PREPARING FOR A HEALTHY RELATIONSHIP
Advice for effective engagement with the National Health Service in Wales
1.1 From April 2003 the National Health Service in Wales will have reorganised itself once again. While NHS restructuring has been a regular, even frequent, event over many years, the changes which are currently underway (with "Shadow" arrangements coming into place in many instances from October 2002) are perhaps the first which are uniquely Welsh in their approach, reflecting the now established role of the National Assembly, and significantly different in many regards from those occurring in England. This paper summarises the key changes in the NHS and identifies issues, and opportunities, for local authorities in Wales which arise from them.
1.2 So why should local authorities be particularly exercised by this latest round of changes? For the first time these reforms attempt to put on a par with acute services a number of aspects of health in which local authorities have significant interests, both on behalf of their local population, and as service providers. Moreover, the Assembly Government has also acknowledged more strongly than before the fact that the NHS does not operate in its own vacuum, but as part of a complex social and organisational system in which local authorities are key players. As such the themes of public involvement and of partnership are reflected strongly in these changes with explicit requirements on the various elements of the new NHS organisation to demonstrate that they are operating in accordance with these themes.
1.3 The Welsh Local Government Association argued forcibly for strong local authority representation in the management of the new NHS and has been successful through having 4 representatives on each Local Health Board, the keystone of local NHS planning and commissioning and coterminous with local authority boundaries. It will be important to exploit to the maximum the opportunity which this gives local authorities to make a real contribution to the new arrangements.
1.4 However, it is equally important to recognise that these are not just changes to the health service structure into which local government is expected to fit. New duties are also laid on local authorities, particularly in relation to the newly required Health and Well-Being Strategies (possibly to be known in Wales as Health, Social Care and Well-Being Strategies) and participation in the commissioning of health services locally. As such, local government needs to prepare itself effectively to maximise the benefits of these opportunities.
1.5 Because much of the detailed work involved in the restructuring is still underway, it is not possible to offer definitive advice at this stage. Equally, because one of the intentions of the reforms is to promote local solutions to local problems, no single model can apply: to give the most obvious example, in Powys an approach to the management of NHS community health service provision is being introduced which is specifically different from the rest of Wales. However, Powys County Council will have 4 places on the Powys Health Board and there will be the same duty on the local authority and health board to produce a health and wellbeing strategy for Powys. Therefore in relation to LHB participation and the duties to produce Health and Well-Being Strategies, the ideas and suggestions in this paper about how local authorities might prepare themselves to engage effectively with the new NHS structures to maximise their influence on and contribution to these and, through them, to the health and well being of the people living in their area are equally applicable to Powys county council.
The advice in this paper is based on information available in September 2002 from draft Regulations, Guidance and internal National Assembly working papers about the structures and arrangements arising from NHS reforms in April 2003.
2.1 A fundamental aim of the NHS Wales Plan is to have clearer lines of local accountability, a patient and primary care led NHS and to deliver tangible improvements in the health and well being of the population. In achieving this, the new arrangements are intended to
_ Be simpler for patients to understand
_ Be accountable for the actions it takes and the service it delivers
_ Have a stronger democratic voice in the way it is governed
3.1 Arguably even more important than what is changing, is what is remaining unaltered. No organisational changes are occurring in the NHS Trusts in Wales (with the exception of Powys) which are the direct service providers of most secondary health care and community health services. Nevertheless, the Trusts are expected to engage more effectively with other elements of the new structure, based on a partnership approach. This is culturally significantly different from the purchaser/provider or commissioner/contractor model that has been the basis of the NHS for a decade.
3.2 For the rest, however, radical changes are occurring:
3.2.1 The existing 5 Health Authorities (HAs) are to be abolished and , replaced by 22 Local Health Boards (LHBs), coterminous with local authorities.
3.2.2 The LHBs will be "stand alone" statutory bodies within the NHS, responsible for the majority of what were previously health authority functions. In addition to the joint statutory duty with local government to produce a Health and Well-Being strategy, they will:
_ Secure the delivery of primary and community health services for their area, including NHS occupational therapy, physiotherapy and intermediate care
_ Commission most secondary health care, eg acute hospital care in partnership with the local authority and NHS Trust
_ Have a joint role with the local authority to improve the population's health
_ Lead an NHS public engagement strategy
_ Increasingly be involved in the direct provision of primary care services
_ Be responsible for securing the delivery of most health authority public health functions and health improvement services
3.2.3 However, LHBs will not be responsible for the full range of duties:
_ Some specialised services (eg some cancer services) will be commissioned by a new agency, the Health Commission Wales (Specialist Services), based within the Welsh Assembly Government.
