Appendix B

Hampshire and Isle of Wight Federation of Community Health Councils

(extract from representation on County Council's consultation document setting out current consultations on `substantial development and change')

It is our understanding that the Committee will be taking over the role of the CHC in consultations, when CHCs are abolished, and we are aware of the time and resource required by responding to consultations.

It may be helpful to note the forthcoming consultations next year in which CHCs would be involved, if they are in existence:

· Reprovision of services at Shawford Ward, Royal Hampshire County Hospital. This consultation is already in its preliminary stages and Winchester & Central Hampshire CHC has serious concerns about the proposals.


· Changes to Andover War Memorial Community Hospital. The repovision of some services is planned early next year and there will be other changes to meet a substantial savings target.


· Closure of all beds at The Mount Hospital, Eastleigh.


· Reprovision of Locally Based Hospital Units across the area.


· Redesign of older people's services which will include review of other community hospitals, such as phase II of the reconfiguration of community hospitals in the New Forest.

In addition there are the many changes to services proposed by the Health Authority in the "Healthfit" exercise which will be in the public domain by the beginning of next year. These proposals in the draft document include:

· The development of nurse-led midwifery service which, it is proposed, would include the transfer of high-tech obstetrics from the Royal Hampshire County Hospital to Southampton.


· The concentration of most inpatient paediatric care in Southampton, Portsmouth and Basingstoke.


· The transfer of acute trauma and surgical emergency treatment to Southampton from the Royal Hampshire County Hospital.


· The possible movement of some elective surgery to Winchester from Southampton.

The impact of these proposals on the A&E services at the Royal Hampshire County Hospital and on the future of the hospital will be part of this debate.

The draft proposals also include some significant changes to the way some services are provided on the Isle of Wight, which is likely to impact on the hospitals in Southampton, Portsmouth and possibly the rest of Hampshire.

There are also the likely consultations on GP's branch surgeries, the current one being Southwick and Widley.

Finally, it must be recognised that CHCs often must respond to consultations which are developed at short notice. Sometimes these are `temporary' changes due to financial or safety reasons.

It is not clear who will be responsible for the public's response to the routine consultations on pharmacy applications and changes to GP partners, currently the responsibility of CHCs.

Whilst CHCs are still functioning in the period of run down to our abolition, we will be pleased to work collaboratively with the emerging Overview & Scrutiny Committee. This opportunity can be used to transfer our experience and expertise to the Overview & Scrutiny Committee members in anticipation of them taking over the responsibility for the public's response to the consultation process.

Appendix C

Health Review in Hampshire

A Consultation Paper

October 2002

Good health is important for us all, individually and as a community. As individuals, we make choices and take decisions that affect our own health. As communities, the decisions and actions of many different bodies affect our health.

Hampshire County Council has long worked successfully in partnership with NHS organisations to improve the health of the community and to support individuals.

As part of the Government's modernisation agenda for the NHS, it is giving councils with social services responsibilities a new power. The Government has recognised that local councils have the authority and legitimacy to speak on behalf of the communities that elect them and which they serve. The Government wants councils like Hampshire County Council to work with the NHS organisations in their areas to help develop and plan health services reflecting needs and aspirations of individuals and communities.

Councils with social services responsibilities have a new power to review, or `scrutinise', the operation of the health service and the way it relates to other services. But scrutiny will not just be of NHS services. Accessibility to health services and the health of communities are directly affected by actions and decisions of councils themselves, other public bodies and the independent and voluntary sectors. Reviews will therefore look across organisational boundaries at the whole picture of health provision and the health of communities.

`Health scrutiny' is about recognising links and making recommendations for working in partnership to improve the health of people in Hampshire as individuals and as communities. NHS bodies will be required to respond to reviews and recommendations made to them and to set out proposed action, or reasons for not acting as recommended.

This paper seeks views on ideas for how Hampshire County Council would work with its partner organisations, especially in the NHS, to use its new power of health review and scrutiny. These proposals are based on what

was set out in a Department of Health consultation document * and from conclusions on principles and actions drawn from a seminar which the Hampshire and Isle of Wight Health Authority held for partner organisations in June 2002.

The Government says it intends making Regulations (and issuing supporting guidance) for power of health scrutiny to be effective from 1 January 2003 and has just issued a further consultation paper on proposed contents. The County Council intends to reach decisions in January 2003 about how it will undertake health reviews, taking account of representations on this paper, the Regulations and Government decisions on funding.

Who are our partners?

1. NHS bodies

· Hampshire and Isle of Wight Health Authority (HIOWHA)


· primary care trusts (PCTs) : there are 7 PCTs in the County Council's area


· NHS Trusts running the hospitals that serve Hampshire, the ambulance and patient transport service and specialist mental health and learning disability services : some are based outside the County Council's area.


These are listed in an appendix.

2. The new bodies intended to help NHS bodies be responsive to service users and patients - Patients Forums and the Patient Advice and Liaison Service (PALS) and, while they continue, the Community Health Councils.

