Proposals for the future provision of ambulance services in Gloucestershire.

Transcription

1 Proposals for the future provision of ambulance services in Gloucestershire. AGENDA NO: 7 Cabinet Date 7 th September 2005 Fire and Regulation and Adult Services and Libraries Key Decision Cllr Shaun Parsons Cllr Tony Hicks Not a key decision Other Documents County Council Minutes of 26 th January 2005 Taking Healthcare to the Patient, transforming NHS Ambulance Services ; DoH June 2005 How Patients can benefit from a single, new Ambulance Trust ; AGW Strategic Health Authority July 2005 Commissioning a Patient Led NHS ; DoH July 2005 Main Consultees The Strategic Health Authority (SHA) is consulting all affected parties including local authorities, but see paragraph 5 re the status of this consultation. Planned Dates July 7 th 2005 to October 7 th 2005 Divisional Councillor Officer Margaret Sheather, Executive Director Social Services Margaret.sheather@gloucestershire.gov.uk Tel: (01452) Purpose of Report To inform the Cabinet of the national and local proposals for the future of the ambulance service, and to provide an opportunity to express the Council s views about these proposals. The Cabinet is recommended: Key Recommendations (i) (ii) To note the report To agree the key points for a response from the Council to be made by the relevant Cabinet members. Resource Implications None arising directly from this report.

2 MAIN REPORT CONTENTS Background 1. There are both national and local proposals for a re-shaping of the Ambulance Service for Gloucestershire. The Strategic Health Authority (SHA) initiated their process, in response to identified performance problems, before the national report Taking Healthcare to the Patient was published, but the management proposals are very similar. Ambulance services in Gloucestershire are currently provided by the Gloucestershire Ambulance NHS Trust and has links both to the Council s community safety responsibilities as part of the emergency services, and to the delivery of adult social care. Local Proposals 2. The SHA convened a meeting on 21 January 2005, attended by the Chairs and Chief Executives from all three Ambulance Trusts for the SHA area, the Primary Care Trusts that lead commissioning of ambulance services for their areas and the Strategic Health Authority. The meeting agreed to commission a detailed review of the benefits, affordability and impact of potentially changing how Ambulance services are managed across Avon, Gloucestershire and Wiltshire. Those attending the original meeting formed a Steering Group for the project. 3. The Steering Group subsequently established terms of reference for the review and commissioned Price Waterhouse Coopers to carry out the work. The work was to compare the existing structures, and look at the whether patients will benefit from either integrating the management teams of all three Ambulance Trusts or integrating the three Ambulance Trusts together to form a new, single organisation. The business case was to be tested by the three Ambulance Trusts with their staff, patients, MPs, Overview and Scrutiny Committees, Patient Forums and other key people and organisations within the local community. This would help the NHS decide on the best way to strengthen and develop ambulance services in this area of the South West. 4. The County Council at its meeting on 26 th January 2005 agreed motion 552: That this Council shares local concerns over the prospect of a regionalised ambulance service, which would not be in the best interests of patients in Gloucestershire and could undermine the Tri-service Centre. We call on the Strategic Health Authority and the Ambulance Services concerned to think carefully and consult widely, including an assessment of the impact on patients, before taking any action and to ensure that this council is a consultee. 5. The Chief Executive of the SHA invited the Chairs of the seven Health Overview and Scrutiny Committees (OSC) in the area to a meeting on 30 th March 2005 where progress on the Ambulance Review was discussed. Section 11 of the Health and Social Care Act 2000, that set up the OSCs, requires NHS bodies to undertake statutory consultation with patients and the public and OCSs whenever they propose to undertake a substantial service change. However, the guidance to the Act states that there is no requirement to undertake such a consultation when changes to management arrangements only are proposed. 6. At the meeting on 30 th March, the SHA stated that the review of ambulance service management arrangements fell outside the requirement to consult, but that they nevertheless proposed to carry out an informal public consultation in the event of a proposal to merge the three Ambulance Trusts in the SHA area. The OSC Chairs and

