Agenda item

This contributor session is to consider the context for the proposed clustering arrangements of NHS Bath & North East Somerset and NHS Wiltshire and the related implications for:

·  Our current arrangements in the form of Bath and North East Somerset’s Health and Wellbeing Partnership and joint commissioning arrangements.

·  Future organisational arrangements with the Clinical Commissioning Group and proposed Commissioning Support Units.

The Wellbeing Policy Development and Scrutiny Panel is asked to:

·  Hear from a variety of invited speakers and participate in question and answer discussions. Invited contributors include:

o  Joint Chief Executive of NHS Bath and North East Somerset and NHS  Wiltshire

o  Chair of NHS Bath and North East Somerset

o  Strategic Director for People and Communities

o  Local Involvement Network (LINks)

o  Clinical Commissioning Group

·  Consider, if appropriate, making recommendations on the clustering proposals to appropriate parties.

The Chairman informed the meeting that the contributors will address the Panel according to the Day Schedule (attached as Appendix 1 to these minutes).

The Chairman invited Jeff James (NHS BANES and NHS Wiltshire Chief Executive) to address the Panel.

Jeff James took the Panel through his summary of the PCT Cluster Implementation Guidance summary, Shared Operating Model for PCT Clusters and the letter from Jim Easton (National Director for Improvement and Efficiency) issued on 29^th September 2011 (all these documents attached as Appendix 2 to these minutes).

Councillor Hall said that Jim Easton said in his letter that ‘key principles of model 2 are adopted by all PCT clusters, by December 2011 or, exceptionally, by a date agreed with the SHA’ and asked what constitute ‘exceptional’.

Jeff James responded that the SHA should give an answer on what constitute ‘exceptional’.  Jeff James surmise was that the SHA felt there was no particular need to keep the PCTs separate hence why the deadline is moved to December 2011.

Councillor Clarke said that he questions what the SHA is trying to achieve here considering that the relationship between the Council and PCT in BANES is different than the one between Wiltshire Council and their PCT.

Jeff James said that part of the argument for clustering arrangements is to speed up the work between the Councils and Clinical Commissioning Groups and put the PCTs away as they, PCTs, will demise in April 2013.

Councillor Jackson commented that for this area we have a very good model of Council’s integration with the PCT.  As a result of that the Health Scrutiny worked well with and for both organisations.  Councillor Jackson also said that there is a mismatch between BANES and Wiltshire and expressed her concern that the new setup will not have the same standards across (i.e. waiting/referral times difference, etc.).

Jeff James responded that absolutely nothing will stop Health Scrutiny to express their views, or scrutinise, the new setup although Health Scrutiny will not be in the position to contend non-executive appointments on the new board.  Jeff James also said that there are differences between BANES and Wiltshire but he will be committed to honour and respect both areas.

Councillor Hall said that her concern was that the Council appeared to have inferior role in these arrangements and not consulted on these issues but expected to act as per requirement.

Councillor Clarke agreed with Councillor Hall and said that he criticise the decision made on the higher level and not on the local level.  The Panel has the right to put forward views of the people they represent.

Jeff James responded that clustering will not change legal issues in the Council and Members will still be able to represent their constituents.

The Chairman said that the biggest issue for this authority is that we are merging with another authority that is not quite into the PCT integration like we are.

Jeff James replied that nothing in the letter from Jim Easton says that joint commissioning should end with the PCT clustering. 

The Chairman thanked Jeff James for his statement.

The Chairman invited Malcolm Hanney (NHS BANES Chair) to address the Panel.

Malcolm Hanney declared the interest as he is the NHS BANES Chair and also BANES Councillor.

Malcolm Hanney said that the December 2011 deadline is too early and it will be impossible to start with clustering from that date.  The issue about model 2 governance option is not about a single chair and single executive team; it is in fact about the proper basis of the partnership.  There is also no issue about differences in BANES in Wiltshire but there is an issue about the list of executives operating on cluster level and omission of people, such as Ashley Ayre, who should be the part of the new board.  There need to be a lot of understanding and consultation on different issues hence why April 2012 should stay on as the deadline.

From this point Malcolm Hanney read out his statement (attached as Appendix 3 to these minutes).

The Chairman commented that lots of issues would need to be considered in preparation for the new cluster board.

Malcolm Hanney responded that there is a need for a thorough discussion on what will happen until April 2013 and beyond that date (after PCTs demise).  There is also a need of the thorough discussion as some people do not understand the scale of the partnership.

The Chairman said that the main complication is that we have integrated services and asked how Wiltshire received that.

