Reforming Health Systems circa 2010 The Case of Wales Reforming Health Systems circa 2010

Reforming the NHS in Wales April 2nd 2008 Consultation paper, Proposal to change the structure of the NHS in Wales December 2008 Second consultation paper, Delivering the new NHS for Wales

Ministerial intent/rationale improve patient care and the patient experience enhance the quality, performance and accessibility to NHS services, ultimately improving health and well being Effective administrative arrangements for the NHS Removal of the internal market

Why Change? Changes said to be necessary to respond to the following features: Health of population is poorer than should be, many public health challenges to overcome. Care is over-institutionalised, too much concentration on in-hospital care and too little effective prevention.

Health organisations do not work well together, and partnership relationships are patchy. Too little effective engagement with clinicians, patients, and the general public in planning service delivery and changes to services Good practice patchy, poor uptake of good service models, poor service evaluation and very varied value for money.

Expected Benefits Service quality benefits – an improvement in services offered to the population with improved health outcomes, improved access to services, more community services, reduction in geographical inequalities. Operational benefits – reduced number of organisations, strategic planning at All Wales level, more efficient use of resources.

Money moved into front line services – reduction in administrative costs, improved purchasing and negotiating power at a national and local level. Better working across NHS= reduction in conflicts between NHS bodies, improved perception amongst patients and public, greater sense of stability of direction Staff benefits – increased career opportunities in unified organisations, improved morale.

Current Organisation 22 Local Health Boards (co-terminus with local authorities) commission primary and secondary care services. Health Commission Wales commissions specialist services on an All Wales basis. A number of hospital Trusts provide services (treatment) to patients.

Key Proposals National Advisory Board to be established – responsible for providing independent advice to minister. Will be chaired by minister, and will meet in public.

National Delivery Group Will be responsible for strategic leadership and management of the NHS. Will provide policy advice to minister, and oversee development and delivery of NHS services across Wales. Responsible for planning and performance management of NHS.

7 Local Health Boards These will replace the existing Local Health Boards and Trusts as unified health bodies. Responsible for planning, designing, developing and securing the delivery of primary, secondary and some specialist services for their citizens.

Stakeholder Reference Group Will provide advice to the LHB board on any issues it considers important to its citizens. Representatives from a number of community based groups could include the following: Young people Provider bodies Fire/Police services Community councils Black and minority ethnic groups

The Professional Forum Advice to LHB board on all professional and clinical issues. Representation from professional groups

Factors favouring reform Perception that current LHBs too small for health service planning at secondary care and specialised level. However, this was going to be addressed through regional commissioning units.

Obstacles PERSONAL VIEW Usual consequences of major change, staff leave, increase in staff sickness, reduced morale In North Wales nine organisations will merge! – takes time to really merge Will be huge organisations – almost certainly too big to last?! Proposals for localism are not clear.

Stakeholder panel particularly in larger LHBs will not be representative. New LHBs could amount to takeover by hospital trusts – will they in reality have focus on prevention, primary and community care, or will they be diverted/dominated by hospital secondary care issues? How will up to six local authority/social services departments meaningfully link to one LHB? Will they agree on shared approaches to care?

Public Health Separate consultation on public health – Unification of Public Health Services in Wales. Proposal is to provide a unified public health system

Rationale To provide a national public health organisation, able to promote and protect the health of the people of Wales To minimise overlap between several organisations To better meet the needs of the new structures of NHS Wales To strengthen public health resilience to support and emergency response To make a more effective contribution in delivering improvements in public health

Proposal UPHO will be established as an independent NHS body and will incorporate the functions of: The Wales Centre for Health The National Public Health Service for Wales The Welsh Cancer intelligence and surveillance unit Screening services Wales Congenital Anomaly Register Welsh Blood Service

Executive responsibility for public health vested in 7 NHS bodies ie LHBs, and at a national level (UPHO)

Factors favouring reform Key issue is that LHBs need more support to health, social care quality work. Main emphasis of current directors and local teams has been on health improvement work. Health protection will continue largely unaffected by reforms

Obstacles Lack of overall capacity to maintain current health improvement work and deliver more support to health service quality work. Not at all clear how management and accountability arrangements will work

Chronic Disease