INTRODUCTION TO WORKING PAPER 5 (WP5)

Revised 19^th May 2004

On March 15^th 2004, we issued Working Paper 1 which described the process we provisionally proposed to adopt, to culminate in decisions in December 2004 after public consultation. A number of views were received by the Programme Board, which we have considered carefully. Attached is WP5 which is a revised process (and therefore replaces WP1) which is our reflection on the issues set out below.

1. Some commentators expressed surprise that cost did not appear as one of the criteria.

2. A number of commentators have suggested that we were trying to achieve too much in one day on June 17^th.

3. Some local authorities and MPs expressed a view that they should be entitled to scrutinise the data ahead of presentation on June 17^th, and present data of their own.

4. The June 17^th appraisal event was planned as an attempt to be transparent at a stage prior to consultation between mid July to end October, and therefore prior to any decision in December 2004. However, it has been interpreted by some – and portrayed to others as if an ‘irreversible decision’ will be made.

More fundamentally, some commentators queried the concept of a network of local care hospitals, supported by a single critical care hospital.

Taking this last point first, the arguments for this model were made in the Strategic Outline Case of November 2003 (and the various public engagement processes which preceded it). But the logic does need to be re-presented and re-evaluated during the formal consultation period mid July to end October, and we commit ourselves to doing this.

Furthermore, in the interests of transparency and openness, we plan to issue a working paper (ahead of formal consultation) which updates people on the ‘Model of Care’ – that is to say, the current estimation of the distribution of services between Local Care Hospital network and the Critical Care Hospital which supports it. The work of the 100 or so clinical professionals engaged in planning the distribution of services will continue to refine this.

Taking the four numbered points in order, our reflections are as follows.

1. The analysis of costs and affordability was always intended be a key part of the eventual decision in December 2004. It was not listed as a criterion because in a cost/benefit analysis, it stands alone on the cost side of the equation. In contrast the sum total of all the criteria comes together to form the benefits side of the equation. We are sorry if that was not clear from our Working Paper 2.

2. We accept we were asking too much of the panel on June 17^th. There were three factors which were to have been considered by the panel on June 17^th. These were Cost, the Local Care Hospital network, and data to appraise the location of the Critical Care Hospital.

We now plan to handle these matters differently. Each will be the subject of a Working Paper in this series, which we will introduce into the public domain in early June. We will take comments on these Working Papers up to early July. This adds 4 weeks to the overall timetable – so formal consultation will run Sept – Nov, with a decision in Jan 05.

3. Since the date of June 17^th is in many people’s diaries, we will retain that day as a ‘question and answer’ session on the Working Papers.

If MPs and Local Authorities wish to present material on that day we will be inviting them to do so. This is in addition to any written comments they may choose to make by early July; and in addition to the formal consultation period.

4. We will no longer be asking an NHS panel to meet (on June17th or any other time) to make a recommendation. Any recommendation to PCT Boards will be made in the more conventional way by their NHS officials.

But we will probably seek to convene an NHS Panel in mid July to participate in a scoring process to rank each site option in terms of benefit.

We propose that this would take place under the observation of the joint local authority overview and scrutiny committees – but insofar as the panel’s deliberations will in any event be part of the material published with the formal consultation document, this may be an unnecessary complication. We shall seek the views of the Local Authority Scrutiny Committee on this.

The analysis of revenue costs and affordability will be undertaken by the Finance Directors of the relevant Trusts and presented, as is proper, to their organisations. It will be at that time, therefore, when the 2 PCTs will reach a view as to whether the costs/benefits are so clear cut as to conclude that there is a preferred option on which to consult, or whether consultation will take place on a range of options.

The analysis of capital costs will be undertaken by our professional advisors, E C Harris and partners. This will be presented to the relevant Trusts – preceded by one of this series of Working Papers.

This process means that all commentators have two bites of the cherry – one opportunity to comment on individual working papers ahead of formal consultation, and the second opportunity to comment on the combination of the working papers when brought together to form the consultation document

In summary the steps are as follows:

(and shown on the attached diagram)

· mid March - Working Papers 1-4 were issued

· end April - comments received and considered

· mid May - WP6 issued (revised criteria and weights)

- WP5 issued – this paper (revised process)

· Early June further working papers to be issued covering the proposed network of local care hospitals; the data on which to appraise the location of the Critical Care Hospital, and capital and revenue costs.

These working papers to be open for comment until early July (plus question and answer opportunity on 17 June).

· July NHS officials to consider comments received and frame a draft consultation paper to PCT Boards.

(plus NHS panel mid July to undertake ‘benefits scoring’ exercise)

· The draft consultation document may indicate a preferred option (particularly if the analysis appears to lead to a clear position) or it may lay out the options without indicating a preference (particularly if the analysis does not lead to a clear cut position).

· Early August PCT Boards receive draft consultation paper and authorise release.

1^st September 12 week consultation begins

series of listening events, open forums, meetings through Sept, Oct, Nov

· end November Consultation concludes

· December Comments considered

· January 2005 Boards to make a decision.