Contact: Denise Holden ex 7338

e-mail: [email protected]

1. Summary and Purpose

1.1. This report is a standing item designed to alert the Committee to proposals from the NHS to vary or develop health services in the area of the Committee.

1.2. Proposals that are considered to be substantial in nature will be subject to formal consultation and the response of the Committee will take account of the criteria adopted by the Committee on 29 July.

2. Consultation by Eastleigh and Test Valley South and Mid-Hants PCTs: reprovision of in-patient services for older people with mental health problems in Eastleigh and Winchester

2.1. Members were appointed to the working group to consider the proposals to vary these services on 29 July 2003.

2.2. In considering the proposal the group has taken account of the national context within which these services should be developed and informed by:

_ The National Service Framework (NSF) for Older People

_ The Audit Commission Document `Forget me not'

_ `The Alzheimer's Society action plan `Lets make it happen'

_ Improvement Expansion and reform: The next three years (Priorities and Planning Framework 2003-2006)

_ The Mental Health NSF

2.3. Particular emphasis has been placed on the need for the services to embrace:

_ the balance between home based, day, outpatient residential and hospital services

_ a clear understanding of demographic data and the needs of the local communities

_ full engagement of carers and service users

_ Good links with other service providers including social services and the voluntary sector

2.4. The Group also took account of the fact that the Commission for Health Improvement (CHI), Audit Commission (AC) and Social Service Inspectorate (SSI) will be reviewing local and national progress with the NSF for older people in 2004/05. The review will measure progress against the NSF standards so that good practice is shared and so that immediate action can be taken where necessary to further improve services. The review will be rooted in the experiences of older people and should result in improved services.

2.5. The Working group meet on the 28 August and 2 October. It was also very helpful that the NHS Trusts involved were willing to invite members to visit the facilities affected. The first visit to Shawford and Barnes Ward took place on 2 September and the report of this is attached at Appendix One. As a result of this a number of questions have been raised with the PCTs concerned.

2.6. The second visit is scheduled for 3 November.

2.7. The consultation process is due to close on the 29 November. In order to be able to respond to this the Chief Executive, in consultation with the Chairman of the working group, will responds to the proposal, taking account of the points outlined above and the criteria agreed by the Committee.

3. `HealthFit' Implementation

3.1. Action in anticipation of this consultation has been initiated by the Committee in recognition that these are wide-ranging proposals relating to the reconfiguration of children's services, maternity services, emergency services, and services for older people. This has included

_ Establishment of a core working group (Cllrs Ellis Bayford and Wright)

_ Identification of leads for each service area (Cllrs McNair -Scott, Dowden, Dickens and Bayford)

_ A protocol for joint working with other Local Authorities has been drafted

_ Requirements for the delegation of health scrutiny powers have been acted on

_ Due to slippage in the timeframe no proposals have been put forward by the Health Authority. The Committee has however confirmed that it expects to be consulted on the nature of the consultation process prior to the launch of any formal consultation process.

4. Mental Health Services in North East Hampshire

4.1. The Committee was advised that this proposal was pending and that this did not involve any change to services provided to the residents of north east Hampshire.

4.2. The document was formally issued at the end of July and brought to the attention of the Chairman by social services. Responses were requested by the 17 October.

4.3. The Chief Executive, in consultation with the Chairman, responded to the discussion document, taking account of the approach to overview and scrutiny of health agreed by the Committee.

4.4. This response is attached at Appendix Two.

5. Blackwater Valley and Hart Primary Care Trust: Consultation Pending- Changes to Service Provision at Fleet Hospital

5.1. The Committee has received notification of this consultation, which is due to formally commence in November 2003. The outline case put by the Trust is attached at Appendix Three

5.2. Members views on the proposal need to be invited once this is published.

5.3. The Trust should be alerted to the emphasis placed by the Committee on `Strengthening Accountability' and the involvement of patients, the public and key stakeholders in planning services

Recommendations

1. Consultation by Eastleigh and Test Valley South and Mid-Hants PCTs: reprovision of in-patient services for older people with mental health problems in Eastleigh and Winchester

_ That the Committee endorse the approach adopted by the working group

_ The Committee authorises the Chief Executive, in consultation with the Chairman of the working group, to respond on behalf of the Committee, taking account of the points outlined above and the criteria agreed by the Committee.

