyd Meddwl - CIM North West Wales NHS Trust Wrexham Local Health Alliance East Radnorshire Day Centre Bro Morgannwg NHS Trust Medical Staff Advisory Committee Gwent Community Health Council Local Health Group General Managers Sports Council for Wales Bro Taf Health Authority Nursing, Midwifery and Health Visiting Committee Welsh Association of Local Health Group Chairs Swansea NHS Trust Medical Staff Committee Local Health Board Local Health Group Gwent Healthcare NHS Trust Powys Local Health Group Anglesey Community Health Council Swansea Local Health Group Anglesey local Health Group North Wales User Involvement Group (Mental Health) Vale Adults’ and Children’s Services Network Welsh Association of Managers in Primary Care Local Health Group Wales Council for Voluntary Action NCH Cymru District Nurses, League of Friends of Mental Health in North Gwent Royal College of General Practitioners Conwy Local Health Group Wrexham Local Health Group Pembrokeshire Nurse Commissioning Forum Gwynedd County Council City and County of Swansea North Wales Health Authority Joint Staff Consultative Committee Health Care Challenges Task and Finish Group Newport Local Health Group 22 Lay members of Local Health Groups in Wales Monmouthshire County Council County Borough Council NHS Wales Equality Unit Gwent Local Dental Committee North Wales Community Dental Service Gwent Local Pharmaceutical Committee Diabetes UK Cymru Riversdale Practice Nurse Executive Wales Community Dental Service Managers’ Group Carmarthenshire County Council Bro Taf Local Medical Committee Chartered Society of Physiotherapists Bridgend Local Health Group Community Health Council BMA Medical Academic Staff Committee United Kingdom Home Care Association Health Promotion Managers, Iechyd Morgannwg Health Authority UNISON Cymru - Wales Healthcare Group Welsh Local Government Association All Wales Speech & Language Therapy Managers’ Committee Cardiff & Vale NHS Trust Advisory Sub-committee in General Medicine Celtic Dimensions North Wales Health Authority Directors of Finance Gwynedd Local Health Alliance Disability Rights Commission Iechyd Morgannwg Local Pharmaceutical Committee Iechyd Morgannwg District Dental Committee Local Health Group North West Wales NHS Trust Joint Staff Consultative Committee Medrwn Mon Mental Health Forum Iechyd Morgannwg Local Nursing and Midwifery Committee Bro Morgannwg NHS Trust Welsh Affairs Committee, Faculty of Public Health Medicine Professional Heads of Health Promotion Services Head of Nursing, Women & Families Directorate North East Wales NHS Trust Cardiff & Vale NHS Trust Bridgend Partnership Board Health Solutions Wales Welsh Clinical Governance Leads Torfaen Local Health Group NHS Trust Directors of Finance Caerphilly County Borough Council Clinical Psychology Advisory Sub Committee Carmarthenshire Local Health Group North Wales Health Authority Welsh Executive of the Royal Pharmaceutical Society of Great Britain Powys Health and Social Care Network Merthyr Tydfil County Borough Council Brecknock and Radnor Community Health Council Health Authority and NHS Trust Chairmen and Chief Executives Trust Professional Nurse Forum, Bro Morgannwg NHS Trust Conwy & Denbighshire NHS Trust Mental Health/Learning Disability Services Directorate Newport County Borough Council Medical Physics and Bioengineering (MPBE) Wales University of Wales College of Medicine Joint Society of Health Education and Promotion specialists/Public Health Alliance Conference, Bridgend, October 2001 Council, Social Services Department Powys Local Medical Committee & Rhondda NHS Trust University of Wales, Bangor Joint Consultative Forum Gwent Health Authority Mind Cymru Conwy & Denbighshire NHS Trust, Child & Adolescent Health Directorate Community Practitioners’ & Health Visitors’ Association (CPHVA) Welsh Health Information Managers’ Group BMA Cymru, Welsh Committee for Public Health Medicine and Community Health Royal College of Nursing, Wales Caerphilly Local Health Group Cardiff County Council Lloydspharmacy, GEHE UK, Primary Care Services Bro Taf Health Authority, Directorate of Public Health & Policy Local Health Group Welsh Scientific Advisory Committee Welsh NHS Confederation Welsh General Practitioners Committee Specialised Health Services Commission for Wales (SHSCW) Welsh Central Pharmaceutical Committee (WCPC,) Board Iechyd Morgannwg Health Authority Association of Welsh Community Health Councils Voluntary Action Merthyr Tydfil Welsh Consultants & Specialists Committee (WCSC BMA Cymru, Welsh Consultants and Specialists Committee BMA Cymru, Welsh Council Denbighshire Local Health Group Carmarthenshire NHS Trust All Wales Service Public Health Network Welsh Forum of Local Negotiating Committees (LNCs) Powys County Council, Social Services Department Blaenau Gwent Local Health Group Cardiff Community Health Council The Vale Local Health Group Welsh Committee for Public Health Medicine and Community Health North West Wales NHS Trust Swansea NHS Trust, Division of Psychiatry Centre for Health Leadership Welsh Collaboration for Health and Environment The College of Optometrists Gwent Local Optometric Committee Alzheimer’s Society Wales Community Practitioners’ and Health Visitors’ Association (CPHVA) Caerphilly County Borough Council Bridgend CBC, Social Services, Adult Services Strategic Division Aberystwyth Labour Party Bro Taf Voluntary Sector Mental Health Network Welsh Food Alliance Arthritis Care in Wales Community Health Council Bro Taf Health Authority( HA), HA & Information & Technology Task and Finish Group Ceredigion and Mid Wales NHS Trust Dyfed Powys Health Authority, Joint Staff Management Consultative Committee Crossroads Wales - Caring for Carers Carmarthenshire Health and Social Care Partnership Board All Wales Health Care Professions North Wales District Pharmaceutical Committee Dyfed Powys Health Authority Welsh Ambulance Services NHS Trust Bro Taf Health Authority Gwent Health Authority The Audit Commission Denbighshire Joint Consultative Committee Institute of Healthcare Management Pembrokeshire and Derwen NHS TrustCare Forum Wales Institute for Applied Health and Social Policy Centre for Mental Health Services Development in Wales, University of Glamorgan UK Central Council for Nursing, Midwifery and Health Visiting The British Dental Association Wales Information Task and Finish Group Carers Wales Dyfed Powys Health Authority District Medical Committee Health Policy and Public Health - All Wales Senior Nurse Advisory Group Bro Morgannwg NHS Trust, Mental Health Directorate Manpower Group Bro Morgannwg NHS Trust, Mental Health Directorate Isle of Anglesey County Council, Social Services Newtown and Machynlleth Local Planning Group Pontypridd & Rhondda NHS Trust, Occupational Therapy Services Neath Port Talbot Council for Voluntary Service Welsh Council of the Association of Optometrists Llanelli Dinefwr Community Health Council Pembrokeshire and Carmarthenshire Health Promotion Service Pontcae Medical Practice Blaenau Gwent Local Health Group Gwent Community Health Council Welsh Nursing & Midwifery Council Velindre NHS Trust Ceredigion Local Health Group Montgomery Community Health Council All Wales Trust Personnel Directors Bro Taf Health Authority, Public Health Directorate The Walton Centre NHS Trust All Wales Dental Public Health Group Cancer Services Co-ordinating Group Gwent Association of Voluntary Organisations National Aids Trust, Cymru Neath Port Talbot Local Health Group Flintshire County Council North Glamorgan NHS Trust Powys Health Care NHS Trust Blaenau Gwent County Borough