Agenda item

The Policy and Scrutiny Officer reported on the Health and Social Care Bill, introduced into Parliament on 19^th January, 2011.  The Bill took forward the areas of Equity and Excellence: Liberating the NHS (July 2010) and the subsequent Government response Liberating the NHS: Legislative Framework and Next Steps (December 2010) which required primary Legislation.

It was part of the Government’s vision to modernise the NHS so that it was built around patients, led by health professionals and focussed on delivering world class healthcare outcomes.  It also included provision to strengthen public health services and reform the Department’s arms length bodies.

The Bill contained provisions covering 5 themes:-

-        Strengthening commissioning of NHS services

-        Increasing democratic accountability and public voice

-        Liberating provision of NHS services

-        Strengthening public health services

-        Reforming health and care arms length bodies

The report also set out a summary of the bill proposals listed by Section:-

Section 8        Duties as to improvement of Public Health

Section 13      Other services etc. provided as part of the Health Service

Section 14      Regulations as to the exercise by local authorities of certain Public Health functions

Section 18      Exercise of Public Health Functions of the Secretary of State

Section 19      The NHS Commissioning Board: further provision

Section 22      Commissioning Consortia: general duties etc.

Section 25      Other Health Service functions of local authorities under the 2006 Act

Section 26      Appointment of Directors of Public Health

Section 27      Exercise of Public Health functions of local authorities

Section 42      Charges in respect of certain Public Health functions

Section 50      Co-operation with bodies exercising functions in relation to Public Health

Section 167   Establishment and constitution

Section 170   Independent Advocacy Services

Section 176   Joint Strategic Needs Assessments

Section 177   Joint Health and Wellbeing Strategies

Section 178   Establishment of Health and Wellbeing Boards

Section 179   Duty to encourage integrated working

Section 180   Other functions of Health and Wellbeing Boards

Section 182   Discharge of functions of Health and Wellbeing Boards

Section 183   Supply of information to Health and wellbeing Boards

Section 190   Pharmaceutical Needs Assessments

From April, 2013, Public Health England would allocate ringfenced budgets, weighted for inequalities, to upper tier and unitary authorities in local government.  Shadow allocations would be issued to local authorities in 2012/13 providing an opportunity for planning.  Building on the baseline allocation, local authorities would receive an incentive payment, or ‘health premium’, that would depend on the progress made in improving the health of the local population and reducing health inequalities based on elements of the Public Health Outcomes Framework.  The premium would be simple and driven by a formula developed with key partners, representatives of local government, public health experts and academics.

Discussion ensued on the report with the following issues raised/clarified by the Policy and Scrutiny Officer and Director of Public Health:-

-        The Health and Wellbeing Board (HWB) would be set up by the local authority and would be a statutory board.  There would be a minimum membership including 1 nominated Councillor, Director of Adult Social Services and Children Social Services, local Health Watch, representative from the GP Consortia and other members at the discretion of the local authority and Board members

-        The Board would sit in a shadow form initially.  A report was to be submitted to Cabinet shortly on how the Board may be constituted

-        The Board would have to develop a Joint Strategic Needs Assessment

-        Public Health would come into the local authority as its responsibility including the appointment of the Director of Public Health which would be a joint appointment by the local authority and the National body Public Health England

-        The local authority would take on a number of functions which presently sat within the PCT including teenage public health, work with the Prison Service as well as pupils’ health within schools

-        The local Health Watch would replace the existing LINKS partnership – details still unclear

-        The Board would be responsible for bringing all the commissioning together and would look at the commissioning plans across the different Services (Children Services, Adult Services, GP Consortia).  The Services would have a duty to co-operate with the Board and must give regard to the Joint Strategic Needs Assessment as well as the Health and Wellbeing Strategy

-        In the original consultation paper, “Liberating the NHS”, there had been a suggestion that the HWB would take over the scrutiny role of health.  Many authorities had argued that it did not make sense for the Boards to scrutinise themselves so there had been a u-turn although it was not absolutely clear as yet what the role of Scrutiny would be

-        It was extremely complicated and there was not a lot of detail as yet and needed working through as to what it meant locally.  Essentially, the Government was to split off NHS provision from Health so the outcomes of health would be the responsibility of Public Health England and have a commissioning board responsible for health services through the GP Consortia.  It was proposed to join that up at a local level by the Health and Wellbeing Board with responsibility to try and co-ordinate local health and social care and as well as the prevention of illness through Public Health.  There would be some resources come to it but not sufficient

-        The School Visiting and Health Visiting Service would initially be nationally commissioned through Public Health England.  They would be handed over to a local level at some stage in the future

-        There was a key role for Scrutiny in terms of scrutinising the governance arrangements within the GP Consortia locally and how they used public money to commission services on behalf of the Rotherham public

-        Currently the PCTs were being clustered for 2 years to manage the process.  Rotherham was being clustered with Sheffield, Doncaster, Barnsley and Bassetlaw.  The responsibility for NHS Rotherham would pass to that South Yorkshire cluster

-        Rotherham’s GP Consortia had been set up and was Chaired by Dr. David Tooth

-        It was hoped that staff from Public Health would transfer to the local authority and would come with some NHS funding.  However, 45% of NHS funding would come from Public Health England not all of which would reach the Council.  There would be a number of services that had to be commissioned, Sexual Health Services, Screening Services, Specialist Clinics etc., that would transfer either to the local authority or Public Health England

It was noted that the report was to be submitted to the Performance Scrutiny Overview Committee and Cabinet for consideration before a response to the consultation was submitted.

Resolved:-  That the implications arising from the Health and Social Care Bill be noted.