Archived decisions
Hampshire County Council |
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The Cabinet |
Item |
19th November 2001 |
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Title: Health Partnerships |
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Report by the Director of Social Services |
Contact: Yvonne Le Brun Ext: 7790 or Carole Bennett Ext: 7153
1. Summary
The attached report informs Cabinet of recent developments that affect the County Council's partnership with the local NHS and recommends:
1.1 That paragraphs 4.1 to 4.10 of the report, attached as an appendix to this summary sheet, be the response of the County Council to consultation on the proposal for a new strategic Health Authority for Hampshire and the Isle of Wight.
1.2 That the nomination of Social Services Partnership Managers as officer representatives of the County Council on Primary Care Trust Executive Committees be endorsed. The officers are:
North Hampshire Felicity Harding, Partnership Manager
South West Hampshire Pauline Owen, Partnership Manager
Mid Hampshire Mike Gardiner, Partnership Manager
South East Hampshire Vacant
In recognition of the need to recruit to the post of Partnership Manager for South East Hampshire, the department has made arrangements for this duty to be temporarily undertaken by Tony Warnes, Service Manager (Older People), Havant/Petersfield.
1.3 That The Cabinet receive a report on the options for formal partnership arrangements with New Forest Primary Care Trust.
1.4 That elected Members be encouraged to apply for lay membership of Primary Care Trusts and that responsibility be delegated to The Leader for nominating elected members to attend PCT board meetings on behalf of the County Council.
1.5 That the County Council seeks clarification from the Secretary of State concerning the representation of the Council as an important partner of the National Health Service in Hampshire, on the Boards of Primary Care Trusts, noting that the Patient forum attached to each NHS Trust has the right to nominate to the Board of the Trust.
2. Reason
2.1 The developments have significant implications for the County Council's relationship and partnership arrangements with local health organisations.
3. Other options considered and rejected.
3.1 Not applicable
4. Conflicts of interest declared by decision maker, member or officer consulted
4.1 None
5. Dispensation granted by the Standards Committee
5.1 Not applicable
6. Reason(s) for the matter being dealt with if urgent
6.1 Not applicable
Approved by: ............................................ Date of Decision ...............
Councillor Ken Thornber
Contact: Yvonne Le Brun Ext: 7790 or Carole Bennett Ext: 7153
1. Introduction
1.1 The NHS Plan published in July 2000, set out the Government's plans to reform the NHS. The plan places the patient at the centre of the reforms and aims to deliver fast and convenient care to a consistently high standard. It is a far reaching plan and extends across all aspects of NHS services and functions. Many of the proposals have significant implications for Social Services and the wider County Council, some of which require legislative change.
1.2 The Social Services Department has been given the lead in role in partnership working with the NHS, and works not only to implement the necessary changes, but to ensure the County Council has a strong voice in shaping national thinking and in influencing local NHS decision making. The local NHS organisations are set out in Appendices 1 and 2.
1.3 This report informs Cabinet of recent local work to consider the opportunities for formalising our partnership with New Forest Primary Care Trust and seeks approval to increase the County Council's participation in the Primary Care Trusts in serving Hampshire.
1.4 The report also informs Cabinet of Department of Health consultation on public and patient involvement and on changed roles and responsibilities for NHS organisations and seeks approval of the County Council's response to consultation on a proposed Strategic Health Authority for Hampshire and the Isle of Wight. It also advised Cabinet of the Performance Improvement Plan for North and Mid Hampshire Health Community.
2. New Roles and Responsibilities within the NHS
2.1 In July 2001, the Department of Health published `Shifting the Balance of Power in the NHS'. This document set out, at a national level, the organisational changes to be made to the NHS to focus efforts on supporting front line staff to enable them to deliver the service improvements of the NHS Plan. The organisational changes are aimed at:
· developing Primary Care Trusts to fulfil their potential
· creating fewer, larger strategic health authorities
· re-focusing the Department of Health on doing those things which only it can do
2.2 Primary Care Trusts (PCTs) will be the lead organisation in assessing need, planning and securing health services and improving health. They will develop new partnerships with local communities and lead the NHS contribution to joint work with local authorities and other partners.
2.3 NHS Trusts will continue to provide hospital based and specialist care, such as mental health services, and will work within delivery agreements with PCTs. They will be expected to devolve greater responsibility to clinical teams and high performing Trusts will earn greater freedoms and autonomy.