3. Voluntary and independent sector providers of health and social care services and support.

4. Organisations representative of social care service users and carers.

* Local Authority Health Overview and Scrutiny, a consultation document, Department of Health, January 2002.

5. Other local authorities

· neighbouring councils with health scrutiny powers where NHS bodies providing services to Hampshire residents are based


· Hampshire district councils.

What can we review?

There are two separate but related functions. First, the County Council can develop a programme of reviews of health services commissioned or delivered in its area. These may focus on a particular service or facility - and so may be `thematic', looking at a particular issue or related activities over a wide area - or focused on an individual facility or service within a confined area. The County Council will choose and determine the focus for these reviews.

Second, NHS bodies will have to consult the County Council at an early stage before making decisions on proposals for significant change in the services they provide. These will not be chosen by the County Council : they will result from the management planning decisions of the PCTs and NHS Trusts.

Acting on behalf of the community

The Government's intention is that health services should become more responsive to the communities they serve. It is giving this power of health scrutiny to councils because they democratically represent their communities. But it is expecting councils to undertake reviews in partnership with NHS bodies and with community participation.

There is the expectation that reviews will involve the active collection of views from those providing services and those using them. That may be achieved by commissioning research, by making visits and by holding public sessions when individuals and organisations can present their views. NHS bodies will be obliged to provide information and chief executives or their representatives can be required to attend to answer questions.

It is important that the arrangements Hampshire County Council makes for health review and scrutiny make possible involvement of partners and seek out information about health provision and how it impacts on the health of the community.

The arrangements we are considering and on which we invite views

1. A new Health Review Committee?

Health review and scrutiny must be undertaken not by the Council's Executive (Cabinet) but by one of its overview and scrutiny committees. The County Council has 5 Policy Review Committees and has gained experience and developed expertise in `scrutiny' through its programme of Best Value Reviews.

Health review is an important new role, and the County Council will consider setting up a new Policy Review Committee for that express purpose.

2. Membership of the Health Review Committee

The County Council would appoint the members of a new committee and the chairman. No Executive Member can be appointed. Members who are also members of a NHS Board can be appointed but will not consider issues relating to that NHS body. The new Health Review Committee would be constituted in the same way as other Council committees, with membership proportional to the representation of political groups on the Council.

The County Council will consider asking the Association of Hampshire and Isle of Wight Local Authorities (HIOWLA) to appoint 3 district councillors, representative of all Hampshire district councils, to be co-opted to the Health Review Committee. Representatives from other partner organisations, such as Patients Forums and user organisations, will be involved in individual reviews as proposed below.

3. How the Health Review Committee could operate

It would meet formally six times a year. But individual members of the Committee would take the lead in the work it commissions and so their commitment is much greater than attendance at those meetings.

The Committee would, in consultation with NHS partner organisations and district councils, develop a programme of reviews. The Committee would have to prioritise the issues and services it might wish to review and decide annually on a programme of reviews to be carried out each year. Capacity to undertake reviews will be determined by resources. The Government has not yet said how the new power is to be funded.

The Committee would also respond to individual NHS bodies when they come forward with preliminary proposals for substantial development or change in health services. Consideration of those proposals and deciding a response will take time and capacity.

Arrangements made for undertaking individual reviews would be flexible and developed taking account of the particular issue under review to bring in the right expertise. The Committee could commission others to undertake work on particular reviews - for example, district councils and user and carer organisations - and would set up a working group for each review drawing in people with specific local knowledge or topic expertise. So the working group undertaking a review focused on services or facilities of a particular PCT or NHS Trust could include the local County Councillor, district councillors and representation from the Local Strategic Partnership. It could include representation from patient and user organisations, such as Patient Forums. In that way it should represent and reflect local circumstance and opinion and bring in topic expertise. The review working group would consider whether to:

undertake research, possibly commissioning studies and surveys
meet those providing and using the service to gather evidence

hold public hearings

ask for evidence and information from individual NHS bodies, including meeting with the chief executive or appropriate officers.

The review working group would prepare a report of its findings for presentation to the Health Review Committee. NHS bodies and other organisations responsible for the services under review (including County Council services) would be consulted informally on the draft report before it is considered by the Health Review Committee. The report and recommendations would then be published. The Government requires NHS bodies to respond. The County Council would expect other organisations to respond in the same way. The Health Review Committee would consider the responses made by those bodies and organisations and their proposals for action.

Although not proposed in the Government's consultation document, the County Council thinks the Health Review Committee should subsequently look again, when proposals have been acted on, to check that intended outcomes were achieved.

Working with neighbouring Councils

Residents in the County Council's area use health facilities in the area of neighbouring councils. NHS Trusts based outside the county provide services to Hampshire residents. The County Council's Health Review Committee may want, jointly with a neighbouring council, to review and scrutinise those services. The County Council will agree with neighbouring councils protocols and arrangements for joint reviews.


