Agenda item

12:10

Contact Officer: John Jackson, Director for Social & Community Services, Tel (01865) 323574

The NHS White Paper ‘Equity and Excellence: Liberating the NHS’, sets out the government's long-term vision for the future of the NHS. The vision builds on the core values and principles of the NHS - a comprehensive service, available to all, free at the point of use, based on need, not ability to pay.

It sets out how the government intends to:

• put patients at the heart of everything the NHS does;
• focus on continuously improving those things that really matter to patients - the outcome of their healthcare; and
• empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services.

The Department of Health is consulting on elements of these proposals.

In particular, the Department would welcome comments on the implementation of the proposals requiring primary legislation, and will publish a response to the views raised on the White Paper and the associated papers, prior to the introduction of the Bill.

A full copy of the White Paper can be viewed by clicking on the link below or by going on to the Department of Health Web site:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353

Copies of the ensuing consultation documents can also be found on the Department of Health Web site:

• Liberating the NHS: Increasing democratic legitimacy in health

• Liberating the NHS: commissioning for patients – consultation on proposal

Hard copies of all of the above documents have been circulated to all members of the Committee and placed on public deposit.

A paper setting out issues and points for discussion is attached at AS8 - to follow.

The Director for Social & Community Services, accompanied by the Cabinet Member for Adult Services, Ms Sonia Mills (Chief Executive – NHS Oxfordshire)and Dr Jonathan McWilliam (Director of Public    Health) will attend for this item in order to answer any questions which the Committee may wish to ask.

The Committee will consider the changes in light of:

(1)   Public Health

(2)   Democratic Accountability  

(3)   Adult Social Care including integration with health.

The views of this Committee will be taken into account in considering what response the Cabinet will make to the White Paper.

The Committee is invited to discuss its views on the consultation questions and to forward its comments to the Oxfordshire Joint Health Overview and Scrutiny Committee.

13:10 – 13:40  SANDWICH LUNCH

The Committee had been provided with copies of the NHS White Paper ‘Equity and Excellence: Liberating the NHS’, together with the following consultation documents: Liberating the NHS: Increasing democratic legitimacy in health and Liberating the NHS: commissioning for patients – consultation on proposal. The Department of Health was consulting on elements of the proposals and welcomed comments on the implementation of the proposals requiring primary legislation. A response to the views raised on the White Paper and associated papers would be published prior to the introduction of the Bill.

The Committee had before it the following papers:

·        Public Health in Oxfordshire: Implications of the Coalition Government’s Plans

·        Health White Paper - Implications for Adult Social Care (report by Director for Social & Community Services)

·        The NHS White Paper (report by Health Scrutiny Review Officer)

·        Local Democratic Legitimacy in Health (report by Health Scrutiny Review Officer).

and was asked to consider the changes in light of:

·        Public Health

·        Democratic Accountability

·        Adult Social Care including integration with Health.

The Director for Social & Community Services, together with the Cabinet Member for Adult Services, Dr Jonathan McWilliam (Director of Public Health) and Ms Sonia Mills (Chief Executive – NHS Oxfordshire) attended before the Committee in order to discuss issues arising from the White Paper and to answer the Committee’s questions.

Mr Dermot Roaf, Chair of the Oxon LINk Stewardship Group, addressed the Committee on behalf of the Stewardship Group, drawing the Committee’s attention to the points set out on the schedule of addenda as listed below:

The Oxfordshire LINk (Local Information Network) succeeded (in 2008) the former Patient Forums and the even more former Community Health Council as a way in which the public could comment on local health and social care.  It consists of about 650 members of the public who have registered an interest - of whom eight elected volunteers form a "Stewardship Group" to co-ordinate responses to their concerns.  The County Council appointed Help and Care of Bournemouth to develop the LINk and support the volunteers from August 2008 to March 2011.  The LINk has certain statutory powers to require commissioners and providers of health and social care to answer questions and allow visits.  It does not deal with individual complaints. It has reported on matters of concern to the Health Trusts, to Social Services and to the two Scrutiny committees.  I am the Chair of the Stewardship Group and have been discussing the White Paper with other Chairs in the South East. I am speaking on behalf of the Stewardship Group; the wider membership has not been consulted and Help and Care may well have different views.

The White Paper proposes that the LINk be transformed into a local "HealthWatch" in 2012 with similar duties, except that the County Council can, if it wishes, commission advocacy and other help for individuals and their complaints. The HealthWatch would be set up by and accountable to the County Council and would also be accountable to a national quango "HealthWatch England".

The Stewardship Group has discussed the HealthWatch proposal and is happy with it, subject to detailed discussions with the County Council.  There is one immediate concern which is the interim arrangements between the end of the contract with Help and Care in 2011 and the initiation of HealthWatch in 2012.  The County Council has suggested that support might be provided in house for that period and we would accept this (subject to detailed discussions). 

The Stewardship Group has not formally discussed the other proposals in the White Paper, but some members have expressed concern about the dangers to the excellent co-operation between the Health Trusts (in particular the PCT) and Social Services if General Practice Commissioning Consortia do not give a high priority to that co-operation. The suggestion that there could be a Health and Well-being Board may be the best way forward, provided that it has teeth.