_ For some local services, some LHBs will be required to do their commissioning in partnership with neighbouring LHBs.
3.2.4 A new National Public Health Service for Wales is being established as part of the Velindre NHS Trust. As well as undertaking existing public health responsibilities, this organisation will also absorb NHS health promotion functions. The National Public Health Service (NPHS) will draw together the majority of public health functions that are currently managed by Health Authorities. The NPHS will be hosted by Velindre NHS Trust but staff will be working through the 3 NHS regional offices, each of which will have a Regional Public Health Director. The NPHS will have a Service Level Agreement with each LHB which will now have the statutory responsibility for undertaking most of the NHS's public health duties in its area. The LHBs will receive dedicated specialist public health support through a specialist employed in the NPHS who will also be a member of the LHB Board. Local authorities also depend on the health authority public health service for a variety of functions and will want to be assured that access to these services will not be impaired by the changes (see section 7 below).
ACTION POINT: Authorities will need to satisfy themselves that their access to public health advice will be maintained and strengthened, and should enter dialogue with the Director of Public Health for their area and their shadow LHB about the new arrangements at the earliest opportunity.
3.3 These arrangements are summarised in tabular form as Appendix 1.
3.4 Clearly in such a complex set of arrangements it is vital for the various elements to work closely together, not just in the development phase to ensure that no duties or responsibilities are overlooked, but continuously to ensure effective use of resources and service quality. A number of examples already exist of this being built into the structure: each LHB must have as a member a public health specialist, someone employed in the National Public Health Service; some other LHB members are likely by nature of their professional background to be employed in NHS Trusts, while Chief Executive and Chairman of Trusts are likely to be included in the proceedings of LHBs as associate members.
3.5 Fundamental to the role of the LHBs is the duty to work in partnership with the local authority to develop, formulate and publish a Health and Well-Being Strategy for their area in "co-operation" with other parties. This represents a further stage in attempting to integrate the often disparate planning requirements laid on local and health authorities and as such offers a real opportunity to local authorities.
4.1 The Welsh Assembly Government is determined that these Strategies are a new development not just in terms of outcome but also of the process by which they are constructed. Although they are the dual responsibility of the new Local Health Boards and of local authorities, they are to be developed in a way that is inclusive of all relevant partners, particularly , Community Health Councils, the voluntary sector and NHS Trusts. They are expected to involve representatives of local voluntary organisations and businesses involved in or which have a contribution to make to health,social care and wellbeing locally.
4.2 As the statutory responsibility of local government and Local Health Boards the Strategies must be reviewed and formally approved on an annual basis. Both must develop annual operational plans to implement the priorities of the Strategy. In terms of scope, the strategies are formidable, setting the strategic planning framework for health and well-being in each local authority area. The links between the development of the health and wellbeing strategy and the community strategy is critical. The commuity strategy which sets a 10-15 year vision and priorities for the area is the overarching strategy. The local health, and well-being strategy and the partnership arrangements to support its development should have a clear relationship to the Community Strategy Partnership and the Community Strategy. The H&WB strategy will both inform and reflect the headline strategic objectives and priorities set out in the community strategy and support its implementation. Most importantly, health and wellbeing strategies are to be based on a comprehensive assessment of local health and well-being needs. Local authorities have much information which they can contribute to this.
ACTION POINT: Authorities should review how their sources of information and data are coordinated and accessed corporately to maximise their contribution to the new Health and Well-being Strategies
4.3Each local authority and LHB should develop a strategic approach, involving all relevant partners, to the health of the population in the local authority area through investment in and the development and provision of services and action to tackle poor health and health inequalities and to improve health and social care services. This approach should span the whole spectrum from preventative action and regulation to improve the population's health and reduce the risk of ill health to acute and long term care services providing by both the local authority and the NHS, including primary health care, community health services, hospital and specialist health services, domiciliary or residential care.
4.4 A summary of the key features of the Strategies is attached as Appendix 2.
4.5 As well as representing an exciting opportunity, these new requirements also offer authorities some real potential challenges. Complex planning arrangements across all local authority services both individually and corporately already exist and a few of these will be replaced by the new Health and Well-being Strategies. Authorities will need to review their existing planning activity both in terms of structure and content to avoid future duplication and to ensure that full account is taken of the priorities and needs identified in the Health and Well-Being Strategy in their other plans. Ensuring that successful existing partnership and planning arrangements such as Health Alliances, Children and Youth Partnerships and similar bodies fit effectively with the new Health and Well-Being requirements for developing the strategy and consulting on it, will go a long way to maximising their own and the LHB's performance.