Council, Social Services Powys Health Care Trust Bridgend Local Health Group Council Joint Consultants’Committee Wales Alliance for Mental Health (NSF Cymru) Pembrokeshire and Derwen NHS Trust (Mental Health and Learning Disabilities Division) Youthlink Wales All Wales Public Health Nurses in Communicable Disease Control Bro Taf Health Authority, Public Health Bro Taf Health Authority, Environmental Public Health Medicine Bro Morgannwg NHS Trust Association for Spina Bifida and Hydrocephalus (ASBAH) Multi-centre Research Ethics Committee for Wales List of Individuals who responded to the Consultation:

Russell Hopkins, Chairman, Bro Morgannwg NHS Trust Fiona Peel, Chairman, Gwent Health Authority Maggie Aikman, Director of Finance, Gwent Health Authority Paul Parker, National Assembly Dr Carys Graham, North Wales Health Authority Alison Hughes, Gwent Health Authority Dr John Pritchard Mr Emrys Roberts Dr Ruth Parry, North Wales Health Authority Ms Jean Matthes, Swansea NHS Trust A W Roberts, University of Wales College of Medicine S M Sandham, Gwent Healthcare NHS Trust Mr Peter Harrop, Caernarfon Helen Fine, University Of Wales College of Medicine Gwenda Thomas AM Gill Jones, National Assembly R J Lewis and H Crawford Dr S Boyle Professor J G Williams, Bro Morgannwg NHS Trust Dr P E Williams, Cardiff & Vale NHS Trust Carwyn Jones AM, National Assembly Nigel Monaghan, Bro Taf Health Authority B Yate, West Wales General Hospital Alison Jones, Conwy & Denbighshire NHS Trust Ruth Marks Dr S K Raha Julie Harvey, Bro Morgannwg NHS Trust Bob Hutchings, Cardiff & Vale NHS Trust Dr Kay Saunders, Butetown Health Centre Lisa Howells, Swansea NHS Trust R G T Phillips, Bro Taf Health Authority Robert Kidd, Cardiff & Vale NHS Trust D E Roberts, Cardiff & Vale NHS Trust Dr M Vaughan and T Hurrell, Carmarthenshire Local Health Group Jeremy Savage, Carmarthenshire NHS Trust , MP, Bridgend Dr M J R Corney, Conwy & Denbighshire NHS Trust John Wrangham, Acting Group Director, Community Services. E Davies, District Nursing Sister, o/b Nurses in the Rhondda , MP, Cardiff Central Professor Dame June Clark, Prof. of Community Nursing, UCW, Swansea. Peter Black, AM, Welsh Liberal Democrat Ms Brenda Rees, Head of Midwifery & Gynaecology Nursing, UHW Dr John Morgan, President Welsh Paediatric Society Mr. P Davies, Managing Director, Endo Plus (UK) Ltd. Orthopaedic Specialists Mr. P D Ll Edwards, Consultant Paediatrician, Princess of Wales Hospital, Bridgend Ms Helen Hortop, Head of Occupational Therapy Services, UHW Dr Rhian E Owen, Lead Cancer Clinician, Bro Morgannwg NHS Trust Dr Joan Rule, Consultant in Psychogeriatrics Professor Gareth Williams, o/b Triangle Project, UCW Cardiff, Social Sciences Gill Worgan, Administration Manager, Bro Morgannwg NHS Trust Ms Angela Hurley, Professional Development Nurse Mrs. Barbara Bowness, Director of Mental Health Services Ms Helen Kays, Powys Health Care NHS Trust, Local Planning Group Helen Page, Head Occupational Therapist, Cardiff Royal Infirmary Ms Mary Pakes, Head Occupational Therapist (Mental Health Mr. Keith Sylvester, Swansea NHS Trust

In addition to the respondents listed, a further two were received from individuals wishing to exercise their rights under Data Protection legislation to have their personal details withheld. Some of the respondents shown may also have been associated with more than one response; consequently their names will appear only once on the list. There were also multiple responses summarised in Question and Answer format from three open staff fora held at the National Assembly and from three Roadshows held in Swansea, Cardiff and Llandudno. Arrangements to view, or to receive copies of the consultation responses, can be made by contacting:

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