Contact: Yvonne Le Brun, ext 7790 or Carole Bennett, ext 7153

1. Introduction

1.1 Local health organisations in North and Mid Hampshire, comprising the health authority, primary care trusts and groups (PCT/G) and NHS Trusts, have been required to develop a Performance Improvement Plan (PIP) to meet the targets set out in the NHS Plan and achieve a financial balance by 2004. While the NHS in North and Mid Hampshire is performing well, there is currently a financial deficit of £7.5 million.

1.2 The PIP comprises a number of plans that have been developed at PCT/G level. The Health Authority led the process resulting in the production of a public information document `Improving Performance in North and Mid Hampshire: Setting the Context', attached as Appendix 1. The document states that most of the plans will not involve changes to the way patient services are delivered but savings will come from doing things differently and through more efficient use of NHS land and buildings. Views are welcomed but it is not a consultation document.

1.3 Where the proposals do require changes to the way in which patient services are delivered, the public will be consulted and a companion document entitled `Paper 1: Consultation on proposals to modernise health services in North Hampshire by redesigning intermediate care and developing new partnerships for orthodontics' is the first of a series of proposals emanating from the Performance Improvement Plan. This document, attached as Appendix 2, is out for consultation until 31 January 2002.

1.4 This report examines the impact of the proposals on health and social care services in North and Mid Hampshire and seeks approval of the formal response of the County Council to both publications.

2. Improving Performance in North and Mid Hampshire: Setting the Context

2.1 In 1999/2000, the health community produced `Meeting the Challenges' - a range of measures to reduce the then budget deficit of £10 million. Some of these have been achieved and have contributed to reducing the overspend to its present level of £7.5 million per year.

2.2 The local health organisations remain committed to achieving the future savings arising from `Meeting the Challenges', which would reduce the overspend to £6.2m. These are summarised on page 21 of Appendix 1.

2.3 The Health Authority is currently consulting on the first of a series of proposals to change the way some services are provided in their area and make annual savings of £500,400. These proposals relate to the area served by North Hampshire PCT and are concerned with orthodontic services for all age groups, and community hospital and intermediate care services for older people.

3. Orthodontic Services

3.1 Nationally the demand for orthodontic services is increasing to such an extent that an `Index of Orthodontic Treatment Need (IOTN) has been established to ensure that resources are directed to those in greatest need and who are likely to benefit most. Patients are classified as Grade 1 (least severe) to Grade 5 (most severe). The index focuses on dental health need but is also able to recognise the psychological impact of disfiguration.

3.2 The consultant orthodontic service at North Hampshire Hospitals NHS Trust of one full time post was established to provide a service to Grade 4 and 5 patients and give advice to general practice dentists who provide treatment for Grades 1 to 3. In 1999/2000 there were 867 referrals to the service.

3.3 The current position is that due to recruitment problems, it has not been possible to sustain the service at this level and in August 2000, the decision was made to reduce the service to a half time post and not to treat Grade 4 patients. In 2000/2001, there were 396 referrals to the service.

3.4 The proposal is to maintain the current level of provision and reduce support staff to match the service being offered. From 2004, a fulltime consultant post will be shared between North Hampshire Hospitals NHS Trust (two-thirds share) and the Royal Surrey NHS Trust (one-third share).

3.5 While the consultation process is still at an early stage the issues emerging are:

· At a time when demand nationally for orthodontic services is increasing, the service is planned to cater for a 54% reduction on referral levels as at 1999/2000.

· It is unclear where and how Grade 4 patients will be treated

· While the proposal will generate savings, the impact on NHS plan targets is not stated.

· The problems associated with `single handed consultants' are not addressed i.e. lack of peer support, holiday and sickness cover, undue pressures and training recognition.

· That some Hampshire residents will be required to travel to Guildford for treatment

4. Redesigning Intermediate Care

4.1 Recent national initiatives for the care of older people, such as the National Service Framework for Older People, focus on the development of intermediate care and rehabilitation. They emphasise the need to develop services that prevent and reduce hospital admissions and promote independent living.

4.2 Services currently available in North Hampshire include The Chase Hospital, Bordon which provides 24 beds for older people, a Community Intensive Support Service (CISS) providing patient care to 6-8 people per week (receiving referrals Monday to Friday) in the Basingstoke area and an orthopaedic Hospital at Home Service.

4.3 The proposal is to relocate 8 beds for elderly mentally infirm people, possibly to Parklands Hospital, Basingstoke and for the remaining 16 beds to be closed from 1^st April 2002. A proportion of the money saved will be used to expand the CISS to receive referrals seven days a week and care for up to 40 patients per week across the whole of North Hampshire, including the Hospital at Home Service.

4.4 While the consultation process is at an early stage, the issues emerging are:

· The possible financial impact for Social Services in terms of the plan's aim to care for more people in non hospital settings. It is not clear whether the PIP costing includes social care.

· The costings for the new service are hard to understand. The current service caters for approximately 8 people for five days a week (plus Home from Hospital patients) at a cost of £296,000 per annum. The proposed service will cater for 40 people and accept referrals seven days week at a cost of £425,000 per annum.

· While the proposal will generate savings, the impact on NHS plan targets is not stated.

· The proposal in the context of the capacity of the independent sector, recognising that in the last three years approximately 100 beds have been lost within the Bordon area.

5. Conclusion

5.1 The local health organisations in North and Mid Hampshire face the difficult challenge of reducing recurrent spending while improving their performance through delivering on NHS Plan targets.

5.2 It is difficult to determine to what extent the Performance Improvement Plan will achieve improved performance. While savings plans have been included, planned performance against the NHS national targets has not.

5.3 The approach to phase consultation on the planned service changes of the PIP makes it difficult to understand the wider picture in the context of needing to achieve savings of £7.5million. The current proposals subject to consultation will save approximately £500,000 per year.

5.4 It is difficult to assess the impact on social care services. There is a concern that if this is not jointly understood and planned for, the PIP, in terms of meeting NHS targets, may be undeliverable.

5.5 Some of the proposals will require more detailed information and analysis before it will be possible to determine the full impact on the County Council, and Hampshire residents.

5.5 This report outlines some early views but does not include responses to consultation currently being undertaken within the County Council.

That the Policy and Resources Policy Review Committee be informed:

1. That the County Council has written to the Health Authority seeking further information in relation to the overall Performance Improvement Plan and proposed service changes.

2. That views of members would be very welcome particularly to inform the formal response.

3. That a report should be presented to Cabinet to agree the formal response of the County Council.

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