2.4 Approximately 30 Strategic Health Authorities (StHAs) will replace 95 health authorities nationally. Their role will be to lead the strategic development of the local health service and performance manage PCTs and NHS Trusts through local accountability agreements. They will be responsible for ensuring strong and professional leadership and for developing cohesive strategies for capital investment, information management and the development of the workforce. The new health authorities will start work in April 2002, with a view to becoming Strategic Health Authorities once Parliament has passed legislation changing the balance of functions between health authorities and PCT's.
2.5 The Department of Health Regional Offices will be abolished and four new Regional Directors of Health and Social Care have been appointed to oversee the development of the NHS and provide the link between local organisations and the Department centre.
2.6 Revenue allocations will be made direct to PCTs rather than the health authorities as at present. PCTs and NHS Trusts will also receive direct capital allocations for the maintenance of their facilities. StHA's will control further capital allocations to support strategic change and modernisation of services.
3. Shifting the Balance of Power in the South East of England
3.1 The South East NHS Regional Health office of the Department of Health is currently consulting on proposals to establish a strategic health authority for Hampshire and the Isle of Wight. The health authorities of North & Mid Hampshire, The Isle of Wight, Portsmouth and SE Hampshire and The Southampton and SW Hampshire Health Authorities will be abolished and many of their functions will be devolved to the seven Primary Care Trusts. The role of the strategic health authority will be to create a coherent strategic framework for the development of services across the range of local NHS organisations.
3.2 A copy of the consultation document has been circulated for comment to all County Council departments, Social Services senior staff and the Executive Member for Social Care.
3.3 The proposed strategic health authority would oversee 10 primary care trusts and 6 NHS Trusts in addition to local arrangements for ambulance services. This configuration is the NHS Regional Offices preferred option as it satisfies the requirements set out in `Shifting the Balance of Power' i.e. that the strategic health authorities should serve populations of approximately 1.5 million, be broadly aligned with clinical networks and not cross local authority or regional boundaries. It was also felt this proposal:
· has a more recognisable geographical identity than any other option
· has a shared identity with other NHS organisations e.g. NHS Direct Hampshire and the Isle of Wight
· enables shared boundaries with key partner organisations including Hampshire County Council, the Police and Probation Services.
4. Implications for the County Council
4.1 It is recommended that the proposals be broadly supported as they will create, for the first time, co-terminus boundaries for joint strategic decision making between the County Council and one health authority. They also set out a broad framework for local partnership working.
4.2 The proposals give a broad structure for and clarify the roles of the local health organisations. They also provide a welcomed framework for the Health contribution to partnership working. The County Council is well placed to respond to the proposed arrangements following the restructuring of the Social Services Department. The department has recently established four Partnership Manager posts, at senior management level, to work closely with PCTs. Paragraph 8.4 seeks Cabinet approval of their nomination to the PCT executive committees.
4.3 The strategic health authorities will be charged with creating a coherent strategic framework for the development of services across the full range of NHS organisations. The Chief Executives of the three local health authorities are meeting regularly to prepare for the new strategic health authority and the County Council is represented on this group by an Assistant Director for Social Services. A shared boundary is to be welcomed, as is the opportunity for the Council to shape thinking and to clarify the relationship between the County Council and the new strategic health authority. This will need to include the formation of the Strategic Health Authority Board and its relationship with elected Members.
4.4 Within Social Services, the department's performance management, planning and partnership functions are directly managed by the Deputy Director. The department is thus well placed to ensure the County Council is a strong partner in jointly managing health and social care performance at a strategic level.
4.5 There are a number of areas of concern to the County Council which include a concern for the capacity of PCTs as new organisations to take on a range of new functions. The main focus for PCTs must be to plan, commission and provide local healthcare that meets the needs of local people. This is a newly devolved range of responsibilities that include managing large services, employing staff and negotiating with NHS Trusts. In addition to these functions, PCTs are also being asked to make plans to modernise services across the healthcare sector, involve patients and the public in decision making, develop the local healthcare workforce, lead on partnership working with local authorities and work more closely with the independent sector.
4.6 Members may be aware that in order to manage this agenda and ensure economies of scale, some PCTs are entering into `host' arrangements where one PCT is managing for example services for children, or the personnel function, on behalf of neighbouring PCTs. This is similar to the `lead authority' arrangements explored at the time of the Local Government Review. It should be stressed that service delivery remains local, but the management responsibility can lie some way from the point of service.
4.7 Paragraphs 2.2 to 2.6 and 4.3 to 4.6 set out the enormous agenda for newly formed health organisations and it will be important for the County Council to be a strong partner and share its breadth of experience and skills in responding to the needs of the local population.
