Hampshire County Council

Health Overview and Scrutiny Committee Item 7

28 March 2006

Health Overview and Scrutiny Thematic Review Programme

Report of the Chief Executive

Contact: Martin Combs ex 7479

e-mail martin.combs@hants.gov.uk

1. Summary and Purpose

1.1 The purpose of this report is to provide members with a progress update on the review programme agreed by the Committee in May 2005 for 2005/6.

1.2 The format and focus of each topic presented reflects the previously agreed criteria selected by members, namely:

2. The Thematic Reviews

2.1 Two thematic reviews have been undertaken:

2.2 The background, key issues and recommendations will be summarised in this report, but each review is appended in its own right for further information.

2.3 This report and supporting recommendations support the delivery of the annual work programme of the Health Overview and Scrutiny Committee for 2005/6, and Aim 5 (Improving Services) of the Corporate Strategy.

3. Review of Public Health & Wellbeing

3.1 Background to the Public Health & Wellbeing Review

3.2 Responses and updates to the Public Health & Wellbeing Review

3.3 Key issues in Public Health & Wellbeing

3.3 Recommendations for Public Health & Wellbeing

4. Review of Out-of-Hours Service Provision

4.1 Background to the Out-of-Hours Review

4.1 Key Issues in Out-of-Hours

4.2 Recommendations for Out-of-Hours

Section 100 D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents that disclose exempt or confidential information as defined in the Act.

Appendix One

Hampshire Health Overview and Scrutiny Committee

Review of Public Health and Wellbeing in Hampshire

1. Introduction

1.1 Public Health and Wellbeing was identified as an area of interest for the Committee's Review Programme for 2005/6. Since then Government has given increasing attention to improving the health foundations for citizens of all ages by identifying that a preventative agenda is the way forward for Local Authorities and Health alike. This review attempts to bring together summary information from Local Authority and Health sources into one place to enable members to view at a glance initiatives being undertaken against a generally acknowledged set of objectives.

1.2 Of significance are the recent statements by the Secretary of State for Health which say that HOSCs are increasingly conducting reviews that recognise the role of local authorities in improving community wellbeing, instead of only focusing on the NHS. The Secretary of State also says that Scrutiny Committees are very active, not only looking at the planning and delivery of healthcare, but increasingly tackling the public health agenda and promoting what local councils can do to improve health

1.3 Since the Committee selected public health as a key topic for review there have been a number of national and local developments that have significantly raised the profile of this work and the way in which it can be most effectively delivered for local people. Key drivers of change have been:


1.4 Hampshire County Council's published Local Public Service Agreement schedule supports the Public Health and Wellbeing agenda, where some targets have a direct bearing on objectives in this paper.

1.5 As a consequence the Committee has been able to work with those currently considering the way in which public health is planned and delivered across Hampshire. The emphasis of this initial report has therefore been on identifying activities already taking place across Hampshire, to inform the identification of any gaps and more importantly, highlight good practice.

1.6 This report therefore, represents one element of a number of work strands that are currently being progressed.

1.7 Particular thanks need to be expressed to Katie Crabbe and Mary Amos for their contribution to the findings that informed this report.

1.8 The report and recommendations provide members with an opportunity to inform and influence the planning and delivery of Public Health across Hampshire and therefore support Aim 5 (Improving Services) of the Corporate Strategy.

2. Public Health and Wellbeing Objectives: reported activity - updated

2.1 The first draft of the Review of Public Health and Wellbeing was circulated with the intent that Districts, PCTs, LSP Chairs, and the Public Health Network could comment on it, or provide information if they felt that representation of work or initiatives should be more accurately reflected. As a result, Rushmoor Borough Council and Mid Hampshire PCT sent additional information, and the tables have been adjusted to reflect the new material.

2.2 The SHA, in addition, sent a draft Review of Delivering Choosing Health: making healthier choices easier in Hampshire and Isle of Wight, published by the SHA, December 2005. The review addresses nine National Service Framework targets and uses the self assessments of PCTs to record progress against the targets. While there is partial co-incidence of the targets, and objectives considered in this paper, The SHA Review does not, however, focus on the wider Public Health and wellbeing initiatives or objectives planned by the PCTs for their areas.