3 officers present asked the SHA, nevertheless, to carry out an impact assessment on the scope of the change proposals before any consultation was launched. The impact assessment is an agreed mechanism between the NHS bodies and their OSCs for assessing whether any proposed change falls within the statutory requirements. This was agreed by the SHA. 7. Price Waterhouse Coopers completed their work and reported to the SHA. The three options assessed were: Option 1 Retention of the existing organisational arrangements Option 2 The creation of an integrated management team across the three organisations Option 3 The establishment of a single new NHS Trust with a distinct divisional structure The report recommends Option 3 as the way forward. 8. The review focussed on the suitability of the structures to support the future development of Ambulance Trusts, so that they offer greater patient benefit. As agreed with the OSC Chairs, the SHA agreed with the Department of Health to hold a period of non-statutory consultation through communication and discussion to ensure openness and transparency in their work. That process started on 7 th July and is running until 7 th October. The SHA published a consultation document How Patients can benefit from a single, new Ambulance Trust and the executive summary of that report is shown at Annex 1. National Proposals 9. In June 2005 the Department of Health published the report Taking Healthcare to the Patient which reviewed the role, functions and structures of the ambulance service nationally. The Executive Summary of that report is shown at Annex 2. The full report makes a total of 70 recommendations to achieve the future vision of the ambulance service nationally, covering the five areas of Improving leadership; Improving the consistency and quality of care provision; Improving efficiency and effectiveness; Supporting performance improvement and Developing the workforce. 10. The most relevant recommendation that links with the local proposals is that there should be a reduction in the number of services, broadly in line with SHA boundaries. Precise decisions on the configuration and number of services should be made after consultation with NHS and the public to ensure that configuration reflects local operational requirements. 11. The DoH response to that recommendation was to express the view that there should be a reduction of at least 50% in the number of ambulance services and that it would consult with the NHS and the public over the next few months to determine the number and configuration of services and agree a plan for rapid implementation. This was confirmed in the guidance issued to the NHS at the end of July, which announced consultation to run from September to November, with ministerial decisions about configuration in December and the first of the new Trusts coming into being as early as July 2006.

4 Key Issues 12. The SHA s consultation document argues that the significant national developments proposed will see Ambulance Trusts playing a more pivotal role in the NHS and their staff playing a greater role in caring for patients. This care will more often be delivered in the patient s home, either as part of routine services or as a response to urgent but not life-threatening conditions. It is argued that the development of these roles requires stronger structures to deliver them and to achieve the required performance standards. The three existing trusts in the SHA are some of the smallest in the country. 13. The Cabinet, in deciding its response, will want to consider their views of the following points made in the consultation document about the creation of a single trust: Ability to improve response times for 999 calls, which are currently below target. Potential for more frontline ambulance staff, vehicles and equipment through reinvestment of savings on bureaucracy. Enhanced flexibility of resource use across current Trust boundaries according to local needs Potential for more efficient use of resources across the SHA area rather than on an individual county basis Improved drive and strategic direction Commitment to retaining a local focus through a divisional structure building on local pride Stronger influence on NHS developments generally 14. There are two potential aspects to the Council s response: its views for or against the proposed merger and its priorities for services in Gloucestershire should the merger in fact go ahead. 15. In addition to the Council s own response to the consultation, the NHS Overview and Scrutiny Committee (OSC) is fully engaged in the consultation process. The OSC has been provided with the impact assessment as agreed and has set up a sub-group to investigate the review in detail to help the committee develop an informed response to the consultation. The sub-group was asked to test the adequacy of the review and consultation process and consider whether the proposals are in the interests of the people of Gloucestershire. 16. As a result of the sub-group s initial report to the OSC the Committee has decided to dedicate the whole of its meeting on September 14 th to inquiring in public into the proposals. The Chief Executives of the SHA and of the Ambulance Trust will both be in attendance and there will be opportunities for the public to ask questions, as well as the Committee members. Options The Cabinet has the options to: (i) Support the merger (ii) Oppose the merger, stating its objections (iii) In addition to (i) or (ii), state its priorities for the delivery of ambulance services in Gloucestershire should the merger proceed.