ACTION POINT: Authorities should consider reviewing their existing planning arrangements to ensure they will meet the requirements of the Health and Well-Being Strategies in the most effective way, both feeding in the local authority perspective and reflecting health priorities.
4.6 Although the new requirements may lead to some rationalisation the Assembly has recognised that the increased level of joint working and of developing and cross-referencing of plans will place additional burdens on authorities. There is a real possibility that some medium-term resources may be available to local authorities in response to this. Again, authorities might consider how best to deploy any such resources should they indeed become available.
ACTION POINT: Authorities may wish to consider and discuss with their shadow LHB the deployment of new and existing planning staff at a service and corporate level
4.7 However, this is not just an issue of process - the National Assembly clearly sees local authority experience in coordinating a range of statutory and non-statutory partnerships as very useful in contributing to a more coherent and comprehensive well-being approach, utilising their community leadership role to bring about actual change and improvement.
ACTION POINT: Authorities should "map" their existing plans and partnership arrangements and clarify their interrelationships and links
4.8 In addition to working in "co-operation" with relevant partners, local authorities and LHBs are required to consult the community on both the Needs Assessment and on the draft Strategy before the final version is formally adopted. In deciding how to co-operate with relevant partners and what consultation and public participation mechanisms to use, it will be important to build on existing mechanisms and structures and avoid duplication with other local public engagement mechanisms.
ACTION POINT: Authorities should identify relevant user consultation mechanisms and fora that could contribute to strategy development and agree a joint approach to their utilisation with them and their shadow LHB
5.1 Although all the new elements within the NHS structure are important, inevitably much of the focus will be on the new LHBs, not least from a local authority perspective because of their shared boundaries and direct participation. Interestingly, local authorities are both a partner of their LHB and provide a significant number (4) of the membership.
5.2 The exact number of LHB members may differ slightly according to local circumstances (details as currently known given at Appendix 3), but will always be in excess of 20. As such the nature of the operation of the Board (which it is envisaged will meet every 2 months) has considerably altered from how it was originally conceived and will depend heavily on Executive Officers and a range of sub-committees (see Appendix 4) to conduct the day to day business. While it is obviously too early to say exactly how all this will work in practice, some similarities to Council structures could be anticipated, with the Board being seen as the equivalent of a full Council meeting. Overall, significant commitment of time (Board members must formally agree to devote 2 days per month to these duties) is likely to be required by all Board members and any practical difficulties of clashing commitments such as Board and Council meetings taking place at the same time need to be identified and resolved at the earliest possible moment.
5.3 Local Authority representatives are not "delegates" to the LHB; indeed, given that as members of the Board they will have personal responsibilities in that capacity they could not be so. While authorities will obviously make their own decisions about who to appoint, the WLGA would recommend that, in common with all other Board Members, they will have strong links with the local community and should have an understanding of local health and well-being issues along with a commitment to improving health and well-being locally.
ACTION POINT: Authorities should decide who will represent them on the LHB as soon as possible, aiming to maximise their contribution and taking account of the expectations, opportunities and commitment this will require of those involved (see paragraph 6.3 below for further comment).
5.4 The commissioning of secondary hospital services from NHS Trusts will now be devolved to LHBs who must create a commissioning partnership with their respective local authority and the relevant Trust(s) This is therefore a major opportunity for local government to contribute to the priorities for and development of hospital services in their area. Decisions on commissioning secondary services will be based on the needs and priorities identified in each Health and Well-Being Strategy, although in the first year these are likely to be based on the content of the existing NHS Health Improvement Programme (HIP). It is not yet clear how membership of these commissioning partnerships will be determined and, given that LAs will have 4 places on the LHB, authorities need to consider how they can most efficiently and appropriately contribute to secondary care commissioning.
5.5 In some areas and in relation to particular specialisms, the relevant Trust's services cover patients who live in more than one local authority area. Where this occurs, it has been decided that two or more LHBs and their respective local authorities will come together in a commissioning arrangement to jointly commission the services (see Appendix 5 for the specified regional groupings). Over and above this, however, it will be for each LHB and its respective authority to decide when it is appropriate to work in this way to achieve efficiency and best value for money. These jointly commissioned services will still be based on an aggregation of what is in each local strategy.