_ That the NHS Trusts concerned are thanked for arranging for the working group to visit the facilities

2. `HealthFit' Implementation

_ That the Committee reaffirms to the Health Authority that there should be early engagement in agreeing the conduct of any consultation process

_ The Committee reaffirms its expectation that any proposals from the Health Authority are able to demonstrate full engagement of local people and key stakeholders in accordance with `Strengthening Accountability' (section 11) requirements

_ That the Committee authorises the Chief Executive, in consultation with the core group, to respond to any approach from the Health Authority regarding the conduct of a formal consultation exercise, taking account of the criteria agreed by the Committee.

3. Mental Health Services in North East Hampshire

_ The Committee endorses the response from the Chief Executive

_ The Committee is advised of the response of the lead PCT

4. Blackwater Valley and Hart PCT: Provision at Fleet Hospital

_ members will be invited to comment on the proposal when received

_ the Trust will be alerted to the requirements set out in `Strengthening Accountability'.

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 which disclose exempt or confidential information as defined in the Act.

File Location

Appendix One

Consultation by Eastleigh and Test Valley South and Mid-Hants PCTs: reprovision of in-patient services for older people with mental health problems in Eastleigh and Winchester.

Working Group Report

Present: Cllrs Mrs Holden Brown, Mrs Banks, Knasel, Mrs Randall

In attendance: Denise Holden, Kay Docherty, Kevin Page, Janet Rowse, Martin Goode

Background

The purpose of the visit was to familiarise members with the changes to the provision of in-patient services for older people with a mental illness in Winchester. A second visit will be arranged for members to see the changes proposed for that same group of patients in the Eastleigh area. The proposals relating to both services are currently the subject on a formal consultation by Mid-Hants Primary Care Trust (PCT) and Eastleigh and Test Valley South PCT.

Shawford Ward

The visit commenced in Shawford ward, located in the main hospital building. The ward is the only one for patients with dementia in the wing, adjacent wards being general medical and rehabilitation. The ward was spacious and well laid out with good internal facilities including a kitchen area for occupational health assessment.

Melbury Lodge

Although based on the main hospital site this is a discreet facility in a secluded and quiet area. It has it own public car parking area and dedicated gardens area (which include a secure area. Adult mental health patients and older people with a functional mental illness currently use this facility. The intention is to extend one wing to provide an additional four beds and to make better use of space already available to provide a facility for people with organic and functional mental illness living in the Winchester area.

General observations

The atmosphere in both facilities was clam and welcoming. The standards of decoration were high and efforts had been made to make bay areas that were shared as private as possible.

Melbury Lodge was a secluded and quiet location that nevertheless had ready access to the full range of acute hospital services. The setting, in particular the garden was an especially attractive feature.

The level of beds set aside for people in Winchester was comparable with other localities in Hampshire.

Although social services were not members of the community mental health team there were good links.

Although the CC strategy for additional care home provision was progressing this would not be available in the short term. The emphasis on keeping people at home for as long as possible was one to be welcomed and in this respect the additional memory clinics would have a particular part to play.

The scope for a `specialing' service to give intensive short term support from specialists was one that would support the objective of helping people stay ay home as long as possible. The possibility of using different skill mixes- such as dementia nurses merited further exploration to build capacity within the CMHT.

The extension to Melbury Lodge will proceed, otherwise capital funding available will be lost. If the consultation is not supported then other uses for the additional space will be considered.

The WHT will not lose any funding as a result of the proposals. The 40% savings released through the move will remain within the Trust to support the delivery of other services.

The intention is that the changes to the provision of services in Eastleigh, Winchester and Andover would provide for greater integrated working across the localities in terms of specialist and community/primary care services. This model has been successfully developed in other areas of Hampshire, such as the New Forest. As such it is an affordable first step supporting the delivery of the national policy framework.

The stakeholder workshops will continue to inform service developments in the future.