5 Summary of SHA Consultation Document Annex 1 NHS Ambulance Trusts across England are the first and often the most important contact fo over five million 999 callers each year. When people dial 999 in an emergency, they need fast, reliable, effective and efficient care. A Steering Group of NHS Chairs and Chief Executive recommended in principle that a single Trust should manage ambulance services across Avon, Gloucestershire and Wiltshire to meet this need. The creation of a single new Ambulance Trust would replace the three existing Trusts in our area. The Group reviewed a report by leading consultants, PricewaterhouseCoopers which examined the suitability of three options to deliver the new national agenda for ambulances: Option 1: Option 2: Option 3: Retaining the existing three Ambulance Trusts Creating one management team (instead of three) across the Trusts. Establishing a single new NHS Trust with distinct local operations The independent report highlighted that a single new Ambulance Trust would deliver the greatest benefit for patients, both now and in the future. It said that this would: lead to stronger management capacity and capability, a better equipped workforce, and the adoption of best practice from across the three Trusts Strengthen the ability to achieve the national performance targets, which currently are not all achieved Provide the opportunity to save management costs, which would be reinvested over a number of years in frontline ambulance staff, equipment and services. The report assessed the options for the future of ambulance services against a series of criteria. The benefits to patients were given the highest weighting (70%). Other criteria included patient safety and value for money. It was concluded that Option 3 the creation of a single new Ambulance Trust would bring the greatest benefits to patients. The new organisation would have more capacity to meet the enhanced role it needs to play within the NHS and improve performance in the face of increasing demand from patients.

6 Annex 2 Summary of Taking Healthcare to the Patient 1.1 In May 2004, the Department of Health invited Peter Bradley CBE, Chief Executive of London Ambulance Service NHS Trust, to become National Ambulance Adviser and to lead a strategic review of NHS ambulance services in England. This report sets out the review s conclusions. The Department supports these conclusions and will now take forward a programme of work to support the NHS in implementing the main recommendations. The Department will consult further on the implementation of some of the recommendations. 1.2 The report sets out how ambulance services can be transformed from a service focusing primarily on resuscitation, trauma and acute care towards becoming the mobile health resource for the whole NHS taking healthcare to the patient in the community. Ambulance services and NHS communities as a whole have already started this journey. But there is much more to do, and we need to increase the pace and consistency of progress. Best practice needs to be adopted faster and innovation needs to become a systematised part of how ambulance services do business with their health and social care partners. 1.3 The vision set out by the reference group is that over the next five years ambulance services, working with patients and the public, will: improve the speed and quality of call handling, provide significantly more clinical advice to callers (hear and treat), and work in a more integrated way with partner organisations to ensure consistent telephone services for patients who need urgent care; provide and co-ordinate an increasing range of mobile healthcare for patients who need urgent care (see and treat); provide an increasing range of other services, e.g. in primary care, diagnostics and health promotion; continue to improve the speed and quality of service provided to patients with emergency care needs. 1.4 The benefits of delivering this vision include: Patients will receive improved care, consistently receiving the right response, first time, in time; More patients treated in the community, and potentially one million fewer unnecessary A&E attendances;

7 Greater job satisfaction for staff as they use their additional knowledge and skills to care for patients; More effective and efficient use of NHS resources; Improvements in self care and health promotion. 1.5 The reference group has made recommendations in five areas about how this vision should be achieved. These will form the basis of a national programme to support the NHS in transforming ambulance services: A B C D E Improving leadership, both clinical and managerial, so that organisation structure, culture and style match new models of care. Improving the consistency and quality of care provision. Improving efficiency and effectiveness. Supporting performance improvement. Developing the workforce.