Written - Specialised and Tertiary Services

On the 14th July 2009, I issued a Written Cabinet Statement setting out my decisions in relation to Specialised and Tertiary Services.  These were:

•  To establish the Joint Committee comprising all seven Local Health Boards (LHBs) (to be known as the Welsh Health Specialised Services Committee), hosted by Cwm Taf LHB, from the 1st October 2009;
•  To appoint a Project Director;
•  To proceed with further work on those services to be provided locally/nationally;  
•  To have further discussion about the practicalities of a mid year transfer as the Minister was considering a shadow-running period (Oct 2009 – April 2010);
•  To consider an All-Wales Renal Network; and 
•  To commission an option appraisal on an All-Wales Cancer Trust.

In that Statement I agreed to update Assembly Members on progress in the autumn. 

Following a short consultation with the seven LHB Chief Executives and with senior officials in Health Commission Wales, I have signed and made The Welsh Health Specialised Services Committee (Wales) Directions 2009 (the Directions), which bring a number of the issues identified in my earlier statement into effect.

I have directed the seven LHBs to set up the Welsh Health Specialised Services Committee (the Joint Committee) to undertake the joint planning of Specialised and Tertiary Services, as soon as practicable after the 1st October 2009. 

To ensure that the Joint Committee has the time to set up detailed and transparent governance structures, I have decided that the Joint Committee will have limited functions until it is fully operational on the 1st April 2010.  It will during that time plan specialised and tertiary services for 2010/11.

During that shadow period (October 2009 to the end of March 2010), Health Commission Wales will continue to plan specialised and tertiary services for the remainder of this financial year.   

The Membership of the Joint Committee will remain as set out on the Consultation Paper.  The core membership of the Joint Committee will comprise the Chief Executives of the seven LHBs.  In addition, it is proposed to appoint: 

•  An Independent Chair; 
•  A Vice-Chair - to be drawn from non-officer members of one of the seven LHBs;
•  2 Non-Officer Committee Members – Independent Members who would be drawn from LHBs non-officer members;
•  The following Officer Committee Members;

•  Director of Specialised and Tertiary Services;
•  Medical Director of Specialised Services;
•  Nursing Director of Specialised Services;  and 
•  Finance Director of Specialised Services.

The Chief Executives of Velindre NHS Trust, the Welsh Ambulance Services NHS Trust and Public Health Wales NHS Trust will be Associate Members and as such would also attend the Committee meetings on an ex-officio basis, but will not have any voting rights.

Cwm Taf LHB will provide administrative support for the running of the Joint Committee and establish the Welsh Health Specialised Services Team.

As Members are aware, in September 2007, I invited Professor Mansel Aylward CB, Chair of the Wales Centre for Health, to undertake a Review of Health Commission Wales.  The Review – Health Commission Wales: A Review (the first Review) - published on the 10th June 2008, made 21 recommendations on the provision of specialised and tertiary health services in Wales. 

In light of Professor Aylward’s first Review, and after considering the responses to the two NHS Reform Consultation Papers: Proposals to Change the Structure of the NHS in Wales (April 2008) and Delivering the new NHS for Wales (December 2008), I asked Professor Aylward to advise further on which of Health Commission Wales’ responsibilities might be allocated to the seven LHBs.  As part of that work, Professor Aylward was asked to consider the governance implications resulting from that proposal. 

In February 2009, Professor Aylward provided me with his Review of the Responsibilities, Functions and Governance of Health Commission Wales (the second Review), which made 17 recommendations.  I agreed these recommendations in principle and the Review, although not forming part of the Consultation Paper: Proposals for the future of Specialised and Tertiary Services, was published on the Welsh Assembly Government’s website.

The establishment of the Joint Committee will address the governance issues raised by Professor Aylward in his Reviews; ensure that any new system will be independent, fair, open and transparent, and will both involve and be understood by patients. 

Since the first Review, there have been a number of positive changes within HCW:

•  A Nurse Director was appointed in April 2008 in order to lead the Individual Patient Commissioning (IPC) process, to develop the organisations capacity in relation to patient experience, to improve the clinical governance process and to provide an additional link to LHBs at a clinical level;
•  In April 2008, two commissioners have been recruited to strengthen the resource to plan services;  
•  Staff have been supported by an Organisational Development programme, with a significant number completing formal higher qualifications, diplomas and professional qualifications with success;
•  The Audit Committee has appointed two non-Executive members to  strengthen its independence; 
•  The Clinical Governance Committee has been significantly strengthened with the appointment of a new chair; 
•  A new Information Governance Committee is in place to provide greater assurance around the information handling and management in the organisation; 
•  The Nurse Director has established a clear process of reviewing compliance against the Health Care Standards; 
•  The Prioritisation and Commissioning Plan Process has been fully audited giving a high level of assurance; 
•  An internal process has been implemented to review each main service area on a quarterly basis to improve performance management and focus on the identification of key planning issues at service level.  This now also feeds the annual planning process of HCW;  
•  Revised Standing Financial Instructions have been developed and core systems audited with high assurance scores; 
•  The Medical Director has developed a framework and programme for measuring clinical outcomes which is reported through the Clinical Governance Committee.

In December 2008, Professor Aylward provided me with a report setting out a model for an administrative independent appeals process, which could be used by all NHS bodies in Wales involved in Individual Patient Commissioning – An Independent Appeals Model for Individual Patient Commissioning in Wales (December 2008). 

HCW’s Individual Patient Commissioning (IPC) process is now chaired by the Nurse Director to ensure an improved balance of clinical input oversight to decisions.  The core IPC policies and procedures have been reviewed to ensure fitness for purpose and consistency with the wider NHS.  In addition, the style and nature of communication to patients has been changed, with the process for making decisions regarding mental health patients fully integrated into the core IPC process to ensure greater consistency and oversight.  The IPC process has been audited giving improved assurance levels.

Assembly Government officials are progressing the Independent Appeals Model for Individual Patient Commissioning to ensure its implementation by April 2010.   Interim Guidance will be issued in respect of complaints/appeals about decisions around access to treatment and drugs for issue as soon as possible. It will include reference to individual patient commissioning decisions and those services currently commissioned by Health Commission Wales.  Final guidance will then be developed for issue from April 2010 to coincide with the Joint Committee becoming fully operational.