Reportof Meeting Date HeadofLeisureandCultural Services CustomerOverviewandScrutinyPanel 1March2006 (IntroducedatExecutiveCabinet OverviewandScrutinyCommittee 2March2006 bytheExecutiveMemberforLife andLeisure, ExecutiveCabinet 9March2006 CouncillorCathHoyle) CONSULTATION ON CHANGES TO THE STRATEGIC HEALTH AUTHORITY, PRIMARY CARE TRUSTS AND AMBULANCE SERVICE NHS TRUSTS IN LANCASHIRE AND CUMBRIA PURPOSEOFREPORT 1. ToconsideraresponsetotheconsultationonchangestotheStrategicHealthAuthority (SHA),PrimaryCareTrusts(PCT)andAmbulanceServiceNHSTrustsinCumbriaand Lancashire. CORPORATEPRIORITIES 2. Tackling health inequalities in the Borough is a priority area of work in the Community Strategy. RISKISSUES 3. Theissueraisedandrecommendationsmadeinthisreportinvolveriskconsiderationsin thefollowingcategories: Strategy √ Information Reputation Regulatory/Legal Financial Operational People Other Asmentionedabove,tacklinghealthinequalitiesintheBoroughisapriorityareaofwork intheCommunityStrategy.Theexistingarrangements,inparticularwithaPCTcovering ChorleyandSouthRibble,haveidentifiedhealthinequalitiesintheBoroughandarelocal enoughtomakeadifference.ThereisariskthatthefocusontheBorough’sinequalities couldbedilutediftheywerehiddenamongstotherinequalitiesacrossalargerarea. BACKGROUND 4. InrecentyearstheNHShasseensignificantinvestmentandreform.Thesereformshave concentratedontheprovisionofservices,forexampleprovidingpatientswithmorechoice anddevelopmentssuchasNHSFoundationTrusts. 5. InJuly2005,proposalswereannouncedtoimprovecommissioningofservicesbyPCTs andtoensurelocalhealthservicesareworkingeffectivelyforpatients.SHAswereasked todevelopproposalsforconsultationwhich: • strengthen commissioning of health services, including putting more control of decisionsaboutlocalhealthservicesinthehandsoffront-linehealthprofessionals suchasGPs; • improvehealth,particularlythehealthofdisadvantagedcommunities;and • achieve savings in management costs of £250m nationally to be re-invested in healthcare. 6. Strategic Health Authorities, known as the local headquarters of the NHS, are accountable for the performance of NHS Trusts (except NHS Foundation Trusts) and PCTsintheirarea.Otherresponsibilitiesincludeensuringthereisacoherentstrategyfor health across the SHA area, co-ordinating the NHS response to major incidents, developingthecapacityandcapabilityofNHSTrustsandensuringtheimplementationof nationalpoliciesandinitiativesbyNHSTrustsandPCTs. 7. In future, SHAs will be directly accountable for fewer NHS organisations. More NHS TrustsareexpectedtoachieveFoundationstatusandiftheproposalsunderconsultation forPCTsareaccepted,therewillbeareductioninPCTs. 8. SHAswillhaveastrategicoverview,ensuringtheNHSinitsareaisperformingwelland deliveringhighqualityhealthcareforpatients. 9. InJuly2005,theGovernmentpublishedTakingHealthcaretothePatient:transforming NHSAmbulanceServices.Thisdocumentmade70recommendationsforimprovingNHS ambulanceservices,includingstrengtheningmanagementcapacityandcapabilitythrough fewerandlargerNHSAmbulanceTrusts. 10. Eachofthethreeconsultationsaretakeninturn.TheboldtexthighlightstheCouncil’s proposedresponsetoeachconsultation. STRATEGICHEALTHAUTHORITYARRANGEMENTS 11. CumbriaandLancashireSHAisoneofthreeSHAsinthenorthwest.Theproposalisto createasingleSHAforthenorthwestbymergingCheshireandMerseyside,Cumbriaand LancashireandGreaterManchesterSHAs. 12. Ashealthreformpoliciescontinuetodeveloptheremaybeadditionalrolesandfunctions identifiedforSHAs.AninitialviewofthenewSHAroleisasfollows: • MaintainastrategicoverviewoftheNHSanditsneedsintheirarea; • Improve and protect the health of the population they serve by having a robust publichealthdeliverysystemincludingemergencyplanning; • Provide leadership and performance management for effective delivery of government policy for health and health protection through NHS commissioned services; • Provide leadership for engagement of health interests in the development of strategicpartnershipsacrossthepublicsector(workingwithGovernmentOffices oftheRegions,RegionalAssemblies,SkillsCouncilsandRegionalDevelopment Agencies)tosecuredeliveryofgovernmentpolicy; • Buildstrongcommissioningprocesses,organisationsandsystems; • Ensure NHS Trusts are in a position to apply for Foundation Trust status by 2008/09; • Work with regulators and external inspectorates to develop the local health community,includingensuringchoiceandpluralityofprovisionandmanagingthe consequencesofclinicalperformancefailureandpatientsafetybreaches • PromotebetterhealthandensurethattheNHScontributiontothewidereconomy isrecognisedandutilisedatregionallevel; • LeadtheNHSonEmergencyandResiliencePlanningandManagement; • Work closely with the Department of Health to inform and support policy development and implementation and handle routine Parliamentary, Ministerial andtheDepartmentofHealthbusiness; • ImprovementofResearchandDevelopmentstrategicdevelopmentanddeliveryin each health economy in conjunction with the Healthcare Commission and UK ClinicalResearchNetwork;and • ProvideaneffectivecommunicationslinkwiththeDepartmentofHealth,facilitating clearandconsistentmessages. 