The local Alzheimer's Society has indicated its support for the proposals

The PCTs are providing funding for those patients requiring continuing care and there is currently no problem with placing these patients in appropriate care home settings

Appendix Two

Response to discussion on mental health services in Surrey and North East Hampshire

It is helpful to have an opportunity to contribute to discussions as this early stage and I hope this feedback will provide the context within which the Hampshire County Council Health Review Committee will be considering any proposals to change services in the future. We will of course wish to work closely with Surrey Health Select Committee where any proposals affect both our populations.

The emphasis placed by the proposal on engaging with people using these services, carers and staff is one that reflects the commitment of the Health Review Committee to ensuring that services are responsive and of a high quality. In considering any proposals for changing services the Committee will place particular weight on the way in which the NHS organisation concerned has engaged with service users, the public and key stakeholders in accordance with the requirements set out in `Strengthening Accountability'. The range of criteria that the Committee will apply when assessing proposals for substantial change to services from the NHS are attached for information.

In addition there are some general points that may be useful to make at this stage of the discussion, which hopefully will be able to inform the planning and commissioning of these key services:

The diagram set out on page 9 of the document was helpful in drawing attention to the different levels of services that need to be in place. It would be useful to see this developed to reflect the diverse range of services that need to be in place to support people in the community. Whilst there is a commitment to providing a service that is shaped around individual need and the delivery of the relevant NSFs, it is not clear how this will translate into action in relation to issues such as the provision of intermediate care close to people's home and support to primary care.

The extent to which primary care practitioners in north east Hampshire will have access to specialist training and advice through the Trust could usefully be developed.

It would be helpful to know what progress has been made with the implementation of the relevant NSFs, for example progress with establishing a single assessment process and joint care pathways. This will then give a baseline against which improvements could be assessed.

The choice agenda and `keeping the NHS local' will have an impact on the way in which services develop. The views of different local communities will be essential in this respect and it would be helpful to have a commitment to recognising that the Hampshire perspective may, on occasion, be different from that of Surrey. In some circumstances it may be more appropriate for there to be links with Hampshire county networks.

The focus on effective services, rather than existing organisational boundaries is innovative and as such should be welcomed. Funding flows will however continue to follow traditional patterns at least in the short-term. The document states that the Trust will face a challenging 4% efficiency savings target in 2003/04. From a pragmatic perspective it would therefore be helpful to have further information about the safeguards that will be in place to ensure that the Trust is properly accountable to the health community of north east Hampshire for the use of funding directed through Hampshire and the Isle of Wight Strategic Health Authority and the local Hampshire PCTs.

There needs to be an explicit commitment to links with Local Strategic Partnerships and the voluntary sector (e.g. through the Compact) as well as service users and carers. A clear strategy should be in place for achieving this (in line with `Strengthening Accountability'). Effectively this would provide the Health Review Committee with an assurance that any proposals that come before it have been developed in conjunction with key local stakeholders.

The potential for genuine partnership working to support the delivery of integrated services should be fully explored

There is a distinction between the services that are provided for people with dementia and those with a functional problem, such as depression. It is not clear how this is being taken forward in the context of the proposals included in the document. It is important that older people with a functional problem, or those who may be younger with an organic problem, are treated according to need and not age.

It is difficult to ascertain how specialist services for people with learning disabilities will be developed. This is potentially an extremely vulnerable group and it would be helpful to know that the views of individuals using the services and other key stakeholders would be engaged to shape any developments.

Similarly the provision of substance misuse services was only very briefly referred to in the document. There would be a particular concern to ensure that services are appropriately provided for people with a dual diagnosis.

Links with the development of the workforce could usefully be drawn out. In particular it would be helpful to see how planning would be taken forward in relation to two workforce development confederations. Issues such as specialist training for primary care practitioners and other service providers needs to be considered in this context, as well as continuing professional development.

Arrangements for clinical networks and clinical governance need to be clear, particularly given the emphasis placed on professional self-regulation and lifelong learning in the NSF for Mental Health.

Appendix Three

Proposed Service Changes Blackwater Valley and Hart PCT