5.6 The LHBs will be overseen by one of 3 Regional Offices (N Wales, SE Wales, SW Wales) whose role is emphasised as enabling and coordinating rather than dictating, but although the chairs of the LHBs are directly responsible to the Minister at the Assembly, line management does run down from the Director of NHS Wales via the Regional Offices to the Chief Executives of the LHBs.
6.1 Local Authorities will recognise from their own experiences in the mid-1990s that much of the current effort within the NHS is being devoted to ensuring that all existing functions are properly transferred to the new bodies within the organisation, that human resources issues, legal authority to conduct business and the whole range of very practical requirements to ensure smooth transition is accomplished without detriment to patients.
6.2 The fact that the NHS Trusts are remaining in their current form will undoubtedly assist in continuity, while the transfer of Health Authority functions across several different bodies perhaps offers added risk. Local authorities will also wish to consider the changes from two perspectives:
_ Areas of service where they rely on the NHS for support or assistance (see section 7 below).
_ Areas of opportunity within the new arrangements to enhance both the local authority role and, more importantly, the positive outcomes for citizens.
In addition, at a practical level, they will need to give consideration to the steps they need to take to prepare themselves for the changes.
6.3 Local Authorities must arrange their 4 representatives to be members of their Local Health Board. As the draft Assembly Regulations currently stand at least one must be an elected Member, and one must be a "senior social services official". These limits still offer authorities considerable scope in their choice and these choices will need to reflect each authority's own organisational and democratic structures. Authorities need to recognise, however, that neither elected member nor officer representatives are delegates to the Board, but are Board Members in a personal capacity and some thought should be given to the implications of this for those involved.
6.4 Other underlying issues for authorities are
6.4.1 How can the proceedings of the LHB be effectively linked in to those of the Council? There is little point in having the local authority well represented if what happens at the LHB is dislocated from events and thinking within the Council. Having the appropriate Cabinet/Executive Member(s) may address this point, although remembering that they are not at the LHB in their formal Councillor role. Some LHB Chairs have indicated a willingness to attend appropriate Council meetings to brief elected members on the LHB's work. But what is going to be most effective for each Council needs some early consideration. Obvious links to be made are between the new Health, Social Care and Well Being Strategies which LHBs must devise and the Councils' Community Plans, and UDPs but there are many other more specialist areas (transport, education, etc) and thought should be given to how to integrate these planning arrangements as far as possible to avoid duplication or, worse, conflict of aim.
ACTION POINT: Authorities should consider reporting mechanisms and routes to ensure that they are well informed about the work of LHBs and allied activity and vice versa.
6.4.2 As with elected members, officers of the council will have personal obligations as LHB members. While it would not be realistic to anticipate regular potential conflicts of interest in these roles, nevertheless Authorities should consider what are their expectations of officers to avoid placing them in invidious positions.
ACTION POINT: Authorities should clarify any expectations they have of staff who become members of LHBs and ensure that these are not in conflict with their obligations as LHB members
6.4.3 For all representatives, time is likely to be an issue. While it is envisaged that the LHBs will meet only every two months and that members will commit themselves to only 2 days work per month for the Boards, a significant array of sub-committees are to be set up. Experience of other NHS work shows that there will also be considerable additional ad hoc activity. In determining their nominees for the LHB local authorities need to give detailed consideration to the implications of this, along with the more mundane but very practical matters: for example, if an elected member or officer is nominated and the LHB meetings clash with a Council requirement (eg Cabinet, Scrutiny Committee) on a regular basis. The obvious step of nominating a more junior officer may not be the best way of maximising the effects of LHB membership - the NHS is looking for representation experienced in local authority work and thinking.
ACTION POINT: In determining nominations to the LHB, authorities should take account of workloads and competing commitments of those involved.
6.4.4 For those nominated who have limited experience of the inner workings of the NHS, membership of the LHBs may be a challenging experience initially. While the proceedings of the Boards may be superficially familiar, the role of senior NHS Managers as members of the Board offers a significant difference as will having both Members and local authority officers as members of the same Board. Moreover, the agendas can sometimes seem a strange mix of the massively strategic and general and the very specific and particular, relating to decisions over the expenditure of a few pounds. The National Assembly intends to offer training for all LHB members and this will no doubt be valuable, by local authorities may wish to consider how they themselves will prepare nominees and support them through at least the early days of the Boards, not least in relation to financial issues which are sure to dominate a good deal of time and energy (see section 8.6 below).