13. Thesystemofmanagementofthehealthsystemwillcontinuetodevelopandchangeas Payment by Results and patient choice are fully implemented and moves are made towards a greater number of providers through NHS Foundation Trusts and greater independentsectorinvolvement. 14. TheDepartmentofHealthhasasignificantprogrammeofpolicydevelopmentworkonthe futureregulationandmanagementofthehealthsystemoverall.Furtherguidancein2006 willsetouttheimplicationsofthisworkforSHAs,PCTsandotherNHSbodies. 15. TheconsultationdocumentarguesthatSHAswillbebetterequippedforthesechallenges throughtheir: • Numbers :ThereislikelytobeasmallernumberofmorestreamlinedSHAs.This isbecausetheywillberesponsibleforareducednumberoflargerPCTs,anda smallernumberofNHSTrustsasmoregainFoundationstatus. • Boundaries :TheirboundarieswilllargelymatchthoseofGovernmentOfficesfor the Regions, helping SHAs to work more closely and strategically with public sectorpartnerstostreamlineservices. • Role :ThefocusforSHAswillbeonbuildingthenewsystemofcommissioning andthenmaintainingastrategicoverviewoftheNHSanditsperformanceintheir area.Theywillberesponsibleforensuringthattheorganisationscommissioning andprovidinglocalservicesaredoingsoinawaywhichmeetsthekeynational objectivesofahealthiernationandcareserviceswhicharehighquality,safeand fairandresponsivetochangingcircumstances. 16. The existing three SHAs considered whether the current SHA configuration was best suited to deliver the new functions outlined above. In particular they took into considerationthedevelopmentofNHSFoundationTrusts,andtheproposedreductionin thenumberofPCTsfrom42tobetween21–23acrossthenorthwestwhich,subjectto the outcome of consultation, will require the three SHAs to relate to significantly fewer organisations. 17. SHAs have a duty to streamline management costs in order to contribute towards the Government’s manifesto commitment to save £250 million for reinvestment in patient care. 18. The SHAs believe that the best way to deliver the new roles is to dissolve the existing threeSHAsandcreateanewsingleStrategicHealthAuthorityforthenorthwest.This would share the same boundary as the Government Office for the North West. ItisproposedthatthenewSHAiscalledtheNorthWestStrategicHealthAuthority.Itis envisagedthattheproposalwillmakeacontributionof£8.5milliontothenationalsavings targetof£250million.IftheconsultationsupportstheestablishmentofanewsingleNorth WestStrategicHealthAuthority,itisenvisagedthatthenewSHAwouldbeestablished duringtheperiod1July2006and31March2007. 19. TheSHAsdidconsiderwhetherthecurrentconfigurationofthreeseparateSHAscould successfullydeliverthenewfunctionsrequired;itwastheirviewthatonlytheproposed new SHA would meetthe national criteria andachieve the management costs savings. Thereforenootheroptionisbeingproposed. 20. In terms of the consultation, there is one question – do you support the proposal for dissolving the existing three SHAs and to create a new North West Strategic Health AuthoritycoveringtheareaoftheexistingthreeSHAsandthegovernmentregionaloffice boundary? In the absence of any alternative options that meet the criteria and financialtargetsitisdifficulttosuggestalternatives.Membersmaychoosetosay yes or not comment. Members may wish officers to comment on the appropriatenessofaconsultationexercisethatispresentedasafaitaccompli. AMBULANCETRUSTS 21. Therearecurrentlyfourambulancetrustsinthenorthwest:Cumbria,Lancashire,Mersey RegionandGreaterManchester.Theproposalistoreplacethefourtrustswithonenew trustcoveringthenorthwest. 22. TheDepartmentofHealth,intheirconsultationdocument,claimthatthebenefitsofthis proposalare: • moreinvestmentinfront-lineservices • moreopportunitiesforstaff • improved planning for, and ability to handle, chemical, biological, radiological or nuclearincidents,terroristattacksornaturaldisasters • betterequippedandtrainedworkforceandtheabilitytoadoptbestpracticequickly andconsistently • betteruseofresourcestosupporthighperformanceinalltrusts • greatercapacitytocarryoutresearchandcheckthatpatientcareisofthehighest standard • greater influence in planning and developing better patient services, both regionallyandnationally • greater financial flexibility and resilience, ability to plan and make longer-term investmentdecisions • financial savings achieved through greater purchasing power and economies of scale • improvedcontingencyplanningtomakesurethatthecontrolroom(wherethe999