Agenda item

The Health Trainer initiative was set up by the PCT in July 2006 as an experimental approach to try to improve the health of hard-to-reach individuals. Recently the PCT undertook an evaluation of the service and decided that it could not be shown to be providing good value for money. The PCT is therefore proposing to close the service. 

The staff involved believe that changes could be made that would improve the outreach service and that, before the service is closed, there should be full public consultation.

Members should consider the evidence to be provided and decide whether they believe that this a substantial service change that would require full public consultation.

Speakers will include the Director of Public Health, the Convenor for the Oxfordshire PCT Unison Branch and a LINk representative. The following papers are attached:

1 Equality Impact Assessment (HIA) (JHO8a)

2 Consultation paper from the PCT (JHO8b)

3 Paper, “In Defence of Public Health” from Unison (JHO8c)

4 Oxfordshire LINk briefing (JHO8d)

The Health Trainer initiative was set up by the PCT in July 2006 as an experimental approach to try to improve the health of hard-to-reach individuals. Recently the PCT undertook an evaluation of the service and decided that it was not providing good value for money. The PCT is therefore proposing to close the service. 

The staff involved believe that changes could be made that would improve the outreach service and that, before the service is closed, there should be full public consultation.

Members were asked to consider the evidence to be provided and decide whether they believe that this a substantial service change that would require full public consultation.

Dr Jonathan McWilliam and Jackie Wilderspin introduced a report on behalf of the PCT. To summarise – Dr McWilliam stated that the staff have performed well within the constraints of what is in fact a flawed service model. In order to make the service anywhere near cost effective it would need to improve by around about 3,000%. The public interest would not be best served by continuing the service.

All of the services that trainers advise their clients to use would still be in place and patients would be continue to be able to get access to those services. The money saved by discontinuing the service would be re-invested in alternative services.

Dr McWilliam concluded by pointing out that the client base was very small and that, in his view, it was difficult to see what benefit there would be in consultation.

Mark Ladbrooke, on behalf of Unison and the Health Trainers, presented the case for retaining the service. Mr Ladbrooke pointed out that:

The PCT case was predicated on a costing per client whereas the trainers made multiple visits to each client. Many clients had multiple needs whereas only one was recorded. Partial success was never recognised and, although the service did appear to be expensive in fact only a small proportion of the cost related to staff costs. That was in part because the budget was always underspent thus reducing the number of clients seen and increasing the cost of each one against the budget.

Mr Ladbrooke also raised a number of questions about; (i) the lack of alternatives proposed by the PCT; (ii) the fact that while it was true that GPs were able to provide many of the same services as Health Trainers many of the Trainers’ clients were not registered with GPs; and (iii) the importance of targeting the service and that many services are actually generalised. Mr Ladbrooke also stated that the Health Impact Assessment was not acceptable.

He concluded by stating Unison’s view that there should be consultation with patients and that, if there were to be no consultation it could be seen as a precedent for the future every time the PCT chose to describe a service as “failing”.

The presentations were followed by a question and answer session during which the following further information was provided:

• The actual underspend on the budget for 2009/10 was £55,000.
• Existing clients would be able to get the same services via GPs and other agencies.
• Existing clients would receive a full handover to new service providers.
• The PCT’s “Staff Partnership Forum” would work to reduce the number of compulsory redundancies although there could be no guarantee of future employment.

Following the discussion a vote took place on whether or not the Committee considered that the proposed change of service amounted to a substantial service change that would merit full public consultation. By 7 votes to 4 the Committee decided that it was not  a substantial change.

It was AGREED that a letter be sent to the PCT confirming the decision of the HOSC that the closure of the service does not amount to a substantial service change and so there would be no need for full public consultation on this matter.

It was stressed that members would expect that all of the people at present being supported by Health Trainers would have all possible options clearly explained to them for gaining access to other support services and steps would be taken to help them gain access to those services. Members would also expect that their progress would be monitored closely.

Members would seek an assurance that everything possible would be done to avoid compulsory redundancies amongst the Health Trainers.