Oral - End of Consultation on Delivering the New NHS for Wales

I am grateful for this opportunity to report on the emerging findings arising from the second period of consultation on NHS reform, which closed on 25 February. During that period, three consultation events were held across Wales, each attended by over 120 stakeholders. At the closing date, 413 responses had been received, all of which have been published in full.

Responses were received from a wide range of organisations and representative bodies with an interest in the health service in Wales. I have taken the opportunity to read each of these responses over recent weeks. As a result, I am able to confirm my intention to proceed, subject to legal Orders and regulations, to establish the six new local health boards in shadow form from 1 June 2009, and for these bodies to be fully operational from 1 October 2009. Powys teaching LHB is the seventh LHB.

This is not about merging LHBs and trusts to make a hybrid organisation; these LHBs will be new bodies—ones that have a new purpose. Therefore, they must have new boards—boards that are strategic, can make decisions, innovate, act collaboratively, and have, at their core, a responsibility to sustain the ethos and values of public service. Board members must hold the executive team to account for service planning and delivery, and for local engagement, bringing to the board their experiences of a sector that they understand, but do not simply represent.

There is a theme in the consultation that will not come as a surprise to Members. Uniformly, consultees agree that boards must be kept to a size that allows them to be effective and focused. However, many also argued that their own particular interests needed greater representation. Doctors want more doctors, local government wants more places for local government representatives, the voluntary sector wants more representation for voluntary bodies, and carers want more places for carers. However, no-one wants boards to be bigger.

I appreciate that the tensions between inclusiveness and agility in decision making are real. I have to conclude that the size of boards will remain largely as set out in the consultation document. All of the key interests are represented, albeit not at a scale that some would wish.

As board members, those from trade unions have a particularly difficult role—to balance their role as a corporate member, whereby they will be bound by the decisions of the board, against their role representing staff working within these organisations. A number of important points on the details of the role of the trade union board members were raised in the consultation. I will discuss these issues further during the next week.

A number of respondents suggested a director of therapies and scientific services should be included on the board. Such an appointment would be unique in the UK, reflecting the importance of these professional groups to the delivery of health—both now and increasingly in the future. That is another issue that I am considering in light of the responses.

Of course, board membership is only one of the ways in which health service interests and partners will be able to make their voices heard and views known in the new system. Local government, for example, is directly involved on the national advisory board through the membership of Councillor Meryl Gravelle, leader of Carmarthenshire County Council, and the Welsh Local Government Association’s presiding officer and the lead on social services and health. Local authorities will also be key members of community health council boards as well as major players in local service boards in each locality.

The statutory duty for health, social care and wellbeing strategies, and children and young people’s plans, will remain, building on existing partnership working and placing the NHS close to the citizen and the community. Just as the new structure will work closely with local government, so, too, the importance of the third sector was regularly emphasised in consultation. I also endorse that again this afternoon. The third sector contribution is important because it reflects not only the diversity of Wales as a nation, but the unifying support for the national health service that is so powerful in every part of our country.

There are a number of further issues for which, through consultation, a direction of travel has been suggested or endorsed, but where further detailed work is now needed. I thought that it might be helpful to Members if I were to identify those areas briefly this afternoon. First, I can report that there has been support for the suggestion of a professional forum. I know that the success of the new organisations will rely on the strongest possible clinical engagement in the services that they provide and the decisions that they will have to take. I see the professional forum as central to engaging the healthcare professions and there will be a real benefit to arrangements that bring the professions within each LHB together in one group. Of course, the interface between the new fora and the longer-standing statutory advisory committees must be clear and complementary. I have asked my senior officials to undertake some more detailed work, so that we can move forward with the most effective and workable model.

My second issue, that of specialised services, has moved forward through the work of Professor Mansel Aylward, who has reported to me on the functions and services that are currently undertaken by Health Commission Wales and which should, in future, be undertaken by the new LHBs. There remain those services that you can only provide at a higher population level than that of local organisations. I agree with the views expressed during the consultation that these must be organised collaboratively through the new LHBs. A further consultation paper on such a collaborative future for specialised services will be issued shortly. I want to ensure that we arrive at a solution to this complex problem that would address the concerns that have arisen with regard to such services in recent years—concerns that I have, of course, discussed with Members previously.

Thirdly, I wish to make it clear that I share the view expressed in the consultation that duplication must be avoided in the roles of the stakeholder reference groups and community health councils. CHCs have a formal statutory role—they must hold LHBs to account on behalf of the citizen. Stakeholder reference groups are non-statutory bodies intended to provide an added dimension involving citizens in a broader range of debates and to open up boards to a wide variety of views. Consultation on the future strengthened role of CHCs comes to an end in mid April. In responding to that consultation, I will ensure that further advice will be given to clarify the different contributions that those two groups will make to putting the citizen at the centre of the new, co-producing, democratically renewed, NHS in Wales.

I am grateful to all those who attended the consultation events and wrote to me with their views. Once again, this exercise has been a great success and a testimony to the spirit of dialogue and engagement that has been at the heart of these reforms. Now we must press ahead with the action needed to make all of this a reality. I intend to begin laying the legal Orders and regulations required to make these changes within the next 14 days.