The Committee noted that the Oxon LINk Stewardship Group had not discussed specifically whether HealthWatch England should be overseen by the Care Quality Commission, although they had been discussing how HealthWatch England should be appointed to, for example, to what extent it should have appointees from the grassroots who were close to communities and understood the situation on the ground. It was also hoped that HealthWatch would report to all three scrutiny committees.

Ms Sonia Mills (Chief Executive – NHS Oxfordshire) then made a number of points. Key points are listed below:

o       discussions needed to take place about the commissioning structures. GPs were very engaged and there would be discussions about how to run the consortia;

o       the primary care contracts would go to whatever regional structure the commissioning board would be;

o       discussions needed to take place regarding where staff would be transferred to and how the connection between Health and the local authority could be strengthened;

o       there would be very significant gaps in staffing if the current structure was maintained by the deadline date;

o       on the provider side all of those functions would have to go to Foundation Trust status;

o       it would be necessary to ensure that the economic regulator supported rather than opposed local arrangements;

o       at the same time, NHS Oxfordshire was faced with the challenge of reducing 40% of its expenditure and this structural change would be taking place amidst a very flat funding position;

o       there would be a gap of approximately £180m if demand, demography and the existing range of services provided continued.

The Director for Social & Community Services made a number of points, including the need to determine how advocacy would be provided in future. Under the Mental Capacity Act if someone was deemed not to have the capacity to make decisions, another person would be authorised to act on their behalf. The County Council commissioned people to act as advocates and one issue was how this would relate to the proposed role for HealthWatch in this respect, as those individuals would need assistance to make health and social care decisions. Other points which needed to be discussed included the role of the local authority in terms of supporting GPs with commissioning (eg Oxfordshire County Council was currently the lead commissioner for learning disabilities), what would happen with mental health (eg NHS Oxfordshire Community Services would go across to the Oxfordshire and Buckinghamshire Mental Health Partnership NHS Foundation Trust) and what would happen regarding the commissioning of services for people with long term needs in terms of using those resources in the most effective way. Genuine joint budgets would need to be set up for them.

The Director for Public Health commented that once the changes were implemented the local authority would be the only public body with fixed boundaries who could co-ordinate policy. For example, the GP Consortia would not have fixed boundaries. Therefore the Health and Wellbeing Partnership Board would have an important role in binding together all of the relevant public sector bodies.

Following discussion, the Committee agreed to advise the Cabinet as follows:

·       With regard to the implications for public health in Oxfordshire:

This Committee:

• endorses the Director for Public Health’s recommendation that a high-level group led by the major public sector stakeholders is set up now on an informal basis, to ensure that public sector organisations in Oxfordshire work closely together over the coming months to secure the continuation of a successful Public Health function for the future;
• awaits publication of the Public Health White Paper in December - which should provide further clarity - thus enabling these arrangements to be formalised;
• recommends Councillor involvement at some level to ensure that the transfer of the public health function from Health to the local authority is carried out satisfactorily.

·        With regard to health scrutiny:

This Committee strongly urges that:

• Health Overview and Scrutiny Committees should retain all of their existing functions and powers, to enable them to scrutinise effectively and work to ensure that health services continue to provide equity of access, equity of outcome and improvement in the quality and safety of services for patients and carers, as evidenced by the notable successes of the Oxfordshire Joint Health Overview and Scrutiny Committee;
• these powers and functions should not be transferred to the Health and Wellbeing Board on the grounds that:

o                   the Board needs to focus on being an effective decision making forum;

o                   it is questionable as to how the Health and Wellbeing Board could be perceived as independent if it was also tasked with undertaking health scrutiny, when it could be central to many of the decisions that were to be scrutinised, including co-ordinating those partnerships which it would be scrutinising.

·       With regard to joint working between Health and Social Care:

This Committee:

·                                welcomes the emphasis on joint working between health and social care and the role of the Health and Wellbeing Board in joining up the commissioning of local NHS services, social care and health improvement;

·                                (whilst recognising that Oxfordshire County Council is to be viewed as exemplary in terms of joint working with Health in comparison with other local authorities in England), acknowledges that there is still scope to improve joint working in Oxfordshire, especially in terms of people with long term conditions, notably older people;

·                                wishes to emphasise the importance of joint working between Health and Children's Social Care in order to prevent another 'Baby P';

·                                wishes to emphasise that local authorities have considerable expertise and experience in commissioning adult social care services over the past 20 years and already lead on commissioning some health services - for example, health services for adults with learning disabilities in Oxfordshire - and also work closely with PCTs on commissioning other health services. Examples in Oxfordshire include work on stroke, falls and continence. Therefore it will be important for local authorities to explore in conjunction with GPs and the PCT what role they can play to support the role of the GP Consortia;

·                                wishes to emphasise that in order for stronger joint working to take place and further efficiencies to be achieved, the necessary infrastructure needs to be in place supported by appropriate attitudes from all partners;

·                                advises that policy and financial decisions must come together into a single place and therefore strongly recommends that the government should prescribe in the forthcoming legislation that joint commissioning and pooled budgets must apply in appropriate circumstances (eg learning disabilities, mental health and supporting people with long term conditions). This would enable public resources to be used to best effect based on the needs of the local population. Therefore it is paramount that joint working is underpinned by statutory powers.