2.3 The earlier draft produced by the Committee attracted two types of comments. Some comments have expressed appreciation of the attempt to bring together Public Health and Wellbeing information from NHS and Local Authority sources. On the other hand, some have expressed concern that the tables may not be underpinned with enough information to give a fair representation of the relative contributions of the different bodies to the objectives. This latter issue is acknowledged and has been addressed where organisations sought to assist by providing that information. The paper also acknowledges that in summarising, details get lost.

2.4 This is a complex area to analyse, reflecting the diverse nature of communities across Hampshire. As such, this is only a `snapshot' of information provided to us in October 2005. This work gives an impression of the range of work currently being taken forward by local Government and the NHS across Hampshire and hopes it may be seen as a whole system.

2.5 The following tables capture initiatives taken forward by Hampshire County Council, Hampshire District Councils and Primary Care Trusts (PCTs) against the national standards for Public Health/Well-being outcomes. Symbols are used to provide a quick indicator of work initiated or planned in different communities.

2.6 The additional information has been gratefully received, however caution should still be exercised since it is still probable that the tables may not include all activity, and some commitments to initiatives may have been frustrated due to lack of funding or critical staff shortages. Therefore the charts are primarily indicative of activity or achievement and not absolute guides.

2.7 The tables try to align council areas with PCT areas as far as possible. This is a first draft attempt to consolidate information about progress against the Public Health objectives. In subsequent reports it may be helpful to include, where possible, activity by voluntary sector partners.

2.8 What do the symbols represent? Given the foregoing comments, the responses have been analysed as follows:

2.9 Please note: this report does not see its purpose as judgemental, but rather as an instrument, and in so far as it summarises activity and intent, broad brush. In particular we are very conscious that the difficulty in aligning county, district and health boundaries of influence (administrative responsibility) and activity, in turn this makes it difficult to consolidate information. The tables attempt to relate district with local health boundaries, whilst county activity is taken to be broadly true for all district and health areas. The current consultation `Commissioning a Patient-Led NHS' provides an opportunity to addresses some boundary anomalies between local government and the NHS

2.10 The report is organised to reflect the following health and well-being objectives:

2.11 The objectives include the `Health Improvement Foundations for LAAs' developed by the Government Office for the South East in conjunction with the Department of Health. They also capture the `overarching priorities' of the Government/Department of Health white paper, `Choosing Health: making healthy choices easier', 2004.

Objective 1: Reducing the number of people who smoke

County Council

District Council

PCT


Departments

    · PBRS

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 2: Drinking sensibly and harm reduction

County Council

 

District Council

 

PCT

 

Departments

· Trading Standards

· Hampshire DAAT

· PBRS

_

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

 

_

Fareham

_

Fareham & Gosport

_

Gosport

_

 

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

 

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

 

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

 

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

 

_

New Forest

_

New Forest

_

Comment:

Objective 3: Reducing health inequalities

County Council

District Council

PCT

Departments

· Environment

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 4A: Tackling obesity - Healthy eating for adults

County Council

District Council

PCT

Departments

· PBRS

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 4B: Tackling obesity - Increasing physical activity for adults

County Council

District Council

PCT

Departments

· R&H

· Environment

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 5: Helping children and young people to lead healthy lives

County Council

District Council

PCT

Departments

· Children's Services

· R&H

· PBRS

· Environment

_

_

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 6: Mental health and well-being

County Council

District Council

PCT

Departments

· R&H

· Adult Services

· Children's Services

_

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 7: Promoting healthy and active life amongst older people

County Council

District Council

PCT

Departments

· Adult Services

· Corporate Comms

· R&H - Arts Service

_

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

Objective 8: Promoting health and well-being

County Council

District Council

PCT

Departments


· Chief Executive's

· Adult Services

· R&H

· PBRS

· Trading Standards

· Environment

· Health Scrutiny

· Hampshire DAAT2

_

_

_

_

_

_

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

3. Promoting health and well-being Sub-objective

3.1

Promoting health and well-being

What staff have the specific remit for promoting health?

3.2

Improving fitness levels

What partnership initiatives such as `walking to health' are in place?

3.3

Health & Safety/Food safety and environmental health

What local initiatives are in place?

3.4

Working to improve the health service

What specific initiatives are in place across PCTs?

