news

Local health groups may be too inexperienced to take on the extra responsibilities being proposed in a radical restructuring of the NHS in Wales, according to HSJ sources.

Last week saw the launch of a consultation document by Welsh health minister Jane Hutt which recommends the abolition of the five health authorities and the transformation of the 22 existing local health groups into statutorybased local health boards.

The aim is a shift towards primary care, but senior management sources have told HSJ that LHGs - still only in their infancy - may be too inexperienced to take on the responsibilities envisaged once the HAs go.

'I think that people have looked at the system in England with primary care trusts and think they can basically impose the same structures in Wales. The problem is that some of these LHGs are small - dealing with 60,000 people. There may be too many of them to deliver what is being demanded, ' said one.

The fact that re-structuring must to be done at 'neutral cost' is another major concern.

'I do not know where the savings will come from. Cutting bureaucracy by getting rid of health authorities is fine, but you still have to run services and take on responsibilities left behind.'

Formal links between LHBs and community services will be one focus of the three-month consultation: LHBs could become accountable for community health and intermediate care, either directly or through arrangements with 'other providers', or responsibilities could remain within integrated trusts.

Director of NHS Wales Ann Lloyd said the integrated trusts set up two years ago needed time to show they could work, but pilots will also run in Powys from next year using the LHB model to see what advantages it could offer.

'We need to gather the evidence before making the decision, and we felt the integrated trust approach has to be given the chance to show it can be a success, ' she said.

Another aim is to ensure a 'direct line of accountability' from the Welsh Assembly to LHBs and trusts as well as a 'direct relationship' between Ms Lloyd's office and all chief executives and general managers.

The report recommends the creation of three directorates for North, Mid and South Wales to take on responsibility for each health economy.

Alan Brace, finance director at Pontypridd and Rhonda trust and chair of the Healthcare Financial Management Association in Wales, said the role of the directorates will need fleshing out: 'It will be interesting to see how these are going to operate between the different NHS tiers and how accountable they are going to be.'