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 Wales. 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 community. 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 Powys 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 Anglesey Local Health Group Information Quality Review Group Blaenau Gwent 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 Port Talbot County Borough Council Royal College of Midwives UK Board for Wales Swansea 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