Malcolm Hanney confirmed that we have joint staffing (i.e. Ashley Ayre) set under Section 113 Agreement and that makes situation here much more complex.  Malcolm Hanney said that he will meet with the SHA and NHS Wiltshire Chair to discuss these issues further.

Malcolm Hanney said that he will send a copy of the letter, which he will write to the Leader of the Council after the meeting with the Strategic Health Authority on 30th November, to the whole Panel.

Malcolm Hanney concluded by saying that it is important that discussions between BANES and Wiltshire continue in order to understand the guidance on cluster arrangements.

The Chairman thanked Malcolm Hanney for his statement.

The Chairman invited Ashley Ayre (Strategic Director for People and Communities) to address the Panel.

Ashley Ayre said that his starting point is to protect local arrangements and also to provide the best for patients and public.  The Council expressed their reservation to the Strategic Health Authority deadlines as it might undermine what we have locally, including what local Clinical Commissioning Group what to do with the Council in near future.  In Wiltshire things might be different and they might have different relationships between their Council, PCT and their Clinical Commissioning Group.  Ashley Ayre asked the Panel also to bear in mind policies and financial issues within the Council. 

Ashley Ayre said that his role is to develop a new structure and he recognised that the change is inevitable.  Mike Bowden (Active Director for Service Development) had been seconded for 18 months by the Council to think about the structure of the new department which would also provide the support to the colleagues in the PCT.

Ashley Ayre also said that there were very good a discussion locally between the Council, PCT and the Clinical Commissioning Group and that there is a good will from all sides to provide the best outcome.

Ashley Ayre informed the Panel that the amount per head that the Clinical Commissioning Group will work with is £25 per head.

Jeff James added that the current PCT costs per head are £37. 

The Chairman thanked Ashley Ayre for his statement.

The Chairman invited Jayne Pye (BANES Local Involvement Network) to address the Panel.

Jayne Pye referred to the letter sent by Diana Hall Hall to Sir Ian Carruthers (Chair of NHS South of England) on 3^rd November (Appendix 4) and the reply from Charles Howeson (Vice-Chair NHS South of England) on 23^rd November this year (Appendix 5).

Jayne Pye said that, as long they get the service, our community do not care who is providing the services to them.  Jayne Pye also said that the LINk do not want to lose the good working relationship with the Council and PCT.

The Chairman thanked Jayne Pye for her statement.

The Chairman invited Dr Ian Orpen (Chair of the BANES Clinical Commissioning Group) to address the Panel.

Dr Orpen referred to his briefing (Appendix 6) submitted in advance of the meeting which includes his letter to John Everitt (Council Chief Executive) dated 2^nd November.

The Chairman thanked Dr Ian Orpen for his statement.

The Chairman thanked the contributors for their statements and invited the Panel Members to comment.

Councillor Organ said that the Council worked hard for a very long time to be integrated with the PCT and December deadline for cluster arrangements is too short.  Councillor Organ asked that the deadline should be April 2012.

Councillor Clarke said that the Panel did not want to undermine on-going process but there are clear differences between BANES and Wiltshire PCTs.  Councillor Clarke also did not agree that cluster arrangements should start as of December 2011.

Councillor Jackson agreed with the statements from Councillors Organ and Clarke and added that there is a cross party disapproval of December deadline.

Councillor Hall said that she also did not agree that cluster arrangements should start as of December 2011.

The Chairman concluded that December deadline for cluster arrangements is quite unreasonable and disruptive.

The Panel unanimously AGREED with the following:

The Wellbeing Policy Development and Scrutiny Panel heard from a range of contributors on proposed clustering arrangements between NHS Bath and North East Somerset and NHS Wiltshire at their meeting on Tuesday 29th November 2011.

The Panel made the following RECOMMENDATIONS:

1.  The Panel did not support the conclusion of the NHS Management Board that the key principles of model 2 PCT cluster governance must be adopted by December 2011. The Panel did not agree with the ‘top down’ approach from the NHS Management Board when a local decision of April 2012 had been mutually agreed between both NHS Bath and North East Somerset and NHS Wiltshire.

2.  The Panel felt that the deep integration between the Council and NHS Bath and North East Somerset and the Clinical Commissioning Group’s commitment to continuing these partnership arrangements in the future qualified as exceptional circumstances to allow deferral until April 2011 to allow the complexities of future working arrangements to be properly established.

3.  The Panel asked Malcolm Hanney to send a copy of the letter, which he will write to the Leader of the Council after the meeting with the Strategic Health Authority on 30th November, to the whole Panel.