Healthcare Features
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A massive shared services programme is to go ahead in west central Scotland.
The Clyde Valley Councils partnership’s shared services would cover 35% of Scotland’s population. Areas due to be shared are waste management, health and social care, support services and social transport.
The participating councils are: East Dunbartonshire, East Renfrewshire, Glasgow, Inverclyde, North Lanarkshire, Renfrewshire, South Lanarkshire and West Dunbartonshire.
Options will be developed in workstreams this summer and councils will decide in the autumn which they wish to pursue.
The partnership said the support services stream, which will be led by East Renfrewshire and Inverclyde, was “believed to be the most ambitious shared service project currently being taken forward in the UK”, designed to create a publicly-owned organisation delivering finance, payroll, revenues and benefits, human resources, IT and customer services.
The proposals do not as yet include shared legal services, and no decision has been taken on whether this should be considered in future.
The waste management stream would be led by North Lanarkshire, health and social care by Renfrewshire and social transport by Glasgow.
Ronnie McColl, chair of the Clyde Valley Community Planning Partnership, said: “Given the scale of financial challenge facing local government there is a clear need to introduce new and innovative ways of delivering services.
“These changes aren’t simply motivated by cost. We genuinely believe that by working collaboratively and maximising our combined resources we could actually deliver a better service to the local community.”
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The Information Commissioner’s Office is investigating the loss three weeks ago of an NHS laptop containing 8.6m medical records.
The Sun has reported that the loss was notified to police only last week.
According to the newspaper, the information on the computer was not encrypted and additionally held records of 18m hospital visits, operations and procedures but did not include names.
An ICO spokesperson said: “Any allegation that sensitive personal information has been compromised is concerning and we will now make enquiries to establish the full facts of this alleged data breach.”
It was reportedly one among 20 computers that went missing from NHS North Central London, eight of which have been recovered.
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Health secretary Andrew Lansley has accepted all the core recommendations of the NHS Future Forum report, set up after his plans to reform the NHS led to a political furore.
Under the changes now proposed, GP consortia will be known as ‘clinical commissioning groups’ and will have lay members, in addition to medical ones, and will meet in public.
Health and wellbeing boards will gain the right to refer back local commissioning plans that are not in line with the health and wellbeing strategy.
The duty original proposed for the watchdog Monitor to promote competition will be replaced by one to protect and promote the interests of patients – not to promote competition as an end in itself.
There will be stronger duties on commissioners to promote integrated care, for example by extending personal health budgets and joint health and social care budgets.
Mr Lansley said: “The independent NHS Future Forum has made a number of recommendations and we are accepting them. This has been a genuine exercise and it is clear from our response today that substantial changes have been made in the interests of patients.
“The Forum confirmed that there is widespread support for the principles underpinning our plans for change: greater patient choice, ‘no decision about me, without me’, more control for doctors, nurses and frontline professionals, a focus on quality and results for patients, more information and more clout for the public. These changes now will help us make those principles a reality.”
The heavily-amended Health and Social Care Bill will now be referred back to Parliament.
David Rogers, chairman of the Local Government Association’s community wellbeing board and also a member of the forum, said: “It’s crucial the newly proposed clinical commissioning groups don’t just focus on their own practice lists, but also work with councils on the ‘Cinderella services’ such as homelessness, mental health, learning disabilities, AIDS/HIV, dementia and child health.
“Local government has decades of experience and expertise in this field and it’s a role we’re willing and able to take the lead on. The forum’s recommendations for joint commissioning and shared boundaries between GPs and councils should help make sure there are no gaps.”
Cllr Rogers said the requirement for commissioning groups to share and agree plans with wellbeing boards, publish board papers and hold public meetings were “strides in the right direction”, as was the proposed power for councils to decide how many councillors should sit on boards.
“This should help avoid communities being dictated to from above and see people genuinely involved in decisions made about themselves or their loved ones," he said.
The report’s Patient Involvement and Public Accountability section was led by Geoff Alltimes, chief executive of the London Borough of Hammersmith and Fulham.
Its 16 detailed recommendations included that NHS commissioners and local authorities should be jointly responsible for improving outcomes where they depend on joint working and that health and wellbeing boards should set and monitor outcomes.
Boundaries of commissioning consortia should “not normally” cross those of their local authority although this would not be an absolute requirement.
Health and wellbeing boards should be the place where the local NHS and local authorities “explain and are challenged on how they are involving patients and the public in the design of care pathways and development of their commissioning plans”, Mr Alltimes’ group said.
Mark Smulian
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The government should strengthen the role and influence of health and wellbeing boards as part of its reforms, the NHS Future Forum has recommended.
The Forum – an independent group set up by the government to “pause, listen and reflect” on the Health and Social Care Bill – argued that the boards should be given stronger powers to require commissioners of both local NHS and social care services to account if their commissioning plans are not in line with the joint health and wellbeing strategy.
Its report said: “Local government and NHS staff see huge potential in health and wellbeing boards becoming the generators of health and social care integration and in ensuring the needs of local populations and vulnerable people are met.”
The Forum also suggested that better integration of commissioning across health and social care should be the ambition for all local areas. “To support the system to make progress towards this, the boundaries of local commissioning consortia should not normally cross those of local authorities, with any departure needing to be clearly justified,” it said.
Other key recommendations include:
- The pace of the proposed changes should be varied so that the NHS implements them only where it is ready to do so
- There should be a comprehensive system of commissioning consortia but they should only take on their full range of responsibilities when they can demonstrate they have the right skills, capacity and capability to do so
- Nurses, specialist doctors and other clinicians must be involved in making local decisions about the commissioning of care – not just GPs – but in doing this the NHS should avoid tokenism, or the creation of a new bureaucracy
- Competition should be used as a tool for supporting choice, promoting integration and improving quality and must never be pursued as an end in itself. Monitor’s duty to ‘promote’ competition should be removed and the Bill should be amended to require Monitor to support choice, collaboration and integration
- Private providers should not be allowed to ‘cherry pick’ patients and the government should not seek to increase the role of the private sector as an end in itself. “Additional safeguards should be brought forward”
- The duties placed on the Secretary of State, the NHS Commissioning Board and commissioning consortia to reduce health inequalities are welcome but they need to be translated into practical action
- Improving the public’s health is “everyone’s business” but should be supported by independent, expert public health advice at every level of the system. “In order to ensure a coherent system-wide approach to improving and protecting the public’s health, all local authorities, health and social care bodies (including NHS funded providers) must cooperate"
- All organisations involved in NHS care and spending NHS money should be subject to the same high standards of public openness and accountability.
The recommendations will now be considered and responded to by the Government.
Forum Chairman Professor Steve Field, a practising GP from Birmingham, said: “There is no doubt that the NHS needs to change. The principles underlying the Bill – devolving control to clinicians, giving patients real choices and control, and focusing on outcomes – are well supported.
“However, during our listening we heard genuine and deep-seated concerns from NHS staff, patients and the public that must be addressed if the reforms are to be progressed. If the substantial changes we propose are accepted by Government, then I think the resulting framework will place the NHS in a strong position to meet this objective and tackle the pressing challenges in the years ahead.”
The Forum’s reports can be downloaded here.
Philip Hoult