4.8 There will be a need for NHS managed transitional arrangements and support for PCT's to take on the lead partnership role. While health authorities have been happy to delegate much work, the PCT's to date have not been resourced effectively to take on this role. PCTs will be important members of Local Strategic Partnerships and must be able to play their full part.
4.9 The new roles for PCTs include population needs assessment and public and patient involvement. This affords new joint opportunities to pool knowledge and skills at a local level particularly as these are not new roles for local authorities.
4.10 There are also benefits to be derived from joint planning for many workforce issues, in particular recruitment and retention solutions such as affordable housing and childcare arrangements. These have been raised with the Department of Health with regard to the Local Modernisation Review (the name given to NHS Plan implementation). The shared benefits of such an approach need to be recognised nationally as well as locally.
5. Patient and Public Involvement
5.1 The reforms proposed in `Shifting the Balance of Power within the NHS' are aimed at devolving power to frontline staff and breaking down traditional barriers between services. Nevertheless, these reforms can only work if they are informed by the views of people who use the services. Public expectations are rising and people want an NHS that provides responsive and effective services. They also want services that respond to their needs, listen to their views and act on their concerns.
5.2 The Health and Social Care Act 2001, makes provision for new powers and duties to give the public greater control and influence over the NHS:
· A new duty on the NHS to involve the public in the planning and development of services, and in major decisions
· A new duty on the Secretary of State to make independent advocacy services available to people wishing to make a complaint against the NHS
· New powers for local government Overview and Scrutiny Committees to scrutinise the NHS. These powers are anticipated to come into force next year and will enable democratically elected bodies to scrutinise the NHS and call local NHS Chief Executives and other NHS managers to account. There will be formal consultation on the necessary regulations and guidance in due course.
5.3 Work is in hand to ensure that by April 2002, Patient Advocacy and Liaison Services (PALS) will be established in every NHS Trust and PCT to provide information to patients, carers and families to help resolve concerns more quickly, provide support to patients to resolve concerns more quickly and put people in touch with advocacy and complaints services.
5.4 In September 2001, the Department of Health published for local discussion and response its emerging thoughts on `Involving Patients and the Public in Healthcare' and setting out further proposals to involve the public in the NHS. The intention is to replace Community Health Councils with a range of services. These are - independent Patient's Forums for every NHS Trust and PCT with powers to inspect the work of the trusts, local bodies called `Voice' for every strategic health authority to work with the local community focusing on hard to reach groups and a new national body called `Voice: the Commission for Patient and Public Involvement in Health'.
5.5 The County Council has responded as part of the Hampshire and Isle of Wight group of local authorities to the discussion document and it is anticipated that formal consultation will take place in due course. The HIOWA response welcomed the aims of the proposals to involve both patients and the wider public in the NHS. However it expressed concern that the complexity of the proposals may hinder its effective implementation.
6. Care Trusts
6.1 A care trust is one of several options available to Health and Social Services to deliver integrated care to people who require both and traditionally have depended on two separate organisations. The other options also possible through recent legislation, know as `Health Act flexibilities', are - lead commissioning, integrated service provision and pooled resources.
6.2 Care Trusts present an opportunity to create a single organisational framework to encourage working across traditional boundaries and the development of integrated services. They cannot in themselves, however, solve the difficult issues that arise when there are complex services to co-ordinate, nor can they compensate for, or solve problems related to poor joint working.
6.3 The County Council, in partnership with New Forest PCT, is exploring the benefits of a more formalised health and social care partnership. The New Forest benefits from shared boundaries and has a history of positive joint working between our two organisations together with the local district council. The work involves looking at both the Health Act flexibilities and Care Trust options for the New Forest and determining whether and how they would improve services for local people. Subject to local consultation and agreement by all partners as the most appropriate option, the Care Trust would be established as a national demonstrator site from April 2003. Work is now in hand to consider the benefits for services users and the range of governance, legal, financial, personnel and built estate matters that will need to be addressed as part of any application to establish a Care Trust, or utilisation of Health Act flexibilities.
6.4 The governance of care trusts, the arrangements to ensure an organisation is publicly accountable, is currently the subject of Department of Health consultation. Current proposals are that Care Trusts will be NHS organisations accountable to strategic health authorities and to local authorities. They will be a partnership between the NHS and local authority and council functions will be delegated to it through the Health Act 1999. Local councils will remain ultimately accountable for the delegated services.
6.5 As a potential early Care Trust partner, the County Council has a particular interest in the governance arrangements and The Leader has responded to the Department of Health consultation exercise. The draft guidance provides a useful framework to consider many of the key issues related to the development of Care Trusts. There is a concern that the proposed arrangements do not recognise the strengths of local government, in particular local democratic accountability and the principles of Best Value which are central to ensuring local government provides modern and effective services.