The Health Review Committee will need to establish protocols with Portsmouth City Council and Southampton City Council about reviews considering services to Hampshire residents provided by the Portsmouth Hospitals NHS Trust, the Southampton University Hospitals NHS Trust and the City PCTs.

A conclusion from the seminar arranged by HIOWHA was that each of the four councils with health scrutiny powers in the strategic health authority's area would want its own health review arrangements and did not want a single joint committee. The four health scrutiny committees will need to co-ordinate programmes of reviews and the approaches made to the PCTs and NHS Trusts for information and may agree to undertake specific joint reviews.

The County Council is proposing regular consultation between the respective health scrutiny committees, and that there should be joint meetings of chairmen as required.

Arrangements will be considered with Surrey County Council for review of services provided by Frimley Park Hospital, Royal Surrey County Hospital and Surrey Hampshire Borders NHS Trusts, and may be considered with Bournemouth Borough Council (for review of services provided by Royal Bournemouth and Christchurch Hospitals) and Wiltshire County Council (about services provided by Salisbury Healthcare NHS Trust).

There may be the need to work with other councils, on an ad hoc basis, for joint review of particular services used by residents but located outside Hampshire.

Timetable

2002

November/ Hampshire County Council consults with partner

December organisations on this consultation paper

28 Nov County Council meeting : consider a recommendation that a new Health Review Committee be set up

December The Government says it will publish guidance and get Parliamentary approval of the Regulations necessary for...

2003

January ...health scrutiny powers to be effective from 1 January 2003

January Committee meeting to consider representations received on this consultation paper, Regulations and Government guidance plus any announcement about funding. The meeting may also consider starting a review : initial thoughts are that an appropriate topic would be `The Health of our Children and young persons,' covering a range of issues over a period of time, of which the first could be
health care for looked-after children
followed by
health of school age children, focusing particularly on health inequalities

and then
mental health services for children and the mental health problems of 14-19 year olds
access to therapy in schools.

Your views are invited on:

· choice of topic


· those who should be included in the review working group


· how the working group might approach its task (eg public hearings, collection of data and views/opinions of service users and providers)

Discussing our proposals, making comments and expressing your views

We hope to meet and discuss issues and our draft proposals with our principal partners, especially the PCTs. We will try to meet other partners organisations if requested.

To allow time for proper consideration of what you tell us, we would like to have completed meetings and received written responses by 31 December.

Representations should be addressed to:-

The Chief Executive

Hampshire County Council

The Castle

Winchester

SO23 8UJ

You may also send comments by e-mail to: [email protected]

We have a partnership manager for each PCT and a County Councillor who attends PCT Board meetings:-

Blackwater Valley & Hart Cllr Mrs C Leversha Helen Clanchy

North Hampshire Cllr P Heath Felicity Harding

East Hampshire Cllr E Gale Nicky Pendleton

Mid Hampshire Cllr Mrs P West Mike Gardiner

Eastleigh & TVS Cllr C Davidovitz Pauline Owen

Fareham & Gosport Cllr Mrs M Snaith David Browning

New Forest Cllr Mrs P Banks Yvonne Le Brun

APPENDIX

Health Services in Hampshire and the Isle of Wight

Primary Care Services

Primary Care Services in Hampshire and the Isle of Wight include:

· Over 1000 general medical practitioners (family doctors)


· Over 300 pharmacies


· Over 650 opticians and ophthalmic medical practitioners


· Over 650 general dental practitioners

There are ten Primary Care Trusts serving Hampshire and the Isle of Wight, broadly aligned with district and unitary authorities:

· Blackwater Valley and Hart (covering Hart and Rushmoor)


· East Hampshire (covering Havant and the southern part of East Hampshire)


· Eastleigh and Test Valley South (covering Eastleigh and the southern part of Test Valley)


· Fareham and Gosport (covering Fareham and Gosport)


· Isle of Wight (covering the Isle of Wight)


· Mid Hampshire (covering Winchester and the northern part of Test Valley)


· New Forest (covering the New Forest)


· North Hampshire (covering Basingstoke and Deane and the northern part of East Hampshire)


· Portsmouth City (covering Portsmouth City)


· Southampton City (covering Southampton City)

NHS Trusts

There are seven NHS Trusts with their HQs in Hampshire and the Isle of Wight and accountable to the Hampshire and Isle of Wight Health Authority. Their role includes providing acute hospital services, specialist mental health and learning disability services, ambulance services and patient transport.

· Hampshire Ambulance Service


· Isle of Wight Healthcare


· North Hampshire Hospitals


· Portsmouth Hospitals


· Southampton University Hospitals


· West Hampshire (mental health and learning disabilities for Hampshire, excluding Basingstoke, Hart, Rushmoor and northern part of East Hampshire)


· Winchester and Eastleigh Healthcare

Hampshire residents use health facilities and services provided by NHS Trusts based in adjoining areas, especially residents in north-east and south-west Hampshire.

Appendix D

Representations received on the County Council's consultation document `Health Review in Hampshire'