ACTION POINT: Authorities should consider the training requirements of their LHB representatives and opportunities, including those provided internally and by Syniad, as well as by the National Assembly
6.4.5 With partnership working as one of the foundations of the NHS changes it is no surprise that the Welsh Assembly Government is taking the opportunity to press the role of the Voluntary Sector and its importance to the health service. Health Authorities developed Voluntary Sector Compacts in much the same way that local authorities have done (indeed some authorities have introduced a single, tri-partite Compact) and LHBs will be responsible for taking these on. The Assembly sees the voluntary sector as contributing advocacy, self-help, actual service provision, and research and innovation and has developed a checklist for the NHS bodies to use to ensure that they are working effectively in partnership with it. A copy of this is given at Appendix 7 and local authorities may find it helpful to consider a similar approach not just in the context of the NHS changes but in their own overall approach.
ACTION POINT: Authorities should use the NHS voluntary sector checklist to compare their approach to partnership working to that being developed in the health service
7.1 As indicated, local authorities rely on the NHS for a variety of services, advice or support for functions where they have lead responsibility. A list of such areas and issues is given at Appendix 6, along with an indication of where, within the new health service arrangements, the NHS input can be accessed in future. However, local authorities need to consider for themselves any service issues which should be added to this list and make enquiries as to how these will be maintained after April 2003.
ACTION POINT: Authorities should ask all Departments to identify areas of activity and statutory functions where the NHS currently provides a service and check successor arrangements at the earliest possible time with their shadow LHB
8.1 The restructuring of the NHS offers a number of new opportunities for local authorities.
8.2 More effective influence over NHS planning at a local level
With shared boundaries between local authorities and the new LHBs comes a genuinely shared focus on the local area and population. While some commissioning decisions (for example, on specialist services) will lie elsewhere, there should be an unprecedented "ownership" of the new boundaries within the NHS and, as such, greater common cause. The shared responsibility for producing, and delivering the new Health and Well-Being Strategies will also make a major contribution to this.
8.3 Better "fit" with Council's corporate agendas
As councils continue with their own process of modernisation, developing their own strategic priorities, the NHS changes are timely. Not only do they give local authorities themselves further encouragement to think about how they will themselves address health issues locally, but they also provide a forum to which to take those priorities and have them integrated in the broader development of health planning and delivery. Councils should identify a small number of key priorities which can be promoted within the new LHBs, bearing in mind that they wide and large membership of these bodies will make prioritisation potentially very competitive.
8.4 Greater democratic input
While some authorities have already achieved elected member cooption or other representation on Local Health Groups, the new changes offer direct participation in the LHBs, albeit not as Council "delegates". As well as an opportunity promote the Council perspective within the health service, membership of LHBs also gives elected members access to the whole range of health service "interests" and will allow them to be better informed about and influence all aspects of the health service. Having argued successfully for this, councils must consider carefully their expectations of the new system and how to show the "added value" of what they have pressed for. Effective two way links between the Council's own proceedings and the LHBs are a must.
8.5 Improved Health Service Support for local authority functions
The purpose of the changes is, of course, not just to maintain existing standards but to improve. As well as the more local focus of planning and commissioning which should achieve better outcomes for local people, service providers are also looking to improve what they can offer. In particular the National Public Health Service wishes to provide not just greater levels of expertise at a national and local level, but to look to provide a broader range of such expertise and support to local authorities. Local authorities have an opportunity with all the new health service bodies to promote their own priorities and to help reshape the direction of these services as they become established, particularly through the medium of the local Health and Well Being Needs Assessment which must be carried out.
ACTION POINT: Authorities should consider the opportunities for gaining improved health service support at corporate level and assess the potential for utilising the new National Public Health Service, perhaps via nominating a "lead" in this field.
8.6 More flexible use of resources
8.6.1 The conventional wisdom about partnerships and joint working is that it gives "added value" through unlocking additional resources (not just financial) and for those resources to be used more effectively. The new structure of the NHS does offer the prospect of increased use of "new flexibilities" in this way resulting from closer joint working at political as well as officer level. However, authorities also need to be aware of some cautions in this:
8.6.2 Despite considerable extra funding for the NHS in Wales in recent years, many Health Authorities have been overspending and some are in a process of financial "Recovery". As such, LHBs may, in some cases, inherit financial deficits which they have to redress. In addition, many areas are also overspending on their prescribing budgets (7 figure sums are not unknown) and, again, these sums may have to be redressed by LHBs.