6.6 The proposals also do not recognise the considerable experience local authorities can bring to a Care Trust in terms of commissioning and contracting of services for people with complex needs, user and carer involvement and extensive relationships with the voluntary sector who make a valued and significant contribution to the development of local services.
6.7 It is recommend that a further report be submitted to Cabinet setting out the options for more formal partnership arrangements with New Forest Primary Care Trust.
7. North and Mid Hampshire Performance Improvement Plan
7.1 In response to the drive to improve performance locally, North and Mid Hampshire Health Authority has been required to produce a Performance Improvement Plan. This has been developed to identify the gaps in local services which will assist joint planning as well as serving as a financial recovery plan. Potential savings identified to date total £6.213m.
7.2 The plan is recommending a number of service changes which will require public consultation in due course. The earliest implementation of any change will be April 2002.
7.3 The Leader, on behalf of The Cabinet has invited the Chief Executive of North and Mid Hampshire Health Authority to discuss the plan and its implications for the residents of North and Mid Hampshire.
8. Primary Care Trusts: Board and Executive Membership
8.1 Primary Care Trusts are free standing statutory NHS bodies set up to bring decision making closer to local people and to improve the health of the local population. Appendix 3 provides background information on their role and governance arrangements.
8.2 The County Council is very keen to build on existing partnerships with the PCT's in Hampshire in order to play a full role in improving services. It has been exploring with PCT's how this might best be facilitated at elected member/PCT board level.
8.3 PCT's are overseen by a Board comprising a lay Chair and a majority of non executive (lay) members from the local community who are appointed by the Secretary of State. In summary, the role of the Board is to provide strategic oversight and verification of the work of the Executive committee, including monitoring progress against the Health Improvement and Modernisation Programme. The Board must also ensure that the key requirements of public accountability, probity and public involvement are fully met through publicly transparent systems. The options available to the County Council are:
8.4 To encourage elected members to apply for lay membership positions on PCT boards. Elected members are likely to be among the most experienced lay members and would make a valuable contribution in terms of their knowledge of the local population and their expertise in local accountability.
The key issues are that:
· While elected members, in this role, would not be there to represent the County Council, their skills, knowledge and experience will make a valuable contribution to the partnership with PCT's.
· Lay members are full members of the board with voting rights and clear accountabilities for the performance of an NHS body. There are potential conflicts of interest that would need to be managed, for example:
- the scrutiny function of the local authority
- decisions to change or reduce NHS services which could result in increased costs to Social Services
· there is considerable time commitment over and above board meeting attendance. PCT's have indicated they would be looking for senior politicians to undertake this role, and these members and inevitably the busiest. Lay members must be local and this requirement would need to be considered alongside the constituencies held by senior members of the County Council.
8.5 The County Council could also nominate elected members to attend board meeting. PCT's do not have powers of co-option but elected members would attend the public meetings, representing the County Council, to further discussion and debate about local needs and the joint roles and resources of key public services.
8.6 It is recommended that The Cabinet agree in principle to encourage elected members to apply for lay membership of Primary Care Trusts and to delegate to The Leader responsibility for nominating elected members to attend PCT board meetings on behalf of the County Council. There will need to be arrangements to ensure close liaison with the Social Services officer on the executive committee.
8.7 The day-to-day decisions are delegated by the board to an Executive committee on which local authorities are represented by a senor officer from Social Services. Following the restructuring of the Social Services Department, The Cabinet is asked to endorse the nomination of Partnership Managers to this role. The Partnership Managers are:
North Hampshire Felicity Harding, Partnership Manager
South West Hampshire Pauline Owen, Partnership Manager
Mid Hampshire Mike Gardiner, Partnership Manager
South East Hampshire Vacant
In recognition of the need to recruit to the post of Partnership Manager for South East Hampshire, the department has made arrangements for this duty to be temporarily undertaken by Tony Warnes, Service Manager (Older People), Havant/Petersfield.
Recommendations
1. Paragraphs 4.1 to 4.10 of the report as the response of the County Council to consultation on the proposal for a new strategic Health Authority for Hampshire and the Isle of Wight.
2. The nomination of Social Services Partnership Managers as officer representatives of the County Council on Primary Care Trust Executive Committees be endorsed.
3. That The Cabinet receive a report on the options for formal partnership arrangements with New Forest Primary Care Trust.
4. That elected Members be encouraged to apply for lay membership of Primary Care Trusts and to delegate to The Leader responsibility for nominating elected members to attend PCT board meetings on behalf of the County Council.