Objective 9: Promoting health and well-being for LA staff

`investing in the workforce'

County Council

District Council

PCT

Departments


· HR

· R&H

· Chief Executive's

· Environment

_

_

_

_

Hart

_

Blackwater Valley & Hart

_

Rushmoor

_

_

Fareham

_

Fareham & Gosport

_

Gosport

_

_

Havant

_

East Hampshire

_

East Hampshire (S)

_

_

East Hampshire (N)

_

North Hampshire

_

Basingstoke

_

_

Winchester

_

Mid Hampshire

_

Test Valley (N)

_

_

Test Valley (S)

_

Eastleigh & Test Valley South

_

Eastleigh

_

_

New Forest

_

New Forest

_

Comment:

4. Summary and Key Issues

4.1 This paper sets out the first steps in identifying plans and programmes to improve the health of people living in Hampshire. It provides a baseline, albeit tentative, of progress reported against national objectives for Public Health. By drawing together work undertaken by local government and the NHS in Hampshire, a dialogue across different communities can be encouraged, raising the profile of public health and supporting any further action required.

4.2 The County Council, local NHS and District Councils have recently undertaken a programme of seminars to support the effective delivery of Commissioning a Patient-Led NHS. Part of this work includes consideration of the local arrangements that need to be in place to improve the health of the population of Hampshire.

4.3 This version of the paper is the final draft, however it is hoped that the work will be taken up and continued, possibly by the Public Health Network, who are in the best position to discover and consolidate Public Health and Wellbeing activity across Hampshire. As a living document, it will always be valuable for stakeholders to identify how the Review could be improved by better local information, and presentation. The potential to better identify partnership working and including the contribution of voluntary sector partners could add further to a more holistic perspective.

4.4 It is noticeable that in some reports provided by NHS organisations, lack of resource prevents progress on some issues. Given the breadth of the Public Health and Wellbeing agenda, resources will always face the challenge of finite resources, but resources will need to follow commitment to agreed objectives.

4.6 Further updates and amendments will then be driven through lead officers in local government and NHS organisations. A report back on progress will be presented to the Committee at the November meeting

5. Recommendations









Glossary

Hampshire County Council departments

Appendix Two

Hampshire Health Overview and Scrutiny Review of Out-of-Hours Services in Hampshire

1. Introduction

2. What does the `Out-of-Hours' service consist of?

3. National Quality Requirements: Out of Hours

4. Terms of reference for the SHA Review Group

5. Current Hampshire Out of Hours

6. Learning from current out-of-hours models and experience

7. Recommendations to the Chief Executive Community

7.8 Whilst the principle of a pan-Hampshire out-of-hours model may promise operational benefits in terms of efficiency and economies of scale, the `phased' process will be complex, at least in the shorter term. The Committee will therefore be interested in contributing to this work and would highlight a number of initial questions for consideration by the Implementation Group:

8. Next Steps in progressing Out-of-Hours in Hampshire

8.1 Whilst many questions may have been prompted by the SHA Review and the proposed way forward, it should be emphasised that despite the different models of service currently in operation in Hampshire, much success has been achieved since 2004 with relatively little turbulence. An example of this would be the change of providers in South West Hampshire which has significantly reduced the number of concerns raised with the Committee.

8.2 It should also be acknowledged that the journey towards the `strategic direction of travel' ie. achievement of a pan-Hampshire model, is closer to the starting point than the finishing line. The next stages will require the development of a comprehensive plan for engaging with key stakeholders. This will be critical at a time when the local NHS is likely to be experiencing significant reorganisation. Consultation is likely to follow and the Committee will wish to play a full part in this.

8.3 The SHA recognises that scope exists for improving consistency and achieving efficiencies, and will work closely with the Committee as the implementation programme is developed.

9. Recommendations

9.1 The SHA Review provides a useful summary of information about current performance of Out-of-Hours in Hampshire, and is helpful in identifying a way forward that will support the development of an integrated pan-Hampshire model for OOH services. The Committee has previously acknowledged the complexity of OOH care and the additional challenges that national policy changes will pose for local service delivery. In taking this work forward it is recommended that the Committee continues to take an active interest in the development of OOH services. In the first instance it would be helpful to have a response to the queries raised in 7.8 of this report.

9.2 In addition the Committee will wish to have a response to the following:

9.3 The SHA leads be invited to the May meeting to advise members of their response to the issues raised and confirm the next steps in moving this process forward.

Appendix