Agenda item

Merseyside NHS Cluster


The Board received a presentation from Mr Derek Campbell, Chief Executive, Merseyside NHS Cluster on the role and function of the cluster and how it operated within the context of the emerging NHS reforms.


The presentation, which was circulated at the meeting:-


·        Gave an overview of the proposed NHS reforms;


·        Outlined the Strategic Health Authority and Primary Care Trust roles in transition;


·        Detailed the Milestones;


·        Demonstrated the current geographic footprint;


·        Set out the clinical commissioning groups – phases of authorisation; and


·        Detailed the Merseyside cluster priorities during transition.


Mr Campbell introduced himself and Mr Steve Spoerry, Chief Executive of Halton and St Helens Primary Care Trust and reported that as he covered the four Primary Care Trusts he could not be fully involved and had therefore, appointed a managing director in each PCT.  Mr Spoerry would be based in Widnes and would help address issues in the Halton area. 


Mr Campbell reported that since being in the post he had developed a clear understanding of the relationship between Runcorn and Warrington and the boundaries.  The cluster, he added, was a temporary arrangement and would cease to exist in 18½ months.  The reasons the cluster had been established was to ensure resources and service delivery was maintained during the transition and support the development of the new system, working to a shared operating model.  He added that it was crucial that the boundaries did not have an impact on future joined up arrangements.


Mr Campbell advised the Board that the Clinical Commissioning Groups would lead commissioning and be responsible for 60% of the NHS budget.  The National Commissioning Board would allocate resources, set commissioning standards, commission specialised and primary care services and hold commissioners to account.  The local Health and Wellbeing Boards would oversee, scrutinise and co-ordinate commissioning plan.


In conclusion, Mr Campbell reported that the NHS Commissioning Board would be in shadow form as a Special Health Authority in October 2011.  Local Clinical Commissioning Groups were in the process of undertaking risk assessments and the Group’s authorisation process and ‘dry run’ would begin in October 2011.  Delegated budgets would also be in place by 2011 and it was emphasised the importance of the Local Authority establishing the Health and Wellbeing Board on the same timeline as the Clinical Commissioning Group obtaining the delegated budget i.e. October 2011.


Mr Spoerry advised the Board that it would be advantageous if the new system emerged rapidly.  Gp’s, he reported, had taken positive steps and were ahead of the timescale and would be receiving their delegated budgets and new functions in October 2011.  He emphasised the importance and benefits of the HWBB being established at the same time. 


The following comments arose from the discussion:-


·        Concern was raised that expertise would be lost during the transition period and whether there would be enough expertise remaining in the new shared system.   In response, it was reported that employees from public health would TUPE over and local expertise would remain in the new system.  The importance of ensuring that there was a reduction in operational costs, whilst retaining the skills and expertise required in the future was noted;


·        Clarity was sought on whether the Health and Wellbeing Board (HWBB) would be able to make decisions or recommendations.  In response, it was reported that the HWBB would be the Local Authoritys responsibility and would be responsible for the health of the population.  The public health budget would be transferred and the Authority would be responsible for the strategy and have a lead role of working with clinical commissioners;


·        It was noted that the size of the clinical commissioning groups had not been specified by the Government.  However, it was also noted that it was more important for Merseyside to work together, with good local working relationships and connections;


·         Clarity was sought on whether it would result in centres of excellence being located further away.  In response, it was reported that Merseyside health services was underpinned by very strong localism.  There was a need to change and work together better than previously across the Merseyside area.  Standards were also rising constantly.  However, the financial situation would need to be recognised and Warrington and Whiston would need to work closer together sharing services, ensure there were no duplications and difficult decisions would have to be made as the transition progressed;


·        the Members of the Board emphasised the levels of deprivation and the increase in the elderly population in Halton.  The Members noted the Cheshire and Merseyside vascular review and the impact it would have on Halton should the current proposal be accepted.  It was also noted that the Board felt that there should be three arterial centres and that this issue should be reconsidered and looked at with the health reforms.  In response, it was reported that a decision had not been taken as yet and it would be considered in November 2011.  In addition, it was reported that Mr Speorry was looking for solutions on how Halton Hopsital could be brought back into use and consideration was also being given to taking services from Liverpool to Halton.


·        Clarity was sought on whether waiting lists would increase as a result of the transition.  In response, it was reported that early intervention and prevention was vital.  In addition, it was reported that it was important that the HWBB foster and develop a relationship with the clinical commissioners who would be responsible for waiting lists;


·        Clarity was sought on the risks associated with the fast pace of the reforms.  In response, it was reported that the changes could have an impact on the priorities i.e. improving life expectancy in Halton, retaining the delivery and quality of services and to continue to improve services.  There was also a risk of losing the experience and corporate memory;


·        It was noted that there was a provision in the Bill that if the HWBB was not satisfied with the overall performance and it did not meet with the JSNA then there was an option to make a referral to the Commissioning Board and the Secretary of State; and


·        Clarity was sought on how GP’s would manage their patients if 30% of their time would be used for commissioning.  In response, it was reported that funding would be available from the downsizing to pay for additional GP’s to cover the’ commissioning time.  It was noted that the budget for Halton could be in the region of £240m.


The following questions had been submitted prior to the meeting and the responses circulated at the meeting:-


1                    In light of the recent poor showing of a major Care Home owner and the CQC to look after the residents of those homes, do you feel that the Care Home Inspection and Registration Units should be taken back under the control of the Local Authorities who had a great deal of success prior to CQC?




It is not the role of the PCT to take a view on the remit or performance of the Care Quality Commission or Registration Units.


2          I feel that the PALS system of overseeing patients complaints has been inferior to the Local CHC system which was PALS predecessor.  What will the NHS Cluster do to improve the inferior system?



Subject to the passage of the Health and Social Care Bill, Local HealthWatch organisations would be established in October 2012, and continue the functions currently provided by Local Involvement Networks (LINks).

From October 2012, subject to parliamentary approval, Local HealthWatch would also signpost people to information regarding health and social care services. This was one of a range of services currently provided by the PCT Patient Advice and Liaison Services (PALS).

HealthWatch would be the independent consumer champion for the public i.e. service users, citizens, carers and patients – locally and nationally – to promote better outcomes in health for all and in social care for adults.

At local authority level, Local HealthWatch would act as a point of contact for individuals, community groups and voluntary organisations when dealing with health and social care. Local HealthWatch would also have a seat on local health and wellbeing boards to influence commissioning decisions by representing the views of local stakeholders. The information that Local HealthWatch gathers on patients’ and the public’s views and experiences of the NHS would inform HealthWatch England’s role in influencing health and social care services at the national level.

The Department of health was currently asking for views from stakeholders on options for distributing the additional funding to local authorities for local HealthWatch. The consultation on Allocation Options for distribution of additional funding to local authorities for Local HealthWatch, NHS Complaints Advocacy, PCT Deprivation of Liberty Safeguards could be accessed from the Department of Health website:

This consultation would be open until 24th October.




(1)                     Mr Derek Campbell be thanked for his informative presentation; and


(2)                     The comments raised be noted.

Supporting documents: