PAPER A

NOTES OF EVIDENCE

Meeting	Policy Commission for Care, Health and Housing
Ref	He.PC.15/02/06
Date	15^th February 2006
Time	18.00hrs
Place	Committee Room 1, County Hall, Newport, Isle of Wight
Purpose of meeting	Formal public meeting
Attendance	Commission	Cllrs Erica Oulton (Chairman), Geoff Lumley, Roger Mazillius, Win McRobert, Margaret Webster, Colin West and David Whittaker Co-opted Members Mr Robert Jones – Vice Chairman, Primary Care PPIF Mr David White – Vice Chairman, Healthcare PPIF
	Cabinet	Cllr Dawn Cousins
	Secretariat	Cllr David Pugh
	Other Councillors	Cllr Andy Sutton, Cllr G Kennett
	Officers	Ms Louise Biggs - Overview and Scrutiny (O&S) Team Mr Andrew Shorkey - O&S Team Mr Andrew Williamson, Director of Adult and Community Services
	Stake holders	Mrs Val Anderson, Chair, Isle of Wight Primary Care Trust (IWPCT) Mr Graham Elderfield, Chief Executive, Isle of Wight Healthcare NHS Trust (IWHNHST) and IWPCT Mr Tony Horne, Director of Corporate Affairs, Hampshire and Isle of Wight Strategic Health Authority (HIOWSHA) Mr Rodney Ireland, Chair, IWHNHST Professor Jonathan Montgomery, Chair, HIOWSHA Mr Stephen Ward, Project Manager, Transition Team Mrs Jane Wilshaw, Director of Nursing and Patient Care, Isle of Wight Healthcare NHS Trust (IWHNHST)
	Apologies	None
Agenda Items
1. To agree the notes of evidence arising at the extraordinary meeting held on 14 December 2006	Notes agreed with no amendments.
2. Declarations of Interest.	None
3. To receive an update on the consultation on the proposed changes to Strategic Health Authorities (SHA) /Primary Care Trusts (PCT) and Ambulance Trusts areas.	3.1 There are three specific consultation questions: changes to the geographical arrangements of Strategic health authorities (SHAs) Primary Care Trusts (PCTs) and Ambulance Trusts. 3.2 There are currently four SHAs in the south east. The proposals are to change this to either one or two SHAs for whole of the south east. The aim of these changes is to improve the ability of NHS to better manage its debt. 3.3 It is also proposed that the number of PCTs is reduced nationally. There are two options for the South East region, but both suggest one PCT for the Island to reflect its unique situation. 3.4 The plan for the rest of the UK is that PCTs will eventually become commissioning bodies only, with no provider function. This will not be the case on the island in light of the plans for integrating the two NHS trusts. This new organisation would have to be both a commissioner and provider of services. 3.5 The aim of these proposals is to: 3.5.1 Provide effective, safe, high quality services. 3.5.2 Improve patient care and local responsiveness and responsibility as the current system is felt to be too ‘top-down’. To this end trusts are attempting to improve their financial situation and meet all necessary targets. 3.5.3 Redress the balance between large hospitals and Primary Care Trusts and in particular through giving smaller localities the ability to use ‘practice-based commissioning‘ to implement services. 3.5.4 Reduce health inequalities and improve public health. 3.5.5 Improve public involvement – the new PCT areas are bigger but the aim is for more local decision based around GP practices and this should help to improve public involvement. More support is also needed for Patient and Public Involvement Forums. 3.5.6 Drive improvements in the quality of care and the decisions of what care is available. This should be done through commissioning process rather than the through national benchmarks or National Service Frameworks (NSFs). 3.5.7 Strengthen leverage through commissioning: Nationally, the bigger hospitals have been more powerful in influencing where resources go. The main problems with the overall health economy in Hampshire and Isle of Wight are a result of the fact that there are two large acute hospitals in Portsmouth and Southampton. Commissioning a patient-led NHS should allow commissioners to get exactly what they want from providers. Fragmented commissioning has meant it has been difficult to get what is required out of providers. 3.5.8 Better align local authority and PCT boundaries within Hampshire. 3.5.9 Improve money-management and risk management 3.5.10 Reduce management costs. However, this would not be a principle focus as other changes to commissioning arrangements are worth more in terms of savings. 3.6 Many of the changes in the rest of the country do not make sense for the Island and instead work here is being focussed toward the development of more integrated services. No-change is not an option.
4. To receive an update on the integration work from Mr Stephen Ward, Transition Team	4.1 There are four options for social care on the Island and there will be a business for each of the four options: 4.1.1 To concentrate upon integrating the two NHS organisations and leave social care / health integration alone at this point. 4.1.2 To form a single health organisation by April 2007 and then go onto form a Care Trust in 2008. 4.1.3 To put in place a single, overarching section 31 (of the Health Act 1999) agreement, which will allow for pooled funds between NHS organisations and health-related services provided by Local Authorities. 4.1.4 To agree more than one, service-specific Section 31 agreements across health and social care. 4.2 A new business case is currently being formulated for each of the options. 4.3 The IWHNHST and the IWPCT will merge to form a new organisation, which for legal reasons will be a Primary Care Trust. This PCT will have a substantial provider-arm, which is unique compared with the rest of the country. One key objective is to effectively separate the commissioner and provider function within the new organisation 4.4 The suggested principles underlying any new organisation are that: it would not be a take-over or ‘bolt-on’, that it would include ambulance and social care until the outcome of the business case is know, it will take account of the Care Outside Hospital White Paper. 4.5 Integration is dependant upon the Island’s health economy reaching financial balance. This is expected to take between 15 to 18 months. 4.6 There must be a separation in the governance arrangement between provision and commissioning. 4.7 There will be an emphasis on community-based services rather than services delivered in a hospital setting.
5. Other issues	5.1 Mr Elderfield confirmed that funds for replacement capital would not be affected by the financial deficit. The back log had been reduced over time but there is more to do. 5.2 Equality in access and quality patient treatment by different GP practices could be ensured through the new GMS contract / Quality Outcomes Framework (QOF) which involves assessments and visits to practices. There are rewards for GP practices who meet these standards. 5.3 Mr Montgomery said that he would be pleased to attend a future commission meeting to discuss other matters more focussed around improving patient care. 5.4 The problems encountered by the Island’s NHS organisations in regard with recruiting to vacancies is being overcome.
Actions	For the Policy Commission to submit a response to the consultation to the SHA	Policy Commission / O&S Team