Meeting documents

Cabinet
Tuesday, 20 September 2005

CA200905-10

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ITEM CA10

CABINET – 20 SEPTEMBER 2005

COMMISSIONING A PATIENT- LED NHS

Report by Chief Executive

Introduction

  1. This paper outlines some of the implications for Oxfordshire of the Department of Health paper on the NHS published in July.

    2. Background

  2. The Chief Executive of the Department of Health and NHS, Sir Nigel Crisp, published a document at the end of July: "Commissioning a Patient-led NHS". In it he set out his proposals for supporting a faster roll-out of Practice Based Commissioning. This will involve a changing role for Primary Care Trusts and a reduction in their number. In addition, the Patient-led NHS also envisages fewer Strategic Health Authorities and Ambulance NHS Trusts. Finally, the Department of Health would like to see all NHS Trusts achieve Foundation Status by April 2008.

  3. The implications of this major change programme are significant for the Oxfordshire health economy and Oxfordshire County Council.

    4. Primary Care Trusts

  4. In a paper to the Strategic Health Authority Board on 3 August 2005, the Chief Executive of the Thames Valley Strategic Health Authority, indicated his preference to see only one PCT in Oxfordshire compared with five currently in place. Informal comments have been invited on the basis of three possible options:

    • No change to 5 PCT structure

    • 3 PCTs based on the three localities North, City and South

    • 1 PCT for Oxfordshire

  1. The Director for Social & Health Care’s view is that only 1 PCT for Oxfordshire gives the Health system a commissioning body of sufficient size to be effective. It dramatically reduces the cost of the management structure for the existing 5 PCTs and enables the whole of the Oxfordshire health economy to be shaped according to the needs of the population. It is envisaged that the provider arrangements may still be on the basis of 3 localities (North, City and South).

  2. The Department of Health envisages agreeing with Strategic Health Authorities the necessary configuration of PCTs by the end of November with the intention of having the new structure in place by April 2006. The Leader has already indicated his willingness to play a full and active role in consultation arrangements.

  3. "Commissioning a Patient-led NHS" also sets out a direction for PCTs which will enable them to concentrate on promoting health and commissioning services. Directly provided services such Community Hospitals may be provided instead through a range of other potential providers. The Department of Health hopes to secure a greater variety of service offerings which are responsive to patient needs. Exactly how this will work is not clear. The Government is hoping for comments on this in the consultation process on the future arrangements for PCTs and from the forthcoming White Paper "Your Health, Your Care, Your Say".

  4. The Department of Health also envisages the new PCTs having ".. a clear relationship with local authority social services boundaries". For Oxfordshire, this will hopefully result in a resolution to the problems of overlapping boundaries in South Northamptonshire, Thame and Shrivenham.

    5. Practice Based Commissioning

  5. The least developed aspect of the document is the section which deals with Practice Based Commissioning (PbC). PbC will see GP practices take on the responsibility from PCTs for commissioning services that meet the health needs of their local population. This will include the following:

    • Designing improved patient pathways

    • Creating Community based services which are convenient for patients

    • Budgets covering acute, community and emergency care

  1. It is not clear how those functions will fit with the residual duties of the PCTs which the Department of Health confusingly states ".. will focus on promoting health and commissioning services .." It is, however, envisaged that PCTs will make arrangements for coverage of PbC no later than December 2006.

  2. It will be important to pay close attention to the contraction of the number and role of PCTs and the speed of coverage of PbC. During the 1990s a similar model of provision, Fundholding GPs and Total Fundholding GPs was developed. After a period of considerable difficulty, it was eventually made to work reasonably effectively. It did, however, take between 3 and 4 years during which GPs built up their expertise and knowledge in this area. The County Council needs to make sure that PbC in Oxfordshire is robust enough to take on functions from the reconfigured PCTs.

    3. NHS Foundation Trusts

  3. The Government now envisage that all NHS Trusts will take a Foundation Status by April 2008. None of the four NHS Trusts in Oxfordshire currently has Foundation status.

    4. Ambulance Trusts

  4. There is a review of ambulance services which was published on 30 June 2005 "Taking Healthcare to the Patient". This sets out a vision of a service which takes only 40% of patients to A&E in future compared with the current average of 70%. More patients will be treated at home or in local NHS centres such as Urgent Care Centres. In addition, the review foresees a reduction in the number of ambulance trusts. The Strategic Health Authority, in a paper to the Board in August, stated it would like to merge all 3 ambulance trusts into one within the Thames Valley.

    5. Strategic Health Authority

  5. With these changes, the role of the Strategic Health Authority will also change. The Board’s paper in August envisages Strategic Health Authorities also becoming focussed on the commissioning process. Any new arrangements for Strategic Health Authorities should see them fit with local government boundaries, but possibly for areas as large as Government offices. The Department of Health has recently notified the NHS that there will either be one or two Strategic Health Authorities for the area covered by the Government Office for the South East. In the 2nd Strategic Health Authority model, Thames Valley Strategic Health Authority would be linked to Hampshire and the Isle of Wight.

    6. Implications

  6. The size and scope of these changes are very significant. The County Council will want to respond fully to the consultation process. There will be a full 90-day consultation on all organisational changes. It will also want to work with the Strategic Health Authority to ensure that the interim arrangements will continue to secure good quality health care for Oxfordshire residents.

  7. The Strategic Health Authority has to submit PCT proposals to the Department of Health by 15 October. In a letter from the Chief Executive of the Strategic Health Authority to all local authority Chief Executives (31/8/2005), the County Council has been asked to give its informal view about the re-configuration of PCTs by 30th September. This would not prejudice the Council in expressing views as part of the full consultation process once ministers had agreed the Strategic Health Authority’s proposals.

  8. The document "Commissioning a Patient Led NHS" foresees the possibility of a tendering process to bring in new commissioners as well as providers. The County Council has considerable expertise in tendering for services and we have already offered to help the Strategic Health Authority with this aspect of the work if required.

  9. The forthcoming White Paper on "Your Health, Your Care, Your Say" will clearly be of major interest to the County Council as a Social Services Authority. It is expected it will contain the Government’s response to the comments received on the Green Paper on adult social care (March 2005).

  10. The Social & Health Care Directorate has been working closely with the PCTs to bring the management of community health services and adult social care closer together. The Executive had given its approval for the Directorate to consult on the merger of the senior management arrangements in the PCTs and Social & Health Care. In the light of the considerable change and uncertainty in the health system, the Director suspended this consultation in July 2005 to await the outcomes of these new and far-reaching proposals.

    11. Conclusion

  11. It is important for the County Council to be aware of the considerable changes which the Government are proposing to make to the organisation of NHS services. They will have major implications for residents in Oxfordshire. They will also almost certainly lead to increased demand for services from the Social & Health Care Directorate as more patients are treated by primary care.

  12. As the proposals for change in the PCTs, the Ambulance Trusts and the Strategic Health Authority are developed, there will be a need to consult interested bodies including the County Council in the Autumn.

    13. RECOMMENDATIONS

  13. The Cabinet is RECOMMENDED to:

          1. endorse the view that one PCT will more adequately meet the health needs of Oxfordshire, whilst reserving its final position for the formal consultation process after November;

          2. authorise the Chief Executive and the Director for Social & Health Care to work with the Chief Executive of the Strategic Health Authority to support him in his efforts to reconfigure PCTs in Oxfordshire.

JOANNA SIMONS
Chief Executive

Background papers: Nil

Contact Officer: Charles Waddicor, Tel. 01865 816041

September 2005

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