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Paper 6 - 23 September 2005 Meeting


23 September 2005


Report by the Director ________________________________________________________________________


That Members consider the implications of these latest proposals to re-organise the Health Service.


1. The NHS Chief Executive, Sir Nigel Crisp, issued a statement on 28 July which is summarised in paragraphs 4-10. The Chief Executive of the Hampshire and Isle of Wight Strategic Health Authority, Sir Ian Carruthers, is now putting together proposals for "redesigning local health systems" by 15 October. He has had to decline an invitation to attend this meeting of the Association but has offered to attend a special meeting if one can be arranged in the first half of October. He is also meeting the County and Unitary Authorities individually. Professor Jonathan Montgomery, Chairman of the Strategic Health Authority, is planning to attend this Association meeting.

2. The policy documents foreshadowing these latest proposals for further re-organisation are:

C The NHS Improvement Plan: Putting People at the Heart of Public Services (June 2004) - proposing 18-week waiting-times, choice of providers, improved services outside hospital, and more emphasis on prevention

CCreating a Patient-Led NHS: Implementing the NHS Improvement Plan (March 2005) - proposing choice and control for patients, integrated networks for emergency and specialist care, more health promotion and improvement, Foundation Trusts, Payment by Results, and financial and quality incentives.

3. The following summary of the 28 July communication has been provided by the Strategic Health Authority and Mid Hampshire PCT.


4. i Strategic Health Authorities (SHAs) are to co-ordinate and submit by 15 October 2005 proposals for redesigning their local health systems, featuring:

C ‘objective’ commissioning functions, based on decision-making processes separate from those governing provision

C ‘clear relationships’ between PCTs and social service boundaries (though not necessarily 1:1 co-terminosity)

C primary and community services offered by a range of providers; the forthcoming White Paper will make suggestions about how competition can be introduced for these.

The aims are:

C for PCTs to reduce their providing functions to a minimum by December 2008
‘significant’ reductions in management and administrative costs

ii SHA proposals should also include plans for extending Practice-Based Commissioning, business and continuity plans showing how 2008 targets will be achieved, and evidence of consultation.

iii Agreement on whether implementation can proceed will be reached between SHAs and the DH by the end of November. If required, statutory consultation (possibly undertaken in clusters) is to be complete by March 2006.

iv PCT reconfigurations are to be complete by October 2006, SHA changes by April 2007, and PCT service provision changes by December 2008.

v There will then be independent assessment of PCTs’ and SHAs’ internal capacity and capability, particularly leadership ability.


5. Practice-based commissioning

PCTs will delegate to GPs the responsibility for:

C designing improved patient pathways
creating community services
managing budgets covering acute, community and emergency care

GPs will not be responsible for placing or managing contracts. ‘Back-office’ functions, including payment, will be administered by regional/national hubs. The DH expects to see 100% coverage of PBC by December 2006.

6. PCTs

PCTs will be custodians of their population’s health budget. Their functions (which may be contracted out) will be:

C improving health and reducing health inequalities
managing contracts
consulting local people and service providers
emergency planning
securing the provision of safe, high-quality services

7. SHAs

SHAs will be responsible for performance management of the NHS public health function and PCTs, strategic planning, tertiary-level commissioning not undertaken by PCTs, working with regulators, and ensuring the integration of research, innovation and education and training with commissioning. There will be fewer of them, mergers probably (but not necessarily) taking place to line up with Government Office boundaries.

8. Trusts

All are to move towards Foundation Trust status by April 2008.

9. Other providers

There will be greater use of private sector providers.

10. Ambulance trusts

There will be a 50% reduction in the number of ambulance trusts. Those remaining will prepare to move towards foundation status.


Date: 9 September 2005
Annex: 0
Contact: Nick Goulder - 023 8068 8431, E-mail hiow@eastleigh.gov.uk

Last update: 14/09/2006
Author: Nick Goulder, Director

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