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Highland NHS Board today agreed the way forward for the structure of NHS Highland following the abolition of Highland Primary Care NHS Trust and Highland Acute Hospitals Trust in April 2003.

The Board had published its proposals for the dissolution of Trusts and the creation of an integrated healthcare system for NHS Highland in its document Care without Barriers. Formal consultation on the proposals took place between 5th August and 6th October 2003 and the Board heard today of the detail of the 112 responses to that consultation.

Mrs Caroline Thomson, Chairman of NHS Highland, welcomed the large number of responses received:
“The response to the consultation has been tremendous. We are very pleased that so many people have taken the time and trouble to consider our proposals and give us their views. We are indebted to them and would want to thank all who contributed. The Board is committed to listening to what it has been told and to providing the direction, vision and leadership that consultees have told us they are looking for.”

The Board agreed that Highland Acute Hospitals Trust and the Highland Primary Care Trust be dissolved at 31st March 2004 and replaced by Highland NHS Board. The NHS Board Chief Executive, Dr Roger Gibbins, commented: “There has been complete support for the concept of a single fully integrated system within NHS Highland, breaking down the barriers between acute hospital and community based services. People clearly want one NHS in the Highlands with greater integration at all levels. The Board therefore agreed to recommend the abolition of both Trusts in the Highlands. These will be replaced by one NHS Highland, led by the NHS Board.”

The new NHS Highland will have a single integrated operating division, running all patient’s services, entitled Direct Health Services. Three community health partnerships (CHPs) are to be established from 1st April 2004. They will be responsible for managing a range of health services to a defined geographical area. The precise details are to be discussed further with Highland Council and other key stakeholders.

Caithness General

The Board debated at length the position of the Belford Hospital and Caithness General Hospital. In the consultation, some people wanted to retain links with acute services. Others felt that these hospitals should be in their respective CHPs but not yet. The Board felt that a key plank of sustainability of these hospitals is better local integration across primary and acute services. It was agreed that the future of these services, to ensure sustainability, is as an integrated service alongside Community Health Partnerships. Given feedback from the consultation - and decisions yet to be made regarding Community Health Partnerships and the West Highland Health Services Project – it agreed that now is not the time to introduce these changes. Therefore Direct Health Services be charged with bringing forward a plan to the Board by August 2004 as to how this integration can take place and the timescale, recognising the need for links with other specialist services and the need to develop ownership and commitment from those involved.

The NHS Board has revised its planned timetable in response to comments received during the consultation. Dr Gibbins said:
“Many of the comments we received expressed concern at the scale and pace of change. Some commented the focus on delivery of day to day services and achievement of key objectives may be compromised if there was too much change too quickly. As a result, we have revised the pace of the change to achieve a more phased approach. The Trusts will be abolished and the CHPs established from 1st April 2004, but the majority of the other changes will be phased in over the following year.”

Mrs Chris McIntosh, Employee Director of NHS Highland, welcomed the revised timetable:
“Staff were particularly concerned about the timescales proposed in the consultation paper for implementation of the changes. I am pleased that NHS Highland has listened to those concerns and revised the timescales accordingly.”

The NHS Board will now formally submit these proposals to the Minister for approval.

The full recommendations agreed are as follows:

(i) The Highland Acute Hospitals Trust and the Highland Primary Care Trust be dissolved at 31st March 2004 and replaced by Highland NHS Board consisting of integrated corporate and support services and a single integrated operating division entitled Direct Health Services

(ii) The precise details of the configuration and operation of CHPs be discussed in partnership with Highland Council and other stakeholders

(iii) The Highland CHP Project Steering Group continue its work, in collaboration, to determine a scheme of delegation and accountability for ratification at the December NHS Board

(iv) Three Community Health Partnerships be established from 1st April 2004 recognising that these need to be confirmed in light of the eventual guidance from the Scottish Executive

(v) As part of the proposals to develop CHPs a framework for evaluation and review be established

(vi) That current PCT Highland-wide services - Sexual Health Services, the Community Dentistry Service and in-patient Mental Health and Learning Disability Services - be hosted on behalf of Highland as a whole by one or other of the Community Health Partnerships

(viii) The CHP Steering Group be asked to define how hosting arrangements will work to ensure equitable access to services across the whole of Highland and include this in the scheme of delegation and accountability including any clinical or other networks

(ix) That specialist paediatric services be integrated into single management and the working group bring forward proposals to the December Board

In respect of Belford Hospital and Caithness General:
Ø The future of these services, to ensure sustainability, is as an integrated service alongside Community Health Partnerships

Ø Given feedback from consultation and decisions yet to be made regarding Community Health Partnerships and the West Highland Project, now is not the time to introduce these changes

Ø Therefore Direct Health Services be charged with bringing forward a plan to the Board by August 2004 as to how this integration can take place and the timescale recognising the need for links with other specialist services and the need to develop ownership and commitment from those involved

(xi) Non-clinical support services – Finance, Planning, Human Resources, IM&T and Corporate Services – be integrated under the NHS Board Chief Executive by 1st April 2004 or earlier if possible

(xii) Facilities management be integrated within Direct Health Services by 1st April 2004

(xiii) Further consideration be given, alongside the arrangements for management of Direct Health Services for ensuring there is capacity to support and lead change and innovation

(xiv) A Direct Health Services Sub-Committee of the Board be established formally from 1st April 2004, and prior to that in shadow form, to govern the delivery of integrated services across NHS Highland

(xv) The Minister be asked to appoint the full complement of six Non-Executives to replace Trustees

(xvi) Existing chief executives and clinical directors work as a single team for a transitional year to manage the operating division

(xvii) Explicit responsibilities and capacity are identified for leading and implementing the change agenda

(xviii) The existing Board governance structure be reviewed in the light of these proposals prior to taking effect on 1st April 2004 and kept under review thereafter.

(xix) The division develops plans for the complete integration of clinical services to take effect from 1st April 2005. This will include explicit accountabilities and clear schemes of delegation.

(xx) The division brings forward plans for the formal definition of managed clinical networks in Highland, the priorities for their establishment and an implementation plan