Memorandum by Karen Bell, Chief Executive,
Huntingdonshire Primary Care Trust (FT28)
SUBJECT:
I have been the Chief Executive of the Huntingdonshire
Primary Care Trust and its predecessor Primary Care Group since
1999. The Trust formally came into being on 1st April 2001.The
Trust serves a population of about 150,000. Its catchment is nearly
coterminous with Huntingdonshire District Council. Huntingdonshire
is a large rural district with four market towns: Huntingdon,
St Ives, St Neots and Ramsey. It is relatively affluent but there
are pockets of significant deprivation, some rural, mainly in
the Fens and some urban.
The Trust has an annual budget of over £100
million that it uses to:
— Ensure the provision of primary care
through local "independent" General Practitioners, optometrists,
pharmacists and dentists. We have 24 GP practices with 85 doctors.
— Provide other primary care services
through the employment of district nurses, health visitors, school
nurses, the professionals allied to medicine (physiotherapists
etc) and acute rehabilitation specialists.
— To provide an integrated children's
services for Huntingdonshire that includes primary care and the
direct management of hospital based paediatric services (this
is unusual).
— Commission appropriate secondary
and tertiary health services for its population from NHS Trusts.
We commission the majority of our secondary
hospital services from the Hinchingbrooke Hospital NHS Trust in
Huntingdon. Addenbrooke's NHS Trust in Cambridge is our main tertiary
referral hospital but we also commission a range of secondary
care and specialist services from this Trust. Mental health services
are commissioned from the Cambridgeshire and Peterborough Mental
Health Partnership NHS Trust.
Huntingdonshire Primary Care Trust supports
the basic intention of NHS Foundation Trusts to move away from
centralised control to greater local accountability and local
control. Consequently our main interest in developing NHS Foundation
Trusts is in the area of Governance and Accountability.
Thus far, the Trust has only been engaged in
preliminary discussions and consultation with the Addenbrooke's
NHS Trust in Cambridge that has expressed an interest in achieving
"first wave" Foundation Trust status. We currently expend
about 10% of our budget commissioning services from Addenbrooke's.
However, the assumption is that, over time, all NHS provider trusts
will become NHS Foundation Trusts.
At present the local Strategic Health Authority
(covering Norfolk, Suffolk and Cambridgeshire) "oversees"
and to some extent regulates the commissioning relationships between
primary care trusts and NHS provider trusts. It is assumed that,
with the formation of NHS Foundation Trusts the main channel for
central (Government) control of the NHS will be through the Strategic
Health Authority and its local primary care trusts such as Huntingdonshire.
As far our trust is concerned Hinchingbrooke
is virtually a monopoly provider of local general hospital services
and Addenbrooke's is a monopoly provider of specialist and tertiary
services. This is not a problem but when these provider trusts
become "independent" foundation trusts, there must be
robust accountability and governance arrangements in place.
The Board of Governors of Foundation Trusts
will have a mix of elected and appointed members with representation
of the interests of "main commissioning primary care teams".
It may be that this representation linked to an appropriate Trust
Licence and the role of the Independent Regulator will provide
what we are looking for in terms of governance and the influence
of primary care trusts. As far as we are concerned we want to
be sure these governance arrangements will ensure that our primary
care trust is able to:
— influence the service and investment
plans of Foundation Trusts so that they are truly "driven"
by and responsive to primary care priorities and practice (both
local and national targets);
— monitor the performance of Foundation
Trusts against agreed plans and targets and, where appropriate
and necessary, ensure action is taken to ensure plans and targets
are delivered; and
— promote joint working between Foundation
Trusts—we believe hospital care, general and local, will,
increasingly, be provided by clinical networks that involve a
number of hospitals working collaboratively, sharing clinical
expertise, staff and resources. It is important that the governance
and accountability arrangements put in place for Foundation Trusts
facilitate such collaboration and joint working. This point is
also relevant to the impact of Foundation Trusts on the wider
NHS.
We are optimistic that the "freedoms"
and greater autonomy conferred by NHS Foundation Trust status
will provide us with more effective, more efficient and more responsive
NHS services. However it is critical that their accountability
and governance arrangements are sufficiently flexible to take
account of local factors and local preferences. Therefore the
arrangements that might best suit a Foundation Trust in a large
metropolitan area may well not be the same as those required for
one serving a dispersed, rural population such as ours. In our
view "one size" should not be made to "fit all".
The fundamental principles should be shared by all but the governance
arrangements should be tailored to fit local circumstances.
For example, although we are only one of many
primary care trusts commissioning care from Addenbrooke's, we
would be very interested to know how many "Huntingdonshire"
members (either elected or appointed) there might be on its Board
of Governors and what influence they might be expected to have.
This is particularly important for us because we anticipate our
local hospital, Hinchingbrooke, will become increasingly reliant
on Addenbrooke's as a partner in clinical networks—if there
is going to be real local control and local accountability, Huntingdonshire
must have appropriate representation.
5 February 2003
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