Hampshire County Council

Cabinet Item 6

20 March 2006

Configuration of NHS Ambulance Trusts in England - Consultation

Report of the Chief Executive

Contact: Peter Robertson, Ext 7200, email: [email protected]

1. Summary

1.1 The County Council has been invited by the Hampshire and Isle of Wight Strategic Health Authority to comment on a consultation document in respect of the reconfiguration of ambulance services, which has been published by the Department of Health. It is one of a suite of documents currently being consulted on, the others being the reconfiguration of both Strategic Health Authorities and Primary Care Trust. The closing date for the consultation period is 22 March 2006. The County Council's Health Overview and Scrutiny Committee will also be commenting on the consultation document. A copy of the consultation document has been placed in the Members' Rooms and can also be found on the website: www.dh.gov.uk/consultations

1.2 The document sets out how ambulance services in England would be structured in the future and focuses on the size of these trusts and the geographical boundaries they would have. 11 large, integrated ambulance trusts are proposed, organised around Government Office of the Region boundaries. Due to the large geographical area of the South East and South West Government Regions, the proposals recommend that these areas are split into two; Hampshire is included in South East B.

1.3 This report details the background to, and the implications for the ambulance service in Hampshire.

2. Background

2.1 In September 2005, the County Council indicated that it would support further exploration of local solutions to reduce the duplication of functions supporting emergency services across Hampshire. Fire and ambulance services were indicated as a possible combination that would preserve local knowledge whilst minimising managements costs and overheads. It was also anticipated that the formal consultation on the configuration of ambulance services would take full account of the direction of travel set of `Taking Healthcare to the Patient: Transforming NHS Ambulance Services'. In particular the following principles set out in that document were noted:-

· that services should be designed around the needs of the patient and the care provided by frontline staff


· that services should work in an integrated way with other health and social care providers in their local area

an approach that was felt to be entirely consistent with `Keeping the NHS Local' and other key policy documents.

3. Latest position

3.1 Clearly the position has changed since that time. Following a review of the consultation document, strong reservations exist about the proposals and the impact they may have on front line emergency care. The suggested configuration for Hampshire to merge with Thames Valley (South East B), which will combine four separate ambulance services (Hampshire, Royal Berkshire, Oxfordshire, and half of Buckinghamshire plus Milton Keynes) is not supported by any evidence of either savings that could be achieved, or quality improvement in service delivery. There will be separate consultations on the Isle of Wight to find out if there would be a single NHS organisation responsible for all aspects of healthcare including the provision of ambulance services on the island. However, should this proposal not go ahead, it is suggested that the Isle of Wight also be included in South East B.

3.2 The broad areas of concern can be summarised as follows:-

· The recently published White Paper on Health Care Outside Hospital reinforces the ongoing shift in the NHS towards community based primary and secondary care services. The intention is that patients receive care as close to home as possible, particularly in rural areas where there is a greater difficulty in accessing traditional district hospital and Accident and Emergency Services. As a mobile resource, with highly trained staff, the ambulance service is able to play a key role in providing a continuum of care close to people's homes. Hampshire is a predominantly rural county with significant areas that are difficult to access


· Local knowledge is a fundamental pre-requisite to ensuring that emergency services are able to reach people as quickly as possible. Significant difficulties have been experienced with a local out-of-hours provider that used a call centre in Birmingham. Although action has now been taken to address this problem, the proposals could undermine this progress


· It is clear that the ambulance service has a key part to play in co-ordinating the range of out of hours and unscheduled care that people need. The skills that ambulance staff have in call handling, providing clinical advice and working with partner organisations are developing well within Hampshire. It is anticipated that this will be lost if the services are reconfigured as suggested. It is therefore proposed that further work be undertaken to explore how ambulance services can be configured to act as a single point of telephone access for the range of unscheduled, urgent and emergency care that is required, including mobile health services in Hampshire working in partnership with health and other service providers


· There is no indication of the additional resources that will go to the ambulance services as a result of these mergers. Experience locally has been that reorganisation on this scale inevitably incurs costs


· The new roles for ambulance staff envisaged have enormous potential to improve the services provided to our population. There is no indication that the merger will increase capacity to invest in and develop these skills, or that the arrangements will extend the resources available to support training programmes


· The proposal is in direct contradiction of the move to strengthen commissioning and make service delivery more local. This could add to, rather than reduce the administrative burden on ambulance services, effectively imposing another layer of bureaucracy


· The geographic boundaries proposed are an administrative convenience. They do not reflect patients flows (for example, in the north east and south west of Hampshire)


· The suggestion that Patient Transport Services, which comprise of many community and voluntary sector providers, could be run from such a remote organisation is untenable


· No work appears to have been undertaken to evaluate the causes of the variation in funding levels across the county. The figures for Thames Valley/Hampshire funding to population ratio is the lowest in the country, despite the fact that Hampshire is joint third in terms of calls per square mile


· It is accepted that there is a case for centralising procurement and technology, however this is quite distinct from the suggested merger of services


· There has been no risk assessment of the impact of these proposals

4. Next Steps

4.1 Following the closure of the consultation period, the responses submitted will be collated, summarised and put to Department of Health ministers prior to a final decision being taken on ambulance trust boundaries.

Recommendations:

That the following response to the consultation document `Configuration of NHS Ambulance Trusts in England' be approved:

That the Department of Health be informed that Hampshire County Council rejects the proposed merger of Hampshire Ambulance Service with Thames Valley on the grounds that it is not in the interests of either the population or the NHS in Hampshire. It is further proposed that further work be undertaken to test:

(a) the procurement and other `back of office' activities that could be provided on an Strategic Health Authority or national basis to achieve greater efficiency


(b) the scope for the ambulance service to provide the initial point of contact for all unscheduled, emergency health calls including out of hours for Hampshire (e.g. emergency ambulance, home visit, accident and emergency)


(c) the scope for other providers to take on the running of ambulance services, working alongside local partners in the voluntary sector, health and social care