8.6.3 Added to that is a new basis for the allocation of funds between LHBs although changes arising from this will not begin until 2004. Overall, Health Service finance, like that of local authorities, can seem obscure at times and authorities might look to training for their representatives in this field specifically (see paragraph 6.4.4 above).
8.6.4 Overall then, the financial position in some areas may be far from comfortable and local authorities may need to consider how they use their own resources in pursuit of the strategic health improvement in support of the health service as much as looking for additional resources from that source in support of their own contribution to this activity.
ACTION POINT: Authorities should assess preliminary financial position of their Local Health Board at the earliest opportunity and also consider their own approach to flexible use of budgets in light of the opportunities offered by the NHS changes
Conclusion and Summary of Action Points
9.1 The forthcoming changes to the NHS offer a more community focussed and integrated approach to health than currently. As such they represent a considerable opportunity for local authorities to influence the future of health, as well as of the health service, in their area.
9.2 With those opportunities come additional responsibilities: not just the legal duties in respect of the Health, Social Care and Well-Being Strategy, important although that is, but in commitment and contribution to the new structures of the health service. To make the most of these considerable investment of time and resources is likely to be required.
9.3 Most local authorities in Wales have already worked hard to establish effective working relationships with all aspects of the health service and these changes provide the chance to take this forward to the next level. By the same token, because each authority is different, no report of this nature can hope to provide suggestions which are relevant or appropriate to all. The Action Points which have been highlighted are therefore not intended to be prescriptive but do, hopefully, offer some ideas which authorities can consider in their own preparation for these changes. Those Action Points are summarised again below:
_ Authorities will need to satisfy themselves that their access to public health advice will be maintained and is strengthened, and should enter dialogue with the Director of Public Health for their area and their shadow LHB about the new arrangements at the earliest opportunity. [paragraph 3.2.3]
_ Authorities should review how their sources of information and data are coordinated and accessed corporately to maximise their contribution to the new Health and Well-being Strategies. [paragraph 4.3]
_ Authorities should consider reviewing their existing planning arrangements to ensure they will meet the requirements of the Health, Social Care and Well-Being Strategies in the most effective way both feeding in the local authority perspective and reflecting health priorities. [paragraph 4.6]
_ Authorities may wish to consider and discuss with their shadow LHB the deployment of new and existing planning staff at a service and corporate level. [paragraph 4.7]
_ Authorities should "map" their existing plans and partnership arrangements and clarify their interrelationships and links. [paragraph 4.8]
_ Authorities should identify relevant user consultation mechanisms and fora that could contribute to strategy development and agree a joint approach to their utilisation with them and their shadow LHB. [paragraph 4.9]
_ Authorities must determine their nominations for LHB membership as soon as possible, aiming to maximise their contribution and taking account of the expectations, opportunities and commitment this will require of those involved. [paragraph 5.3]
_ Authorities should consider reporting back mechanisms and routes to ensure that they are well informed about the work of LHBs and allied activity and vice versa. [paragraph 6.4.1]
_ Authorities should clarify any expectations they have of staff who become members of LHBs and ensure that these are not in conflict with their obligations as LHB members. [paragraph 6.4.2]
_ In determining nominations to the LHB, authorities should take account of workloads and competing commitments of those involved. [paragraph 6.4.3]
_ Authorities should consider the training requirements of their LHB representatives and opportunities, including those provided internally and by Syniad, as well as by the National Assembly. [paragraph 6.4.4]
_ Authorities should use the NHS voluntary sector checklist to compare their approach to partnership working to that being developed in the health service. [paragraph 6.4.5]
_ Authorities should ask all Departments to identify areas of activity and statutory functions where the NHS currently provides a service and check successor arrangements at the earliest possible time with their shadow LHB. [paragraph 7.1]
_ Authorities should consider the opportunities for gaining improved health service support at corporate level and assess the potential for utilising the new National Public Health Service, perhaps via nominating a "lead" in this field. [paragraph 8.5]
_ Authorities should assess preliminary financial position of their Local Health Board at the earliest opportunity and also consider their own approach to flexible use of budgets in light of the opportunities offered by the NHS changes. [paragraph 8.6.4]
This report has been prepared for the Welsh Local Government Association by Q&A Management Services Limited. Should you require any information about Q&A Management Services Limited they can be contacted on 01873 859941 or by email at QAMS@fsmail.net
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